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Communicable Disease

Surveillance & Reporting

What is disease surveillance?

Public health disease surveillance is the ongoing, systematic collection, analysis and interpretation of the who, what, where, when and how of disease case occurence in a population. All 50 states and United States territories have laws, statutes or other regulations that mandate reporting of communicable or infectious diseases and have the authority to collect and monitor a central repository of disease case information where patterns, clusters, and outbreaks may be detected. Although the list of reportable diseases may vary slightly from state to state, everyone uses the same criteria to define what constitutes a case of a given disease. These case definitions are standardized by the Council of State and Territorial Epidemiologists External link in consensus with the U.S. Centers for Disease Control and Prevention (CDC). Timely and complete disease reporting allows public health practitioners to monitor and respond to the changing health status of their community. It also helps ensure that prevention activities reach the right people and that public health and community programs get the resources they need.

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Who reports disease cases and to whom?

Physicians, school administrators and child care operators, medical facilities and operators of restaurants and other food or drink establishments (G.S. § 130A-135 through 130A-139) must report cases or suspected cases of reportable diseases to their local health department, which in turn reports this information to the N.C. Division of Public Health (G.S. § 103A-140). Laboratories may report to the local health department, except in the case of syphilis results, which the laboratories must report directly to the Communicable Disease Branch or the nearest regional office (10A NCAC 41A .0102). In North Carolina, hospital emergency department visits also are reported to the Division of Public Health (DPH), which in turn provides the data, as authorized by North Carolina law and in accordance with HIPAA regulations, to the CDC (G.S. § 130A-480). Healthcare-associated infections (HAIs) are reported directly by healthcare facilities to the CDC's National Healthcare Safety Network (NHSN), External link which then provides the data to N.C. DPH. Reportable diseases are monitored by DPH's Communicable Disease Surveillance Unit (CDSU) and Medical Consultation Unit (MCU).

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Which diseases are reportable in North Carolina?

The lists of reportable diseases vary slightly from state to state. North Carolina's list of reportable diseases and the timeframes in which they are required to be reported to DPH is specified in the N.C. Administrative Code rule 10A NCAC 41A .0101. Required notification times are effective from the time that a reportable condition is reasonably suspected to exist and range from immediate to seven days, depending on the disease. Immediate reporting is required for potential bioterrorism-related diseases, such as anthrax and botulism; the severe or highly communicable diseases, such as cholera and cryptosporidiosis, must be reported within 24 hours of diagnosis; other diseases and conditions, such as mumps and chlamydia, have a seven-day reporting timeframe.

Since January 1, 2012, North Carolina hospitals are required to report the healthcare-associated infections (HAIs) listed in the schedule outlined in the Centers for Medicare and Medicaid Services Inpatient Prospective Payment System Rules, External link as specified in the N.C. Administrative Code Rule 10A NCAC 41A .0106. See details on HAI Reporting and Surveillance.

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What reporting systems and processes are used in North Carolina?

For most reportable communicable diseases, cases are reported to the local health department through a number of mechanisms, including direct communication like phone calls, mail, electronic reporting, and via a standardized DHHS disease questionnaire and reporting form (DHHS 2124), which is available from local health departments and DPH.

Following the initial notification, a local public health department will begin an epidemiologic investigation. A department communicable disease nurse or epidemiologist will collect demographic, clinical, epidemiologic and sometimes case contact information and will verify that a reported case meets the reporting requirements in the standardized case definitions. The collected case information is entered into the North Carolina Electronic Disease Surveillance System (NC EDSS) for confidential reporting to the Division of Public Health.

Emergency department visit data go into a separate system called N.C. Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) External link. NC DETECT authorized users are able to monitor data from hospital emergency departments, poison control center calls and ambulance runs. With this system in place, public health officials and hospital-based users conduct daily surveillance for suspicious patterns and specific cases that may be caused by infectious, chemical and environmental agents. NC DETECT use has dramatically improved public health surveillance capabilities, because detecting unexpected cases and outbreaks earlier in their course allows prompt implementation of public health control measures.

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How are the data used?

All individually identifying information reported to the Division of Public Health is confidential and protected by law. HIPAA (Health Insurance Portability and Accountability Act)-compliant surveillance information is shared routinely with the CDC as part of the Nationally Notifiable Diseases Surveillance External link and BioSense External link systems and with public health partners and practitioners throughout the state. North Carolina is committed to the meaningful use of electronic disease surveillance data, including contributing to the CDC's Morbidity and Mortality Weekly Report (MMWR) External link and the North Carolina Epidemiology Section's Epi Notes newsletter.

HAI data are made available to healthcare providers and consumers on a quarterly basis with the publication of N.C. Healthcare-Associated Infections reports. Details on reporting and surveillance of healthcare-associated infections in North Carolina can be found on the HAI Surveillance and Reporting page.

Health surveillance data is used to:

  • Guide immediate action for cases of public health importance and prevent the spread of diseases under surveillance in the community;
  • Monitor trends in the burden of a disease, including the detection of outbreaks;
  • Identify needs for and guide the planning, implementation, and evaluation of programs to prevent and control disease (such as immunization recommendations and the development of Best Practices guidelines);
  • Evaluate public policy;
  • Detect changes in health practices;
  • Prioritize the allocation of health resources;
  • Describe the clinical course of a disease;
  • Provide a basis for epidemiologic research; and
  • Create statistical and geographic reports on the health of our state and its communities.

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Where can I find N.C. communicable disease reports?

Statistical reports for communicable disease in North Carolina are available in the Communicable Disease Branch Facts & Figures section of this website. National information and statistics are available at the CDC's website External link.

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How do I request additional data/reports?

The legal rules for the release of communicable disease records for bona fide research purposes are covered by 10A NCAC 41A .0104. For information on available health statistics or to inquire about additional reports and data, contact us.

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