Malcolm Rivera
Active surveillance is a critical component of public health, aiming to detect every case of an outbreak to enable effective monitoring and response. It involves regular contact with healthcare providers to identify cases, promote awareness of reporting responsibilities, and encourage cooperation with health departments. Active surveillance is resource-intensive, requiring significant human and financial investment, and is often limited to short-term disease control activities or seasonal events like influenza. It complements passive surveillance, where healthcare providers submit reports to health departments as part of their routine duties, which is simpler and cheaper but less comprehensive. Surveillance systems aim to detect incidents early, identify the causative pathogen, and initiate an appropriate response. They are essential for outbreak management, monitoring disease burden, and informing interventions. Surveillance methods include laboratory-based approaches, syndromic surveillance using electronic medical records and social media data, and spatial analysis of individual movements during outbreaks.
| Characteristics | Values |
|---|---|
| Purpose | Detect every case of an outbreak to monitor disease burden and epidemiology of disease |
| Data Sources | Syndromic surveillance systems, electronic medical records, social media, sentinel physician practices, nursing homes, schools, hospital discharge records, Medicare or Medicaid databases, immunization records, mobile phone data |
| Reporting Entities | Physicians, laboratories, hospitals, clinics, schools |
| Reporting Protocols | Standard case definitions and minimum data elements, reporting to local health department, feedback to healthcare providers |
| Surveillance Methods | Active, passive, laboratory-based, syndromic, sentinel |
| Surveillance Systems | IDSR, Global Outbreak and Response Network (GOARN), Flowminder |
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What You'll Learn
Surveillance methods for early outbreak detection
Laboratory-based Surveillance
The use of laboratory testing to confirm cases of vaccine-preventable or infectious diseases is essential for early outbreak detection. Laboratory-based surveillance enhances diagnostic accuracy and the timeliness of recognizing outbreaks. Molecular subtyping, for example, can identify the molecular "fingerprint" of an outbreak strain, distinguishing it from sporadic cases. PulseNet, maintained by the CDC, is an example of a network that utilizes standardized genotyping for outbreak detection.
Syndromic Surveillance
Syndromic surveillance systems leverage large data streams from electronic medical records and social media to monitor disease activity. This approach has been valuable in monitoring influenza-like illnesses in various settings, including sentinel physician practices, nursing homes, and schools. Syndromic surveillance supplements traditional disease-specific surveillance methods.
Healthcare Provider Reporting
Licensed physicians and healthcare providers are typically required by law to report the occurrence of specific diseases, such as sexually transmitted infections, vaccine-preventable diseases, and bloodborne pathogens, to health departments. Regular feedback to these healthcare providers reinforces their crucial role in public health surveillance. Feedback should be timely, informative, and relevant to their practice, including information on disease patterns and control activities in their region.
Sentinel Surveillance
Sentinel surveillance systems involve regular contact between health departments and healthcare providers to identify cases and promote awareness of reporting responsibilities. This active surveillance method is often employed during short-term disease control activities, such as during outbreaks or seasonal events like the influenza season.
Surveillance in Emergencies
Humanitarian emergencies, natural disasters, and conflicts increase the risk of infectious disease outbreaks. Environmental surveillance, such as testing wastewater for pathogens, has been historically used for poliovirus surveillance and can be applied to other disease outbreaks. The World Health Organization (WHO) provides guidance and leadership in global surveillance and reporting, especially for emerging threats like SARS and Zika virus.
The effectiveness of these surveillance methods relies on accurate data analysis, timely reporting, and appropriate responses to detected outbreaks. Standard case definitions and quality indicators are essential for consistent and successful disease surveillance.
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The role of physicians and healthcare facilities in reporting
Reporting Responsibilities
Physicians and healthcare facilities are legally required to report the occurrence of specific diseases to local, state, and federal health authorities. This includes diseases such as sexually transmitted infections, vaccine-preventable illnesses, bloodborne pathogens, tuberculosis, and certain bacterial infections. In addition, they must report disease outbreaks, regardless of the cause, and emerging or new diseases. This reporting duty is shared with laboratories and local and state health departments.
