Figure 1: Form for Weekly Report of Communicable Diseases Used at the Pan American Health Organization
Country___________________
Week ended___________________
19___________________
Number___________________
Disease and Category
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Total
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Cumulative
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International Classification of Diseases
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for
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Total
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(1975 Revision)
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Week
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for Year
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Diseases Subject to the International Health Regulations +
Cholera (001)
Plague (020)
Smallpox (050)
Sylvatic yellow fever (060.0)
Urban yellow fever (060.1)
Unspecified yellow fever (060.9)
Diseases under International Surveillance
Influenza (487)
Louse-borne (epidemic) typhus (080)
Louse-borne relapsing fever (087.0)
Malaria (084)
Diseases of the Expanded Program on Immunization
Poliomyelitis, acute (045)
Measles (055)
Diphtheria (032)
Tetanus (excludes neonatorum) (037)
Tetanus neonatorum (771.3)
Whooping cough (033)
Other Diseases of Regional Interest
Typhoid fever (002.0)
Dengue (061)
Meningococcal infection (036)
Arenaviral hemorrhagic fever (Argentinian or Bolivian hemorrhagic fever) (078.7)
Mosquito-borne viral encephalitis (062)
Western equine encephalitis (062.1)
Eastern equine encephalitis (062.2)
St. Louis encephalitis (062.3)
Venezuelan equine fever (066.2)
Other encephalitides (specify)
Other Diseases of Sub-regional or National Interest
+ Complete information on reverse. ... Data not available. - Quantity zero.
* Disease not notifiable.
Return one copy to:
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Pan American Sanitary Bureau525 Twenty-third St., N.W. Washington, D.C. 20037 U.S.A.
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and one copy to:
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Caribbean Epidemiology Center P.O. Box 164 Port-of-Spain Trinidad
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Date: ___________________
Signature: ___________________
Title: ___________________
Figure 1 is a reproduction of the Pan American Health Organization weekly report form for communicable diseases. It contains a list of the diseases that countries are asked to investigate through their national system of surveillance. The diseases included in the national surveillance program of each country vary considerably. Diseases given the highest priority for international reporting are invariably investigated, but in some countries certain diseases are not unless they are endemic or unless the control program is organized. At the other extreme, a few countries still maintain a surveillance list of nearly one hundred diseases. The Pan American Health Organization's Caribbean Epidemiology Center, CAREC, uses a modified form in that region.
Promulgating official reporting forms and diagnostic guidelines, and complying with international reporting requirements does not per se constitute an effective system for the surveillance and control of disease. In a surveillance system in operation, close ties to the reporting units are maintained, data analysis is prompt, and regular reports about disease conditions and recommendations for locally appropriate action are circulated to the field. In active programs, assistance is often provided in investigating epidemics, with laboratory diagnosis, in organizing intensified control measures, and with inservice training of local health workers, from epidemiologists at the intermediate to the national level.
In practice, in a country where communications and laboratory services are good, the communicable disease control officer rarely learns of a serious or urgent problem through the weekly forms sent from the field. Telephone notification, consultation or notification through the public health laboratory usually precede official reporting. Moreover, epidemiologists are increasingly using interested clinics and physicians as "sentinel" reporting units (30). Regular telephone or mail surveys of a sample of physicians can also yield a good appreciation of actual levels of disease in the population (31). Indirect measures, such as school or industrial absenteeism, may be useful in such special situations as the surveillance of influenza (32). The effective communicable disease epidemiologist also monitors unofficial sources of information - such as television news programs, newspaper clippings, enquiries from the public, and even casual conversations - for early information about unconfirmed or potential communicable disease problems.
Descriptive material and operational research concerning the effectiveness of surveillance systems is not only surprisingly scanty, but that which does exist is usually devoted to only a single disease. While very exotic and fatal, or uncommon, diseases are reported frequently to health authorities, common communicable diseases are grossly underreported, even where the physicians have the legal obligation to do so. For example, in the United States it has been demonstrated in telephone surveys that, prior to the current national effort to eliminate the disease, only about 10% of measles cases were reported (31). In a national survey only 11% of gonorrhea cases treated by private physicians were shown to have been actually reported (33). Results of a state survey were that 42% of cases with gonorrhea listed in physicians' medical records were reported to authorities (34).