Epidemiological Surveillance System Research Articles

Epidemiological Surveillance of Type 2 Diabetes Among Adolescents and Children

With a high incidence of the condition worldwide, type 2 diabetes has emerged as one of the most worrisome chronic diseases. Type 2 diabetes has been identified in certain public health research to have an early beginning tendency, and the rapid rise in teen and child prevalence may be an epidemiological warning sign. This study uses systematic retrieval and induction techniques to examine the prevalence and trajectory of type 2 diabetes in children and adoles-cents. In this paper, the useful data and literature collected are discussed and sorted out in an attempt to establish a complete field of analysis of current type 2 diabetes, which is to criti-cally discuss the practice of current epidemiological surveillance and screening systems for adolescents and children, and to propose possible constructive suggestions. This study finds that the development trend in adolescents and children may not be optimistic, and there are differences in risk based on geographic demography, gender, race, etc. Epidemiological screening and surveillance of type 2 diabetes in adolescents and children, as well as targeted public and individual prevention and intervention, could have significant implications.

Features of the system of epidemiological surveillance of infectious diseases in the Socialist Republic of Vietnam

The results of the analysis of the system of epidemiological surveillance of infectious diseases in the Socialist Republic of Vietnam and the assessment of the possibilities of its improvement are presented . The levels of organization of epidemiological surveillance in Vietnam , their compliance with the administrative division of the country ( state , provincial , district and commune levels ) are shown . It is noted that epidemiological surveillance has a passive nature and is based on the online reporting system of the Department of Preventive Medicine , which has been the official notification channel for 42 infectious diseases since 2016. For the purposes of epidemiological surveillance , all registered infectious diseases are divided into 3 groups according to the potential for epidemic spread (A, B and C), on which strategies for carrying out sanitary and anti-epidemic ( preventive ) measures depend . It has been established that modern computer technologies , including geoinformation systems , in Vietnam have found their application in certain areas of epidemiological surveillance of current infectious diseases , but further i mprovement o f t he m ethods o f t heir u se f or t hese p urposes i s r equired .

On Urgently Tackling the Mosquito-Borne Diseases in the European Union

Context: According to a recent Lancet report the world is dangerously close to reaching climate-driven points of no return. Climate change, together with other drivers, contributed to a large diffusion of mosquito-borne diseases (MBDs) in the last decades. The intensity of such a phenomenon led various mosquito species to migrate to new areas, outside their historical habitats. Europe is among the affected territories. Moreover, the problem is projected to rise and expand within the continent, including populations who have never been exposed to MBDs and impacting the whole society, especially the most vulnerable groups. As Europe is a relatively new area for the diffusion of MBDs, no strong and unified measures have been put into practice yet. Meanwhile, MBDs surveillance experiences implemented across Europe report gaps, such as the absence of entomological research and legal support, the capacity limitation for surveillance, and variability in entomological and epidemiological surveillance systems. Hence, it could be necessary to use the experiences from Latin America, Asia and Africa. Given the aforementioned overview, this policy brief aims to provide policy options in order for the European Union to address MBDs, with a particular emphasis on strengthening surveillance across the Member. States given recent attention drawn to this issue by the ECDC’s 2021 report on vector control and surveillance. Policy Options and recommendations: This advisory group conducted a non-systematic literature review to determine three policy options, with a specific focus on surveillance, to address the issue of MBDs. 1. Surveillance systems for mosquitoes and MBDs should be implemented in all member states, and case definitions for these MBDs should be harmonised to enable coordination and consistency of MBDs surveillance across the European Union (EU). 2. Create an EU-level networks umbrella for financial and organisational coordination of Member States (MS)’ multi-sectoral collaboration on MBDs surveillance. 3. Developing the competencies for surveillance and research professionals for mosquitoes and MBDs surveillance.

