what are the 5 steps of surveillance? what are the 5 steps of surveillance?

Presented at 53rd Annual Epidemic Intelligence Service Conference, April 1923, 2004, Atlanta. 1. Choosing controls. Planning and sampling tools. What is the peak of the outbreak or the median date of onset? (35), Sometimes a more specific control group is needed to test a more specific hypothesis. For example, in the investigation of Legionnaires disease (Table 6.11), what about Grocery Store A linked it to disease? * Excludes 1 or more persons with indefinite history of consumption of that food. For other diseases, particularly those with a relatively short incubation period, hour of onset may be more suitable (see Lesson 6). J Infect Dis 1992;165:7369. This is an online version of a printed textbook. Is the attack rate low among persons not exposed to that item? Peterson LR, Marshall SL, Barton-Dickson C, Hajjeh RA, Lindsley MD, Warnock DW, et al. Presented at Northeast Regional Epidemic Intelligence Service Conference, March 14, 2002, New York City. They are often helpful in explaining why an outbreak occurred. But there are steps you can take to protect yourself, like using a #VPN at all times. CDC twenty four seven. So the investigators rejected the null hypothesis (that beef was not associated with illness) and adopted the alternative hypothesis (that beef was indeed associated with illness). You will be subject to the destination website's privacy policy when you follow the link. For a notifiable disease, the expected number is based on health department surveillance records. Discovery and Development. In non-technical terms, a confidence interval for a risk ratio is the range of values of the risk ratio consistent with the data in a study. Torok TJ, Tauxe RV, Wise RP, Livengood JR, Sokolow R, Mauvais S, et al. Understand the Needs of People with Disabilities. In theory, a propagated epidemic one spread from person-to-person with increasing numbers of cases in each generation should have a series of progressively taller peaks one incubation period apart, but in reality few produce this classic pattern. This confidence interval indicates that the study is consistent with risk ratios for the beef/gastroenteritis association in that range. Subtract the time of onset of the median case from the time of exposure to estimate the median incubation period. If the map shows a cluster or other pattern (such as cases along a road), the investigator must consider possible explanations perhaps water supplies, wind currents, or proximity to a restaurant or grocery. Public health workers must therefore look for additional cases to determine the true geographic extent of the problem and the populations affected by it. Another useful way to generate hypotheses is to talk to a few of the case-patients, as discussed in Step 3. Even in the era of computers, many epidemiologists still maintain a handwritten line listing of key data items, and turn to their computers for more complex manipulations and cross-tabulations. Quality CPR and fast response can help a victim stay alive long enough to get advanced life support, but post-cardiac arrest care is equally important. Tan C. A preventable outbreak of pneumococcal pneumonia among unvaccinated nursing home residents New Jersey, 2001. The hypotheses should be testable, since evaluating hypotheses is the next step in the investigation. The average incubation period for coccidioidomycosis is 12 days, with a minimum incubation period of 7 days. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Sometimes, health agencies respond to small numbers of cases, or even a single case of disease, that may not exceed the expected or usual number of cases. Secondly, it helps the audit body confirm the scope of activity and plan the Stage 2 audit. All information these cookies collect is aggregated and therefore anonymous. However, surveillance data only reflects a subset of cases that are actually occurring. To apply this test, calculate the chi-square statistic, then look up its corresponding p-value in a table of chi-squares, such as Table 6.10. This assumption is known as the null hypothesis. Public Video Surveillance Brings Convenience for Everyday Life. In an outbreak of 50 or more cases, one control per case will usually suffice. Interruption of direct transmission may be accomplished by isolation of someone with infection, or counseling persons to avoid the specific type of contact associated with transmission. Coccidioidomycosis among workers at an archaeologic site, northeast Utah. In addition, investigators must consider logistical issues, such as how to contact potential controls, gain their cooperation, ensure that they are free of disease, and obtain appropriate exposure data from them. Data collection tools. Through Epi-X, CDC officials, state and local health departments, poison control centers, and other public health professionals can access and share preliminary health surveillance information quickly and securely. This graph, called an epidemic curve, or epi curve for short, provides a simple visual display of the outbreaks magnitude and time trend. Most of the case-patients were exposed to the item, so that the exposure could explain or account for most, if not all, of the cases. It is not intended to be an online course. Surveillance remains fundamental to understanding the evolution of the virus, the risk factors for severe disease and the impact of vaccination and public health and social measures. In general, the more subjects (case-patients and controls) in a study, the easier it will be to find a statistically significant association. They also enrolled two controls per case, a total of 54 controls. Some simple and effective strategies protect portals of entry. In addition, operational and logistical details are important. A systematic difference between