Disease surveillance

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Disease surveillance is an epidemiological practice by which the spread of disease is monitored in order to establish patterns of progression. The main role of disease surveillance is to predict, observe, and minimize the harm caused by outbreak, epidemic, and pandemic situations, as well as increase knowledge about which factors contribute to such circumstances. A key part of modern disease surveillance is the practice of disease case reporting.

Epidemiology is the study and analysis of the distribution and determinants of health and disease conditions in defined populations.

Disease abnormal condition negatively affecting organisms

A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that is not due to any external injury. Diseases are often construed as medical conditions that are associated with specific symptoms and signs. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies and autoimmune disorders.

In epidemiology, an outbreak is a sudden increase in occurrences of a disease in a particular time and place. It may affect a small and localized group or impact upon thousands of people across an entire continent. Two linked cases of a rare infectious disease may be sufficient to constitute an outbreak. Outbreaks include epidemics, which term is normally only used for infectious diseases, as well as diseases with an environmental origin, such as a water or foodborne disease. They may affect a region in a country or a group of countries. Pandemics are near-global disease outbreaks.

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In modern times, reporting incidences of disease outbreaks has been transformed from manual record keeping, to instant worldwide internet communication.

The number of cases could be gathered from hospitals - which would be expected to see most of the occurrences - collated, and eventually made public. With the advent of modern communication technology, this has changed dramatically. Organizations like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) now can report cases and deaths from significant diseases within days - sometimes within hours - of the occurrence. Further, there is considerable public pressure to make this information available quickly and accurately. [1]

World Health Organization Specialised agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organisation, was an agency of the League of Nations.

Centers for Disease Control and Prevention government agency

The Centers for Disease Control and Prevention (CDC) is the leading national public health institute of the United States. The CDC is a United States federal agency under the Department of Health and Human Services and is headquartered in Atlanta, Georgia.

Mandatory reporting

Formal reporting of notifiable infectious diseases is a requirement placed upon health care providers by many regional and national governments, and upon national governments by the World Health Organization to monitor spread as a result of the transmission of infectious agents. Since 1969, WHO has required that all cases of the following diseases be reported to the organization: cholera, plague, yellow fever, smallpox, relapsing fever and typhus. In 2005, the list was extended to include polio and SARS. Regional and national governments typically monitor a larger set of (around 80 in the U.S.) communicable diseases that can potentially threaten the general population. Tuberculosis, HIV, botulism, hantavirus, anthrax, and rabies are examples of such diseases. The incidence counts of diseases are often used as health indicators to describe the overall health of a population.

A notifiable disease is any disease that is required by law to be reported to government authorities. The collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks. In the case of livestock diseases, there may also be the legal requirement to destroy the infected livestock upon notification. Many governments have enacted regulations for reporting of both human and animal diseases.

In medicine, public health, and biology, transmission is the passing of a pathogen causing communicable disease from an infected host individual or group to a particular individual or group, regardless of whether the other individual was previously infected.

Cholera Bacterial infection of the small intestine

Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.

World Health Organization

The World Health Organization is the lead agency for coordinating global response to major diseases. The WHO maintains Web sites for a number of diseases, and has active teams in many countries where these diseases occur.

During the SARS outbreak in early 2004, for example, the Beijing staff of the WHO produced updates every few days for the duration of the outbreak. [1] Beginning in January 2004, the WHO has produced similar updates for H5N1. [2] These results are widely reported and closely watched.

Beijing Municipality in Peoples Republic of China

Beijing, formerly romanized as Peking, is the capital of the People's Republic of China, the world's third most populous city proper, and most populous capital city. The city, located in northern China, is governed as a municipality under the direct administration of central government with 16 urban, suburban, and rural districts. Beijing Municipality is surrounded by Hebei Province with the exception of neighboring Tianjin Municipality to the southeast; together the three divisions form the Jingjinji metropolitan region and the national capital region of China.

Global spread of H5N1

The global spread of highly pathogenic H5N1 influenza in birds is considered a significant pandemic threat.

