Area 2: A Global Approach to Disease Surveillance
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.
employs computer-based modules to:
cases of measles as part of PAHO's campaign to eliminate
measles in the Americas
cases of HIV/AIDS
cases of unusual or unexplained diseases reported
by CAREC's Physician-Based Sentinel Surveillance system
weekly reports of notifiable diseases
a database of deaths caused by infectious agents
provide distance-learning courses for public health
and medical personnel
new module that facilitates hotel-based disease surveillance
is under development.
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
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 Centers 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.
CDCs priorities in global surveillance will be balanced with the
priorities of collaborating countries, and CDCs 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 Walls
(PHSWOW), and Sustainable Management Development Programs (Priority
Area 6, Boxes 16 and 24).
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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