How outbreaks of infectious disease are detected: a review of surveillance systems and outbreaks.

To learn how outbreaks of infectious disease are detected and to describe the entities and information systems that together function to identify outbreaks in the U.S., the authors drew on multiple sources of information to create a description of existing surveillance systems and how they interact to detect outbreaks. The results of this analysis were summarized in a system diagram. The authors reviewed a sample of recent outbreaks to determine how they were detected, with reference to the system diagram. The de facto U.S. system for detection of outbreaks consists of five components: the clinical health care system, local/state health agencies, federal agencies, academic/professional organizations, and collaborating governmental organizations. Primary data collection occurs at the level of clinical health care systems and local health agencies. The review of a convenience sample of outbreaks showed that all five components of the system participated in aggregating, analyzing, and sharing data. The authors conclude that the current U.S. approach to detection of disease outbreaks is complex and involves many organizations interacting in a loosely coupled manner. State and local health departments and the health care system are major components in the detection of outbreaks.