WHO's Epidemic and Pandemic Alert and Response (EPR) to detect, verify rapidly and respond appropriately to epidemic-prone and emerging disease threats covers the following diseases: [3]

Political challenges

As the lead organization in global public health, the WHO occupies a delicate role in global politics. It must maintain good relationships with each of the many countries in which it is active. As a result, it may only report results within a particular country with the agreement of the country's government. Because some governments regard the release of any information on disease outbreaks as a state secret, this can place the WHO in a difficult position.

The WHO coordinated International Outbreak Alert and Response is designed to ensure "outbreaks of potential international importance are rapidly verified and information is quickly shared within the Network" but not necessarily by the public; integrate and coordinate "activities to support national efforts" rather than challenge national authority within that nation in order to "respect the independence and objectivity of all partners". The commitment that "All Network responses will proceed with full respect for ethical standards, human rights, national and local laws, cultural sensitivities and tradition" ensures each nation that its security, financial, and other interests will be given full weight. [4]

Technical challenges

Testing for a disease can be expensive, and distinguishing between two diseases can be prohibitively difficult in many countries. One standard means of determining if a person has had a particular disease is to test for the presence of antibodies that are particular to this disease. In the case of H5N1, for example, there is a low pathogenic H5N1 strain in wild birds in North America that a human could conceivably have antibodies against. It would be extremely difficult to distinguish between antibodies produced by this strain, and antibodies produced by Asian lineage HPAI A(H5N1). Similar difficulties are common, and make it difficult to determine how widely a disease may have spread.

There is currently little available data on the spread of H5N1 in wild birds in Africa and Asia. Without such data, predicting how the disease might spread in the future is difficult. Information that scientists and decision makers need to make useful medical products and informed decisions for health care, but currently lack include:

H5N1

Surveillance of H5N1 in humans, poultry, wild birds, cats and other animals remains very weak in many parts of Asia and Africa. Much remains unknown about the exact extent of its spread.

H5N1 in China is less than fully reported. Blogs have described many discrepancies between official China government announcements concerning H5N1 and what people in China see with their own eyes. Many reports of total H5N1 cases have excluded China due to widespread disbelief in China's official numbers. [5] (See Disease surveillance in China.)

"Only half the world's human bird flu cases are being reported to the World Health Organization within two weeks of being detected, a response time that must be improved to avert a pandemic, a senior WHO official said Saturday. Shigeru Omi, WHO's regional director for the Western Pacific, said it is estimated that countries would have only two to three weeks to stamp out, or at least slow, a pandemic flu strain after it began spreading in humans." [6]

David Nabarro, chief avian flu coordinator for the United Nations, says avian flu has too many unanswered questions. [7] [8]

CIDRAP reported on August 25, 2006 on a new US government Web site that allows the public to view current information about testing of wild birds for H5N1 avian influenza which is part of a national wild-bird surveillance plan that "includes five strategies for early detection of highly pathogenic avian influenza. Sample numbers from three of these will be available on HEDDS: live wild birds, subsistence hunter-killed birds, and investigations of sick and dead wild birds. The other two strategies involve domestic bird testing and environmental sampling of water and wild-bird droppings. [...] A map on the new USGS site shows that 9,327 birds from Alaska have been tested so far this year, with only a few from most other states. Last year officials tested just 721 birds from Alaska and none from most other states, another map shows. The goal of the surveillance program for 2006 is to collect 75,000 to 100,000 samples from wild birds and 50,000 environmental samples, officials have said." [9]

See also

Further reading

Related Research Articles

References

  1. 1 2 WHO SARS
  2. WHO H5N1
  3. WHO EPR
  4. WHO Outbreak Network
  5. WHO Archived July 27, 2011, at the Wayback Machine . WHO Archived 2006-02-13 at the Wayback Machine . WHO WHO
  6. ABC News from AP published May 7, 2006
  7. NYT article picked up by IHT
  8. International Institute for Sustainable Development (IISD) Scientific Seminar on Avian Influenza, the Environment and Migratory Birds on 10–11 April 2006 published 14 April 2006.
  9. CIDRAP News article New Web tool tracks H5N1 testing of US wild birds published August 25, 2006