Design of a Surveillance System

 

 

 

Design your own surveillance plan for a new outbreak or syndromic event that is hypothetically occurring in your hospital. Select the disease or pathogen and provide a case definition.

 

 

DESIGN OF A SURVEILLANCE SYSTEM

Introduction 

The overly known idea of the surveillance system is related to the detection of certain areas regarding specific factors or functions. This helps to monitor the impact of those factors upon the population for certain time in order to measure the remedy. In the context of health issues and diseases application of surveillance system is beneficial in order measure the effect of the diseases as well as the reaction of the people. Application of surveillance system is related to such factors that could help the authority to restrict the impact of certain infectious diseases. This study is intending to present a surveillance system design regarding the impact of Zika virus in the USA. This will present the data related to the spending of the virus, its impact on the people and they are covered by the virus. A detailed study will shed light on the factors related to the Zika virus. It will also develop an evaluation plan to measure the surveillance plan.

Background information 

Zika is an RNA virus which first noticed in 1947 in the forest of Uganda. In general, it has the characteristics of low-fever, conjunctivitis, and rash and almost 20% infected people are symptomatic. Aedes mosquito is the main responsible for the spreading of this virus. Those liable mosquitoes could bite in the night or even in daytime. This infectious virus could transform to the fetus from a pregnant mother which could result in certain birth defects of the child (Cdc.gov 2018). Medical science is unable to figure out any medicine to prevent the diseases. It has reported that this virus could be spread through transfusion of blood as well as physical intercourse. Though people have a minimum symptoms to record while attacked by this infectious virus, some common symptoms have been figured out. Those symptoms can be visible for a week. This virus generally unable to make people too much sick even after attacked by it nor they required reporting in the hospital. This also limited the number of recording of those cases where people are affected by this virus. Though there is still no medical vaccine for this virus, it has been reported that an infected people are safe from further attack. Before 2015, it was considered as a minor factor but the microcephaly case clusters in Brazil change the scenario and forced WHO in 2016 to announce Public Health Emergency of International Concern (PHEIC) (Pnas.org 2018).Along with microcephaly other birth defects has been reported in Brazil which is also associated with the infection because of Zika.
 

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Figure 1: Zika Symptoms
(Source: Cdc.gov 2018)

Affected population 

As reported by Centers for Disease Control and Prevention (CDC) infection of the Zika virus has been considered as a noticeable national condition. People of state and territorial of US have registered as infected by Zika virus. In the states of US, 418 cases of symptomatic Zika virus diseases have been reported. It also reported that 409 travelers have returned from the infected areas. In 4 cases it has been presumed that local-bourne mosquito of Texas and Florida has been transmitted. There has also registration of 5 cases where sexual transmission has played a vital role regarding the infection. In case of US territories, 637 cases have been reported. Only 1 case of those 637 has been recorded as traveler returning from those infected areas. Rest of the 636 cases has been presumed through the transmission of local mosquito-borne (Cdc.gov 2018).  
    

Figure 2: Zika cases by states and territories of US
(Source: Cdc.gov 2018)

As the provisional data presented by CDC in May 2017 there have been 5,102 symptomatic cases of Zika virus has been recorded in US states. 4,830 cases are related with the traveler who returned from those infected areas. On the other hands, 36,079 symptomatic cases of Zika virus has been reported in US territories. CDC has marked those localities as a red area which has a significant risk of Zika virus, whereas it has marked the mild risked locations as yellow areas. 

Discussion of available data and outbreak existence 

Zika has been spread out across the USA. This also spreads in the local areas. This has been announced by the Health Department of Florida based on the identification of four of such individuals. They are supposed to carry the virus in Miami. An official of this same department has also confirmed 10 additional cases where the affected people are identified in Miami (Cdc.gov 2018). Based on those cases, CDC also enforces certain guidelines regarding the traveling and pregnant women. In the case of Miami, it has been advised to the people and the pregnant woman and the expected to be to avoid the area by one square mile consideration the north of the downtown of the city. Raising effect of Zika virus forces the CDC to guide pregnant women to avoid the specific area of continental United States. In order to extend the outbreak, officials of the health department of Florida is continuing their investigation. They are also evaluating the affected people and communities to in this purpose. In the context of US, Miami and Florida is the tiny geographical area that only suggests the severance of this infection. This risk is constrained by climate and geography. Those mosquitos have several places to live and this increase the threat. CDC has introduced travel advisory for certain areas as they found some areas are under real threat. In case of Wynwood, the director of CDC has accepted that it has been a difficult task to control the mosquito in those areas and it is possible to detect at least 12 such cases of Zika infection out of 150 square meters.  

