Lesson 5: Public Health Surveillance

Summary, References, Further Reading, and Websites

Surveillance has a long history of value to the health of populations and continues to evolve as new health-related problems arise. In this lesson, we have defined public health surveillance as continued watchfulness over health-related problems through systematic collection, consolidation, and evaluation of relevant data.2 Data and interpretations derived from surveillance activities are useful in setting priorities, planning and conducting disease control programs, and assessing the effectiveness of control efforts. We have reviewed the identification and prioritization of health problems for surveillance; the need for a clear, functional definition of a health problem to facilitate surveillance for it; and various approaches for gathering data about health problems, including environmental monitoring, surveys, notifications, and registries. Sources of data are often available and used for surveillance at the national, state, and local levels.

We have described and illustrated basic methods for analyzing and interpreting data and have focused on time, place, and person as the foundation for characterizing a health-related problem through surveillance. Potential problems with surveillance data that can lead to errors in their analysis or interpretation have been presented. We have emphasized the importance of the timely, regular dissemination of basic data and their interpretation as a critical component of surveillance. These data and surveillance reports must be shared with those who supplied the data and those responsible for the control of health problems.

Critical to maintaining useful, cost-effective surveillance is periodic evaluation and implementation of recommended improvements. Stakeholders should be identified and included in evaluation processes; a clear description and diagram of surveillance activities should be developed; and the usefulness, resource requirements, and characteristics of optimal surveillance should be individually assessed. This lesson ends with examples of surveillance and recommendations for further reading.


