ments. When the wastewater-derived TOC is below this level, no special toxicological monitoring should be required. When the wastewater-derived TOC is above this level, public safety should be protected with continuous toxicological monitoring using in vivo systems (see Chapter 5).

Although establishing such a TOC level appears to be a legitimate risk management strategy, there is no scientific basis for determining what that level should be. The committee believes this judgment should be made by local regulators, integrating all the information they have available to them concerning a specific project.

Public Health Surveillance

Public health surveillance programs are essential components of a community-wide strategy to provide early warning of possible health problems. Adequate disease surveillance requires continuing scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control.

The most comprehensive and internationally accepted definition of public health surveillance is that found in the American Public Health Association report entitled Control of Communicable Diseases Manual (Benenson, 1995). That report calls for the systematic collection and evaluation of

  1. morbidity and mortality reports;
  2. special reports of field investigations of epidemics and individual cases;
  3. isolation and identification of infectious agents by laboratories;
  4. data concerning the availability, use, and untoward effects of vaccines and toxins, immune globulins, insecticides, and other substances used in disease control;
  5. information regarding immunity levels in segments of the population; and
  6. other relevant epidemiologic data.
  7. A report summarizing the above data should be prepared and distributed to all of those involved in public health protection. This procedure applies to all jurisdictional levels of public health protection, from local to international (Benenson, 1995).

    This definition of surveillance of disease is distinct from health surveillance of specific persons, which is a form of public health quarantine. Any surveillance programs should be tailored to the needs of its community, and not all of the elements of the definition above necessarily apply



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