Concepts and Methods in Infectious Disease Surveillance E-Book
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- Herausgeber: John Wiley & Sons
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- Sprache: Englisch
Infectious disease surveillance has evolved at an extraordinary pace during the past several decades, and continues to do so. It is increasingly used to inform public health practice in addition to its use as a tool for early detection of epidemics. It is therefore crucial that students of public health and epidemiology have a sound understanding of the concepts and principles that underpin modern surveillance of infectious disease.
Written by leaders in the field, who have vast hands-on experience in conducting surveillance and teaching applied public health, Concepts and Methods in Infectious Disease Surveillance is comprised of four sections. The first section provides an overview, a description of systems used by public health jurisdictions in the United States and legal considerations for surveillance. The second section presents chapters on major program-area or disease-specific surveillance systems, including those that monitor bacterial infections, foodborne diseases, healthcare-associated infections, and HIV/AIDS. The following section is devoted to methods for conducting surveillance and also approaches for data analysis. A concluding section summarizes communication of surveillance findings, including the use of traditional and social media, in addition to showcasing lessons learned from the New York City Department of Health’s experience in surveillance and epidemiology training.
This comprehensive new book covers major topics at an introductory to intermediate level, and will be an excellent resource for instructors. Suitable for use in graduate level courses in public health, human and veterinary medicine, and in undergraduate programs in public-health-oriented disciplines, Concepts and Methods in Infectious Disease Surveillance is also a useful primer for frontline public health practitioners, hospital epidemiologists, infection control practitioners, laboratorians in public health settings, infectious disease researchers, and medical and public health informaticians interested in a concise overview of infectious disease surveillance.
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Table of Contents
Title page
Copyright page
List of Contributors
Foreword
Preface
Acknowledgments
Acronyms and Abbreviations
SECTION I: Introduction to Infectious Disease Surveillance
CHAPTER 1: Surveillance as a Foundation for Infectious Disease Prevention and Control
Background and Rationale
Definitions
Historical Development of Infectious Disease Surveillance
Conclusion
References
CHAPTER 2: The Legal Basis for Public Health Surveillance
Introduction
The Roles of State and Federal Laws in Infectious Disease Surveillance
The Limits of the Law
Examples from Recent Infectious Disease Outbreaks
Key Summary Points for Public Health Practitioners
References
CHAPTER 3: National, State, and Local Public Health Surveillance Systems
Organization and Roles of Public Health Infectious Disease Surveillance Infrastructure in the United States and Steps in the Surveillance Process
Methods Used for Surveillance
Resources
Electronic Methods and Other Recent Innovations
Conclusion
References
CHAPTER 4: Quarantine and the Role of Surveillance in Nineteenth-Century Public Health
Overview
Introduction
Debating Quarantine and Yellow Fever, 1850–1880
Summary
References
SECTION II: Specific Surveillance Systems
CHAPTER 5: Surveillance for Vaccine-Preventable Diseases and Immunization
Introduction
Step One: Understanding the Background: Burden and Risk Factors of VPD Illness and Transmission Processes of the Target Pathogen
Step Two: Understanding the Vaccines
Step Three: Identify the Data Sources for Disease Surveillance and Their Availability, Strengths, and Weaknesses
Step Four: Assessing the Performance: Conducting Post-Marketing VPD Surveillance and Assessing Vaccine Effectiveness
Step Five: Preparing for the Unexpected and Continuing the Evaluation
Conclusion
References
CHAPTER 6: Surveillance for Seasonal and Novel Influenza Viruses
Introduction
Clinical, Epidemiological, and Virological Characteristics and Implications for Surveillance
Possible Surveillance Schemes
Animal Influenza Surveillance
Surveillance during a Pandemic
Monitoring of Vaccination Programs
Conclusions
Acknowledgements
References
CHAPTER 7: Population-Based Surveillance for Bacterial Infections of Public Health Importance
Introduction
History of ABCs
ABCs Sites and Infrastructure
ABCs Methods
Examples of Use of ABCs Data for Specific Pathogens
Challenges and Opportunities
Conclusions
Acknowledgements
References
CHAPTER 8: Surveillance for Foodborne Diseases
Introduction
Objectives of Foodborne-Disease Surveillance
Methods for Foodborne-Disease Surveillance
Advances in the Detection of Foodborne Outbreaks in the United States
Conclusions
References
Further Reading
CHAPTER 9: Surveillance of Healthcare-Associated Infections
Introduction
National Healthcare Safety Network
Limitations of Rates for Interhospital Comparison
The Role of Microbiologic Surveillance in the Control and Prevention of HAI
Conclusion
References
CHAPTER 10: Surveillance for Zoonotic Diseases
Introduction
Transmission
Public Health Risk
Emerging Zoonotic Disease and Global Impact
Zoonotic Disease Surveillance
Bioterrorism
Stakeholders
National Surveillance and Reporting
Global Surveillance and Reporting
Examples of Surveillance for Zoonotic Diseases
Conclusions
References
CHAPTER 11: Surveillance of Viral Hepatitis Infections
Introduction
Clinical Background of Viral Hepatitis
Epidemiology of Viral Hepatitis
Purpose of Viral Hepatitis Surveillance
Surveillance Methods
Acute Viral Hepatitis
Chronic HBV and HCV Infections
Progress in Viral Hepatitis Surveillance
Surveillance Mechanisms
Conclusions
References
CHAPTER 12: Surveillance for Sexually Transmitted Diseases
Introduction
Health Impact of STDs
Objectives of STD Surveillance
Challenges in STD Surveillance
Strategies for STD Surveillance
Conclusion
References
CHAPTER 13: Surveillance for HIV in the United States
