Establishing priorities for national communicable disease surveillance: SEVERITY
Severity is defined as ‘most likely outcome’ and classified into three groups. One point is assigned to the disease if it is of short duration and the patient completely recovers. Five points are assigned if the most likely outcome is death; for example, HIV, AIDS and rabies were each assigned a score of 5.
POTENTIAL TO SPREAD TO THE GENERAL POPULATION
A score of 0 is assigned to a disease if there is no potential threat of spread to the general population. A score of 1 is assigned if the potential for spread is localized and managed on a case-by-case basis. A score of 3 is assigned for ‘local’ outbreaks, and a score of 5 is assigned if the outbreak is national. For example, influenza, measles and chickenpox were each assigned 5 points. HIV was assigned 3 points, rabies was assigned 1 point and CJD was assigned 0 points.
Socioeconomic burden is defined as ‘the global cost per case’. The subcommittee considered factors such as the cost of immunization and food inspection programs, nonhospital health care, and long term disability. Economic impact analyses are not available for many communicable diseases, so subjective comparison was often necessary. The variable is classified into three groups: low is assigned a score of 1; medium has a score of 3; and ‘high socioeconomic burden’ is given a score of 5. Chickenpox and salmonellosis were assigned a ‘low’ score; influenza was designated ‘medium’, and HIV was assigned a ‘high socioeconomic burden’.
Preventability is defined as the feasibility of a public health process to prevent or control the disease in question. A score of 0 is assigned if there is no potential for public health intervention. A score of 1 is awarded if the disease incidence can be modified by educational program or behavioural modification. A score of 5 is awarded to those diseases that are preventable by vaccination. CJD and invasive group A streptococcal disease were each awarded a score of 0. Several of the foodborne and waterborne diseases were awarded a score of 1, reflecting the impact of educational material on safe food practices and the nonexistence of national strategies or programs for primary source control. HIV and AIDS were each awarded a score of 1 to reflect educational material on ‘safer sex’. The sexually transmitted diseases, such as genital chlamydia, gonorrhea and syphilis, were assigned a score of 3, reflecting the role of contact tracing as a public health intervention.
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