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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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Date published: 2002 |
National
Center for Infectious Diseases |