THE REPORTING OF COMMUNICABLE DISEASES - A CONTROLLED-STUDY OF NEISSERIA-MENINGITIDIS AND HAEMOPHILUS-INFLUENZAE INFECTIONS

Surveillance systems for communicable diseases in the United States ar e primarily passive. We compared the passive reporting system for inva sive disease caused by Neisseria meningitidis and Haemophilus influenz ae with a concurrent, active laboratory-based system in the four metro politan counties of Tennessee. The passive reporting system identified similar to 50% of all cases that were identified by the active system and accurately reflected trends in disease occurrence during the stud y period. Of all reported cases, physicians contributed fewer than 4%. Nearly 40% of all hospitals in the study area did not participate in the passive system, This lack of participation resulted in disproporti onately increased reporting of disease among blacks. Inconsistencies i n case definition within the state also contributed substantially to u nderreporting and lack of demographic representativeness of reported c ases, The median reporting interval (the time from the onset of diseas e to transmission of the case report to the Centers for Disease Contro l and Prevention) was 24 days (range, 5-157 days). Efforts to improve surveillance of those infections for which isolation of a pathogen is tantamount to a diagnosis should concentrate on laboratory-based repor ting and the use of currently available computer telecommunication sys tems.