Comprehensive Surveillance System Research Articles

Tuberculosis and HIV/AIDS-attributed mortalities and associated sociodemographic factors in Papua New Guinea: evidence from the comprehensive health and epidemiological surveillance system

ObjectiveTuberculosis (TB) and HIV/AIDS are public health concerns in Papua New Guinea (PNG). This study examines TB and HIV/AIDS mortalities and associated sociodemographic factors in PNG.MethodAs part of a longitudinal...

A Feasible Methodological Approach to Estimate the Burden of Autism Spectrum Disorder: Results from the EPI-ASD Study in the Province of Lecce (Southern Italy).

Diagnoses of Autism Spectrum Disorder (ASD) have rapidly increased globally. However, the lack of comprehensive epidemiological surveys and surveillance systems, able to provide official data at a national or European level is one of the main issues in the monitoring of this condition. The present study aimed to estimate the prevalence of ASD in children and adolescents aged 3–18 years old living in the province of Lecce (Southern Italy) through official data provided by the Local Health Authority of Lecce (ASL/LE) up to 31 October 2020, and compare it with school-based data concerning the number of students needing support for ASD. Based on data provided by the ASL/LE, in 2020 there were 509 cases of ASD among children and adolescents aged 3–18 years old, corresponding to a prevalence of 0.46%. A total of 408 (80.2%) were boys and 101 (19.8%) were girls. In relation to their age, 155 ASD cases (0.90%) were diagnosed in the 3–5 age group, while 222 (0.55%) in the 6–11 age group and 132 (0.25%) in the 12–18 age group. Prevalence of ASD assessed by school-based dataset was underestimated in the 3–5 age group, while the 6–11 and 12–18 age groups were consistent with the official data provided by the ASL/LE.

A Proactive Recognition System for Detecting Commercial Vehicle Driver’s Distracted Behavior

Road traffic accidents regarding commercial vehicles have been demonstrated as an important culprit restricting the steady development of the social economy, which are closely related to the distracted behavior of drivers. However, the existing driver’s distracted behavior surveillance systems for monitoring and preventing the distracted behavior of drivers still have some shortcomings such as fewer recognition objects and scenarios. This study aims to provide a more comprehensive methodological framework to demonstrate the significance of enlarging the recognition objects, scenarios and types of the existing driver’s distracted behavior recognition systems. The driver’s posture characteristics were primarily analyzed to provide the basis of the subsequent modeling. Five CNN sub-models were established for different posture categories and to improve the efficiency of recognition, accompanied by a holistic multi-cascaded CNN framework. To suggest the best model, image data sets of commercial vehicle driver postures including 117,410 daytime images and 60,480 night images were trained and tested. The findings demonstrate that compared to the non-cascaded models, both daytime and night cascaded models show better performance. Besides, the night models exhibit worse accuracy and better speed relative to their daytime model counterparts for both non-cascaded and cascaded models. This study could be used to develop countermeasures to improve driver safety and provide helpful information for the design of the driver’s real-time monitoring and warning system as well as the automatic driving system. Future research could be implemented to combine the vehicle state parameters with the driver’s microscopic behavior to establish a more comprehensive proactive surveillance system.

Vaccination

Vaccination

Leveraging Experience From Active TB Drug-Safety Monitoring and Management for Monitoring Active Antiretroviral Toxicity.

<h3>Key Messages</h3> The introduction of novel medicines and regimens for antiretroviral (ARV) and TB treatment requires comprehensive surveillance systems for adverse events and adverse drug reactions. Many TB programs have introduced and institutionalized active drug safety monitoring and management (aDSM) platforms for drug-resistant TB. Because HIV programs must develop active ARV toxicity monitoring systems to ensure safe global scale-up of newer regimens, such as tenofovir-lamivudine-dolutegravir, we propose building on existing aDSM infrastructure to actively monitor ARV regimens as a synergistic TB/HIV collaborative activity and to narrow active toxicity monitoring gaps.

WHO method for estimating congenital syphilis to inform surveillance and service provision, Paraguay.

