The History of Public Health Surveillance

by Carolina on December 23, 2009

Author: Dr. Arana

The concept of public health surveillance has evolved over time. This concept arose in Europe some 600 years ago with the emergence of scientific thought during the Renaissance, and subsequently spread to the Americas with the European settlers (Declich,  Carter 1994). Prior to 1950, surveillance meant the close observation of persons exposed to a communicable disease to detect early symptoms and institute prompt isolation and control measures. Over the time differences between “surveillance” and “personal surveillance”, the use of “epidemiological” term to describe surveillance, monitoring and controlling definitions have been distinguished.

Public health surveillance dates back to the time of John Graunt, who published the Natural and Political Observations Made Upon the Bills of Mortality in 1662 (Thacker,  Berkelman 1988). Graunt, an English statistician generally considered to be the founder of the science of demography, the statistical study of human populations, attempted to define the basic laws of natality and mortality. He developed some fundamental principles of public health surveillance, including death rates, death counts, disease patterns, and disease-specific death counts.  Prior to 1662, in 1403 in Republic of Venice and later in 1741 in Rhode Island case surveillance approach was fundamental in public health. This approach was applied to control communicable diseases. In both places, authorities had the power to control communicable diseases by identifying persons with symptoms of plague and preventing from disembarking, or reporting contagious disease to local authorities and control spread of disease, respectively.  In U.S reporting of infectious diseases began in 1874 when a postcard reporting format was developed in Massachusetts. In 1878 Congress authorized the forerunner of the United States Public Health Service to collect morbidity data for use in quarantine measures against “pestilential diseases” such as cholera, smallpox, plague, and yellow fever. In 1881 in Italy reporting of infectious diseases began on a national basis and in other European countries shortly afterwards (MMWR 1996).  All these surveillance systems were focused on identifying and reporting cases, and isolating those cases to control infectious disease outbreaks. Smallpox eradication in 1970 is a good example of a successful public health strategic based on an intensive surveillance –based approach. During this time, before the development and widespread availability of antibiotics and vaccines in the twentieth century, control strategies traditionally include monitoring, contact tracing, treatment, and quarantine. These were the most common actions that public health and medicine could do.

Although these days there are few cases of “pestilential diseases”, and the need for quick action to prevent the spread of infectious diseases still remains. One of the main goals of surveillance for diseases such as TB and sexually transmitted diseases (STDs) is to identify infectious individuals before they infect others, thus preventing an exponentially growing epidemic. In this manner, case surveillance has maintained its importance with the increasing interest in emerging infections and bioterrorism since the attacks of September 11, 2001. Indeed, case surveillance was a critical tool in controlling SARS in 2003 (Heymann, Rodier 2004). In 2005 the World Health Organization (WHO) modified the International Health Regulations to require that all countries notify to WHO of all events “which may constitute a public health emergency of international concern” (World Health Organization 2005), and required that countries have the core surveillance and response capacities needed to fulfill the international reporting requirements.

