Active and passive survillance

Passive and Active surveillance
Presented
By
K.Manipriya

PASSIVE SURVEILLANCE
For reporting diseases, risk factors or health-related events.
Health practitioners report events as they come to their attention.
This is the more common type of surveillance.
Eg: A physician sees a patient, diagnoses measles,
and then initiates a case report by contacting the
local health department and providing the details
as required for a case of measles.
It is not a huge burden on the reporter.

Voluntary communication by healthcare
professionals or consumers to a company,
regulatory authority or other organization
Defines one or more adverse drug reactions (ADRs) in a patient who was
given one or more medicinal products.
Identification of safety signals once a medicine is marketed.
Can vigilant a company to rare adverse events that were not noticed in
earlier clinical trials or other pre-marketing studies.
A) Spontaneous reports

It can also deliver important information on at-risk groups, risk factors and
clinical features of known serious ADRs.
Bayesian theorem.
Data mining techniques
High Sensitivity and Low Specificity of the method.

A series of case-reports can deliver sign of an association between a
medicine and an adverse event
But they are normally more valuable for producing theories than for
confirming a relationship between medicine exposure and outcome.
B) Case series

C) Stimulated reporting
Such systems comprise on-line reporting of adverse events
Info about Patient, Medication, ADR,s observed and reporter info.

For reporting disease (or its absence), risk factors or health events.
When there is an indication that something unusual is occurring.
Determine the particular number of adverse events through a constant
pre-organized process.
ACTIVE SURVEILLANCE

Eg: If a health department receives a case
report for measles, a serious vaccine-preventable
disease, active surveillance will be triggered.
Means of validating the representative
nature of passive reports and providing a more
complete reporting of health events.
Its major disadvantage is its high use of resources.
For this reason, when it is used, it is for a limited time period

Revising medical records or questioning
patients and/or physicians in a section of
sentinel sites
To guarantee that comprehensive and
precise data on reported adverse events are
collected from these sites.
The selected sites can deliver
information, such as data from specific
patient subgroups.
A) Sentinel sites

The major weaknesses of sentinel sites comprise difficulties with
selection bias, small numbers of patients and augmented costs.
Most effective for those medicines used primarily in institutional settings
such as hospitals, nursing homes and haemodialysis centers.
Intensive monitoring of sentinel sites can also be supportive in
recognizing risks among patients taking orphan medicines.

Studies using this process are cohort- based
and prospective and observational.
For medication event monitoring, patients
can be acknowledged from electronic or
automated health insurance claims.
A single prescription or a series might be composed over the period of
monitoring.
B) Medicine event monitoring

A follow-up questionnaire can then be sent to
each prescribing physician or patient at pre-
specified intervals to acquire outcome data.
Requests for data on patient demographics,
indication for treatment, duration of therapy,
dosage, clinical events, reasons for termination
and applicable past history can be involved in
the questionnaires.

A registry is a list of patients presenting with
the identical representative(s).
This representative can be a disease (disease
registry) or a specific exposure (medicine
registry).
A registry may be a disease registry or
exposure registry.
C) Registries

Disease registries, such as registries for blood dyscrasias, severe cutaneous
reactions, or congenital malformations can help to gather data on medicine
exposure.
Exposure (medicine) registries address populations exposed to the
medicines of interest to govern if a medicine has a distinct influence on this
group of patients.
Some exposure (medicine) registries address drug exposures in specific
populations, such as pregnant women.

Patients can be followed over time and included in a cohort study to collect
data on adverse events using standardized questionnaires.
Single cohort studies can quantity incidence, but, without a comparison
group, cannot deliver proof of association.
This type of registry can be very valuable when examining the safety of an
orphan medicine indicated for a specific condition.
The most imperative of these designs is cross-sectional studies, case-control
studies and cohort studies.

The major disadvantage of cross-sectional studies is that the temporal
relationship between exposure and outcome cannot be straight addressed.
D) Cross-sectional study (survey) (Samad notes)

In a case-control study, cases of disease
(or events) are recognized.
E) Case-control study (Samad notes)

In a cohort study, a population at risk for the disease (or event) is
monitored over time to record the occurrence of the disease (or event).
Information on exposure status is accessible during the follow-up period
for each patient.
A patient might be exposed to a
medicine at one time during follow-up,
but not exposed at another time.
In many cohort studies concerning
medicine exposure, appraisal cohorts of
interest are selected on the basis of
medicine use and monitored over time.
f) Cohort study(Samad notes completely)

Cohort studies are useful when there is a
requisite to know the incidence rates of
adverse events in addition to the relative risks.
Multiple adverse events can also be
scrutinized using the similar data source in a
cohort study.
Conversely, it can be problematic to recruit
adequate numbers of patients who are exposed
to the medicine of interest or to study very rare
outcomes.
Similar to case-control studies, patients in
cohort studies can be recognized from large
automated databases or from data collected
precisely for the study at hand

In addition, cohort studies can be used to scrutinize
safety issues in special populations through
oversampling of these patients or by stratifying the
cohort if adequate numbers of patients are included.
There are numerous automated databases obtainable
for pharmacoepidemiological studies.
They consist of databases that contain automated medical records or
automated accounting/billing systems.
Databases that are fashioned from accounting/billing systems might be
connected to pharmacy claims and medical claims databases.

These datasets may contain millions of patients.
Subsequently, they are fashioned for administrative or billing purposes;
they might not have all the detailed and precise information needed for some
research, such as authenticated diagnostic information or laboratory data.
Even though medical records can be used to establish and authenticate test
results and medical diagnoses, one should know about the privacy and
privacy regulations that apply to patient medical records.

When significant risks are identified
from pre-approval clinical trials, further
clinical studies might be called in to
evaluate the mechanism of action for the
adverse reaction.
In some instances, pharmacodynamics
and pharmacokinetic studies might be
conducted to evaluate adverse events.
.
G) Targeted clinical investigations

Moreover, based on the pharmacological properties
and the predictable use of the medicine in general
practice, conducting specific studies to scrutinize
potential medicine-medicine interactions and food-
medicine interactions might be entitled to.
These studies can comprise population pharmacokinetics studies and medicine
concentration monitoring in patients and normal volunteers.
Have an influence on the quality and eventual usefulness of the results of the
trial.
Large, simplified trials are similarly resource-intensive

1. ICH Guideline E2D; Post-approval safety data management: definitions
and standards for expedited reporting, 3.1.1 Spontaneous reports 2004.
International Conference on Harmonisation.
2. Pinkston V, Swain EJ. Management of adverse drug reactions and
adverse event data through collection, storage, and retrieval. In: Stephens
MDB, Talbot JCC, Routledge PA, eds. Detection of new adverse drug
reactions. 4th ed. London, MacMillan Reference Ltd, 1998; 282.
3. Faich GA, U.S. adverse drug reaction surveillance 1989-1994.
Pharmacoepidemiology Drug Safety, 1996; 393-398.
4. Goldman SA. Limitations and strengths of spontaneous reports data.
Clinical Therapeutics, 1998; 20(Suppl C): C40-C44.
REFERENCES

Active and passive survillance

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