WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases - Introduction

Why infectious diseases are still a problem and surveillance is still required

In the 1970s many experts thought that the fight against infectious diseases was over. In fact, in 1970, the Surgeon-General of the United States of America indicated that it was "time to close the book on infectious diseases, declare the war against pestilence won, and shift national resources to such chronic problems as cancer and heart disease".

Indeed, complacency about the threat of communicable diseases in the 1970s led to less priority for communicable disease surveillance systems. Partly as a result, these systems were not maintained in large parts of the developing world, and this retarded recognition of the magnitude of problems posed by new and re-emerging communicable diseases, and therefore effective action to control them.

During the last two decades, this opinion has been reversed, and there is now a renewed appreciation of the importance of communicable disease. The spread of new diseases such as HIV/AIDS, hepatitis C, and dengue haemorrhagic fever, and the resurgence of diseases long since considered under control such as malaria, cholera, and sleeping sickness, have drawn considerable attention. Infectious diseases cause 63% of all childhood deaths and 48% of premature deaths. Many of these deaths are caused by epidemic infectious diseases such as cholera, meningococcal disease, and measles. There are continuing threats of large epidemics with widespread mortality like the 'Spanish flu' epidemic in 1918-1919 which killed an estimated 40 million people worldwide, or the HIV/AIDS epidemic which has caused widespread morbidity and mortality, and reversed hard-won gains in life expectancy in Africa.

In light of this, it is clear that effective public health surveillance is critical for the early detection and prevention of epidemics. There is a clear and urgent need for surveillance of (i) known existing communicable diseases, especially those with high epidemic potential, (ii) early recognition of new infections (over 20 new pathogens have been discovered since the mid-1970s), and (iii) monitoring the growing resistance to antimicrobial drugs.