Sexually Transmitted Diseases  >  Program Guidelines  >  Surveillance and Data Management

Program Operations Guidelines for STD Prevention
Surveillance and Data Management

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Sections on this page:

• INTRODUCTION S-1
• OBJECTIVES OF A PUBLIC HEALTH SURVEILLANCE SYSTEM
• COMPONENTS AND OPERATION OF A SURVEILLANCE SYSTEM
• Legal Authority
• Types of Surveillance Systems

INTRODUCTION S-1

Surveillance is the ongoing and systematic collection, analysis, interpretation, and dissemination of health data in the process of describing and monitoring disease trends. This information can assist programs to better plan, implement, and evaluate efforts to control STDs. For this reason, surveillance is a core public health function and must be considered one of the most essential and of the highest priority in any STD prevention program. This chapter examines the objectives of a STD surveillance system, describes the components and operation of such a system, and provides case definitions for selected STDs.

The national STD surveillance system uses a reported case registry method. Data sources include laboratory reports, morbidity reports, patient interviews, and information provided by or obtained from health care providers. The system is used to estimate the burden of disease, acquire and allocate resources, detect trends signaling changes in the occurrence of disease, detect epidemics, stimulate epidemiologic research, identify risk factors associated with disease occurrence, and assess the efficacy of control measures.

When using these guidelines, consideration should be given to the disease prevalence in the community, the characteristics of the existing networks of providers and laboratories, and the level of resources available to support STD prevention and control activities. Except for those areas where standardization is clearly indicated (e.g., essential data elements), these guidelines should not be construed as inflexible rules, but as a source of guidance to state and local health departments and laboratories and to their partners in STD prevention and control.

OBJECTIVES OF A PUBLIC HEALTH SURVEILLANCE SYSTEM

Surveillance supports public health efforts by providing a framework for:

• Problem detection—surveillance can identify the emergence of a disease as well as changes in the levels of existing endemic disease. Certain diseases, while not initially perceived as a problem in the population as a whole, may be a significant problem for specific sub-populations.
• Problem description—surveillance can present a picture of disease transmission; can describe both geographic and temporal trends in disease occurrence, populations affected, and changes in the etiologic agent (e.g., antibiotic resistance of microorganisms); and can identify factors mediating disease occurrence.
• Problem solving—surveillance can provide information needed to develop and implement strategies for disease control and prevention. It can help develop priorities for the proper allocation of resources necessary to deal with problems and provide a trigger mechanism to activate a public health response to a problem. Surveillance can also be used to generate or confirm a hypothesis.
• Evaluation—surveillance data can be used to determine how well a public health response addressed a specific health problem. It also provides a basis for predicting patterns of disease.

COMPONENTS AND OPERATION OF A SURVEILLANCE SYSTEM (GENERAL PRINCIPLES)

Legal Authority

Every state has communicable disease laws that give the department of health the authority to determine which diseases are reportable. However, not every disease is reportable in every state. For STDs, many states have statutes that define the reportable diseases. The legal authority for deciding which conditions (and which accompanying case data) are reportable in a given jurisdiction can vary by state, territory or local law or regulation, but is usually the state and/or local health department. Every state requires physicians to report diagnosed cases of, and/or laboratories to report tests indicative of, specific diseases. In most states, other health care or public health professionals (persons in charge of hospitals, clinics, prisons, detention centers) are also required to report cases of specified diseases to the health department. For more details, see the chapter on LEADERSHIP.

Some disease reports are legislatively mandated; others are declared notifiable by the state or local health officer, state epidemiologist, or board of health. The latter is particularly important in the face of a need to act quickly as new conditions arise. Mandated disease reporting requires demographic information, onset date or date of diagnosis, and responsible county. Other data collection requirements are normally left to the local health jurisdiction, but should be consistent with national surveillance case definitions. Reporting requirements should also be time-specific to provide the best opportunity for disease intervention. For example, the states of California, New York, and New Jersey require that acquired and congenital syphilis infections be reported within 24 hours of diagnosis.

Types of Surveillance Systems

Surveillance data are usually collected and used explicitly for a specific surveillance purpose.

• Case-based: Tracks the incidence of a disease with data reported through mandatory provider and laboratory reports of notifiable STDs.
• Prevalence monitoring: Utilizes testing at sentinel sites where specific populations are tested for STDs to determine prevalence. It can also be helpful for monitoring resistance (e.g., GISP—Gonococcal Isolate Surveillance Project).
• Population-based: Collects STD related information such as sexual and health care seeking behavior and provider clinical and prevention practices (risk assessment, screening, counseling, and behavioral interventions) through periodic surveys of at-risk populations, from case investigation/case interview reports, and from providers.

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