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      The Enteric Diseases Epidemiology Branch (EDEB), Division of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, is responsible for surveillance of bacterial enteric pathogens. National case surveillance encompasses two systems administered outside EDEB; the National Notifiable Diseases Surveillance System (NNDSS), which is clinical case-based, and the Public Health Laboratory Information System (PHLIS), which is a laboratory isolation-based reporting system. The laboratory-based system alone includes important pathogen characteristics data such as serotype for Salmonella, Shigella, and Shiga toxin-producing Escherichia coli isolates. Serotype information for these pathogens is crucial for surveillance, outbreak detection and investigation. The PHLIS also includes some pathogens that are not formally nationally notifiable, but may be notifiable at the state level. In addition EDEB primarily collects information for botulism, typhoid fever, cholera and other Vibrio illnesses and Shiga toxin-producing E. coli, non-O157. The 2003 case and isolate counts for nine diseases and pathogens are presented in Table 1-1. Information in this report includes case and isolate counts in 2003 as of June 2006; the numbers may have changed compared with previous publications The number of reported cases of diseases under surveillance is a vast underestimate of the true burden because most episodes of disease never reach the reporting systems. Many ill persons do not seek medical care, medical practitioners may not order the tests to make a specific diagnosis, and laboratories may not conduct the appropriate tests to isolate the causative pathogens. Some pathogens are not included on the list of nationally notifiable diseases (e.g. Campylobacter and Yersinia) and are not included in this report, though individual states may require reporting and collect surveillance data. The completeness of surveillance data concerning these pathogens at the national level is variable. The Foodborne Diseases Active Surveillance Network (FoodNet) conducted more intensive surveillance in nine states in 2003; the reader is referred to their World Wide Web sites for more information (http://www.cdc.gov/foodnet/).concerning 2003 surveillance data.

      The number of reported cases of diseases under surveillance is a vast underestimate of the true burden because most episodes of disease never reach the reporting systems. Many ill persons do not seek medical care, medical practitioners may not order the tests to make a specific diagnosis, and laboratories may not conduct the appropriate tests to isolate the causative pathogens. Some pathogens are not included on the list of nationally notifiable diseases (e.g. Campylobacter and Yersinia) and are not included in this report, though individual states may require reporting and collect surveillance data. The completeness of surveillance data concerning these pathogens at the national level is variable. The Foodborne Diseases Active Surveillance Network (FoodNet) conducted more intensive surveillance in nine states in 2003; the reader is referred to their World Wide Web sites for more information (http://www.cdc.gov/foodnet/). A still greater number of illnesses are not included in any surveillance of individual cases, in part because there are no standard clinical tests to detect them. Examples include illnesses due to enterotoxigenic E. coli and due to enterotoxins produced by Bacillus cereus, Clostridium perfringens and Staphylococcus aureus. For such conditions, reports of foodborne outbreak investigations provide the best available surveillance information. Foodborne outbreak reports may be accessed at http://www.cdc.gov/foodborneoutbreaks/. It should be noted that all surveillance reports from state and territorial departments of public health to the Centers for Disease Control and Prevention (CDC) is voluntary.

      Each year, EDEB summarizes surveillance results in multiple formats, including letters to state and territorial epidemiologists and public health laboratory directors, reports in the CDC publication Morbidity and Mortality Weekly Report (MMWR), and publications in peer-reviewed scientific journals. For information about these documents, the reader is referred to the following sections at the end of this report: World Wide Web sites for Foodborne and Diarrheal Diseases, Sources and Contacts for Bacterial Foodborne and Diarrheal Diseases, and Publications by the Enteric Diseases Epidemiology Branch, 2003.

      This report is the first of a new annual series summarizing results from nationally notifiable bacterial foodborne and diarrheal diseases case surveillance systems. A description of the surveillance systems is included to help one understand the differences among these systems, which sometimes leads to different case counts for the same disease entity (see Data Sources and Background section). The specialized sentinel site surveillance system, FoodNet, provides complementary surveillance information for a range of foodborne infections of public health concern. It currently collects more detailed data on these infections from 10 sites. FoodNet annual summaries are available at http://www.cdc.gov/foodnet/reports.htm.

      Suggested citation: Centers for Disease Control and Prevention. Bacterial Foodborne and Diarrheal Disease National Case Surveillance. Annual Report, 2003. Atlanta Centers for Disease Control and Prevention; 2005: pg. Nos

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