ProblemIn Paraguay, incomplete surveillance data resulted in the burden of congenital syphilis being underestimated, which, in turn, led to missed opportunities for infant diagnosis and treatment.ApproachThe prevalence of congenital syphilis, as defined by the World Health Organization (WHO), was estimated for Paraguay using the WHO congenital syphilis estimation tool. This tool was also used to monitor progress towards the elimination of mother-to-child transmission of syphilis.Local settingThe burden of syphilis in Paraguay has historically been high: its prevalence in pregnant women was estimated to be 3% in 2018.Relevant changesThe incidence rate of congenital syphilis estimated using the WHO tool was around nine times the reported prevalence. Subsequently, Paraguay: (i) provided training to improve diagnosis and case reporting; (ii) strengthened information systems for case monitoring and reporting; and (iii) procured additional rapid dual HIV–syphilis and rapid plasma reagin tests to increase syphilis testing capacity. In addition, the Ministry of Health prepared a new national plan for eliminating mother-to-child transmission of syphilis, with clear monitoring milestones.Lessons learntHealth-care providers’ reporting and surveillance procedures for congenital syphilis may not adequately reflect national and international case definitions. Use of the WHO congenital syphilis estimation tool in Paraguay drew attention to congenital syphilis as a national public health problem and highlighted the importance of comprehensive national surveillance systems and accurate data. Ongoing use of the WHO tool can track progress towards the elimination of mother-to-child transmission of syphilis by helping improve syphilis service coverage and national surveillance.

Mental Health Surveillance Among Children - United States, 2013-2019.

SummaryMental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children’s mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children’s mental health, particularly mental disorders. The 2013–2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3–17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%–9.8%) children. Among children and adolescents aged 12–17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10–19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3–17 years, 9.6%–10.1% had received mental health services, and 7.8% of all children and adolescents aged 3–17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12–17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children’s mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

The role of high-risk geographies in the perpetuation of the HIV epidemic in rural South Africa: A spatial molecular epidemiology study.

In this study, we hypothesize that HIV geographical clusters (geospatial areas with significantly higher numbers of HIV positive individuals) can behave as the highly connected nodes in the transmission network. Using data come from one of the most comprehensive demographic surveillance systems in Africa, we found that more than 70% of the HIV transmission links identified were directly connected to an HIV geographical cluster located in a peri-urban area. Moreover, we identified a single central large community of highly connected nodes located within the HIV cluster. This module was composed by nodes highly connected among them, forming a central structure of the network that was also connected with the small sparser modules located outside of the HIV geographical cluster. Our study supports the evidence of the high level of connectivity between HIV geographical high-risk populations and the entire community.

Developing a Case Investigation and Contact-Tracing System in Puerto Rico, 2020.

We present a record of events that led to the creation of the Puerto Rico Case Investigation and Contact-Tracing System (CICTS) to monitor and control the spread of severe acute respiratory syndrome coronavirus 2 in Puerto Rico. The development of the CICTS is a significant step toward establishing a comprehensive infectious disease surveillance system in Puerto Rico. Furthering the development of a CICTS infrastructure is critical in the response against future emerging infectious diseases in the region. (Am J Public Health. 2022;112(2):223-226. https://doi.org/10.2105/AJPH.2021.306584).

Evaluation of the diagnostic capacities for emerging arboviral diseases in the international network MediLabSecure from 2014 to 2018 - Importance of external quality assessments

