High-quality Surveillance Systems Research Articles

European Board and College of Obstetrics and Gynaecology position statement on maternal mortality surveillance in Europe

Maternal mortality data and review are important indicators of the effectiveness of maternity healthcare systems and an impetus for action. Recently, a rising incidence of maternal mortality in high income countries has been reported. Various publications have raised concern about data collection methods at country level, as this usually relies mainly on national vital statistics. It is therefore essential that the collected data are complete and accurate and conform to international definitions and disease classification. Accurate data and review can only be truly available when an Enhanced Obstetric Surveillance System is in place. EBCOG calls for action by national societies to work closely with their respective ministries of health to ensure that high quality surveillance systems are in place.

Dramatic resurgence of malaria after 7 years of intensive vector control interventions in Eastern Uganda.

Tororo District, Uganda experienced a dramatic decrease in malaria burden from 2015-19 during 5 years of indoor residual spraying (IRS) with carbamate (Bendiocarb) and then organophosphate (Actellic) insecticides. However, a marked resurgence occurred in 2020, which coincided with a change to a clothianidin-based IRS formulations (Fludora Fusion/SumiShield). To quantify the magnitude of the resurgence, investigate causes, and evaluate the impact of a shift back to IRS with Actellic in 2023, we assessed changes in malaria metrics in regions within and near Tororo District. Malaria surveillance data from Nagongera Health Center, Tororo District was included from 2011-2023. In addition, a cohort of 667 residents from 84 houses was followed from August 2020 through September 2023 from an area bordering Tororo and neighboring Busia District, where IRS has never been implemented. Cohort participants underwent passive surveillance for clinical malaria and active surveillance for parasitemia every 28 days. Mosquitoes were collected in cohort households every 2 weeks using CDC light traps. Female Anopheles were speciated and tested for sporozoites and phenotypic insecticide resistance. Temporal comparisons of malaria metrics were stratified by geographic regions. At Nagongera Health Center average monthly malaria cases varied from 419 prior to implementation of IRS; to 56 after 5 years of IRS with Bendiocarb and Actellic; to 1591 after the change in IRS to Fludora Fusion/SumiShield; to 155 after a change back to Actellic. Among cohort participants living away from the border in Tororo, malaria incidence increased over 8-fold (0.36 vs. 2.97 episodes per person year, p<0.0001) and parasite prevalence increased over 4-fold (17% vs. 70%, p<0.0001) from 2021 to 2022 when Fludora Fusion/SumiShield was used. Incidence decreased almost 5-fold (2.97 vs. 0.70, p<0.0001) and prevalence decreased by 39% (70% vs. 43%, p<0.0001) after shifting back to Actellic. There was a similar pattern among those living near the border in Tororo, with increased incidence between 2021 and 2022 (0.93 vs. 2.40, p<0.0001) followed by a decrease after the change to Actellic (2.40 vs. 1.33, p<0.001). Among residents of Busia, malaria incidence did not change significantly over the 3 years of observation. Malaria resurgence in Tororo was temporally correlated with the replacement of An. gambiae s.s. by An. funestus as the primary vector, with a marked decrease in the density of An. funestus following the shift back to IRS with Actellic. In Busia, An. gambiae s.s. remained the primary vector throughout the observation period. Sporozoite rates were approximately 50% higher among An. funestus compared to the other common malaria vectors. Insecticide resistance phenotyping of An. funestus revealed high tolerance to clothianidin, but full susceptibility to Actellic. A dramatic resurgence of malaria in Tororo was temporally associated with a change to clothianidin-based IRS formulations and emergence of An. funestus as the predominant vector. Malaria decreased after a shift back to IRS with Actellic. This study highlights the ability of malaria vectors to rapidly circumvent control efforts and the importance of high-quality surveillance systems to assess the impact of malaria control interventions and generate timely, actionable data.

Health risk communication and infodemic management in Iran: development and validation of a conceptual framework

ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran’s and other health systems’ risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health...

