Clinton proposes national infection surveillance plan

Funds earmarked for emergency room tracking

In a critical step for the Centers for Disease Control and Prevention’s emerging infections plan, the Clinton administration has proposed a $20 million allocation to develop a national disease surveillance system. If approved by Congress, the increased funding would be included in the fiscal year 2001 budget.

The increased funding, which supplements the CDC’s current budget of $44.3 million, is intended to speed the development of a national electronic disease surveillance network linking all 50 states. The CDC’s 1998 emerging infection plan underscored the importance of upgrading and integrating infectious disease surveillance to rapidly detect new syndromes and outbreaks.1

The CDC currently is integrating data from several systems, including the epidemiology and laboratory program, the emerging infections program, and provider-based sentinel networks.

"Our surveillance systems, to some degree, have grown up over time almost independent from each other," says Stephen Ostroff, MD, associate director of the CDC National Center for Infectious Diseases. "That makes it very difficult not only within CDC to exchange information across these systems, but also makes it very difficult for [clinicians and public health officials] out there. So one of the components of overhauling our system is to fix that particular problem."

Through state and local health departments, the CDC hopes to be able to use computers to access reports from clinical laboratories and emergency departments, he tells Hospital Infection Control. CDC would not actually gather patient identification data, but would get a much clearer picture of trends in populations and regions, he notes. "The local health departments would get the information sooner so that they can investigate the circumstances," Ostroff says. "In addition, as [reports] work their way up through the system, we might potentially recognize patterns of additional cases. That would warn us quite quickly — much earlier than currently — that there is a new outbreak occurring somewhere."

Global travel, population growth, increased use of antibiotics, and increased human contact with animal wilderness habitats have all been cited for the increase in new infectious agents or the resurgence of old ones over the last 25 years.

Plans call for information collected through the surveillance activities to be compiled and sent to physicians electronically, enabling providers to hone treatment strategies. For example, physicians may find out which types of bacteria are resistant to antibiotics or which strain of influenza is circulating among their patients.

The new funds also will be invested in developing public-private partnerships to ensure that commercial labs implement an electronic reporting system compatible with the one currently being developed for state and local public health departments. Under this system, private commercial labs, with appropriate privacy protections, will automatically send information on the incidence of infectious diseases to public health departments for analysis and integration into larger surveillance efforts. Pilot projects implementing this type of system in seven states have indicated significant increases in reporting of infectious disease. The increase in reported data provides a more complete picture of disease incidence to public health officials, allowing them to move quicker to address potential public health threats.


1. Centers for Disease Control and Prevention. Preventing Emerging Infectious Diseases: A Strategy for the 21st Century. Atlanta, 1998.