BackgroundEmerging infectious diseases pose an increasing threat to all nations around the world, including to developed countries. By definition, because they are rare or unknown, public health systems are not well prepared against these emerging diseases. To be fully prepared, countries must have implemented surveillance systems to monitor rare or unusual sanitary events. MethodsThe capacity of diagnostic laboratories is a key component of surveillance systems since they are in charge of identifying the pathogens responsible for outbreaks in a timely manner. The MediLabSecure project aims at implementing a comprehensive surveillance system for vector-borne diseases around the Mediterranean and Black Sea regions. From 2014 to 2018, the human-virology group of MediLabSecure notably supported the implementation of molecular diagnostic capacities for eight arboviruses and one coronavirus in 19 laboratories of its network through sharing of protocols and reagents, and technical training of the scientific staff of beneficiary laboratories. ResultsWe report the results of External Quality Assessments for four of these viruses to assess the efficiency of the diagnostic for these threats emerging in the geographic area. The results for these EQA demonstrate the success of the project in the implementation of diagnostic technics for the identification of Dengue, Chikungunya, Zika, and West Niles viruses in laboratories that did not have the capacity before. However, results also show that some work is still to be done to strengthen the newly acquired capacity. ConclusionThe MediLabSecure project deployed an effort to build an efficient capacity in identifying and survey the emergence of arboviruses in the Mediterranean area. Diagnostic technics were successfully implemented in many of the laboratories of the network, but the effort must be maintained over time to strengthen these capacities.

1.M. Workshop: Protecting and preparing healthcare workers: what to learn from COVID-19 to strengthen resilience?

BackgroundThis workshop is dedicated to the WHO International Year of Health and Care Workers in 2021 in recognition of their commitment during the COVID-19 pandemic. During the first wave of the pandemic healthcare workers were lionised, yet societies' and health policymakers' appreciation of their new ‘heroes' was decreasing when corona fatigue was increasing. Health systems and policymakers have not fully understood the new emergent threats during the COVID-19 pandemic. Health workforce protection and pandemic preparedness are not limited to individual healthcare workers, but strongly impact in health system resilience.ObjectivesThis workshop sets the focus on the protection and preparedness of healthcare workers for global public health emergencies, like the COVID-19 pandemic. It aims to identify strengths and weaknesses of health workforce policy during COVID-19 and to highlight the need for a health system and governance approach. The following major questions will be addressed: How can the protection and pandemic preparedness of healthcare workers be improved? How can the capacities of the health workforce be used and governed more effectively during a pandemic? What policy priorities can be identified to support the health and wellbeing of healthcare workers and prevent infection and deaths, as well as post-COVID fatigue, burn-out and job leaves? How can we build back better and more equitable, including strengthening gender equality and establishing solidarity-based health workforce migration policy?ResultsThe workshop introduces novel results drawn from four European comparative studies. A number of important policy recommendations are emerging from the research, which include among others: (1) improve attention to the complex health and social needs of healthcare workers, (2) implement comprehensive surveillance and monitoring systems, (3) establish European health workforce governance to mitigate shortages and inequality between countries and globally, and (4) take action to implement gender equality policies and to better protect female healthcare workers.ConclusionsThe workshop will stimulate critical debate and improve knowledge exchange across countries and between researchers. It will contribute to creating resilience of the health workforce and health systems and to build back better after COVID-19 in a fair and equitable manner.Key messages Health systems must be accountable for the protection and preparedness of healthcare workers.Action is needed to develop a health workforce surveillance system on national and EU level.

Impact of Elevated Systolic Blood Pressure Levels on Mortality and Life Expectancy in Southeast Chinese Residents.

Background:We aimed to analyse the impact of elevated systolic blood pressure (SBP) levels on mortality and life expectancy among ≥25 yr adults in the municipality of Ningbo, China.Methods:The death cause data were collected from the Internet-based Comprehensive Chronic Disease Surveillance System in Zhejiang Province in 2015, and SBP level data were obtained from the Ningbo Adult Chronic Disease Surveillance survey. According to the comparative risk assessment theory, the population attributable fraction (PAF) of elevated SBP levels by gender and urban-rural regions has been calculated. The deaths and life expectancy loss due to elevated SBP levels were estimated.Results:In 2015, the average SBP level among ≥25 yr adults in Ningbo was 129.01 ± 17.73 mmHg, which was higher in men (131.67 ± 16.89 mmHg) than in women (126.24 ± 18.15 mmHg) and was higher among adults in rural regions (130.55 ± 18.75 mmHg) than among adults in urban regions (127.15 ± 16.19 mmHg). A total of 6181 deaths were attributed to elevated SBP levels among adults in Ningbo. The PAF of deaths caused by elevated SBP levels among adults was 16.14%, which was higher in women (18.73%) than in men (14.31%). The overall loss of life expectancy caused by elevated SBP levels among adults was 1.76 yr, which was higher in women (1.99 yr) than in men (1.53 yr) and was higher in rural regions (1.91 yr) than in urban regions (1.49 yr).Conclusion:Elevated SBP levels had a serious impact on the death and life expectancy loss of residents in Ningbo.

