Epidemics often result in organizational, policy and technical changes within a country. In 1999, an epidemic of campylobacteriosis was reported in Iceland. The recent availability of fresh poultry products in the marketplace was suggested as the source of infection. This paper reports on the context of the epidemic, reviews interventions implemented to prevent campylobacteriosis, and discusses lessons learned. A retrospective study of interventions implemented in Iceland from June 1995 to December 2007 was conducted by interviewing key informants and reviewing Iceland's literature. Cumulative incidence rates of domestic campylobacteriosis by year and average incidence rates per epidemic period were calculated. Interventions included on-farm surveillance of Campylobacter, producer education, enhanced biosecurity measures, changes in poultry processing, a leak-proof packaging policy, a freezing policy for products from Campylobacter-positive poultry flocks, consumer education, and the creation of a legislated inter-organizational response committee. These interventions appear to have collectively contributed to a decrease in campylobacteriosis' incidence rate near pre-epidemic baseline levels. Expert consultations revealed that the implementation of a Campylobacter surveillance program in poultry and the freezing policy were critical to controlling the disease in the Icelandic population. It was also recognized that new multidisciplinary collaborations among public health, veterinary, and food safety authorities and a sustained co-operation from the poultry industry were integral factors to the mitigation of the epidemic. Iceland's response to the campylobacteriosis epidemic is a lesson learned of inter-disciplinary and inter-organizational precautionary public health action in the face of a complex public health issue.

Background: Hemolytic Uremic Syndrome (HUS) was made reportable in British Columbia (BC) in 1998 to detect, control and prevent verotoxigenic Escherichia coli (VTEC) cases. Concerns about under-reporting of HUS cases triggered the assessment of the sensitivity and timeliness of the reporting process in order to guide recommendations around reportability of this syndrome in BC. Methods: The BC hospitalization database was used to estimate the total number of HUS cases from April 30, 1998 to December 31, 2005. HUS and VTEC cases reported in the integrated Public Health Information System (iPHIS), and HUS cases reported by a surveillance form were linked to hospitalized cases. The proportion of HUS cases detected by each of the surveillance processes was assessed. The time interval between onset of diarrhea and reporting of HUS and VTEC cases to the BC Centre for Disease Control was compared. Results: 57 HUS cases were hospitalized. Sensitivity of reporting through the surveillance form and through iPHIS was 7.0% and 19.3%, respectively. The median time interval between onset of diarrhea and reporting of both HUS and VTEC cases to iPHIS was seven days. The median time interval for reporting HUS cases via the surveillance form was 25 days. Conclusions: HUS cases were severely under-reported, the timeliness of reporting of these cases had no advantage when compared to the reporting of VTEC cases, and no public health action aimed at reducing the transmission of VTEC infections resulted from this surveillance system. The reportability of HUS in BC needs to be reconsidered, or its surveillance considerably improved.

Surveillance practice is evolving rapidly: globalization of health threats, emergence of infectious diseases, and explosion of easily accessible new technologies. This fluid environment challenges the public health community, but provides it with a fertile environment to innovate and improve its practice. As surveillance is a core function of public health practice, public health practitioners need to be well equipped to achieve this function and address present and future public health challenges. We developed a training course that focused on the practical use of surveillance concepts and principles. We are sharing findings on the development of the course and learner outcomes.