Establishing priorities for national communicable disease surveillance: DISCUSSION
It is vital to emphasize that what is important in this exercise is not the absolute number of points given to a disease, but rather the relative position of the disease to others, and the cut-off point chosen. After ranking the scores, the subcommittee chose a cut-off of 13 points to recommend a disease for national surveillance. This decision was based on the experience of the raters with regards to the practical considerations of time, effort and money.
The results of the priority-setting exercise are presented in Table 1. The diseases on this list constitute the list of diseases that are under national surveillance; reporting of these diseases is effective January 1,2000. The ‘top five’ diseases were HIV, AIDS, laboratory-confirmed influenza, tuberculosis and measles. Of the ‘newly proposed’ diseases, two did not make the list: Reye syndrome and hemolytic uremic syndrome. The subcommittee decided that Lyme disease and legionellosis require monitoring but on a ‘need-to-know’ basis. The following diseases from the current list did not make the cut-off point, and consequently, will no longer warrant national surveillance: ‘meningitis, other bacterial’, listeriosis, gonococcal opthalmia neonatorum, trichinosis, chancroid, ‘meningitis, viral’, and amoebiasis.
The United Kingdom’s Public Health Laboratory Service (PHLS) recently undertook a priority setting exercise using six criteria: present burden of ill health social and economic impact; potential threats; health gain opportunity; public concern and confidence; and PHLS-added value. A more in-depth analysis comparing the PHLS results with the results of the priority setting exercise described in this paper is forthcoming.
Disease surveillance is much more than collecting numbers. It also means compilation, consolidation and analysis of data, and making conclusions. Provincial epidemiologists and the LCDC have attempted to meet this challenge by developing standardized case definitions for the notifiable diseases, instituting case-by-case disease reporting to the federal level and defining a core set of variables for each case reported.
The members of the subcommittee should be commended for their diligence in undertaking the priority setting exercise.
Communicable disease surveillance in Canada will benefit from their task; the information collected will lead to action which, in turn, will improve the health of all Canadians. The partnership between the provinces and territories, and the LCDC will continue the information exchange to form the foundation of a national communicable disease strategy.
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