Clinical and epidemiological characteristics of cancers associated with human papillomavirus in the regions of North-West Russia

Introduction. The leading role of the human papillomavirus in the etiopathogenesis of malignant neoplasms of some localizations is generally recognized. Vaccines that are used in the world and in Russia for the prevention of papillomavirus infection create the basis for the elimination of diseases associated with the human papillomavirus in the future.
 The aim of the study is to determine the regional, gender and age-specific features of cancers associated with the human papillomavirus to substantiate the development of a unified system of epidemiological surveillance and vaccination.
 Materials and methods. The retrospective epidemiological analysis of the incidence of cancers associated with the human papillomavirus and mortality due to these neoplasms in the regions of the North-Western Federal District of Russia in 20112020 was carried out based on data from Statistic Form 7 "Information on malignant neoplasms" and the Population cancer Registers of St. Petersburg (13,117 cases), Leningrad region (3204 cases) and the Kaliningrad region (2898 cases).
 Results. In the structure of cancers associated with the human papillomavirus in St. Petersburg, Leningrad and Kaliningrad regions, more than 90% of men had tumors of the oral cavity, oropharynx and larynx, more than 60% of women had cervical cancer. Regional and age-specific features of the incidence of cervical cancer and mortality from this pathology have been established. Statistically significant differences in the incidence of cancer of the head and neck, anus and anal canal in different age groups of the male and female population were revealed.
 Conclusion. As a result of the study, regional, gender and age-specific features of the incidence of human papillomavirus-associated malignant neoplasms in the North-West of Russia were established. These data should be used to develop a system of epidemiological surveillance of papillomavirus infection and vaccination program.

Clinical-epidemiological profile of deaths from influenza with a history of timely vaccination, Mexico 2010-2018.

Influenza epidemics are of higher risk at the extremes of life and in people with comorbidities. Effective vaccination prevents the occurrence of serious cases and decreases mortality. To describe deaths from influenza with a history of timely vaccination, from the 2010 to the 2018 season in Mexico. Cross-sectional, descriptive study where the Influenza Epidemiological Surveillance System database was used. From 2010 to 2018, 65 vaccinated individuals died from influenza, from which 55% of cases (n = 36) were due to type A (H1N1), 51% (n = 33) were females, median age was 57 years, 21 % (n = 14) did not meet the operational definition of influenza-like illness or severe acute respiratory infection, 83% (n = 54) had at least one comorbidity, with the most common being diabetes mellitus and hypertension (32% each); 55% (n = 36) of deaths received antiviral treatment and only 8% (n = 5) had no comorbidities and received treatment with oseltamivir. Deaths from influenza with timely vaccination represent a very low percentage of the totality. Vaccination against influenza has been a specific prevention strategy that decreases disease burden.

Characterization of Patients with Type 2 Diabetes Mellitus and covid-19 in Primary Care

Objectives: To describe the characteristics of the population diagnosed with type 2 Diabetes Mellitus (dm2) infected by sars-CoV-2, and to evaluate whether there is an association between dm2 history and covid-19 severity. Methods: non-probabilistic by convenience sampling, information was obtained from the Online Notification System for Epidemiological Surveillance (sinolave) of the Family Medicine Unit No. 28 of the Mexican Institute of Social Security. A total of 1688 confirmed cases of covid-19 were identified and grouped into patients with and without dm2. Bivariate statistical analysis was performed with Excel 2019 and Stata v. 15.1 programs; measures of association were used using Poisson logistic regression and χ2 test with statistical significance <0.05. Results: it was observed that, in patients with covid-19 and dm2, the prevalence ratio of severe acute respiratory infection, diagnosis of pneumonia, hospitalization, and death were higher compared to the group without dm2. Conclusion: the frequency, of unfavorable characteristics, was higher in the group of patients with dm2. Health conditions caused by covid-19 reinforce the relevance of an intentional search for undiagnosed diabetic patients, untreated or under treatment with poor glycemic control, in order to avoid major health complications.

Guidelines on epidemics in Mexico. Historical perspective.

