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DPR Korea

DPR Korea

Training on Epidemiology and Use of Epidemiological Software, DPR Korea, Nov 12 - Dec9, 2005
Training on Epidemiology and Use of Epidemiological
Software, DPR Korea, Nov 12 - Dec9, 2005
WHO/CSRWHO/CSR
WHO/CSRWHO/CSR
Principles of Disease Surveillance WHO/CSR WHO/CSR

Principles of Disease Surveillance

Principles of Disease Surveillance WHO/CSR WHO/CSR

WHO/CSRWHO/CSR

Principles of Disease Surveillance WHO/CSR WHO/CSR

Surveillance

Surveillance Surveillance is the ongoing systematic collection, collation, analysis and interpretation of data; and the

Surveillance is the ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken

WHO/CSRWHO/CSR

and the dissemination of information to those who need to know in order that action may

Rationale for Disease Surveillance

Rationale for Disease Surveillance • The disease is of public health importance • Caution! – Is

The disease is of public health importance

Caution!

Is it worth the effort (money, human resources)?

Are relevant data easily available?

Can action be taken?

WHO/CSRWHO/CSR

the effort (money, human resources)? – Are relevant data easily available? – Can action be taken?

Objectives of surveillance

Objectives of surveillance • Monitoring trends and estimate magnitude of health problem • Epidemic (outbreak)

Monitoring trends and estimate magnitude of health problem

Epidemic (outbreak) detection and prediction

Monitor progress towards a control objective

Monitor programme performance

Estimate future disease impact

Evaluating an intervention

Understand characteristics of health events

Distribution and spread

Natural history

Facilitate planning

WHO/CSRWHO/CSR

of health events • Distribution and spread • Natural history • Facilitate planning WHO/CSR WHO/CSR

Objective:

To monitor the trend of laboratory confirmed malaria and proportion due to P. falciparum

Cases of malaria in a region, 1992-1996

600 500 400 300 200 100 0 1992 1993 1994 1995 1996
600
500
400
300
200
100
0
1992
1993
1994
1995
1996

Othersof malaria in a region, 1992-1996 600 500 400 300 200 100 0 1992 1993 1994

Faciparumof malaria in a region, 1992-1996 600 500 400 300 200 100 0 1992 1993 1994

WHO/CSRWHO/CSR

in a region, 1992-1996 600 500 400 300 200 100 0 1992 1993 1994 1995 1996

Objective:

To detect outbreaks of dysentery by monitoring number of blood diarrhoea cases

Cases of acute bloody diarrhoea in a rural district by month, January 1994- April 1995
Cases of acute bloody diarrhoea in a rural district by month,
January 1994- April 1995
120
Cases
100
80
60
40
20
0
Jan Feb Mar
Apr May Jun
Jul
Aug Sep
Oct Nov Dec Jan
Feb Mar
Apr
1994
1995

WHO/CSRWHO/CSR

100 80 60 40 20 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Objective:

To monitor progress towards polio eradication by monitoring the incidence of poliomyelitis where wild poliovirus is isolated in children under 14 years

Cases of poliomyelitis where wild poliovirus was isolated in children in a rural district, 1980-1996

250 NID Cases 200 150 NID 100 50 0 80 81 82 83 84 85
250
NID
Cases
200
150
NID
100
50
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96

Objective:

To monitor the ability of a TB programme to ensure treatment completion and cure

Treatment completion and cure in TB cases, 1994-1997 1600 1400 1200 1000 Cases 800 Completion
Treatment completion and cure in TB cases, 1994-1997
1600
1400
1200
1000
Cases
800
Completion
600
Cure
400
200
0
1994
1995
1996
1997

WHO/CSRWHO/CSR

1600 1400 1200 1000 Cases 800 Completion 600 Cure 400 200 0 1994 1995 1996 1997

Objective:

To predict future trends of AIDS for health service planning

Cases of AIDS in a city district, 1990-2004

700 600 500 400 300 200 100 0 90 91 92 93 94 95 96
700
600
500
400
300
200
100
0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04

Steps in planning a surveillance system

Steps in planning a surveillance system • Establish objectives • Develop case definition • Determine data

Establish objectives

Develop case definition

Determine data source or data collection mechanism

Develop data collection instrument

Field-test methods

Develop and test analytic mechanism

Develop dissemination mechanism

Assure use of analysis and interpretation

Evaluation

WHO/CSRWHO/CSR

• Develop dissemination mechanism • Assure use of analysis and interpretation • Evaluation WHO/CSR WHO/CSR

Case definition

Case definition • Clinical versus laboratory • Level of case definition (suspected, probable, confirmed) •

Clinical versus laboratory

Level of case definition (suspected, probable, confirmed)

