Current U.S. disease surveillance efforts include both domestic and international components. Domestically, the bulk of federal disease-reporting requirements (individual states also require reporting) are implemented through the National Notifiable Diseases Surveillance System, established in 1961 and administered by the Centers for Disease Control (CDC). The CDC also operates a domestic influenza surveillance program that supplies epidemiological information to public health officials, physicians, the media, and the public.

Notwithstanding such programs, the United States has no comprehensive national system for detecting outbreaks of infectious disease (except for food-and waterborne diseases). Outbreaks of any disease that is not on CDC's current list of notifiable illnesses may go undetected or may be detected only after an outbreak is well under way. Emerging infectious diseases, with the exception of those reportable diseases that reemerge, also are not detected through established surveillance activities. Another problem is the lack of coordination among the various U.S. government agencies, or between government agencies and private organizations, involved in these efforts. The effectiveness of U.S. domestic surveillance could be vastly improved by designating an agency or central coordinating body as a focus for such activities.

The committee recommends the development and implementation of strategies that would strengthen state and federal efforts in U.S. surveillance. Strategy development could be a function of the Centers for Disease Control (CDC). Alternatively, the strategy development and coordination functions could be assigned to a federal coordinating body (e.g., a subcommittee of the Federal Coordinating Council for Science, Engineering, and Technology's [FCCSET] Committee on Life Sciences and Health,1 specifically constituted to address this issue. Implementation of the strategies would be assigned to the appropriate federal agencies (e.g., CDC, National Institutes of Health, U.S. Department of Agriculture). Approaches for consideration could include simplifying current reporting forms and procedures, establishing a telephone hotline by which physicians could report unusual syndromes, and using electronic patient data collected by insurance companies to assist in infectious disease surveillance.

1  

The FCCSET is a federally appointed body of experts that serve on seven standing committees and act as a mechanism for coordinating science, engineering, technology, and related activities of the federal government that involve more than one agency. In addition to conducting cross-cutting analyses of programs and budgets, the various committees and their subcommittees (interagency working groups) examine wide-ranging topics with the goal of reaching consensus on fundamental assumptions and procedures that can guide the actions of the participating agencies in achieving their mission objectives more effectively.



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