A laboratory-based surveillance of human blastomycosis in Wisconsin between 1973 and 1982

Blastomycosis appears to be prevalent in states around the Great Lakes. However, its incidence in these states has not been reported. The Wisconsin Division of Health established a laboratory-based surveillance for human blastomycosis in Wisconsin to estimate disease incidence and identify endemic areas in the state for the interval 1973 to 1982. Certified mycology and pathology laboratories in Wisconsin and at two major medical centers in Minnesota were surveyed for all laboratory isolates and identifications in tissue of Blastomyces dermatitidis obtained in Wisconsin residents during 1973-1982. A total of 235 isolates and identifications of B. dermatitidis were obtained; 214 (88%) Wisconsin laboratories participated. It was estimated that the annual incidence of blastomycosis in Wisconsin for 1973-1982 ranged between 0.32 and 0.72 cases per 100,000 total population (mean, 0.48 cases/100,000 population). Cases were reported in residents from 40 (56%) of the 72 Wisconsin counties. Residents of seven counties in northern and central Wisconsin had significantly higher incidences of blastomycosis than residents of other counties in which cases were documented. The incidence of blastomycosis in Wisconsin for 1973-1982 is similar to that noted in Mississippi, Kentucky, and Arkansas where this disease is thought to be endemic and where similar surveys have been performed.     

A hospital discharge code review of toxic shock syndrome in Wisconsin

The Wisconsin Division of Health conducted a review of discharge coding for 142 (97%) of the state's general care hospitals for the period 1980-1983 to evaluate the use of International Classification of Diseases codes for toxic shock syndrome and to estimate completeness of reporting of recognized hospitalized cases of the syndrome to the Division of Health. Hospital use of code 040.89 (other bacterial diseases-other) recommended for toxic shock syndrome by the National Center for Health Statistics in January 1981 increased from 23% of Wisconsin hospitals in 1980 to 92% in 1983. The sensitivity of this code for toxic shock syndrome increased from 54% to 85% from 1981 to 1983; study population specificity was stable at approximately 95%, and the predictive value was 65% in 1981 and 70% in 1983. The use of codes 785.50 (shock, unspecified) and 785.59 (nontraumatic shock-other) frequently assigned to toxic shock syndrome was also assessed; all measures of their utility decreased in proportion to the increasing use of 040.89. The coding review identified 20 previously unreported cases of toxic shock syndrome; the 10 confirmed and 10 probable cases represent 4% and 21% of the state's 223 confirmed and 47 probable cases with onsets in 1980-1983. Results indicate that a National Center for Health Statistics coding recommendation for a disease of emerging significance can result in relatively uniform coding of the illness, which can provide a tool for case finding and surveillance evaluation for hospitalized cases.     

Surveillance of diarrhoeal diseases in Thailand

To provide information for prevention and control activities at national and local levels, Thailand's Ministry of Public health has monitored trends for diarrheal diseases since 1970. Data for the 1978-83 period obtained from the national epidemiological surveillance system are reported. The data were collected largely through a passive surveillance network in each province of Thailand. After preliminary analysis and tabulation at the local level, data were sent to the Ministry of Public Health for further analysis. Details on each case of diarrheal disease included the age, sex, place of residence, date of onset, and place of treatment. 5 categories of diarrheal diseases were distinguished: cholera, enteric fever, food poisoning, dysentery, and acute diarrhea. The causative agents of diarrheal diseases generally were isolated and identified in provincial hospital laboratories or at a government regional laboratory. During the 1978-83 period, 1,979,118 cases of diarrheal diseases were reported to the Thai Ministry of Public Health through the national surveillance system. The annual number of cases increased from 175,411 in 1978 to 537,972 in 1983, and this is reflected in an increase in the annual incidence from approximately 400/100,000 population in 1978 to over 1000/100,000 population in 1983. The average annual incidence of diarrheal diseases reported over this period was 694/100,000 or approximately 330,000 cases per annum. The number of cases of all categories of diarrheal disease increased, except cholera, which fluctuated from year to year. Acute diarrhea exhibited the highest average annual incidence (537/100,000), followed by that of dysentery (85), food poisoning (43), and enteric fever (25). Cholera had the lowest incidence (4/100,000). Over the 6-year study period, the majority of cases reported were acute diarrhea (77.4%), followed by dysentery (12.2%), food poisoning (6.3%), and enteric fever (3.5%). Cholera accounted for 0.6% of cases. A total of 3300 deaths from diarrheal diseases were reported over the study period. Deaths in each disease category, except cholera, decreased, and the annual number of deaths declined from 911 in 1978 to 370 in 1983. Acute diarrhea was the most common category leading to death. For acute diarrhea, the highest age-specific mortality rate was among children aged 0-4 years. Age-specific mortality rates for the remaining disease categories were much lower. The highest mean incidence rate for reported cases of acute diarrhea occurred in the central region of Thailand (608/100,000).     

