Inter-rater agreement in defining chemical incidents at the National Poisons Information Service, London

BACKGROUND: National surveillance for chemical incidents is being developed in the UK. It is important to improve the quality of information collected, standardise techniques, and train personnel. OBJECTIVE: To define the extent to which eight National Poison Information Service specialists in poison information agree on the classification of calls received as "chemical incidents" based on the national definition. DESIGN: Blinded, inter-rater reliability measured using the kappa statistic for multiple raters. SETTING: National Poison Information Service and Chemical Incident Response Service, Guy's and St Thomas's NHS Trust, London. PARTICIPANTS: Eight specialists in poison information who are trained and experienced in handling poisons information calls and have been involved in extracting information for surveillance. RESULTS: The overall level of agreement observed was at least 69% greater than expected by chance (kappa statistic). Fire and incidents where chemicals were released within a property had a very good level of agreement with kappa statistic of 83% and 80% respectively. The lowest level of agreement was observed when no one or only one person was exposed to a chemical (33%) and when the chemical was released into the air (48%). CONCLUSION: High levels of agreement were observed. There is a need for more training and improvement in consistency of the data collected by all organisations.     

Poison Center Data for Public Health Surveillance: Poison Center and Public Health Perspectives

Objective

To describe the use of poison center data for public health surveillance from the poison center, local, state, and federal public health perspectives and to generate meaningful discussion on how to address the challenges to collaboration.

Introduction

Since 2008, poisoning has become the leading cause of injury-related death in the United States (US); since 1980, the poisoning-related fatality rate in the US has almost tripled.1 Many poison-related injuries and deaths are reported to regional poison centers (PCs) which receive about 2.4 million reports of human chemical and poison exposures annually.2 Federal, state, and local public health (PH) agencies often collaborate with poison centers and use PC data for public health surveillance of poisoning-related health issues. Many state and local PH agencies have partnerships with regional PCs for direct access to local PC data which help them perform this function. At the national level, CDC conducts public health surveillance for exposures and illnesses of public health significance using the National Poison Data System (NPDS), the national PC reporting database.Though most PC and PH officials agree that PC data play an important role in PH practice and surveillance, collaboration between PH agencies and PCs has been hindered by numerous challenges. To address these challenges and bolster collaboration, the Poison Center and Public Health Collaborations Community of Practice (CoP) was created in 2010 by CDC as a means to share experiences, identify best practices, and facilitate relationships among federal, state and local public health agencies and PCs. To date, the Poison Center and Public Health Collaborations CoP includes over 200 members from state and local public health, regional PCs, CDC, the American Association of Poison Control Centers (AAPCC), and the Environmental Protection Agency (EPA). A leadership team was created with representatives of the many stakeholders of the community to drive its direction and oversee activities.

Methods

The panel will consist of 4 presenters and 1 moderator, who are members of the Poison Center and Public Health Collaborations CoP leadership team. Each presenter will bring a unique perspective of the use of PC data for PH practice and surveillance: CDC, state department of health, a local department of health, and a PC. Royal Law from the CDC National Center for Environmental Health will present on using PC data for identification of exposures and illnesses of public health significance identified from NPDS data collected from all 57 PCs. Dr. Jay Schauben from the Florida/USVI Poison Information Center - Jacksonville will discuss PC participation in surveillance and use of PC data for tracking and mitigation of PH events in Florida. Dr. Prakash Mulay from the Florida Department of Health will discuss utilization of PC data to enhance ESSENCE-based chemical-associated exposure and illness surveillance in Florida. Katherine Wheeler from the New York City (NYC) Department of Health and Mental Hygiene will discuss NYC’s use of PC data in surveillance of potential emerging issues, from energy drinks to synthetic marijuana. Each presenter will discuss the use of PC data for PH practice and surveillance in his or her organization and jurisdiction, the successes of using PC data, and their challenges.

Results

The moderator will engage the audience by facilitating discussion of the successes and challenges to using PC data for PH practice and surveillance with the audience.Sample questions:What are your current capacities and collaborative activities between your state/local health department and your poison center?What non-funding related barriers hinder the collaboration between your state/local health department and poison center?If more funding were available, how would you use this funding to increase the level of interactivity with the poison center and state/local health department?     

Occupationally related illness reported to a regional poison control center.

