Surveillance systems for public health

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# Infectious disease surveillance
# information for action

Jakob Schumacher

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# Part I: Why?

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# What do you percieve as a global health problem?

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# What action could you take?

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# What information do you need?

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# What data do you need to get that information?

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# How can we collect that data?

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# Part II: Mechanism of public health surveillance

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# What is a surveillance system?

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* __event__: disease marker, risk factors...

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* __classification__: applying a definition

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* __data__: structured items (excel-sheet) usually on time, place person

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* __information__: data with meaning, trends, outbreaks...

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* __action__: interventions, policy change, resource planing..

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# Part III: Examples

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# Example 1: [German surveillance system](https://de.wikipedia.org/wiki/Meldepflichtige_Krankheit)

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# Example 2: [kindergarten surveillance](http://www.nlga.niedersachsen.de/infektionsschutz/akute_respiratorische_erkrankungen_are/akute-respiratorische-erkrankungen-are-19408.html)

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# Example 3: [event conference](https://edoc.rki.de/handle/176904/916)

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# Example 4: [HIV-Sentinal-Surveillance](https://www.rki.de/DE/Content/InfAZ/H/HIVAIDS/Epidemiologie/Surveillance/ClinSurv/ClinSurv_node.html)

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# Example 5: Wikipedia surveillance

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# Part IV: Classification of surveillance systems

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# Classifcation of surveillance system
* Indicator-based vs event-based surveillance
* Passive or active surveillance
* Sentinal surveillance
* Syndromic surveillance
* Lab vs clinician-based surveillance

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# Whats NOT a surveillance system

Surveillance    | Science
  :---------------|:-------------
  ongoing         | temporary
  problem known   | problem unkown
  no intervention | intervention
  action driven   | hypothesis driven

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# Part V: Problems

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# Typical problem: underreporting

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# Typical problem: timeliness

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# Typical problem: event definition

* norovirus causes gastroenteritis
* case defintion: lab + gastroenteritis
* lab reports come on their own
* info on gastroenteritis must come from patient
* if you dont ask the patient -> less cases
Solutions tried:
* Monitor lab reports as well
* Analyze the system often

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# Typical problem: change

* Surveillance systems dont like change
* Example: people see less doctors --> less cases

Solutions tried:
* Create resilient systems

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# Typical problem: costs and motivation

* No reimbursment -> no reporting
* Lots of reimbursment -> invented cases

Solutions tried
* Establish a strong legal system
* Sentinal surveillance

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# Typical problem: unkown event

* New events are difficult to monitor
* Example Anatoxin A

Solutions tried:
* invest in networks
* event based surveillance

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# Typical problem: close to elimination

* nearly eliminated diseases increase false alarms
* example measles: 80% false alarms

Solutions tried:
* adjust case definition

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# Part VI: Questions

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# Is a single survey a surveillance system?

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# What problems would you expect with the Wikipedia Surveillance?

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# How would you setup a surveillance system for drug abuse?

- Is there action that helps?
- What information do we need?
- What data do we need?
- How can we collect data?

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# About me
* Medical studies in Göttingen
* Small hospital in Berlin
* Robert-Koch-Institute
* Ministry of health
* Local public health office

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# Public health office Reinickendorf

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# What we do
* contact tracing for infectious diseases
* school entrance exams
* coordinate psychiatric patients
* hygiene control in hospitals
* water safety
* at the moment: corona

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# Thank You!

Questions to <a href="mailto:jakob.schumacher@web.de?subject=CIEE-course">jakob.schumacher@web.de</a>

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# Resources

Database
* [ECDC surveillance atlas](http://atlas.ecdc.europa.eu/public/index.aspx)
* [Promed](http://www.promedmail.org/)

Learning
* [Field Epidemiology Manual](https://wiki.ecdc.europa.eu/fem/w/wiki/1321.surveillance-principles)