Introduction: Biology and Natural History of HIV
Surveillance Implications of the Unique Epidemiology of HIV
The Impact of Stigma on the Development of HIV Surveillance Systems
Surveillance Methods for HIV
Surveillance Activities Specific to HIV
Data Management
Training and Technical Assistance for HIV Surveillance Staff
Security and Confidentiality
Uses of HIV Surveillance Data
Expanded Surveillance
Conclusion
Acknowledgments
References
Additional Resources
CHAPTER 14: Public Health Surveillance for Tuberculosis
Introduction
Laboratory Detection of
M
ycobacterium
t
uberculosis
TB Case Verification Criteria
History of Tuberculosis Surveillance in the United States
Current Tuberculosis Reporting in the United States
Tuberculosis Surveillance Data Reporting and Publication
References
SECTION III: Methods Used in Surveillance and Data Analysis
CHAPTER 15: Analysis and Interpretation of Surveillance Data
Introduction
Challenge 1: Understand the Purpose and Context of Surveillance Systems
Challenge 2: Identify Baselines and Recognize Deviations
Challenges 3, 4, and 5: Interpretation of Meaning, Significance, and Degree of Certainty
Challenge 6: Communicate for Public Health Action
Evolving Approaches to Disease Detection, Analysis, and Interpretation
Conclusions
Acknowledgments
References
CHAPTER 16: Global Surveillance for Emerging Infectious Diseases
Introduction
Overview of Surveillance
Key Developments in Approaches to Global Surveillance
Remaining Challenges
Conclusion
References
CHAPTER 17: Infectious Disease Surveillance and Global Security
Introduction
U.S-Based Global Disease Surveillance
Challenges in Disease Surveillance for Global Security
Conclusions
References
CHAPTER 18: Implementation of the National Electronic Disease Surveillance System in South Carolina
Background: Organization of Public Health in South Carolina
Surveillance Versus Surveillance Systems
Historical Perspective: The NETSS Era
Beginning of the NEDSS Era
Options for Deployment of NEDSS-Compatible Software Systems
Early Administrative and Technical Challenges
NEDSS Technical Characteristics
Resources for NBS Users
Case Counting and Notifications to CDC
Demonstrated Benefits of the NBS
Summary
References
CHAPTER 19: Practical Considerations in Implementation of Electronic Laboratory Reporting for Infectious Disease Surveillance
Introduction
The Role of Clinical Laboratories in Surveillance
Benefits and Challenges in Implementation of Electronic Laboratory Reporting
Experiences and Lessons Learned from Implementation of Electronic Laboratory Reporting in Florida
Summary
References
CHAPTER 20: Use of Geographic Information Systems in Infectious Disease Surveillance
Introduction
An Overview of geographic information system Technology
Current Uses of the geographic information system in Infectious Disease Surveillance
Integration of Spatial Information in geographic information system–Based Decision Support Systems
Privacy Concerns, Spatial Scale Issues, and Data Quality Challenges
Summary Points
References
SECTION IV: Cross-Cutting Issues in Infectious Disease Surveillance
CHAPTER 21: Communication of Surveillance Findings
Introduction
Three Essential Partners: Public Health Professionals, the Mass Media, and Lay Audiences
Lessons Learned and Recommendations
Summary
Acknowledgment
References
CHAPTER 22: Lessons Learned in Epidemiology and Surveillance Training in New York City
Introduction
The Public Health/Preventive Medicine Residency Program: Training Physicians in Public Health Theory and Methods
The Health Research Training Program: Fostering Interest in Public Health across Disciplines:
The Epi Scholars Program: Providing Hands-on Training for Future Epidemiologists
Surveillance Scholars: Partnership with the MSPH at Columbia University
EIS Officers and CSTE Applied Epidemiology Fellows: DOHMH Involvement in National Training Programs
Other Programs
Summary of Lessons Learned
Conclusion
References
Additional Resources
Index
End User License Agreement
List of Tables
Table 1.1 Ten diseases with the highest numbers of reported cases.
Table 2.1 Role of law in public health surveillance.
Table 3.1 Potential uses of infectious disease surveillance data by level of the public health system.
Table 3.2 Case reporting and case notification.
Table 6.1 Summary of the three components of pandemic surveillance.
Table 7.1 Average annual incidence of meningococcal infection, Maryland college students, 1992–1997 [56]. Reproduced with permission of the American Medical Association.
Table 9.1 Definition of device-associated rates.
Table 9.2 Laboratory-confirmed bloodstream infections.
Table 10.1 Zoonotic diseases reportable to in humans and animals.
5
Table 11.1 Summary of viral hepatitis A–E, inclusive of serologic tests in clinical use.
Table 11.2 Summary of viral hepatitis A–E risk history and screening recommendations
Table 11.3 Case definitions for viral hepatitis, nationally notifiable in the United States, 2012.
Table 12.1 Examples of strategies for STD surveillance.
Table 13.2 How HIV's epidemiology and its natural course, as well as the use of data, differ from most infectious diseases.
Table 13.1 HIV infection stage* based on age-specific CD4+ T-lymphocyte count or CD4+ T-lymphocyte percentage of total lymphocytes.
Table 13.3 Performance attributes, minimum performance measures, and activities to achieve maximum performance.
Table 14.1 National TB Surveillance System TB Case Classifications.
Table 14.2 Report of verified case of tuberculosis, Follow-up 1, and Follow-up 2 selected reporting variables.
Table 16.1 Comparison of key attributes and components of event-based and indicator-based surveillance.
Table 18.1 Divisions of the DHEC Bureau of Disease Control with responsibilities related to disease surveillance and control.
Table 18.2 Advantages and disadvantages of adoption of NBS.
Table 19.1 Calculation for sensitivity and predictive value positive for a surveillance system.
Table 21.1 World Health Organization Outbreak Communication Guidelines.
Table 22.1 Formal training programs available at the New York City Department of Health and Mental Hygiene.
List of Illustrations
Figure 3.1 Public health surveillance data flow for state reportable and nationally notifiable diseases.
