Public Health Informatics in Global Health Surveillance: A Review

Background: Surveillance is the backbone for effective public health practice. Traditionally, surveillance system relies on the collection of information regarding health-related events through healthcare facilities, disease notification system from the physician, syndromic notification networks, selected sentinel healthcare facilities, or by event-based data. However, there are several limitations in using conventional surveillance. Methods: With the advancement of technology and computer science, overcoming those limitations and complementing the traditional method has been recommended. Three leading emerging technologies are applied in public health surveillance: the internet of things, artificial intelligence, and blockchain. Results: Application of informatics in public health surveillance could raise several issues including accessibility and affordability of innovations; public health informatics’ experts, law, and regulation to protect patients’ information; social and ethical considerations, norms, and standards of implementing new technologies; data ownership; privacy and sharing of information; biosecurity; biosafety; and cybersecurity. Conclusion: This article aimed to review several applications of informatics system in public health surveillance practice and its several issues related to the use of technology. Several applications of informatics could be useful for incoming challenges in public health. However, application of informatics can pose significant issues and must be taken into consideration in public health practice.

APCDs can Provide Important Insights for Surveilling the Opioid Epidemic, With Caveats

State-level all-payer claims databases (APCDs) are a possible new public health surveillance tool, but their reliability is unclear. We compared Colorado’s APCD with other state-level databases for use in monitoring the opioid epidemic (Colorado Hospital Association and Colorado’s Prescription Drug Monitoring Program database for 2010–2017), using descriptive analyses comparing quarterly counts/rates of opioid-involved inpatient and emergency department visits and counts/rates of 30-day opioid fills between databases. Utilization is lower in the Colorado APCD than the other databases for all outcomes but trends are parallel and consistent between databases. State APCDs hold promise for researchers, but they may be better suited to individual-level analyses or comparisons of providers than for surveillance of public health trends related to addiction.

NextGen Public Health Surveillance and the Internet of Things (IoT)

Recent advances in technology have led to the rise of new-age data sources (e.g., Internet of Things (IoT), wearables, social media, and mobile health). IoT is becoming ubiquitous, and data generation is accelerating globally. Other health research domains have used IoT as a data source, but its potential has not been thoroughly explored and utilized systematically in public health surveillance. This article summarizes the existing literature on the use of IoT as a data source for surveillance. It presents the shortcomings of current data sources and how NextGen data sources, including the large-scale applications of IoT, can meet the needs of surveillance. The opportunities and challenges of using these modern data sources in public health surveillance are also explored. These IoT data ecosystems are being generated with minimal effort by the device users and benefit from high granularity, objectivity, and validity. Advances in computing are now bringing IoT-based surveillance into the realm of possibility. The potential advantages of IoT data include high-frequency, high volume, zero effort data collection methods, with a potential to have syndromic surveillance. In contrast, the critical challenges to mainstream this data source within surveillance systems are the huge volume and variety of data, fusing data from multiple devices to produce a unified result, and the lack of multidisciplinary professionals to understand the domain and analyze the domain data accordingly.

The impact of the novel coronavirus disease (COVID-19) pandemic on drug overdose-related deaths in the United States and Canada: a systematic review of observational studies and analysis of public health surveillance data

Background There are preliminary indications that the trajectory of drug overdose-related deaths in North America has been exacerbated due to the novel coronavirus disease pandemic (COVID-19). As such, the impact of COVID-19 on drug overdose-related deaths was examined through a systematic review of the literature and percentage change analyses of surveillance data. Methods Systematic searches in electronic databases were conducted, a topical issue brief and bibliography were reviewed, reference lists of included studies were searched and expert consultations were held to identify studies (Registration # CRD42021230223). Observational studies from the United States and Canada were eligible for inclusion if drug overdose-related deaths were assessed in quantitative or qualitative analyses onwards from at least March 2020. In addition, percentage changes comparing drug overdose-related deaths in the second annual quarter (Q2 2020 [April to June]) with the first annual quarter (Q1 2020 [January to March]) were generated using national and subnational data from public health surveillance systems and reports from jurisdictions in the United States and Canada. Results Nine studies were included in the systematic review, eight from the United States and one from Canada. The maximum outcome assessment period in the included studies extended until September 2020. Drug overdose-related deaths after the onset of COVID-19 were higher compared with the months leading up to the pandemic in 2020 and the comparative months in 2019. In additional percentage change analyses, drug overdose-related deaths increased by 2 to 60% in jurisdictions in the United States and by 58% in Canada when comparing Q2 2020 with Q1 2020. Conclusions Drug overdose-related deaths increased after the onset of COVID-19. The current situation necessitates a multi-pronged approach, encompassing expanded access to substance use disorder treatment, undisrupted access to harm reduction services, emphasis on risk reduction strategies, provision of a safe drug supply and decriminalization of drug use.

