10-29-a Public Health Surveillance, Public Health Law, and Epidemics (outbreak investigation).txt

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10-29-a Public Health Surveillance, Public Health Law, and Epidemics (outbreak investigation).txt
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  1. 10-29-a Public Health Surveillance, Public Health Law, and Epidemics (outbreak investigation)
    • Assessment
    • Policy development
    • Assurance
    • Ten essential Public health services
  2. Federal Basis: .
    • Commerce Clause – interstate commerce – feds can regulate the drugs here
    • Taxing and spending power – granting or withholding federal funds
    • State Basis: .
    • Police power – Threat to society
    • “parens patriae” (state act as father) – threat to self
  3. Surveillance
    • Establish baseline data: Estimate magnitutde, determine geographic distribution
    • Evaluate time trends: long-term secular trends; seasonal variation – mode of transmission
    • Identify outbreaks: disease outbreak is occurrence of disease at unexpectedly high frequency; epidemic threshold
    • Evaluate control measures: vaccination
    • Set disease control priorities: monitor changes in infectious disease agents; detect changes in health practices; facilitate planning
    • Generate hypothesis/research: MDR tuberculosis and AIDS; stimulate research – vaccines
  4. Surveillance: Establish baseline data: Estimate magnitutde, determine geographic distribution
    • Necessary for detection of epidemics
    • Analysis by
    • Time: date or hour of onset of illness
    • Person: characteristics such as age
    • Place: geographic area
    • Gives an idea where and on whom might want to focus screening and prevention to prevent the spread of an epidemic
  5. Morbidity – prevalence
    • Proportion (not rate) of individuals in a population who have disease for a specific time period
    • P = k * #existing cases of disease / total population
  6. Morbidity – incidence
    • Number of new cases in a population of a specific time
    • I = k * number of new cases in specified time period / total population at risk
    • Used more in iteologic studies
  7. Selected sources of Data
    • Environmental monitoring systems
    • Animals/vectors
    • Individuals
    • Laboratories
    • Medical Records
    • Administrative records
    • Police records
    • Birth/death certificates
  8. Data sources and methods for surveillance
    • Notifiable diseases
    • Lab speciments
    • Vital records
    • Sentinel surveillance
    • Registries
    • Surveys
    • Administrative data systems
    • Other data sources
  9. Responsibility for surveillance
    • Federal: Centers for Disease Control and Prevention
    • State: state agency
  10. Surveillance Activities
    • Passive surveillance: NY state Dept. of Health waits for report from physicians, labs, hospitals
    • Active surveillance: NY State Dept. of Health calls health care providers
  11. Infectious Disease Surveillance in New York State
    • About 50 legally reportable communicable disease
    • Notifiable disease if link between case report and public health action
  12. New York State Communicable Disease Data Sources
    • Physicians: case reports
    • Laboratories: lab specimen reports
    • Hospitals: case reports
  13. New York State reporting
    • Report to local county or city health department except AIDS/HIV
    • Then local dept. reports to New York State
  14. Chronic Disease Data Sources:
    • Viral records: death certificates, computerized database
    • Registries: cancer registries; hospital-based with medical record review
    • Surveys: behavioral risk factor surveillance system (BRFSS); state-based telephone survey
  15. National Notifiable Disease Surveillance
    Report to local, local reports to State, reports transmitted to CDC primarily through an electronic dsease surveillance system (National Electronic Disease Surveillance System) – NEDSS: .
  16. Current status: National Notifiable Diseases Surveillance System (NNDSS)
    • CSTE/CDC collabotation
    • List revised at annumal CSTE meeting
    • Voluntary reporting by states to CDC
    • Reporting mandated at state level
    • Reportable diseases vary by state
  17. National non-infectious disease surveillance
    • Death rates across the country, births, deaths, marriages, divorces
    • National Infant Mortality Surveillance (NIMS):
    • Linked birth and infant death data; and the National Death Index
  18. Use of NCHS Data systems for Surveillance
    • Population-based surveys:
    • National health interview survey
    • National health and nutrition examination survey
    • Provider-based surveys:
    • National hospital discharge survey
    • National ambulatory medical care
  19. Limitations of Surveillance
    • Completeness, accuracy, and representativeness of data
    • Underreporting
    • Lack of telephones, small sample of minorities
    • Latency period of data
  20. National HIV Case Sruveillance
    • Advances antiretroviral therapy: slowed progression of disease and decline in AIDS 1996
    • New treatment for HIV infection
    • AIDS trends not representative of HIV trends
    • CDC recommends surveillance
  21. Invesitgating outvreaks
    • Epidemic: upon the population
    • Endemic: disease at usual level
    • Purpose of investigation: describe outbreak; attack rate = new cases/ exposed persons
  22. How to conduct an outbreak investigation
    • Establish the diagnosis
    • Establish the case definition – specific criteria – symptoms, lab, epidemiology – location, contacts
    • Determine whether an epidemic exists: look for unreported cases; determine population at risk; ongoing surveillance
    • Characterize the epidemic by: place, person, time
  23. Questions regarding time: epidemic curve exercise
    • What is the index case?
    • What is the incubation period?
    • When was the exposure?
    • What is the type of exposure?
    • Common source vs propagated?
  24. Outbreak investigation
    • Develop hypotheses about disease transmisson: source and pattern of spread
    • Test the hypotheses: cases vs controls; question cases, laboratory studies
    • Initiate control measures: sanitation, prophylaxis (vaccination), Dx and treatment, control of disease vector

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