Population-based incidence of invasive pneumococcal disease in children and adults in Ontario and British Columbia, 2002–2018: A Canadian Immunization Research Network (CIRN) study

BackgroundInvasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases.MethodsWe established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario’s integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models.ResultsIn Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007–2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique PPV23 and non-vaccine serotypes increased in both provinces.ConclusionsIPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique PPV23 and non-vaccine serotypes.     

Lyme Disease in Maine: a Comparison of NEDSS Surveillance Data and Maine Health Data Organization Hospital Discharge data

Background

Lyme disease is the most commonly reported vector borne disease in the United States and is a major public health concern in Maine. Maine Center for Disease Control and Prevention (Maine CDC) monitors Lyme disease through a passive surveillance system. In order to validate the Lyme disease surveillance system, Maine CDC was interested in comparing trends with a secondary data source. Specifically, Maine CDC was interested in comparing trends by age group, gender, geography, and timelines. Also, because hospitalization due to Lyme disease is rare, this analysis provided an opportunity to look at the diagnosis codes used for Lyme disease visits. The purpose of this paper is to compare the data acquired through surveillance to a secondary data source in order to evaluate the completeness of the data and verify trends.

Methods

Surveillance data was extracted from Maine’s NEDSS Base System for the years 2008 – 2011. Only confirmed and probable cases were included in data analysis. The Maine Health Data Organization (MHDO) collects information on all hospital inpatient and outpatient data visits and was used for this comparison. MHDO inpatient and outpatient hospital encounters with a diagnosis of 08881 in any diagnosis field were extracted from the full dataset from 2008 – 2011.

Results

Surveillance data showed the 5-14 year old age group had the highest rates of Lyme disease while outpatient data showed adults over the age of 45 to have the highest rates. Outpatient data showed a higher percentage of females with Lyme disease visits. Geographic trends did not match well between surveillance data and MHDO data which may be due to the hospital being used as proxy for the patient address. Timeliness trends were consistent between all sources, with the majority of Lyme disease occurring in the summer months of June, July and August. The majority of outpatient visits had Lyme disease listed as their primary diagnosis while the majority of inpatient visits had Lyme disease as a secondary or lower diagnosis.

Conclusions

There were several limitations to this study including incomplete data, and the inability to differentiate between new and old Lyme diagnoses. There is reasonably good similarity in the trends of these two systems helping validate the usefulness of Maine’s Lyme disease surveillance system. Many of the discrepancies warrant further investigation, and may lead to future opportunities for education or improvement in Lyme disease surveillance.     

Brand-specific rates of pertussis disease among Wisconsin children given 1–4 doses of pertussis Vaccine, 2010–2014

BackgroundAcellular pertussis vaccines were initially licensed based on placebo-controlled efficacy trials, but such trials are no longer ethical. The effectiveness of current pertussis vaccines among properly vaccinated children <5 years is so high that a randomized trial is infeasible. Fluctuations in pertussis incidence and characteristics of the US vaccine marketplace make selection of suitable controls for a case-control study problematic. To satisfy an FDA requirement to evaluate rates of pertussis following licensure of Pentacel® vaccine, we used a case-cohort study design with a novel method for characterizing the cohort population.MethodsThis prospective, observational study was conducted in Wisconsin from 2010 to 2014 among Wisconsin residents <60 months of age who received ≤four doses of pertussis vaccine (surveillance population). Cases were identified by the Wisconsin Division of Public Health. Characteristics and pertussis vaccinations of the surveillance population were estimated by ongoing random telephonic survey. The primary objective was to determine rates of pertussis disease among those who received only Pentacel vaccine (Group 1) vs those who received a single brand of vaccine other than Pentacel vaccine (Group 2).Results1195 pertussis cases were identified. It was estimated that the surveillance population accrued a total of 1,133,403 person-years (Group 1, 39%; Group 2, 41%; Group 3 [those not in Group 1 or Group 2], 20%). Pertussis rates were similar in Group 1 (98.9/100,000) and Group 2 (96.2/100,000); rate ratios were 1.03 (unadjusted; 90% CI, 0.92–1.15) and 0.99 (adjusted; 90% CI, 0.89–1.12). Persons with one or more delayed vaccinations had a 66% higher risk of pertussis (90% CI, 39–96%).DiscussionPertussis protection was not found to differ for recipients of the newly licensed vs other available pertussis vaccines. Delayed vaccination substantially increased risk of pertussis. Sample survey methodology was able to characterize the study cohort and enable an otherwise-infeasible study.Clinical Trial Registry number: ClinicalTrials.gov, NCT01129362.     

