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Ethnic group and perhaps occupation for tuberculosis in some countries, and food handlers for salmonella reports, are examples. Age grouping is the critical analysis for detecting subtle changes in disease trends. Standard age groups should normally be used. 4 What age groups would you use in surveillance? Are there exceptions? 28 Surveillance Feedback It is important to use standard age groups, but equally important not to be too rigid about them. These are generally 0–4, 5–9, 10–14, 15–24, 25–44 etc.

Are the staff trained and understand how to deal with the data? • How well does the surveillance meet the qualitative and quantitative criteria of timeliness, representativeness, consistency, completeness and accuracy? Is the process flexible? 34 Surveillance Feedback • • • • Timely? Understandable? Reaching appropriate audience? Have any public health actions resulted from the surveillance? Have any outbreaks been uncovered? Has the surveillance produced new information about the infection? A report with recommendations should be made after each evaluation.

Consider an infection, say influenza, and a finite population at risk. When influenza causes an outbreak, only a proportion of the population will be infected. 3). 5 How can you detect asymptomatic infections? Feedback Carriers can be detected by identifying the organism via: swabbing (throats for meningococci, streptococci, respiratory viruses); testing faeces (polio, other enteroviruses, salmonella); blood (hepatitis B, C, D). Asymptomatic infections can be detected by swabbing, as above, and by serological testing, usually blood but also saliva.

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