Molecular Epidemiological Study of Measles Cases in Gyeonggi Province

Measles is one of the highly contagious infectious diseases in which about 90% of the groups that have no immunity against measles are infected when exposed to the measles virus. Even after the Republic of Korea was certified as a ‘national measles eradication’ by the WHO in March 2014, two import-related outbreaks of measles occurred in 2014 and 2019. In this study, we analyzed epidemiological characteristics and genetic distribution of measles cases. Ninety-eight nasopharyngeal or oropharyngeal swab samples that confirmed cases of measles in Gyeonggi province in 2019 were conducted genotyping assay and sequence analysis. Fifty cases were classified as group outbreak-related cases and Forty-eight cases were classified as sporadic cases. As a result of genetic analysis, these cases were classified into D8, B3, and A genotypes, and except for the A type which was known as the vaccine type, D8 and B3 types were identified as import-related measles viruses. As with these results, for the complete eradication of measles, not only a high-quality surveillance system but also molecular epidemiological analysis data must be supported. The results of this study are expected to be used as important data for establishing a quarantine system through the accumulation of measles virus genotyping data and case reports data in the future when measles occurs in South Korea.

A global comprehensive vaccine-preventable disease surveillance strategy for the immunization Agenda 2030

As part of the Immunization Agenda 2030, a global strategy for comprehensive vaccine-preventable disease (VPD) surveillance was developed. The strategy provides guidance on the establishment of high-quality surveillance systems that are 1) comprehensive, encompassing all VPD threats faced by a country, in all geographic areas and populations, using all laboratory and other methodologies required for timely and reliable disease detection; 2) integrated, wherever possible, taking advantage of shared infrastructure for specific components of surveillance such as data management and laboratory systems; 3) inclusive of all relevant data needed to guide immunization program management actions. Such surveillance systems should generate data useful to strengthen national immunization programs, inform vaccine introduction decision-making, and reinforce timely and effective detection and response. All stakeholders in countries and globally should work to achieve this vision.

Re-verifying the elimination of measles, rubella and congenital rubella syndrome in Canada, 2016-2020.

Elimination, in the context of measles, rubella and congenital rubella syndrome (CRS), refers to the absence of endemic measles/rubella virus transmission in a region or other defined geographic area for at least 12 months, in the presence of a high-quality surveillance system that meets targets of key performance indicators. In 1994, Canada and other countries of the World Health Organization (WHO) region of the Americas committed to the objectives of measles elimination by 2000 and rubella and CRS by 2010. Canada met these targets: eliminating measles transmission in 1998; rubella transmission in 2005; and endemically-acquired CRS in 2000. The WHO region of Americas was declared free of endemic rubella/CRS in 2015 and endemic measles in 2016. At the request of the Pan American Health Organization (PAHO), Canada’s elimination status of measles, rubella and CRS was verified in 2012 and again in 2017. Prior to submission to PAHO, the verification reports were reviewed, approved and endorsed by Canada’s National Certification Committee (NCC). The NCC is a group of experts who are not directly involved with the management of vaccine preventable diseases or immunization program implementation at the national level, but who have the expertise to assist in ensuring that Canada is meeting PAHO’S goals of elimination and eradication. Members are responsible for reviewing Canada’s current mechanisms of surveillance and progress towards elimination of targeted vaccine preventable diseases in Canada. Members have expertise in the fields of public health, infectious diseases and/or laboratory sciences.

An emergent infectious disease: Clostridioides difficile infection hospitalizations, 10-year trend in Sicily

BackgroundClostridioides difficile is the most common cause of healthcare-associated diarrhoea worldwide and C. difficile infection is an emerging infectious disease. In the US, its rates are monitored trough an active surveillance system, but many European Union member states still lack this, and in Italy no epidemiological data on C. difficile infection are available except for a few single-centre data.AimTo provide data on the C. difficile infection incidence in Sicily (the biggest and 5th most populous region of Italy) during a 10-year period.MethodsWe revised all the regional standardized discharge forms between 2009 and June 2019 using the code ICD-9 00845 of the International Classification of Diseases, Ninth Revision Clinical Modification, which refers to C. difficile infection with or without complications.Results1139 cases of CDI were identified. 97% were adults with a median age of 73.2 years and a male-to-female ratio of 1:1.4. Female patients were older than males and patients who died were older than patients who did not. The main comorbidities were renal disease, diabetes, pneumonia and hypertension. There were 65 reporting hospitals and 86% of cases were provided by level III and II hospitals. Between 2009 and 2019, the incidence increased 40-fold. 81.5% of cases were reported in Medicine Units, Infectious Diseases Units and long-term care facilities. The mean length of stay was 20 days. Mean case fatality rate was 8.3% over the 10-year period.ConclusionClostridioides difficile infection is a dramatically increasing condition in Sicily. A high-quality surveillance system and shared diagnostic protocols are needed.