A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

COVID-19 surveillance: Large decrease in clinical notifications and epidemiological investigation questionnaires for laboratory-confirmed cases after the 2nd epidemic wave, Portugal March 2020-July 2021.

In Portugal, COVID-19 laboratory notifications, clinical notifications (CNs), and epidemiological investigation questionnaires (EI) were electronically submitted by laboratories, clinicians, and public health professionals, respectively, to the Portuguese National Epidemiological Surveillance System (SINAVE), as mandated by law. We described CN and EI completeness in SINAVE to inform pandemic surveillance efforts. We calculated the proportion of COVID-19 laboratory-notified cases without CN nor EI, and without EI by region and age group, in each month, from March 2020 to July 2021. We tested the correlation between those proportions and monthly case counts in two epidemic periods and used Poisson regression to identify factors associated with the outcomes. The analysis included 909,720 laboratory-notified cases. After October 2020, an increase in the number of COVID-19 cases was associated with a decrease in the submissions of CN and EI. By July 2021, 68.57% of cases had no associated CN nor EI, and 96.26% had no EI. Until January 2021, there was a positive correlation between monthly case counts and the monthly proportion of cases without CN nor EI and without EI, but not afterward. Cases aged 75 years or older had a lower proportion without CN nor EI (aRR: 0.842 CI95% 0.839-0.845). When compared to the Norte region, cases from Alentejo, Algarve, and Madeira had a lower probability of having no EI (aRR;0.659 CI 95%0.654-0.664; aRR 0.705 CI 95% 0.7-0.711; and aRR 0.363 CI 95% 0.354-0.373, respectively). After January 2021, CN and EI were submitted in a small proportion of laboratory-confirmed cases, varying by age and region. Facing the large number of COVID-19 cases, public health services may have adopted other registry strategies including new surveillance and management tools to respond to operational needs. This may have contributed to the abandonment of official CN and EI submission. Useful knowledge on the context of infection, symptom profile, and other knowledge gaps was no longer adequately supported by SINAVE. Regular evaluation of pandemic surveillance systems' completeness is necessary to inform surveillance improvements and procedures considering dynamic objectives, usefulness, acceptability, and simplicity.

Multicountry cholera outbreak alert in Kenya: Current efforts and recommendations

Multicountry cholera outbreak alert in Kenya: Current efforts and recommendations

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Usutu virus: a Flavivirus on the rise amid COVID-19 and monkeypox

Methodological approaches to evaluate the over-time mortality in SENTIERI epidemiological surveillance system: a focus on cohort analyses

The SENTIERI Project analyses the health profile of the populations residing in Italian national priority contaminated sites in specific calendar periods using a cross-sectional approach. An aspect that has not been evaluated so far is the analysis over a long period, for understanding the changes in health profiles over time and studying them also in function of the changes occurred in the territories. This article studies temporal trends by birth cohort and calendar period for overall mortality and lung cancer mortality from 1980 to 2018, separately for men and women, for three sites: Priolo (Sicily Region, Southern Italy), Pitelli (Liguria Region, Northern Italy), and Terni-Papigno (Umbria Region, Central Italy). A method for selecting the temporal model that best fits the data is then proposed. General mortality presents complex temporal profiles when considering cumulative risks, and usually the most important temporal axis is the birth cohort for cumulative SMRs (i.e., after adjusting for trends in the reference population). For lung cancer, the most important time axis is the birth cohort and the age-cohort model is the most appropriate, in particular for men of Priolo and Terni.

