2.2.3 National surveillance agencies
The ability of national surveillance, response and reporting systems in WHO member states to monitor outbreaks of infectious disease of public health importance are less developed in LMICs where major disease outbreaks most often occur. But strenuous efforts to help them catch up are being made by agencies in wealthier countries.
The UK has four such agencies:
- the Health Protection Agency in England
- the National Public Health Service Wales
- Health Protection Scotland
- the Department of Health, Social Services and Public Safety, Northern Ireland.
The functions of the public health agencies in the four nations of the UK are similar and are encapsulated in the Act of Parliament that created the Health Protection Agency (HPA) in England (HM Government, 2004). Principally, the agencies all function to protect the community (or any part of the community) against infectious diseases and other dangers to health through surveillance and data analysis, and to provide advice and information to the general public, health professionals and national and local government.
The HPA also provides expertise to assist the British Commonwealth countries and Brazil, Russia, India, China and South Africa (known collectively as ‘BRICS’) to implement the WHO International Health Regulations – IHR (2005). Projects include:
- building meningococcal serology capacity across Sub-Saharan Africa
- improving public health emergency preparedness and response in India
- developing an influenza surveillance network across South America to detect antiviral drug resistance (HPA, 2011b).
The huge range of outbreaks reported via national infectious disease surveillance networks can be judged from the ‘snapshot’ in Table 1, based on data published in the international journal The Lancet Infectious Diseases in the four months from August to November 2011.
| Country, region or town | Infectious disease outbreak |
|---|---|
| Cambodia | 6 deaths (all children under 15 years) from H5N1 avian influenza |
| Canada, Ontario | 80 cases of Clostridium difficile in hospitals, causing 21 deaths |
| Central African Republic | 57 cases and 16 deaths from Vibrio cholerae infection |
| Congo, Brazzaville | more than 7000 cases of chikungunya, a mosquito-borne viral disease causing fever and prolonged arthritic inflammation of the joints |
| India, Eastern Uttar Pradesh and Bihar | more than 2000 cases and 400 deaths from mosquito-borne Japanese encephalitis virus and enterovirus infection from contaminated water |
| France, Vaucluse and Somme districts | 8 cases of botulism traced to eating contaminated green olive tapenade or tomato paste from a French food company |
| Pakistan, Punjab region | more than 4000 cases and at least 8 deaths from dengue fever, causing the closure of all schools in Lahore for 12 days |
| South Sudan, Jur River county | 12 new cases of cutaneous anthrax and 777 cases of guinea worm disease |
| England, Scotland and Wales | 250 infections and one death from Escherichia coli O157, possibly originating from leeks and potatoes |
| USA, Albuquerque, New Mexico | 5 cases and 3 deaths from hantavirus pulmonary syndrome, transmitted to humans from rodents |
| USA (24 states) | 109 infections and 23 deaths from listeriosis traced to Listeria monocytogenes in cantaloupe melons and lettuces |
| Vietnam (national epidemic) | more than 42 000 cases and 98 deaths from hand, foot and mouth disease, caused by picornaviruses |
| Zambia, Chama district | 278 cases and 5 deaths from anthrax, thought to have been contracted from contact with infected hippopotamus meat |
But such high-profile outbreaks are only the tip of the public health ‘iceberg’. Submerged below the level that excites media interest are the day-to-day public health routines of surveillance, direct intervention, education and community action that seek to control infection all over the world. Although these strategies save millions of lives every year and prevent many more episodes of infectious disease, they are largely disregarded outside public health circles.
The rest of this course will give you an insight into their diversity and the success of some public health campaigns to control – and in some cases eliminate – major infectious diseases.