Surveillance Data

Health departments collect a variety of biosurveillance data. We begin this section by discussing vital statistics, which serve many functions such as monitoring increases in unexplained deaths. We also discuss notifiable disease reports. Both vital statistics and disease reports are among the earliest types of data collected systematically by governments for the purpose of biosurveillance. We also discuss sentinel surveillance.

5.1. Vital Statistics

A vital statistic is a record of a birth, death, or changes in civil status, such as marriage, divorce, and adoption (University of Washington, 2005). The basis for vital registration is rooted in state and federal law (Dean, 2000), which require local registrars, hospitals, and attending physicians to register births, deaths, and civil status changes.

Although each state is free to determine the required information and its preferred format (Birkhead and Maylahn, 2000), workgroups sponsored by the Division of Vital Statistics of the DHHS develop specifications that encourage uniform reporting so national comparisons are possible. Although the use of these specifications is voluntary, they have resulted in a fair degree of uniformity among the states.

Generally, health departments use birth and death data for biosurveillance, not civil status; therefore, we limit our discussion to these two vital statistics.

TABLE 5.1 Selected agencies which comprise the Department of Health and Human Services

Agency for Healthcare Research and Quality (AHRQ)

Centers for Disease Control and Prevention (CDC)

Agency for Toxic Substances and Disease Registry (ATSDR)

Food and Drug Administration (FDA)

Health Resources and Services Administration (HRSA)

Indian Health Service (IHS)

Nationals Institute of Health (NIH)

Substance Abuse and Mental Health Services Administration (SAMHSA)

5.1.1. Death Certificates

Physicians and medical examiners issue death certificates to certify death for legal purposes. A death certificate is required before a funeral home will bury an individual, a court will probate a will, any property of the deceased can be sold, and a variety of other civil functions. The death certificate includes the cause of death and the deceased age and place of death, which may be helpful in characterizing an outbreak and may give clues about the identity of the causative agent. Figure 5.2 is the 2003 national death certificate developed by the Division of Vital Statistics workgroup.

As discussed in Chapter 3, a health department may analyze disease-specific or overall death rates to detect and track outbreaks. For example, the CDC uses total deaths from pneumonia and influenza reported by selected cities weekly as a means of tracking outbreaks of influenza. Death certificates are the source of data for such analyses.

5.1.2. Birth Certificates

Various entities (e.g., clinicians, hospitals, midwives) record and certify births. Health departments issue birth certificates based on their certifications. Birth certificates have potential utility for detecting outbreaks due to infectious agents that may cause premature delivery (e.g., Neisseria gonorrhoeae, Treponema pallidum, herpes simplex, group b streptococcus) or birth defects (e.g., rubella, cytomegalovirus, Toxoplasma gondii). Birth certificates are only issued for live births; thus, birth certificates do not have potential usefulness in detecting increases in fetal deaths or miscarriages owing to infectious diseases such as HIV. There are databases, such as the Infant Mortality Database, that are formed by linking birth records and death records. These databases allow the detection of increases in deaths among infants, and the linkage provides additional information that may identify the cause.

Figure 5.3 is an example of a standard U.S. birth certificate.

5.2. Notifiable Disease Reports

As discussed in Chapter 3, the healthcare system (laboratories, hospitals, and physicians) within a health department's jurisdiction reports cases of notifiable diseases directly to the health department. Health departments decide to make diseases notifiable based on their potential as threats to a community. The list of diseases that are considered notifiable varies slightly by state (Koo and Wetterhall, 1996).To encourage uniformity across states, the Council of State and Territorial Epidemiologists (CSTE) and the CDC collaborate in establishing the Nationally Notifiable Disease List. These groups make recommendations annually for additions to and deletions from the list of nationally notifiable diseases. Diseases may be added to the list as new pathogens emerge and deleted as their incidence declines.

Most commonly, the healthcare system files reports of notifiable diseases manually through phone calls, mail, or faxes.

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