Vigilância epidemiológica: breve histórico e a experiência dos Estados Unidos e do estado de São Paulo / Inteligencia epidemiológica: breve histórico y la experiencia de los Estados Unidos y del estado de São Paulo, en Brasil / Epidemiological surveillance: a brief history and the experiences of the United States and the state of São Paulo

Objetivo: O objetivo desta revisão narrativa foi elencar alguns aspectos históricos da vigilância epidemiológica, modelo tecnológico de intervenção inicialmente desenhado para auxiliar no controle das doenças transmissíveis, no último século. Métodos: Narrativa construída a partir de textos selecionados, para registrar o desenvolvimento da vigilância epidemiológica nos Estados Unidos e no estado de São Paulo, Brasil. Resultados: São apresentadas as origens de algumas das ações componentes do repertório da vigilância epidemiológica, e uma breve história da construção do originalmente nomeado Center for Disease Control, agência dos Estados Unidos exemplar na forma como se faz vigilância em praticamente todo o mundo. Do mesmo modo, são delineados os caminhos que levaram à organização do sistema de vigilância no estado de São Paulo, traçando alguns paralelos com o sistema brasileiro. Conclusão: A narrativa é concluída com uma diferenciação conceitual entre vigilância epidemiológica, monitoramento e vigilância em saúde.

Objetivo: El objetivo de esta revisión narrativa es enumerar algunos aspectos históricos de la vigilancia epidemiológica modelo tecnológico de intervención diseñado para apoyar en el control de las enfermedades transmisibles en el último siglo. Métodos: Narrativa construida a partir de textos seleccionados y la experiencia del autor, para registrar el desarrollo dsen en los Estados Unidos y en el estado de São Paulo, Brasil. Resultados: Se presentan los orígenes de algunas de las acciones que componen el repertorio de la vigilancia epidemiológica, así como una breve historia de la construcción del Center for Disease Control, una agencia de Estados Unidos que es ejemplar por la forma en que realiza la vigilancia en, prácticamente, todo el mundo. Asimismo, se delinean los caminos que llevaron a la organización del sistema de vigilancia en el estado de São Paulo, trazando algunos paralelos con el sistema brasileño. Conclusión: Finalmente, concluye con la diferenciación entre vigilancia epidemiológica, monitoreo y vigilancia en salud.

Objective: The objective of this narrative review was to list some historical aspects of epidemiological surveillance, a technological intervention model initially designed to help control communicable diseases in the last century. Methods: This narrative was built based on texts selected to record the development of epidemiological surveillance in the United States and in the state of São Paulo, Brazil. Results: The origins of some of the actions that constitute epidemiological surveillance activities are presented, as well as a brief history of the establishment of the originally named Center for Disease Control, a United States agency that is held up as an example in relation to the way surveillance has been performed, practically all over the world. Likewise, we outline the paths that led to the establishment of the surveillance system in the state of São Paulo, drawing some parallels with the Brazilian system. Conclusion: The narrative concludes with a conceptual differentiation between epidemiological surveillance, monitoring and health surveillance.

Epidemic assistance by the Centers for Disease Control and Prevention: role of the Epidemic Intelligence Service, 1946-2005.

Since 1946, the Centers for Disease Control and Prevention has responded to urgent requests from US states, federal agencies, and international organizations through epidemic-assistance investigations (Epi-Aids). The authors describe the first 60 years of Epi-Aids, breadth of problems addressed, evolution of methodologies, scope of activities, and impact of investigations on population health. They reviewed Epi-Aid reports and EIS Bulletins, contacted current and former Epidemic Intelligence Service staff, and systematically searched the PubMed and Web of Science databases. They abstracted information on dates, location, staff involved, health problems, methods, and impacts of investigations according to a preplanned protocol. They assessed the methods presented as well as the quality of reports. During 1946-2005, a total of 4,484 investigations of health events were initiated by 2,815 Epidemic Intelligence Service officers. In the early years, the majority were in response to infectious agents, although environmental problems emerged. Investigations in subsequent years focused on occupational conditions, birth defects, reproductive health, tobacco use, cancer, violence, legal debate, and terrorism. These Epi-Aids heralded expansion of the agency's mission and presented new methods in statistics and epidemiology. Recommendations from Epi-Aids led to policy implementation, evaluation, or modification. Epi-Aids provide the Centers for Disease Control and Prevention with the agility to respond rapidly to public health crises.