Example Influenza:

Suspected: A person with sudden onset of fever > 39C, respiratory symptoms, myalgias, headaches

Probable: A suspected case , epidemiologically linked to labortory-confirmed case

Confirmed: A suspected case with virus isolation or direct antigen detection

WHO/CSRWHO/CSR

case – Confirmed : A suspected case with virus isolation or direct antigen detection WHO/CSR WHO/CSR

Data source and data collection mechanism

Data source and data collection mechanism • Data source – notifiable diseases – vital statistics –

Data source

notifiable diseases

vital statistics

survey

laboratory

member of the public, media

other information sources, e.g. sanitarian data, metereological data, immunisation, nutrition

Data collection

passive vs active

WHO/CSRWHO/CSR

sanitarian data, metereological data, immunisation, nutrition • Data collection – passive vs active WHO/CSR WHO/CSR

Dissemination mechanism

Dissemination mechanism • Directly to all who need to know • Press release to the public

Directly to all who need to know

Press release to the public

Reports, bulletins

Others

WHO/CSRWHO/CSR

• Directly to all who need to know • Press release to the public • Reports,

Assure use of analysis and interpretation

Assure use of analysis and interpretation • Control measures – rapid response – case management –

Control measures

rapid response

case management

prevention programme (immunisation)

Planning/ policy making

epidemic preparedness

policy modification

prediction and future planning

Feedback to the system

WHO/CSRWHO/CSR

preparedness – policy modification – prediction and future planning • Feedback to the system WHO/CSR WHO/CSR

Surveillance: Tasks

Peripheral level
Peripheral level

Intermediate level

Surveillance: Tasks Peripheral level Intermediate level Central level Ministry of Health Detect Treat Report Analyse
Surveillance: Tasks Peripheral level Intermediate level Central level Ministry of Health Detect Treat Report Analyse
Surveillance: Tasks Peripheral level Intermediate level Central level Ministry of Health Detect Treat Report Analyse

Central level

Ministry of Health
Ministry
of Health

Detect

Treat

Report

Analyse

Investigate

Report

Respond

Feedback

Analyse Investigate Confirm Respond Plan and Fund Feedback

Regional/International level

WHO
WHO

Analysis and feedback Support Policy and targets Funding

Surveillance: General Principle

Health Care System

Public Health Authority

Data

Data Action

Action

Information

Information Decision

Decision

Reporting

Authority Data Action Information Decision Reporting A n a l y s i s & Interpretation

Analysis & Interpretation

Evaluation

Feedback

Information Decision Reporting A n a l y s i s & Interpretation Evaluation Feedback WHO/CSR

WHO/CSRWHO/CSR

Information Decision Reporting A n a l y s i s & Interpretation Evaluation Feedback WHO/CSR

Surveillance functions

Surveillance functions Core function • Reporting • Detection • Investigation & confirmation • Analysis

Core function

Reporting

Detection

Investigation & confirmation

Analysis & interpretation

Action / response

Support function

Training

Supervision

Resources

Standards / guidelines

WHO/CSRWHO/CSR

/ response Support function • Training • Supervision • Resources • Standards / guidelines WHO/CSR WHO/CSR

Surveillance: Basic Ingredients

Surveillance: Basic Ingredients A good network of motivated people Clear case definition and reporting mechanism

A good network of motivated peopleSurveillance: Basic Ingredients Clear case definition and reporting mechanism Efficient communication system Basic

Clear case definition and reporting mechanism Efficient communication system Basic but sound epidemiology
Clear case definition and reporting mechanism Efficient communication system Basic but sound epidemiology Efficient communication system
Clear case definition and reporting mechanism Efficient communication system Basic but sound epidemiology Basic but sound epidemiology

Laboratory support Good feedback and rapid response
Laboratory support Good feedback and rapid response Good feedback and rapid response

WHO/CSRWHO/CSR

system Basic but sound epidemiology Laboratory support Good feedback and rapid response WHO/CSR WHO/CSR

Report

Lab. confirmation

Clinical case

Seek medical attention

Disease

Infected

Exposed

WHO/CSRWHO/CSR

Report Lab. confirmation Clinical case Seek medical attention Disease Infected Exposed WHO/CSR WHO/CSR

What is the difference between recording/reporting and surveillance

WHO/CSRWHO/CSR

What is the difference between recording/reporting and surveillance WHO/CSR WHO/CSR

Disease notification is not the only method in surveillance system!!!

WHO/CSRWHO/CSR

Disease notification is not the only method in surveillance system!!! WHO/CSR WHO/CSR
Venice: L. Thaikruea

Venice: L. Thaikruea

Venice: L. Thaikruea

Venice: L. Thaikruea

Krop khun Krap
Krop khun Krap