National Research Council
Dr. Keene summarized the view of the American participants on how a foodborne disease surveillance system can be operationalized in a country.
To begin, the purpose of a surveillance system should be clear. The sources of information must be identified, as this information can come from a number of sources, such as laboratories, physicians, hospitals and clinics, infection control staffs, public reports, media reports, inspectors, and pharmaceutical distribution data.
There are a variety of legal considerations that should be addressed at the very outset of administering a surveillance system. Adequate legal authority to collect surveillance information and to investigate outbreaks is necessary. If such authority is not in place, new legislation may be required. The system’s design needs to address the question of who would have access to confidential medical records and to determine whether disease reporting will be compulsory and if so, by whom and to whom. Another consideration is whether diagnostic laboratories should be required to provide isolates to reference laboratories. Attached to the legal issues of surveillance are the implications of using surveillance data. It must be clear how the data will be disseminated and to whom. At the outset there must be a determination of whether specialists have the legal authority and the motivation to take action that may hurt business interests. Similarly, will the specialists have the necessary credibility with the public and the medical community? The sources of financial support should be clearly determined, and need to be stable, given the infrastructure and personnel required for a surveillance system to function.
Turning to laboratory considerations, the system will require access to specimens for analyses. The system must be capable of confirming diagnoses and