Japanese encephalitis in the Western Pacific Region: Implication from the Republic of Korea

Japanese encephalitis (JE) is endemic in the Western Pacific Region. We aim to describe the regional status of control of JE, based on the World Health Organization (WHO) surveillance data, and to share the experience from the Republic of Korea. Substantial progress has been made in the region to date; however, epidemiologic changes have not been delineated. The vaccination coverage should be addressed to close the immunity gap. The lessons learned from Korea may aid in establishing a high-quality surveillance system with a sustainable JE vaccination program in order to prepare for new challenges that this region will face.

Progress towards measles, rubella and congenital rubella syndrome elimination: Oman experience

Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defined as the absence of endemic measles and rubella transmission in a defined geographical area for ≥ 12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of CRS cases associated with endemic transmission in the presence of high-quality surveillance system. Strategies to reach this goal included: a) achieving and maintenance high rates of vaccination coverage; b) syndromic surveillance programs to monitor fever and rash illness syndromes for effective detection of cases; c) and high-quality surveillance system, and sensitive for CRS. Measles and rubella was a leading cause of infant and child morbidity and mortality in Oman before the introduction of measles vaccine by 1975 and thereafter until 1994. With the introduction of a second dose of measles and first rubella vaccines in 1994, coverage for first and second doses of measles and rubella vaccines increased more than 95% in 1996 and has been sustained thereafter. A national measles and rubella immunization catch-up campaign targeting children ages 15 months to 18 years was conducted in 1994 that achieved 94% coverage. As a result, the incidence of measles and rubella have declined markedly in recent years, to ≤ 1 case per million persons in 2012 and to zero cases for measles and rubella in 2013. Similarly, no case of CRS has been notified since 2007. Oman has made significant progress toward measles and rubella elimination and has met the regional elimination goals. However, new challenges faced by Oman, for instance with increased globalization, has led to issues such as outbreaks from imported cases. Additional challenges still remain with regard to increasing identification and immunization of unvaccinated non-Omani workers and their families.

Surveillance footage and space segregation in Mexico City

This study discusses police use of surveillance footage to solve crimes in urban locations and in marginalized neighborhoods, and in particular explores how surveillance cameras and the quality of video they produce result in differential displays of crime. Videos of young people being kidnapped in downtown Mexico City reveal that surveillance systems in marginalized areas are of consistently poor definition and clarity, which contrasts sharply with the clear and distinct images produced by video surveillance in financial, commercial, and upscale residential districts. Social inequality is revealed between the high-quality surveillance systems in the middle- and high-income protective bubbles that exclude the ‘dangerous classes’ and the low-quality and poorly functioning surveillance systems that are operational in low-income and ‘dangerous’ areas. The article shows how surveillance cameras function not only as mechanisms to prevent and solve crimes but also as instruments of the government that seek to ensure and manage order in urban areas.

Verificación de la eliminación del sarampión y la rubéola en la Región Europea de la OMS: el caso de España

Like some other countries in the Region, Spain has recently experienced multiple but small measles outbreaks resulting from several importations and in which health care professionals were also infected. The European Regional Verification Commission (RVC) for Measles and Rubella Elimination, an independent panel of experts, conducted an annual review of the reports submitted by the National Verification Committees (NVC) and a country visit to assess the status of interruption of endemic transmission of these diseases in Spain. Essential criteria supporting interruption included absence of endemic transmission in the presence of high-quality surveillance system and genotyping evidence. High vaccination coverage with the first dose of measles -and rubella-containing vaccine (MRCV1) has been maintained above 95% at national level. The figure is based on the number of doses administered to children aged 12-24 months. However, there are two autonomous regions, namely Cataluña and Castilla y Leon with low (<90%) vaccination coverage. In the autonomous regions of Murcia and Melilla, although the coverage with MRCV1 was above 95%, that of the second dose of measles -and rubella-containing vaccine was below 90. On the basis of the evidence provided, with only two imported cases of rubella in 2013, the RVC concluded that endemic transmission of rubella had been interrupted in Spain, but there is a risk of re-establishing transmission due to the sub-optimal population immunity in at least four regions as the coverage with two doses of measles- and rubella- containing vaccines was below the required minimum of 95%.