Environmental justice promotion in the Italian contaminated sites through the national epidemiological surveillance system SENTIERI

Conceptual and operational aspects of studying and promoting environmental justice and the results from assessments on environmental justice carried out within the epidemiological surveillance SENTIERI focused on communities living close to main Italian contaminated sites are here summarized. The communities under SENTIERI surveillance often have environmental injustice conditions associated with the cumulative impact of environmental pressures due to contamination and a high socioeconomic deprivation and mortality risk. In Italy, a North-South divide gradient is present, with the worst conditions in the South&Island, where most communities affected by contaminated sites are socioeconomically deprived. The main mechanisms of development and maintenance of distributive injustice in contaminated sites are attributable to procedural injustice conditions, with marginalization and misrecognition of disadvantaged communities or subgroups in decisional processes regarding both the location and permanence of polluting industrial plants and the interventions on remediation and reduction of hazardous exposures and health-related impacts. Within SENTIERI, strategies have been developed to produce participative territorial communication plans and to strengthen the environmental health literacy of local institutional and social actors. SENTIERI contributes in promoting environmental justice through the empowerment of social capacities of local communities.

The concept map of SENTIERI Project: a communication interactive digital tool of the national epidemiological surveillance system of Italian contaminated sites

This paper describes the development and the envisioned use of concept maps in the framework of the SENTIERI communication strategies as an information and scientific communication tool applied to epidemiological surveillance in contaminated sites. The concept map of SENTIERI 2019-2022 was designed and implemented to foster access to complex scientific information ensuring usability of the contents and communication with the various stakeholders. The concept map aims to promote environmental health literacy in contaminated sites. The methodology adopted to create the map includes the following phases: 1. choice of a dynamic focus question; 2. selection of the representative terms of the addressed topics; 3. elaboration of the glossary of the selected terms; 4. representation of the links among the selected terms; 5. identification of the significant propositions that make explicit the meaning of each link. Online access to the map is guaranteed by the Mindomo software. The use of the concept map promotes active learning of the topics that characterize SENTIERI 2019-2022 through knowledge paths chosen because of the specific interests and learning purposes. The concept map derives from the integration of specific approaches of the epidemiological discipline with those of the social sciences and offers the possibility of developing site-specific maps through the interactions with local actors and the integration of elements related to emerging problems as well as institutional and local interests.

“Pressed OXY M30 Pills, Great Press, Potent, Fast Shipping!!!”: Availability of Counterfeit and Pharmaceutical Oxycodone Pills on One Major Cryptomarket

ABSTRACT From 2018 to 2021, seizures of counterfeit oxycodone pills containing non-pharmaceutical fentanyl or other novel synthetic opioids increased significantly contributing to continuing increases in overdose mortality in Northern America. Evidence suggests that counterfeit pills are distributed through cryptomarkets. This article presents data regarding the availability and characteristics of oxycodone pills advertised on one major cryptomarket between January and March 2022. Collected data were processed using a dedicated Named Entity Recognition algorithm to identify oxycodone listings and categorized them as either counterfeit or pharmaceutical. Frequency of listings, average number of pills advertised, average prices per milligram, number of sales, and geographic indicators of shipment origin and destination were analyzed. In total, 2,665 listings were identified as oxycodone. 48.2% (1,285/2,665) of these listings were categorized as counterfeit oxycodone, advertising a total of 652,699 pills (93,242.7 pills per datapoint) offered at a lower price than pharmaceutical pills. Our data indicate the presence of a large volume of counterfeit oxycodone pills both in retail- and wholesale-level amounts mostly targeting US and Canadian customers. These exploratory findings call for more research to develop epidemiological surveillance systems to track counterfeit pill and other drug availability on the Dark web environment.

A commentary on cancer prevention and control in India: Priorities for realizing SDGs.

In India, cancers along with cardiovascular diseases contribute to significant mortality and morbidity. With less than 10 years remaining towards achieving Sustainable development Goals (SDGs), public health systems in India need to be critically assessed and strengthened, for addressing non-communicable diseases (NCDs) in general and cancers in particular. Our Commentary address the public health response to cancer prevention and control, with specific pointers based on emerging evidence. The relevant issues are stratified as: emphasis on the critical appraisal of national programs, strengthening primary health care (PHC) systems, enhancing focus on client and community centricity, exploring integrative approaches to cancer management and stepping up implementation and multidisciplinary research. Ongoing surveillance is essential to assess the current and future trends of cancer as well as the outcomes of prevention and treatment measures. For revitalizing comprehensive PHC, much depends on our epidemiological capacity and surveillance systems which impart information for local planning. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs. SDG 3 has ushered the wellbeing agenda at an opportune time. There is a compelling need to conduct research on an integrated approach (ayurveda complimenting allopathic medication) for the treatment of cancer. The unique challenges posed by the rise in NCD morbidity in LMIC, requires horizontal integration of the health systems with new services focused on cancer control.

