pub 540 Principles of epidemiology Topic 2 DQ 1
Disease surveillance is a necessary public health role. Passive surveillance relies on individuals and local authorities “pushing” information to national agencies who then compile, analyze, and disseminate the information. Unfortunately, significant gaps occur in reporting.
Review your textbook, and the CDC’s National Notifiable Disease Surveillance System (NNDSS). Discuss the strengths of the current surveillance systems, the gaps you identified, and why these gaps occur. Discuss the global challenges of coordinating surveillance between multiple countries and provide an example highlighting the challenges. What could other governments and agencies, such as the World Health Organization and the Centers for Disease Control and Prevention, do to strengthen global disease surveillance systems? pub 540 Principles of epidemiology Topic 2 DQ 1
Topic 2 DQ 1
Before I address this week’s topic, I will write about a personal experience that illustrates a gap in surveillance. Many years ago while still living in New Jersey, I contracted food poisoning from eating undercooked chicken at a picnic. I knew it was raw the moment I put it in my mouth. I sought care because I was very ill and a stool sample was sent to the lab who, I assume, was mandated to report the illness under jurisdictional law. I do not recall the offending organism, but it was most likely Salmonella. Six months after I was ill, I received a call from the health department asking where I had eaten. Six months! I always think of this and about how many people could have been made ill if I had eaten in a restaurant rather than a picnic pub 540 Principles of epidemiology Topic 2 DQ 1. Potentially six months of customers could have been at risk.
Disease surveillance is the mechanism by which public health organizations monitor changes in disease distribution, congenital malformations, toxic environmental hazards, noncommunicable diseases, and other injuries (Celentano & Szklo, 2019). This was done by analyzing and interpreting data that has been collected from local, state, and territorial health departments (Centers for Disease Control and Prevention [CDC], n.d.). While there are various modes of surveillance, there are strengths gaps associated with each. Passive surveillance, or passive reporting, is the mandated reporting of reportable diseases, such as sexually transmitted infections, to local health departments (Celentano & Szklo, 2019). Mandated reporting allows public health departments to constantly monitor for these reportable diseased with little effort or cost. Some of the gaps caused by passive surveillance are related to the small numbers of cases and that it relies on the conscientiousness of the reporter (Celentano & Szklo, 2019). In Active surveillance, or active reporting, people are specifically recruited and trained to perform surveillance duties which inherently makes them more conscientious (Celentano & Szklo, 2019). Surveyors may conduct interviews of providers or patients or pull data from medical records (Celentano & Szklo, 2019). Sentinel surveillance consists of a well-designed system of selected reporting sites and are employed when high-quality data are needed (World Health Organization [WHO], 2020). Selected reporting sites serve a large population, have providers trained in diagnosing and treating the disease that is under surveillance, and high-quality diagnosis equipment (WHO, 2020). Because this type of surveillance if focused on specific geographic areas and monitoring for certain diseases, it is likely to miss diseases outside of that geographic area or rare diseases that are seen in small numbers (WHO, 2020). pub 540 Principles of epidemiology Topic 2 DQ 1
“No single agency can confront all global health challenges alone” (Centers for Disease Control and Prevention [CDC], n.d., para. 6). This is why the Centers for Disease Control (CDC) partners with the World Health Organization (WHO), and others, to coordinate global health monitoring and strategies. Surveillance can be challenging in undeveloped areas related to the difficulty in physically accessing these areas and in maintaining communication with health departments (Celentano & Szklo, 2019). Sometimes, lack of up-to-date diagnostic equipment in these areas results is underreporting of diseases because they simply were not detected (Celentano & Szklo, 2019). Another challenge that exists when attempting to coordinate surveillance is the use of common terms, forms, surveillance systems. An example of this is the WHO report, World Malaria Report of WHO, that reported 584,000 deaths from malaria worldwide in 2014 while another group of researchers reported 854,000 deaths from malaria that same year (Celentano & Szklo, 2019).
What can be done to improve our global surveillance? Standardization of terms and methods. The National Notifiable Diseases Surveillance Systems (NNDSS) is doing just that by implementing reporting systems based on the National Electronic Disease Surveillance System (NEDSS) architectural standards (Centers for Disease Control and Prevention [CDC], 2018). This will standardize communication between health care systems and health departments, increase interoperability, provide resources to local health departments, and assist health departments to manage and report reportable disease data to the CDC (CDC, 2018). pub 540 Principles of epidemiology Topic 2 DQ 1
Celentano, D. D., & Szklo, M. (2019). Gordis epidemiology (6th ed.). Retrieved from https://www.gcumedia.com/digital-resources/elsevier/2019/gordis-epidemiology_6e.php
Centers for Disease Control and Prevention. (2018). National notifiable diseases surveillance system [Fact sheet]. Retrieved from https://wwwn.cdc.gov/nndss/document/NNDSS-Fact-Sheet-508.pdf pub 540 Principles of epidemiology Topic 2 DQ 1
Centers for Disease Control and Prevention. (n.d.). Global health: What CDC is doing. Retrieved January 11, 2020, from https://www.cdc.gov/globalhealth/what/default.htm
Centers for Disease Control and Prevention. (n.d.). National notifiable diseases surveillance system (NNDSS). Retrieved January 11, 2020, from https://wwwn.cdc.gov/nndss/ pub 540 Principles of epidemiology Topic 2 DQ 1
World Health Organization. (2020). Types of surveillance. Retrieved January 11, 2020, from https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/en/