Figure 4.1 Main Building of Philadelphia's Lazaretto quarantine station (ca. late 1880s). The Lazaretto station was built in 1799, 12 miles downriver from the Port of Philadelphia, in response to a series of devastating yellow fever epidemics in the city in the 1790s. Source: Photo from Henry Leffmann,
Under the Yellow Flag
(Philadelphia, 1896).
Figure 4.2 René La Roche's map of the yellow fever epidemic at the Lazaretto in 1870, showing the sequential locations of the brig
Home
(thought to have caused the outbreak) and the location of each patient at the time of the onset of symptoms. In La Roche's view, the map showed that each patient was immediately downwind of the infected vessel shortly before becoming ill and contracted the disease from the ship's foul air rather than through contagion. Source:
Remarks on the Origin and Mode of Progression of Yellow Fever in Philadelphia
(Philadelphia: E.C. Markley, 1871).
Figure 6.1 WHO Global Influenza Surveillance and Response System (GIRS), 2013. Source: Reproduced with permission from WHO.
Figure 6.2 Influenza intensity, trends, and dominating strain in European Union countries, week 5, 2011. Source: European Centre for Disease Prevention and Control.
Figure 6.3 EIP influenza laboratory-confirmed cumulative hospitalization rates, 2009–2010 and the previous three seasons. *The 2008–2009 EIP rate ended as of April 14, 2009, because of the onset of the 2009 H1N1 season. Source: Centers for Disease Control and Prevention.
Figure 7.1 Incidence of early- and late-onset invasive group B streptococcal (GBS) disease—Active Bacterial Core surveillance areas, 1990–2008, and activities for prevention of GBS disease (www.cdc.gov/groupbstrep/guidelines/downloads/Figure_1_GBS_Decline.pdf). ACOG: American College of Obstetricians and Gynecologists; AAP: American Academy of Pediatrics. Source: Centers for Disease Control and Prevention.
Figure 7.2 Changes in invasive pneumococcal disease incidence by serotype group among children <5 years old, 1998–2007 [20]. Seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the United States for routine use among young children and infants in the second half of 2000. Source: Reproduced with permission of OUP.
Figure 7.3 Changes in invasive pneumococcal disease incidence by serotype group among adults ≥65 years, 1998–2007 [20]. Seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the United States for routine use among young children and infants in the second half of 2000. Source: Reproduced with permission of OUP.
Figure 8.1 Cycle of foodborne-disease surveillance, control, and prevention. Source: U.S. Centers for Disease Control and Prevention.
Figure 8.2 Surveillance steps that must occur for laboratory-confirmed cases to be reported to surveillance. Source: Centers for Disease Control and Prevention.
Figure 9.1 Ventilator-associated pneumonia (VAP) rates by type of intensive care unit. Source: 2006 NHSN Annual Report, posted at http://www.cdc.gov/nhsn/dataStat.html.
Figure 10.1 Transmission of zoonotic disease infections. Zoonotic disease transmission can occur directly through direct contact with animals (e.g., rabies) or indirectly through contact with an animal's environment (e.g., tapeworm) or through a vector (e.g., deer tick for Lyme disease). Source: Sameh Boktor, Pennsylvania Department of Health. Reproduced with permission of Sameh Boktor.
Figure 10.2 Plague maintenance cycle in the United States. Plague is caused by infection with
Yersinia pestis
, which can result in various forms of disease depending on route of exposure (e.g., bubonic plague through person-to-person contact.) As shown in this figure, human and domestic animals bitten by fleas are at risk of plague infection. Source: Centers for Disease Control and Prevention.
Figure 12.1 Trends in chlamydia case rates among women aged 15–24 years [3], percentage of women aged 16–24 years tested for chlamydia through Medicaid [29], and use of NAAT for screening for chlamydia in women aged 15–24 tested in family planning clinics [54].
Figure 12.2 Percentage of
Neisseria gonorrhoeae
isolates with resistance or intermediate resistance to ciprofloxacin, 1990–2010, obtained from the Gonococcal Isolate Surveillance Project (GISP) [55]. Note: Resistant isolates have ciprofloxacin minimum inhibitory concentrations (MICs) ≥1 μg/mL. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125–0.500 μg/mL. Susceptibility to ciprofloxacin was first measured in GISP in 1990. Source: CDC,
Sexually Transmitted Disease Surveillance
, 2010. 2011, Department of Health and Human Services: Atlanta, GA.
Figure 13.1 Viral load and antibody levels following initial HIV infectionSource: Das G, Baglioni P, Okosieme O. Easily Missed? Primary HIV Infection. BMJ 2010; 341:c4583. Reproduced with permission of BMJ Publishing Group Ltd.
Figure 13.2 Sentinel events in HIV/AIDS case surveillance. Source: Nkuchia M. M'ikanatha, Ruth Lynfield, Chris A. Van Beneden and Henriette de Valk, eds.
Infectious Disease Surveillance.
Blackwell Publishing, 2007. Reprinted with permission of John Wiley & Sons.
Figure 13.3 Flow of electronic laboratory data in Michigan.
Figure 13.4 Flow of case reports, lab test, risk factor, demographic information in HIV Surveillance: South Carolina, calendar year 2010. Source: Division of Surveillance and Technical Support, South Carolina Department of Health and Environmental Control, Columbia SC.
Figure 14.1 Tuberculosis incidence rates, United States, 2010. (Source: Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2010. Atlanta, GA: U.S. Department of Health and Human Services, CDC, October 2011. www.cdc.gov/features/dstb2010data/index.html.)
Figure 14.2 Number and rate of tuberculosis (TB) cases among U.S.-born and foreign-born persons, by year reported—United States, 1993–2010. Source: Centers for Disease Control and Prevention, Division of TB Elimination, National TB Surveillance System.