Environmental- and injury-related epidemic-assistance investigations, 1946-2005.

This paper summarizes environmental investigations (n = 458) conducted during the first 60 years of the epidemic-assistance investigation program at the Centers for Disease Control and Prevention. These investigations were grouped into 10 categories: toxic chemicals (n = 102), indoor air quality and outdoor air toxics (n = 21), new or rare epidemic diseases and unexplained syndromes (n = 29), natural disasters (n = 81), terrorism and unintentional human-made disasters (n = 9), substance use and abuse (n = 13), environmental aspects of infectious disease (n = 132), those affecting neonates and infants (n = 11), violence and injuries (n = 51), and miscellaneous (n = 9). Among the most important or prominent were studies of lead and arsenic toxicity at smelters, mercury in paint and beauty creams, dioxin in waste oil in Missouri, polychlorinated biphenyls and multiple other toxic chemicals, global pesticide poisoning outbreaks, hepatic angiosarcoma among vinyl chloride workers, toxic oil syndrome in Spain, eosinophilia-myalgia syndrome from contaminated L-tryptophan, diethylene glycol poisoning in Haiti, aflatoxicosis in Kenya, Gulf War illness among veterans, impact and needs assessments during natural disasters (e.g., Hurricane Katrina (2005) and the Mount St. Helens volcano eruptions (1980)), risk factors for heat-related mortality, domestic and international terrorist attacks, Parkinsonism related to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine in California, and unintentional injury- and violence-related events.

Maternal and child health epidemic-assistance investigations, 1946-2005.

In this article, the authors focus on epidemic-assistance investigations that dealt with maternal and child health problems, including unintended and adolescent pregnancy and family planning; international reproductive health surveys among refugees; pregnancy outcomes, including abortion, maternal mortality, infant mortality, and birth defects; leukemia; and Reye syndrome. During 1946-2005, a total of 1,969 investigations had sufficient data to classify them as possibly related to maternal and child health and were characterized by distinctive periods. Those related to family planning, pregnancy intention, and reproductive health among refugees began in the early 1970s and continued through 2005. Abortion-related investigations occurred during 1971-1982. Investigations of non-abortion-related maternal morbidity and mortality began in 1979 and included 2 international epidemic-assistance investigations. Investigations of clusters of disease among infants began in the 1960s, with a special focus on Reye syndrome during 1964-1984. Investigations of childhood cancer and birth defects began in the late 1950s. The Centers for Disease Control and Prevention has used the epidemic-assistance investigations mechanism to respond to a wide range of health concerns of women and children. The investigations of abortion-related health problems might have had the best-documented impact on public policy and public health.

"A wild and wondrous ride": CDC field epidemiologists in the east Pakistan smallpox and cholera epidemics of 1958 / "Uma louca e maravilhosa jornada": epidemiologistas de campo do CDC nas epidemias de varíola e cólera do Paquistão Oriental em 1958

In mid-April of 1958 the Government of Pakistan summoned the press to announce a grave need for international aid to cope with smallpox and cholera epidemics in East Pakistan. In response, and with the backing of the US State Department, Dr. Alexander D. Langmuir, chief epidemiologist of the CDC, led a team of epidemiologists to assist authorities in Dacca strengthen their immunization programs. Langmuir's superiors hoped for a Cold War advantage, but he saw an opportunity for trainees in the Epidemic Intelligence Service to learn about public health in a developing country. Langmuir later described the episode as a "wild and wondrous ride," but it had been more like a nightmare: the East Pakistan health department had collapsed; a popular movement had taken over vaccination and squandered vaccine supplies; hostile journalists had questioned the Americans' deeper motives; and a professional rivalry opened between the Americans and a British epidemiologist named Aidan Cockburn. By the time the epidemic subsided in July 1958, 30 million Bengalis had been vaccinated for smallpox but another 20,000 had succumbed to the disease. This episode was CDC's first sustained foreign intervention, a precursor to its extensive role in the 1970s helping WHO eradicate smallpox from Bangladesh.

