A final component of surveillance is the ability to rapidly and reliably exchange information on disease incidence and distribution, preferably in real time. Disease intelligence relies on formal and informal networks for dissemination and sharing of timely, accurate information on occurrences and outbreaks of infectious diseases and diffusion of prevention recommendations. One of the key lessons that emerged from the 2003 global SARS epidemic was the importance of networks of laboratory scientists, clinicians, and public health experts, aided by electronic communications, in rapidly generating the scientific basis for public health action. It was the "virtual" international network of laboratories, linked by a secure web site and daily teleconferences, that identified the causative agent and developed early diagnostic tests. The laboratory network served as a model for groups of clinical and epi-demiologic experts who shared and compiled the data needed to track the outbreak and assess the effectiveness of containment measures.
In the current electronic era, countries are increasingly aware of the value of network-facilitated early warning systems, rapid information exchange, and technology transfer for the control of infectious agents. Technologies developed and enhanced over the last several years have stimulated the creation of web-based public health tools for improving national and international disease reporting and facilitating emergency communications. In the United States, CDC communicates breaking surveillance information to public health officials through two electronic networks: the Epidemic Information Exchange (Epi-X), a secure mechanism for sharing health surveillance information on outbreaks and other unusual events, and the Health Alert Network (HAN), which links local, state, and federal health agencies and provides an electronic platform for emergency alerts and long distance training. In similar fashion, the Eurosurveillance Project, funded by the European Commission, promotes the diffusion and exchange of information on communicable diseases in Europe. Globally, WHO shares information through the Outbreak Verification List distributed weekly by electronic mail, the WHO Disease Outbreak News on the WHO web site, and the Weekly Epidemiological Record. Supplementing these mechanisms are less formal networks of individuals and organizations, such as GPHIN, the web-based application that scans global electronic news media for information on health risks and the Program for Monitoring Emerging Diseases (ProMED), a web-based reporting system.
Another essential component of information exchange during infectious disease outbreaks is risk communication. Any outbreak of a novel or reemerging infectious disease is likely to be characterized by scientific uncertainties and high levels of concern that public health officials will be challenged to harness and guide. Since the 2001 anthrax attacks and the 2003 global SARS outbreaks, CDC and WHO have been actively involved in efforts to incorporate risk communication into public health practice.
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