Research on innovative systems of surveillance that capitalize on advances in information technology should be supported. Before widespread implementation, these systems should be carefully evaluated for their usefulness in detection of infectious disease epidemics, including their potential for detection of the major biothreat agents, their ability to monitor the spread of epidemics, and their cost-effectiveness. Research on syndromic surveillance systems should continue to assess such factors as the capacity to transmit existing data electronically, to standardize chief complaint or other coded data, and to explore the usefulness of geospatial coding; CDC should provide leadership in such evaluations. In addition, promising approaches will need to be coordinated nationally so that data can be shared and analyzed across jurisdictions.
Etiologic diagnosis—identifying a microbial cause of an infectious disease—is the cornerstone of effective disease control and prevention efforts, including surveillance. Etiologic diagnosis has declined significantly over the past decade. A dangerous consequence of decreased etiologic diagnosis has been an increase in the inappropriate use of broad-spectrum antibiotics and the emergence of antimicrobial resistance. Improving etiologic diagnosis would be of value to human health worldwide in directing appropriate therapy, as well as informing disease surveillance and response activities.
CDC and NIH should work with FDA, other government agencies (e.g., DOD, USDA, the national laboratories), and industry on the development, assessment, and validation of rapid, inexpensive and cost-effective, sensitive, and specific etiologic diagnostic tests for microbial threats of public health importance.
Public health agencies and professional organizations (e.g., those concerned with patient care, health education, and microbiological issues) should promulgate and publicize guidelines that call for the intensive application of existing diagnostic modalities and new modalities as they are established. Such guidelines should be incorporated into continuing education programs, board examinations, and accreditation practices. Payers for health care should cover diagnostic tests for infectious diseases to increase specific diagnoses and thereby inform both public health and medical care, including monitoring of inappropriate use of antimicrobials.