Many of the issues that face those responsible for the development and management of surveillance systems have been covered elsewhere in this chapter, such as:
- the need to reduce the burden on data providers in the face of increasing pressures to reduce the costs of healthcare
- the need to improve the completeness of coverage and the quality of data collected through surveillance systems
- the need for common data and information system standards that will facilitate the exchange of information between information systems (as healthcare services move towards electronic patient records)
- the need to comply with laws on Data Protection and Human Rights
- the collection of appropriate denominator data
There are also a new range of challenges for surveillance, related to the continuing emergence of new threats, changes in technology, changes in the physical and political environment, and changes in human behaviour. One of the greatest challenges of the last few decades has been the emergence of new diseases, including HIV, Ebola, West Nile virus, BSE, SARS and avian influenza among many dozens of others. Many of these diseases are zoonoses, and it is predicted that the trend in emergence of human disease arising from zoonotic sources is likely to continue , particularly as international trade and travel increase, and with the possibility of global warming. There is a need for surveillance systems that can provide better intelligence on environmental hazards and exposures, making use of veterinary and environmental information sources. There is also a need for syndromic surveillance systems that might not only detect emerging zoonoses, but also the occult release of infectious disease agents by bioterrorists.
The threat of bioterrorism, and the need to be able to undertake surveillance at the time of mass gatherings, such as the Olympic Games, is also posing new challenges for surveillance, and in particular the need for 'real time' surveillance systems. Exciting advances have been made in the development of syndromic surveillance systems and in the use of novel data sources such as over the counter medicines sales, as a step towards meeting these requirements, and it is likely that this is an area that will see further development in the next few years.
The emergence of antimicrobial resistance and the development of more sophisticated disease control programmes also brings with them the need for surveillance that can be used to monitor the outcome of interventions, rather than just the events (cases of infection) that require those interventions.
Advances in technology, both diagnostic and information technology, provide exciting new opportunities for surveillance. The increasing move to electronic patient records and standards for exchange of health data between patient record systems provides significant opportunities, not only for more complete and more rapid capture of information about health events and exposures, but also for syndromic surveillance and for record linkage within surveillance.
Increasing computer processing power, and developments in geographic information systems also provide the opportunity for real time tempero-spatial modelling of emerging epidemics.
The development of molecular diagnostic tests, and of bio-informatics software for manipulating and analysing molecular sequence data, provides significant opportunities for more rapid and more precise data on the characterisation of infections, which could be used for surveillance. The advent of near patient testing also provides new opportunities for surveillance, not only in that it could provide earlier confirmation of aetiology in some clinical settings, but also because confirmation of aetiology may provide a prompt to reporting clinicians to seek important risk factor or exposure data while the patient is still in front of them.
1. Report of the WHO/FAO/OIE joint consultation on emerging zoonotic diseases. Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO), and World Organisation for Animal Health (OIE), 2004 (http://whqlibdoc.who.int/hq/2004/WHO_CDS_CPE_ZFK_2004.9.pdf)