Timely and Complete Reporting
The success of disease surveillance relies on timely and complete reporting. Early detection of outbreaks can be achieved through prompt recognition and reporting by physicians and healthcare facilities. Every hour of delay in reporting can impact the prevention of illness and death. To facilitate timely reporting, healthcare providers should have access to efficient reporting systems, such as the Health Provider Network (HPN) used in New York.
Surveillance and Outbreak Investigation
Physicians and healthcare facilities play a vital role in disease surveillance by actively monitoring and identifying cases. This includes regular contact with health departments and participation in special surveillance activities, such as sentinel surveillance systems and laboratory-based surveillance. Healthcare providers are trained in surveillance methods and outbreak investigation to enhance their ability to detect and respond to disease outbreaks.
Feedback and Continuous Improvement
Providing regular feedback to physicians and healthcare facilities that report disease outbreaks is essential. Feedback should include information on disease patterns, control activities, and the impact of their reporting. This reinforces the importance of their participation in public health surveillance and encourages continuous improvement in reporting practices.
Collaboration and Coordination
During disease outbreaks, physicians and healthcare facilities collaborate with public health experts and other healthcare partners in the community. They coordinate patient management, share supplies, and implement safety protocols, such as the proper use of personal protective equipment (PPE). Smaller facilities may contract with other facilities or individuals to access specialized healthcare expertise during outbreaks.
Incident Management and Emergency Response
Physicians and healthcare facilities are integral to incident management and emergency response during disease outbreaks. They work closely with public health officials and follow established protocols for reporting and managing suspected or confirmed cases. This includes identifying exposed and infected individuals and reporting them to infection prevention and control staff. Additionally, they interpret surveillance data and advisories to assess the potential impact on their facilities.
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Laboratory-based surveillance for diagnostic accuracy
Laboratory-based surveillance is a critical tool for enhancing diagnostic accuracy and improving the timeliness of disease outbreak recognition and intervention. It involves the use of laboratory testing to confirm cases of vaccine-preventable diseases and other public health concerns. The availability and accessibility of laboratory testing are essential to confirm diagnoses and support disease control and prevention efforts.
Laboratory-based surveillance plays a crucial role in monitoring and managing outbreaks, such as the COVID-19 pandemic. Clinical laboratory testing is vital for early diagnosis, treatment, and epidemiological surveillance. The rapid identification of SARS-CoV-2 mutations helps control the spread of the virus. Laboratory professionals are responsible for validating investigative processes and ensuring analytical performance in healthcare operations. The utilization of multiple techniques, including molecular, serological, and biochemical assays, is necessary for accurate diagnosis and management.
In the context of vaccine-preventable diseases, laboratory support is essential for confirming cases and providing epidemiologically important information. Healthcare providers should be encouraged to collaborate with local or state health departments to obtain appropriate laboratory testing. The laboratory diagnosis of SARS-CoV-2, for example, utilizes nucleic acid amplification techniques (NAAT) and serological tests to detect antibodies against the virus.
The success of laboratory-based surveillance relies on the accurate determination of triggers or thresholds that signal unusual events or trends. Syndromic surveillance systems, for instance, take advantage of large data streams through electronic medical records and social media to monitor influenza activity. Additionally, laboratory networks, such as the Diphtheria-LabNet in Europe, aim to improve laboratory performance and ensure accurate and comparative surveillance across regions.
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Surveillance for multiple risk factors leading to a single condition
To effectively address such multifaceted health threats, a comprehensive surveillance system is necessary. This involves the collaboration of multiple sectors, including animal, human, and environmental health sectors, to proactively identify and manage risk factors. For instance, the Surveillance and Response Strategies for Zoonotic Diseases suggest implementing One Health principles by engaging relevant stakeholders from diverse sectors such as animal farms and wastewater surveillance to identify novel pathogens. This multisectoral collaboration enables the strengthening of surveillance capabilities, promotion of data sharing, enhancement of laboratory testing, and coordination of joint outbreak responses.