Em meados de abril de 1958, o Governo do Paquistão convocou a imprensa para anunciar a urgente necessidade de auxílio internacional para lidar com epidemias de varíola e cólera no Paquistão Oriental. Em resposta, e com o apoio do Departamento de Estado dos Estados Unidos, Dr. Alexander D. Langmuir, chefe de epidemiologia do CDC em Atlanta, liderou um time de epidemiologistas para auxiliar as autoridades em Dacca a reforçar seus programas de imunização. Os superiores de Langmuir ansiavam por demonstrações de capacidade dos EUA na Guerra Fria, mas ele vislumbrou uma chance para o Serviço de Inteligência Epidemiológica aprender sobre saúde pública em países em desenvolvimento. Langmuir descreveu o episódio como uma "jornada louca e maravilhosa", porém pareceu mais um pesadelo: o departamento de saúde do Paquistão Oriental entrou em colapso; um movimento popular assumiu a vacinação e desperdiçou suprimentos de vacinas; jornalistas hostis questionaram as motivações ocultas dos americanos; e iniciou-se uma rivalidade profissional entre americanos e o epidemiologista britânico Aidan Cockburn. No final da epidemia, em julho de 1958, tinham sido vacinados trinta milhões de bengalis contra varíola, mas outros vinte mil sucumbiram. Esse episódio foi a primeira intervenção sistemática do CDC no exterior.

CDC's 60th anniversary: director's perspective--Jeffrey P. Koplan, M.D., M.P.H., 1998-2002.

CDC approached the new millennium with strong programs, strong partners, and a strong reputation. Emblematic of scientific integrity, evidence-based information, and public trust, the quality of CDC's "brand" rivaled any in corporate America and was unique among federal agencies. CDC built on this brand recognition to advance its public health mission into the 21st century. Introduction of a new design element showcased the agency as a valuable federal asset.

CDC's 60th anniversary: director's perspective--David Satcher, M.D., Ph.D., 1993-1998.

One of the important legacies at CDC is continuity of leadership. Like runners in a relay race, each CDC leader passes the baton of leadership smoothly to the next without disrupting the important programs necessary to protect the health of the nation. This perspective provides reflections on three aspects of CDC during the mid-1990s: first, continuing momentum in several important programs; second, strengthening CDC's infrastructure in terms of resources, programs, and organization; and third, responding to the emerging epidemic of overweight and obesity and the need to encourage healthy lifestyle choices.

CDC's 60th anniversary: director's perspective--James O. Mason, M.D., Dr.P.H., 1983-1989.

The growing momentum toward expanding CDC's responsibilities beyond infectious diseases gained strength during the 1980s. Tremendous advances in controlling infectious diseases had dramatically reduced illness and death from many long-standing health threats. In addition, the detrimental effects of chronic and other noncommunicable diseases on the nation's health were rapidly increasing. Programs to address cancer, heart disease, diabetes, and other leading killers became central to CDC's focus. Yet, for much of this decade, a newly emerging infectious disease would demand the skills and talents of persons across the agency. These new responsibilities led to additional funding, programs, staff, and partnerships for the growing agency, while introducing a host of new challenges.

125 years of public health in the USA.

The past 125 years of public health in the United States are viewed from the perspective of the most significant public health areas of the 20th century as developed by the US Centers for Disease Control and Prevention. The long-term impacts and development of the areas include: immunizations, healthier mothers and babies, family planning, safer and healthier foods, fluoridation of drinking water, control of infectious diseases, decline in deaths from heart disease and stroke, recognition of tobacco as a health hazard, motor vehicle safety, and safer workplaces. The current and future of public health in the US is encapsulated in several developing areas, including: personal lifestyle modifications, politicalization of health, evolving knowledge base, knowledge transfer and globalization.

Public Health: years of leadership and vision.

From its work in immigration and rural health to its fight against smoking and AIDS, the U.S. Public Health Service has stood on the cusp of science and politics. As the PHS looks forward to the year 2000, a new book details its two centuries of service and its ongoing role in the health of the nation.