Multi-source Surveillance System Research Articles

Multisource surveillance conducted by the Tokyo Metropolitan Government during the Tokyo 2020 Olympic and Paralympic Games.

The Tokyo 2020 Olympic and Paralympic Games (the Games) were held from 23 July to 5 September 2021 in Tokyo, Japan, after a 1-year delay due to the coronavirus disease (COVID-19) pandemic. The Tokyo Metropolitan Government was responsible for monitoring and responding to infectious disease outbreaks other than COVID-19 during the Games. A multisource surveillance system was used from 1 July to 12 September 2021 for the early detection and rapid response to infectious diseases. This included routine notifiable disease surveillance, sentinel surveillance, syndromic surveillance, cluster surveillance, ambulance transfer surveillance and the Tokyo Infectious Alert system. Daily reports were disseminated summarizing the data collected from the multisource surveillance system. No case of infectious disease under the Tokyo Metropolitan Government system required a response during the Games. The multisource surveillance was useful for providing intelligence during the Games and, if required, could contribute to the early detection and rapid response to outbreaks during other mass gatherings. The system could be improved to overcome the challenges implied by the findings of this multisource surveillance.

Towards an integrated animal health surveillance system in Tanzania: making better use of existing and potential data sources for early warning surveillance

BackgroundEffective animal health surveillance systems require reliable, high-quality, and timely data for decision making. In Tanzania, the animal health surveillance system has been relying on a few data sources, which suffer from delays in reporting, underreporting, and high cost of data collection and transmission. The integration of data from multiple sources can enhance early detection and response to animal diseases and facilitate the early control of outbreaks. This study aimed to identify and assess existing and potential data sources for the animal health surveillance system in Tanzania and how they can be better used for early warning surveillance. The study used a mixed-method design to identify and assess data sources. Data were collected through document reviews, internet search, cross-sectional survey, key informant interviews, site visits, and non-participant observation. The assessment was done using pre-defined criteria.ResultsA total of 13 data sources were identified and assessed. Most surveillance data came from livestock farmers, slaughter facilities, and livestock markets; while animal dip sites were the least used sources. Commercial farms and veterinary shops, electronic surveillance tools like AfyaData and Event Mobile Application (EMA-i) and information systems such as the Tanzania National Livestock Identification and Traceability System (TANLITS) and Agricultural Routine Data System (ARDS) show potential to generate relevant data for the national animal health surveillance system. The common variables found across most sources were: the name of the place (12/13), animal type/species (12/13), syndromes (10/13) and number of affected animals (8/13). The majority of the sources had good surveillance data contents and were accessible with medium to maximum spatial coverage. However, there was significant variation in terms of data frequency, accuracy and cost. There were limited integration and coordination of data flow from the identified sources with minimum to non-existing automated data entry and transmission.ConclusionThe study demonstrated how the available data sources have great potential for early warning surveillance in Tanzania. Both existing and potential data sources had complementary strengths and weaknesses; a multi-source surveillance system would be best placed to harness these different strengths.

Incidence of recreational sports-related sudden cardiac arrest in participants over age 12 in a general African population

BackgroundThe incidence of sports-related sudden cardiac arrest (SrSCA) in sub-Saharan Africa is unknown.ObjectiveTo determine the incidence of sudden cardiac arrest (SCA) in non-competitive athletes in an urban population of Cameroon,...

Assessing the accuracy of the death certificate injury at work box for identifying fatal occupational injuries in Michigan.

Death certificates contain a box labeled "Injury at Work" which is to be marked "Yes" for all fatal occupational injuries. The accuracy of this box in Michigan is not fully characterized. The accuracy of the Injury at Work box on the Michigan death certificate was compared to deaths identified from 2001 through 2016 by the Michigan Fatality Assessment and Control Evaluation multi-source surveillance system. The sensitivity was calculated across this time period, while specificity and positive and negative predictive values were derived for 2011-2016. Univariate and multivariate regression were used to examine differences in the sensitivity over time and across demographic variables, industry, and the type of death. We found a sensitivity for the Injury at Work box of 73.1% among 2156 deaths. The sensitivity showed a significant declining trend over the 17 years, from 79.8% to 63.1%. Sensitivity varied significantly across incident type (aircraft, animal-related, drug overdose, motor vehicle, and suicides having particularly lower sensitivities, and electrocutions, falls, and machine-related incidents having higher sensitivities), and industry sector (construction, manufacturing, public safety, transportation, and trade sectors having higher sensitivities, and agriculture and services sectors showing lower sensitivities). Across nearly all categories the sensitivity was significantly below 1. The Injury at Work box on the Michigan death certificate was often incorrectly completed and has become less accurate with time, though the degree of this inaccuracy varies by the industry of the victim and the type of incident.

