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Event based surveillance systems Alicia Barrasa EPIET Introductory course 2011 Lazareto, Menorca, Spain.

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Presentation on theme: "Event based surveillance systems Alicia Barrasa EPIET Introductory course 2011 Lazareto, Menorca, Spain."— Presentation transcript:

1 Event based surveillance systems Alicia Barrasa EPIET Introductory course 2011 Lazareto, Menorca, Spain

2 Arise from many different pathogens: viruses, bacteria, parasites Spread in many different species: humans, insects, domestic and wild animals, aquatic animals and sometimes breach barrier between animal and humans (70% of emerging infections arise from animal population) Take many different routes of transmission: direct contact, vectors, food, environmental Affect all populations in all regions of the world Infectious diseases

3 Emerging and Re-emerging infectious diseases A(H1N1)v EHEC

4 Accidental and deliberate release of infectious agents Increased research, biotechnology is widely available Increased risk for accidental release (e.g. SARS 2004 from laboratory) World tensions remain and the deliberate release of infectious agents is no longer a remote threat.

5 International Health Regulation 1374Venice Quarantine for Plague 1851Paris1st International Sanitary Conference 1947GenevaWHO Epidemiological Information Service 1951GenevaInternational Sanitary Regulations 1969GenevaInternational Health Regulations 2004Regional consultations Nov 2004 Geneva Intergovernmental Working Group meeting Feb 2005 Geneva Intergovernmental Working Group meeting May 2005Geneva Revised IHR, World Health Assembly

6 4 diseases that always have to be notified polio (wild type virus), smallpox, human influenza caused by a novel virus, SARS. Diseases that always lead to the use of the algorithm : cholera, pneumonique plague, yellow fever, VHF (Ebola, Lassa, Marburg), WNF, meningitis, others *Q1: serious repercussions for public health? Q2: unusual or unexpected? Q3: risk of international spread? Q4: risk of travel or traffic restrictions? Insufficient information : re-evaluate IHR Decision Instrument

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8 International Health Regulation - 2005 To decide on need for notification any public health event can be assessed by the criteria Is the public health impact of the event serious? Is the event unusual or unexpected? Is there a significant risk of international spread? Is there a significant risk of international travel or travel restrictions ? Obligation to establish core capacities: Surveillance Response

9 Preparedness and response - ECDC Detection of public health threats related to infectious disease, or of unknown origin Risk assessment, investigation and control Strengthening preparedness of EU member states Strengthening and building capacity through training Provision of technical advice and support to third countries upon request

10 Epidemic Intelligence Definition The systematic collection and collation of information from a variety of sources, usually in real-time, which is then verified and analysed and, if necessary, activates response Objective to speed up detection of potential health threats and allow timely response

11 Data Events Collect Analyse Interpret Capture Filter Verify Assess Investigate Signal Control measures Public health Alert Disseminate Event monitoringSurveillance systems Event-based surveillanceIndicator-based surveillance Epidemic Intelligence

12 Indicator based Surveillance Surveillance systems Ongoing and systematic Collection and analysis of data Interpretation and dissemination of results related to health events of interest Diagnosis-based or Syndromic surveillance For action Outbreak investigation Immunization programmes Programme planning and evaluation Operational research hypothesis Risk assessments

13 Event based Surveillance Organized and rapid capture of information about events that are a potential risk to public health: Events related to the occurrence to the disease in humans (clusters, unusual patterns, unexpected deaths…) Events related to potential exposures (diseases in animals, contaminated food or water, environmental hazards…)

14 Data Events Collect Analyse Interpret Capture Filter Verify Assess Investigate Signal Control measures Public health Alert Disseminate Event monitoringSurveillance systems Event-based surveillanceIndicator-based surveillance Risk assessment Risk Management Early warning Response Epidemic Intelligence

15 Event based Surveillance Sources of information: Hospitals/health care centres/emergency rooms Veterinary services, food agency -West Nile Virus, Rift Valley Fever -Foodborne outbreaks Meteorological data -Pollution -Heat Laboratories -Identification of specific pathogens -Increase in demand for hepatitis serology

16 Event based Surveillance Sources of information Media -systematic searching of news -often in electronic format International networks

17 Indicator vs event based Indicator basedEvent based Definitions- Clinical presentation - Characteristics of people - Laboratory criteria - Specific -...events that are a potential risk -...unusual events in the community - Sensitive Timeliness- Weekly / monthly (some may be immediate) - Possible delay between identification and notification - All events should be reported to the system immediately - Real time

18 Indicator vs event based Indicator basedEvent based Actors- Involved in the system- Might not know Reporting structure - Clearly defined - Reporting forms - Reporting dates - Teams to analyse data at regular intervals - No predefined structure - Reporting forms flexible for quali and quantitative data - At any time - Teams to confirm evens and prepare the response

19 Indicator vs event based Indicator basedEvent based Trigger for action - a pre-defined thresholds- a confirmed event Response- depends on the delay between identification, data collection and analysis - depends on the confirmation of the event, but ideally is immediate

20 A small summary Indicator and event based systems are tools for PH Surveillance Event based systems have already been successfully used The challenge: confirmation of the events

21 Public Health Surveillance during the 2012 Olympic and Paralympic Games Helen Maguire acknowledgements Brian McCloskey, Director, HPS London region Ellen Heinsbroek, EPIET fellow, HPS Colindale

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23 London 2012 Olympic and Paralympic Games - 26 Olympic sports in ~34 venues - 20 Paralympic sports in 17 venues - 10,500 Olympic and 4,200 Paralympic athletes - 21,000 media and broadcasters - Over 10.2 million tickets - 180,000 spectators per day in the Olympic Park - 17,000 people living in the Olympic Village

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25 What influences our preparations for London 2012? - Politics - Media - Scale

26 Where do we start? Whats been learned before at other mass gatherings? What is the risk assessment? Whats proportionate in relation to the risk? What capability and capacity have we got? What aims /objectives for our surveillance ?