Figure 15.1 This map is adapted from CDC Situation Awareness unit surveillance maps of Haiti, 2011. It identifies affected cities and treatment centers based on the best publically available data at the time and illustrates walking buffers around the treatment centers. The map superimposes information from CDC; the National Cholera Monitoring System; Haiti's Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population, MSPP); MSPP's Division of Epidemiology, Laboratory and Research (Direction d'Epidémiologie, de Laboratoire et de Recherches, DELR); Haiti's National Public Health Laboratory (Laboratoire National de Sante de Publique, LNSP) (case data); the United Nations Stabilization Mission in Haiti (MINUSTAH) (Department boundaries); and the Pan-American Health Organization (PAHO) (cholera treatment center) as of January 2011 onto a base layer developed from NASA [30]. John Snow's hand-drawn map of the residences of fatal cholera cases associated with the Broad Street pump in London in 1850 is inset. This figure illustrates the utility of integrating surveillance data into visualization products (specifically maps), of handheld computing devices for transmission of georeferenced surveillance data, and of spatial analysis combined with satellite imagery to assess risk factors. Source: Left image adapted from Snow, John. On the Mode of Communication of Cholera, 2nd edition. London: John Churchill, New Burlington Street, England, 1855. Reproduced with permission of Ralph R. Frerichs, University of California, Los Angeles School of Public Health Department of Epidemiology. Right image developed by Brian Kaplan with the CDC GRASP unit and with the Situational Awareness Unit of the Centers for Disease Control and Prevention Emergency Operations.
Figure 15.2 Percentage of all deaths attributable to pneumonia and influenza (P&I) by surveillance week and year—122 U.S. Cities Mortality Reporting System, United States, 2007–2012. This graph illustrates the periodicity of influenza infection and the seasonal range of associated baseline observations, the utility of time series forecasting, the determination of epidemic thresholds, and the potential for mathematical models to contribute to the scientific basis for public health policy. Source: Adapted from [10]. Centers for Disease Control and Prevention.
Figure 15.3 Number of reported cases of Reye's syndrome in relation to the timing of public announcements of the epidemiologic association of Reye's syndrome with aspirin ingestion and in relation to the labeling of aspirin-containing medications. Source: Adapted from [11] to illustrate the value of time series plotting and of context for interpretation.
Figure 15.4 Monthly measles time series for the United States, 1960–1990, at (top to bottom) four descending spatial scales: the United States, the West Division, the Pacific Region, and the state of California. Source: Adapted from [13] to illustrate the periodicity of infectious and vaccine preventable diseases, the impact of diminishing numbers of observations or regional bias in data collection on analysis, the use of both vertical chart axes to allow comparison of two time series, the use of solid bar charts (left-hand axis) vs. line traces (right-hand axis), and of the same data plotted using linear (left-hand axis) and logarithmic (right-hand axis) scales.
Figure 15.5 Selected notifiable disease reports, United States; comparison of provisional 4-week totals April 21, 2012, with historical data. Note that no measles cases were reported for the reporting week illustrated in this figure. This graph illustrates the utility of ratios and log scales for visualizing surveillance data, of the comparison of current to historic data, and of defined thresholds for interpretation of significance. Adapted from [12], Centers for Disease Control and Prevention.
Figure 16.1 General phases of activity that occur during disease surveillance.
Figure 17.1 CDC Global Disease Detection and Response network. Source: http://www.cdc.gov/globalhealth/gdder/gdd/regionalcenters.htm. Centers for Disease Control and Prevention.
Figure 17.2 DoD Global Emerging Infections Surveillance network.
Figure 17.3 WHO's Global Influenza Surveillance and Response System map. *Based on UN M49 classification of developing/developed countries. Source: Reproduced with permission of WHO. http://gamapserver.who.int/mapLibrary/Files/Maps/GISRS_20130425_1.jpg.
Figure 17.4 Mobile penetration in resource-limited settings. Source: Adapted from International Telecommunications Union.
Key Global Telecom Indicators for the World Telecommunication Service Sector
. http://www.itu.int/en/ITU-D/Statistics/Documents/statistics/2013/ITU_Key_2005-2013_ICT_data.xls (accessed January 23, 2014).
Figure 19.1 Percentage of laboratory reports received by 57 public health jurisdictions through electronic laboratory reporting in the United States in 2013. The jurisdictions include 50 states, the District of Columbia, Puerto Rico, and five cities. As of July 31, 2013, a total of 54 of the 57 jurisdictions were receiving at least some laboratory reports through ELR. Source: Centers for Disease Control and Prevention,
Morbidity and Mortality Weekly Report
. September 27, 2013;62(38);797–799.
Figure 19.2 Poster used in Oregon to disseminate a list of conditions reportable by clinical laboratories. Immediately reportable conditions are highlighted with a telephone icon. Source: http://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/ReportingCommunicableDisease/Pages/index.aspx. Reproduced with permission of Oregon Division of Public Health.
Figure 20.1 Distribution of human cases of West Nile virus disease in the continental United States, 1999–2004. Source: Adapted from http://www.cdc.gov/ncidod/dvbid/westnile/surv&control_archive.htm. Centers for Disease Control and Prevention.
Figure 20.2 Combining different types of data in a GIS.
Figure 20.3 Human plague case occurrence in the West Nile region of Uganda. Reported cumulative incidence per 1000 population (1997–2007) by parish [38]. (A) Model prediction of parishes characterized as elevated risk [38]. (B) Subparish-level model of areas predicted to pose an elevated risk of exposure to
Y. pestis
[39]. (C) Location of the area of interest is shown as an inset. Source: Reproduced with permission of The American Journal of Tropical Medicine and Hygiene [38].
Figure 22.1 Dr. Michael Phillips, EIS 2000 (far left), consults a map of Staten Island with epidemiologists Beth Maldin, Anne Labowitz, and Debjani Das (from left to right). Dr. Phillips, as a member of the Bureau of Communicable Disease of the NYC Department of Health, led the West Nile virus serosurvey in the fall of 2000, a year after the virus was first recognized in the Western Hemisphere. Source: Reproduced with permission of Don Weiss, Director of Surveillance, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene.
