COMMUNICABLE DISEASE SURVEILLANCE Dr.Somsak Wattanasri, M.D. Board - PowerPoint PPT Presentation

COMMUNICABLE DISEASE SURVEILLANCE Dr.Somsak Wattanasri, M.D. Board of Pediatrics, FETP does@health.moph.go.th Bureau of Epidemiology Department of Disease Control Ministry of Public Health

Epidemiology and and Public Health Public Health Epidemiology “ Laws of nature mattered for health one could not understand the public rate of disease simply by studying individuals. .... “ Dr. Somsak Wattanasri

Definition of of Definition epidemiology epidemiology The study study of of the the distribution distribution and and The determinants of of the the health health status status or or events events determinants in the the population population and and its its application application to to in control public health health problems problems control public th Edition. Oxford University Press: New Source: Last Last 2001. A Dictionary of Epidemiology: 4 2001. A Dictionary of Epidemiology: 4 th Source: Edition. Oxford University Press: New York. York.

Basic Epidemiological Concept Basic Epidemiological Concept Community Health Problem Community Health Problem - WHAT WHAT - - WHO WHO - - WHERE WHERE - WHEN - WHEN - Facts Facts HOW MUCH - HOW MUCH - - WHY WHY - - HOW HOW -

� Tools Tools � – Descriptive Epidemiology (generate hypotheses) Descriptive Epidemiology (generate hypotheses) – � Person Person � – Age, sex, occupation Age, sex, occupation – � Place Place � – Spot map Spot map – � Time Time � – Epidemic curve Epidemic curve – � Interview cases Interview cases - - hypothesis generation hypothesis generation � – Analytic Epidemiology (test hypotheses) Analytic Epidemiology (test hypotheses) – � 2 2- -x x- -2 Tables 2 Tables � – Associations between outcome (e.g., illness) and exposure (e.g., Associations between outcome (e.g., illness) and exposure (e.g., – food eaten) food eaten) � More sophisticated analyses More sophisticated analyses �

surveillance surveillance � An ongoing systematic observation of An ongoing systematic observation of � the incidence of CD, NCD, Injury or the incidence of CD, NCD, Injury or any health problems to gain specific any health problems to gain specific data , information for further action to data , information for further action to control and prevent public health control and prevent public health problem problem

EPIDEMIOLOGICAL SURVEILLANCE EPIDEMIOLOGICAL SURVEILLANCE DATA DATA INFORMATION INFORMATION CASE DEFINITION CASE DEFINITION standardize standardize uniformly applied uniformly applied ACTION ACTION

Why disease surveillance? � I t uses a data m odel, standardizes, fair. � I t em phasizes quality in data and w ork. � I t links analysis, prevention, and control. � I t’s been tested. I t w orks. � I ts benefit to costs is large and undeniable � I t is additive: recom m ends, teaches, and builds to a logical experim ent and believable results.

III. Source of information 1. Morbidity 2. Mortality 3. Laboratory 4. Vaccines and drug 5. Outbreak news/ rumor 6. Vector 7. Behavior 8. Environmental 8. Demographic

Important CD Diseases Notification within 24 hours 1 SARS and Avian Flu 2.Cholera 3. Acute severely ill or death of unknown etiology 4. Cluster of diseases with unknown etiology 5. Anthrax 6. Meningococcal meningitis 7. Food poisoning outbreak 8. Encephalitis 9. Acute flaccid paralysis (AFP) 10. Severe Adverse Events Following Immunization ๑๑ Diptheria ๑๒ Rabies

Important CD Diseases 1 Measles 2. Pertussis 3. Hand Foot and Mouth Diseases 4. Influenza 5. Leptospirosis 6. Dysentery 7. Severe pneumonia of unknown etiology 8. Cluster of infectious cases 9. Dengue/DHF

Organization of Surveillance System Organization of Surveillance System Ministry of Public Health Dep of Disease Control International Organization Bureau of Epidemiology Regional Disease Control Center ขอมูลรายงานโรค Provincial Epidemiological Unit ขาวสาร / ขาวกรอง District Surveillance information center Hospitals and clinic under Hospitals Private hospitals and clinics universal coverage scheme Under MOH And universal coverage schemes

The he epidemiological epidemiological p practices ractices T NORMAL D.R. E.1 TIME TABLE E.2 ANALYSIS & GRAPH PLACE 506/507 INTERPRETATION E.3 Report PERSON CHART E.0 E.4 Review other outbreaks INVESTIGATION ABNORMAL and other source of information EPIDEMIOLOGICAL STUDY KNOWLEDGE RECOMMENDATION & & ACTION ACTION RECOMMENDATION