Additionally, surveillance systems can incorporate various data sources and technologies to improve early warning capabilities. For instance, modern technologies such as cloud computing, the Internet of Things, and Artificial Intelligence can be leveraged to strengthen cooperation between health authorities, research institutions, and technology companies. Furthermore, early warning systems can integrate diverse trigger indicators, including environmental factors, social media discussions, drug sales trends, quarantine data, and sewage analysis, to improve the speed and sensitivity of risk identification.
An example of a comprehensive surveillance system is the Behavioral Risk Factor Surveillance System (BRFSS), which collects state-level data on health-related risk behaviors, chronic conditions, and preventive health services in the United States. The BRFSS has been utilized to study various topics, including mental illness stigma, industry and occupation variables, and smoking policies. Another example is the Pregnancy Risk Assessment Monitoring System (PRAMS), which focuses on monitoring maternal behaviors, conditions, and experiences before, during, and after pregnancy. These surveillance systems contribute to our understanding of multiple risk factors and their impact on specific health conditions.
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Surveillance for adverse effects of drugs
Active surveillance is a comprehensive method that aims to detect every case of a disease outbreak. It requires significant human and financial resources, and involves calling or visiting health facilities to encourage follow-up, as well as having staff review medical records to identify cases that meet prescribed case definitions. Passive surveillance, on the other hand, often misses cases due to its reporting structure and is less resource-intensive. Examples of passive surveillance include the monitoring of adverse effects of drugs.
The importance of adverse drug event monitoring lies in the fact that the complete adverse event profile of a drug is typically unknown at the time of its approval due to the limitations of pre-approval clinical trials. These trials often involve small sample sizes and short durations, which may not uncover all potential risks associated with the drug. Therefore, post-marketing surveillance plays a critical role in identifying hazards and adverse events that were not observed during the approval process.
Physicians and other healthcare professionals are strongly encouraged to report adverse outcomes and events related to drug use. Spontaneous reporting systems, such as the Adverse Event Reporting System (AERS), are commonly used and effective methods for identifying new or rare adverse events. These systems rely on vigilant healthcare professionals to submit reports, which are then scrutinized by post-marketing safety evaluators to identify previously unrecognized serious adverse events.
Additionally, computerized monitors and electronic monitoring systems have been developed to detect and prevent adverse drug events (ADEs). These systems can be particularly useful in community hospitals and settings without sophisticated electronic systems. One example is the DPV surveillance tool, which has been effective in identifying patients at high risk for potential ADEs and allowing clinicians to intervene and change clinical practice.
In summary, surveillance for adverse effects of drugs is a critical component of public health and pharmacovigilance. It involves monitoring, reporting, and reviewing adverse events associated with medication use. By utilizing both spontaneous reporting systems and electronic monitoring tools, healthcare organizations and regulatory bodies can identify and address potential risks and hazards of drugs, even after they have been approved and marketed. This continuous surveillance process helps ensure the safety of patients and improves the overall understanding of the drugs' effects.
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Frequently asked questions
Active surveillance involves the health department initiating contact with healthcare providers to identify cases. This involves regular contact with healthcare providers to promote awareness of reporting responsibilities and increase cooperation with the health department.
Active surveillance aims to detect every case, while passive surveillance may miss cases due to its reporting structure. Active surveillance is also used to validate data seen in passive reporting.
During a cholera outbreak in Haiti in 2010, researchers from Flowminder mapped the movement of people using anonymous data from mobile usage in the affected areas. This was shown to be an effective way of mapping the spread of the outbreak.
Active surveillance requires significant human and financial resources, so passive surveillance is often implemented. Active surveillance is generally limited to short-term disease control activities or seasonal activities due to the expense of sustaining an active system and the low yield when disease incidence is low.
In passive surveillance, hospitals, clinics, and other sources submit reports to a health department as part of their routine duties. Licensed physicians are required to report the occurrence of selected diseases to the health department.
