Emerging infectious diseases--United Kingdom.

Update Dr. Walford is director of the Public Health Laboratory Service, which is responsible, through its Communicable Disease Surveillance Centre (CDSC), for the surveillance of infections and com-municable diseases in England and Wales. Dr. Walford recently chaired a national committee that produced The Path of Least Resistance, a report containing recommendations to minimize the development of antimicrobial resistance through the more prudent use of antimicrobial drugs in clinical practice. Professor Noah is a consultant epidemiologist at CDSC. This review describes some of the most important new or reemerging infectious diseases in the United Kingdom in the past decade. Most of the statistics relate to England and Wales, where the surveillance system is operated by the Public Health Laboratory Service (PHLS), through its Communicable Disease Surveillance Centre (CDSC). The statistics come from three main sources and several more specialized ones. The most important is the laboratory-based surveillance system, started more than 50 years ago, to which the national network of 48 public health laboratories and the specialized reference microbiology laboratories of PHLS and more than 150 National Health Service laboratories contribute regularly. Most data collection is performed electronically, through a computerized system that allows laboratory data to be captured at the source, augmented with clinical or risk factor data, and transmitted both centrally to CDSC and locally to the responsible public health professionals. CDSC also runs, on behalf of the Office of National Statistics, the long-established statutory notification system, which is based on clinical reporting of a schedule of infectious and communicable diseases including food poisoning. The third system is a sentinel system based on general practice run by the Royal College of General Practitioners Research Unit. These three systems complement each other, and the data are collated, analyzed, and disseminated by CDSC and are then extensively used to inform both government policies and local activities for the prevention and control of communicable disease. In addition to the “big three,” the United Kingdom has several other more specific surveillance systems, in particular, confidential clinical reporting systems for AIDS and sexually transmitted diseases and serosurveillance (including unlinked anonymous) systems for HIV infection. In addition, active surveillance systems, developed jointly by PHLS and the relevant professional associations, capture clinical case reports of rare diseases, such as pediatric AIDS and Reye syndrome. These active systems are particularly suited to the surveillance of rare and emerging diseases, such as pediatric Creutzfeldt-Jakob (CJD) disease. A growing …