The Evolution of Infectious Disease Reporting in the United States

Public health officials are well aware of the benefits of epidemiological tracking of infectious diseases and rely heavily on the stalwart Morbidity and Mortality Weekly Report (MMWR). However, it may not be well known that the US practice of tracking such diseases started in 1878 when Congress was forced to institute quarantines in response to disease epidemics. Since then, infectious disease surveillance has evolved to help identify such public health threats as the AIDS epidemic, Hantavirus pulmonary syndrome, and SARS.

Concern for the spread of dangerous diseases into the US motivated the first official collections of data on infectious diseases over a hundred years ago. At that time, congress passed the National Quarantine Act and authorized the collection of reports from US consuls overseas to identify outbreaks of diseases such as plague, cholera, smallpox, and yellow fever so as to institute quarantines against them.

It wasn’t until 1893 that Congress expanded the reporting of such cases to include those from states and municipal authorities within the US. In 1902, Congress directed the Surgeon General to provide reports to unify the data on infectious diseases that was reported and published at the national level.

State and territorial epidemiologists became involved in deciding which diseases should be reported in 1950 at the request of the Director of CDC’s Bureau of Epidemiology. The federal publication of infectious disease data became known as the MMWR in 1952, and the CDC took over its publication in 1961.

MMWR evolved from a recounting of infectious disease statistics to an entity that now helps clinicians diagnose AIDS. In 1981, Michael B. Gregg, the MMWR editor at the time, received a report of five previously healthy men in Los Angeles who had had sex with other men and came down with Pneumocystis pneumonia.

This type of pneumonia was generally associated with cancer or other immunosuppressive conditions, and it was extremely noteworthy for previously healthy people to contract this disease. Gregg published a report of the outbreak in MMWR, and clinicians across the US recognized their local connections to those from LA. The first article on AIDS in a peer-reviewed medical journal appeared four months later.

Although the Internet has since revolutionized the publication of medical information, MMWR continues to play a vital role in the dissemination of information on infectious diseases. This publication can publish health investigations within hours—much more quickly than peer-reviewed journals.