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Originally, and still today, surveillance was disease specific and generally based on identification of the responsible pathogen in the laboratory or on clinical case definitions, usually with subsequent laboratory confirmation of at least some of the cases.13,14 In this traditional schema, most surveillance systems are passive, requiring someone (usually the proverbial ‘‘astute clinician’’) to notice a possible disease
of interest and to act appropriately by reporting to appropriate authorities and by providing access to the patients and suitable specimens. Surveillance is labor intensive and relatively expensive, but often only limited resources are available. Active surveillance systems, in which interested agencies (such as health departments) make intensive outreach efforts, are particularly resource and labor intensive and therefore less common. Some active systems are short term, when a particular disease condition is of immediate concern, such as during an outbreak.
In all countries, most surveillance systems in use today are still disease-specific systems requiring the identification of specific pathogens or groups of pathogens. In the United States, examples include surveillance for methicillinresistant Staphylococcus aureus (MRSA); a number of foodborne infections; waterborne infections, in a surveillance system managed jointly by CDC and the Environmental Protection Agency (EPA); HIV; influenza; poliovirus; and many others.13,14 Internationally, surveillance includes influenza, polio, HIV, and a number of others. At each level, priority will often appropriately be given to diseases of particular concern in that locality, country, or region, or to infections that are targeted by special programs, such as smallpox during the smallpox eradication program or polio today. When appropriately implemented, such systems can
be very effective for surveillance of the pathogens of interest, but they require appropriate laboratory capacity and capabilities for specimen collection and transport. At each level, whether local, municipal, state, national, or international, priorities and effectiveness of surveillance for a particular disease will vary with the interests and capacity of those carrying out the surveillance and with the perceived importance of the disease. The problem of comparing and tabulating surveillance data is further complicated by differences in the habits of data sharing among reporting jurisdictions and a lack of standardization in data formats. Finally, these systems are generally not designed to identify diseases or pathogens outside the scope of the system, which can also result in the loss of critical information.
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