Acute Viral Hepatitis, Acute Viral Hepatitis, Thailand 2005 Thailand 2005 � Thailand have surveillance of acute viral Thailand have surveillance of acute viral � hepatitis for 5 extinct viruses : hepatitis for 5 extinct viruses : � 1971 began with Total Acute Hepatitis ( � 1971 began with Total Acute Hepatitis ( infectious, serum) infectious, serum) � 1980 established Hepatitis A, Hepatitis B � 1980 established Hepatitis A, Hepatitis B and Non A , Non B and Non A , Non B � 1997 fully divided into 5 extinct viral � 1997 fully divided into 5 extinct viral hepatitis, A , B, C, D and E hepatitis, A , B, C, D and E � Hepatitis B vaccine was routinely introduced Hepatitis B vaccine was routinely introduced � nationwide in 1992 nationwide in 1992

Case Definition for Case Definition for Surveillance Surveillance Clinical Criteria Clinical Criteria Have jaundice without receiving hepatotoxic hepatotoxic Have jaundice without receiving agents and at least one of the following agents and at least one of the following - Dark urine Dark urine - - Fever Fever - - Abdominal discomfort Abdominal discomfort - - Right upper quadrant pain Right upper quadrant pain - - Anorexia Anorexia - - Fatigue/Weakness Fatigue/Weakness -

Case Definition for Surveillance Case Definition for Surveillance Laboratory Criteria Laboratory Criteria General Lab General Lab -SGPT (ALT) > 100 U/L in all age group SGPT (ALT) > 100 U/L in all age group - Specific Lab Specific Lab 1. Hepatitis A: Positive anti HAV 1. Hepatitis A: Positive anti HAV IgM IgM Hepatitis B: Positive anti 2. Hepatitis B: Positive anti HBc HBc IgM IgM and/or and/or 2. positive anti anti HBs HBs IgM IgM and/or positive and/or positive HBs HBs Ag Ag positive Hepatitis C: Positive anti HCV (total 3. Hepatitis C: Positive anti HCV (total 3. antibody) antibody) and/or detect HCV RNA HCV RNA and/or detect Hepatitis D: Positive 4. Hepatitis D: Positive HBs HBs ag ag with with anti HDV anti HDV 4. IgG IgG Hepatitis E: Positive anti HEV 5. Hepatitis E: Positive anti HEV IgM IgM 5.

Case Classification Case Classification Suspected case Suspected case Refer to patient who met clinical Refer to patient who met clinical criteria criteria Probable case Probable case Refer to patient who met clinical Refer to patient who met clinical criteria and SGPT (ALT) > 100 U/L criteria and SGPT (ALT) > 100 U/L Confirmed case Confirmed case Refer to patient who met clinical patient who met clinical Refer to criteria and has confirmed specific criteria and has confirmed specific laboratory testing laboratory testing

Number of Hepatitis A Cases by Number of Hepatitis A Cases by week of onset, Thailand, 2003- - week of onset, Thailand, 2003 2007 2007

Number of Hepatitis B Cases by Number of Hepatitis B Cases by week of onset, Thailand, 2003- - week of onset, Thailand, 2003 2007 2007

Number of Hepatitis C Cases by Number of Hepatitis C Cases by week of onset, Thailand, 2003- - week of onset, Thailand, 2003 2007 2007

Number of Hepatitis D Cases by Number of Hepatitis D Cases by week of onset, Thailand, 2003- - week of onset, Thailand, 2003 2007 2007

Number of Hepatitis E Cases by Number of Hepatitis E Cases by week of onset, Thailand, 2003- - week of onset, Thailand, 2003 2007 2007

Summarized of Acute Viral Hepatitis Summarized of Acute Viral Hepatitis A,B and C, Thailand 2005 A,B and C, Thailand 2005 No of Median Hospitalize No of Median Hospitalize Virus Sex Virus Sex Case age d Case age d 22 years M:F 22 years M:F Hepatitis A 2,421 10.6% Hepatitis A 2,421 10.6% (14,33) 1.5:1 (14,33) 1.5:1 33 years M:F 33 years M:F Hepatitis B 2,742 12.3% Hepatitis B 2,742 12.3% (22,44) 1.5:1 (22,44) 1.5:1 42 years M:F 42 years M:F Hepatitis C 407 12.0% Hepatitis C 407 12.0% (30,53) 1.5:1 (30,53) 1.5:1

Hepatitis A Cases by Age, Hepatitis A Cases by Age, Thailand 2005 Thailand 2005

Hepatitis B Cases by Age, Hepatitis B Cases by Age, Thailand 2005 Thailand 2005

Hepatitis C Cases by Age, Hepatitis C Cases by Age, Thailand 2005 Thailand 2005

Rate of Hepatitis B Rate of Hepatitis B I nfection, I nfection, 1980- -2005 , Thailand 2005 , Thailand 1980 Rate/100,000 7 6 5 4 3 2 HB Vaccine, 1992 1 0 0 2 4 0 2 4 6 8 0 2 4 6 8 8 8 8 8 8 9 9 9 9 9 0 0 0 0 0 0 2 2 2 Source: Report 506, BoE Year

Cases Time Person Place 25 1200 1000 20 800 15 600 10 400 200 5 0 0 0-4 '5-14 '15- '45- '64+ 1 2 3 4 5 6 7 8 9 10 44 64 Age Group Evaluate information Pathogen? Transmission? Source? 32