performance monitoring data so public resources can be used wisely and efficiently.
When disease incidence and burdens are high, the immunization infrastructure is often concerned with launching prominent national campaigns designed to attack infectious disease and deliver vaccines through special stand-alone and short-term programs. During active stages of disease transmission, infectious disease control includes three key components: (1) campaigns to change behavior to reduce the risk of disease transmission, (2) contact tracing, and (3) mass immunization of high-risk populations in outbreak areas.
In periods when disease burdens are low (as they are today), the use of sentinels that monitor the health of the general population acquires greater importance (IOM, 2000). These sentinels are essential to the prevention of disease outbreaks and transmission because they reveal long-term trends and provide early warnings of new patterns of disease reports. The persistent presence of infectious disease in reservoirs scattered around the world requires constant vigilance within each U.S. community until disease eradication is complete (IOM, 1992).
Although the threat of morbidity and mortality associated with vaccine-preventable diseases has decreased significantly, overall mortality from infectious diseases continues to rise as a result of the appearance of new infectious agents and the reemergence of diseases previously considered to be under control (Department of Health and Human Services [DHHS], 1998). As a group, infectious diseases were the third leading cause of death in the United States in 1992; overall mortality from infectious diseases rose 58 percent in the United States between 1980 and 1992. Although much of this increase reflects the growing burden of HIV-associated disease, the removal of HIV-associated diagnoses still leaves a 22 percent increase in mortality from infectious diseases (DHHS, 1998).
Responsibilities for prevention and control of disease outbreaks are shared among all levels of government. Local jurisdictions have on-site responsibility for dealing with outbreaks of disease in schools and the community. Each state has its own health codes and its own on-site epidemiologist, but federal expertise is often requested during outbreaks and as part of disease monitoring and reporting arrangements. Indeed, several states with unique infectious disease circumstances have disease reporting requirements that exceed those of CDC. When disease outbreaks occur, the three levels of government usually cooperate in their control efforts. States can request technical assistance from CDC to address both