Variations in national infectious diseases surveillance in Europe

Because the Maastricht treaty includes a chapter on public health in the European Community (EC) public health surveillance needs to be developed at EC level. To assess the feasibility of EC surveillance we did a survey of national systems in Europe in 1991-92. In seventeen countries (twelve EC plus Austria, Finland, Norway, Sweden, and Switzerland) the public health institution(s) responsible for surveillance were visited to collect standardised data on surveillance systems for sexually transmitted diseases (STD), hepatitis, and tuberculosis (TB). Surveillance systems varied widely by type, design, and quality. Although mandatory notification has a place in nearly all countries there is a trend towards voluntary systems based on samples of physicians, clinics, or laboratories. The time unit for reporting ranged from daily to once a year. For mandatory notification systems of STD completeness of reporting varied from over 90% to less than 10% and most countries did not use case definitions. Surveillance data were disseminated through national epidemiological bulletins in twelve countries, and the bulletin was a weekly one in six. The heterogeneity of national public health surveillance systems that this survey has revealed points to the need for a coordinated approach if surveillance at an EC level is to be developed.