  1. Merriam-Webster. Merriam-Webster’s Dictionary of English Usage. Springfield (MA): Merriam-Webster, Inc. 1976.
  2. Langmuir AD. The surveillance of communicable diseases of national importance. N Engl J Med 1963;268:182–92.
  3. Thacker SB, Berkelman RL. Public health surveillance in the United States. Epidemiol Rev 1988;10:164-190.
  4. Communicable Disease Center. Communicable Disease Center Activities 1952-1953. Atlanta: Department of Health, Education, and Welfare; 1953. Public Health Service Publication Number 391, p. 17.
  5. World Health Organization. Report of the technical discussions at the twenty-first World Health Assembly on ‘national and global surveillance of communicable diseases.’ Geneva: World Health Organization; 18 May 1968, p. A21.
  6. Thacker SB, Stroup DF, Parrish RG, Anderson HA. Surveillance in environmental public health: issues, systems, and sources. Am J Public Health 1996;86:633–8.
  7. Vaughan JP, Morrow RH. Manual of epidemiology for district health management. Geneva: World Health Organization; 1989.
  8. Wegman DH. Hazard Surveillance. In: Halperin W, Baker E, Monson R (editors). Public Health Surveillance. New York: Van Nostrand Reinhold; 1992, pp. 62–75.
  9. Protocol for the evaluation of epidemiological surveillance systems [monograph on the Internet]. Geneva: World Health Organization [updated 1997; cited 2006 Jan 20]. Available from: http://whqlibdoc.who.int/hq/1997/WHO_EMC_DIS_97.2.pdfpdf iconexternal icon.
  10. Hopkins RS. Design and operation of state and local infectious disease surveillance systems. J Public Health Management Practice 2005;11(3):184–90.
  11. Doherty JA. Establishing priorities for national communicable disease surveillance. Can J Infect Dis 2000;11(1):21–4.
  12. Rushdy A, O’Mahony M. PHLS overview of communicable diseases 1997: results of a priority setting exercise. Commun Dis Rep CDR Suppl 1998;8 (suppl 5):S1–12.
  13. Centers for Disease Control and Prevention. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR 1997;46(No. RR-10):1–55.
  14. Parrish RG, McDonnell SM. Sources of health-related information. In: Teutsch SM, Churchill RE, editors. Principles and practice of Public Health Surveillance, 2nd ed. New York: Oxford University Press; 2000, pp. 30–75.
  15. Groves RM, Fowler FJ, Couper MP, Lepkowski J, Singer E, Tourangeau R. Survey methodology. New York: John Wiley; 2004.
  16. Hutwagner L, Thompson W, Seeman GM, Treadwell T. The bioterrorism preparedness and response Early Aberration Reporting System (EARS). J Urban Health 2003;80:89–96.
  17. Croner CM. Public health GIS and the Internet. Annu Rev Public Health 2003;24:57–82.
  18. Guerra M, Walker E, Jones C, Paskewitz S, Cortinas MR, Stancil A, Beck L, Bobo M, Kitron U. Predicting the risk of Lyme disease: habitat suitability for Ixodes scapularis in the north central United States. Emerg Infect Dis. 2002;8:289–97.
  19. SaTScan [Internet]. Boston: SaTScan [updated 2006 Aug 14] Available from: http://www.satscan.org/external icon.
  20. Centers for Disease Control and Prevention [Internet]. Atlanta: CDC [updated 2005 Nov 8; cited 2006 Jan 31]. EpiInfo. Available from: https://www.cdc.gov/epiinfo/.
  21. The HealthMapper [Internet] Geneva: World Health Organization [updated 2006; cited 2006 Jan 31]. Available from: http://www.who.int/health_mapping/tools/healthmapper/en/external icon.
  22. Centers for Disease Control and Prevention. Current Trends Update: Impact of the expanded AIDS surveillance case definition for adolescents and adults on case reporting—United States, 1993a. MMWR 1994;43:160–1,167–70.
  23. Ryan CA, Nickels MK, Hargrett-Bean NT, et al. Massive outbreak of antimicrobial-resistant salmonellosis traced to pasteurized milk. JAMA 1987;258:3269–74.
  24. Friedman DJ, Parrish RG. Characteristics, desired functionalities, and datasets of state webbased data query systems. J Public Health Management Practice 2006;12(2):119–129. In press.
  25. Henderson DA. Surveillance of smallpox. Int J Epidemiol 1976;5(1):19-28.
  26. Centers for Disease Control and Prevention. Outbreak of West Nile-Like Viral Encephalitis — New York, 1999. MMWR 1999;48(38):845–9.
  27. Centers for Disease Control and Prevention. Updated guidelines for evaluating public health surveillance systems: recommendations from the guidelines working group. MMWR 2001;50(No. RR-13):1–35.
  28. Centers for Disease Control and Prevention. Framework for evaluating public health surveillance systems for early detection of outbreaks; recommendations from the CDC Working Group. MMWR 2004;53(No. RR-5):1-13.
  29. World Health Organization Regional Office for Africa and the Centers for Disease Control and Prevention. Technical Guidelines for Integrated Disease Surveillance and Response in the African Region. Harare, Zimbabwe and Atlanta, Georgia, USA. July 2001: 1–229.
  30. Hopkins RS. Consumer product-related injuries in Athens, Ohio, 1980-85: assessment of emergency room-based surveillance. Am J Prev Med 1989 Mar-Apr;5(2):104–12.
  31. Schrieber, R.A., Branche-Dorsey, C.M., Ryan, G.W. et al. Risk factors for injuries from in-line skating and the effectiveness of safety gear. N Engl J Med 1996;335:1630–1635.
  32. NEISS: The National Electronic Injury Surveillance System — A Tool for Researchers [monograph on the Internet]. Washington (DC): U.S. Consumer Product Safety Commission, Division of Hazard and Injury Data Systems [updated 2000 Mar; cited 2005 Dec 2]. Available from: http://www.cpsc.gov/neiss/2000d015.pdfpdf iconexternal icon.
  33. Mannino DM, Homa DM, Pertowski CA, et al. Surveillance for asthma — United States, 1960–1995. In: Surveillance Summaries, April 24, 1998. MMWR 1998;47(No. SS- 1):1–28.
  34. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for Asthma—United States, 1980–1999. In: Surveillance Summaries, March 29, 2002. MMWR 2002;51(No. SS-1):1–13.
  35. Doyle TJ, Glynn MK, Groseclose SL. Completeness of notifiable infectious disease reporting in the United States: an analytic literature review. Am J Epidemiol 2002;155:866–74.
  36. Rosenberg MJ, Marr JS, Gangarosa EJ, Pollard RA, Wallace M, Brolnitsky O. Shigella surveillance in the United States, 1975. J Infect Dis 1977;136:458–60.
  37. Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis 1999;5:607–25.
  38. Campos-Outcalt D, England R, Porter B. Reporting of communicable diseases by university physicians. Public Health Rep 1991;106:579–83.
  39. Marier R. The reporting of communicable diseases. Am J Epidemiol 1977;105:587–90.
  40. Konowitz PM, Petrossian GA, Rose DN. The underreporting of disease and physicians’ knowledge of reporting requirements. Public Health Rep 1984;99:31–5.
  41. Hajjeh R, Reingold A, Weil A, Shutt K, Schuchat A, Perkins BA. Toxic shock syndrome in the United States: surveillance update, 1979–1996. Emerg Infect Dis 1999;5:807–10.

