An essential public health function is to monitor and track diseases and conditions that impact the general population. Complete and timely reporting of morbidity data is critical to public health management of trends and outbreak identification.

This surveillance function is carried out through collaboration among local healthcare providers, laboratories, and state and national public health agencies. This partnership is described in regulations that define the diseases and conditions to be reported, as well as the specific responsibilities of each of the partners. Title 17 of the California Code of Regulations requires healthcare providers and/or laboratories to report to local health authorities in a timely fashion certain health conditions, listed in Sections 2500 and 2505 of the CCR (the "reportable disease list").

The primary objectives of disease surveillance are to:
1) Determine the extent of morbidity within the community,
2) Evaluate risks of transmission, and
3) Rapidly intervene when appropriate.

The reporting of communicable diseases must be timely for surveillance to be effective. Confidential patient information is always protected subject to compliance with disease control and other laws.

Delays or failure to report communicable diseases has contributed to serious outbreaks in the past. Removing people from sensitive occupations, such as food handling, prevents the spread of diseases such as salmonellosis and hepatitis A. The detection and treatment of patients with tuberculosis, the identification of asymptomatic carriers of typhoid and gonorrhea, and the immunization of people exposed to vaccine-preventable diseases are just a few of the benefits derived by the entire community when reporting is timely and accurate. Failure to report can result in increased disease in the community, time lost from work or school, increased costs for diagnosis and treatment, hospitalization, and possibly death. Failure to report can also result in disciplinary action by the Medical Board of California.

California Health and Safety Code Section 120130, which is the authority for Title 17, was first published in 1945 and has been amended several times in order to reflect current needs and priorities for public health surveillance. Recent legislation now permits the reportable disease list to be modified by the California Department of Public Health, in consultation with the California Conference of Local Health Officers, without going through the previous formal regulatory process.

For example, in fall 2006 as a result of the outbreak of E. coli O157 infections associated with spinach, all Shiga-toxin producing E. coli infections are reportable in addition to Shiga toxin detectable in feces. In June 2007, four new diseases were added to the list, including avian influenza, hospitalizations and deaths related to varicella, Creutzfeldt-Jakob disease and other transmissible spongiform encephalopathies, and influenza deaths in people younger than 18. Section 2505 was updated to include specific laboratory reporting for avian influenza (a report is required upon receipt of a specimen for testing) and hepatitis C (that meet the Centers for Disease Control and Prevention case definition). In addition, a case or suspected case of any unusual disease, even if not currently named on the list, must be reported to the local health department.

All public health departments in Southern California have staffs of well-trained epidemiologists and communicable disease investigators who are available for consultation and technical support during regular business hours. However, reporting can be done 24 hours a day, seven days a week. In fact, extremely urgent conditions, such as anthrax, botulism, cholera, dengue, diphtheria, plague and rabies, should be reported by telephone immediately, 24 hours a day. Other urgent conditions should be reported by telephone during regular business hours. Non-urgent conditions may be reported by telephone or mail on confidential morbidity report forms. These forms must be filled out completely. All of the requested information is essential, including the laboratory information for selected diseases on the front of the form.

The full list of reportable diseases, including the allowable timeframes for reporting them, can be found at www.dhs.ca.gov/
ps/dcdc/html/publicat.htm (scroll down to "Reporting Guidelines").

We appreciate healthcare providers' continuing efforts on the frontlines of disease surveillance in California. Public health officials really depend upon the information that you provide to keep our community as safe as possible.
Margaret Beed, MD, is the health officer for the San Bernardino County Department of Public Health. A pediatrician, she has expertise in both the public and private sector including serving as the chief medical officer for CalOptima and medical director for FHP Healthcare Inc.-Quality/Risk Management. She can be reached at 909/387-6218 or mbeed@dph.sbcounty.gov.