SEARO –CSR Early Warning and Surveillance System Module Prioritization in EWAR Methodology and Objectives

E P I D E M I C A L E R T A N D R E S P O N S E SEARO –CSR Early Warning and Surveillance System Module

Prioritization in EWAR

Methodology and Objectives


Objectives of this lecture

• To describe the rationale of prioritizing

diseases for EWAR

• To define the methodology of prioritization

• To give an example of how prioritization is

carried out by WHO


Prioritization

Rationale

Methodology

Prioritizationexercise

Determining priorities is a process of

assessing the relative importance

or value of alternative concerns.


Rationale

Methodology


Human and financial resources are limited

Public health risks change

over time

International context

Too many

diseases

impair

surveillance

Prioritization


Past experiences

Rationale

Methodology


•All countries should review their list of priority

diseases for surveillance periodically,

•Adaptation of the Delphi

method using workshops

and combinations of

e-mail/mail and workshop

sessions.


Prioritization Criteria1. Present burden of disease2. Case fatality ratio3. Epidemic potential4. Potential threat/emergence/changing

pattern5. Health gain opportunity

through public health activities6. Social and economic impact7. International regulations or

programmes for surveillance and control

8. Public perception

Rationale

Methodology



WHO-proposed adaptation of the Delphi method

Rationale

Methodology


a Steering Committee formulates a list of diseases,

and criteria to include/exclude diseases for surveillance

a Steering Committee formulates a list of diseases,

and criteria to include/exclude diseases for surveillance

list is presented in a workshop to a group of

key people involved in surveillance

list is presented in a workshop to a group of

key people involved in surveillance

Each participant scores the diseases against

the criteria

Each participant scores the diseases against

the criteria

A summary of results is used to assess with statistical parameters

group agreement

A summary of results is used to assess with statistical parameters

group agreement

Results are discussed in plenary and, if the group feels that there is not enough agreement,

a second round of scoring can be undertaken

Results are discussed in plenary and, if the group feels that there is not enough agreement,

a second round of scoring can be undertaken


Steps in the WHO Prioritization exercise

• 1st step: Appointment steering

committee

• 2nd step: Preparation

• 3rd step: Prioritization workshop

• 4th step: Postworkshop activities

Rationale

Methodology



1st step: Appointment steering committee

• Suggested 8-12 members.– ministry of health executive director– head of the surveillance

department/unit– heads of ministry of health or other

ministry departments involved in surveillance

– WHO representative and/or other international partners

– other relevant partners.

Rationale

Methodology



Tasks

Agree on the objective and approach

Rationale

Methodology



2nd step: Preparation of prioritization exercise

• Agreeing the approach for the

prioritization exercise

• Planning the implementation

• Preparing the score sheet

• Preparing the disease fact sheet

• Inviting the participants

Rationale

Methodology



Example of score sheet for participants

Rationale

Methodology


Disease Burden CFR Epidemic potential

Potential threat

Effect PH

activities

Social &

economic

IHRPublic

perception

Anthrax

Brucella

Cholera

Dengue

Diphtheria

JE

Hepatitis A


Step 3: Prioritization workshop

• Introduction to the workshop• Discussion and clarification of the

criteria and the disease list• First round of scoring• Ranking and summary of the results

– For each disease, sum of raw scores (criteria)

– Each disease has a total score => ranking of disease

– To show degree of consensus: median score, inter-quartile range

Rationale

Methodology



Example of scoring results

Rationale

Methodology



Step 3: Prioritization workshop

• Feedback and discussion

• Second (and subsequent rounds) of scoring

• Presentation of results

Rationale

Methodology



Step 4: Post-workshop activities

• Report writing

• Report on prioritization to health authorities

Rationale

Methodology



Next steps after prioritization

• To strengthen surveillance and response

activities

FOCUS should be on TOP priority

diseases.

• No real cut-off point: number of diseases

under surveillance adapted to needs and

resources

Rationale

Methodology




• Low scoring diseases

– consider discontinuing surveillance efforts

– review surveillance objectives

– look for alternative ways to get

information

Rationale

Methodology




• Priority diseases not under surveillance

• Priority diseases already under

surveillance

• For each priority disease, revise

– Lab capacity

– Training needs

– Guidelines

Rationale

Methodology



References• WHO guidelines. Setting priorities in communicable disease surveillance

WHO/CDS/EPR/LYO/2006.3 • Fink A, Kosecoff J, Chassin M, Brook R. Consensus methods: characteristics,

and guidelines for use. American Journal of Public Health Medicine, 1984, 74:979–983.

• Carter A. Establishing goals, techniques and priorities for national communicable disease surveillance. Canadian Journal of Infectious Disease, 1991, 2:37–40.

• Doherty J. Establishing priorities for national communicable disease surveillance. Canadian Journal of Infectious Disease, 2000, 11:21–24.

• Horby P, Rushdy A, Graham C, O'Mahony M. PHLS overview of communicable diseases 1999. Communicable Disease and Public Health, 2001, 4:8–17.

• Hubert B, Haury B. Orientations pour la révision des modalités de surveillance des maladies transmissibles en France. Bulletin Epidémiologique Hebdomadaire, 1996,

• Rushdy A, O'Mahony M. PHLS overview of communicable diseases 1997: results of a priority setting exercise. Communicable Disease Report, 1998, 8:1–12.

• Valenciano M. Définition des priorités dans le domaine des zoonoses non alimentaires 2000-2001. Institut de Veille Sanitaire, 2002 (http://www.invs.sante.fr/publications/2002/def_priorite_zoonoses)

• Weinberg J, Grimaud O, Newton L. Establishing priorities for European collaboration in communicable disease surveillance. European Journal of Public Health, 1999, 9:236–240.


Question Time

1. Why should the prioritization exercise be conducted?

2. Do you agree with the WHO approach to prioritization?

Documents

SEARO –CSR Early Warning and Surveillance System Module Prioritization in EWAR Methodology and Objectives