What happens when you fall asleep on the steering wheel?
we will start back from square one in a game of snakes and ladders.
Little information is available about measles epidemiology in India. Reliable surveillance data are missing and few outbreaks are investigated
"In disease eradication programs, robust surveillance
systems are necessary to detect every case.
However, with low levels of disease, it is hard to
convince decision makers to allocate sufficient resources
for surveillance and a risk of undetected
relapse remains. As a result of an ambitious plan to
eradicate malaria in the mid-1950s, some countries
(e.g., India) had sharp reductions in the number of
cases followed by, after efforts ceased, increases to
substantial levels"
The desire of societies to control the spread of
highly contagious and virulent infectious pathogens
(e.g., pandemic strains of influenza virus) may
allow acceptance of quarantine by public health
authorities even at the expense of individual liberty.
However, without surveillance data, public
health officials will have difficulties designing
rational isolation and quarantine strategies and
can expect to encounter legal obstacles and public
disapproval.
Merely
collecting disease data for surveillance has little impact.
However, successful surveillance programs
also analyze and disseminate data to inform prevention
and control activities.
Control emergence of antimicrobial-resistant
organisms in domesticated animals
Widespread use of antimicrobial agents as growth
promoters in animal husbandry is associated with
increased resistance to antibiotics in bacteria isolated
from animals and humans [19]. Surveillance
for antimicrobial-resistant organisms in food animals
is important to inform policies regarding use of
antimicrobials outside human medicine. For example,
the Danish Integrated Antimicrobial Resistance
Monitoring and Research Programme (DANMAP)
was established in 1995 to monitor antimicrobial
resistance in bacteria from livestock, food, and humans,
and to monitor use of antimicrobial agents
[20]. Due to demonstration of rising antimicrobial
resistance among bacteria isolated from food animals,
Denmark banned use of certain antimicrobial
agents as growth promoters in the 1990s (e.g.,
avoparcin, a glycopeptide similar to vancomycin,
in 1995)
Detect and respond to emerging infections
Surveillance is useful for detecting and controlling
new or reemerging pathogens. The recent outbreak
of SARS illustrates the role of surveillance in guiding
response to an emerging global public health
threat. First reported in Guangdong Province,
China, in 2003, SARS resulted in 8098 probable
cases with 774 deaths reported in 29 countries.
Surveillance played a critical role in assessing the
spread of the SARS epidemic and guiding quarantine
recommendations and other control measures
Despite being legally mandated, diseases are
grossly underreported [28]. There are essentially
no penalties for failing to report cases of disease.
Health-care providers and other reporters are often
unaware of which diseases to report, they may
not believe in the utility of surveillance, and the
logistics of reporting cases can become unmanageable
for busy clinicians. Creative means to motivate
and support disease reporters is essential, but often
overlooked.
a classic example of falling asleep on the steering wheel?
chikungunya was made a mandatory notifiable
condition in mainland France and the overseas departments
in the Caribbean, but not in the department
La Reunion in the Indian Ocean, where a ´
massive epidemic involving over 100,000 persons
in 2006 overwhelmed the disease reporting structure
However, infectious
pathogens do not respect country borders, and
therefore some disease outbreaks are not solely
the concern of the “index” country—intensified
global public health response may become essential.
( this was made so clear to me when I was searching for measles in Hyderabad ( without putting telangana in the search box) I came across a number of reports of measles deaths in Hyderabad ,Pakistan
Official assessments from
WHO, as an internationally prominent and neutral
public health authority, can avoid unnecessary, uncoordinated
interference with international traffic
and trade that has previously made some
countries
reluctant to report significant events.
Many surveillance strategies involve collaborations
with laboratories for sharing of data
and isolates. For example, utilizing advancing information
technologies, public health organizations
have worked with clinical laboratories to
enable electronic, automated transfer of information
on reportable diseases to public health agencies ( some thing like self driven cars!)
(Infectious Diseases Surveillance Information System
(ISIS) in the Netherlands: development and
implementation).
. It is also
true that no surveillance system should be entirely
“passive,” even from the point of view of the public
health agency, as regular communication and feedback
to healthcare providers are necessary.
The Foodborne Disease Surveillance Network
(FoodNET) established by the US CDC in collaboration
with the US Department of Agriculture
and the US Food and Drug Administration,
and participating US Emerging Infection Program
sites, is an active, laboratory-based surveillance
program for foodborne pathogens
. Typically,
only a small fraction of foodborne illnesses are
reported to public health authorities, and often
they lack accurate epidemiologic information (e.g.,
specific attributed causes, outcomes).
In France, a network of primary care physicians
report information, at weekly intervals, on a selected
group of health events that are relatively common
in general practice: influenza-like illness, acute
gastroenteritis, measles, mumps, chicken pox, male
urethritis, hepatitis A, B, and C. Data are extrapolated
to regional and national levels. The system
detects and describes the occurrence and progression
of regional and national outbreaks (available
at:
http://rhone.b3e.jussiue.fr/senti).
zoonotic diseases cannot be adequately understood
and controlled by only monitoring the disease in
human populations. Brucellosis control in the US has been successful
because of the focus on animal health as
a way to protect human health—comprehensive
animal testing, vaccination of breeding animals,
and depopulation of affected herds ( a politically correct way of saying kill the animals ) ( what will Maneka Gandhi and all the GoRAKSHAKS say to this ?)
The identification of the fungus Cryptococcus gattii
in British Columbia, Canada, illustrates the use
of surveillance to detect and define an emerging
pathogen intrinsically linked to the environment.
This fungus was previously known only in tropical
and subtropical climates, but the organism emerged
around 1999 in Vancouver Island as a pathogen
in humans and domestic and wild animals. Environmental
sampling has identified the fungus on
trees, in soil, in air samples, and in water
healthcare facilities in the US assign
diagnosis codes (e.g., International Classification of Diseases, Tenth Revision (ICD-10)) to
clinical care encounters—this is a potential data
source for surveillance for a range of diseases ( but most of the codes are not utilized properly due to a very cumbersome access and also lack of lab testing mainly in poorly funded community clinics where theses cases are more likely to occur)
Monitoring
of drug utilization and drug sales may be an
indirect measure of disease activity. Pharmaceutical
databases have been explored for a variety of
syndromic surveillance systems. At the US CDC,
where a supply of “orphan” drugs are housed for
treatment of rare diseases, increased requests for
pentamidine in the 1980s led to an investigation
of a cluster of Pneumocystis pneumonia which, in
turn, led to the first detection of AIDS in the world
Use of media reports for disease surveillance
The availability and speed of information transmission
over the Internet have allowed development
of innovative electronic media-based surveillance
systems. For example, the Global Public Health
Intelligence Network (GPHIN) gathers, in seven
languages on a real-time, 24/7 basis, electronic
media reports of occurrence of diseases. Although
the electronically gathered information requires further
verification, GPHIN is used extensively as an
early source of outbreak information by Health
Canada, WHO, the US CDC, and others ( should they not add more languages? can they use automatic translation of various other languages in to the 7 languages to improve this ?may be they can use the help of Google to translate!
