Completeness and Timeliness of Infectious Disease Morbidity Reporting Open Access
Silk, Benjamin (2008)
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
About this Dissertation
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