The San Francisco Bay Area Regional Poison Control Center studied 189 cases of toxic workplace exposure occurring over a six-month period in the belief that Regional Poison Control Center reporting could be a useful surveillance measure for occupational disease. Dermatitis was a relatively uncommon occurrence, but systemic complaints were frequent, a pattern differing from that seen in standard occupational surveillance programs. As compared to chemically caused illness detected through a statewide physician reporting program in California, increases in proportional frequencies of certain industrial chemical causes were observed. A matching strategy utilizing the physician reporting system identified only 15.9 per cent of poison control center cases that appear to have been otherwise detected through established surveillance. A nationwide system of Regional Poison Control Centers already exists with a computerized data base in place. This study indicates that these centers could be utilized as a supplementary system for acute occupational illness related to chemical exposures.     

毒物数据库及有毒动植物标本库平台系统的信息建设与应用

目的 建立毒物和中毒医学相关信息的广泛覆盖、内容准确的毒物数据库，为各级各类突发事件应急处置人员和医务工作者全面、准确、规范的处理各类中毒事件信息，为快速、精准应对各类突发中毒事件提供技术支持。方法毒物规范分类，信息数据结构化，建立包括毒物的理化性质、毒性、现场处理、现场抢救、临床治疗等内容的数据库构架。选用可靠的信息来源，经收集、整理、审核、入库、发布等步骤，完成数据库信息内容建设。利用精确查询和模糊查询两种方式提供数据查询功能。结果 本数据库由30个信息单元模块、500多个数据集组成，拥有16 720种毒物的文字信息和7 053张毒物图片信息，还包括中毒控制相关信息20 633条。结论 本数据库为全球最大的中文毒物数据库，能为我国突发中毒事件应急处置和中毒病人救治提供最有力的信息数据支持。     

Surveillance for Radiation-Related Exposures Reported to the National Poison Data System

Objective

To describe radiation-related exposures of potential public health significance reported to the National Poison Data System (NPDS).

Introduction

For radiological incidents, collecting surveillance data can identify radiation-related public health significant incidents quickly and enable public health officials to describe the characteristics of the affected population and the magnitude of the health impact which in turn can inform public health decision-making. A survey administered by the Council of State and Territorial Epidemiologists (CSTE) to state health departments in 2010 assessed the extent of state-level planning for surveillance of radiation-related exposures and incidents: 70%–84% of states reported minimal or no planning completed. One data source for surveillance of radiological exposures and illnesses is regional poison centers (PCs), who receive information requests and reported exposures from healthcare providers and the public. Since 2010, the Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers (AAPCC) have conducted ongoing surveillance for exposures to radiation and radioactive materials reported from all 57 United States (US) PCs to NPDS, a web-based, national PC reporting database and surveillance system.

Methods

We collaborated with the American Association of Poison Control Centers (AAPCC), Poisindex® and Thomson Reuters Healthcare to develop an improved coding system for tracking radiation-related exposures reported to US PCs during 2011 and trained PC staff on its usage. We reviewed NPDS data from 1 September 2010 – 30 June 2012 for reported exposures to pharmaceutical or nonpharmaceutical radionuclides; ionizing radiation; radiological or nuclear weapons; or X-ray, alpha, beta, gamma, or neutron radiation. CDC medical toxicology and epidemiology staff reviewed each reported exposure to determine whether it was of potential public health concern (e.g. exposures associated with an ongoing public health emergency, several reported exposures clustered in space and time). When further information was needed to classify the potential public health importance of a call, CDC and AAPCC staff contacted the regional PC where each call originated. When exposures were spatially and temporally clustered, we reviewed news stories in the public media for evidence of an associated radiation incident.

Results

Of 419 exposures reported during the study period, 25 were associated with a radiation-related incident. Of these, 4 were related to an exposure to x-ray radiation from an industrial radiography incident, 11 were related to a transportation accident involving potential contamination with radioactive material, and 10 were related to the Fukushima Daiichi Japan nuclear reactor disaster. Public health, hazardous materials, or hospital radiation safety staff were involved in responding to each of these events. We also identified 26 reported exposures associated with a regional radiation anti-terrorism exercise. The reported exposures were followed-up and removed from analysis once we determined they were part of the exercise. The remaining (n=368; 88%) were either requests for information, confirmed non-exposures, or exposures deemed unrelated or non-significant.

Conclusions

The capability to monitor self- or clinician-reported exposures to radiation and radioactive materials is available in NPDS for state and local public health use in collaboration with their regional PC and may improve public health capacity to identify and respond to radiological emergencies. Next steps include testing the system’s capability to accurately classify and rapidly respond to a cluster of calls to PCs reporting radiation exposures associated with a “dirty bomb” exercise during July, 2012.     

