Setting Up a Disease Surveillance System

In emergency conditions, the routine disease surveillance system is either not up to the task, is disrupted as a direct consequence of the disaster, or cannot provide data quickly enough for timely decisions to be taken. It is recommended, therefore, that a local, syndrome-based surveillance system be prepared at the national level and temporarily instituted in the disaster aftermath. It should be a more flexible and faster reporting system than used in normal conditions. The routine surveillance system must be reestablished as soon as possible.

In order to collect and interpret data, it is essential that a national epidemiologist be assigned adequate epidemiologic and clerical staff who have transportation to the field and priority access to public or private laboratory facilities. In addition to the national epidemiologic staff, university departments, research centers, and bilateral or international agencies may provide trained epidemiologists and laboratory support nationally or regionally. The national epidemiologist should be the secretary of a disease surveillance and control subcommittee of the Health Emergency Committee (see Chapter 5). The subcommittee should provide direct feedback to hospitals and other health facilities where surveillance data are being collected.

The epidemiologist closest to the local reporting unit should investigate suspected disease outbreaks detected by the surveillance system as soon as possible. Until epidemiological assistance arrives, initial investigation and control measures are the responsibility of the local health unit.

Background data should be collected on the geographical areas affected, the major disease risks in the affected area (e.g., whether cholera or malaria are endemic), available resources, and the at-risk and affected populations. The national epidemiologist and Health Disaster Coordinator should designate syndromes or diseases to be included in the surveillance system (for example, fever, fever and diarrhea, fever and cough, trauma, bums, and measles). All health facilities and temporary shelters should institute the system, using a standardized form as shown in Figure 7.1.

In addition to information provided by the health system, information from humanitarian workers, NGOs, community groups and from unconventional sources such as newspaper accounts, including unconfirmed public rumors, are important as early warnings.

FIGURE 7.1. Post-disaster disease surveillance daily report.