Issue 7 - February 2003: THE EMERGENCE OF SARS UNDERSCORES THE NEED FOR SYNDROMIC SURVEILLANCE

Like an unusual alignment of planets, a number of health care groups aligned in the last month to re-emphasize the importance of syndromic surveillance. And with the emergence of Severe Acute Respiratory Syndrome (SARS), this alignment has come none too soon.

On March 12th, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)released "Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems" urging the creation of community emergency preparedness programs. Stating that “nearly all disasters, including intentional terrorist events, will be experienced at the local level”(1) and involve many types of health care services (e.g., EMS, fire, hospitals, & public health), preparation needs to involve all of them.

The report states that while the larger metropolitan areas such as New York and Washington are much better prepared to deal with disasters than they were prior to September 11, 2001, most smaller communities are “waiting for someone to call the meeting”.(1)

Critical to the community-wide organization is the “authority, funding, and accountability for planning, assessing and maintaining community-wide emergency preparedness - including management of disease outbreaks”.(1) Clearly, syndromic surveillance is an important part of this management effort.

Following on the heels of this important report, the Centers for Disease Control released the Institute of Medicine (IOM) Report on Microbial Threats to Health on March 18, 2003. A similar IOM report in 1992 decried the complacency that has developed regarding infectious diseases and the resulting deteriorating public health systems.(2) Their plea to rebuild public health surveillance systems was reinforced when within just eight months of its publication, the United States experienced a multi-state outbreak of E. coli 0157:H7, a huge waterborne outbreak of cryptosporidiosis in Milwaukee, and the identification of Hantavirus pulmonary syndrome in the Southwest.(2)

The new IOM report emphasizes that “infectious diseases, both naturally occurring and those resulting from bioterrorism, are a potential threat to national security”.(2) To identify threats, they state that links between clinical medicine and the world of public health must be strengthened, “especially strengthening surveillance systems in the United States at the local, state and national level.”(2)

About the time the IOM report was released, a global outbreak of severe acute pneumonia (SARS) was recognized. On March 14th, the CDC activated its emergency operations center upon learning that an outbreak of a virulent pneumonia was spreading from Southeast Asia to the West by way of travelers and their family contacts.(3) Over one thousand cases have been identified, with a mortality rate of about 3 percent.(4) Suspect cases have now appeared in several U.S. cities.

Is your community prepared to identify SARS and other unusual disease clusters? Syndromic surveillance is the most reliable way to identify outbreaks so that immediate action can be taken. In fact, environmental biosensors and lab-based surveillance would completely miss a new disease like SARS! Health care facilities and public health agencies must work together to develop syndromic surveillance in your community, not only for new diseases like SARS, but also for naturally occurring and/or deliberately-caused disease outbreaks.

(1) http://www.jcaho.org/news+room/news+release+archives/emergency+preparedness.htm

(2) http://www.cdc.gov/od/oc/media/transcripts/t030318.htm

(3) http://www.infectioncontroltoday.com/hotnews/33h1771534.html

(4) http://www.cdc.gov/mmwr/preview/mmwrhtml/m2d321.htm

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