periodical, Morbidity and Mortality Weekly Reports, and in electronic form on the Internet. As described in one report, “State and local public health officials rely on health-care providers, laboratories, and other public health personnel to report the occurrence of notifiable diseases to state and local health departments. Without such data, trends cannot be accurately monitored, unusual occurrences of diseases might not be detected” (Morbidity and Mortality Weekly Reports, 1997).

One might ask what motivates the practitioners to provide the case reports for processing and tabulation. The answer is, in part, the existence of state laws and regulations, which mandate reporting of specified “notifiable” diseases and conditions. The mandated list of notifiable diseases differs across the states, as do the requirements for information to accompany each report. The Centers for Disease Control and Prevention (CDC) has become a partner with the states in this process, first by offering technical assistance, and more recently by establishing policies that regularize reporting of cases and a set of uniform criteria for public health surveillance. For example, the CDC definitions provide for distinctions between laboratory-confirmed cases, epidemiologically linked cases (e.g., in which the patient had contact with one or more infected or exposed other), probable and suspected cases (e.g., classified as “probable” or “suspected” for reporting purposes on the basis of clinical features but not confirmed by laboratory tests). In addition to receiving weekly reports, the CDC collates the reports and publishes them weekly in the Morbidity and Mortality Weekly Reports, with a level of detail for states, cities, and counties that has never been seen in national surveillance of drug use or drug-associated problems.

About five years ago, a CDC steering committee was convened to help create integrated public health information and surveillance systems for the United States. The final report of the steering committee provides a comprehensive overview of the CDC’s notifiable disease reporting system, as well as supplemental sources of public health information and surveillance. The report is remarkable for its scope and depth, but it is striking that it does not discuss the integration of surveillance activities or information on the use of illegal drugs, one of the foremost public health challenges that faces the nation.

At first, one might ask whether this omission is due to the highly sensitive and confidential nature of information about an individual’s drug use. After all, a physician or other health care provider might hesitate to provide a report about an illegal activity. In counterpoint, it is possible to reply that the same types of consideration come into play with respect to other notifiable diseases, including sexually transmitted diseases such as syphilis and gonorrhea, and one imagines that the confidentiality of notifiable information about HIV and AIDS cases is as sensitive



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