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In 2004, Bravata and colleagues conducted an extensive literature review and identified some 115 surveillance systems that could be used for early detection of bioterrorism related diseases; many of them we re systems for public health surveillance. The y noted : Existing surveillance systems for bioterrorism-related diseases vary widely with respect to the methods used to collect the surveillance data, surveillance characteristics of the data collected, and analytic methods used to determine when a potential outbreak has occurred.15(p910) Many of the existing surveillance systems have been well described and catalogued in several recent reviews, which are recommended for more detailed information.14,16-18 Unfortunately, like the assessment by Bravata and colleagues, the picture that emerges is of a fragmented system with a large number and diversity of surveillance systems, many dedicated to special purposes, often utilizing divergent data formats, and very uneven in coverage.16-18 This fragmentation is often an impediment to timely information exchange. The field also needs consistent terminology and a more clearly articulated overarching strategy and goals. Some useful definitions have been offered by Hitchcock and
colleagues.16 There have also been recent efforts to develop national strategies for surveillance. In the U.S., in 2007 the White House issued Homeland Security Presidential Directive 21 (HSPD-21),19 which detailed a National Strategy for Public Health and Medical Preparedness, building on principles set forth in an earlier government document, Biodefense for the 21st Century (April 2004).20 The strategy in HSPD-21 called for the development of a nationwide approach to biosurveillance in order to enhance the U.S.’s ability to detect and respond to biological threats. The Department of Health and Human Services (HHS) was given responsibility for biosurveillance for human health and designated CDC for this purpose.21 HSPD-21 defines
biosurveillance as. the process of active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health—whether infectious, toxic, metabolic, or otherwise,
and regardless of intentional or natural origin—in order to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity.19 The report of the National Biosurveillance Advisory Subcommittee reviews the state of biosurveillance in the U.S. and makes recommendations for improvements.22
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