Toward Establishing Integrated, Comprehensive, and Sustainable Meningitis Surveillance in Africa to Better Inform Vaccination Strategies.

Large populations across sub-Saharan Africa remain at risk of devastating acute bacterial meningitis epidemics and endemic disease. Meningitis surveillance is a cornerstone of disease control, essential for describing temporal changes in disease epidemiology, the rapid detection of outbreaks, guiding vaccine introduction and monitoring vaccine impact. However, meningitis surveillance in most African countries is weak, undermined by parallel surveillance systems with little to no synergy and limited laboratory capacity. African countries need to implement comprehensive meningitis surveillance systems to adapt to the rapidly changing disease trends and vaccine landscapes. The World Health Organization and partners have developed a new investment case to restructure vaccine-preventable disease surveillance. With this new structure, countries will establish comprehensive and sustainable meningitis surveillance systems integrated with greater harmonization between population-based and sentinel surveillance systems. There will also be stronger linkage with existing surveillance systems for vaccine-preventable diseases, such as polio, measles, yellow fever, and rotavirus, as well as with other epidemic-prone diseases to leverage their infrastructure, transport systems, equipment, human resources and funding. The implementation of these concepts is currently being piloted in a few countries in sub-Saharan Africa with support from the World Health Organization and other partners. African countries need to take urgent action to improve synergies and coordination between different surveillance systems to set joint priorities that will inform action to control devastating acute bacterial meningitis effectively.

Invasive Bacterial Vaccine-Preventable Disease Surveillance: Successes and Lessons Learned in Bangladesh for a Sustainable Path Forward.

We have made considerable progress in setting and scaling up surveillance systems to drive evidence-based policy decisions, but the recent epidemics highlight that current systems are not optimally designed. Good surveillance systems should be coordinated, comprehensive, and adaptive. They should generate data in real time for immediate analysis and intervention, whether for endemic diseases or potential epidemics. Such systems are especially needed in low-resource settings where disease burden is the highest, but tracking systems are the weakest here due to competing priorities and constraints on available resources. In this article, using the examples of 3 large, and mostly successful, infectious disease surveillance studies in Bangladesh, we identify 2 core limitations—the pathogen bias and the vaccine bias—in the way current surveillance programs are designed for low-resource settings. We highlight the strengths of the current Global Invasive Bacterial Vaccine Preventable Disease Surveillance Network of the World Health Organization and present case studies from Bangladesh to illustrate how this surveillance platform can be leveraged to overcome its limitations. Finally, we propose a set of criteria for building a comprehensive infectious disease surveillance system with the hope of encouraging current systems to use the limited resources as optimally as possible to generate the maximum amount of knowledge.

Vaccine preventable diseases surveillance in Nepal: How much does it cost?

Assessing the cost of vaccine preventable diseases (VPD) surveillance is becoming more important in the context of the Global Polio Eradication Initiative (GPEI) funding transition, since GPEI support to polio surveillance helped the incremental building of VPD surveillance systems in many countries, including low income countries such as Nepal. However, there is limited knowledge on the cost of conducting VPD surveillance, especially the national cost for surveillance of multiple vaccine-preventable diseases. The current study sought to calculate the economic and financial costs of Nepal’s comprehensive VPD surveillance systems from July 2016 to July 2017. At thecentral level, all surveillance units were included in the sample. At sub-national level, a purposive sampling strategy was used to select a representative sample from locations involved in conducting surveillance. The sub-national sample costs were extrapolated to the nationwide VPD surveillance system. Nepal’s total annual economic cost of VPD surveillance was USD 4.81 million or USD 0.18 per capita, while the total financial cost was USD 4.38 million or USD 0.16 per capita. Government expenditures accounted for 56% of the total economic cost, and World Health Organization accounting for 44%. The biggest cost driver was personnel accounting for 51% of the total economic cost. WHO supported trained surveillance personnel through donor funding, mainly from Global Polio Eradication Initiative. As a polio transition priority country, Nepal will need to make strategic choices to fully self-finance or seek full donor support or a mixed-financing model as polio program funding diminishes.