cases and controls that results in a mistaken estimate of the association between exposure and disease is called a bias. A 95% confidence interval, the interval used most commonly by epidemiologists, corresponds to a p=0.05 cut-off. Cookies used to make website functionality more relevant to you. Finally, recall that one reason to investigate outbreaks is research. Who is in charge? When the epidemiology does not fit the natural pattern, think unnatural, i.e., intentional. A wide confidence interval indicates that the study is consistent with a wide range of values, i.e., the study is not very precise in describing the strength of the association (risk ratio) between exposure and disease. To look for clustering in an outbreak of surgical wound infections in a hospital, cases may be plotted by operating room, recovery room, and ward room. The data showing the relationship between an exposure and disease are often displayed in a two-by-two table. They can use closed circuit television to. JAMA 1985;253:12758. Depending on the type of outbreak, the number of involved agencies may be quite large. An intermittent common-source epidemic (in which exposure to the causative agent is sporadic over time) usually produces an irregularly jagged epidemic curve reflecting the intermittence and duration of exposure and the number of persons exposed. Figure 6.7 shows the location of staff in two offices in the U.S. Senates Hart Building who had nasal swabs positive for B. anthracis after an envelope containing anthrax spores was opened in their presence.(33). 2. For example, in an outbreak of listeriosis in 2002 caused by contaminated sliceable turkey deli meat, announcements in the media alerted the public to avoid the implicated product and instructed them to see a physician if they developed symptoms compatible with the disease in question.(27). Even with top-notch security in place, breaches can occur . Fortunately, potential controls are usually plentiful. Outcomes of treated human granulocytic ehrlichiosis cases. Outbreak of histoplasmosis among industrial plant workers Nebraska, 2004. Arrange a Post Mortem Managing a project isn't only about tasks and resources, budget and deadlines, it's an experience you can constantly learn from. For some diseases, the most appropriate intervention may be directed at controlling or eliminating the agent at its source. As a field investigator, you must have the appropriate scientific knowledge, supplies, and equipment to carry out the investigation before departing for the field. The STEPS instrument is comprised of three different levels or "steps" of risk factor assessment: Step 1 (questionnaire), Step 2 (physical measures) and Step 3 (biochemical measures). Epidemiologic clues to bioterrorism. Bopp DJ, Saunders BD, Waring AL, Waring AL, Ackelsberg J, Dumas N, et al. First, consider what you know about the disease itself: What is the agents usual reservoir? : Yes; Hospital Alerted: Yes; Lab Results: WB IgM+, WB IgG+; Comments: Erythema migrans; Physician Reporting: Dr. Howard; Phone: 555-1950; Date of Report: 11/24/06. Refer to the book or to the electronic PDF version (511 pages) for printable versions of text, figures, and tables. If the epidemic curve points to a narrow period of exposure, what events occurred around that time? Flourescein dye poured into the bathroom of the dorm found its way into the well water, revealing cross-contamination. Start at the earliest case of the epidemic and count back the minimum incubation period, and note this date as well. New Engl J Med 1982;306:124953. Source: Jani AA, Barrett E, Murphy J, Norton D, Novak C, Painter J, Toney D. A steamship full of trouble: an outbreak of Salmonella Typhimurium DT 104 gastroenteritis at a holiday banquetVirginia, 2003. The curve can be used for evaluation, answering questions like: How long did it take for the health department to identify a problem? Pro 5. A good field investigator must be a good manager and collaborator as well as a good epidemiologist, because most investigations are conducted by a team rather than just one individual. (36) A year later, a member of a local cult admitted that the cult had intentionally contaminated the salads bars with Salmonellaorganisms. And it will make your attackers, whether they're the NSA or a local criminal, have to work that much harder. Review the six case report forms in Figure 6.1. If patient information is disclosed to unauthorized persons without the patients permission, the patient may be stigmatized or experience rejection from family and friends, lose a job, or be evicted from housing. Figure 6.8 shows the number of cases of human granulocytic ehrlichiosis by county in Wisconsin during 19961998. : no; Lab Comments: arthritis, arthralgias, fatigue; Physician Reporting: Dr. Steere; Phone: 555-1234; Date of Report: 11/24/06. The health department is responsible for protecting the publics health, but how does it learn about cases of communicable diseases from which the public might need protection? JAMA 1997;278:38995. For smaller studies, a test called the Fisher Exact Test may be more appropriate. Environmental inspection of the fairgrounds identified lack of chlorination of the well supplying water to that zone. Return to text. Preparedness and readiness go hand in hand as organizations and communities prepare for disaster. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. When designing a case-control study, one of the most important decisions is deciding who the controls should be. Because cases can occur from 15 to 50 days after exposure, all cases from a point source exposure should occur within a span of 50 15 = 35 days. STEP . A case might be temporarily classified as probable or possible while laboratory results are pending. Figure 6.5 Hepatitis A from Sub Shop Massachusetts, 2001. It permits the investigator to distinguish epidemic from endemic disease. Salem, VA; County: Columbia; Sex: Male; Race: black; Disease: Lyme Disease; Date of Onset: 2005; Lab Confirmed? You can review and change the way we collect information below. The first step of the ISO 9001 audit process is a 'Stage 1' audit. Nonetheless, many investigators attempt to enroll such population-based controls through dialing of random telephone numbers in the community or through a household survey. This is because at each step in the surveillance process, some individuals or patients are missed. You can review and change the way we collect information below. Active surveillance requires substantially more time and resources and is therefore less commonly used in emergencies. Finally, before departing, you should have a plan of action. In the outbreak setting, the investigators would need to specify time and place to complete the outbreak case definition. These incubation periods can be compared with a list of incubation periods of known diseases to narrow the possibilities. We had Thierry Tanoh, the former energy minister of Cte d'Ivoire. Step 1 Identify, define, and measure the health problem of interest Step 2 Collect and compile data about the problem (and if possible, factors that influence it) Step 3 Analyze and interpret these data Step 4 Provide these data and their interpretation to those responsible for controlling the health problem Step 5 Presented at 53rd Annual Epidemic Intelligence Service Conference, April 1923, 2004, Atlanta. In December 2003, an outbreak of gastroenteritis occurred among tenth-grade students who had participated in a city-wide field trip. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. In studying sick-building syndrome and other disorders related to air-flow patterns in buildings, cases should be plotted by work location. Given recent concerns about bioterrorism, investigators should consider intentional dissemination of an infectious or chemical agent when trying to determine the cause of an outbreak. Interestingly, all case-households but only 41% of control households included persons aged 1535 years. (45) However, capitalizing on this unfortunate experiment of nature, investigators continued to follow the patients to determine the persistence of IgM and the prognosis of patients up to two years after infection. (24) Here you can see the different categories that PAHO uses for this diagnosis. departments can use to locate and engage local chapters of five prominent national disability-focused organizations. A spot map is a simple and useful technique for illustrating where cases live, work, or may have been exposed. Case definitions: meningococcal disease and viral meningitis. Disease surveillance involves a constellation of information systems that identify and record health related outcomes. Surveillance and Integrity Review Section (SIRS) PCA Provider Agency Training Author: Minnesota Department of Human Services Subject: Surveillance and Integrity Review Section (SIRS) PCA Provider Agency Training Keywords: Surveillance and Integrity Review Section (SIRS) PCA Provider Agency Training Created Date: 1/12/2023 7:55:00 AM Finding and reporting children with AFP 2. Overview. The 95% confidence interval ranged from 2.3 to 78.7. This allows disease prevention across a further area and can address public concerns regarding the outbreak. Odds ratios. Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, et al. After a hypothesis that might explain an outbreak has been developed, the next step is to evaluate the plausibility of that hypothesis. Table 6.3 Line Listing of 7 Persons with Suspected Eosinophilia-myalgia, * Severe enough to affect the patients ability to pursue usual daily activities, Eventually, public health officials agreed on the following revised case definition:(26). Confidence intervals. Centers for Disease Control and Prevention. Efforts to prevent fecal-oral transmission often focus on rearranging the environment to reduce the risk of contamination in the future and on changing behaviors, such as promoting hand washing. In addition, conversations with patients are very useful in generating hypotheses about disease etiology and spread. Ramsey AH, Belongia EA, Gale CM, Davis JP. Step 5: Integrated post-cardiac arrest care. The team members must be selected before departure and know their expected roles and responsibilities in the field. When a federal agency is involved in the survey of 10 or more individuals, the data collection instrument must first be cleared by the White House Office of Management and Budget (OMB). Operational security (OPSEC) is an approach to risk management that promotes viewing operations from the perspective of an antagonist. Adapted from: Lukacs SL, Hsu V, Harper S, Handzel T, Hayslett J, Khabbaz R,,et al. Klee AL, Maldin B, Edwin B, IPoshni I, Mostashari F, Fine A, et al. Whatever the criteria, they must be applied consistently to all persons under investigation. The population attributable risk percent may actually be an underestimate in many outbreaks, since it does not take into account such common occurrences as cross-contamination of foods or sampling of a spouses dish. The local staff know the people in the community and their practices, and often have hypotheses based on their knowledge. In many other investigations, however, the circumstances are not as straightforward, and information from the series of cases is not sufficiently compelling or convincing. The shape of the epidemic curve is determined by the epidemic pattern (for example, common source versus propagated), the period of time over which susceptible persons are exposed, and the minimum, average, and maximum incubation periods for the disease. Which item shows the highest attack rate? By asking about drug use in a second case-control study, the investigators implicated