Surveillance Systems

India is one of the global Ôhot-spotsÕ for emergence and re-emergence of pathogens and propagation of those that are drug resistant. Disease surveillance gained momentum in India only after the outbreaks of cholera in Delhi in 1988 and plague in Surat in 1994, which not only had significant mortality, morbidity and economic consequences. The current key indicator based surveillance system in the country, the Integrated Disease Surveillance Project (IDSP) has evolved from systems that were initiated and scaled up as a response to these outbreaks. IDSP is constrained by challenges of human and material resources and the quality of data generated at the frontline is questionable making it difficult to detect, diagnose, and control outbreaks until they had become quite large. Timeliness and Completeness of weekly reports are the two key SQIs even suggested by the World Health Organization (WHO) to monitor the quality of the surveillance system in the districts and states. The goal of the current study was to assess the validity of these SQIs in predicting the overall surveillance quality in a system where data quality was questionable.

Objective

To assess the validity of the Surveillance Quality Indicators (SQIs), Timeliness and Completeness of the weekly surveillance reports as indicators for overall quality of surveillance system and core and supplementary surveillance functions.

The Armed Forces Health Surveillance Center (AFHSC) supports the development of new analytical tools to improve alerting in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) disease-monitoring application used by the Department of Defense (DoD). Developers at the Johns Hopkins University Applied Physics Laboratory (JHU/APL) have added an analytic capability to alert the user when corroborating evidence exists across syndromic and clinical data streams including laboratory tests and filled prescription records. In addition, AFHSC epidemiologists have guided the addition of data streams related to case severity for monitoring of events expected to require expanded medical resources. Evaluation of the multi-level fusion capability for both accuracy and utility is a challenge that requires feedback from the user community before implementation and deployment so that changes to the design can be made to save both time and money. The current effort describes the design and results of a large evaluation exercise.

Objective

To evaluate, prior to launch, a surveillance system upgrade allowing analytical combination of weighted clinical and syndromic evidence with multiple severity indicators.

Under-ascertainment of severe outcomes of influenza infections in administrative databases has long been recognised. After reviewing registered deaths following an influenza epidemic in 1847, William Farr, of the Registrar-General's Office, London, England, commented: ''the epidemic carried off more than 5,000 souls over and above the mortality of the season, the deaths referred to that cause [influenza] are only 1,157"[1]. Even today, studies of the population epidemiology, burden and cost of influenza frequently assume that influenza's impact on severe health outcomes reaches far beyond the number of influenza cases counted in routine clinical and administrative databases. There is little current evidence to justify the assumption that influenza is poorly identified in health databases. Using population based record linkage, we evaluated whether the assumption remains justified with modern improvements in diagnostic medicine and information systems.

Objective

To estimate the degree to which illness due to influenza is under-ascertained in administrative databases, to determine factors associated with influenza being coded or certified as a cause of death, and to estimate the proportion of coded influenza or certified influenza deaths that is laboratory confirmed.

Situational awareness is important for both early warning and early detection of a disease outbreak, and analytics and tools that furnish information on how an infectious outbreak would either emerge or unfold provide enhanced situational awareness for decision makers/analysts/public health officials, and support planning for prevention or mitigation. Data sharing and expert analysis of incoming information are key to enhancing situational awareness of an unfolding event. In this presentation, we will describe a suite of tools developed at Los Alamos National Laboratory (LANL) that provide actionable information and knowledge for enhanced situational awareness during an unfolding event; The biosurveillance resource directory (BRD), the biosurveillance analytics resource directory (BaRD) and the surveillance window app (SWAP).

Objective

To develop a suite of tools that provides actionable information and knowledge for enhanced situational awareness during an unfolding event such as an infectious disease outbreak.

Legionellosis is a respiratory disease that can lead to serious illness such as pneumonia, and can even result in death. Since 2010, increased reports of legionellosis have been received in Toronto during the summer months and led to a five-fold increase by 2012. This underscored the need to rule out common sources through a rapid assessment of exposure data (i.e., locations visited) for any spatio-temporal links. Legionella bacteria from a single source can affect individuals at distances as great as 10 km (1) but dispersion of Legionella bacteria is generally within 1 km of the source (2). This information was used to describe an area of potential risk around each exposure location. Adding temporal information from dates of potential exposures could provide a useful tool for outbreak detection. An automated tool was developed to link spatial and temporal data to assess need for further follow up.

Objective:

To develop an outbreak detection tool which uses spatial information related to temporally clustered legionellosis cases reported in Toronto, Canada.

