Publication of CDC Surveillance Summaries

Since 1983, CDC has published the CDC Surveillance Summaries under separate cover as part of the MMWR series. Each report published in the CDC surveillance Summaries focuses on public health surveillance; surveillance findings are reported for a broad range of risk factors and health conditions.

Summaries for each of the reports published in the most recent (August 28, 1992) issue of the CDC Surveillance Summaries (1) are provided below; this is the second issue this year focusing on international topics in public health surveillance. All subscribers to MMWR receive the CDC Surveillance Summaries, as well as the MMWR Recommendations and Reports, as part of their subscriptions.

ENVIRONMENTAL RESPIRATORY DISEASE SURVEILLANCE: A HUNGARIAN EXAMPLE

In October 1989, the Hungarian National Institute of Hygiene initiated the Children's Acute Respiratory Morbidity Surveillance System to assess the association between nine reportable respiratory diseases and air pollution. The weekly number of physician-diagnosed, reportable respiratory diseases among four age groups of children (less than 1, 1-2, 3-5, and 6-14 years) was tabulated for Sopron, a city with 60,000 residents. The proportion of diseases were calculated that occurred during weeks with low, moderate, and high sulfur dioxide (SO2) and nitrogen dioxide (NO2) concentrations. The weekly averages of the 24-hour median SO2 concentrations were divided into thirds at less than or equal to 17.6, greater than 17.6 to less than or equal to 26.3, and greater than 26.3 ug/m3 (range=0.9-79.6 ug/m3), and the NO2 concentrations at less than or equal to 29.8, greater than 29.8 to less than or equal to 44.1, and greater than 44.1 ug/m3 (range=4.2-90.1 ug/m3). During 1990, 11,474 respiratory disease cases occurred among the 4020 children less than 15 years old living in Sopron. The two most frequently reported disease categories were rhinitis/tonsillitis/pharyngitis (71.5%) and acute bronchitis (8.5%). Sixty-seven percent of pneumonia cases occurred when SO2 concentrations were highest. No association was found between NO2 and respiratory diseases. The Children's Acute Respiratory Morbidity Surveillance System may better characterize which groups of children develop which respiratory diseases following exposure to air pollution. Authors: Peter Rudnai, MD, Bela Johan National Institute of Hygiene, Budapest, Hungary. Mary M. Agocs, MD, Ruth A. Etzel, MD, PhD, Division of Environmental Hazards and Health Effects, National Center for Environmental Health and Injury Control, CDC.

SURVEILLANCE IN EVACUATION CAMPS AFTER THE ERUPTION OF MT. PINATUBO, PHILIPPINES

To obtain accurate, timely data on the health status of refugees in evacuation camps after the eruption of the Mt. Pinatubo volcano, the Philippine Department of Health (DOH) conducted a survey on the health needs of the evacuees and established disease surveillance in each camp. Survey of the camps revealed that sources of potable water, sanitary means of waste disposal, and shelters were inadequate. Disease surveillance showed that measles, acute respiratory infections, and diarrhea were the most important problems. Surveillance detected outbreaks of measles and an outbreak of vomiting and diarrhea in the camps. Deaths, primarily caused by diarrhea, measles, and respiratory infections, totaled 277 in the first 10 weeks. Death rates peaked in the seventh week, when a death rate of 26/10,000 occurred among the Aetas, a tribe evacuated from the slopes of the volcano. The surveys guided the DOH in allocating supplies and medicine, while disease surveillance enabled disaster managers to monitor the effectiveness of health programs, identify high-risk groups, and respond optimally to the situation. Authors: Maria Ruth S. Surmieda, MD, Ilya P. Abellanosa, MD, Florante P. Magboo, MD, Rio L. Magpantay, MD, Maria Luz G. Pascual, MD, Enrique A. Tayag, MD, Grace Abad-Viola, MD, Franklin C. Diza, MD, Juan M. Lopez, MD, Mary Elizabeth G. Miranda, MD, Maria Concepcion R. Roces, MD, Robert A. Sadang, MD, Nancy S. Zacarias, MD, Manual M. Dayrit, MD, MSc, Mark E. White, MD, Field Epidemiology Training Program, Philippine Department of Health.

MEASLES -- NEW ZEALAND, 1991

In New Zealand, where measles is not a reportable disease, an increase in the number of suspected cases of measles was first noticed in mid-February 1991. A surveillance system was established through the 14 area health boards to enable timely monitoring of the magnitude and extent of the epidemic. A total of 9239 cases that met the clinical case definition for measles was reported to the New Zealand Communicable Disease Center from July through December 1991. The actual number of cases may have been three to four times greater. The first vaccination coverage survey ever conducted in New Zealand, which was completed in July 1991, showed that only 61% of children 16 months of age in the Hawke's Bay Area had received measles vaccine. A nationwide vaccination survey is under way to evaluate the level of vaccination coverage among preschool-aged children. Ongoing surveillance is required to provide timely, representative information to guide decision-making. Authors: Yvonne Galloway, New Zealand Communicable Disease Centre. Paul Stehr-Green, DrPH, National Center for Prevention Services, CDC.

HEALTH INFORMATION SYSTEM DEVELOPMENT IN TOGO, WEST AFRICA

Since 1988, the Ministry of Health (MOH) of Togo, with technical assistance from CDC, has systematically adapted and strengthened its health information system (HIS) to enable improved monitoring of trends in diseases. The previous system had been hampered by complicated, lengthy reporting forms; incomplete and delayed receipt of reporting forms; absence of mortality reporting; slow, cumbersome manual compilation and analysis methods; and lack of standard case definitions. To simplify the adaptation process, the system was divided into three main activities: data collection, data compilation and analysis, and dissemination of reports and follow-up action. Public health authorities in Togo have built on existing strengths and successfully adapted the HIS to focus on national morbidity and mortality prevention priorities. Authors: T. Karsa, MD, Epidemiology Division, Ministry of Health, Togo, West Africa. Michael J. Toole, MD, Brian Fitzgibbon, Kelly Bussell, International Health Program Office, CDC.

SURVEILLANCE OF SEXUAL EXPERIENCE AND USE OF CONTRACEPTION AMONG YOUNG ADULTS IN LATIN AMERICA

Although a formal public health surveillance system has not yet been established in Latin America to document the attitudes of young people toward sex education, sexual activity, and contraception and their behaviors in these areas, representative data are available from 12 household-based Young Adult Reproductive Health Surveys conducted in seven countries since 1985. The surveys indicate that the rate of sexual experience before marriage or consensual union for males is much higher than that for females, and first sexual experience occurs at a younger age for males than for females. However, from 34% to 90% of females 20-24 years of age report having had premarital sexual relations. No more than 41% of females and 31% of males report that they or their partner used contraception at first sexual experience. Less than one-third of both young men and young women could identify the most fertile period during the menstrual cycle. The results of such surveys have provided program officials and policymakers with data to plan, implement, and evaluate interventions targeted for young adults. Author: Leo Morris, PhD, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Reference

1. CDC. CDC surveillance summaries. MMWR 1992;41(no. SS-4).

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