Farm Suicides in Wisconsin, 2017–2018: Preliminary Findings and a Call for Future Research

Studies across the last few decades have consistently found farmers and farmworkers at an elevated risk of death by suicide compared to other occupational groups in the United States. Still, there is currently no comprehensive national surveillance system for agricultural-related injuries or suicides. For this study, we analyzed Wisconsin death certificate data from 2017 and 2018 to identify the burden of suicide among farmers and farmworkers. In 2017 and 2018, 44 farm-related suicides were identified, or 14.3 per 100,000 farmers and farmworkers. The median age of victims was 51.5 ± 20, and six (13.6%) were female. As these suicide cases were cross-checked, we found that none were identifiable solely from previously published news media or obituaries, indicating: (1) a clear need for a multi-sourced suicide data approach and inter-agency collaborations for future research, and (2) the need for a deeper investigation into the reporting of farm-related suicides. These data are necessary for informing state and local level policy, resource prioritization, and the evaluation of intervention efforts.

Surveillance Strategies for the COVID-19 Virus in India

The Covid 19 situation in India holds forth tremendous challenges for the Indian public healthcare system. The current situation is unprecedented. The Covid 19’s high infectivity rate coupled with a high case fatality rate have created a situation where India could see between 2 and 25 lakh deaths over the next 12 to 18 months. The final number of fatalities will depend a great deal on several factors of which surveillance is a critical one. Surveillance will determine the extent to which the government is able to mount a data driven response.Surveillance will help in identifying hot spots and clusters. This in turn will help in mounting targeted responses. In the words of the WHO director general: “Test, test, test. A fire cannot be fought blindfolded.”India’s response has not been satisfactory. This paper discusses the need for a stronger surveillance system and a higher testing rate. If the avalanche of Covid 19 cases requiring hospitalisation comes, the current infrastructure and manpower will be grossly inadequate for it.If India is able to set up a robust and comprehensive surveillance system across urban-rural divides, that might well be a game changer in the covid 19 battle. Failure could mean lakhs more die

Optimizing Village-Level Targeting of Active Case Detection to Support Visceral Leishmaniasis Elimination in India.

BackgroundIndia has made major progress in improving control of visceral leishmaniasis (VL) in recent years, in part through shortening the time infectious patients remain untreated. Active case detection decreases the time from VL onset to diagnosis and treatment, but requires substantial human resources. Targeting approaches are therefore essential to feasibility.MethodsWe analyzed data from the Kala-azar Management Information System (KAMIS), using village-level VL cases over specific time intervals to predict risk in subsequent years. We also graphed the time between cases in villages and examined how these patterns track with village-level risk of additional cases across the range of cumulative village case-loads. Finally, we assessed the trade-off between ACD effort and yield.ResultsIn 2013, only 9.3% of all villages reported VL cases; this proportion shrank to 3.9% in 2019. Newly affected villages as a percentage of all affected villages decreased from 54.3% in 2014 to 23.5% in 2019, as more surveillance data accumulated and overall VL incidence declined. The risk of additional cases in a village increased with increasing cumulative incidence, reaching approximately 90% in villages with 12 cases and 100% in villages with 45 cases, but the vast majority of villages had small cumulative case numbers. The time-to-next-case decreased with increasing case-load. Using a 3-year window (2016–2018), a threshold of seven VL cases at the village level selects 329 villages and yields 23% of cases reported in 2019, while a threshold of three cases selects 1,241 villages and yields 46% of cases reported in 2019. Using a 6-year window increases both effort and yield.ConclusionDecisions on targeting must consider the trade-off between number of villages targeted and yield and will depend upon the operational efficiencies of existing programs and the feasibility of specific ACD approaches. The maintenance of a sensitive, comprehensive VL surveillance system will be crucial to preventing future VL resurgence.