Tracking excess of maternal deaths associated with COVID-19 in Brazil: a nationwide analysis

BackgroundThe COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19.MethodsWe performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death.ResultsMost maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (μ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35–1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13–1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39–5.37), ICU admission (OR 1.73; 95% CI 1.50–1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42–1.86) among maternal deaths were higher than in the control group.ConclusionsThere was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium.

Lethality risk markers by sex and age-group for COVID-19 in Mexico: a cross-sectional study based on machine learning approach

BackgroundMexico ranks fifth worldwide in the number of deaths due to COVID-19. Identifying risk markers through easily accessible clinical data could help in the initial triage of COVID-19 patients and anticipate a fatal outcome, especially in the most socioeconomically disadvantaged regions. This study aims to identify markers that increase lethality risk in patients diagnosed with COVID-19, based on machine learning (ML) methods. Markers were differentiated by sex and age-group.MethodsA total of 11,564 cases of COVID-19 in Mexico were extracted from the Epidemiological Surveillance System for Viral Respiratory Disease. Four ML classification methods were trained to predict lethality, and an interpretability approach was used to identify those markers.ResultsModels based on Extreme Gradient Boosting (XGBoost) yielded the best performance in a test set. This model achieved a sensitivity of 0.91, a specificity of 0.69, a positive predictive value of 0.344, and a negative predictive value of 0.965. For female patients, the leading markers are diabetes and arthralgia. For males, the main markers are chronic kidney disease (CKD) and chest pain. Dyspnea, hypertension, and polypnea increased the risk of death in both sexes.ConclusionsML-based models using an interpretability approach successfully identified risk markers for lethality by sex and age. Our results indicate that age is the strongest demographic factor for a fatal outcome, while all other markers were consistent with previous clinical trials conducted in a Mexican population. The markers identified here could be used as an initial triage, especially in geographic areas with limited resources.

Dependency of sanitation infrastructure on the discharge of faecal coliform and SARS-CoV-2 viral RNA in wastewater from COVID and non-COVID hospitals in Dhaka, Bangladesh

The detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA in wastewater can be used as an indicator of the presence of SARS-CoV-2 infection in specific catchment areas. We conducted a hospital-based study to explore wastewater management in healthcare facilities and analyzed SARS-CoV-2 RNA in the hospital wastewater in Dhaka city during the Coronavirus disease (COVID-19) outbreak between September 2020–January 2021. We selected three COVID-hospitals, two non-COVID-hospitals, and one non-COVID-hospital with COVID wards, conducted spot-checks of the sanitation systems (i.e., toilets, drainage, and septic-tank), and collected 90 untreated wastewater effluent samples (68 from COVID and 22 from non-COVID hospitals). E. coli was detected using a membrane filtration technique and reported as colony forming unit (CFU). SARS-CoV-2 RNA was detected using the iTaq Universal Probes One-Step kit for RT-qPCR amplification of the SARS-CoV-2 ORF1ab and N gene targets and quantified for SARS-CoV-2 genome equivalent copies (GEC) per mL of sample. None of the six hospitals had a primary wastewater treatment facility; two COVID hospitals had functional septic tanks, and the rest of the hospitals had either broken onsite systems or no containment of wastewater. Overall, 100 % of wastewater samples were positive with a high concentration of E. coli (mean = 7.0 log10 CFU/100 mL). Overall, 67 % (60/90) samples were positive for SARS-CoV-2. The highest SARS-CoV-2 concentrations (median: 141 GEC/mL; range: 13–18,214) were detected in wastewater from COVID-hospitals, and in non-COVID-hospitals, the median SARS-CoV-2 concentration was 108 GEC/mL (range: 30–1829). Our results indicate that high concentrations of E. coli and SARS-CoV-2 were discharged through the hospital wastewater (both COVID and non-COVID) without treatment into the ambient water bodies. Although there is no evidence for transmission of SARS-CoV-2 via wastewater, this study highlights the significant risk posed by wastewater from health care facilities in Dhaka for the many other diseases that are spread via faecal oral route. Hospitals in low-income settings could function as sentinel sites to monitor outbreaks through wastewater-based epidemiological surveillance systems. Hospitals should aim to adopt the appropriate wastewater treatment technologies to reduce the discharge of pathogens into the environment and mitigate environmental exposures.