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Library of Congress Cataloging-in-Publication Data
Concepts and methods in infectious disease surveillance / edited by Nkuchia M. M'ikanatha, John K. Iskander.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-470-65939-7 (paper)
I. M'ikanatha, Nkuchia M., editor. II. Iskander, John K., editor.
[DNLM: 1. Communicable Disease Control. 2. Disease Notification. 3. Disease Outbreaks–prevention & control. 4. Public Health Surveillance–methods. WA 110]
RC111
616.9–dc23
2014017664
A catalogue record for this book is available from the British Library.
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Cover image: Left-hand image: adapted from Snow, John. On the Mode of Communication of Cholera, 2nd edition. London: John Churchill, New Burlington Street, England, 1855. Reproduced with permission of Ralph R. Frerichs, University of California, Los Angeles School of Public Health Department of Epidemiology. Right-hand image: developed by Louisa Chapman with the Situational Awareness Unit of the Centers for Disease Control and Prevention Emergency Operations.
Cover design by Andy Meaden
List of Contributors
Lennox K. Archibald
Hospital Epidemiologist
Malcom Randall Veterans Administration Medical Center
North Florida/South Georgia Veterans Health System
Gainesville, FL, USA
Lori R. Armstrong
Epidemiologist
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
Atlanta, GA, USA
David S. Barnes
Associate Professor
Department of History and Sociology of Science
University of Pennsylvania
Philadelphia, PA, USA
Casey Barton Behravesh
Commander, U.S. Public Health Service
Deputy Branch Chief
Outbreak Response and Prevention Branch
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA, USA
Kyle T. Bernstein
Director
Applied Research, Community Health Epidemiology, and Surveillance
Population Health Division
San Francisco Department of Public Health
San Francisco, CA, USA
David L. Blazes
Director, Military Tropical Medicine
US Navy Specialty Leader for Infectious Diseases
Uniformed Services University of the Health Sciences,
Bethesda, MD, USA
Eric Brenner
Medical Epidemiologist
South Carolina Department of Health and Environmental Control
Columbia, SC, USA
Louisa E. Chapman
Captain, U.S. Public Health Service
Medical Epidemiologist
Public Health Surveillance Program Office
Office of Surveillance, Epidemiology, and Laboratory Services
Centers for Disease Control and Prevention
Atlanta, GA, USA
Elizabeth Chuang
Assistant Professor
Department of Family and Social Medicine
Palliative Care Services
Montefiore Medical Center
Bronx, NY, USA
Daniel R. Church
Epidemiologist/Viral Hepatitis Coordinator
Bureau of Infectious Disease
Hinton State Laboratory Institute
Massachusetts Department of Public Health
Jamaica Plain, MA, USA
Bruno Christian Ciancio
Head, Epidemiological Methods Section
Surveillance and Response Support Unit
European Centre for Disease Prevention and Control
Stockholm, Sweden
Alfred DeMaria, Jr.
State Epidemiologist, Medical Director
Bureau of Infectious Disease
Hinton State Laboratory Institute
Massachusetts Department of Public Health
Jamaica Plain, MA, USA
Rebecca J. Eisen
Research Biologist
Division of Vectorborne Diseases
Centers for Disease Control and Prevention
Fort Collins, CO, USA
Lars Eisen
Associate Professor
Department of Microbiology, Immunology and Pathology
Colorado State University
Fort Collins, CO, USA
James J. Gibson
Director of Disease Control and State Epidemiologist (Retired)
South Carolina Department of Health and Environmental Control
Columbia, SC, USA
Carolyn Greene
Deputy Commissioner
Division of Epidemiology
New York City Department of Health and Mental Hygiene
Queens, NY, USA
Gillian A. Haney
Director
Integrated Surveillance and Informatics Services
Bureau of Infectious Disease
Hinton State Laboratory Institute
Massachusetts Department of Public Health
Jamaica Plain, MA, USA
Lee H. Harrison
Infectious Diseases Epidemiology Research Unit
Division of Infectious Diseases
University of Pittsburgh Graduate School of Public Health and School of Medicine
Pittsburgh, PA, USA
Richard S. Hopkins
Department of Epidemiology
Colleges of Public Health and Health Professions and of Medicine
University of Florida
Gainesville, FL, USA
Gail Horlick
Senior Legal Analyst
Office of Scientific Integrity
Centers for Disease Control and Prevention
Atlanta, GA, USA
John K. Iskander
CAPT, United States Public Health Service
Senior Medical Consultant
Office of the Associate Director for Science
Centers for Disease Control and Prevention
Atlanta, GA, USA
Ruth A. Jajosky
Epidemiologist
Division of Health Informatics and Surveillance
Center for Surveillance, Epidemiology and Laboratory Services
Office of Public Health Scientific Services
Centers for Disease Control and Prevention
Atlanta, GA, USA
Bridget J. Kelly
Health Communication Research Scientist
RTI International
Washington, DC, USA
Monina Klevens
Medical Epidemiologist
Epidemiology and Surveillance Branch
Division of Viral Hepatitis
Centers for Disease Control and Prevention
Atlanta, GA, USA
Piotr Kramarz
Deputy Chief Scientist
European Centre for Disease Prevention and Control
Stockholm, Sweden
Gayle Fischer Langley
Medical Epidemiologist
Respiratory Diseases Branch
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta, GA, USA
Sheri Lewis
Global Disease Surveillance PM
Johns Hopkins University Applied Physics Laboratory
Columbia, MD, USA
Theresa J. McCann
Associate Dean of Basic and Allied Health Sciences
Director, Simulation Center Education and Research
Epidemiologist and Professor, Department of Behavioral Sciences
School of Medicine, St. George's University
Grenada
Nkuchia M. M'ikanatha
Surveillance Epidemiologist
Pennsylvania Department of Health
Harrisburg, PA, USA
Roque Miramontes
Epidemiologist, Surveillance Team Lead
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention
Atlanta, GA, USA
Eve D. Mokotoff
Managing Director
HIV Counts
Ann Arbor, MI, USA
Jennifer B. Nuzzo
Senior Associate
UPMC Center for Health Security
Baltimore, MD, USA
Jean O'Connor
Director
Health Promotion and Disease Prevention
Georgia Department of Public Health and Rollins School of
Public Health
Atlanta, GA, USA
Daniel C. Payne
Epidemiologist
Division of Viral Diseases
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta, GA, USA
Linda Capewell Pimentel
Acting Chief
Animal Care and Use Program Office
Office of Scientific Integrity, Office of the Associate Director for Science
Centers for Disease Control and Prevention
Atlanta, GA, USA
Elaine Scallan
Assistant Professor
Department of Epidemiology
Colorado School of Public Health
University of Colorado Denver
Aurora, CO, USA