marijuana as the likely vehicle. Using the dates of onset listed below, draw an epidemic curve. Step 3: Work on the plan as a team. This probability is called the p-value. The opposite can also occur a p-value less than 0.05 can actually be a chance finding rather than the true explanation of the outbreak. In other words, they should be similar to the cases except that they dont have the disease. Including more than four controls per case is rarely worth the effort in terms of increasing the statistical power of your investigation. Since both the peak and the median of the outbreak occurred during the week of November 4, the most likely period of exposure was a month earlier, in early October. Public health surveillance - the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice Predictive analytics - Statistical techniques analyzing facts to make predictions about unknown events If the duration of exposure is prolonged, the epidemic is called a continuous common-source epidemic, and the epidemic curve has a plateau instead of a peak. As noted earlier, the severity of the illness, the potential for spread, availability of control measures, political considerations, public relations, available resources, and other factors all influence the decision to launch a field investigation. This approach ensures that the investigation proceeds without missing important steps along the way. Acceptance. Thus you would look for exposures during the weeks of October 7 and 14, plus or minus a few days. quadrant, offices of Senators A & B and the hallway outside. Commonly, the investigator compares the attack rate in the exposed group to the attack rate in the unexposed group to measure the association between the exposure (e.g., the food item) and disease. However, this ideal is not always met. From an epidemiologic point of view, hypotheses are evaluated in one of two ways: either by comparing the hypotheses with the established facts or by using analytic epidemiology to quantify relationships and assess the role of chance. The investigators asked case-patients and controls how much time they spent in the store and where they went in the store. Some interventions aim to increase a hosts defenses. This process, in which the outbreak is characterized by time, place, and person, is called descriptive epidemiology. 5 BIOSURVEILLANCE SYSTEMS The definitions of biosurveillance, disease surveillance, and public health surveillance all include the word systematic. Last JM. For example, case definitions often miss infected people who have mild or no symptoms, because they have little reason to be tested. The curve shows where you are in the course of the epidemic still on the upswing, on the down slope, or after the epidemic has ended. A case definition is a tool for classifying someone as having or not having the disease of interest, but few case definitions are 100% accurate in their classifications. In addition, no illness was reported among students who did not go on the field trip, and no cases of E. coli O157 were reported in the community that week. Bargaining. The descriptive epidemiology may provide useful clues that can be turned into hypotheses. This association was confirmed in the laboratory, where the outbreak subtype of the Legionnaires disease bacillus was isolated from the water in the mist machines reservoir. When local data are not available, a health department may use rates from state or national data, or, alternatively, conduct a telephone survey of physicians to determine whether they are seeing more cases of the disease than usual. Heyman DL, ed. Many agencies and organizations have strict approval processes and budgetary limits that you must follow. This sounds pretty obvious but youd be surprised. Why do the people living in one particular area have the highest attack rate? Single case of disease caused by an uncommon agent (e.g., glanders, smallpox, viral hemorrhagic fever, inhalational or cutaneous anthrax) without adequate epidemiologic explanation, Unusual, atypical, genetically engineered, or antiquated strain of an agent (or antibiotic-resistance pattern), Higher morbidity and mortality in association with a common disease or syndrome or failure of such patients to respond to usual therapy, Unusual disease presentation (e.g., inhalational anthrax or pneumonic plague), Disease with an unusual geographic or seasonal distribution (e.g., tularemia in a non-endemic area, influenza in the summer), Stable endemic disease with an unexplained increase in incidence (e.g., tularemia, plague), Atypical disease transmission through aerosols, food, or water, in a mode suggesting deliberate sabotage (i.e., no other physical explanation), No illness in persons who are not exposed to common ventilation systems (have separate closed ventilation systems) when illness is seen in persons in close proximity who have a common ventilation system, Several unusual or unexplained diseases coexisting in the same patient without any other explanation, Unusual illness that affects a large, disparate population (e.g., respiratory disease in a large population may suggest exposure to an inhalational pathogen or chemical agent), Illness that is unusual (or atypical) for a given population or age group (e.g., outbreak of measles-like rash in adults), Unusual pattern of death or illness among animals (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in humans, Unusual pattern of death or illness among humans (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in animals, Ill persons who seek treatment at about the same time (point source with compressed epidemic curve), Similar genetic type among agents isolated from temporally or spatially distinct sources, Simultaneous clusters of similar illness in noncontiguous areas, domestic or foreign, Large number of cases of unexplained diseases or deaths.