Disease surveillance

Last updated

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. [1]

Contents

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. [2] [ failed verification ]

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.[ citation needed ]

World Health Organization

The World Health Organization (WHO) is the lead agency for coordinating global response to major diseases. The WHO maintains Websites for a number of diseases and has active teams in many countries where these diseases occur. [3]

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. [2] Beginning in January 2004, the WHO has produced similar updates for H5N1. [4] These results are widely reported and closely watched.[ citation needed ]

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: [5]

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.[ citation needed ]

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. [6]

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.[ citation needed ]

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:[ citation needed ]

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.[ citation needed ]

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. [7] [8] [9] [10] (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." [11]

David Nabarro, chief avian flu coordinator for the United Nations, says avian flu has too many unanswered questions. [12] [13]

CIDRAP reported on 25 August 2006 on a new US government Website [14] 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, 9327 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 75000 to 100000 samples from wild birds and 50000 environmental samples, officials have said". [15]

See also

Related Research Articles

<i>Influenza A virus</i> Species of virus

Influenza A virus (IAV) is a pathogen with strains that infect birds and some mammals, as well as causing seasonal flu in humans. Mammals in which different strains of IAV circulate with sustained transmission are bats, pigs, horses and dogs; other mammals can occasionally become infected.

<span class="mw-page-title-main">Avian influenza</span> Influenza caused by viruses adapted to birds

Avian influenza, also known as avian flu or bird flu, is a disease caused by the influenza A virus (IAV) which primarily affects birds but can sometimes affect mammals including humans. Wild aquatic birds are the primary host of Influenza A virus (IAV), which is endemic in many bird populations.

<span class="mw-page-title-main">Influenza A virus subtype H5N1</span> Subtype of influenza A virus

Influenza A virus subtype H5N1 (A/H5N1) is a subtype of the influenza A virus, which causes influenza (flu), predominantly in birds. It is enzootic in many bird populations, and also panzootic. A/H5N1 virus can also infect mammals that have been exposed to infected birds; in these cases, symptoms are frequently severe or fatal.

<span class="mw-page-title-main">Swine influenza</span> Infection caused by influenza viruses endemic to pigs

Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.

<span class="mw-page-title-main">Influenza pandemic</span> Pandemic involving influenza

An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.

Singapore has taken a series of measures against avian influenza and the potential threat of a pandemic.

<span class="mw-page-title-main">Global spread of H5N1</span> Spread of bird flu

The global spread of H5N1 influenza in birds is considered a significant pandemic threat. While other H5N1 influenza strains are known, they are significantly different on a genetic level from a highly pathogenic, emergent strain of H5N1, which was able to achieve hitherto unprecedented global spread in 2008. The H5N1 strain is a fast-mutating, highly pathogenic avian influenza virus (HPAI) found in multiple bird species. It is both epizootic and panzootic. Unless otherwise indicated, "H5N1" in this timeline refers to the 2008 highly pathogenic strain of H5N1.

<span class="mw-page-title-main">Transmission and infection of H5N1</span> Spread of an influenza virus

Transmission and infection of H5N1 from infected avian sources to humans has been a concern since the first documented case of human infection in 1997, due to the global spread of H5N1 that constitutes a pandemic threat.

<span class="mw-page-title-main">Influenza A virus subtype H5N2</span> Virus subtype

H5 N2 is a subtype of the species Influenzavirus A. The subtype infects a wide variety of birds, including chickens, ducks, turkeys, falcons, and ostriches. Affected birds usually do not appear ill, and the disease is often mild as avian influenza viral subtypes go. Some variants of the subtype are much more pathogenic than others, and outbreaks of "high-path" H5N2 result in the culling of thousands of birds in poultry farms from time to time. It appears that people who work with birds can be infected by the virus, but suffer hardly any noticeable health effects. Even people exposed to the highly pathogenic H5N2 variety that killed ostrich chicks in South Africa only seem to have developed conjunctivitis, or a perhaps a mild respiratory illness. There is no evidence of human-to-human spread of H5N2. On November 12, 2005 it was reported that a falcon was found to have H5N2. On June 5, 2024, the first confirmed human case of H5N2 was reported in Mexico.

<span class="mw-page-title-main">Social effects of H5N1</span>

The social impact of H5N1 is the effect or influence of H5N1 in human society, especially the financial, political, social, and personal responses to both actual and predicted deaths in birds, humans, and other animals. Billions of dollars are raised and spent to research H5N1 and prepare for a potential avian influenza pandemic. Over ten billion dollars were lost, and over two hundred million birds were killed to contain H5N1. People reacted by buying less chicken causing poultry sales and prices to fall. Many individuals stockpiled supplies for a possible flu pandemic.