Further Reading

Buehler JW. Surveillance. In: Rothman KJ, Greenland S, editors. Modern Epidemiology, 2nd ed. Philadelphia: Williams and Wilkins; 1988, pp. 435–57.

Eylenbosch WJ, Noah ND, editors. Surveillance in health and disease. Oxford: Oxford University Press; 1988.

Langmuir AD. Evolution of the concept of surveillance in the United States. Proc R Soc Med. 1971;64:681–4.

Langmuir AD. William Farr: founder of modern concepts of surveillance. Int J Epidemiol 1976;5(1):13–8.

Orenstein WA, Bernier RH. Surveillance: information for action. Pediatr Clin N Amer 1990;37:709–734.

Rothman KJ. Lessons from John Graunt. Lancet. 1996;347(8993):37–9.

Sandiford P, Annett H, Cibulskis R. What can information systems do for primary health care? An international perspective. Soc Sci Med 1992:34(10):1077–87.

Teutsch SM, Churchill RE, editors. Principles and practice of public health surveillance, 2nd ed. New York: Oxford University Press; 2000.


For more information on: Visit the following websites:
CDC Case Definitions https://www.cdc.gov/ncphi/disss/nndss/casedef/case_definitions.htm
CPSC National Electronic Injury Surveillance System (NEISS)On-line http://www.cpsc.gov/library/neiss.htmlexternal icon
Emergency Preparedness and Response: A-Z Index http://emergency.cdc.gov/az/a.asp
FDA Adverse Event Reporting System (AERS) http://www.fda.gov/Drugs/ GuidanceComplianceRegulatoryInformation/ Surveillance/AdverseDrugEffects/default.htmexternal icon
Healthy People 2010: Tracking Healthy People 2010: Part C. MajorData Sources for Healthy People 2010 http://www.healthypeople.gov/Document/html/ tracking/THP_PartC.htmexternal icon
MedWatch, The FDA Safety Information and Adverse Event ReportingProgram http://www.fda.gov/Safety/MedWatch/default.htmexternal icon
National Health and Nutrition Examination Survey https://www.cdc.gov/nchs/nhanes.htm
Nationally Notifiable Infectious Diseases https://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm
NCI CancerMortality Maps & Graphs http://www3.cancer.gov/atlasplus/index.htmlexternal icon
NCI SEER http://seer.cancer.gov/faststats/external icon
NIDA DAWN http://www.drugabuse.gov/pubs/assessing/external icon
NIDA Monitoring the Future Survey http://www.drugabuse.gov/DrugPages/MTF.htmlexternal icon
SAMHSA Officeof Applied Studies http://www.drugabusestatistics.samhsa.gov/external icon
Summary of notifiable diseases — United States, 2004 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5353a1.htm
World Health Organization International Classification of Diseases, 10th revision http://www.who.int/classifications/icd/en/external icon