Meta-analysis of latent tuberculosis in healthcare workers in Iran: a retrospective review

Here we review the status of latent tuberculosis (LTB) in Iranian healthcare workers (HCWs). A literature search was conducted using keywords according to the Preferred Reporting Items for Systematic Review and Meta-Analyses instructions. Cross-sectional studies published from 1 January 2000 through 1 January 2019 were retrieved. Meta-analysis was performed using Comprehensive Meta-Analysis software using the random effects model, Cochran's Q and I2 tests. Publication bias was estimated by funnel plot and Egger's linear regression test. Among 774 articles retrieved in the primary literature search, 21 studies met the eligibility criteria. No publication bias was observed among the included studies (p=0.07). The prevalence of LTB ranged from 7% to 63% in Iranian HCWs from different geographical areas. The overall combined prevalence of LTB among Iranian HCWs was 30.9% (95% confidence interval 24.2 to 38.5). Also, 52.4% of the included studies showed a significant correlation between occupation and LTB incidence (p<0.05). The prevalence of LTB was high among Iranian HCWs. This requires developing comprehensive information databases and surveillance systems for detecting LTB among HCWs. It is also essential to periodically screen for LTB in HCWs to provide a timely diagnosis of the infection. It is recommended to perform a tuberculin skin test, a useful tool for screening and treatment of LTB, on an annual basis in HCWs.

Spatial Distribution of Cancer Cases Seen in Three Major Public Hospitals in KwaZulu-Natal, South Africa.

Background:Noncommunicable diseases (NCDs) like cancer are posing a challenge in the health system especially in low- and middle-income countries (LMICs). In South Africa, cancer is under-reported due to the lack of a comprehensive cancer surveillance system. The limited knowledge on the extent of cancer burden has led to inaccurate allocation of public health resources. The aim of this study was to describe cancer incidence and spatial distribution of cancer cases seen at 3 main public oncology facilities in KwaZulu-Natal.Methods:In this retrospective study, cases of cancer observed from year 2015 to 2017 were extracted from medical records. The crude incidence rate was estimated for the total cancer cases and for different type of cancer reported over that period. Age-standardised incidence rates (ASR) per 100 000 was calculated per year using age groups and sex according to the district population data of KwaZulu-Natal. The comparisons of cancer diagnosed incidences were made between 11 districts using the ASR. Choropleth spatial maps and Moran’s Index were used to assess the ASR cancer spatial distribution along with geographical patterns among the districts. One sample chi-square test was used to assess the significant increase/decrease over time.Results:The study lost numerous cases due to incompleteness. A total of 4909 new cases were diagnosed with cancer during 2015 to 2017, 62% of which were female. Both uMgungundlovu and eThekwini districts had the highest ASR among district municipalities of KwaZulu-Natal for both male and female (83.6 per 100 000 per men year for men, 158.2 per 100 000 women per year, and 60.1 per 100 000 men per year and 96.9 per 100 000 women per year, respectively). Random distribution of reported cancer cases in KwaZulu-Natal was observed with a high concentration being in and around 2 metropolitan districts. Spatial variation showed a significant difference from year to year between the districts with the random spatial distribution. Overall, there was a significant decline of cancer incidences observed from 2015 to 2017 (P < .05) in the province.Conclusion:The overall cancer incidence in the study shows that female cancers (breast and cervical) are still on the rise and still need to be given priority as they were most prevalent in KwaZulu-Natal. Spatial analysis (choropleth maps) was used to show a pattern of higher concentration of cancer incidence in the north-western parts of the province.