Surveillance systems public health

The monitoring system was a stimulated passive surveillance system. In other words, when vaccines purchased with federal funds were administered in the public sector, Important Information forms were given to recipients or their parents or guardians instructing them to report any illnesses requiring medical attention that occurred within four weeks of vaccination. System coordinators at each immunization project or grantee site and the state health department completed standardized forms that were reviewed for consistency and completeness and then forwarded to the CDC for data entry and analysis. 

The United States is one of the only countries that has established a formal surveillance system for post-approval monitoring of adverse reactions to food additives. Despite the obvious limitations of a passive surveillance system, ARMS provides an important venue for the public and others to report health problems perceived to be related to food additives. It provides a means of spotting potential longer-term problems with additives which can then be investigated further. 

Zeitz, P., Orr, M. F. and Kaye, W. E. (2002). Public health consequences of mercury spills Hazardous Substances Emergency Events Surveillance system, 1993-1998. Environ Health Perspect, 110(2), 129-132. 

According to the Drug Abuse Warning Network (DAWN), a public health surveillance system, in the second half of 2003, there were 627,923 drug-related visits to the emergency rooms of hospitals. Of these visits, 141,343 involved alcohol alone or alcohol along with other drugs. Of all the alcohol-related visits, 16,770 were made by 12-to 17-year olds in a ratio of about 2 1, males to females. ... 

Public health nurses have a central function in the public health system and, as such, become invaluable resources both to the community and to other nurses during times of disaster (see chapter 31, The Role and Preparation of the Public Health Nurse for Disaster Response, for further discussion). Public health nurses are expert in population health care and routinely conduct disease surveillance, implement programs in health promotion, and are knowledgeable in healthy standards for food, water, and sanitation. Public health nurses working at the local level are extremely dedicated to serving their communities, routinely form informal partnerships that are essential for disease surveillance, and effectively use informal communication channels to obtain critical surveillance information (Atkins, Williams, Salinas, Edwards, 2005). Increased surveillance activities for disaster recovery add more responsibilities to the work of public health nurses. In all types of... 

Community service organizations can contribute to public health surveillance systems as formal or informal surveillance partners. 

In the field of public health, the term surveillance refers to the ongoing, systematic collection, analysis, interpretation, and dissemination of health data (CDC, 2001b, p. 2). The data collected and analyzed through surveillance systems provide information about patterns of disease occurrence in a population. In turn, this information forms the basis of action by public health officials in designing, implementing, and evaluating interventions to control or prevent disease (CDC, 1992). The activities carried out in a surveillance system are described briefly in the following. 

The first indicator of a biological event may come from routine public health surveillance systems (Institute of Medicine [lOM] National Research Council [NRC], 1999). Tfaditional systems for surveillance fall into four general categories ... 

Syndromic surveillance refers to surveillance using health-related data that precede diagnosis and signal a sufficient probability of [a] case or an outbreak to warrant further public health response (CDC, 2004a, p. 1). Such surveillance occurs in real-time or near real-time to achieve what has been termed pre-emptive surveillance (Teich, Wagner, Mackenzie, Schafer, 2002, p. 6). The primary purpose of syndromic surveillance systems is earlier and more complete detection of outbreaks (CDC, 2004b), although systems to monitor other health... 

Syndromic surveillance is a work in progress. There is a need for continued development of standardized signal detection methods and signal response protocols (Henning, 2004). Also, whereas reporting of patient information as part of traditional public health surveillance has been deemed exempt from the confidentiality guidelines in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), how those guidelines may be applicable to syndromic surveillance systems remains unclear (Buehler, 2004). 

New York City. The New York City Department of Public Health and Mental Hygiene collects health indicator data on emergency department visits, retail pharmacy sales, and ambulance dispatch logs, along with one employer s worker absenteeism rates, as part of an integrated, citywide surveillance system (Heffer-nan et al., 2004). 

Community service organizations can play a direct role in providing specific health indicator data that would contribute to a syndromic surveillance system. Worksite absenteeism or patterns of health care behavior among clients are examples of potential indicators, but issues related to the confidentiality of such information under HIPAA have yet to be fully addressed. Even if no formal surveillance partnership to provide data exists, community service organizations should still consider themselves as stakeholders in the overall community response plans for biological events. They should also publicize the emergency public health contact information within their organizations. Table 20.3 lists several specific actions that community service... 

Public health surveillance is an essential process for detection of biological events. The traditional notifiable disease reporting system remains an important component of infectious diseases surveillance however, new approaches are being implemented that may enhance capabilities for early detection of events. The increasing availability of electronic health data and advances in information technologies provide opportunities for active, real-time surveillance systems (Teich et al., 2002). Syndromic surveillance systems that rely on alternative health indicators and detection of unusual patterns have... 

Centers for Disease Control and Prevention. (2001b). Updated guidelines for evaluating public health surveillance systems Recommendations from the Guidelines Working Group. Morbidity andMortality Weekly Report, 50(RR-13), 1-35. 

Centers for Disease Control and Prevention, (n.d.). National Electronic Disease Surveillance System The surveillance and monitoring component of the Public Health Information Network. Retrieved November 30, 2004, from http //www.cdc.gov/nedss/ About/overview.html... 

Recognition by routine surveillance systems (local, state, and federal) may be the first indicator of a bioterror event (Institute of Medicine [lOM] National Research Council, 1999). Background data on disease occurrence are needed so that an unusual pattern can be detected above the endemic (i.e., usual noise ) level. Current public health surveillance systems related to bioterrorism preparedness, including syndromic surveillance systems, are discussed in detail in chapter 20. 

With any suspicious outbreaks, the local health department, poison center, law enforcement agency, and US Federal Bureau of Investigations (FBI) should be contacted immediately. Due to the absence of a nationwide surveillance system for animal diseases, the responsibility for detecting possible outbreaks of unusual symptoms in animals will fall over several different groups of people. Farmers, agriculture officials, veterinarians, animal control officers, wildlife rehabilitators, (animal) poison control centers and the lay public (animal owners) may all be involved in detecting outbreaks. 

Rosenthal S, Chen R. The reporting sensitivities of two passive surveillance systems for vaccine adverse events. Am J Public Health 1995 85(12) 1706-9. 

Drug registration, coupled with efficient and effective post-marketing surveillance, provide the Ministry of Heeilth with a means to control the quality, safety and efficacy with the introduction of medicinal products into Singapore. Drug registration also provides for a more effective system of product recall in cases of detection of defective or drugs harmful to public health. 

Several years ago in Belgium, terrorists contaminated chickens by adding dioxin to fat used to make animal feed. Authorities did not discover the contamination for several months, long after Europeans sold and ingested contaminated chicken meat and eggs in early 1999 (4,6). Besides pointing out the vulnerability of commercial food supplies, the experience demonstrated that our public health disease surveillance system must promptly recognize suspicious patterns of disease in animals to protect human health (4). 

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