Human exposures to pesticides in the United States

Pesticides are used in most homes, businesses, and farms to control a variety of pests, including insects, weeds, fungi, rodents, and even microbial organisms. Inappropriate use of pesticides can lead to adverse effects to humans and the environment. This study provides updated information on the magnitude of adverse pesticide exposures in the United States. Data on pesticide exposure were obtained from calls to poison control centers (PCCs) reported by the American Association of Poison Control Centers. Estimates of emergency department visits, hospitalizations, and health care costs were reported by the Agency for Healthcare Research and Quality (AHRQ), and deaths from pesticide poisonings reported by the Centers for Disease Control and Prevention (CDC) WONDER (Wide-ranging Online Data for Epidemiologic Research). An average of 23 deaths occur each year with pesticides as the underlying cause of death, most due to suicidal ingestions. An average of 130,136 calls to poison control centers were reported from 2006 to 2010, with an average of 20,116 cases (17.8%) treated in health care facilities annually. AHQR reported an annual average of 7385 emergency room visits during 2006 to 2008, and 1419 annual hospitalizations during 2005 to 2009. Excluding cost from lost work time, hospital physician fees, and pesticide-induced cancers, the annual national cost associated with pesticide exposures was estimated as nearly $200 million USD based on data from emergency department visits, hospitalizations, and for deaths. Pesticide exposures remain a significant public health issue. Health care providers, cooperative extension agents, and pesticide manufactures can help prevent exposures by increasing education of parents and workers, encourage use of less toxic agents, and encourage the practice of integrated pest management.     

Comparing Syndromic Surveillance and Poison Center Data for Snake Bites in Missouri

Objective

This study intends to use two different surveillance systems available in Missouri to explore snake bite frequency and geographic distribution.

Introduction

In 2010, there were 4,796 snake bite exposures reported to Poison Centers nationwide (1). Health care providers frequently request help from poison centers regarding snake envenomations due to the unpredictability and complexity of prognosis and treatment. The Missouri Poison Center (MoPC) maintains a surveillance database keeping track of every phone call received. ESSENCE, a syndromic surveillance system used in Missouri, enables surveillance by chief complaint of 84 different emergency departments (ED) in Missouri (accounting for approximately 90% of all ED visits statewide). Since calling a poison center is voluntary for health care providers, poison center data is most likely an underestimation of the true frequency of snake envenomations. Comparing MoPC and ESSENCE data for snake envenomations would enable the MoPC to have a more accurate depiction of snake bite frequency in Missouri and to see where future outreach of poison center awareness should be focused.

Methods

Archived data from Toxicall®, the MoPC surveillance system, was used to query the total number of snake bite cases from 01/01/2007 until 12/31/2011 called into the MoPC center by hospitals that also participate ESSENCE. Next, ESSENCE data was used to estimate the total number of snake envenomations presenting to EDs in Missouri. This was accomplished using the same date range as well as searching for key terms in the chief complaints that would signify a snake bite. The results of each datasearch were compared and contrasted by Missouri region.

Results

The Toxicall® search showed a total of 324 snake bite cases. The initial ESSENCE data query showed a total of 1983 snake bite cases. After certain data exclusions, there was a total of 1763 ESSENCE snake bite visits. This suggests that approximately 18% of all snake bite visits reported in Missouri ESSENCE were called into the MoPC. The results are demonstrated by Missouri region in Figure 1. This figure also shows that the greatest number of ESSENCE visits for snake bites were reported by Southwest region hospitals whereas the Eastern region hospitals placed the greatest number of calls to MoPC regarding snake bites.Open in a separate windowFigure 1:ESSENCE Snake Bites Cases Compared to Toxicall® Snake Bite Cases in Missouri by Region

Conclusions

The total number of snake bite cases from Missouri ESSENCE ED visits is much greater than the number of snake bites cases called into the MoPC by ESSENCE participating hospitals. This underutilization of the poison center demonstrates the increased need for awareness of the MoPC’s free services. In Missouri, the MoPC should target hospitals in the Southwest region for outreach in particular based on these findings. Poison centers are staffed by individuals trained in all types of poisonings and maintain a list of consulting physicians throughout the United States experienced in management and treatment of venomous snake bites (2). Any healthcare facility would benefit from MoPC assistance. Finally, syndromic surveillance allows for quick and easy data compilation, however there are some difficulties when attempting to search for a particular condition. Communication and partnership between two different public health organizations will be beneficial toward future public health studies.     

