Electronic communication and the rapid dissemination of public health information.

To the Editor: In the United States, communicable disease surveillance, investigation, and control are the responsibility of the states. The Centers for Disease Control and Prevention (CDC) provides epidemiologic and laboratory support to the state and territorial epidemiologists (state epidemio-logists) and state public health laboratory directors (state laboratory directors), who are located in each of the 50 states, Washington, D.C., the Virgin Islands, the Federated States of Micronesia, American Samoa, the Marianas Islands, and Puerto Rico. Historically, communication between CDC and these state representatives has been conducted by telephone, facsimile, or letter, and more recently by the WONDER (1) electronic mail (e-mail) system. We examined the timeliness and coverage of the WONDER system when used to contact state epidemiologists and laboratory directors during two recent foodborne outbreaks. The first outbreak was reported to CDC on February 10, 1995, by the Communicable Disease Surveillance Centre (CDSC) in the United Kingdom. CDSC had linked an outbreak of sal-monellosis in the United Kingdom to a snack food distributed to many countries including the United States (2). CDC decided to notify all state epide-miologists about the outbreak immediately so that they could take appropriate action to protect consumers and report suspected cases. This e-mail message was ready to be accessed by all state epidemiologists from 4:27 p.m. The second outbreak involved Salmonella serotype Stanley infections associated with the consumption of alfalfa sprouts. In the United States, the outbreak was recognized when a larger than expected number of isolates of Salmonella Stanley for the first week of June 1995 was reported (3). CDC notified state epidemiologists and laboratory directors about the outbreak and requested that cases of Salmonella Stanley infection be reported and Salmonella Stanley isolates be sent to CDC. This e-mail message was ready to access from 9:41 a.m. These two e-mail messages were sent to two group codes maintained by the Council for State and Territorial Epidemiologists and the Association of State and Territorial Public Health Laboratory Directors on the CDC WONDER e-mail system. The subject heading for these messages indicated that they were urgent and from CDC. The messages were available for 22 days from the day of posting, at which time unaccessed messages were automatically returned to sender. Each message was sent with an automatic receipt acknowledgment function. variation in population density. Moreover, the place of residence is not necessarily the place of exposure to leptospirosis. We emphasize the importance of …