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05-Event Based Surveillance 2012

This document provides an overview of event-based surveillance systems and epidemic intelligence. It discusses how infectious diseases can emerge and spread globally. It also describes how the International Health Regulations were established to help monitor and respond to public health events and emerging infectious diseases. The key aspects of event-based surveillance and indicator-based surveillance systems are contrasted. Event-based surveillance focuses on rapidly reporting and investigating unexpected health events, while indicator-based surveillance continuously monitors known disease indicators. Epidemic intelligence involves systematically screening information sources, validating potential public health events, assessing risks, and communicating findings to support timely responses.

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Lakshmi Seth
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218 views

05-Event Based Surveillance 2012

This document provides an overview of event-based surveillance systems and epidemic intelligence. It discusses how infectious diseases can emerge and spread globally. It also describes how the International Health Regulations were established to help monitor and respond to public health events and emerging infectious diseases. The key aspects of event-based surveillance and indicator-based surveillance systems are contrasted. Event-based surveillance focuses on rapidly reporting and investigating unexpected health events, while indicator-based surveillance continuously monitors known disease indicators. Epidemic intelligence involves systematically screening information sources, validating potential public health events, assessing risks, and communicating findings to support timely responses.

Uploaded by

Lakshmi Seth
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Event based

surveillance systems
Alicia Barrasa

Introductory course 2012


Lazareto, Menorca, Spain

Infectious diseases

Arise from many different pathogens: viruses, bacteria, parasites


Spread in many different species: humans, insects, domestic and
wild animals, aquatic animals and sometimes breach barrier
between animal and humans (70% of emerging infections arise
from animal population)
Take many different routes of transmission: direct contact,
vectors, food, environmental
Affect all populations in all regions of the world

Emerging and Re-emerging


infectious diseases
Legionnaires disease

Cryptosporidiosis
Shigellosis
Human monkepox

West
Nile
Virus

E. coli O157

Multidrug resistant Salmonella

v
)
1
N
1
H
(
A
BSE

nvCJD

E.coli non-O157
Malaria Typhoid

E. coli O157

Rabies
SARS
Diphtheria
West
Nile
Fever
Lyme Borreliosis
Reston
Typhoid
Influenza A (H5N1)
Kyasanur f.
Lassa fever
Echinococcosis
Nipah Virus
Yellow fever
Cholera O139
RVF/VHF
Reston Virus
Venezuelan
Buruli ulcer
Dengue
equine encephalitis
Onyong-nyong haemhorrhagic
Respiratory
fever
Ebola
fever
infection
haemorrhagic
Dengue
Human
haemhorrhagic feverCholera fever
Ross
monkeypox
Hendra
River
virus
Cholera
virus
Shigellosis
Epidemic Alert and Response (EAR), WHO Regional Office for Europe

Accidental and deliberate release of


infectious agents
Increased research, biotechnology is widely
available

Increased risk for accidental release (e.g. SARS


2004 from laboratory)

World tensions remain and the deliberate release


of infectious agents is no longer a remote threat.

International Health Regulation


1374 Venice
1851 Paris
1947 Geneva
1951 Geneva
1969 Geneva

Quarantine for Plague


1st International Sanitary Conference
WHO Epidemiological Information
Service
International Sanitary Regulations
International Health Regulations

2004 Regional consultations


Nov 2004
Geneva
Intergovernmental Working Group
meeting
Feb 2005
Geneva
Intergovernmental Working Group
meeting
May 2005
Geneva
Revised IHR, World Health
Assembly adopted

IHR Decision Instrument


4 diseases that always have to be notified
polio (wild type virus), smallpox, human
influenza caused by a novel virus, SARS.
Diseases that always lead to the use of the
algorithm : cholera, pneumonique plague,
yellow fever, VHF (Ebola, Lassa,
Marburg), WNF, meningitis, others
*Q1: serious graves repercussions for
public health?
Q2: unusual or unexpected?
Q3: risk of international spread?
Q4: risk of travel or traffic restrictions?
Insufficient information : re-evaluate

IHR Decision Instrument

International Health Regulation - 2005


To decide on need for notification any public
health event can be assessed by the criteria

Is the public health impact of the event serious?


Is the event unusual or unexpected?
Is there a significant risk of international spread?
Is there a significant risk of international travel or
travel restrictions ?