Outbreak of Campylobacter jejuni infections associated with drinking unpasteurized milk procured through a cow-leasing program--Wisconsin, 2001

On December 7, 2001, the Sawyer County Department of Health and Human Services in northwestern Wisconsin notified the Wisconsin Division of Public Health about five cases of Campylobacter jejuni enteritis. All of the ill persons drank unpasteurized milk obtained at a local dairy farm. This report summarizes the investigation of these and other cases and of a cow-leasing program used to circumvent regulations prohibiting the sale of unpasteurized milk in Wisconsin. The outbreak highlights the hazards of consuming unpasteurized milk and milk products.     

Notes from the field : hepatitis C virus infections among young adults--rural Wisconsin, 2010

During November 2010, Wisconsin Division of Public Health (DPH) staff members noted the number of hepatitis C virus (HCV) infections reported annually among persons aged <30 years in six contiguous rural counties of Wisconsin had increased from an average of eight cases per year during 2004-2008 to an average of 24 cases per year during 2009-2010. To understand factors associated with this increase, DPH, local health departments, and CDC investigated the epidemiologic and laboratory characteristics of 25 cases reported during 2010 among adults aged <30 years who resided in these six counties.     

Lyme disease--United States, 2003-2005

Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted to humans by the bite of infected blacklegged ticks (Ixodes spp.). Early manifestations of infection include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. Left untreated, late manifestations involving the joints, heart, and nervous system can occur. A Healthy People 2010 objective (14-8) is to reduce the annual incidence of Lyme disease to 9.7 new cases per 100,000 population in 10 reference states where the disease is endemic (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin). This report summarizes surveillance data for 64,382 Lyme disease cases reported to CDC during 2003-2005, of which 59,770 cases (93%) were reported from the 10 reference states. The average annual rate in these 10 reference states for the 3-year period (29.2 cases per 100,000 population) was approximately three times the Healthy People 2010 target. Persons living in Lyme disease--endemic areas can take steps to reduce their risk for infection, including daily self-examination for ticks, selective use of acaricides and tick repellents, use of landscaping practices that reduce tick populations in yards and play areas, and avoidance of tick-infested areas.     

Under-notification of giardiasis in Auckland, New Zealand: a capture-recapture estimation

Estimation of the degree of undercount is important for disease surveillance. Capture-recapture techniques are now being used to evaluate the completeness of disease ascertainment. This study estimated the level of under-notification of giardiasis in the Auckland adult population using a capture-recapture method. Two independent datasets of giardiasis cases > or = 15 years were generated from the 1998-1999 Auckland Giardiasis Study (AGS) case database and cases notified to Auckland Regional Public Health Services (ARPHS) for the same period of time. Cases were matched and under-notification was estimated using a two-sample capture-recapture method. During the 12-month period, 199 cases participated in the AGS and 413 cases were notified to ARPHS. The capture-recapture calculation indicated that only 49% of cases were notified. Under-notification by a factor of 2 obscures the true burden of giardiasis. Socio-economic conditions and water quality may influence disease notification inversely. Capture-recapture techniques are useful in evaluating the completeness of surveillance.     

West Nile virus infection among turkey breeder farm workers--Wisconsin, 2002

In 2002, Wisconsin public health officials were notified of two cases of febrile illness in workers at a commercial turkey breeder farm (farm A) in county A. The Wisconsin Division of Public Health (WDPH) initiated an investigation that found a high prevalence of West Nile virus (WNV) antibody among farm A workers and turkeys. An associated high incidence of febrile illness among farm A workers also was observed. This report summarizes the results of this investigation, which indicate possible nonmosquito transmission among birds and subsequent infection of humans at farm A. Because the mode of transmission in this outbreak is unknown, turkey handlers should take appropriate precautions, including use of DEET--containing mosquito repellents, protective clothing and gloves, respiratory protection, and proper hand hygiene. Suspected occupationally acquired WNV infections should be reported immediately to local and state health departments.     