Sport-related sudden cardiac arrest in black African non-competitive athletes: Incidence in a general population of Cameroon

Incidence estimates of sudden cardiac arrest (SCA) in athletes living in sub-Saharan Africa (SSA) are unknown. Over 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala (Cameroon) registered all deaths among 86,188 inhabitants aged under 18 years. As part of an extended multi-source surveillance system, all sport fields, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths. There were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3–40.6]/100,000 person–years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4–44.9)/100,000 person–years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital SCA occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed CA, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%. While running, death occurred in 1 (3.7%) non-competitive female athlete aged 35 years. Sport-related SCA in this African population claimed an annual incidence of 1.15 cases per 100,000 person–years, which is in accordance with reported rates in the literature. Long-term cohort studies in many African countries are warranted to better understand incidence estimates of SCA in black athletes.

Multi-source surveillance for work-related crushing injuries.

Work-related crushing injuries are serious but preventable. For 2013 through 2015, the U.S. Bureau of Labor Statistics' (BLS) Survey of Occupational Injuries and Illnesses (SOII) reported 1260 crushing injuries in Michigan. In 2013, Michigan initiated multi-data source surveillance of work-related crushing injuries. Records from all 134 of Michigan's hospitals/emergency departments (EDs), the Workers Compensation Agency (WCA) and Michigan's Fatality Assessment Control and Evaluation (MIFACE) program were used to identify work-related crushing injuries. Companies, where individuals were hospitalized or had an ED visit for a crushing injury, potentially had an OSHA enforcement inspection conducted. From 2013 through 2015, there were 3137 work-related crushing injury incidents, including two fatalities. The Michigan OSHA program completed inspections at 77 worksites identified by the surveillance system. The Michigan multisource surveillance system identified two and a half times more crushing injuries than BLS and was useful for initiating case-based enforcement inspections.

Epidemiology of sudden cardiac death in Cameroon: the first population-based cohort survey in sub-Saharan Africa.

BackgroundIncidence estimates of sudden cardiac death (SCD) in sub-Saharan Africa (SSA) are unknown.MethodOver 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala, Cameroon, registered all deaths among 86 188 inhabitants aged >18 years. As part of an extended multi-source surveillance system, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths.ResultsThere were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3–40.6]/100 000 person-years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4–44.9)/100 000 person-years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital sudden cardiac arrest occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed cardiac arrest, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%.ConclusionThe burden of SCD in this African population is heavy with distinct characteristics, whereas awareness of SCD and prompt resuscitation efforts appear suboptimal. Larger epidemiological studies are required in SSA in order to implement preventive measures, especially in women and young people.

Surveillance for work-related skull fractures in Michigan

Objectives: The objective was to develop a multisource surveillance system for work-related skull fractures. Methods: Records on work-related skull fractures were obtained from Michigan's 134 hospitals, Michigan's Workers' Compensation Agency and death certificates. Cases from the three sources were matched to eliminate duplicates from more than one source. Workplaces where the most severe injuries occurred were referred to OSHA for an enforcement inspection. Results: There were 318 work related skull fractures, not including facial fractures, between 2010 and 2012. In 2012, after the inclusion of facial fractures, 316 fractures were identified of which 218 (69%) were facial fractures. The Bureau of Labor Statistic's (BLS) 2012 estimate of skull fractures in Michigan, which includes facial fractures, was 170, which was 53.8% of those identified from our review of medical records. The inclusion of facial fractures in the surveillance system increased the percentage of women identified from 15.4% to 31.2%, decreased severity (hospitalization went from 48.7% to 10.6% and loss of consciousness went from 56.5% to 17.8%), decreased falls from 48.2% to 27.6%, and increased assaults from 5.0% to 20.2%, shifted the most common industry from construction (13.3%) to health care and social assistance (15.0%) and the highest incidence rate from males 65+ (6.8 per 100,000) to young men, 20–24years (9.6 per 100,000). Workplace inspections resulted in 45 violations and $62,750 in penalties. Conclusions: The Michigan multisource surveillance system of workplace injuries had two major advantages over the existing national system: (a) workplace investigations were initiated hazards identified and safety changes implemented at the facilities where the injuries occurred; and (b) a more accurate count was derived, with 86% more work-related skull fractures identified than BLS's employer based estimate. Practical Applications: A more comprehensive system to identify and target interventions for workplace injuries was implemented using hospital and emergency department medical records.

