Reflexões sobre a vigilância epidemiológica : reflexões sobre a vigilância epidemiológica : mais além da notificação compulsória

In face of the necessity of reorientation of the National Surveillance System, this article’s object is to discuss issues related to: (1) the revision and optimization of the list of notifiable diseases, (2) the integration and coverage of reporting units and, (3) updating and widening of monitoring strategies for relevant public health problems. After the definition of basic concepts of surveillance, almost four decades ago, several factors have collaborated to the current need of reform of the surveillance based on mandatory reporting. This strategy proved to be scarcely effective, low efficiency, high underreporting, difficult characterization of indigenous cases, low degree of representation, and especially, slow flow of information hampering timely interventions. It is important to review the notifiable disease list based on sound criteria, in face of current changes of the epidemiological patterns. Networks of laboratories and health care institutions, both private and public, receiving financial resources from the National Health System, should be included in the institutional range of surveillance, in an effective manner. Another important issue refers to the quality of information systems and disease registers as well as, the compatibility between them and with other systems. Diversification of monitoring strategies should be considered, including active surveillance (based on events, places and practitioners) as well as, syndromic reporting. The integration of national and international surveillance centers through computerized networks is also important. Other considerations are made on the competence of the federal level of government on activities of monitoring and surveillance.