How to find flu, or any other disease

In the United States, more energy is invested in tracking flu than practically any other illness. The Centers for Disease Control and Prevention (CDC) rely on a vast network of laboratories, state departments of health, physicians and hospitals to report back suspected and confirmed cases of the flu, hospitalizations due to flu, and deaths associated with the condition.

Of course not every country has the resources or technical capacity of the CDC. So what’s the most efficient way to track diseases in lower resource areas such as Africa? A group of leading experts is considering that question this week in a gathering in Brazzaville, Democratic Republic of the Congo. Most disease surveillance in Africa, and elsewhere, looks to the International Health Regulations created by the World Health Organization (WHO) as a blue print for how to look for disease. The IHR were designed primarily to keep a handful of highly virulent diseases from spreading to other countries. Over time the list of contagions to watch out for has grown, and the associated paperwork grown to the point where an estimated 40 to 60% of local disease surveillance time was taken up with filling out forms. And searching in specific places for specific symptoms of specific diseases may take your attention away from typical or unexpected health happenings. That’s why the concept of integrated disease surveillance, developed by the CDC, has received more attention. This approach emphasizes awareness of surveillance functions among many levels of public health workers, from district offices to local pharmacists, for example. Folks are essentially trained to scan the environment for new and unusual health developments and report them accordingly. For something like hemorrhagic fever or cholera, a single case may warrant massive, internationally-supported response. For an endemic condition such as malaria, a lack of reduction in the overall number of cases may be the threshold that triggers more attention.

Among the considerations on the table in Brazzaville this week was the concept of adding chronic or non-communicable disease to the list of conditions to watch for. This raises a number of interesting questions, such as: Which chronic disease to consider? And how to track them? Chronic disease is not typically the sort of thing where you report each individual case, instead you may look at overall prevalence of risk factors or deaths associated in a population. Is this the sort of thing that resource-strapped countries in Africa should be focusing on? After all, the vast majority don’t even keep track of births and deaths. We’ll soon find out what the experts meeting in the Congo decide.