[ACCOMPLISHMENTS AND FUTURE PROSPECTS IN THE CONTROL OF INFECTIOUS DISEASES IN CHILDREN].
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The recent war in Iraq presents significant challenges for the surveillance and control of communicable diseases. In early April 2003, the World Health Organization (WHO) sent a team of public health experts to Kuwait and a base was established in the southern Iraqi governorate of Basrah on May 3. We present the lessons learned from the communicable disease surveillance and control program implemented in the Basrah governorate in Iraq (population of 1.9 million) in April and May 2003, and we report communicable disease surveillance data through June 2003. Following the war, communicable disease control programs were disrupted, access to safe water was reduced, and public health facilities were looted. Rapid health assessments were carried out in health centers and hospitals to identify priorities for action. A Health Sector Coordination Group was organized with local and international health partners, and an early warning surveillance system for communicable disease was set up. In the first week of May 2003, physicians in hospitals in Basrah suspected cholera cases and WHO formed a cholera control committee. As of June 29, 2003, Iraqi hospital laboratories have confirmed 94 cases of cholera from 7 of the 8 districts of the Basrah governorate. To prevent the transmission of major communicable diseases, restoring basic public health and water/sanitation services is currently a top priority in Iraq. Lack of security continues to be a barrier for effective public health surveillance and response in Iraq.
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BACKGROUND: Communicable diseases do not respect national boundaries and are important challenges to health internationally. Considerable variation exists in the structure and performance of surveillance systems for communicable disease prevention and control. European Union (EU) countries should share ideas to improve the quality of surveillance systems. The study aims to support the improvement and integration of surveillance systems of communicable diseases in Europe while using benchmarking for the comparison of national surveillance systems. METHODS: Surveillance systems from England and Wales, Finland, France, Germany, Hungary, and The Netherlands were described and analysed. After comprehensive data collection and validation by several European public health (PH) experts, a descriptive data analysis was carried out. Benchmarking processes were performed with selected criteria (e.g. case definitions, early warning applications, and outbreak investigations). After the description of benchmarks, best practices were identified and described. RESULTS: Benchmarking of national surveillance systems is applicable as a new tool for the comparison of communicable disease control in Europe. The countries included in the study have in general well-functioning communicable disease control and prevention systems. Nevertheless, there are different strengths and weaknesses in various countries. Practical examples from the various surveillance systems were demonstrated and recommendations were given to policy makers. CONCLUSION: A gold standard of surveillance systems in various European countries is very difficult to achieve because of heterogeneity (e.g. in disease burden, personal, and financial resources). However, to improve the quality of surveillance systems across Europe, it will be useful to benchmark the surveillance systems of all EU member states.
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Control of imported communicable diseases hitherto has been based on a paradigm of exclusion, isolationism and quarantine. Yet such policy is inconsistent with globalization of communication, commerce and travel, thus ignoring the potential for rapid dissemination of infectious disease worldwide. Prevention and containment strategies founded on such a premise ultimately cannot be effective. Instead, the perspective in control of communicable diseases must become international with monitoring and study of disease emergence, vector and reservoir patterns, and factors which facilitate and impede pathogen traffic. Our public health system must be reorganized with an international focus to ensure adequacy of surveillance mechanisms, related applied research, prevention and control strategies (including vaccination and information dissemination and education), and maintenance of optimal infrastructure--nationally, locally and internationally. Clear national and provincial contingency plans must be developed, ideally with international cooperation, for dealing with emerging infectious disease threats.
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In each time and each place, man has avoided diseases, has tried to limit diffusion of diseases. The purpose of this article was to present in a general manure the measures taken in Hispano America during colonial times to control communicable diseases. The main problems of health during the XVI, XVII, and XVIII centuries, in Hispano American region were communicable diseases. Practices to avoid them derived from observation, control measures referred to stay away from the contagious places, and to isolate sick persons by means of quarantine, and implied some epidemiologic surveillance. The supply of safe drinking water, sewage disposal systems and sanitary control of food were not habitual practices; garbage, residuals, and waste collection were not opportune, This favored the existence of vectors-insects and animals. Domestic waste did not go away in a timely fashion, it allowed to accumulate excreta and waste near houses. In some places, the were measures related to water supply, excreta disposal, handling of dead bodies, and environmental sanitation. It was believed that with prayers and processions, prevalent diseases could be avoided. Demographic information, data on mortality, births, and morbidity, were irregular and incompletes, some data were compiled in parishes: physicians should inform and notify the governmental medical board, which regulated medicine and public heath who the cared for an action carried out only as and exception. Compiled data had no clear medical or sanitary use.
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In its much-publicized report (2000) the National Audit Office (NAO) has emphasized the important part surveillance plays in determining infection rates and infection control in general. Community nurses may be forgiven for pointing out that this report concentrates on hospitals, however it strongly recommends that surveillance be extended out into the community. This is a sensible move as studies quoted in the NAO report indicate that 50-70% of surgical wound infection occur during the post-discharge period. The boundaries between acute and primary care are becoming ever more blurred; increasing numbers of susceptible patients are being managed in the community and the number of invasive procedures carried out is rising in line with government policy. Action to control infection extends beyond the narrow boundaries of health care to involve the whole population, and although the idea of extending the surveillance of healthcare related infection from hospital to community settings appears to be relatively new, the surveillance of infectious diseases that occur in the community is not. It is, in effect, a key proactive infection control activity which facilitates targeted and effective infection control measures. This article aims to define and explain surveillance as it relates to infection control and communicable disease control in the community by using examples from history, the current Meningitis C vaccination programme and the surveillance of hospital-acquired infection in the USA.
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