Surveillance of congenital rubella syndrome in Brazil, 1995–2005

In Brazil, routine childhood rubella vaccination was introduced during 1992-2000 and a campaign targeted to women of childbearing age was conducted during 2001-2002 to accelerate control of congenital rubella syndrome (CRS). Surveillance of CRS was implemented in 2000, to detect CRS cases and evaluate impact of rubella vaccination strategies and an elimination goal was established in 2003. National CRS surveillance data were analyzed to describe CRS incidence and positive predictive value (PPV). International standard CRS case definitions were used. Completeness of coverage was estimated by a capture-recapture method using surveillance data and a retrospective study in maternity hospitals. Case detection strategies were evaluated using data from three CRS clusters investigated in Brazil during 1999-2002. In 2001, CRS incidence was 2.3 per 100,000 children <1 year of age and PPV was 18%, decreasing to 0.1 and 4%, respectively, in 2004. No new confirmed or compatible cases of CRS were identified in 2005. Of 2,443 suspected CRS cases reported during 1995-2005, 1,889 (77%) were born during 2000-2005. Of these, 1,486 (79%) had one blood sample for IgM testing; 93% (n =1 ,024) within six months of age. A total of 280 (12%) infants had confirmed or compatible CRS, of which 51% (93/184) had fatal outcome. Completeness of coverage was estimated at 7%. PPV of active case finding (63%) was 4.3-fold greater than follow-up of pregnant women with confirmed rubella (15%). Rubella and CRS incidence have declined dramatically in Brazil demonstrating the impact of national rubella control strategies, and representing surveillance challenges in the end-stage of elimination. High routine rubella vaccination coverage and a high-quality surveillance system will be critical to achieve the elimination goal. Active CRS surveillance at maternity and referral tertiary hospitals is recommended.

Using Pneumococcal Carriage Data to Monitor Postvaccination Changes in Invasive Disease

Pneumococcal conjugate vaccines (PCVs) have been introduced worldwide. However, few developing countries have high-quality surveillance systems available for monitoring vaccine impact. We evaluated whether data from nasopharyngeal carriage studies can be used to accurately monitor post-PCV changes in the incidence of invasive pneumococcal disease (IPD) among children under 5 years of age. For various dates during 1991-2010, data on nasopharyngeal pneumococcal carriage and on IPD before and after administration of 7-valent PCV (PCV7) were available from England and Wales, the Netherlands, the Navajo and White Mountain Apache American Indian populations, and the US states of Massachusetts and Alaska. We estimated the change in carriage prevalence for each serotype in each study and then either calculated the average change (inverse variance-weighted) among vaccine and nonvaccine serotypes (model 1) or used mixed-effects models to estimate the change for each serotype individually, pooling serotype data within or between studies (models 2 and 3). We then multiplied these values by the proportion of IPD caused by each serotype during the pre-PCV7 period to obtain an estimate of post-PCV7 disease incidence. Model 1 accurately captured overall changes in IPD incidence following PCV7 introduction for most studies, while the more detailed models, models 2 and 3, were less accurate. Carriage data can be used in this simple model to estimate post-PCV changes in IPD incidence.

Real-Time Illegal Parking Detection in Outdoor Environments Using 1-D Transformation

With decreasing costs of high-quality surveillance systems, human activity detection and tracking has become increasingly practical. Accordingly, automated systems have been designed for numerous detection tasks, but the task of detecting illegally parked vehicles has been left largely to the human operators of surveillance systems. We propose a methodology for detecting this event in real time by applying a novel image projection that reduces the dimensionality of the data and, thus, reduces the computational complexity of the segmentation and tracking processes. After event detection, we invert the transformation to recover the original appearance of the vehicle and to allow for further processing that may require 2-D data. We evaluate the performance of our algorithm using the i-LIDS vehicle detection challenge datasets as well as videos we have taken ourselves. These videos test the algorithm in a variety of outdoor conditions, including nighttime video and instances of sudden changes in weather.

Evaluation of acute flaccid paralysis surveillance system in Kerkuk governorate

Context: High quality acute flaccid paralysis surveillance system is a aquite important strategy for polio eradication. Surveillance data are the cornerstone to document a national polio free status. The aim of the present study is to evaluate the acute flaccid paralysis surveillance system in Kerkuk Governorate. Methods: Program evaluation of the Directorate of health, primary health care districts (sectors), hospitals, and primary health care centers in Kerkuk Governorate. All the responsible personnel for the acute flaccid paralysis surveillance system were interviewed and included in addition to the relevant records. Ordinary percentages were used in the description of acute flaccid paralysis cases. While rates were used in the evaluation of the performance indicators. Results: The study revealed a sensitive acute flaccid paralysis surveillance system (Non polio acute flaccid paralysis rate 3.98 and 3.1 in 2005 and 2006 respectively) with clear field guidelines. All the performance indicators were high indicating a high quality surveillance system in Kerkuk Governorate.Conclusions: Solid surveillance structure, regular contract and excellent case management were observed, in addition to regular passive and active surveillance.