What happens when you fall asleep on the steering wheel?

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).

 A different benign ISIS

. 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!