Abstract
BackgroundThe 2009 H1N1 outbreak provides an opportunity to learn about the strengths and weaknesses of current U.S. public health surveillance systems and to identify implications for measuring public health emergency preparedness.Methodology/Principal FindingsWe adopted a “triangulation” approach in which multiple contemporary data sources, each with different expected biases, are compared to identify time patterns that are likely to reflect biases versus those that are more likely to be indicative of actual infection rates. This approach is grounded in the understanding that surveillance data are the result of a series of decisions made by patients, health care providers, and public health professionals about seeking and providing health care and about reporting cases to health authorities. Although limited by the lack of a gold standard, this analysis suggests that children and young adults are over-represented in many pH1N1 surveillance systems, especially in the spring wave. In addition, the nearly two-month delay between the Northeast and the South in the Fall peak in some surveillance data seems to at least partially reflect regional differences in concerns about pH1N1rather than real differences in pH1N1 infection rates.Conclusions/SignificanceAlthough the extent of the biases suggested by this analysis cannot be known precisely, the analysis identifies underlying problems with surveillance systems – in particular their dependence on patient and provider behavior, which is influenced by a changing information environment – that could limit situational awareness in future public health emergencies. To improve situational awareness in future health emergencies, population-based surveillance systems such as telephone surveys of representative population samples and seroprevalence surveys in well-defined population cohorts are needed.
Highlights
The 2009 H1N1 outbreak provides an opportunity to learn about the strengths and weaknesses of current U.S public health surveillance systems and to identify implications for measuring public health emergency preparedness
Conclusions/Significance: the extent of the biases suggested by this analysis cannot be known precisely, the analysis identifies underlying problems with surveillance systems – in particular their dependence on patient and provider behavior, which is influenced by a changing information environment – that could limit situational awareness in future public health emergencies
Two-thirds are younger than 18.’’ [7] an August 2009 PCAST report said that confirmed cases were concentrated in younger age groups, up to age 24, almost all severe cases were in people younger than age 65, and the consequences of infection in this epidemic were already known to be far more severe for children and young adults, and seemingly milder for people over age 65 [3]
Summary
The 2009 H1N1 outbreak provides an opportunity to learn about the strengths and weaknesses of current U.S public health surveillance systems and to identify implications for measuring public health emergency preparedness. We address the widely-held perception that children and young adults were at ‘‘higher risk.’’ Second, we assess the validity and utility of syndromic surveillance systems that were promoted by the President’s Council of Advisors on Science and Technology (PCAST) [3] and other authorities. Both of these questions relate to the ability of public health surveillance systems to provide ‘‘situational awareness,’’ critical information needed to respond to disease outbreaks and other public health emergencies. This includes numbers of cases and other traditional surveillance data as well as information on critical response resources, medical care capacity, environmental threats, and public awareness [6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
