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. 2020 Apr 4;139:105689. doi: 10.1016/j.envint.2020.105689

Table 1.

Routes to assessing public health and infectious disease surveillance techniques with advantages and disadvantages.

Technique Examples Advantages Disadvantages References
Sentinel Surveillance General practitioner’s (GPs) reporting cases of influenza Making use of an efficient system that is already in place
Increase communication within communities
Can help detecting larger health problems in a population
Rare and novel microbes occurrences are likely to be missed, e.g. new emerging virus
Often focus on specific diseases
(Lee et al., 2010)
Clinical-based surveillance Increased knowledge transfer between epidemiologists and microbiology laboratories
Detailed information found on specific details of microbe e.g. virulence
Online reporting available for specific diseases and up-to-date global databases publically available e.g. FluNet from WHO (https://www.who.int/influenza/gisrs_laboratory/flunet/en/)
Requires significant facilities, resources, trained staff and good communication links.
Central reference laboratory is needed for standardisation and support
If pathogens are rare, can lead to staff being complacent
Selection bias on which samples are sent to the laboratory
(Choi, 2012)
Questionnaires or surveys Recurrent or cross-sectional surveys Can collect data for multiple diseases or exposures at one time
Capability for local, national or international level
Standardised methods utilised and high quality data often obtained
Flexibility in questions asked
Build up trends if survey is done repeatedly
Bias
More information about public health
Expensive – costs will vary on sample size, time period of survey
Time delay to results
If optional might not get a good response – might not be representative of whole populations
Results can be difficult to interpret
(Thacker and Berkelman, 1988)
Search engine trends Google Flu Trends (http://google.com/trends/) Rapid obtainment of results
Effective for large populations of web users
Potential to track epidemics or diseases with high prevalence in a population
Difficult to determine if individuals searching are having symptoms or googling as concerned or to find out more
Requires internet access, not as suitable for developing countries
Differences in language backgrounds can lead to different words to describe symptoms being googled
Diseases with low prevalence won’t spike enough to notice
(Carneiro and Mylonakis, 2009)
Mortality and morbidity rates Deaths recorded for diseases like Ebola or influenza Inexpensive and well-established system of reporting
Death certificates are legally required in most countries
Can aid in monitoring the progression of an epidemic
If deaths from a particular cause are too low, mortality statistics potentially don’t reflect accurate incidence of the disease

Long delays in getting results
Significant variation into how death certificates are filled
Passive form of surveillance
(Choi, 2012)
Hospital admission data ED-based surveillance for The
Emerging Infectious Disease Surveillance Network
Can provide data on severity of injury, new emerging infectious disease and drug abuse
Help identify if changes in healthcare are needed
Potential early flagging of bioterrorism attack
Significant human and resource investment for setting up system and connecting with public health system
Confidentiality challenges in sharing information to public health agencies
Compliance of often busy emergency department staff to fill in data
Need to standardise data collection
(Hirshon, 2000)
Prescription Rates Generate trends of dug patterns in a community Prescription data not always easily accessible
Potential under-representation of what’s being used
  • -

    Over-the-counter drugs

  • -

    Prescription medications can be bought without prescription

  • -

    Hospital data is not captured

Cannot know if patient has taken drug
(Cadarette and Wong, 2015)
Human bio-monitoring Assess an environmental exposure of a toxin Information received detailed and of high quality
Can assess suspected exposure of an individual
If collected repeatedly can build up exposure pattern over time.
Small focus group – might not be representative of a large population
Selection of control group is challenging
Lengthy ethical considerations, samples collected must be used for specific research project – further approval and consent needed for new analysis
(Bauer, 2008, Needham et al., 2007)
Wastewater-based Epidemiology
Assess exposure to chemicals at the community level Capable of spatial and temporal trends
Data in near-real time (potential for real time with biosensors)
Information given on whole population
Ethical considerations, does not require approval depending on size of urban area
Selection of biomarkers can be challenging
Biomarker stability in wastewater
Uncertainties related to contributing population and wastewater flows
Significant time-lag between data collection and analysis
(Been et al., 2017, Choi et al., 2019, Lopardo et al., 2018, Rousis et al., 2017)