 Goals for the state 

In order to handle the threat of Zika, US states and territories are required to adopt certain planning. Vector control and the application of surveillance is one such goal in this context that could facilitate the country in this context. These goals are intending to consider those areas where Aedes mosquitoes are endemic. Another goal in this context is the surveillance of public health as well as epidemiological investigation. This is aiming to ensure proper reporting as well as diagnosis of such cases infected by Zika virus. In also includes to monitor the trends of epidemiology regarding distribution, severity, and transmission, to direct effort to control and prevent and also to identify such cases that need to follow or intervention. Support service along with laboratory testing is another goal in this aspect which suggests ensuring proper support for the health department of territories as well as states of US. It will ensure the proper testing of those specimens regarding the suspected cases of Zika virus. Another goal in this context is to prevent the sexual transmission of the infection of Zika virus. Hence the goal is aiming to reduce the threat of sexual transmission of Zika virus through offering proper guidance to the people about the threat and development of consciousness among them as well as clinicians.  

Initial planning 

Development of awareness against the threat of Zika is one of the important steps regarding the planning to fight against this infectious virus. Along with that, such planning will also include certain aspects in this scenario. One of such step is to prevent the blood transfusion infected with the Zika virus. This requires the coordination and support with the local partners and authorities regarding surveillance and epidemiology to investigate further context. As Zika virus has been suspected as related to the blood transfusion, it is required to collaborate with the blood centers of the state or the territory regarding the healthcare facilities about blood transfusion. It is also required to test the collected blood especially in the case of infected areas. Application of pathogen-reduction technology is used in this aspect. Travel health report and the communication with the clinician is also important here. This suggests the ensuring of the risks to the travels in the case of infected areas to ensure the prevention. Design of disseminating travel notice is required to inform the travels for preventing Zika to spread. Healthcare service providers are the important part in this campaign against Zika virus infection and it is important to inform them about the diagnosis, reports, threats, prevention, clinical management and outcomes to ensure their support and effort. This planning also includes the identification of proper functional channels in order to share such information with the clinicians. 

Pre-screening activities 

There are certain types of pre-screening test which could assist to detect the illness because of the infectious effect of Zika virus. One of such activities is a molecular test. This could assist to detect RNA at the earliest stage of the illness. It required performing RNA NAT (nucleic acid testing) on the urine and serum sample. As stated by Mansuy et al. (2016), in case of a pregnant woman, this would be performed with IgM serology. It is recommending performing NAT for at least three times for asymptomatic pregnant women during the period of pregnancy. In the context of an asymptomatic pregnant woman who has the possibility but no exposure to Zika virus, it is recommended to perform NAT based on the model of physician-patient model considering case-by-case basis. In this context, it could follow the testing algorithm for symptomatic pregnant women. In case of those pregnant women who have possible exposure of Zika virus as well as fetus along with prenatal ultrasound findings which is consistent with the congenital infection of Zika virus, NAT would be performed based on the serum and maternal urine concurrently with the IgM serology. The negative result of NAT testing does not confirm exclusion of the infection of Zika virus.  

Advantages of electronic medical record system 

Electronic medical record system can facilitate the user by providing records in relevant effective ways.

Accessibility
Hard copy or pare records can be in one place at one time. On the other hand, records provided by the electronic medical system can be accessed by authorized persons regardless of the location and time. This could provide certain benefits, especially in the complex and emergency medical cases.  

Real-time records
A major advantage of electronic medical record system is the application and availability of real-time records. As commented by Hsiao & Hing (2012), this allows the medical to communicate regarding complex cases through sharing important records including diagnostic images, notes of the doctors or test results. As this provides soft copy of records, multiple health service providers can also analyze the records at the same time. 

Security
As records provided by this system are securely stored in the database, these records are safe. This also reduces the chances to lose those data. This system also permits to apply specific tools and software to ensure the security of data and this data are accessible only to the authorized people.

Safety
Effective control of medication could help to improve the quality of care of the patient and also help to prevent certain avoidable and dangerous oversights. Advantages of electronic medical record system offer automatic initiation regarding the prescription about the checking of the drug to allergy and drug to drug interaction. This helps to minimize the threats of wrong prescriptions and such related issues.   