Brian G. Southwell
Program Director
Science in the Public Sphere Program
RTI International
Research Triangle Park, NC, USA
Ethel V. Taylor
Veterinary Epidemiologist
Health Studies Branch
National Center for Environmental Health
Centers for Disease Control and Prevention
Atlanta, GA, USA
Elizabeth A. Torrone
Epidemiologist
Division of STD Prevention
Centers for Disease Control and Prevention
Atlanta, GA, USA
James N. Tyson
Chief, Situation Awareness Unit
Division of Emergency Operations
Office of Public Health Preparedness and Response
Centers for Disease Control and Prevention
Atlanta, GA, USA
Jennifer Ward
Epidemiologist
Communicable and Environmental Diseases and Emergency Preparedness
Tennessee Department of Health
Nashville, TN, USA
Foreword
If you don't know where you are going, any road will get you there.
Lewis Carroll
When I was young, my family used to take the occasional long-distance road trip. During the 1960s, these trips required months of planning and preparation. Requests were sent to tourism divisions in the states we would pass through, in the hope that maps and brochures would be sent so that we could plot our route and identify things to do and see along the way. Booklets were also requested from major motel chains to reserve places to stay based on our anticipated route and daily driving distances. Sometimes a package of information came quickly in the mail; but, just as often, nothing arrived or the material came too late. Afterward, the well-worn maps and booklets were tossed in a drawer for future use, even though the information was often out of date. Once on the road, if car trouble, bad weather, or road closures disrupted our itinerary, we'd spread out the maps to plot an alternative route, seek out pay phones to cancel lodging reservations, and take a chance on finding a place to stay overnight on the new route. International trips were more involved, and pretravel information was much more difficult to obtain.
Our road trip experiences could be a metaphor for the state of infectious disease surveillance during that era. Back then, implementing and sustaining surveillance took significant time, effort, and patience. Sources of surveillance data were not easy to locate and available information was difficult to access. Physicians and laboratories, the primary sources of infectious disease data, often complied poorly with disease reporting requirements. These providers were often unaware of what diseases to report and how to report them, or they were disinclined to fill out tedious reports. If submitted at all, forms or cards were filled in by hand or typed; and when they reached the correct officials at the health department days later, forms were often incomplete, difficult to read, damaged, or incorrect. Reports were stored in file cabinets or on shelves where they were susceptible to damage, decay, or misplacement. Summary statistics were calculated by hand with the aid of an adding machine and periodically disseminated in hard copy. All of these factors made disease surveillance inefficient, insensitive, inflexible, and highly variable in place and time. International surveillance efforts were even less dependable, when they existed at all.
It is remarkable to realize how much both the way we arrange travel and the way we conduct infectious disease surveillance have evolved in only a few decades. Hard-copy maps are now quaint anachronisms. Instead, we rely on the Internet or global positioning systems (GPS) to plot our trips. We punch in our intended destination and in seconds have preferred and alternative routes accompanied by stunningly detailed satellite and ground images. Travel arrangement websites and applications provide exquisite details on the destination, transport and lodging options, room and restaurant availability, and prices in even the remotest corner of the world.
Similarly, paper disease report forms previously used for surveillance have been supplanted by encrypted Web-based or smart-phone data entry that includes range and consistency checks to reduce errors. Electronically entered data are easily transmitted by designated disease reporters to the correct recipient. Reporting requirements, forms, and formats are easily accessed online by any provider or laboratory. Electronic health records and electronic laboratory reports allow automated, highly accurate data extraction coupled with direct computer-to-computer transfer from source providers to public health authorities. Once received, these data are assessed using computerized algorithms that manipulate and perform complex analyses and produce outputs on a near–real-time basis. Aberration software detects atypical disease patterns and unusual case reports; and, through automatic alerts, it flags such deviations so they can be immediately investigated. Databases are housed in server farms and cloud-based storage systems for easy retrieval, transfer, and analysis. Surveillance analyses can be shared with providers and the public via the Web and through social media.
With such a rapidly evolving landscape, it is critically important that students of public health and epidemiology have a sound understanding of the concepts and principles that underpin modern surveillance of infectious diseases. Students should be acquainted with the major surveillance systems used to collect and report infectious disease data domestically and internationally, and they should understand the strengths and limitations of these systems. Every practitioner or organization working in the field of infectious diseases uses surveillance data. That is true whether they provide direct patient care, conduct fundamental or applied research, or implement programs to prevent, control, or eradicate disease. Surveillance information is used to assure science-based decision making, to allocate resources for maximum impact, and to determine whether we have achieved desired outcomes. Only through high-quality surveillance can we measure the burden of and trends in infectious diseases, which today continue to be major contributors to global morbidity, mortality, disability, and social upheaval.
Concepts and Methods in Infectious Disease Surveillance lays out infectious disease surveillance for the student in several ways. First, it familiarizes the reader with basic surveillance concepts; the legal basis for surveillance in the United States and abroad; and the purposes, structures, and intended uses of surveillance at the local, state, national, and international level. This information is important for those who seek to understand our current surveillance systems, their strengths, and their limitations.
