BioWatch and Public Health Surveillance Evaluating Systems for the Early Detection of Biological Threats: Abbreviated Version (2011) / Chapter Skim
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4 Detecting Biological Threats Through the Public Health and Health Care Systems: Current Status
4 Detecting Biological Threats Through the Public Health and Health Care Systems: Current Status
Pages 96-118
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From page 96... ...
In practice, the same surveillance capacities would support detection and monitoring of epidemics, regardless of whether they arise from an act of bioterrorism, from natural factors, or from the consequences of actions such as a failure to observe safe food handling or processing procedures. The committee did not review all of public health surveillance, which includes monitoring a wide spectrum of infectious and noninfectious diseases, injuries, behavioral risk factors, and other conditions; nor did it review all of biosurveillance, which includes monitoring for human diseases and animal or plant diseases and other biosphere conditions that may affect human health.
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From page 97... ...
But surveillance systems aimed at detecting outbreaks quickly must be calibrated in a way that effectively balances the inherently competing demands for timely recognition of outbreaks that merit public health intervention and for avoidance of excessive false alarms that may consume public health and health care resources for investigations, or even lead to an inappropriate and potentially dangerous response. SURVEILLANCE OF INFECTIOUS DISEASES Surveillance refers to an ongoing process of systematic collection, analysis, interpretation, and dissemination of health data that can be used to plan, implement, and evaluate appropriate medical and public health interventions (Thacker and Berkelman, 1988)
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From page 98... ...
Continue Standard steps outbreak investigation and response Steps as needed FIGURE 4-1 Simplified depiction of information flow in outbreak detection and reporting through the public health and health care systems. As a generic diagram, Figure 4-1.eps this figure shows core elements of the generation, capture, and analysis of and response to information on human health and tests of human specimens that are used to detect disease outbreaks.
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From page 99... ...
In addition, these laws typically mandate reporting of recognized disease outbreaks, regardless of whether they are the result of conditions listed as notifiable. Once disease reports are received by local health officials, actions may include verifying the diagnosis, investigating the sources of infection, ensuring appropriate treatment and infection control, identifying and providing appropriate care to contacts, and sometimes additional active case finding to assess the presence of additional cases in the community.
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From page 100... ...
Territories use to submit weekly reports of cases of nationally notifiable diseases.4 Since 1999, CDC has been developing and deploying the National Electronic Disease Surveillance System (NEDSS) , an Internet-based system for automatically capturing and analyzing surveillance data that are already in electronic form, such as reports from many clinical laboratories (CDC, 2008b, 2009e)
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From page 101... ...
diagnosis and Reporting by Health Care Providers Reporting by health care providers is one of the essential sources of information used to recognize or determine that a disease outbreak is occurring. An analysis of 43 disease outbreaks reported in morbidity and mortality Weekly Report in 1999 and 2000 found that information generated by the clinical health care system (defined in the study as nongovernment hospitals, physicians, pharmacists, and laboratories)
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From page 102... ...
A diagnosis may also be missed or delayed if diagnostic laboratory tests are not done. CDC and many state and local health departments have produced pocket cards and posters about case reporting for distribution to clinicians, and several professional organizations have developed short courses and other educational programs to maintain awareness of the clinical signs and symptoms of diseases caused by potential bioterrorism agents.
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From page 103... ...
. Automated Surveillance using Electronic medical Records As electronic medical records and electronic health information exchange become more common and more robust, these resources are also being used to support identification of reportable conditions.
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From page 104... ...
. Public Health Reference Laboratories and Molecular Epidemiology State public health laboratories, and some local public health laboratories, often serve as reference laboratories for definitive characterization of microbial pathogens.
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From page 105... ...
. The rationale for syndromic surveillance is that it may provide warning of intentional or natural disease outbreaks earlier than traditional methods of surveillance that rely on disease diagnosis.
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From page 106... ...
0 BIOWATCH ANd PuBlIC HEAlTH SuRVEIllANCE BOX 4-1 National Biosurveillance System: Laboratory Response Network Definitively LRN National Laboratories Characterize - CDC - USAMRIID LRN Reference Laboratories Conf irm - Public Health LRN Sentinel Laboratories Recognize, Rule-Out, - Health Care Refer �ocal health care laboratories in hospitals and clinics and large com mercial laboratories serve as �RN Sentinel �aboratories. All state public Box 4-1.eps health laboratories and several large local public health laboratories serve as �RN Reference �aboratories.
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From page 107... ...
Syndromic surveillance is still a young science, with much of its potential for success and problems yet to be determined. These surveillance systems present a growing challenge of sifting through and interpreting large quantities of data of uneven precision and accuracy to identify statistical evidence of disease clustering or increasing trends that might signify a potential disease outbreak.
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From page 108... ...
. The committee heard testimony that some public health officials have used their syndromic systems to provide reassurance that outbreaks are not occurring, including the use of syndromic surveillance data as part of assessments they have conducted following actionable alerts from the BioWatch system.
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From page 109... ...
outbreak, can be expected to provide valuable insights into the effectiveness and limitations of syndromic surveillance versus traditional outbreak detection methods. Examples of Collaboration in Surveillance The link between health care laboratories and providers in hospitals and clinics is already established, as is the link between veterinary laboratories and veterinarians within academia and clinical practice.
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From page 110... ...
. DATA INTEGRATION AND SITUATIONAL AWARENESS The data needed to detect an infectious disease outbreak or bioterrorism may come from a variety of sources, and being able to aggregate data across these sources may be necessary to recognize the nature of a disease event or understand its scope (e.g., Proctor et al., 1998)
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From page 111... ...
. Rather than having hospitals report data directly to CDC, bypassing state and local health departments, the program is trying to achieve national coverage by fostering and integrating existing state and local syndromic surveillance systems (TFAH, 2008; CDC, 2009a,c)
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From page 112... ...
PUBLIC HEALTH RESOURCES FOR DISEASE SURVEILLANCE Every state has a public health agency, and there are approximately 2,900 health departments serving "local" jurisdictions (e.g., counties, townships)
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From page 113... ...
These federal funds have helped state and local health departments improve their capacity in disease surveillance and other preparedness areas over the past several years. Among other things, these increases in federal funding helped health departments hire additional staff, including epidemiologists to support improved surveillance capacity, but some of these positions may be lost as state and local budgets are reduced.
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From page 114... ...
Emerging Infectious diseases 9(5)
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From page 115... ...
2005. Three years of emergency department gastrointestinal syndromic surveillance in New York City: What have we found?
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From page 116... ...
2008. Measuring the performance of telephone-based disease surveillance systems in local health departments.
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From page 117... ...
2004. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases.
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From page 118... ...
2004. Field investiga investiga tions of emergency department syndromic surveillance signals -- New York City.
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