EPIDEMIOLOGICAL INTELLIGENCE

Definition

Epidemic Intelligence can be defined as the process to detect, verify, analyze, assess and investigate public health events that may represent a threat to public health and Providing early warning signals is a main objective of public health surveillance systems.

Epidemiological Intelligence

Surveillance

Intensive follow-up

EPIDEMIOLOGICAL INTELLIGENCE

SURVEILLANCE• Multifaceted• Long term• Some directed

action

INTENSIVE FOLLOW-UP• Focussed effort• Short duration• More flexible

SURVEILLANCE

Surveillance means an active intelligence and accounting process intended to continuously monitor the overall disease and health status of a population or a group of population

Components of surveillance

1.Collection of data2.Collation and analysis of data3.Expression , interpretation

and prompt distribution of disease intelligence information

1) Collection of dataOur main focus s’d be• Animal identification• Disease nomenclature• Disease classificationOther consideration• Data availability• Data quality

Animal identification2 types• Herd basis• Individual basisWhy animal identification required?1. To show ownership2. To know breeding status3. Part of some testing or disease

control effort4. Tracing back origin (slaughter

house)

Various methods of identification

A. FirebrandsB. Ear notchingC. Paint marksD. Ear tagsE. Neck chainsF. Freeze brandsG. Detailed physical appearanceH. TattoosI. Electronic identification(s/c implantation of a

transponder) by electronic interrogatorJ. M.C.I. system of cattle identification in USA

DISEASE NOMENCLATURE AND

CLASSIFICATIONRequirement1. Computer processing of disease data2. Numerically coded classification of diseases

Basis of nomenclature and classification

Standard Nomenclature Of Veterinary Diseases And Operation(S.N.V.D.O.)

It is accepted by WHO as a standard Consists of two four digit series(0000-0000) First instance for topographic classification Second instance for etiological designation

Surveillance data sources

A. Mortality registrationB. Ongoing morbidity incidence reportingC. Diagnostic laboratory records of

morbidity and mortalityD. Special programmes for incidence dataE. Morbidity prevalence monitoring or

surveyF. Interview approachG. Other than diagnostic data

A. Mortality registration

• Public health agency- registration of human deaths in government agency

• For veterinary1. Periodic livestock census and survey2. Routine mortality data (heard health

type veterinary practice)3. Intensive follow-up studies of

veterinary outbreak4. Bread registration

A. Mortality registration

4. Herd improvement schemes5. Population based disease registries6. Life table and other summaries

B. Ongoing morbidity incidence and reporting

It is considered as backbone of public health

• Sources1. Farm records (production

records ,reproduction records, vital statistics)2. Individual herd surveillance

programme(disease recording and analysis by veterinarian)

3. Individual farm unit surveillance programme4. Institutional veterinary hospital

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B. Ongoing morbidity incidence and

reporting• ConstraintsA.Mostly depends upon voluntary

reporting of casesB.Lack of laboratory facilitiesC.Lack of co-operation among

reporterD.Incompleteness of reporting

• Steps to improve incidence reporting

A. Better communication(use of telephone communication)

B. Efforts to improve co-operation among reporter

C. Providing good diagnostic lab facilityD. Govt. lab s’d provide subsidized

services for specific diseases to improve surveillance

E. Encourage reporting of unusual/exotic diseases

Problem oriented medical records

Aim- To improve recording system in medical and veterinary hospital

• It consists of 4 parts1. Data base2. Problem list3. Initial plan4. Progress note

1.Data base

• It consists of following components

I. Patient complaintII. Patient profileIII. Past history & system reviewIV. Physical examinationV. Baseline lab examination

2.Problem list• It is core of problem oriented medical

record• Begins with a numbered index

list(patients past and present medical problems + highest possible level of diagnostic precision)

• Problems may be classified asI. Primary/secondary/predisposing/

contributingII. Inactive/active/resolvedIII. Minor/temporary

2.Problem list

• Problem list always needs revision and modification• It provides a key or index for

action to be taken

3. Initial plan

• It follows problem list• Plan is according to

diagnostic effort required and management• Different possibility s’d be

ruled out by using specific tests

4. Progress notes• Consists of results or data produced• The progress notes again to problem

lists then to plan of action• All new data s’d integrated to records

One of the most pre requisite in use of institutional record is record abstracting and retrieval system

