Sentinel surveillance

An often over-looked aspect of surveillance for bioterror events is surveillance of animal populations. Several of the agents considered to have bioterror potential are diseases of animals, for example, anthrax and brucellosis (Franz et al., 2001 Inglesby et al., 1999 USAM-RIID, 2005). A covert attack may first become apparent when animals become ill. The need to coordinate information from medical and veterinary sources was illustrated by the epidemiologic investigation during the 1999 West Nile Virus outbreak in New York City. Investigators found that there had been an outbreak in birds several weeks prior to the human outbreak (Fine Lay-ton, 2001). The current surveillance plan for monitoring West Nile Virus infection in the U.S. includes sentinel surveillance of several animal populations (CDC, 2003). 

Compare and contrast passive, active, and sentinel surveillance. 

A national effort to improve active reporting is the expansion of the Sentinel Surveillance Networks, supported by the EIP program. In this effort, selected reporting relationships are established with medical specialty groups like the Infectious Disease Society of America, the International Society of Travel Medicine, and a group of about 100 emergency departments called the Emerging Infectious Disease Network. These specialists are likely to treat persons with infectious diseases and are periodically contacted about any specific or unusual conditions. 

Butler JC, Hofmann J, Cetron MS, Elliott JA, Facklam RR, Breiman RF. The continued emergence of drug-resistant Streptococcus pneumoniae in the United States an update from the Centers for Disease Control and Prevention s Pneumococcal Sentinel Surveillance System. J Infect Dis 1996 174 986-993. 

The Campylobacter Sentinel Surveillance Scheme Collaborators, Ciprofloxacin resistance in Campylobacter jejuni case-case analysis as a tool for elucidating risks at home and abroad, J. Antimicrob. Chemother., 2002, 50, 561-568. 

Occupational Sentinel Health Events An Up-Dated List for Physician Recognition and Public Health Surveillance, Mullan RJ, Murthy LI. (Am J Ind Med. 1991 19 775-799). 

Until October 2001, no deaths from bioterrorism were reported in the U.S. On September 11, 2001, after the attacks on New York City and Washington, the Centers for Disease Control recommended that the nation increase its surveillance for unusual disease occurrences or clusters, asserting that they could be sentinel indicators of bioterrorist attacks. As predicted, cases of anthrax were reported in Florida, New York City, the District of Columbia, and New Jersey. Over the years, it has become evident that not only is biological warfare attractive to governments, it is equally attractive to terrorist cells because the agents are relatively inexpensive and easy to make. 

ROCK C L, THORNQUIST M D, KRISTAL A R, PATTERSON R E, COOPER D A, NEUHOUSER M L, neumark-sztainer D and cheskin l j (1999), Demographic, dietary and lifestyle factors differentially explain variability in serum carotenoids and fat-soluble vitamins baseline results from the sentinel site of the Olestra Post-Marketing Surveillance Study , J Nutr, 129(4), 855-64. rodale (1996), The Prevention Index - a report card on the nation s health, 1996 summary report. Rodale Press, Inc, Emmaus, Pennsylvania. SANDLER R S, ZORICH N L, FILLOON T G, WISEMAN H B, LIETZ D J, BROCK M H, ROYER M G and MIDAY R K (1999), Gastrointestinal symptoms in 3181 volunteers ingesting snack foods containing olestra or triglycerides , Annals Internal Med, 130, 253-61. 

Continue to develop and enhance population-based surveillance systems for the real-time capture of sentinel health end-points. This includes current surveillance systems such as vital registration for birth size and gestation and birth defects registries for capture of major malformations. Consideration of emerging sentinel end-points such as fecundability, as measured by time to pregnancy and sex ratios, should receive added research consideration. 

The CDC also participates in several collaborative international surveillance systems. An example is the Global Emerging Infections Sentinel Network (GeoSentinel). In the GeoSentinel system, the CDC has partnered with the International Society of Tfavel Medicine to set up a provider-based reporting network at travel and tropical medicine clinics in the U.S. and overseas (CDC, 2002). 

Medical surveillance also includes monitoring for a single case of new disease caused by a chemical agent that triggers an alarm in an astute clinician. Such cases, called sentinel events, result in further study and analysis to determine a true cause and effect relationship. Historically, numerous chemical agent induced disease processes have been determined through medical surveillance and sentinel event determination. For example, the relationship between vinyl chloride exposure and hepatic angiosarcoma development was determined by astute medical surveillance. 

The first element in risk assessment is knowledge of the chemical exposures of a workforce to see if a known sensitizer is present. A chemical becomes accepted as a cause of occupational asthma if there are at least two convincing clinical case reports from independent centres. Specialist clinicians are likely to be aware of the published literature at an early stage and may be a useful source of informal information. There is currently much interest in publishing lists of sensitizers. One is available in a recent textbook (Chan-Yeung and Malo, 1993). The Health and Safety Executive in the UK, the National Institute for Occupational Safety and Health in the USA and other agencies may publish lists with updates. Other sources of information on causes are reporting schemes such as SWORD (Surveillance of Work-related and Occupational Respiratory Disease) in the UK (Ross el al., 1995) and SENSOR (Sentinel Event Notification System for Occupational Risks) in some states in the USA (Matte et al., 1990). 

Cuadrado Jl, de Pedro-Cuesta J, Ara JR, Cemillan CA, Diaz M, Duarte J, Fernandez MD, Fernandez O, Garcia-Lopez F, Garcia-Merino A, Velasquez JM, Martinez-Matos JA, Palomo F, Pardo J, Tobias A (2004) Public health surveillance and incidence of adulthood Guillain-Barre syndrome in Spain, 1998-1999 the view from a sentinel network of neurologists. Neurol Sci, 25(2) 57-65. 

Table 3. Clinical epidemiology as a surveillance system II sentinel health events (i.e. striking sensitization rates urging for further studies and preventive action)...

Rosen, R. Freeman, S. 1992, Occupational contact dermatitis in New South Wales , Australasian Journal of Dermatolc, vol. 33, pp. 1-10 Rutstein, D. et al. 1983, Sentinel health events (occupational) a basis for physicians recognition and public health surveillance , American Journal of Public Health, vol. 73, pp- 1054-62 Schaapveld, H. 1993, How do you gain management commitment to OHS , proceedings of Conference on Strategic OHS Management, Sydney HR Scholz, J. Gray, W. 1990, A behavioural approach to compliance OSHA... 

A. Farajollahi et al.. Field efficacy of BG-Sentinel and industry-standard traps for Aedes albopictus (Diptera Culicidae) and West Nile virus surveillance. Journal of Medical Entomology, 46,919,2009. 

Dendritic Cells as Sentinels of Immune Surveillance in the Airways... 

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