Reporting disease cases
Encyclopedia
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 our knowledge as to what factors might contribute to such circumstances. A key part of modern disease surveillance is the practice of disease case reporting.
In modern times, reporting incidences of disease outbreaks has been transformed from manual record keeping to instant world wide internet communication.
The number of cases could be gathered from hospitals - who could 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 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.
. 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.
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. Beginning in January, 2004, the WHO
has produced similar updates for H5N1
. These results are widely reported
and closely watched.
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:
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.
. 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:
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. (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. Dr. 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."
Dr. David Nabarro
, chief avian flu coordinator for the United Nations
, says avian flu has too many unanswered questions.
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."
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
practice by which the spread of disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
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
Outbreak
Outbreak is a term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected at 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...
, epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
, and pandemic
Pandemic
A pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic...
situations, as well as increase our knowledge as to what factors might contribute to such circumstances. A key part of modern disease surveillance is the practice of disease case reporting.
In modern times, reporting incidences of disease outbreaks has been transformed from manual record keeping to instant world wide internet communication.
The number of cases could be gathered from hospitals - who could 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
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) and the Centers for Disease Control 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.
Mandatory reporting
Infectious diseases reporting is a requirement placed upon health care providers by many regional and national governments, and upon national governments by the World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
. Since 1969, WHO has required that all cases of the following diseases be reported to the organization: cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
, plague
Bubonic plague
Plague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...
, yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
, smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
, relapsing fever
Relapsing fever
Relapsing fever is an infection caused by certain bacteria in the genus Borrelia. It is a vector-borne disease that is transmitted through the bites of lice or soft-bodied ticks.-Louse-borne relapsing fever:...
and typhus
Typhus
Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters...
. 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
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, botulism
Botulism
Botulism also known as botulinus intoxication is a rare but serious paralytic illness caused by botulinum toxin which is metabolic waste produced under anaerobic conditions by the bacterium Clostridium botulinum, and affecting a wide range of mammals, birds and fish...
, hantavirus
Hantavirus
Hantaviruses are negative sense RNA viruses in the Bunyaviridae family. Humans may be infected with hantaviruses through rodent bites, urine, saliva or contact with rodent waste products...
, anthrax
Anthrax
Anthrax is an acute disease caused by the bacterium Bacillus anthracis. Most forms of the disease are lethal, and it affects both humans and other animals...
, and rabies
Rabies
Rabies is a viral disease that causes acute encephalitis in warm-blooded animals. It is zoonotic , most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms...
are examples of such diseases.
World Health Organization
The World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
is the lead agency for coordinating global response to major diseases. The WHO
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
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
Beijing
Beijing , also known as Peking , is the capital of the People's Republic of China and one of the most populous cities in the world, with a population of 19,612,368 as of 2010. The city is the country's political, cultural, and educational center, and home to the headquarters for most of China's...
staff of the WHO
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
produced updates every few days for the duration of the outbreak. Beginning in January, 2004, the WHO
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
has produced similar updates for H5N1
H5N1
Influenza A virus subtype H5N1, also known as "bird flu", A or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species...
. These results are widely reported
Global spread of H5N1
The global spread of highly pathogenic H5N1 influenza in birds is considered a significant pandemic threat.While other H5N1 influenza strains are known, they are significantly different from a current, highly pathogenic H5N1 strain on a genetic level, making the global spread of this new strain...
and closely watched.
WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
'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:
- AnthraxAnthraxAnthrax is an acute disease caused by the bacterium Bacillus anthracis. Most forms of the disease are lethal, and it affects both humans and other animals...
- Avian influenza
- Crimean-Congo hemorrhagic feverCrimean-Congo hemorrhagic feverCrimean–Congo hemorrhagic fever is a widespread tick-borne viral disease, a zoonosis of domestic animals and wild animals, that may affect humans. The pathogenic virus, especially common in East and West Africa, is a member of the Bunyaviridae family of RNA viruses. Clinical disease is rare in...
- Dengue hemorrhagic fever
- Ebola hemorrhagic fever
- HepatitisHepatitisHepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
- InfluenzaInfluenzaInfluenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
- Lassa feverLassa feverLassa fever is an acute viral hemorrhagic fever caused by the Lassa virus and first described in 1969 in the town of Lassa, in Borno State, Nigeria, in the Yedseram river valley at the south end of Lake Chad. Clinical cases of the disease had been known for over a decade but had not been connected...
- Marburg hemorrhagic feverMarburg virusMarburg virus disease is the name for the human disease caused by any of the two marburgviruses Marburg virus and Ravn virus...
- Meningococcal disease
- PlagueBubonic plaguePlague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...
- Rift Valley feverRift Valley feverRift Valley Fever is a viral zoonosis causing fever. It is spread by the bite of infected mosquitoes, typically the Aedes or Culex genera. The disease is caused by the RVF virus, a member of the genus Phlebovirus...
