The July issue of the Journal includes an article, now available online at http://www.JPHMP.com, on implementation of a "hybrid" active public health surveillance system in Virginia designed to cope with a multistate outbreak of fungal meningitis and other infections associated with the use of contaminated steroid products. Laurie G. Fortano and coauthors report that as of September 2012, there were 675 exposed persons in Virginia and 53 cases of fungal infections including 2 deaths. The novel hybrid surveillance system described involved a partnership between public health authorities and key clinical stakeholders. This article is a significant addition to the literature as it outlines an innovative approach to outbreak investigation during a rapidly evolving epidemic associated with the use of contaminated steroid products from a compounding pharmacy. This outbreak of fungal infections associated with contaminated steroid products is the largest of its kind in the US history and required coordination between federal, state, and local public health authorities (http://www.cdc.gov/hai/outbreaks/currentsituation/). During the surveillance period in Virginia, October 1-November 26, 2012, more than 3000 public health contacts to exposed persons were documented over approximately 8 weeks. The type of follow-up pioneered in this outbreak involving the follow-up of a large number of exposed individuals has implications for planning the response to situations with an intentional or unintentional community-wide exposure to biologic, radiologic, or chemical agents.

Also in this issue, focusing on health care-related infections, there is a report by Rachel Stricof and coauthors, "Lessons Learned While Implementing Mandatory Health Care-Associated Infection Reporting in New York State." As commented on by the accompanying editorial "Surveillance of Health Care-Associated Infections: Challenges and Opportunities" by Emily Lutterloh, the New York State Health Department is a leader in addressing these hazards to the health of patients in the health care system.