标题：Innovative Surveillance Methods for Rapid Detection of Disease Outbreaks and Bioterrorism: Results of an Interagency Workshop on Health Indicator Surveillance
摘要：A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group’s findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems. IN LIGHT OF RECENT TRAGIC events, including the deliberate use of a biological organism to cause disease and death among unsuspecting victims, the need is paramount to improve public health capabilities in the United States, especially the ability to rapidly detect and respond to unusual disease events. These events have highlighted our lack of preparedness for biological attacks as well as naturally occurring disease outbreaks. 1– 3 One of the primary goals of public health is to prevent disease in a community. To best prevent disease, knowledge of existing disease rates, risk factors, and the effectiveness of preventive measures is necessary. The first step in gaining this knowledge is a working surveillance system that rapidly allows public health practitioners to know the health status of the community. Indeed, public health surveillance is a core element of public health practice. Unfortunately, most infectious disease surveillance systems are passive and rely on practitioners voluntarily reporting to the public health system, 4 and they are often not sufficiently sensitive or timely to be of great value in terms of controlling outbreaks. In addition to earlier detection of events, surveillance systems are essential for focusing limited response assets and providing evidence-based information to governmental risk communicators. Lessons learned from a May 2000 bioterrorism response exercise conducted in Denver, which involved top government officials, illustrate these needs. 2 Officials interviewed after the exercise noted the need for information systems that could “deliver real-time data showing the number and locations of persons with the specific illness in the affected area” and that “allow rapid collection and analysis of patient epidemiological information to determine source(s) of exposure to an agent.” 4 In the face of these imperatives, plans to improve public health capabilities to identify and address such disease emergencies must include determining how surveillance systems can be made more timely, flexible, and sensitive without overly compromising other aspects of quality. To share experiences, avoid costly mistakes, and foster efficient progress toward the objective of creating innovative, responsive surveillance systems, the Department of Defense’s Global Emerging Infections System sponsored a meeting in May 2000 that focused on 3 areas: (1) identifying surveillance system needs, (2) examining existing prototype systems attempting to meet these needs, and (3) identifying the ideal features of a “system of surveillance systems” that would be more timely, sensitive, and flexible in terms of detection and response. This final area was addressed by gaining a consensus among the meeting attendees and through continued dialogue among the participants in the period following the workshop. Here we summarize the proceedings of the meeting, which we believe was the first national workshop focusing on nontraditional approaches to surveillance for emerging infections, including those related to bioterrorism.