Measles epidemiological surveillance system before and during the COVID-19 pandemic in Pernambuco, Brazil, 2018-2022: a descriptive evaluation.

To evaluate the measles epidemiological surveillance system, before and during the COVID-19 pandemic in Pernambuco, Brazil. This was a descriptive evaluation of the quality (duplicity; completeness; consistency), timeliness and usefulness attributed, classified as excellent ≥ 90.0%, regular ≥ 70.0% and < 90.0%, and poor (< 70.0%). Data from the Notifiable Health Conditions Information System and Laboratory Environment Management System were used, before (03/11/2018-03/10/2020) and during (03/11/2020-03/10/2022) the pandemic. 1,548 suspected measles cases were registered (1,469 before and 79 during the pandemic). In the two periods studied, there were 11 and 1 duplicate records, average completeness in filling out the variables was 99.2% and 95.7%, while average consistency was 96.7% and 97.5%, respectively. Timeliness (receipt of samples, 16.2% and 33.0%. Release of results, 1.3% and 1.3%) and usefulness (43.5% and 24.4%) were poor. Quality was classified as excellent in the periods studied, timeliness and usefulness were classified as poor, signaling non-compliance with the purpose of the system. The quality of data from the measles epidemiological surveillance system in Pernambuco was excellent, while its timeliness and usefulness were poor during both periods. The limited timeliness and, therefore, the low usefulness of the measles epidemiological surveillance system must be discussed in the three government spheres of health service management, with the aim of training the professionals involved, as well as monitoring and evaluating the system. Systematic monitoring and evaluation generates evidence that supports health service managers and workers in the timely identification of gaps that compromise the full fulfillment of the objectives proposed.

Prevazilaženje izazova - model metodologije nadzora infekcija povezanih sa zdravstvenom zaštitom

Healthcare-associated infections are infections people get while they are receiving health care for another condition and they can happen in any health care facility. In the U.S.A. alone the annual number of these infections has been estimated to 1.7 million by the Centers for Disease Control and Prevention. Also, it is estimated that they contribute to around 99,000 deaths per year. The focus on preventive strategies is only possible if reliable data on infection rates per ward are available. For this purpose, a frequent broad-based healthcare-associated infections surveillance is necessary. The aim of this article is to present a specific type of epidemiological surveillance system called Integrated Disease Management Corporation Surveillance. Future research has a great challenge to see how to successfully implement Integrated Disease Management Corporation Surveillance into different types of health care system facilities. The emphasis in the future process of such implementation should consider the definition of quantitative share or qualitative indicator that would be able to present how much an Integrated Disease Management Corporation Surveillance, incorporated in a medical facility would be capable to result in improvement in HAI specific QoL, activities of daily living capacity, hospital admissions, and hospital days per person. Future research should evaluate which combination of Integrated Disease Management Corporation Surveillance components and which intervention duration are most effective for Integrated Disease Management Corporation Surveillance programs, and should consider contextual determinants of implementation and treatment effect, including process related outcomes, long term follow up, and cost effectiveness analyses. All of this should be tailor targeted for specific medical facility that is about to start using the Integrated Disease Management Corporation Surveillance.