Q Epidemiology is based on data collected from public level program.

Explain surveillance
in detail?

Definition
Surveillance from the French sur (over) and veiller (to watch) is the close and
continuous observation of one or more persons for the purpose of direction, supervision, or
control.
Surveillance is defined as the continuous (ongoing) scrutiny of the factors that determine the
occurrence and distribution of diseases and other health related events through a systematic
collection of data.

History:
In his classic 1963 paper, Alexander Langmuir applied surveillance for a disease to mean
the continued watchfulness over the distribution and trends of incidence [of a disease]
through the systematic collection, consolidation, and evaluation of morbidity and
mortality reports and other relevant data.
He illustrated this application with four communicable diseases: malaria, poliomyelitis,
influenza, and hepatitis. Since then, surveillance has been extended to non-communicable
diseases and injuries (and to their risk factors), and we now use the term public health
surveillance to describe the general application of surveillance to public health problems.
The essence of public health surveillance is the use of data to monitor health problems
to facilitate their prevention or control.
Data, and interpretations derived from the evaluation of surveillance data, can be
useful in setting priorities, planning, and conducting disease control programs, and in
assessing the effectiveness of control efforts.

Purpose of surveillance
To be able to identify diseases, injuries, hazards and other health related factors as
early as possible, i.e. prediction and early detection of outbreaks.
To provide scientific baseline data and information for priority setting, planning,
implementing and evaluating disease control program for both communicable and
non-communicable health problems.
To define the magnitude and distribution of diseases by time, person and place
dimension.

Uses of public health surveillance

1) Establish the baseline of a health condition
2) Understand trends and pattern of disease
3) Detect outbreaks or emergence of new disease

4) Estimate the magnitude of health problem

5) Identify resources needed during and after public health emergencies
6) Evaluate public health programs and control measures
7) Determine nature and history of disease
8) Monitor changes in infectious agents
9) Set research priorities
10) Stimulate research
11) Inform research plan and implementation
12) Support public health program planning
13) Monitor changes in public health practice

Types of surveillance
The two common types of surveillance are passive and active surveillance. Passive
surveillance.

Passive surveillance (routine reporting system) may be defined as a mechanism for

routine surveillance based on passive case detection and on the routine recording and
reporting system. The information provider comes to the health institutions for help,
be it medical or other preventive and promotive health services. It involves collection
of data as part of routine provision of health services.
Advantages of passive surveillance
Covers a wide range of problems
Does not require special arrangement
It is relatively cheap
Covers a wider area
Disadvantages of passive surveillance
The information generated is to a large extent unreliable, incomplete and
inaccurate
Most of the time, data from passive surveillance is not available on time
Most of the time, you may not get the kind of information you desire
It lacks representativeness of the whole population since passive surveillance
is mainly based on health institution reports

Active surveillance
Active surveillance is defined as a method of data collection usually on a specific
disease, for relatively limited period of time. It involves collection of data from
communities such as in house-to-house surveys or mobilizing communities to some
central point where data can be collected.
This can be arranged by assigning health personnel to collect information on presence
or absence of new cases of a particular disease at regular intervals. Example:
investigation of out-breaks
Advantages of active surveillance

 The collected data is complete and accurate

Information collected is timely.
Disadvantages of active surveillance
It requires good organization
It is expensive
It requires skilled human power
It is for short period of time(not a continuous process)
It is directed towards specific disease conditions
Conditions in which active surveillance is appropriate
Active surveillance has limited scope. Unlike passive surveillance, it cannot be used for
routine purposes. There are certain conditions where active surveillance is appropriate. These
conditions are:
o
o
o
o
o
o
o

For periodic evaluation of an ongoing program

For programs with limited time of operation such as eradication program
In unusual situations such as:
New disease discovery
New mode of transmission
When a disease is found to affect a new subgroup of the population.
When a previously eradicated disease reappears.

Sentinel surveillance
Sentinel surveillance relies on the reporting of cases of specific diseases or risk
factors that may indicate that a particular preventive or therapeutic activity is not
working as planned.
Examples of sentinel health events would include a case of poliomyelitis, which
might indicate that there has been a breakdown in the vaccine cold chain (such that a
batch of vaccine has not been stored correctly) or that vaccination coverage has fallen
to a low level, there is also a network of sentinel primary care practices that report a
number of diseases on a regular basis

Disadvantage:
If the site is not selected properly, data may not be representative of general
population, thereby proving inadequate estimates of incidence and prevalence.

