Establishing priorities for national communicable disease surveillance: part 2
Before 1987, there was no mechanism in place to evaluate newly emerging diseases and compare them with the diseases that were being reported. Accordingly, in 1987, ACE established a subcommittee on communicable diseases to develop a systematic process to determine which communicable diseases should be monitored at the national level. The subcommittee asked which diseases should be routinely monitored, how should they be monitored and whether they should be monitored at all. These are important questions that have led to a priority setting exercise with the following objectives: to ensure national surveillance of major infectious diseases that threaten the health of Canadians; to support the development and evaluation of programs that are currently in place and those which have been proposed; to ensure the participation of Canada in the global surveillance of specific health threats; and to determine the best use of human and financial resources in the prevention and control of communicable diseases.
The priority setting process involves several steps: establishing the criteria; subdividing each criterion into levels; assigning points to each level within each criterion; summing the points and assigning a total score to each disease; ranking the diseases from highest to lowest score; and determining a cut-off point that would allow the inclusion and exclusion of diseases. The list of diseases for national surveillance that resulted from the 1988 priority setting exercise remained unchanged until the second iteration, with the exception of hepatitis C, which was added in 1991, and a more extensive breakdown for syphilis in 1992.
Several new diseases were proposed for addition to the existing list; these included HIV, laboratory-confirmed influenza, Creutzfeld-Jacob disease (CJD), invasive pneumococcal disease, cryptosporidiosis, invasive group A streptococcal disease, hantavirus pulmonary syndrome, group B streptococcal disease in neonates, acute flaccid paralysis, cyclosporiasis, Reye syndrome, Lyme disease and hemolytic uremic syndrome.
The first iteration of the priority setting process for diseases under national surveillance was undertaken in 1988. This paper provides an overview of the second iteration of the priority setting exercise undertaken in 1997 and 1998. The subcommittee established 10 criteria to measure the importance of each disease. Each criterion was assigned a score from 0 to 5 points based on the subcommittee’s consensus. The majority of the criteria had a scoring schema of 0, 1,3 and 5. The exceptions included ‘incidence’ with a scoring schema of 0,1,2, 3, 4 and 5; ‘severity’ and ‘socioeconomic burden’ with a scoring schema of 1,3 and 5. The following is a brief description of each of the 10 criteria and the points awarded.
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