Using capture-recapture methods to assess varicella incidence in a community under active surveillance

The Varicella (chickenpox) Active Surveillance Project (VASP) has been conducting active surveillance since 1 January 1995 in the high desert community known as Antelope Valley, CA (population 300,000) among 300 public and private schools, daycares, and healthcare providers. Capture-recapture methods were applied to estimate reporting completeness for 1995 varicella incidence data and these were compared with the national average incidence rates by age reported by the National Health Interview Survey (NHIS). Varicella cases reported among individuals aged <20 years reflect under-reporting in excess of 50%. Despite limitations on accuracy, capture-recapture estimates are a reasonably accurate, quick, and inexpensive approach in epidemiologic studies.     

Reporting of vancomycin-resistant enterococci in Connecticut: implementation and validation of a state-based surveillance system.

OBJECTIVE: To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut. DESIGN: Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics. SETTINGS: All 45 clinical laboratories and all 37 (36 for 1995 and 1996) acute-care hospitals in Connecticut were included in the study. MAIN OUTCOME MEASURES: The outcome measures included determination of the statewide incidence of VRE and the accuracy of passive reporting, determination of clinical laboratory proficiency in detecting VRE, and analysis of hospital characteristics that might be associated with an increased incidence of VRE. RESULTS: During 1994 through 1996, 29 (78%) of 37 hospital-affiliated clinical laboratories and 1 (11%) of 9 commercial or other laboratories in Connecticut reported to the CDPH the isolation of VRE from sterile sites; 158 isolates were reported for these 3 years. Based on verification, we discovered that these laboratories actually detected 58 VRE isolates in 1994, 104 in 1995, and 104 in 1996 (total, 266). The age-standardized incidence rate of VRE was 14.1 cases per million population in 1994 and 26.8 cases per million population for both 1995 and 1996. Laboratory proficiency testing revealed that high-level vancomycin resistance was identified accurately and that low- and moderate-level resistance was not detected. The incidence of VRE isolates was three times greater in hospitals with over 300 beds compared with categories of hospitals with fewer beds. Increases in the number of VRE isolates were at least twice as likely in hospitals located in areas with a higher population density, or with a residency program or trauma center in the hospital. CONCLUSIONS: Passive reporting of VRE isolates from sterile sites markedly underestimated the actual number of iso lates, as determined in a statewide reporting system. Statewide passive surveillance systems for routine or emerging pathogens must be validated and laboratory proficiency ensured if results are to be accurate and substantial underreporting is to be corrected.     

Surveillance in hurricane evacuation centers--Louisiana, September-October 2005

On August 29, 2005, Hurricane Katrina made landfall southeast of New Orleans, Louisiana. Before the arrival of Katrina, New Orleans and surrounding parishes were under a mandatory evacuation order. Because of this order and subsequent flooding, approximately 400,000 residents became displaced. On August 28, approximately 50,000 persons began moving into evacuation centers (ECs) throughout the state of Louisiana (American Red Cross, unpublished data, 2005). The Louisiana Department of Health and Hospitals, Office of Public Health (LAOPH) recognized the need for communicable disease surveillance in the ECs. Although the LAOPH Internet-based Reportable Disease Database was intact and never stopped functioning after the hurricane, LAOPH determined that the large number of ECs warranted active surveillance. On September 8, LAOPH, with the cooperation of the American Red Cross (ARC) and the U.S. Public Health Service, initiated statewide daily syndromic surveillance for communicable diseases in the ECs. In addition to collecting and analyzing data on communicable disease syndromes, data were collected on chronic medical conditions, injuries, and mental health conditions. This report summarizes the development and implementation of this surveillance system in the ECs, the types of data collected and how they were used, and the limitations of the data.     

