Laboratories and disease surveillance

The U.S. communicable disease surveillance system depends on high-quality t esting and reporting by clinical and public health laboratories (PHLs). Cli nical laboratories offer a wide range of microbiological services, provide a large portion of all disease reports, and refer isolates and samples to P HLs for confirmation and typing. The PHLs support disease surveillance by p roviding special reference testing, serological or molecular typing to iden tify disease clusters and sources, primary laboratory services for high-ris k clients, quality assurance and training for clinical laboratories, and te sting for unique agents unavailable elsewhere. However, profound changes in the health care industry are threatening the ability of public- and privat e-sector laboratories to carry out disease surveillance activities. Isolate s for typing and confirmation are less available, PHL surveillance testing volumes are lower, and relationships between clinical laboratories and PHLs have changed. The integrity of the U.S, disease control infrastructure dep ends on maintaining a complementary network of clinical and public health l aboratories, and a national system for public health testing is needed.