Implement the Surveillance System

During the floods in the midwestern United States in 1993, it became clear that a surveillance system was essential to assess the magnitude of the health problem created, as well as the nature and distribution of flood-related illness and injury (O'Carroll et al. 1995). Previous examples include the emergence of AIDS (Buehler et al. 1996), toxic-shock syndrome (Schucat and Broome 1991), and eosinophilia-myalgia syndrome (Swygert et al. 1990). In establishing an ongoing system, a natural tendency at the start will be to make the case definition both as specific and sensitive as possible. Logical and defensible though this may be, it should not stand in the way of getting the system off the ground. Many a system has languished for months, even years, because of needless worry over missing or misclassifying a case or two—thus losing interest, cooperation, and potential impact. Since surveillance is a fluid process, as populations or health problems change, the surveillance system must adapt (Spitalny 1996).

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