Once these broad-based principles are addressed, the text introduces the approaches to surveillance for various categories of infectious diseases. The student will quickly discover that surveillance goals and methods differ radically by infectious disease. Surveillance approaches to healthcare-associated infections or antimicrobial resistance are completely different from those used for vectorborne infections, rabies, or influenza. For many (but not all) infectious diseases, it is important to count individual cases of the disease of interest (e.g., HIV, measles, salmonellosis, tuberculosis). However, the methods used to find these cases will vary; and, often, additional types of information are collected to complete the picture. As examples, for vaccine preventable diseases, systems are in place to collect data on vaccine coverage and vaccine-related adverse events; and, for HIV, systems collect data on testing trends, treatment, disease outcomes, coinfections, and risk behaviors.
The student must also understand noncategorical, or nondisease specific, approaches to collection and analysis of surveillance data. Increasingly, these methods have been established as core surveillance practices, especially for emergency preparedness. One example is syndromic surveillance, where the generic patterns of respiratory illness, rash illness, or gastrointestinal disease seen in healthcare settings are monitored. Another example is the monitoring of prescription dispensing or over-the-counter purchases of antidiarrheal medications or cough suppressants in pharmacy settings. Yet another example is the use of social media or websites to observe trends in mentions of, or searches for, infectious disease–related terms like influenza, tick bites, or antibiotics.
It is also necessary for public health practitioners to have a grasp of disciplines like laboratory analytic methods and information technology concepts that play important roles in infectious disease surveillance. In particular, subtyping (or fingerprinting) methodologies in widespread use in public health laboratories, from simple bacterial serotyping to whole genome sequencing of microbes, have revolutionized our ability to identify links among human, animal, and environmental pathogens and to detect and control outbreaks. Geospatial analysis is another emerging technology that has allowed previously unrecognizable or underappreciated patterns of illness to be revealed. The final sections of this book introduce the student to methods of communicating the findings derived from analyses of surveillance data. This is every bit as important as data collection and data analysis. If the findings of surveillance systems are not disseminated to those who can use them, the public health benefits of surveillance cannot be realized.
This text demonstrates the infectious disease landscape and roadmap of today; but we are in an era of dynamic change marked by personal medicine and genomics, the human microbiome, metadata, super-computation, and other trends that will profoundly impact our approach to disease surveillance. In another generation, how we now travel and conduct surveillance may appear as antiquated to public health practitioners as hard-copy road maps and mail-in disease reports of the past generation appear to us today. This illustrates that all of us will be learning new disease surveillance concepts and methods throughout our professional careers.
Stephen M. Ostroff, MD
Acting Chief Scientist at the U.S. Food and Drug Administration
Preface
A functional surveillance system is essential in providing information for action on priority communicable diseases; it is a crucial instrument for public health decision-making in all countries.
World Health Organization, 2000
During the past century, all regions of the world have made significant, but uneven, progress in prevention and control of infectious diseases. Microbial agents inflict widespread suffering on humans and the diseases they cause can disrupt trade and restrict travel resulting in unfavorable economic impacts. The emergence of severe acute respiratory syndrome (SARS) in 2003 and the 2009 pandemic H1N1 influenza virus outbreak are stark reminders that human pathogens are a serious threat to public health. The rapid spread of both SARS and pandemic H1N1 influenza demonstrated the need for effective systems to track, detect, and respond to disease outbreaks at various levels.
At the beginning of this century, many countries, including the United States, scaled up investments in infrastructure to monitor infectious diseases. Those investments have benefited enormously from the widespread use of electronic information systems in clinical laboratories, which enabled creation of new modalities for timely submission of reportable test results to public health authorities. Incentives that are aimed at accelerating adoption of useful electronic health records are expected to increase reporting of designated diseases to public health jurisdictions. Implementation of such systems, however, is complex and requires close collaboration among information technologists and public health professionals with necessary backgrounds in surveillance and epidemiology.
Advances in molecular subtyping methods, including pulsed-field gel electrophoresis and multilocus sequence typing, have increased the specificity and power of laboratory-based surveillance to detect outbreaks. Use of geographic information systems can better clarify pathogen transmission dynamics than methods used in the past, and statistical algorithms can be applied to Internet-based data to monitor evolving public health crises. In addition, social media and mobile technologies have expanded both data sources and means for dissemination of surveillance findings. Novel methods for conducting surveillance, however, raise unresolved legal concerns.
A desire for a readily accessible, concise resource that detailed current methods and challenges in disease surveillance inspired the collaborations that resulted in this volume. Written by colleagues with hands-on experience in conducting surveillance and teaching applied public health, the book has three sections. Section I provides an overview of legal considerations for surveillance and a description of multilevel systems that are the cornerstones for infectious disease surveillance in the United States. Section II presents chapters on major program-area or disease-specific surveillance systems including those that monitor bacterial infections, foodborne diseases, healthcare-associated infections, and HIV/AIDS.
Section III is devoted to methods for conducting surveillance and approaches for data analysis. There are chapters focused on methods used in global surveillance and global disease detection, practical considerations for electronic laboratory reporting, and approaches for analysis and interpretation of surveillance data. Section IV includes a chapter on approaches for communication and use of social media and a concluding chapter on lessons learned from the New York City Department of Health and Mental Hygiene's 50-year experience in surveillance and applied epidemiology training.
The book covers major topics at an introductory-to-intermediate level and was designed to serve as a resource or class text for instructors. It can be used in graduate level courses in public health, human and veterinary medicine, as well as in undergraduate programs in public health–oriented disciplines. We hope that the book will be a useful primer for frontline public health practitioners, hospital epidemiologists, infection-control practitioners, laboratorians in public health settings, infectious disease researchers, and medical informatics specialists interested in a concise overview of infectious disease surveillance. We are delighted by the growing interest in use of surveillance to inform public health practice, in addition to its use as a tool for early detection of epidemics. Our hope is that this volume will contribute to this endeavor.