Five essential activities of surveillance/steps:

1. Identifying Health Problems for Surveillance
2. Identifying or Collecting Data for Surveillance
3. Analyzing and Interpreting Data

4. Disseminating Data and Interpretations

5. Evaluating and Improving Surveillance

Identifying Health Problems for Surveillance

Multiple health problems confront the populations of the world. Certain problems present an
immediate threat to health, whereas others are persistent, long-term problems with relatively
stable incidence and prevalence among the populations they affect.
1. Selecting a Health Problem for Surveillance
2. Defining the health problem, identifying needed information, and establishing the
scope for surveillance

Identifying or Collecting Data for Surveillance

After the problem for surveillance has been identified and defined and the needs and scope
determined, available reports and other relevant data should be located that can be used to
conduct surveillance.
These reports and data are gathered for different purposes from multiple sources by using
selected methods.
Data might be collected initially to serve health-related purposes, whereas data might later
serve administrative, legal, political, or economic purposes.
Sources of Data
1. Individual persons
2. Health-care providers, facilities, and records

Physician offices
Hospitals
Outpatient departments
Emergency departments
Inpatient settings
Laboratories

3. Environmental conditions
Air
Water
Animal vectors
4. Administrative actions

5. Financial transactions
Sales of goods and services
Taxation
6. Legal actions
7. Laws and regulations
Methods
Environmental monitoring,
Surveys,
Notifications, and
Registries.
These methods can be further characterized by the approach used to obtain information from
the sources described previously. For example, the method of collecting information might be
an annual population survey that uses an in-person interview and a standardized questionnaire
for obtaining data

Analyzing and Interpreting Data

After morbidity, mortality, and other relevant data about a health problem have been
gathered and compiled, the data should be analyzed by time, place, and person.
Different types of data are used for surveillance, and different types of analyses might
be needed for each.
For example, data on individual cases of disease are analyzed differently than data
aggregated from multiple records;
Data received as text must be sorted, categorized, and coded for statistical analysis; and data
from surveys might need to be weighted to produce valid estimates for sampled populations
For analysis of the majority of surveillance data, descriptive methods are usually
appropriate.
The display of frequencies (counts) or rates of the health problem in simple tables and
graphs is the most common method of analyzing data for surveillance.
Analyzing by time
Basic analysis of surveillance data by time is usually conducted to characterize trends and
detect changes in disease incidence. For notifiable diseases, the first analysis is usually a

comparison of the number of case reports received for the current week with the number
received in the preceding weeks. These data can be organized into a table, a graph, or both
Analyzing by place
The analysis of cases by place is usually displayed in a table or a map. State and local
health departments usually analyze surveillance data by neighborhood or by country.
CDC routinely analyzes surveillance data by state.
Rates are often calculated by adjusting for differences in the size of the population of
different counties, states, or other geographic areas.
Analyzing by person
The most commonly collected and analyzed person characteristics are age and sex.
Data regarding race and ethnicity are less consistently available for analysis.
Other characteristics (e.g., school or workplace, recent hospitalization, and the
presence of such risk factors for specific diseases as recent travel or history of
cigarette smoking) might also be available and useful for analysis, depending on the
health problem.

Dissemination of surveillance information

Dissemination of surveillance information can take different forms. Perhaps the most
common is a surveillance report or summary, which serves two purposes:
To inform and to motivate.
Information on the occurrence of health problems by time, place, and person informs
local physicians about their risk for their encountering the problem among their
patients.
Other useful information accompanying surveillance data might include prevention and
control strategies and summaries of investigations or other studies of the health problem.
A report should be prepared on a regular basis and distributed by mail or e-mail and
posted on the health departments Internet or intranet site, as appropriate. Increasingly,
surveillance data are available in a form that can be queried by the general public on
health departments Internet sites.

Evaluating and Improving Surveillance

Surveillance for a disease or other health-related problem should be evaluated periodically to
ensure that it is serving a useful public health function and is meeting its objectives. Such as
evaluation:

(1) Identifies elements of surveillance that should be enhanced to improve its

attributes,
(2) Assesses how surveillance findings affect control efforts, and
(3) Improves the quality of data and interpretations provided by surveillance.
Simplified Diagram of Surveillance for a Health Problem

Characteristics of Well-Conducted Surveillance

Acceptability: reflects the willingness of individual persons and organizations to participate
in surveillance. Acceptability is influenced substantially by the time and effort required to
complete and to submit reports or perform other surveillance tasks.
Flexibility: refers to the ability of the method used for surveillance to accommodate changes
in operating conditions or information needs with little additional cost in time, personnel, or
funds.
Predictive Value Positive is the proportion of reported or identified cases that truly are cases,
or the proportion of reported or identified epidemics that were actual epidemics. Conducting
surveillance that has poor predictive value positive is wasteful, because the unsubstantiated or
false-positive reports result in unnecessary investigations, wasteful allocation of resources,
and especially for false reports of epidemics, unwarranted public anxiety

Quality reflects the completeness and validity of the data used for surveillance.
Representativeness is the extent to which the findings of surveillance accurately portray the
incidence of a health event among a population by person, place, or time.
Sensitivity is the ability of surveillance to detect the health problem that it is intended to
detect.
Simplicity refers to the ease of operation of surveillance as a whole and of each of its
components (e.g., how easily case definitions can be applied or how easily data for
surveillance can be obtained).
Stability refers to the reliability of the methods for obtaining and managing surveillance data
and to the availability of those data.
Timeliness refers to the availability of data rapidly enough for public health authorities to
take appropriate action.
Validity refers to whether surveillance data are measuring what they are intended to measure.