The mission of public health is to safeguard and improve the health of the community as a whole. Effectively responding to infectious disease threats therefore requires a robust public health system. In the United States, public health surveillance for infectious diseases is conducted through a variety of agencies.

Health care providers and others report cases of notifiable infectious diseases (as defined by local and state health codes) to state health departments. State and local health department officials, in turn, verify disease reports, monitor disease incidence, identify possible outbreaks, and forward their findings to the Centers for Disease Control and Prevention (CDC). The CDC and other federal agencies, including the Food and Drug Administration, the U.S. Department of Agriculture, and the U.S. Department of Defense, independently gather and analyze information for disease surveillance.

 

Public health advocates have called for improved surveillance to better monitor infectious diseases across the country. Part of this effort was the formation of the   National Biosurveillance Integration System (NBIS) in 2004. Created by the U.S. Department of Homeland Security (DHS), it was intended to be the nation’s first system capable of providing comprehensive and integrated biosurveillance and situational awareness. In 2007, DHS formed the National Biosurveillance Integration Center (NBIC) to identify, integrate, and analyze data to detect biothreats and disseminate alerts. NBIC is charged with working with partner agencies to acquire data that can be analyzed through programs such as BioWatch, which monitors the presence of pathogens in the air, leverages expertise, obtains strategic and operational guidance, and maintains innovative information technologies.

 

Other recommendations include a national electronic infectious diseases reporting system; innovative methods of disease surveillance (e.g., automated laboratory reporting of infectious disease or systematic gathering of informal reports of disease from the Internet); community engagement in planning, preparing, and responding to health incidents; and a strengthening of the entire public health system, which historically has been underfunded compared to biomedical research.

 

Syndromic surveillance—the near- or real-time monitoring of non-specific pre-diagnostic signs of disease outbreaks—is an innovative surveillance method being explored by some cities and states with assistance from the federal government as a means of providing early warning of infectious disease outbreaks. Syndromic surveillance rests on the idea that following large-scale exposure to infectious disease in an epidemic or bioterrorist attack, people will first develop symptoms, stay away from work or school, and attempt to treat themselves before seeing a doctor. These systems therefore monitor school and work absenteeism, sales of over-the-counter medications, illness-related 9-1-1 calls, and other patterns that suggest an outbreak. Nevertheless, most surveillance still focuses on tracking reported infections.