Public Health Surveillance in a changing world

1. Public Health Surveillance in a changing world IANPHI 7th Annual Meeting Jaime Sepulveda October 1, 2012

2. Content • Definitions and lexicon • History of surveillance • Conceptual framework • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

3. Definitions • Public health surveillance is the systematic, ongoing collection, management, analysis, and interpretation of data followed by the dissemination of these data to public health programs to stimulate public health action • Source: Thacker

4. Definitions • Passive surveillance: a system by which a health jurisdiction receives reports submitted from hospitals, clinics, public health units • Active surveillance: a system employing staff members to regularly contact heath care providers or the population to seek information about health conditions. • Syndromic surveillance: an active or passive system that uses case definitions that are based entirely on clinical features without any clinical or laboratory diagnosis • Behavioral risk factor surveillance system (BRFSS): an active system of repeated surveys that measure behaviors that are known to cause disease or injury Source: DCP2

5. Content • Definitions and lexicon • History of surveillance • Conceptual framework • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

6. History of PHS • England--John Graunt and William Petty (XVII Century) • France—Comites de SantePublique • USA—in 1741, the colony passed an act requiring tavern keepers to report contagious diseases among their patrons. Two years later, the colony passed a broader law requiring the reporting of smallpox, yellow fever, and cholera • In 1893, Michigan became the first jurisdiction to require the reporting of specific infectious diseases. Also in 1893, a law was enacted to provide for collecting information each week from state and municipal authorities throughout the United States.

7. History of PHS • In 1951, Langmuir established the Epidemic Intelligence Service (EIS), which provided a unique approach to training men and women in applied epidemiology. • The program has trained approximately 3,000 epidemiologists during the past six decades in the principles and practice of public health surveillance. • It is now emulated as Field Epidemiology Training Programs in approximately 30 countries around the world Source: Thacker

8. CDC Leadership • Surveillance concept evolution • Alexander Langmuir • Steve Thacker • Leadership • Bill Foege • Jim Mason • Bill Roper • David Satcher • Jeff Koplan

9. PHS in Europe

10. Content • Definitions and lexicon • History of surveillance • Conceptual framework • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

11. Disclosure: Some of my comments here are based on a Paper prepared for the 1992 International Symposium on Public Health Surveillance, Carter Center, Atlanta, April 22-24, 1992 “Key issues in Public Health Surveillance for the 1990”s” Authors: Sepulveda, Frenk, Gomez de Leon et al

19. Six PHS needs “To advance public health surveillance in the 21st century, at least six major concerns must be addressed by the public health community: • a common lexicon; • global surveillance needs; • informatics, including information technology; • a skilled workforce; • data access and use; • and data management, storage and analysis. “ Source: Thacker MMWR 2012

20. Global Infectious Disease Surveillance Frameworks

25. Content • Definitions and lexicon • Conceptual framework • History of surveillance • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

26. International Health Regulations • WHO/IHR 1969, 1973, 1981 • Focused only on Cholera, Plague, Yellow Fever • Revised WHO/IHR in 2005 • Includes more conditions (Polio, SARS, new Influenza, viral hemorrhagic fevers • Legally binding • Syndromic surveillance

28. Content • Definitions and lexicon • Conceptual framework • History of surveillance • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

29. PHS in Mexico

30. Human Capacity Building in Public Health. The Mexico Case, 1984-2005 Mexican SPH Strengthening CEPH Accreditation International PH graduate Training strategy First Mexican Public Health Doctorate Program Summer Public Health Course (JHSPH) FETP Program (CDC) Field Epidemiology Training Program • 1985 1990 1995 2000 2005

31. Influence of DGE • 4 Vice-Ministers of Health • 3 DG of INSP (NIPH) • NHI Director • High level offices at MoH • Private and philanthropic sectors

32. Content • Definitions and lexicon • Conceptual framework • History of surveillance • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

33. New tools for PHS • Use of Cell phones • Health Map • Google Flu (local news and rumors) • Electronic Medical Records • Gaming

34. UC-Berkeley Social Apps Lab presents: DENGUE TORPEDO Combining mobile technology and gaming to motivate active community involvement in fighting the dengue disease (C) 2011 Regents of California and Social Apps Lab at CITRIS

35. Content • Definitions and lexicon • History of surveillance • Conceptual framework • IHR 2005 • The case of PHS in Mexico • New tools for rapid detection • Questions for discussion

36. Questions for discussion • More and better FETP’s? Other capacity building approaches? • Evaluation/Certification of PHS programs? • What are the lessons learned from H1N1 pandemic? • Is South-South partnership possible? • Where is funding coming from?