Information technology for surveillance

Can information tools improve surveillance?

Denis CoulombierECDC

New information technologiesThe technology paradox

• A new technology may have a negative

impact on productivity if used without a change of approach

• New technologies require a change of practices to give their full benefit

The technology paradoxExamples

Pre computer ages

The technology paradoxHow it applies to information?Epiinfo 1, 1985 Epiinfo 2/3, 1987 Epiinfo 6, 1994

From data compilation … to decision-making

Information technologies anddata collection

• Benefit– Computerised data entry– Fast data transfer– Structured data

• Prerequisites– Case definitions– Appropriate data models

Information technologies anddata analysis

• Benefits– Fast compilation– Computation of indicators (rates,

standardized rates…)– Thresholds

• Prerequisites– Appropriate hypotheses– Defined plan of analysis

Information technologies anddata presentation

• Benefits– Tables, maps and charts– Automated reports

• Prerequisites– A guide to data review – A decision-making approach

The Serbia Alert Project

• March 2003– Request to WHO to computerised the early

warning system– 73 diseases under mandatory notification– 20 agegroups– Monthly aggregation at national level– No computerized analysis

The Serbia Alert Project

• May 2003: in-depth assessment– Need for prioritization of CD under early

warning surveillance: workshop– Need for syndromic case definitions– Need for guidelines on investigation and

control measures– Need for change in surveillance

regulations

The Serbia Alert Project Strengthening Strategy

A structured and integrated approach to epidemiologicalsurveillance and response strengthening

Prioritization

ImplementationIn-depth

assessment

Monitoring andevaluation

Plan of action

Risk assessment

The Serbia Alert Project Risk Assessment

• Public health risks change over time• Emerging and re-emerging diseases• Changes in epidemiological profile• New strains (meningitis W135)• Antibiotic resistance• Advanced technology, improved knowledge• New vaccines, control programmes• Demographic changes• Environmental changes

Output: risk assessment fact sheets

Risk Assessment Fact Sheets

Present burden of disease Severity Potential threat Health gain opportunity

Need for immediate public health response

Effect of public health activities

on incidence

Social and economic impact

Anthrax Unknown Incidence. Cutaneous form

rarely life-threatening with appropriate treatment. High case-fatality rate for inhalational and gastrointestinal forms.

Spores may persist in the environment for many years and cause periodic localized outbreaks. Potential Bioterrorism agent.

Early detection with appropriate treatment reduces severity. Clinical education for detection and treatment possible.

No risk of person-to-person spread but immediate public health response required to assess exposures and environmental control measures.

Vaccination not indicated.

Unknown. Presumed high economic impact of zoonotic outbreak. Presume very high impact if bioterrorism related.

Brucellosis Unknown Incidence in humans. Assumed enzoonotic infection in Asia as in many parts of the world. Animal reservoirs cattle, swine, goats and sheep. Occupational risk for workers with infected animals. Also consumption of unpasteurised milk and dairy products.

Systemic bacterial infection associated with fever with involvement of joints and various organs. CFR ~2% without treatment due to endocarditis.

Cause of sporadic cases and outbreaks worldwide.

Difficult to assess without data.

Routine response.

Successfully controlled in countries using pasteurization of milk products, occupational IEC strategies, and infected animal identification and control.

Difficult to assess without data.

Prioritization of Communicable Diseases

• Changing risks and priorities• Limited human and financial resources• Priority to diseases of public health importance• Short list of diseases for efficiency• Consensus process• 3 day workshop

Output: list of priorities for surveillance and EWARS

PrioritizationReaching a Consensus on Priorities

Results Communicable Diseases prioritisation exercise (26 participants), Cambodia, 4 Dec 2004

0

5

10

15

20

25

30

35

40

45

HIV

SA

RS

De

ng

ue

fev

er

Tu

be

rcu

los

is

Ch

ole

ra

Ma

laria

Po

lio

He

pa

titis B

Me

as

les

Ra

bie

s

NN

teta

nu

s

Dip

hth

eria

He

pa

titis C

J. e

nc

ep

ha

litis

Pe

rtus

sis

Ty

ph

oid

Dy

se

nte

ria

Ba

ct. M

en

ing

itis

Le

pro

sy

Sy

ph

illis

Vira

l me

nin

gitis

Pla

gu

e

An

thra

x

He

pa

titis A

Sa

lmo

ne

lla

Fila

rias

is

Ru

be

lla

Sc

his

tos

om

ias

is

He

lmin

thia

sis

Clu

ste

r of c

as

es

Ha

em

op

hilu

s

Ye

llow

fev

er

Influ

en

za

Le

pto

sp

ira

VH

F E

bo

la

Bru

ce

llos

is

Ty

ph

us

Diseases

Sc

ore

Median score 3rd quartile 1st quartile

Assessing National Capacities for Surveillance and Response

In-depth assessment helps to identify

• Strengths and weaknesses of a system • Meeting the priorities identified• Areas for improved coordination• Areas for integration• Ways for improvement• Baseline information

to allow measurement of progress

Output: assessment report and recommendations

:

Development of National Surveillance PoA

• Objective: Effective national multi-diseases (integrated) system with an early warning component

• Involvement of key stakeholders in surveillance

• Ensuring coordination

• Prioritized strategic plan (3-5 years) with annual operational plans

• Costing and identification of funding source

Output: a framework in which donors and partners can buy in

Implementation of EWARS

• Prerequisites to implementation of EWARS

• Defining functional specifications: EWARS core functions

• Defining technical specifications: EWARS support functions

• Defining the implementation plan• Implementing EWARS

Output: an efficient early warning system

WHO Guidelines on Implementation

of National Early Warning

and Response SystemsEWARS

June 2004

Reporting districts by WeekEarly Warning System in Albania, 2000

Conclusion

• Information technologies are just tools!

• If not part of a strengthening process, they will fail in improving the early warning function

• Monitoring and evaluation is required