CDC reports on health surveillance

The Centers for Disease Control and Prevention is working with state and local public health partners to create syndromic surveillance systems that will monitor electronic information for early indications of outbreaks, CDC officials told lawmakers May 5.

Syndromic surveillance — which supplements ongoing disease surveillance — requires public health organizations to enhance or create systems that provide information that is not illness-specific and is culled from a variety of sources. Such information would include the nature and frequency of symptoms.

At a hearing of the House Government Reform Committee's National Security, Emerging Threats and International Relations Subcommittee, Rep. Bill Janklow (R-S.D.) expressed concern that states are developing their own systems and questioned whether syndromic surveillance development should be defined by law to ensure compliance and compatibility.

David Fleming, deputy director for public health science at CDC, said he doesn't see a need to legislate uniformity in the systems, because jurisdictions have different needs. However, he said CDC officials are working to ensure that systems conform to standards.

"The fundamental point is, whether [the systems] are homegrown or not, they have to conform to an agreed-upon set of standards," Fleming said. "At the end of the day, these systems will be indistinguishable and transparent from each other."

In an effort to define standards, CDC officials are examining several systems to determine what would constitute the most effective syndromic surveillance system. For example, Pennsylvania is developing an early warning system using data from emergency departments to detect patterns of illnesses and to alert hospitals, Fleming said during his testimony.

In regard to ongoing disease surveillance, Fleming said CDC is making progress toward electronic reporting with the National Electronic Disease Surveillance System (NEDSS).

Disease surveillance calls for clinicians and laboratories to report certain diseases to state and local health departments, which in turn share the information with CDC. However, the reporting generally relies on paper and faxes.

"NEDSS is a program designed to transfer from a paper reporting system to an electronic reporting system," Fleming said.

"Public health surveillance is a system of systems," he said, including vaccine reporting, vital statistics and public health surveys. "We need to be thinking about making the system of systems as robust as possible."

Although the NEDSS project has been in the works for a few years, CDC is still working on defining the standards necessary for seamless reporting, Fleming told lawmakers.

He said a working system is in place for reporting diseases, and it will be enhanced in the coming few years. He was unable to tell lawmakers exactly how much such improvements would cost, saying that CDC officials are working with the Office of Management and Budget to create a strong business case for funding.