Surveillance Summaries Publication of CDC Surveillance Summaries

Since 1983, CDC has published the CDC Surveillance Summaries under separate cover as part of the MMWR series. Each report published in the CDC Surveillance Summaries focuses on public health surveillance; surveillance findings are reported for a broad range of risk factors and health conditions.

Summaries for each of the reports published in the most recent (March 1992) issue of the CDC Surveillance Summaries (1) are provided below; this issue focuses on international topics in public health surveillance. All subscribers to MMWR receive the CDC Surveillance Summaries, as well as the MMWR Recommendations and Reports, as part of their subscriptions.

SURVEILLANCE FOR DRACUNCULIASIS, 1981-1991

In 1986 the World Health Organization (WHO) designated dracunculiasis (guinea worm disease) as the next disease scheduled to be eradicated (by 1995) after smallpox. Dramatic improvement in national and international surveillance has played a key role in the global eradication campaign, which was initiated at CDC in 1980. About 3 million persons are still affected by the disease annually, with adverse effects on their health as well as on agricultural production and education. Over 100 million persons are at risk of having the disease in more than 20,000 villages in India, Pakistan, and 17 African countries. At least one nationwide, village-by-village search to detect all villages with endemic dracunculiasis and count cases is recommended at the outset of each national campaign, followed by monthly reporting by village-based health workers in the targeted villages during the implementation phase. Rapid dissemination of the results of the surveillance is critical. Intensive case detection and containment--with rewards for reporting of cases--are most appropriate near the end of each campaign. Cameroon, Ghana, India, Nigeria, and Pakistan have pioneered the various surveillance methods for this disease in recent years. Methods to conduct surveillance of dracunculiasis and other important diseases must continue to be developed and improved as newly post-endemic countries prepare to apply to WHO for certification of elimination of dracunculiasis. Authors: Donald R. Hopkins, M.D., M.P.H., Global 2000, Inc., The Carter Center of Emory University, and Collaborating Center for Research, Training, and Eradication of Dracunculiasis, World Health Organization; Ernesto Ruiz-Tiben, Ph.D., Collaborating Center for Research, Training, and Eradication of Dracunculiasis, World Health Organization, and Division of Parasitic Diseases, National Center for Infectious Diseases, CDC.

INJURY SURVEILLANCE IN DEVELOPING COUNTRIES

In both developed and developing countries, injuries have a substantial effect on the public's health and on quality of life. Although epidemiologic data regarding the occurrence of injuries in developing countries are limited, recent studies have documented substantial injury-related morbidity and mortality in some of these countries. For example, recent studies in rural Papua New Guinea showed that injuries are the leading cause of death for persons ages 15-44 years. Similarly, injuries are the leading cause of hospitalization in Indonesia and Egypt. Surveillance of injuries is necessary in order for public health practitioners and planners in developing countries to direct and allocate scarce resources appropriately. Author: Philip L. Graitcer, D.M.D., M.P.H., Division of Injury Control, National Center for Environmental Health and Injury Control, CDC.

THE SURVEILLANCE CHALLENGE: FINAL STAGES OF ERADICATION OF POLIOMYELITIS IN THE AMERICAS

Current levels of surveillance have contributed to substantial reductions in morbidity and mortality due to poliomyelitis in the Americas. Despite the success of the poliomyelitis eradication initiative, it has become critical that surveillance be intensified so that the absence of wild poliovirus circulation can be verified with confidence in countries not reporting confirmed cases of poliomyelitis. Cases of acute flaccid paralysis continue to be classified as compatible with poliomyelitis, because investigations of such patients do not provide sufficient information to rule out wild poliovirus as the cause of paralysis. At this stage of the eradication initiative, the presence of compatible cases in some countries in Latin America indicates a failure of the surveillance system. The greatest challenge for the eradication initiative may be correcting the remaining deficiencies of the existing surveillance system that hinder efforts to verify that wild poliovirus is no longer being transmitted in the Americas. Authors: Jon K. Andrus, M.D., Division of Immunization, National Center for Prevention Services, CDC; Ciro A. de Quadros, M.D., M.P.H., Jean-Marc Olive, M.D., M.P.H., Expanded Program on Immunization, Pan American Health Organization, Regional Office of the World Health Organization.

SURVEILLANCE FOR EPIDEMIC CHOLERA IN THE AMERICAS: AN ASSESSMENT

In January 1991, epidemic cholera appeared in Peru and quickly spread to many other Latin American countries. Because reporting of cholera cases was often delayed in some areas, the scope of the epidemic was unclear. An assessment of the conduct of surveillance for cholera in several countries identified some recurrent problems involving surveillance case definitions, laboratory surveillance, surveillance methods, national coordination, and data management. A key conclusion is that a simple, well-communicated cholera surveillance system in place during an epidemic will facilitate prevention and treatment efforts. The following measures are recommended: a) simplify case definitions for cholera; b) focus on laboratory surveillance of patients with diarrhea primarily in the initial stage of the epidemic; c) use predominantly the "suspect" case definition when the number of "confirmed" cases rises; d) transmit weekly the numbers of cases, hospitalized patients, and deaths to regional and central levels; e) analyze data frequently and distribute a weekly or biweekly summary; and f) report the number of cholera cases promptly to the World Health Organization. Authors: Duc J. Vugia, M.D., M.P.H., Jane E. Koehler, D.V.M., M.P.H., Allen A. Ries, M.D., M.P.H., Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

THE NATIONAL SURVEILLANCE SYSTEM FOR SEXUALLY TRANSMITTED DISEASES IN ITALY

Sexually transmitted diseases (STDs) have increased in importance in recent decades as a result of their wider dissemination, the emergence of new etiologic agents, and changes in sexual behaviors. In Italy, gonorrhea and syphilis are among the 71 diseases for which reporting is legally mandated. Despite these legal requirements, however, considerable underreporting has been documented. The need for more reliable data has led to the establishment of a formal sentinel surveillance system for STDs. The Italian National STD Surveillance Network, which involves 47 reporting centers, was established in 1990. A total of 5049 patients were reported during the pilot study and the first 6 months of surveillance. For men, the most frequently reported diseases were genital warts and nongonococcal urethritis; for women, the most frequent diagnoses were nonspecific vaginitis and genital warts. The objectives of this system are threefold: a) to obtain a rapid and accurate picture of the occurrence and spread of STDs; b) to identify trends in disease occurrence; and c) to monitor changes over time by geographic area. Authors: Barbara Suligoi, M.D., Massimo Giuliani, Dott., the STD Surveillance Working Group, Istituto Superiore di Sanita, Rome, Italy; Nancy Binkin, M.D., M.P.H., International Branch, Division of Field Epidemiology, Epidemiology Program Office, CDC.

Reference

1. CDC. CDC surveillance summaries. MMWR 1992;41(no. SS-1).

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