treatment as the disease progresses) necessitates a very rapid medical response to prevent most of the casualties.

  • Local and state public health agencies play a vital role in monitoring disease trends and outbreaks but do not all have sufficient staff, tools, and resources to be as effective as they need to be for rapid detection and response to outbreaks (e.g., adequate numbers of trained personnel, modernized information and communication systems, access to and capacity to fully use epidemiologic data systems and analysis tools, expanded and modernized public laboratories).

  • The sharing of surveillance information between the health care system and state and local public health agencies needs to be improved to detect health threats and detect them earlier.

  • Automated systems to improve the sharing of surveillance information between the health care system and state and local public health agencies to detect widespread outbreaks earlier and manage them better also need to be improved.

  • The integration of human health information with information about infectious agents derived from surveillance of animal disease, water quality, and air quality—or “biosurveillance”—is needed to defend against bioterrorism and natural pandemics.

With its focus on the BioWatch system and a short timeframe in which to conduct its work, this committee acknowledges the large number of completed and ongoing efforts over the past decade, especially since 2001, to improve infectious disease surveillance and detection of disease outbreaks. In this chapter, the committee describes opportunities it has identified for further enhancing the detection of public health threats, especially threats from biological hazards, including bioterrorism. Many of the enhancements derive from the increasing digitalization of health information and resulting opportunities for better information technology systems and tools to aid case recognition, reporting, and analysis of information. A central and desirable aspect of the enhancements—in the context of bioterrorism surveillance—is to improve the timeliness of individual case and outbreak recognition, reporting, and analysis of information.

The opportunities for enhancement of surveillance through the public health and health care systems fall into broad and overlapping categories of improving legally mandated reporting, establishing automated linkages between health care information systems and public health systems, increasing laboratory and diagnostic testing capacity, and promoting information integration and knowledge sharing. These enhancements bring with them the risk of information overload, which must also be addressed through improved information and knowledge management (the field of public health informatics) (Yasnoff et al., 2000). Information tools to manage

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