Public health surveillance

Public health surveillance provides the epidemiologic foundation for modern public health practice. The ongoing monitoring of disease or health trends within populations informs what public health actions are taken and reflects whether those actions are effective. Surveillance may involve monitoring of diseases and other health-related conditions as well as their antecedents, characteristics, and consequences. Surveillance can guide the local response to individual cases of disease or more broadly inform public health programmes and policies. A key function of surveillance is to identify circumstances that merit further public health scrutiny, such as groups or locations that are disproportionately affected or changes in disease occurrence or severity. General principles that underlie the practice of surveillance are essentially the same for all countries, regardless of economic development. However, in many resource-poor countries, challenges to meeting needs for population health information are heightened and include potential tensions between groups with differing interests. Public health surveillance is conducted in many ways, depending on the nature of the health event under surveillance, the nature of healthcare and information infrastructures, the population involved, resources available, and information needs. The widespread and expanding use of the internet, electronic media, communication technologies, and mobile computing have enabled innovations in public health surveillance that reach far beyond traditional methods. Although surveillance methods were originally developed as part of efforts to control infectious diseases, basic concepts of surveillance have been applied to all areas of public health.

Wastewater-based epidemiology: current uses and future opportunities as a public health surveillance tool

Wastewater-based epidemiology (WBE) seeks to use biological or chemical indicators in sewage to provide information on the overall health of a community. This paper provides an overview of the range of applications of WBE over the past two decades, how it has been used to inform public health responses, and considerations for more integrated approaches to WBE based on a review of the literature. The review finds that WBE has been used extensively around the world for the estimation of consumption patterns of illicit drugs and other substances, but a range of novel applications also exist. As a result of the COVID-19 pandemic, many communities used WBE for the first time as a complementary public health surveillance tool, monitoring trends in SARS-CoV-2 prevalence in large cities, and for micro-surveillance on a more targeted level. WBE may continue to be a useful public health surveillance tool in the future; however, several limitations and challenges exist. Consideration of how information obtained through WBE can be used to inform public health responses is essential to understanding the potential costs and benefits compared with conventional public health surveillance techniques.

Suicide and drug toxicity mortality in the first year of the COVID-19 pandemic: use of medical examiner data for public health in Nova Scotia

Introduction The COVID-19 pandemic and governmental responses have raised concerns about any corresponding rise in suicide and/or drug toxicity mortality due to exacerbations of mental illness, economic issues, changes to drug supply, ability to access harm reduction services, and other factors. Methods Data were obtained from the Nova Scotia Medical Examiner Service. Case definitions were developed, and their performance characteristics assessed. Pre-pandemic trends in monthly suicide and drug toxicity deaths were modelled and the observed numbers of deaths in the pandemic year compared to expected numbers. Results There was a significant reduction in suicide deaths in the first year of the COVID-19 pandemic in Nova Scotia, with about 21 fewer non-drug toxicity suicide deaths than expected in March 2020 to February 2021 (risk ratio = 0.82). No change in drug toxicity mortality was detected. Case definitions were successfully applied to free-text cause of death statements and cases where cause and manner of death remained under investigation. Conclusion Processes for case classification and monitoring can be implemented in collaboration with medical examiners/coroners for timely, ongoing public health surveillance of suicide and drug toxicity mortality. Medical examiners and coroners are the stewards of a wealth of data that could inform the prevention of further deaths; it is time to engage these systems in public health surveillance.