Comparing Active and Passive Varicella Surveillance in Philadelphia, 2005–2010: Recommendations for the Transition to Nationwide Passive Varicella Disease Surveillance

Objective

The Philadelphia Department of Public Health (PDPH) conducts active surveillance for varicella in West Philadelphia. For its approximately 300 active surveillance sites, PDPH mandates biweekly reports of varicella (including zero cases) and performs intensive case investigations. Elsewhere in Philadelphia, surveillance sites passively report varicella cases, and abbreviated investigations are conducted. We used active varicella surveillance program data to inform the transition to nationwide passive varicella surveillance.

Methods

We compared classification of reported cases, varicella disease incidence, and reporting completeness for active and passive surveillance areas for 2005–2010. We assessed reporting completeness using capture-recapture analysis of 2- to 18-year-old cases reported by schools/daycare centers and health-care providers.

Results

From 2005 to 2010, PDPH received 3,280 passive and 969 active surveillance varicella case reports. Most passive surveillance reports were classified as probable cases (18% confirmed, 56% probable, and 26% excluded), whereas nearly all of the active surveillance reports were either confirmed or excluded (36% confirmed, 11% probable, and 53% excluded). Overall incidence rates calculated using confirmed/probable cases were similar in the active and passive surveillance areas. Detection of laboratory-confirmed, breakthrough, and moderate-to-severe cases was equivalent for both surveillance areas.

Conclusions

Although active surveillance for varicella results in better classified cases, passive surveillance provides comparable data for monitoring disease trends in breakthrough and moderate-to-severe varicella. To further improve passive surveillance in the two-dose-varicella vaccine era, jurisdictions should consider conducting periodic enhanced surveillance, encouraging laboratory testing, and collecting additional varicella-specific variables for passive surveillance.To monitor the impact of the varicella vaccination program, the Centers for Disease Control and Prevention, in collaboration with the Philadelphia Department of Public Health (PDPH) and Los Angeles County Department of Health Services, conducted varicella surveillance through the Varicella Active Surveillance Project (VASP) from 1996–2011.¹ This new program was essential, because when varicella vaccine was recommended for use in the United States in 1996, varicella was not nationally notifiable; varicella had been removed from the list of notifiable conditions in 1981 because reporting the then-common disease was not feasible in many states.² VASP has supplied vital information for programmatic decision-making, including the 2007 recommendation for a second dose of varicella vaccine.³With the success of the varicella vaccination program in reducing the incidence of disease, relatively small active surveillance areas cannot accurately monitor further declines in varicella incidence, changes in age distribution, and disease severity. Therefore, more widespread passive surveillance is required. In 2003, varicella was again added to the national notifiable diseases list, and the Council of State and Territorial Epidemiologists (CSTE) recommended that all states implement case-based surveillance by 2005.^4–6 To mitigate the burden of varicella surveillance, CSTE recommended that states begin by focusing on the collection of three varicella-specific variables: age at disease onset, number of lesions (as a proxy for disease severity), and vaccination status, adding variables, including rash characteristics, varicella-related complications, and diagnostic laboratory data, when feasible.² As of 2010, 38 states were conducting case-based passive surveillance, but the completeness of information collected is unknown.⁷In this article, we briefly summarize the characteristics of active and passive surveillance in Philadelphia, Pennsylvania, and compare active and passive varicella surveillance data for 2005–2010 as the basis for recommendations to optimize the quality of national passive surveillance. Specifically, we compared (1) the proportions of confirmed, probable, and excluded cases among overall reports; (2) the proportions of cases reported by type of reporting site; (3) the overall reported incidence of varicella; (4) the completeness of reporting assessed by capture-recapture methodology; and (5) the extent of laboratory testing and findings from testing. Our results suggest that optimizing passive surveillance in the U.S. will require efforts to improve the identification and exclusion of non-varicella cases through periodic enhanced surveillance, laboratory testing, or more thorough investigation of rash characteristics.     

Early warning system for West Nile virus risk areas, California, USA

The Dynamic Continuous-Area Space-Time (DYCAST) system is a biologically based spatiotemporal model that uses public reports of dead birds to identify areas at high risk for West Nile virus (WNV) transmission to humans. In 2005, during a statewide epidemic of WNV (880 cases), the California Department of Public Health prospectively implemented DYCAST over 32,517 km2 in California. Daily risk maps were made available online and used by local agencies to target public education campaigns, surveillance, and mosquito control. DYCAST had 80.8% sensitivity and 90.6% specificity for predicting human cases, and k analysis indicated moderate strength of chance-adjusted agreement for >4 weeks. High-risk grid cells (populations) were identified an average of 37.2 days before onset of human illness; relative risk for disease was >39× higher than for low-risk cells. Although prediction rates declined in subsequent years, results indicate DYCAST was a timely and effective early warning system during the severe 2005 epidemic.     

