Evolution of Public Health Surveillance: Status and Recommendations

Remarks in this article stem from my last 18 years' work on surveillance system development at the Johns Hopkins University Applied Physics Laboratory, as consultant to the US Centers for Disease Control and Prevention, and as board member and research committee chair of the International Society for Disease Surveillance. Surveillance system proponents have cited routine situational awareness benefits,1 including tracking disease spread, all-hazard monitoring, rumor control, and clinical decision support. Recent funding from the Centers for Disease Control and Prevention has improved local health department capacity for timely data collection from health care providers. Individuals with upto-date expertise in all three categories are rare. [...]collaboration among staff with disparate backgrounds must repurpose information for surveillance from electronic health records and other sources in a technology-driven environment. A common collaboration challenge is specification of detection performance metrics, mandated in widely referenced publications on automated surveillance.3 In prospective health monitoring, a typical problem is to classify a day or other interval by whether a current incidence measure merits investigation for onset of a significant public health threat. More broadly, before decisions about the number of monitored outcomes, frequency of analysis, or spatial resolution of results, designers should account for the human and technology resources available to a health department and its chief public health concerns and requirements.5 Surveillance system design may thus be viewed as an optimization problem, suggesting enlistment of operations research analysts and sampling statisticians. [...]recent advances in biotechnology fields such as genomic surveillance and clinical laboratory science demonstrate the...