Obligation to establish core capacities:

Surveillance
Response

Epidemic Intelligence
Definition
The systematic collection and collation of
information from a variety of sources,
usually in real-time, which is then verified
and analysed and, if necessary, activates
response
Objective
to speed up detection of potential health
threats and allow timely response

Epidemic Intelligence - ECDC


Identify, assess and communicate current and
emerging communicable disease threats

Establish procedures for the identification of


emerging health threats in cooperation with MS

Inform EC and MS about emerging health


threats requiring their immediate attention

Communication on emerging health threats,


including to the public

Surveillance
is
Information for action

Epidemic Intelligence
Indicator-based surveillance

Event-based surveillance

Surveillance systems

Event monitoring
Data Events
Collect
Screen/collect
Analyse
Filter
Interpret
Validate
Signal

Investigate
Public
health
Alert
Response

Assess

Indicator based Surveillance


Surveillance systems
Ongoing and systematic
Collection and analysis of data
Interpretation and dissemination of results
related to health events of interest
For action
Describe diseases
Outbreak detection
Monitor changes /interventions
Provide evidence for policy making
Generate hypothesis

Event based Surveillance


Organized and rapid capture of information about
events that are a potential risk to public health:
Events related to the occurrence to the disease
in humans (clusters, unusual patterns,
unexpected deaths)
Events related to potential exposures (diseases
in animals, contaminated food or water,
environmental hazards)
Need confirmation

Indicator vs event based


Indicator based

Event based

Definitions - Clinical presentation

- ...events that are a


- Characteristics of people potential risk
- ...unusual events in
- Laboratory criteria
the community
- Sensitive
- Specific

Timeliness - Weekly / monthly

- All events should be


(some may be immediate) reported to the system
- Possible delay between immediately
- Real time
identification and
notification

Indicator vs event based


Indicator based
Actors

Event based

- Involved in the system - Might not know

Reporting - Clearly defined


structure - Reporting forms

- No predefined structure
- Reporting forms flexible for
quali and quantitative data
- At any time
- Reporting dates
- Teams to confirm evens
- Teams to analyse
data at regular intervals and prepare the response

Indicator vs event based


Indicator based
Trigger for - a pre-defined thresholds
action
Response

Event based
- a confirmed event

- depends on the delay


- depends on the
between identification, data confirmation of the
collection and analysis
event, but ideally is
immediate

Epidemic Intelligence
Indicator-based surveillance

Event-based surveillance

Surveillance systems

Event monitoring
Data Events
Collect
Screen/collect
Analyse
Filter
Interpret
Validate
Signal
Assess

Investigate
Public
health
Alert
Response

Epidemic Intelligence - ECDC

The process of Epidemic


Intelligence
1. Screening/collecting
2. Filtering
3. Validating
4. Analysis
5. Assessment
6. Documentation
7. Communication

Screening / Collecting:
Monitoring known threats and detecting new
threats by screening a virtually unlimited
amount of information.

web-based early warning systems


Sophisticated applications able to gather, filter
and classify web-based information for public
health purposes
Advantages Disadvantages

Automatic systems

little or no near real


human
time
interventi information
on

Moderated systems

rely on
human
moderatio
n

False positive
component,
duplication,
overload for
analysts

analysts
Time delay,
reduce
human
redundancy selection bias
and false
positive

Filtering:
The objective of filtering is to decide which
information detected through screening might
be potential public health events of National,
European or international concern.
Early detection

Validation:
This is the process of confirming the
accuracy and credibility of information
received from non-official sources
(unverified information).
Early detection
Identification of signals

Analysis:
Initial evaluation based on preliminary info
available in terms of likelihood and of possible
human public health impact
Risk Assessment

Documentation:
Logging information and actions taken during
the EI process from the beginning is a crucial
action to analyse the ongoing situation and to
trace back all the steps

Communication:
To public/media and to scientific community
about findings and assessment of potential
public health events detected and investigated

Epidemic Intelligence - ECDC

A small summary
Indicator and event based systems are
tools for PH Surveillance
event based systems have already been
successfully used
The challenge: confirmation of the
events

Epidemic Intelligence at ECDC


24/7 Screening of news from different sources
Round table
Daily threat assessment
Daily & weekly reports
Communication
Risk assessment
Response to outbreaks

to know more
WHO. The revision of the International Health Regulations. Wkly
Epidemiol Rec 1996; 71: 233-5
WHO. Revision of the International Health Regulations: progress report,
January 1998. Wkly Epidemiol Rec 1998; 73: 17-9
Paquet C, Coulombier D, Kaiser R, Ciotti M. Epidemic intelligence: a
new framework for strengthening disease surveillance in Europe. Euro
Surveill. 2006;11(12):665
WHO. A guide to establishing event-based surveillance
http://www.wpro.who.int/internet/resources.ashx/CSR/Publications/event
basedsurv.pdf

Thank you for your attention

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