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While the reporting and tabulation of infectious diseases has a long history, Alexander Langmuir at the then–Center for Disease Control (CDC) is generally credited with developing our current concepts of disease surveillance in the 1960s (he was also the originator of CDC’s Epidemic Intelligence Service [EIS], which remains active to this day).9,10 Langmuir suggested that surveillance could be applied to diseases as a public health tool, replacing an earlier notion of surveillance as watching individuals for signs of illness.9 He defined surveillance as ‘‘the continued watchfulness over the distribution and trends of incidence
through the systematic collection, consolidation and evaluation of morbidity and mortality reports and other relevant data.’’ 9(p182) The definition currently used by the U.S. Centers for Disease Control and Prevention and widely accepted is similar and elaborates on this concept: ‘‘Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.’’11(p2) Continuing the interest in surveillance during that time, in 1968 the World Health Assembly (the governing body of the World Health Organization) held technical discussions on ‘‘national and global surveillance of communicable diseases,’’ although the discussions did not lead to implementation plans at that time.10,12 In general, a surveillance system traditionally requires 3 key elements: (1) a clinical facility or other suitable locale to identify and report affected or exposed individuals, (2) epidemiologic capacity to identify additional cases and determine the source and mode of transmission (and possible interventions), and (3) laboratory capacity to identify the disease agent. In relatively few places are all these elements readily found together, and at the global level the task of developing, linking, and sustaining these capacities becomes extremely challenging.
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