The consequences of risk-based surveillance: Developing output-based standards for surveillance to demonstrate freedom from disease
The consequences of risk-based surveillance: Developing output-based standards for surveillance to demonstrate freedom from disease
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DOI：
10.1016/j.prevetmed.2012.01.009
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发表时间：
2012-08-01
影响因子：
2.6
通讯作者：
Cameron, A. R.
中科院分区：
文献类型：
--
作者：
Cameron, A. R.
基于输出的监测标准提供了一种机制，以实现协调和可比的监测（符合规定的目标），同时允许灵活的方法，适应不同的监测人群。如果正确实施，它们可以降低成本，更好地防止疾病传播。本文介绍了基于风险的抽样如何提高监测效率的例子，并描述了基于产出的监测标准的演变，以证明从疾病的三代方法：监测灵敏度，自由的概率，和预期的错误成本。这三种方法逐步捕获更多的因素影响最终结果。前两个概念相对较好地被接受，但第三个概念是新的，涉及感染的后果，在过去几十年里，人们越来越认识到基于风险的抽样对证明没有疾病的价值，但在实际定义和实施方面存在一些分歧，特别是关于“基于风险”是否意味着感染的概率或概率和后果。本文认为，基于风险的抽样应仅基于群体内某个单位的感染概率，而感染后果则应用来设定目标自由概率。这种方法为规划监督提供了一个直观易懂的定量框架。发现疾病的最好方法，如果它存在的话，是集中在那些最有可能被感染的单位。然而，如果监测的目的包括减轻疾病爆发的风险，我们希望确保在未能发现的后果最大的人群中，这种风险最小。(C)2012爱思唯尔有限公司版权所有。
Output-based surveillance standards provide a mechanism to achieve harmonised and comparable surveillance (which meets a defined objective) while allowing flexible approaches that are adapted to the different populations under surveillance. When correctly implemented, they can result in lower cost and greater protection against disease spread. This paper presents examples of how risk-based sampling can improve the efficiency of surveillance, and describes the evolution of output-based surveillance standards for demonstration of freedom from disease in terms of three generations of approach: surveillance sensitivity, probability of freedom, and expected cost of error.These three approaches progressively capture more of the factors affecting the final outcome. The first two are relatively well accepted but the third is new and relates to the consequences of infection.There has been an increased recognition of the value of risk-based sampling for demonstration of freedom from disease over the last decades, but there has been some disagreement about practical definitions and implementation, in particular as to whether 'risk-based' implies probability of infection or probability and consequences. This paper argues that risk-based sampling should be based solely on the probability of infection of a unit within the population, while the consequences of infection should be used to set the target probability of freedom. This approach provides a quantitative framework for planning surveillance which is intuitively understandable. The best way to find disease, if it is present, is to focus on those units that are most likely to be infected. However, if the purpose of surveillance includes mitigating the risk of a disease outbreak, we want to ensure that that risk is smallest in those populations where the consequences of failure to detect are greatest. (C) 2012 Elsevier B.V. All rights reserved.