<span class="mw-page-title-main">Global spread of H5N1 in 2006</span>

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

<span class="mw-page-title-main">Global spread of H5N1 in 2005</span> Pandemic threat

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

<span class="mw-page-title-main">Global spread of H5N1 in 2004</span>

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

<span class="mw-page-title-main">Fujian flu</span> Strains of influenza

Fujian flu refers to flu caused by either a Fujian human flu strain of the H3N2 subtype of the Influenza A virus or a Fujian bird flu strain of the H5N1 subtype of the Influenza A virus. These strains are named after Fujian, a coastal province in Southeast China.

<span class="mw-page-title-main">Human mortality from H5N1</span>

H5N1 influenza virus is a type of influenza A virus which mostly infects birds. H5N1 flu is a concern due to the its global spread that may constitute a pandemic threat. The yardstick for human mortality from H5N1 is the case-fatality rate (CFR); the ratio of the number of confirmed human deaths resulting from infection of H5N1 to the number of those confirmed cases of infection with the virus. For example, if there are 100 confirmed cases of a disease and 50 die as a consequence, then the CFR is 50%. The case fatality rate does not take into account cases of a disease which are unconfirmed or undiagnosed, perhaps because symptoms were mild and unremarkable or because of a lack of diagnostic facilities. The Infection Fatality Rate (IFR) is adjusted to allow for undiagnosed cases.

<span class="mw-page-title-main">Global spread of H5N1 in 2007</span>

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

<span class="mw-page-title-main">Influenza</span> Infectious disease

Influenza, commonly known as "the flu" or just "flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin one to four days after exposure to the virus and last for about two to eight days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia from the virus or a subsequent bacterial infection. Other complications include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

<span class="mw-page-title-main">Pandemic H1N1/09 virus</span> Virus responsible for the 2009 swine flu pandemic

The pandemic H1N1/09 virus is a swine origin influenza A virus subtype H1N1 strain that was responsible for the 2009 swine flu pandemic. This strain is often called swine flu by the public media due to the prevailing belief that it originated in pigs. The virus is believed to have originated around September 2008 in central Mexico.

<span class="mw-page-title-main">Influenza A virus subtype H7N9</span> Subtype of the influenza A virus

Influenza A virus subtype H7N9 (A/H7N9) is a bird flu strain of the species Influenza virus A. Avian influenza A H7 viruses normally circulate amongst avian populations with some variants known to occasionally infect humans. An H7N9 virus was first reported to have infected humans in March 2013, in China. Cases continued to be reported throughout April and then dropped to only a few cases during the summer months. At the closing of the year, 144 cases had been reported of which 46 had died. It is known that influenza tends to strike during the winter months, and the second wave, which began in October, was fanned by a surge in poultry production timed for Lunar New Year feasts that began at the end of January. January 2014 brought a spike in reports of illness with 96 confirmed reports of disease and 19 deaths. As of April 11, 2014, the outbreak's overall total was 419, including 7 in Hong Kong, and the unofficial number of deaths was 127.

Since 2020, global outbreaks of avian influenza subtype H5N1 have been occurring, with cases reported from every continent as of May 2024. In late 2023, H5N1 was discovered in the Antarctic for the first time, raising fears of imminent spread throughout the region, potentially leading to a "catastrophic breeding failure" among animals that had not previously been exposed to avian influenza viruses. The main virus involved in the global outbreak is classified as H5N1 clade 2.3.4.4b, however genetic diversification with other clades such as 2.3.2.1c has seen the virus evolve in ability to cause significant outbreaks in a broader range of species including mammals.

References

  1. "Disease Surveillance". The Task Force for Global Health. Retrieved 2020-11-08.
  2. 1 2 "WHO Chronology of SARS". Archived from the original on 2004-02-23.
  3. "About WHO". www.who.int. Retrieved 2022-04-13.
  4. "WHO Influenza". Archived from the original on 2004-02-01.
  5. "WHO EPR". Archived from the original on 2003-02-23.
  6. "WHO Outbreak Network". Archived from the original on 2003-08-08.
  7. "WHO: H5N1 avian flu timeline" (PDF). Archived from the original (PDF) on 2011-07-27.
  8. "WHO: Cases by country". Archived from the original on 2006-02-13.
  9. "WHO: Influenza A(H5N1) in Hong Kong Special Administrative Region of China – Update 2". Archived from the original on 2003-08-22.
  10. "WHO: Update 95 - SARS: Chronology of a serial killer". Archived from the original on 2003-07-09.
  11. "White House says no 'surprise' bills for COVID-19 patients". ABC News . AP. 2006-05-07.
  12. "NYT article picked up by IHT".
  13. "Scientific Seminar on Avian Influenza, the Environment and Migratory Birds on 10–11 April 2006". International Institute for Sustainable Development (IISD). 2006-04-14.
  14. "new US government Web site". Archived from the original on 2006-09-28.
  15. "New Web tool tracks H5N1 testing of US wild birds". CIDRAP News. 2006-08-25.

Further reading