Current Trends in Current Trends in Surveillance Surveillance University of Toronto/alPHa 14 March, 2003 Dr. David Mowat Dr. David Mowat Director General Director General Centre for Surveillance Centre for Surveillance Coordination Coordination
Dec 29, 2015
Current Trends in Current Trends in SurveillanceSurveillance
University of Toronto/alPHa
14 March, 2003
Dr. David Mowat Dr. David Mowat Director GeneralDirector GeneralCentre for Surveillance CoordinationCentre for Surveillance Coordination
OverviewOverview
The nature of surveillance
History
Surveillance and decision-making
Surveillance and surveillance infostructure
The Network for Health Surveillance in Canada
ICTs and surveillance possibilities & progress
What is surveillance?What is surveillance?
• Health surveillance is the ongoing, systematic use of routinely collected health data to guide public health
• Surveillance processes include data collection, collation, analysis, interpretation and dissemination followed by action
action
Information on: "health events"Information on: "health events"
• morbidity
• mortality
• risk factors
• threats to health
• laboratory diagnosis
• adverse events
• etc.
Information uses:Information uses:
• identifying emerging & re-emerging diseases
• monitoring trends
• identifying outbreaks
• identifying unusual patterns
• forecasting
• generating hypotheses
Information ultimately used for Information ultimately used for decisionsdecisions
• policies
• programs
• practice
• public
Natural and PoliticalNatural and PoliticalOBSERVATIONSOBSERVATIONS
Mentioned in a following Index, Mentioned in a following Index, and made upon theand made upon theBills of MortalityBills of Mortality..
By John GrauntBy John Graunt
with reference to the Government, Religion, Trade, Growth, Ayre, Diseases, and the several Changes of the said CITY.
-- Non, me ut miretur Turba, laboro. Contentus paucis Lectoribus
New ChallengesNew Challenges
• new threats e.g. bioterrorism
• new concerns e.g. biotechnology
• new technologies e.g. genomics
ICTs in Health SectorICTs in Health Sector
Banks, insurance companies typically investing 10% -12% of budget in ICT’s
Health is an intensive information-based business However:
Invested only 1% - 2% in ICT’s during 1990’s
Investments uncoordinated
Health needs larger ICT investments, and an integrated approach
Evidence-Based Decision-MakingEvidence-Based Decision-Making
• information on events
• information on interventions
• information on context
Surveillance & Surveillance InfostructureSurveillance & Surveillance Infostructure
The infrastructure approach provides;
• efficiency
• power of integration
• flexibility & responsiveness
Design ConsiderationsDesign Considerations
• Start with the business
• Make the business explicit
• Document the purpose(s)
• Choose desired characteristics
Developing Data SourcesDeveloping Data Sources
• re-use
• "by-product"
• "transactional"
• preclinical/syndromic
T 0 Time of attack (Fixed)T SMC Time to seek medical care (Mean)T Diag Time of typical diagnosis (Mean)T Death Time of death (Mean)W 1 Window to detect (Non-Traditional)W 2 Window to detect (Non-Trad. Medical)W 3 Window to detect (Trad. Medical)IDW Improved Detection Window
~ ~
T0 TSMC T DeathTONSET T Diagnosis.
W3
IDW
W2
Ease of Detecting Bioagent Effects Over Timeline
Bio-Agent Impact Timeline
Bio-Surveillance Detection TimelineBio-Surveillance Detection Timeline
Detection Analysis TimelineNon-clinical and behavioral
data
Pre-diagnostic clinical data
Diagnostic data
W1
Developing Data SourcesDeveloping Data Sources
• re-use
• "by-product"
• "transactional"
• preclinical/syndromic
• intelligence
The Infospace VisionThe Infospace Vision
• databases• summary reports• daily updates/news• bulletins• systematic reviews• position papers• practice guidelines• regulatory notices• dictionaries, references
• tools: business intelligenceGeographic Information
System• automated alert function• discovery functions:
inventoriesmetadatasearch/navigation
• continuing education• discussion environments• conference, job postings, etc.