Development of surveillance in the past centuries

Year Event Country
Fourteenth and fifteenth centuries
1348 The occurrence of the Black Death or pneumonic plague Venetian Republic
1377 The detention of travelers from plague-infected areas for 40 days Marseilles
1403 The detention of travelers from plague-infected areas for 40 days Venice
Sixteenth century
1532 The first London Bills of Mortality London
Seventeenth century
1662 The plague in London in the seventeenth century. John Graunt. He attempted to define the basic laws of natality and mortality. Developed some fundamental principles of public health surveillance, including death rates, death counts, disease patterns, and disease-specific death counts. London
1680 Gottfried Wilhelm von Leibniz: establishment of a health council and the application of a numerical analysis in mortality statistics to health planning. London
Eighteenth century
1741 Basic elements of surveillance were developed in some colonies in America; when the colony passed an act requiring tavern keepers to report contagious disease among their patrons, smallpox, yellow fever, and cholera. Rhode Island
1766 Surveillance was recognized as an integral part of the provision of population health. Johann Peter Frank created a police medicine system that included school health, injury prevention, maternal and child health, and public water and sewage treatment. And delineated governmental measures to protect public’s health. Germany
Nineteenth century
1800-1890 Sir Edwin Chadwick, Secretary of the Poor Law Commission in England, was the first health administrator to demonstrate, through surveillance, that poverty and disease were closely related. England
1850 Lemuel Shattuck’s “Report of the Massachusetts Sanitary Commission” landmark publication that related living conditions to rates of deaths, infant and matemal mortality and morbidity, and communicable diseases. He recommended census, collection of health data by age, gender, occupation, SES, and locality. He applied these concepts to preventive medicine. USA
1836 Establishment of the General Register Office. United Kingdom
1838-1879 William Farr became the first Compiler of Abstract. Created a modem surveillance system. He is recognized as the founder of the modem concept of surveillance. United Kingdom
1874 Systematic reporting of disease in the United States, when Massachusetts State Board of Health institutes a voluntary plan for physicians to provide weekly reports on prevalent disease, using a standard postcard-reporting format. USA
1878 Congress authorized the forerunner of the United States Public Health Service to collect morbidity data for use in quarantine measures against “pestilential diseases” such as cholera, smallpox, plague, and yellow fever. USA
Reporting of infectious diseases Great Britain and Italy
1881-1890 Mandatory reporting of eleven communicable diseases and death certificates, in Italy. Italy
1888 Michigan became the first U.S. jurisdiction to require reporting of specific infectious diseases (smallpox, TB, and cholera). USA
1893 Publication of international list of causes of death by the International Statistical Institute (founded in London in 1885). Also, law was enacted to provide for the collection of data each week from state and municipal authorities throughout the United States. USA
Twentieth Century
1900 Expansion of the concept of surveillance and the development of many different surveillance systems. USA
1911 Use of surveillance data from National Health Insurance, in the United Kingdom. USA
1916 Poliomyelitis epidemic United Kingdom
1918-1919 Influenza pandemic USA
1925 Increased reporting associated with the severe epidemic and pandemic. USA
1935 First national health survey of U.S. citizens USA
1943 First registry, the Danish Cancer Registry, First Sickness Survey, in the United Kingdom. United Kingdom
1948-1949 National Office of Vital Statistics assumed the responsibility for reporting morbidity. USA
1951 The Conference of State and Territorial Epidemiologists (CSTE) was authorized to determine what disease should be reported by states to the Public Health Service and to develop reporting procedures. USA
1952 Mortality data were added to the publication that was the forerunner of the Morbidity and Mortality Weekly Report (MMWR). USA
1955 CSTE officially incorporated, meets annually and in collaboration with CDC recommends appropriate changes in morbidity reporting and surveillance, including what diseases should be reported to CDC and published in the MMWR. USA
1961 The MMWR publication and its content were transferred to the Communicable Disease Center (now, CDC). USA
1965 Establishment of an Epidemiological Surveillance Unit in the Division of Communicable Diseases at WHO headquarters, Geneva. Geneva
1966 First publication of Communicable Disease Surveillance Reports by WHO United Kingdom And Netherlands
1967 Development of General Practitioners’ Sentinel Systems, in the United Kingdom and the Netherlands. USA
1968 World Health Organization (WHO) defined surveillance as the “systematic collection and use of epidemiological information for the planning, implementation, and assessment of disease control”. USA
1970 Eradication of Smallpox
1990s Contact tracing helped to quell re-emerging tuberculosis (TB) in the United States in the 1990s and is still a common and effective public health tool.
Surveillance of occupational morbidity and mortality, and injury surveillance became more common in the 1990s as public health turned its attention to intentional and unintentional violence.
USA

{ 2 comments… read them below or add one }

Infignics June 7, 2010 at 11:14 pm

Very enjoyed this! Well done!

Trudy January 7, 2015 at 11:42 am

Inaifmrtoon is power and now I’m a !@#$ing dictator.

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