Progress in improving state and local disease surveillance--United States, 2000-2005

In September 2000, states began receiving federal funding to plan and implement integrated electronic systems for disease surveillance. CDC and state and local health departments had recognized the importance of such systems and of uniform standards to improve the usefulness of public health surveillance and the timeliness of response to outbreaks of disease. Previously, state health departments received most case-report forms by mail and then entered the data into computer systems, sometimes weeks after the cases of notifiable disease had occurred, including cases that warranted immediate public health investigation or intervention. In addition, depending on the disease, only 10%-85% of cases were reported, and more than 100 different systems were used to transmit these reports from the states to CDC (CDC, unpublished data, 2005). This report summarizes progress since the initial funding in 2000 in improving state and local disease surveillance through secure, Internet-based data entry and automated electronic laboratory results (ELR) reporting. Both are components of the National Electronic Disease Surveillance System (NEDSS), the surveillance and monitoring component of the broader Public Health Information Network (PHIN) initiative. Local, state, and national public health officials should continue to improve the timeliness and completeness of disease surveillance.     

Manufacturer's recall of rapid assay kits based on false positive Cryptosporidium antigen tests--Wisconsin, 2001-2002

The Wisconsin Division of Public Health and the Wisconsin State Laboratory of Hygiene (WSLH) reported that a recent cluster of cryptosporidiosis cases in a three-county area in southeastern Wisconsin was the result of false-positive tests. During December 1, 2001-February 1, 2002, approximately 30 cases of cryptosporidiosis were diagnosed at a laboratory in southeastern Wisconsin using the Becton, Dickinson, and Company (Franklin Lakes, New Jersey) ColorPAC Cryptosporidium/Giardia rapid assay (lot number 219370, expiration date 2002-06-05). Seventeen stool specimens, which were collected from 11 patients and tested positive by the rapid assay, were re-evaluated at WSLH. Six of these stool specimens were in EcoFix (Meridian Bioscience Inc., Cincinnati, Ohio), eight were in Cary-Blair transport media, and three were formalin fixed. All 17 specimens tested negative for Cryptosporidium at WSLH using the hot safranin stain and MeriFluor (Meridian Bioscience Inc., Cincinnati, Ohio) Cryptosporidium/Giardia direct fluorescent antibody kit with concentrated specimens.     

Disease surveillance in rural communities is compromised by address geocoding uncertainty: a case study of campylobacteriosis

ABSTRACT: This study illustrates the impact of address geocoding uncertainty on rural estimates of reportable disease incidence using campylobacteriosis as an example. After all cases of campylobacteriosis notified from 1993 to 1997 had been geocoded, the minimum and maximum disease notification rates were calculated for rural and urban areas of New Zealand. The estimated maximum rural rates were four times higher than estimated minimum rural rates, whereas estimated minimum and maximum urban rates varied minimally. The impact of address geocoding on the estimation of disease notification rates across Public Health Service Regions showed considerable variation. The relative proportions of ungeocoded notifications to rural notifications ranged from 1.3:1 to 10.2:1, reflecting the range of uncertainty in estimated rural rates of campylobacteriosis. Unless the reliability of captured rural address data is improved significantly, disease surveillance systems will underestimate rural rates of disease and limit small area analyses.     

Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses,United States, 2010–2018

We evaluated MarketScan, a large commercial insurance claims database, for its potential use as a stable and consistent source of information on Lyme disease diagnoses in the United States. The age, sex, and geographic composition of the enrolled population during 2010–2018 remained proportionally stable, despite fluctuations in the number of enrollees. Annual incidence of Lyme disease diagnoses per 100,000 enrollees ranged from 49 to 88, ≈6–8 times higher than that observed for cases reported through notifiable disease surveillance. Age and sex distributions among Lyme disease diagnoses in MarketScan were similar to those of cases reported through surveillance, but proportionally more diagnoses occurred outside of peak summer months, among female enrollees, and outside high-incidence states. Misdiagnoses, particularly in low-incidence states, may account for some of the observed epidemiologic differences. Commercial claims provide a stable data source to monitor trends in Lyme disease diagnoses, but certain important characteristics warrant further investigation.