Nkuchia M. M'ikanatha John K. Iskander
Acknowledgments
We are grateful to many individuals and institutions that embraced the vision for this book. It is a privilege for us to participate in surveillance and the broad field of applied epidemiology at state (NMM) and federal (JKI) levels in the United States. We are grateful for all the direct and indirect support we received from our own institutions and from the institutions represented by contributors to this volume.
Wiley-Blackwell, our publisher, invited us to develop this textbook and supported us throughout the process; we are grateful for the opportunity. In particular, we thank Maria Khan, our Commissioning Editor; Deirdre Barry, and Claire Brewer for their efforts and guidance during various stages of the book.
Contributors to this volume invested enormous time and energy during the writing process—we thank each of them for their collaborative spirit and friendship. A number of individuals provided significant help in either reviewing initial drafts for the overall book or specific chapters. In particular, we thank Chris Carr, Harry Sultz, Jaclyn Fox, Natalie Mueller, and Jacqueline Wyatt for their invaluable feedback. We are grateful to Sameh Boktor for wide-ranging editorial assistance, including the amazing job he did in finalizing many of the illustrations in this book.
Our separate journeys to public health careers and to this specific work began with the love and guidance each of us received at an early age from our parents: Mama Ciomwereria and Kaithia M'ikanatha, and Michel and Betty Iskander. We are eternally grateful for their invaluable gifts. NMM would also like to thank D. A. Henderson for sharing with him insights gained in the application of surveillance in the successful eradication of smallpox. NMM also expresses gratitude to Brian L. Strom for encouragement and opportunities to participate in academic aspects of public health. During our work on this book, we received love and nourishment from our families: the M'ikanatha family: Kathleen and Isaac; and the Iskander family: Susan Duderstadt, Eleanor, and Jonas.
Acronyms and Abbreviations
SECTION IIntroduction to Infectious Disease Surveillance
CHAPTER 1Surveillance as a Foundation for Infectious Disease Prevention and Control
Nkuchia M. M'ikanatha1 and John K. Iskander2
1 Pennsylvania Department of Health, Harrisburg, PA, USA
2 Centers for Disease Control and Prevention, Atlanta, GA, USA
Background and Rationale
Throughout human history, infectious diseases have caused human suffering, disrupted trade, restricted travel, and limited human settlement. Today the emergence of new pathogens and reemergence of new strains of old pathogens in different parts of the world illustrates the continuing threat of infectious diseases to the public's health. A combination of globalization of the food supply and travel within countries and across international borders makes it easy for an outbreak in one location to spread rapidly within and beyond national borders. Endemic infectious diseases, including sexually transmitted diseases (STDs) like gonorrhea, foodborne illnesses like campylobacteriosis, and bloodborne pathogens such as hepatitis B and C remain problems in North America, Europe, and other regions of the world. Table 1.1 lists the ten most commonly reported communicable diseases in the United States, which include multiple types of STDs, infections transmitted by food and water, vaccine-preventable diseases, and a vectorborne disease transmitted by ticks. (The United States population was estimated at 314 million in 2013.) The cumulative morbidity from these 10 diseases, in a single wealthy country, is nearly 2 million cases a year or approximately 32 cases of a communicable disease per 10,000 persons. Given that underreporting occurs in many surveillance systems, the real human toll in terms of cases and attendant suffering and healthcare costs is undoubtedly higher.
Table 1.1 Ten diseases with the highest numbers of reported cases.
Source: Adams DA, Gallagher KM, Jajosky RA, et al. Division of Notifiable Diseases and Healthcare Information, Office of Surveillance, Epidemiology, and Laboratory Services, CDC. Summary of notifiable diseases—United States, 2011. MMWR Morb Mortal Wkly Rep 2013; 5;60:1–117.
Name
Total
Chlamydia trachomatis
infection
1,412,791
Gonorrhea
321,849
Salmonellosis
51,887
Syphilis, total (all stages)
46,042
HIV diagnoses
35,266
Lyme disease, total
33,097
Coccidioidomycosis
22,634
Pertussis
18,719
Streptococcus pneumoniae
, invasive disease (all ages)
17,138
Giardiasis
16,747
Surveillance can provide timely information crucial to public health interventions in an evolving situation. For example, during the 2009–2010 H1N1 influenza pandemic, surveillance data were used to prioritize vaccination to specific high-risk groups such as pregnant women because the supply of vaccine was limited [1]. Surveillance data also form the bases for disease-specific treatment guidelines; in the United States, for example, public health authorities now recommend use of injectable third-generation cephalosporins for treatment of gonococcal infections because of increasing resistance to oral cephalosporins [2]. Information from carefully designed and implemented surveillance systems can also inform the allocation of resources to public health programs and reassure the public in face of public health crises resulting from natural disasters such as the Sichuan earthquake in China in 2008 [3]. Epidemiologic data generated through disease surveillance serve as the bases for research and development of drugs, vaccines, and other therapeutic and prophylactic interventions.
Although central to disease prevention programs, public health surveillance infrastructure is inadequate or weak in many parts of the world. The need to strengthen capacity to conduct public health surveillance for infectious diseases is a priority for practitioners and policy makers in North America and Europe. The establishment of the European Centre for Disease Prevention and Control (ECDC) and the renewed focus on surveillance at the United States Centers for Disease Control and Prevention (CDC) [4,5] demonstrate the growing interest in this field. Furthermore, the current International Health Regulations explicitly call for establishment of functioning surveillance units in the public health systems in all countries. Contrary to the misconception that infectious diseases have been conquered by advances in medicine and technology, established and newly emerging pathogens will likely continue to be threats to public health for the foreseeable future.