27 Experience of mass gatherings In Atlanta [1996] and in Sydney [2000] infectious diseases accounted for less than 1% of healthcare visits In Beijing …there were no problems..

28 Winter Olympic Games, Torino Italy 2006 2 public and private microbiology laboratories provided test results data for Stool culture Hepatitis A serology No difference to non-Olympic period Data reported once a week Experience of mass gatherings

29 Germany World Cup, 2006 Burden of infectious disease did not increase during World Cup Maintenance of daily data transmission in all Federal States Additional free-text reporting for events through usual surveillance system -High sensitivity Syndromic surveillance was regarded as not necessary -as disease surveillance systems already in place Experience of mass gatherings

30 Aim To provide information on selected indicators (including infection related, syndromes, and environmental) as well as on events or incidents that impact on Olympic venues/staff/athletes/visitors -in order to rapidly identify any individual cases or outbreaks /incidents so that interventions can be implemented 30 London Olympics Surveillance

31 Objectives 1 review existing systems completeness, sensitivity to unusual events /outbreaks flexibility, timeliness, ability to detect new pathogens 2 identify gaps or limitations 3 enhance existing or establish new systems 31

32 Enhance reportable disease by clinicians Enhance laboratory capacity and reporting Enhance environmental monitoring Create 24 on-call and rapid response teams Enhance existing …

33 1.Syndromic Surveillance (NHS Direct, Q Surveillance, RCGP, EDSSS, OOH) 2.Notifications of Infectious Diseases 3.Surveillance at Olympic Village Polyclinics 4.Event-Based Surveillance 5.Laboratory Reporting 33 Epidemic Intelligence (existing and new )

34 Surveillance of Undiagnosed Serious Infectious Illness (USII) Environmental monitoring at Centre for Radiation, Chemical (and Environmental Hazards Mortality Surveillance) 34 Existing and new surveillance systems

35 1 Syndromic Surveillance 35 Existing systems NHS Direct GP-based syndromic surveillance Q Surveillance Royal College General Practitioners New systems Out of Hours Providers Emergency Departments

36 To provide enhanced surveillance during weekends/holidays/evenings 1 Syndromic Surveillance out of hours

37 To establish a surveillance network of EDs across England 1 Syndromic Surveillance emergency departments

38 38 Health Protection Unit HPA Colindale: Departments (esp. Immunisation) Registered Medical Practitioner Proper Officer - Local Authority HPA Colindale: Central Information Management Normal: fax: max. 3 days Emergency: phone within 24 hrs Max. 3 days (methods differ by LA/HPU) Report published on internet Extra requirements Olympics: Olympic Venue Attendance Forms + HPZone to be changed Speed up notifications Improve consistency reporting 2 Notifications of infectious diseases

39 3. Surveillance at Olympic Village Requirement to notify infectious diseases compulsory for overseas athletic team doctors Compulsory component of temporary registration Same forms as medical practitioners Notification System being set up HPA presence in Olympic Polyclinic Monitoring of staff absences 39 Olympics Surveillance Systems – 3. Surveillance at Olympic Village

40 4. Event based surveillance What is a significant event? Standard factors – e.g. severity, Olympic factors – proximity to venue, affecting visitors The media! How do we identify significant events HPZone – dashboard – flagging events with an Olympic flag Regional reporting via teleconference or negative reporting Media screening

41 NOIDS 41

42 5 Lab reporting 42 HPA Colindale: Departments Laboratories HPU/Region HPA Colindale: Central Information Management - Weekly, by law (Oct10) - Automatic, with manual checking+sending - Weekly exceedance report published on intranet - Departments access via software Extra requirements Olympics: Daily reporting: software change Automatic extraction software Exceedance Algorithms: daily Adapt for changes in testing, e.g. multiplex PCR

43 6. Surveillance of Undiagnosed Serious Infectious Illness To ensure early detection and response to new and emerging infectious disease threats. 43 Case definition Any person admitted to HDU/IDU with a serious illness suggestive of an infectious process where the clinical presentation does not fit with any recognisable clinical picture OR there is no clinical improvement in response to standard therapy AND initial laboratory investigations for infectious agents are negative

44 7 Surveillance at Centre for Radiation, Chemical and Environmental Hazards -increase to daily reporting 44

45 Olympic Surveillance Matrix: Early Detection Surveillance System Scenario UK based surveillance International Situational Analysis (horizon scanning) Syndromic Surv, (NHSD, Q, OOH) NOIDSOlympic Village Polyclinics CRCELaboratory Reporting Syndromic Surveillance – ED *sentinel USII *sentinel Mortality Localized outbreak, small number of cases e.g. meningococcal * Localized outbreak, large number of cases e.g. measles * Widespread outbreak, small number of cases e.g. food poisoning Widespread outbreak, large number of cases e.g. influenza * Increase in weather related disease, e.g. asthma Chemical, Environmental or Radiation incident * Imported disease, e.g. plague * Newly emerging disease * Deliberate release, e.g. anthrax * 45

46 289 days to go! 46


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