Completeness and Timeliness of Infectious Disease Morbidity Reporting Open Access

Silk, Benjamin (2008)

Permanent URL: https://etd.library.emory.edu/concern/etds/1n79h493q?locale=en
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Abstract

In the United States, health departments depend on reportable disease surveillance for prevention of numerous infectious diseases, but variations in the completeness and timeliness of these reporting systems had not been assessed systematically. For the first two studies, state and large city/county health departments' laboratories and epidemiology programs were surveyed on their policies, practices, and capacities for West Nile fever (WNF) testing and reporting (Study 1) and meningococcal disease serogrouping (Study 2) for 2003 through 2005. Syndrome ascertainment ratios were calculated by dividing case counts of WNF by case counts of West Nile neuroinvasive disease. This indicator identified several factors associated with relatively complete WNF ascertainment, including minimal requirements for testing, conducting at least three surveillance-related activities, and dedication of at least 5.0 surveillance staff per million residents. In addition, the odds of WNF was 44% lower in Blacks and 31% lower in Hispanics compared with non-Hispanic Whites when multilevel modeling was used to predict fever versus neuroinvasive disease. In Study 2, more complete serogrouping (>80% of reported cases' isolates serogrouped) was frequently reported by states that monitored serogrouping completeness using defined targets, states that employed at least 50 analytic laboratorians, and states with at least one city/county laboratory. In multilevel analyses, presence of a serogroup result was marginally associated with serogroup monitoring and remained associated with laboratory staff size. Study 3 documented reporting timeliness gains attributable to implementation of an internet-based reporting system in Georgia from July 2003 through December 2005. Reporting-time quartiles were calculated for the interval between dates of specimen collection and first public health report. Giardiasis, hepatitis A virus infection, legionellosis, malaria, pertussis, and Rocky Mountain spotted fever reports submitted via the internet were timelier than reports submitted by phone, facsimile, or mail. In a Cox proportional hazards model, reports from smaller hospitals (< 200 acute care beds), laboratories that sent out all microbiologic cultures for workup, and infection control programs that described disease reporting as "non-routine" were less timely. Collectively, the studies identified discrete components of the infectious disease reporting process where interventions can improve the quality, representativeness, and value of reportable disease surveillance data.

Table of Contents

CHAPTER 1

INTRODUCTION

Disease reporting from a conditional events framework

Goals and research strategy

Objectives and hypotheses

CHAPTER 2

LITERATURE REVIEW

Public health infrastructure

Public health systems research

Sources of bias in disease reporting

Race and ethnicity data

Completeness of West Nile fever ascertainment

Missing meningococcal disease serogroup data

Internet-based disease reporting and timeliness

Hypothesized mechanisms

CHAPTER 3

METHODS

Surveillance data and public health jurisdictions

State epidemiology and laboratory program surveys

Multilevel modeling

Syndrome ascertainment ratio

Multiple imputation of race and ethnicity

Modeling timeliness of reporting

CHAPTER 4

DIFFERENTIAL WEST NILE FEVER ASCERTAINMENT

Abstract

Introduction

Methods

Results

Discussion

References

CHAPTER 5

MENINGOCOCCAL DISEASE SEROGROUPING

Abstract

Introduction

Methods

Results

Discussion

References

CHAPTER 6

TIMELINESS OF GEORGIA'S STATE ELECTRONIC

NOTIFIABLE DISEASE SURVEILLANCE SYSTEM

Abstract

Introduction

Methods

Results

Discussion

References

CHAPTER 7

CONCLUSIONS

Summary of findings

Summary of limitations

Summary of strengths

CHAPTER 8

REFERENCES

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