Schneider's lunchmate outbreakSchneider's lunchmate outbreakCanada, 1998
0
5
10
15
20
25
30
35
40
01-M
ar
08-M
ar
15-M
ar
22-M
ar
29-M
ar
05-A
pr
12-A
pr
19-A
pr
Schneider’s recall 1(March 31)
Schneider’s recall 2(April 9)
Cheese recall (April 15)
Number of Cases
Lunchmate (386)
Outbreak recognized
(March 25)
Date of Onset Of Illness N=513
No Lunchmate (127)
Recall(March 20)
Outbreak recognized(March 16)
( < 386 )
N < 513
CIPHSCIPHS
• National Reportable Disease Database• Communicable diseases, immunization, VAAE• Data as a by-product of doing regular work• Provides tools to local public health (PHIS) & to
microbiology labs (LDMS)• Connects in near-real-time• Part of end-to-end strategy of HSWG
Supporting end-to-end surveillanceSupporting end-to-end surveillanceenteric diseaseenteric disease
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Public Health Nursecalls or visits homes
Family teaching, investigation, follow up
Alert reportto MOH
Alert reportto Province
Alert reportto HC
Outbreak plan becomes operational
Coordinate other prov agency investigation
Is this a national
outbreak or one involving
CFIA?
Food samplesto lab
Supporting end-to-end surveillanceSupporting end-to-end surveillance(vaccine-preventable disease)(vaccine-preventable disease)
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Child ill
Hospitalvisit
Bench workin Prov lab
Public Health Nursecalls or visits school
Exclusion, immunization, investigation, follow up
Alert reportto MOH
Alert reportto Province
Alert reportto HC
Outbreak plan becomes operational
Identify sources of vaccine
National response; long term work on vaccine strategy
Immunizationregistry
StandardsStandards
“The advantages of a uniform statistical nomenclature, however imperfect, are so obvious that it is surprising that no attention has been paid to its enforcement in bills of mortality…The nomenclature is of as much importance in this department of inquiry as weights and measures in the physical sciences, and should be settled without delay.” - William Farr, 19th Century
CDCDCC
GISGIS
Geographic dataGeographic data
DiseaseDiseasedatadata
Denominator dataDenominator data
G. I. S.G. I. S.
Skills Enhancement for Health SurveillanceSkills Enhancement for Health Surveillance
• Develop an Internet-based training program in both official languages.
• For front-line public health professionals across Canada
• To increase skills in the following areas:–Epidemiology–Surveillance–Information management
Skills Enhancement's RoleSkills Enhancement's Role
• A continuing education training program
• NOT to replace existing training programs
• Support other educational programs
• To help fill the gap for accessible, flexible applied continuing education training for front-line public health practitioners
Modules Currently AvailableModules Currently Available
• Orientation to Online Learning
• Module 1: Basic Epidemiological Concepts
• Module 2: Measurement of Health Status
• Module 3: Descriptive Epidemiological Methods
Key InformationKey Information
• Each module ranges from 10-20 hours in length.
• Students must complete a module within 6-8 weeks.
• Registrants can take a module at no charge, but are responsible for Internet costs & for hardware/software.
Formats OfferedFormats Offered
Facilitated
Students have access to an online facilitator whose
role is to: answer content-related questions; encourage
discussion; provide feedback on exercises; and guide
students through the material.
Unfacilitated
Students progress through the course independently.
Examples of Future ModulesExamples of Future Modules• Introduction to Surveillance
• Introduction to Information Management
• Basic Biostatistics
• Survey Methods
• Communicating Data Effectively
• Moving Data to Action: Evidence-based planning
• Applied Epidemiology 1: eg: Outbreak Management and Control
• Applied Epidemiology 2: eg: Injury
• Applied Epidemiology 3: eg: Chronic Diseases