C. Diagnostic laboratory record for morbidity and

mortality• It includes 1. Sero-epidemiologic survey2. Special investigation3. Intensive follow up of outbreak• Needs adequate laboratory back-

up• Most useful on unset of outbreak• Laboratory records based on

disease nomenclature and classification

C. Diagnostic laboratory record for morbidity and

mortality• Data of an herd health

represents1. Disease of ill animal2. Patterns of disease in herds

• Sampling must be adequate for laboratory diagnosis

• Must not be limited to micro org. isolation ,toxin detection and pathologic changes

D. Special programmes for incidence data

• Examples1. Almora and contra costa animal

tumour registries• It includes epidemiologic information in

neoplasm in cat and dog

2. Quebec animal health insurance programme

• This animal health insurance programme used as a disease surveillance programme

D. Special programmes for incidence data

• It uses invoice provided by veterinarians

• Invoice contains1. Identification of owner2. Identification of animal by

species ,age , breed , sex3. Diagnosis of disease4. It’s treatment5. cost

E. Morbidity prevalence monitoring or survey

• Most useful data for surveillance in veterinary epidemiology

• Periodic mass survey programme is backbone of livestock disease control programme

• Survey by following methods1. Immune diagnostic methods2. Other mass diagnostic tests3. Necropsy examination4. Diagnosis in abattoir

E. Morbidity prevalence monitoring or survey

• Shortcomings1. Abattoir diagnosis mostly confined to

consumer protection2. Potential case finding & infected herd

finding for epidemiological survey is neglected

3. Administrative separation of veterinary food protection service from animal disease control programme

Sero epidemiology(extended

use)1. Periodic or routine surveys for any infection

2. Prevalence estimate surveys (anaemia , nutritional deficiency disease, metabolic disease, toxicity etc.

3. Biological monitoring of environment4. Distribution and frequency genetic

marker( blood group, abnormal hb.)5. Banking of highly selected

specimen(future studies)

F. Disease intelligence by interview aproach

• Mostly Conducted by a veterinarian • Better co-operation than written

qustionare• E.g.- • California sheep industry pilot study.• It gives information about

1. Description of sheep industry2. Number and distribution of sheep3. Management and husbandry

practices

3. Management and husbandry practices

4. Productivity5. Major diseases and problems6. Morbidity and mortality data7. Prevention and control8. Costs and treatment

G. Surveillance data other than diagnostic

data• Monitoring of drug sales to

owner• Useful when diagnosis is made

by farmers• Unusual drug purchases/

unexpectedly large purchased drug indicates requirement of intensive study

Development and improvements of

organization of data sources• Development of a multifaceted

intelligence programmeA.Qualified epidemiologistsB.StatisticiansC.Disease economistsD.Diagnostic veterinary laboratoryE. Veterinary food protectionF. Extension service worker

2) Collation analysis of data

Data is collated and reduced

Subjected to immediate analysis

Data bank is provided

More detailed future analysis

Identification of disease determinants

Study of animal health economics

• Collection of data –government and non-govt agency

• Collation and analysis of data- surveillance agency

3) Expression interpretation and

prompt dissemination of data• Data is disseminated to

A.Who submitted the basic dataB.Who need to knowC.Who participate in directed

actionD.To public(for awareness)

Proper approach for dissemination of data

1. Current, cumulative, comparative tabular data of continuous surveillance

2. More in depth data for selected diseases

3. Ongoing reports of progressive control efforts

4. Alerts of existing/potential problems

5. Notice of relevant changes of legislation

6. Prediction of future disease patterns

7. informative synopsis of specific intensive follow-ups of cases and outbreaks

8. Official or other procedural recommendations

9. Significant literature abstracts or other disease intelligence information

Various forms of data representation

1. Tabular2. Graphic3. Stastical4. Cartographic tech.

Various media to express data

1. Press releases2. Audio tapes3. Video tapes4. Extension veterinarians5. Verbal or written dissemination

of data

Use of surveillance data

1. To identify diseases and identify determinants

2. Disease control strategy3. Prediction of future disease

incidence4. Inputs into decision making

models5. Evaluation of animal health

economics

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