Réunion, a sentinel territory for influenza surveillance in Europe

In Réunion, a French overseas territory located in the southern hemisphere, increase in influenza activity is generally observed several months earlier than in Europe. Influenza activity is monitored in Réunion through a multi-source surveillance system including sentinel practitioners network, hospital emergency department, laboratory and mortality. Since 2009, three successive influenza epidemics occurred on the island. The largest was observed in 2009 while epidemics in 2010 and 2011 were much weaker. In terms of circulating strains, B viruses were predominant at the beginning of the 2009 epidemic but they were completely evicted once A(H1N1)pdm09 circulation started. In 2010, A(H1N1)pdm09 virus was predominant again, but a constant co-circulation of B viruses was observed. In 2011, A(H3N2) virus circulated. The same viruses were identified a few months later in mainland France in the respective seasons. Since 2009, virus circulation, epidemiological trends and health impact of influenza have been similar to those observed in Europe. Influenza surveillance in Réunion may therefore give reliable early information which should be considered apart from the surveillance in mainland France. Then, it might be even a more suitable predictor for Europe than other temperate southern hemisphere countries.

Multisource Surveillance System for Work-Related Burns

The purpose of this study was to develop a multisource surveillance system for work-related burns. For 2009, records about work-related burns were obtained from Michigan's 134 hospitals, the Workers' Compensation Agency, the state's sole Poison Control Center, and death certificates. Companies where the most severe burns occurred were referred to the Occupational Safety and Health Administration. There were 1461 work-related burns in 2009. Sixty-six percent of the burns were reported in male workers and 85.3% in whites. One third of the individuals sustained burns to the wrist(s) and hand(s). Second-degree and thermal burns were the most common. Accommodation and food services and health care and social assistance industries accounted for 50% of all burns. The Michigan multidata source surveillance system identified three times more burns than the Bureau of Labor Statistics' employer-based system, which reported 450 burns in 2009.

Surveillance of Contact Lens Related Microbial Keratitis in Australia and New Zealand: Multi-Source Case-Capture and Cost-Effectiveness

Purpose: To evaluate a multi-source surveillance system used in a 12-month study of contact lens related microbial keratitis in Australia and New Zealand. Methods: All practicing ophthalmologists and optometrists were surveyed on 6 occasions over 12 months via post or the Internet. Participation was defined as reporting at least once during the study period and the response rates represented those who responded on all six occasions. Cases were also detected through hospital audit. All ophthalmologists and a sub-group of optometrists were contacted by phone to elicit a response (active surveillance). The utilization and cost-effectiveness of active surveillance were compared to reports received via the post or the Internet. Case ascertainment and cost-effectiveness were compared for different sources of case capture. Results: The rate of participation for ophthalmologists was 95.8% (711/742) and 88.5% (657/742) responded for all reporting periods. Active surveillance was required for 63% (416/661) of responses in Australia (AU) and 73% (59/81) in New Zealand (NZ) at AUD23.14 per practitioner. Internet reporting was more widely used in New Zealand (NZ: 31% vs. AU:17%, p = 0.006) and was the most cost effective mode of reporting (AUD1.43 per practitioner). Postal reporting (AUD; AU:3.54,NZ:9.84 per practitioner) was under-utilized (3% of responses). Average start-up costs comprised 50% of study costs followed by active follow-up (42%), postal (6%) and Internet reporting (2%). Ophthalmologists (50.4%, 144/286 of cases) were the most cost-effective source of cases, followed by hospital audit (24.5%, 70/286) and optometry (25.1%, 72/286). Duplicate reporting occurred in 13% (37/286) of cases. Conclusions: High response rates were obtained by substantial resource commitment to active follow-up. Internet reporting was widely used and was cost-effective. Hospital audit and supplementary reporting by optometry were used for the first time in a study of contact lens related microbial keratitis, and contributed significantly to case capture.

Pregnancy-related mortality in New Jersey, 1975 to 1989.

National data are thought to underestimate pregnancy-related mortality in the United States. A multisource surveillance system for pregnancy-associated deaths in New Jersey offers an opportunity to identify the magnitude of and the trends in pregnancy-related mortality at the state level. Data from all reported pregnancy-related deaths in the state from 1975 to 1989 were studied, and pregnancy mortality ratios were calculated. The New Jersey pregnancy mortality ratio decreased from the late 1970s to the early 1980s but began to rise in the late 1980s. The pregnancy mortality ratio for non-Whites was 3.6 times that for Whites for the 15-year period. The causes of pregnancy-related deaths changed over the 15-year period, with direct obstetrical causes playing a decreasing role. AIDS has become the major cause of pregnancy-related mortality in New Jersey. Finally, approximately 44% of the pregnancy-related deaths were considered to be preventable by the physician or patient or both. New efforts must be made to combat the recent rise in pregnancy-related deaths, with special attention to preventing deaths among non-White women.