- Severe Acute Respiratory SyndromeSevere acute respiratory syndromeSevere Acute Respiratory Syndrome is a respiratory disease in humans which is caused by the SARS coronavirus . Between November 2002 and July 2003 an outbreak of SARS in Hong Kong nearly became a pandemic, with 8,422 cases and 916 deaths worldwide according to the WHO...
- SmallpoxSmallpoxSmallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
- Tularaemia
- Yellow feverYellow feverYellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
Political challenges
As the lead organization in global public health, the WHOWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
occupies a delicate role in global politics
Global politics
Global politics is the discipline that studies the political and economical patterns of the world. It studies the relationships between cities, nation-states, shell-states, multinational corporations, non-governmental organizations and international organizations.It has been argued that global...
. 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
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
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.
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)H5N1
Influenza A virus subtype H5N1, also known as "bird flu", A or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species...
. 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
H5N1
Influenza A virus subtype H5N1, also known as "bird flu", A or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species...
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:
- Surveillance of wild bird populations
- Cell cultures of particular strains of diseases
H5N1
Surveillance of H5N1H5N1
Influenza A virus subtype H5N1, also known as "bird flu", A or simply H5N1, is a subtype of the influenza A virus which can cause illness in humans and many other animal species...
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. (See Disease surveillance in China
Disease surveillance in China
Surveillance for communicable diseases is the main public health surveillance activity in China. Currently, the disease surveillance system in China has three major components:...
.)
"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. Dr. 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."
Dr. David Nabarro
David Nabarro
Dr. David Nabarro , works as the Senior UN System Coordinator for Avian and Human Influenza at United Nations Headquarters in New York. He has been seconded to this position from the World Health Organization.-Biography:...
, chief avian flu coordinator for the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
, says avian flu has too many unanswered questions.
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."
See also
- 1985 World Health Organization AIDS surveillance case definition1985 World Health Organization AIDS surveillance case definitionThe 1985 World Health Organization AIDS surveillance case definition was developed in October 1985, at a conference of public health officials including representatives of the Centers for Disease Control and World Health Organization in Bangui, Central African Republic. For this reason, it became...
- AIDS defining clinical conditionAIDS defining clinical conditionAIDS defining clinical conditions is the terminology given to a list of diseases published by the United States government run Centers for Disease Control and Prevention . This list governs the U.S. government classification of HIV disease...
- Clinical surveillanceClinical surveillanceClinical surveillance refers to the surveillance of health data about a clinical syndrome that has a significant impact on public health, which is then used to drive decisions about health policy and health education...
- Council of State and Territorial EpidemiologistsCouncil of State and Territorial EpidemiologistsThe Council of State and Territorial Epidemiologists was organized in the USA in the early 1950s in response to the need to have at least one person in each state and territory responsible for public health surveillance of diseases and conditions of public health significance. Since then, CSTE has...
- EWRSEWRSThe Early Warning and Response System for communicable diseases in the European Union was created by the European Commission to "ensure a rapid and effective response by the EU to events related to communicable diseases"...
- GIDEON-Global Infectious Disease Epidemiology NetworkGIDEON-Global Infectious Disease Epidemiology NetworkGlobal Infectious Diseases Epidemiology Network is a web-based program for decision support and informatics in the fields of Infectious Diseases and Geographic Medicine. As of 2005, more than 300 generic infectious diseases occur haphazardly in time and space and are challenged by over 250 drugs...
- Infection controlInfection controlInfection control is the discipline concerned with preventing nosocomial or healthcare-associated infection, a practical sub-discipline of epidemiology. It is an essential, though often under-recognized and under-supported, part of the infrastructure of health care...
- List of notifiable diseases
- STD testing
- UK statutory notification systemUK statutory notification systemThe UK statutory notification system for infectious diseases is a system whereby doctors are required to notify a "Proper Officer" of the local authority if they are presented with a case of a serious infectious disease such as diphtheria or measles...
Further reading
- CDC - Update: Influenza Activity --- United States and Worldwide, 2003--04 Season, and Composition of the 2004--05 Influenza Vaccine
- Global Outbreak Alert & Response Network
- WHO Alert & Response Operations
- WHO Severe Acute Respiratory Syndrome Web site
- WHO Avian Influenza Web site
- HealthMap The HealthMap real-time automated surveillance system is a program of Children's Hospital Boston with support from Google.org
- ProMED-mail The global electronic reporting system for outbreaks of emerging infectious diseases & toxins, open to all sources. ProMED-mailProMED-mailThe Program for Monitoring Emerging Diseases is among the largest of publicly available emerging disease and outbreak reporting systems in the world....
, the Program for Monitoring Emerging Diseases, is a program of the International Society for Infectious Diseases with the support and encouragement of the Federation of American ScientistsFederation of American ScientistsThe Federation of American Scientists is a nonpartisan, 501 organization intent on using science and scientific analysis to attempt make the world more secure. FAS was founded in 1945 by scientists who worked on the Manhattan Project to develop the first atomic bombs...
and SatelLife. http://www.cdc.gov/ncidod/eid/vol7no3_supp/woodall.htm http://www.isid.org/