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Protecting Our Nation's Health in an Era of Globalization: CDC's Global Infectious Disease Strategy
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Priority Area 2: A Global Approach to Disease Surveillance
Personnel at the Caribbean Surveillance System

Disease surveillance personnel at the Caribbean Surveillance System (CARISURV) of the Caribbean Epidemiology Center (CAREC). CARISURV is an electronic disease surveillance system that serves 21 nations: Anguilla, Antigua & Barbuda, Aruba, Bahamas, Barbados, Belize, Bermuda, British Virgin Islands, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, Netherlands Antilles, St. Kitts & Nevis, St. Lucia, St. Vincent & Grenadines, Suriname, Trinidad & Tobago (host country), Turks & Caicos Islands.

CARISURV employs computer-based modules to:

  • Track cases of measles as part of PAHO's campaign to eliminate measles in the Americas
  • Track cases of HIV/AIDS
  • Track cases of unusual or unexplained diseases reported by CAREC's Physician-Based Sentinel Surveillance system
  • Compile weekly reports of notifiable diseases
  • Maintain a database of deaths caused by infectious agents
  • Help provide distance-learning courses for public health and medical personnel

A new module that facilitates hotel-based disease surveillance is under development.

CDC and the Walter Reed Army Institute of Research have worked with CAREC provide CARISURV members with bioinformatics training, technical support, computer equipment, and public health software, including the Public Health Laboratory Information System (PHLIS) for reporting laboratory-confirmed cases of infectious disease. PHLIS was originally developed at CDC for use by U.S. state health departments.

Information Services Unit, CAREC.

Stimulated in part by the AIDS pandemic, national and international groups, including the National Science and Technology Council in 1995 and the Group of Eight in 1997, have called for the establishment of a global system for disease surveillance and outbreak response. U.S. agencies are working with international partners to help achieve this goal.

Despite advances in public health telecommunications, however, the global implementation of this goal has not been straightforward. Notable progress has been made at the regional level, with the establishment of such international programs as the Caribbean Epidemiology Center’s disease surveillance network, the Amazon and Southern Cone networks in South America, the Integrated Disease Surveillance and Epidemic Preparedness and Response Project in Africa, the Mekong Basin Disease Surveillance system in Southeast Asia, and the International Circumpolar Surveillance system in Alaska, Canada, Greenland, and the circumpolar regions of Europe. These and other fledgling networks (Appendix E) represent pioneering attempts to work across borders to enhance detection and control of outbreaks of known diseases while maintaining the flexibility to recognize new disease problems. The networks are testing many different approaches (e.g., syndromic surveillance, laboratory-confirmed disease-specific surveillance, hospital-based surveillance, and district-level surveillance), depending on local needs, cultural preferences, and human and technological resources.

In the years ahead, regional disease surveillance networks will grow in number and geographical scope. In the long run, regional and disease-specific networks should expand, interact, and evolve into a global “network of networks” that helps ensure early warning of new and reemerging threats and increased capacity to monitor the effectiveness of public health control measures.

CDC can stimulate this process by providing technical assistance, evaluating regional progress, and working with WHO, other U.S. agencies, and other interested groups to strengthen the networks’ telecommunications capacities and encourage the use of common software tools and harmonized standards for disease reporting. CDC can also help revise the International Health Regulations, which describe internationally-reportable diseases and syndromes. In addition, CDC will encourage linkages between regional networks and veterinary surveillance systems that monitor illnesses and epidemics among agricultural and feral animals. Several major outbreaks of zoonotic diseases (diseases of animals that also affect humans) involving agricultural animals have occurred in recent years (Box 15). CDC will also support disease surveillance efforts in tropical or heavily forested areas that are likely sources of human infection with unknown zoonotic or vectorborne diseases.

  Box 15
  Agricultural Costs of Controlling Zoonotic Diseases Carried by Food Animals

CDC’s priorities in global surveillance will be balanced with the priorities of collaborating countries, and CDC’s programs will be coordinated with the ongoing efforts of development agencies and NGOs that build disease surveillance capacity at the national level. CDC can best support both national and regional efforts by providing state-of-the-art diagnostic and epidemiologic tools, by developing surveillance standards and guidelines, and by creating new methods for predicting disease risk. CDC can also increase training opportunities by helping establish new or expanded Field Epidemiology Training Programs (FETPs), Public Health Schools Without WallsDisclaimer (PHSWOW), and Sustainable Management Development Programs (Priority Area 6, Boxes 16 and 24).

  Box 16
  A Growing Community of International Public Health Leaders
  Box 24
  Applied Field Epidemiology Programs

The surveillance data gathered by the regional networks will be used not only to detect outbreaks but also to evaluate global health initiatives (Priority Area 5) and to drive national public health programs and decision making. Disease surveillance data are crucial, for example, in assessing the effectiveness of vaccination programs and the risk factors for underimmunization in a given area.

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Booklet Contents
item Contributors
item Table of Contents
item Preface
item Executive Summary
item Introduction
item International Cooperation To Combat Infectious Diseases
item U.S. Investment in Global Public Health
item Protecting the health of U.S. citizens at home and abroad
item Furthering U.S. humanitarian efforts
item Providing economic and diplomatic benefits
item Enhancing security
item CDC's Role in Promoting Global Public Health
item An evolving mission
item Vision for the Future
item Partnerships and Implementation
item Priorities and Objectives
1. International Outbreak Assistance
item Objectives
2. A Global Approach to Disease Surveillance
item Objectives
3. Applied Research on Diseases of Global Importance
item Objectives
4. Application of Proven Public Health Tools
item Objectives
5. Global Initiatives for Disease Control
item Objectives
6. Public Health Training and Capacity Building
item Objectives
item List of Boxes
item Acronyms
item Appendix A
item Appendix B
item Appendix C
item Appendix D
item Appendix E
item Acknowledgments
item References

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Date published: 2002

National Center for Infectious Diseases
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