Strengthening the Early-Warning Function of the Surveillance System: The Macedonian Experience

Epidemics and pandemics can place sudden and intense demands on health systems. The world requires a global system that can identify and contain public health emergencies rapidly and reduce panic and disruption of trade, travel, and society in general. Strengthening public health preparedness requires establishing an integrated global alert and response system for epidemics and other public health emergencies along the lines of the World Health Organization’s International Health Regulations. The revised International Health Regulations provide a global framework to address these needs through a collective approach to the prevention, detection, and timely response to any public health emergency of international concern. A standardized approach for readiness and response to major epidemic-prone diseases should be developed. An early-warning and rapid-alert system is one of the possibilities to improve readiness at the local, regional, national, and international level to limit the spread of disease and to reduce health, economic, and social damage. The Republic of Macedonia, with World Health Organization support, has implemented an earlywarning system (ALERT) for priority communicable diseases to complement the routine surveillance system that reports individual confirmed cases. ALERT relies on reporting of eight syndromes by primary care facilities. Data are analyzed weekly at the regional level and transmitted to national epidemiologists. It is perceived to be a simple and flexible tool for detecting and triggering timely investigation and control of outbreaks. ALERT was identified as a useful instrument for forecasting and detecting the start of the influenza season.