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Infectious diseases remain major causes of disease and death worldwide. In addition, recent years have witnessed the appearance of ‘‘emerging infections’’—that is, infectious diseases that are novel or are rapidly increasing in incidence or geographic range.1,2 These include such well known examples as human immunodeficiency virus/AIDS (HIV/AIDS); severe acute respiratory syndrome (SARS),
which originated from Asia in 2003; hemolytic uremic syndrome caused by certain strains of the bacterium Escherichia coli; avian influenza H5N1; H1N1-2009 pandemic influenza; and numerous others. In addition,
bioterrorism has increasingly become a concern in light of the anthrax mailings in 2001.3,4 Our vulnerability to such events emphasizes the need for effective surveillance systems to provide early warning. The importance of strengthening public health surveillance has been the primary recommendation of all expert studies over the past 2 decades.5-8 In the words of a 1992 Institute of Medicine report, Emerging Infections, ‘‘The key to recognizing new or emerging infectious diseases, and to tracking the prevalence of more established ones, is surveillance.’’5(p113) This review discusses our progress toward that goal and considers perspectives for the future. In general, there have been improvements in the past decade, but public health surveillance capabilities remain limited and fragmented, with uneven global coverage.Several recent initiatives are beginning to address this issue, and new technological and conceptual advances could facilitate reporting and diagnostic capability worldwide. Traditional public health surveillance remains the mainstay, but new nontraditional tools and technologies could complement, or even eventually supplant, traditional public health surveillance. Whatever methods are used, sustained capacity building is essential to achieve this goal.
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