Development of syndromic surveillance system

In this context application of the regional model of surveillance system will be applicable. As a part of this surveillance, New York City will be selected as target area along with the coalition of the healthcare service providers. This surveillance plan will cover the geography of New York City and its demography to collect data. This will apply electronic mediums to store data. This surveillance plan will detect people with the symptoms of Zika infections as the target population. This plan will consider the people with the possibilities of the exposure of Zika virus and their behaviors and health issues will be recorded. This also includes the less available and applied data such as school and office absent data to detect the affected people. Next part of this plan is acquiring data and storing them in a proper process. Electronic medical record system will be applied to store data. This will provide the authority to the respected people to access this data as cull a log, transfer data or email a report. Along with that syndromic grouping is another function of this planning.  In order to identify the observation and data Logical Observation Identifier Names and Codes (LOINC) will be applied as a standard of data. Referring to clinical finding or laboratory value unambiguous codes will be available to this surveillance plan. Regarding the interest of public health, the standard of CDC will be followed during the surveillance plan implementation.
 

Figure 3: Surveillance plan
(Source: Researcher)

This surveillance plan is required to analyze a large amount of data. Hence data security is a major issue in this context. There will be certain challenges regarding the requirement and the maintenance ability to re-identify following the cases which are figured out. This planning may require accessing geospatial address in order to recognize certain data. Legal status of this surveillance plan will be regulated by the state law of US. In this context, HIPAA regulations will be the guidance to maintain the privacy of data. Approaches to control chart including cumulative sum (CUSUM) will be relied on to figure out the differences comparing with the threshold. Along with that approach of temporal modeling will be applicable.  

Evaluation of the plan

 Evaluation of this surveillance plan is depended upon three mean measurements. This includes the measurement of data quality, timeliness and the impact on outbreak detection. Standards of data quality will assist to measure the sensitivity as well as specificity that can classify the data in an accurate way. This will include the gold standard to measure the data. As suggested by Karch et al. (2012), timeliness suggests the period when datum of interest will be available and related with the appearing time considering the presentation of the patient or any emergency case. It is difficult to measure timeliness at any time and this suggests applying different approaches such as aggregate measures for identified data. This also is measured by the behavior of the patient. It also required judging a potential data source including the combination of data quality and timeliness along with the knowledge regarding the threat.

Summary 

Zika virus has infected the people of US on a large scale. It has spread over a wide area and creates certain threats. This study has presented information about the Zika virus and its expansion. This has also provided the population affected by this infectious virus. A surveillance plan has been designed based on the detailed study provided in this assignment. It has also presented certain goals regarding the campaign against the outbreak of Zika virus. Pre-screening is an important factor in this aspect to detect the infection of Zika virus and this study has illuminated on certain approaches that could assist regarding the pre-screening processes. A surveillance syndrome plan has been designed based on this study which declares the detection and surveillance of the medical conditions related to Zika virus. This has also presented the approaches to collect and analyze data regarding the surveillance process. Evaluation of the plan has also exhibited in this study considering the major factors of this surveillance including data quality, timeliness, and impact on the outbreak detection.  

References

Calvet, G., Aguiar, R. S., Melo, A. S., Sampaio, S. A., de Filippis, I., Fabri, A., ... & Tschoeke, D. A. (2016). Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. The Lancet infectious diseases, 16(6), 653-660.
Cdc.gov (2018), Centers for Disease Control and Prevention, Retrieved On: 11th Nov 2017, From:                                                                                   https://www.cdc.gov/zika/reporting/2017-case-counts.html
Hamel, R., Dejarnac, O., Wichit, S., Ekchariyawat, P., Neyret, A., Luplertlop, N., ... & Cao-Lormeau, V. M. (2015). Biology of Zika virus infection in human skin cells. Journal of virology, 89(17), 8880-8896.
Hsiao, C. J., & Hing, E. (2012). Use and Characteristics of Electronic Health Record Systems Among Office-Based Physician Practices, United States, 2001-2012.
Hsiao, C. J., Hing, E., Socey, T. C., & Cai, B. (2012). Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001–2011. system, 18(17.3), 17-3.
Karch, D. L., Logan, J., McDaniel, D., Parks, S., & Patel, N. (2012). Surveillance for violent deaths—national violent death reporting system, 16 states, 2009. Morbidity and Mortality Weekly Report: Surveillance Summaries, 61(6), 1-43.
Mansuy, J. M., Dutertre, M., Mengelle, C., Fourcade, C., Marchou, B., Delobel, P., ... & Martin-Blondel, G. (2016). Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen. Lancet Infect Dis, 16(4), 405.
Ncbi.nlm.nih.gov (2018), Implementing Syndromic Surveillance: A Practical Guide Informed by the Early Experience, Retrieved On: 11th Nov 2017, From:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC353021/figure/fig1/
Pnas.org (2018), Proceedings of the National Academy of Sciences of the United States of America, Retrieved On: 11th Nov 2017, From:                  http://www.pnas.org/content/114/22/E4334.full

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