The start of an epidemic can be dramatic with a large number of cases being reported or many people dying. However, the cause may well be anticipated, as the agents of most communicable diseases are now known. The person reporting the outbreak will probably have made a provisional diagnosis or it might be anticipated, having been reported in a neighbouring region. It will need to be confirmed by laboratory methods or by careful clinical judgement (e.g. measles). A case definition is a useful tool for ensuring that everybody understands what they are looking for. This can either be very general, such as fever with no obvious cause as in a suspected malaria epidemic, or a more detailed description, such as with the rash and symptoms of measles. In the general case definition, this will indicate that laboratory confirmation is required, as in the example of malaria with a blood slide being taken.

Normally, the confirmation of diagnosis is relatively easy, but several laboratory specimens may be required and restraint exercised in rushing to a diagnosis (e.g. in typhoid). Alternatively, it may be a unique and rare disease in which the aetiology and transmission have not been worked out. If this is the case, expert assistance is sought, while general principles of control are carried out.

Enquiry and search is made to determine the extent of the outbreak, whether there are many more cases, especially in areas where there are no medical facilities. Cases may be hidden or exaggerated to avoid or attract medical attention. Is this the first case or have there been several cases over a period of time? Have the cases come from another administrative area or country, and is there a risk that they might infect other areas? Was notification received and should notification be given?

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