Disease Surveillance Comprises a Variety of Efforts at the State and Federal Levels

Disease surveillance comprises a variety of efforts at the state and federal  levels. State public health departments verify cases of  notifiable diseases, monitor disease incidence, and identify possible  outbreaks within their state. Some federal agencies and departments also  support their own national surveillance systems and laboratory networks  and have several means of sharing surveillance information with local,  state, and international public health partners. States Collect and Report Data on Notifiable Diseases, Although the Diseases Considered Notifiable and the Reporting Requirements Vary by State

To conduct disease surveillance at the state level, state public health  officials collect reports on cases of notifiable diseases from health care  providers and others. Federal agencies and departments collect and  analyze national disease surveillance data and maintain disease  surveillance systems. CDC,  for example, analyzes the reports it receives from state health departments  on cases of notifiable diseases in humans. CDC uses the reports from the  states to monitor national health trends, formulate and implement  prevention strategies, and evaluate state and federal disease prevention  efforts. For example, FDA officials told us they analyze state information from  CDC on outbreaks of infectious diseases that originate from foods that  FDA regulates. Other  systems, known as syndromic surveillance systems, monitor the frequency  and distribution of health-related symptoms—otherwise known as  syndromes—among people within a specific geographic area. Public Health Officials Have Implemented Initiatives Intended to Enhance Disease Surveillance, but Challenges Remain

Public health officials at the state and federal level have undertaken  several initiatives that are intended to enhance disease surveillance  capabilities. Finally, federal  officials have also expanded training programs for epidemiologists and  other public health experts. Although syndromic surveillance systems are used by federal agencies and  departments and in all 11 of the states whose officials we interviewed,  concerns about this approach to surveillance have been raised. Relative to  traditional methods of surveillance, syndromic surveillance systems are  costly to maintain and still largely untested. Public Health Officials Are Implementing Initiatives Designed to Enhance Public Health Communications and Disease Reporting, but Some Initiatives Are Incomplete

CDC is taking steps to enhance its two public health communications  systems, HAN and Epi-X, which are used in disease surveillance and  response efforts. For example, CDC is working to increase the number of  HAN participants who receive assistance with their communication  capacities. Federal Public Health Officials Have Enhanced Federal Coordination on Zoonotic Disease Surveillance and Expanded Training Programs, but Surveillance Efforts Still Face Challenges

CDC, USDA, and FDA have made recent efforts to enhance their  coordination of zoonotic disease surveillance. In its written comments, HHS stated that the draft captures many  important issues in surveillance. In this report, we defined  surveillance activities to include detecting and reporting cases of disease,  analyzing and confirming this information to identify possible outbreaks or  longer-term trends, and applying the information to inform public health  decision-making; and the programs and surveillance systems discussed in  this report fit within that definition. Other contacts and staff acknowledgments are listed in  appendix V.

Appendix I: Scope and Methodology

To describe how state and federal public health officials conduct disease  surveillance, we reviewed state documents—such as state policy manuals,  reports, cooperative agreements with the Centers for Disease Control and  Prevention (CDC), and various other documents—from 11 states. We also conducted structured interviews of state public health  officials from these states. We also  reviewed documents and interviewed officials from the Departments of  Agriculture, Defense, and Homeland Security; CDC, and the Food and  Drug Administration. List of Nationally Notifiable Infectious Diseases for 2004 as well as other  selected worldwide emerging infectious diseases. A number of vaccines for  rubella are also available. National Electronic Disease Surveillance System (NEDSS)

CDC’s NEDSS is an initiative that is designed to make the electronic  reporting of disease surveillance data to CDC by state and local health  departments more timely, accurate, and complete. West Nile Virus: Preliminary Information on Lessons Learned.
Why GAO Did This Study

The threat posed by infectious diseases has grown. New diseases, unknown in the United States just a decade ago, such as West Nile virus and severe acute respiratory syndrome (SARS), have emerged. To detect cases of infectious diseases, especially before they develop into widespread outbreaks, local, state, and federal public health officials as well as international organizations conduct disease surveillance. Disease surveillance is the process of reporting, collecting, analyzing, and exchanging information related to cases of infectious diseases. In this report GAO was asked to examine disease surveillance efforts in the United States. Specifically, GAO described (1) how state and federal public health officials conduct surveillance for infectious diseases and (2) initiatives intended to enhance disease surveillance. GAO reviewed documents, such as policy manuals and reports related to disease surveillance, and interviewed officials from selected federal departments and agencies, including the Departments of Defense (DOD), Agriculture (USDA), and Homeland Security (DHS) as well as the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC). GAO conducted structured interviews of state public health officials from 11 states.

What GAO Found

Surveillance for infectious diseases in the United States comprises a variety of efforts at the state and federal levels. At the state level, state health departments collect and analyze data on cases of infectious diseases. These data are required to be reported by health care providers and others to the state. State public health departments verify reported cases of diseases, monitor disease incidence, identify possible outbreaks within their state, and report this information to CDC. At the federal level, agencies and departments collect and analyze disease surveillance data and maintain disease surveillance systems. For example, CDC uses the reports of diseases from the states to monitor national health trends, formulate and implement prevention strategies, and evaluate state and federal disease prevention efforts. FDA analyzes information on outbreaks of infectious diseases that originate from foods that the agency regulates. Some federal agencies and departments also fund and operate their own disease surveillance systems and laboratory networks and have several means of sharing surveillance information with local, state, and international public health partners. State and federal public health officials have implemented a number of initiatives intended to enhance disease surveillance, but challenges remain. For example, officials have implemented and expanded syndromic surveillance systems, which monitor the frequency and distribution of health-related symptoms among people within a specific geographic area. Although syndromic surveillance systems are used by federal agencies and departments and in all of the states whose officials GAO interviewed, concerns have been raised about this approach to surveillance. Specifically, syndromic surveillance systems are relatively costly to maintain compared to other types of surveillance and are still largely untested. Public health officials are also implementing initiatives designed to enhance public health communications and disease reporting. For example, CDC is working to increase the number of participants using its public health communication systems. In addition, state public health departments and CDC are implementing an initiative designed to make electronic disease reporting more timely, accurate, and complete. However, the implementation of this initiative is incomplete. Finally, federal public health officials have enhanced federal coordination on disease surveillance and expanded training programs for epidemiologists and other public health experts. In commenting on a draft of this report, the Department of Health and Human Services (HHS) said the report captures many important issues in surveillance. HHS also provided suggestions to clarify the discussion.