1. North East Surveillance Sources HPA – North East Regional Epidemiology Unit 05 October 2015

2. Why surveillance? Disease surveillance; “Ongoing scrutiny, generally using methods distinguished by their practicability, uniformity and frequently their rapidity, rather than by complete accuracy. Its main purpose is to detect changes in trend or distribution in order to initiate investigative or control measures.” J.M. Last (1995) A Dictionary of Epidemiology

3. Outbreak identification By assessing historical data, any exceedance in the number of cases can be seen. H1N1v RSV

4. 05 October 2015 Influenza surveillance HPA – North East Regional Epidemiology Unit

5. Influenza – health burden An acute viral disease of the respiratory tract. Yearly seasonal influenza imposes a substantial health burden on the population, both in the morbidity and the mortality that it causes. 18,500-24,800 deaths each year in the UK 1 are attributable to seasonal influenza infections. Over 90% of deaths occur among those aged 65 years and older 2. 1. Pitman et al., (2006) Assessing the burden of influenza and other respiratory infections in England and Wales. Journal of Infection. 54, 530-538 2. ed. Heymann (2008) Control of Communicable Diseases Manual

6. Surveillance Streams The following are systems by which influenza information is collected for the purposes of surveillance; RCGP QSurveillance NPFS Schools ILI Outbreak Surveillance SRDS RMN Flu Spotter North East National

7. Royal College of General Practitioners A network of 100 General Practices located throughout England and Wales. The total population covered by the WRS averages approximately 900,000. Practices submit consultation data for a number of diseases, these are used to calculate consultation rates. Also provides information on the number of cases with an influenza-like illness who test positive for the pandemic (H1N1) 2009 virus.

8. RCGP data

9. QSurveillance Utilises a general practice computer system A nationally representative sample of over 3000 practices contributes the data. Provides information on a population of approximately 20 million currently registered patients. Data for a set of key disease indicators are presented in a weekly bulletin. Gives daily GP consultation rates.

10. Qsurveillance data

11. National Pandemic Flu Service Began on 23 rd July 2009. Issues antiviral drugs to people in England with an influenza-like illness who call or log onto the internet site. Provides data on the number of assessments and antiviral collections through this service. Gives a weekly rate (per 100,000) of antivirals collected through NFPS.

12. NPFS data

13. National Schools ILI Outbreak Surveillance Based on reports from schools to local HPUs Schools reported when absence rates exceeded 20% with reports of influenza-like illness. Initially, each region swabbed potential H1N1v cases at the first three schools where the absence rate exceeded 20%. The surveillance progressed in time to view a snapshot of the number of schools affect in each HPU.

14. Seasonal Respiratory Disease Surveillance A North East initiative Uses data from respiratory disease samples sent to three laboratories in the region. Shows the number of samples tested and the number positive for a range of respiratory diseases. Data presented by week over a year period, also shows data from the previous year.

15. SRDS data

16. RMN Flu Spotter Six participating GP practices in the North East (65 nationally) Provides a weekly summary of samples sent to the HPA lab for testing. Shows the number of samples from these practices that tested positive for Influenza. Shows age, sex and region specific trends.

17. Other surveillance streams Antiviral susceptibility tests – Respiratory Virus Unit, CfI Hospitalisation data – number of hospitalisations with confirmed pandemic influenza, voluntary. Weekly (all-cause) death registrations – Office for National Statistics

18. Sexual Health Surveillance HPA – North East Regional Epidemiology Unit 05 October 2015

19. STI – health burden The symptomless nature of many STI’s can result in; Serious complications in later years if left untreated An under representation of the scale of infection – knock on effect to resource allocation A wider spread of infection – before diagnosis / difficulties contacting previous sexual partners Many infections are now common especially in young people

20. Sexual Health Surveillance Systems All sexually transmitted diseases GUMCAD e.g. gonorrhoea HIVe.g. SOPHID SyphilisEnhanced Surveillance ChlamydiaNCSP Antenatal screeningScreen for Infectious diseases

21. Sexual health surveillance Genitourinary Medicine Clinical Activity Dataset (GUMCAD) Records all sexual health diagnoses from all GUM clinics E.g. Chlamydia, Gonorrhoea, HIV and Syphilis diagnoses Also collects age, gender and resident information

22. HIV surveillance Unlinked Anonymous Prevalence Monitoring Programme (UAPMP) Monitors the prevalence of HIV infection in selected adult populations Samples are irreversibly unlinked, anonymised and tested for HIV infection HIV New Diagnoses Database Collects data on new HIV diagnoses, first AIDS diagnoses and deaths in HIV infected individuals Information is received from laboratories, GUM clinics and regional reporting centres

23. HIV surveillance Survey of Prevalent HIV Infections Diagnosed (SOPHID) Individuals with diagnosed HIV infection who attend for HIV-related care within the NHS Drug Resistance Database Systematic collation of HIV resistance data from HIV infected drug- naïve individuals CD4 Count Database Monitors national trends in immunosuppression among HIV-infected adults by analysis of CD4 cell counts Analysis of CD4 cell counts combined with other HIV surveillance data provides information on late diagnoses, trends in immunosuppression and the population effect of antiretroviral therapy

24. HIV surveillance

25. Syphilis surveillance Enhanced surveillance Records in depth information over and above normal surveillance e.g. sexual habits Collects resident and clinic information, sexual orientation and details of contacts Section of enhanced syphilis questionnaire Where did the client meet their sexual contacts? Location Most Some None Details of location(s) Pub/bar __________________________ Club __________________________ Sauna __________________________ Cruising area __________________________ Cottage __________________________ Dark room __________________________ Chatline __________________________ Internet __________________________ Other __________________________

26. Syphilis surveillance

27. Chlamydia surveillance National Chlamydia Screening Programme (NCSP) Records the number of Chlamydia tests completed in the under 25’s and percent positive

28. Antenatal screening Screen for Infectious Diseases Aggregate data collected during routine antenatal assessments Includes number of tests booked and positive results for HIV, Syphilis and Hepatitis B Limitations of this system are; Out dated software No way of collecting disaggregate data Lack of detail