The Influenza Division (ID) in the Centers for Disease Control and Prevention (CDC) maintains the WHO/NREVSS surveillance system, a network of laboratories in the U.S. that report influenza testing results. This system has seen many changes during the past 40 years, especially since the 2009 H1N1 pandemic. This was due in large part to increased adoption of HL7 messaging via PHLIP. PHLIP data is detailed, standardized influenza testing information, reported in near real-time. The data received through this and other report methods is published online in national and regional aggregate form in FluView, a weekly surveillance report prepared by CDC.

Objective

Describe the changes to the World Health Organization/National Respiratory and Enteric Virus Surveillance System (WHO/NREVSS) influenza surveillance system over time, with a focus on the Public Health Laboratory Interoperability Project (PHLIP) and how it has influenced the system

Adoption of electronic medical records is on the rise, due to the Health Information Technology for Economic and Clinical Health Act and meaningful use incentives. Simultaneously, numerous HIE initiatives provide data sharing flexibility to streamline clinical care. Due to the consolidated data availability in centralized HIE models, conducting syndromic surveillance using locally developed systems, such as GUARDIAN, is becoming feasible. During the past year, Chicago has embarked on a city-wide HIE deployment campaign. Perhaps the most unique aspect of this endeavor is that the data warehouse for the HIE is intricately tied to the GUARDIAN syndromic surveillance system.

Objective

The objective is to describe the technical process, challenges, and lessons learned in scaling up from a local to regional syndromic surveillance system using the MetroChicago Health Information Exchange (HIE) and Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification (GUARDIAN) collaborative initiative.

The ASTER system aims at providing an integrated real time epidemiological status of all the French Forces deployed abroad1. But, unlike usual surveillance systems, ASTER must cover several target populations exposed to different biological and chemical threats, and the surveillance of each population must be tailored to meet its specific risk profile2. Moreover, a surveillance may change at any moment, depending on the evolution of the nature of the threats. For coping with these highly varying surveillance profiles within a same surveillance system, we have developed a formal surveillance system model we have used for designing the collaborations of the system components and allowing the required surveillance versatility.

Objective

This paper briefly describes the model for surveillance system design that is used by the ASTER system, which is progressively deployed within the French Forces.

The importance of providing information on epidemic prone diseases in a timely and complete manner cannot be over-emphasized. In many countries WDSS form a core component of national health system notification and response plans. Countries are required to establish WDSS for diseases that have demonstrated ability to cause serious public health impact and spread rapidly across geographic regions. Ministries of Health, the World Health Organisation (WHO) and other sector ministries rely on accurate and timely information to ensure an effective response. Zimbabwe MOHCW's WDSS is a critical component of the health management information system (HMIS). At least fourteen diseases and public health events that include non-specific diarrheal disease, cholera, malaria, vaccine preventable diseases, snake and dog bites have been reported through the system. Due to an unstable macro-economic environment, Zimbabwe's WDSS has struggled with incomplete and delayed reporting from facilities to the district and national level. According to WHO both timeliness and completeness of data were oscillating below 40% since 2005 through 2011. The MOHCW has measured timeliness as a proportion of facility reports received at the national office every Wednesday, completeness of the national report as a proportion of facilities contributing to the report. Rural facilities have reported challenges in transmitting data to the next administrative level. In December 2010, only 8.8% of rural health facilities had a functional fixed-line telephone and only 11.3% had a functional VHF radio. We document the processes in revitalizing the Zimbabwe, MOHCW's WDSS in the period 2009 -2013.

Objective

Documentation of the processes in revitalizing the Zimbabwe, Ministry of Health and Child Welfare (MOHCW)'s weekly disease surveillance system (WDSS) in the period 2009 -2013.

Civil Registration System (CRS) in India has been in vogue for more than 100 years now. The Registration of Births and Deaths Act, 1969 came into force in 1970. Even after 4 decades of the enactment of the Act, there are wide inter-state and intra-state variations. Our study is on Andhra Pradesh (AP), a South Indian state with a population of 84.6 million (Census of India, 2011) wherein the birth and death registrations varies from 23.2% - 148.6% registrations. We conducted an analysis of four (2007 - 2010) years civil registration data of AP.

Objective

1. To assess the district wise reporting and registrations of births and deaths in AP from 2007 - 2010. 2. To make an urban vs. rural comparison of proportions of these registrations. 3. To identify factors influencing civil registration in AP and steps for strengthening CRS.