Surveillance is More Than Disease Notification
Editor's Note: Craig commented on my surveillance post to remind us that disease notification is not the only way we track outbreaks. His additions were important enough that I am giving them their own post.
The current surveillance situation is a little broader than Notifiable Diseases and depends on the methodology used for the surveillance as well as the end purpose of the surveillance.
Most of what you've discussed would fall into a 'direct reporting' capacity used by the national health infrastructure. Separately, there have been attempts at indirect, Syndromic Surveillance - basically looking for indirect indicators of disease in the population. By and large, this has not proven to be effective. Other systems use a methodology of looking at social/societal disruption associated with an outbreak of disease - such things as cancellation of sporting events, festivals, or school closures. This methodology may not be 'disease specific'; however, it has proven to be fairly sensitive. A downside is that one must understand and take cultural perspectives, expectations, and practices into account.
Another point of debate in the biosurveillance community is that regarding purpose of the surveillance system. Traditional monitoring tends to lean toward a true epidemiological approach - it is slow, but you generally get a high degree of specificity. Alternatively, one can take the 'tip off' approach, effectively trading specificity of detection with much more rapid (and sensitive) indication. You might detect that something is happening and have vague descriptions of disease signs, but not a true clinical description.
Each methodology and purpose has its strengths and weaknesses, and use of the various systems is not mutually exclusive. The questions become: How is each system's reporting used most effectively? How do we make decisions from the gathered data? How do we effectively communicate our conclusions? How do we integrate our surveillance and response methodologies?
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