Poison Control Center follow-up of occupational disease.

We followed up 73 of 372 calls to a Regional Poison Control Center (RPCC) that involved workplace disease/exposure(s); most other calls were not made by the workers. An average of 12 additional people per workplace were potentially exposed. Six of the 73 contacted a government agency for investigation of the hazard/illness. Twenty-five percent of callers were still exposed an average of seven months after the original call. The results indicate that poison control centers should develop a public health component to calls about possible workplace poisonings.     

Pesticide poisoning surveillance through regional poison control centers.

The purpose of this study is to describe pesticide exposure in the population of callers to Minnesota Regional Poison Centers. Case files from 1988 reporting pesticide exposure to humans were identified in cooperation with the Minnesota Center for Health Statistics. Data analysis was conducted by computer using SAS statistical package. Of the 1,428 case files indicating pesticide as the primary substance of exposure to Minnesota residents, a mean age of 5 years (range, one month to 85 years) was identified; 50 percent of all cases were below age 3 years. Males accounted for 1.3 times as many cases as females. Insecticide was identified in the largest percentage of case files (74 percent) followed by herbicide (12 percent), rodenticide (11 percent) and fungicide-nonmedicinal (3 percent). Ingestion was the most common route of exposure; 85 percent of all calls originated from a residence. While insecticides are still the most common types of pesticide call, herbicide has surpassed insecticide in production and sales in the US. In this study, herbicide type exposure calls present a much different picture than other pesticide types. The usefulness of poison control centers for examination of pesticide poisoning is explored. Since reporting occurs coincidental with the exposure and its associated symptoms, each pesticide poisoning report could potentially serve as a true sentinel health event.     

Occupational and environmental exposures reported to poison centers.

This analysis of 25,368 occupational and 7,565 environmental exposure cases characterizes the occupational and environmental exposures reported to the American Association of Poison Control Centers Toxic Exposure Surveillance System. Compared with other poisonings, occupational and environmental exposures were predominantly inhalation exposures rather than ingestions, were more often subacute or chronic, and demonstrated greater morbidity, mortality, and increased use of health care resources. As regional poison centers evolve to fill a critical information void in the management and assessment of environmental and occupational exposures, the American Association of Poison Control Centers Toxic Exposure Surveillance System provides an important, untapped passive surveillance mechanism.     

Environmental data assessment for use in public health surveillance

Public health surveillance is the ongoing systematic collection, analysis, interpretation, and dissemination of data on health-related events for use in public health action to reduce morbidity and mortality and to improve health. Total trihalomethanes are an example of a chemical in drinking water that is regulated by the U.S. Environmental Protection Agency (U.S. EPA) but is not under public health surveillance. The U.S. EPA database that stores this environmental information is called the Safe Drinking Water Information System (SDWIS). Its purpose is to collect data on noncompliance events in drinking-water utilities in each state. For this discussion, the SDWIS data on TTHMs, which are an example of environmental data, were assessed for public health surveillance system attributes as defined by the Centers for Disease Control and Prevention: simplicity, flexibility, data quality, acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability.     

Enhanced Surveillance during the Democratic National Convention,Charlotte, NC

Objective

To describe how the existing state syndromic surveillance system (NC DETECT) was enhanced to facilitate surveillance conducted at the Democratic National Convention in Charlotte, North Carolina from August 31, 2012 to September 10, 2012.

Introduction

North Carolina hosted the 2012 Democratic National Convention, September 3–6, 2012. The NC Epidemiology and Surveillance Team was created to facilitate enhanced surveillance for injuries and illnesses, early detection of outbreaks during the DNC, assist local public health with epidemiologic investigations and response, and produce daily surveillance reports for internal and external stakeholders. Surveillane data were collected from several data sources, including North Carolina Electronic Disease Surveillance System (NC EDSS), triage stations, and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT).NC DETECT was created by the North Carolina Division of Public Health (NC DPH) in 2004 in collaboration with the Carolina Center for Health Informatics (CCHI) in the UNC Department of Emergency Medicine to address the need for early event detection and timely public health surveillance in North Carolina using a variety of secondary data sources. The data from emergency departments, the Carolinas Poison Center, the Pre-hospital Medical Information System (PreMIS) and selected Urgent Care Centers were available for monitoring by authorized users during the DNC.

Methods

Within NC DETECT, new dashboards were created that allowed epidemiologists to monitor ED visits and calls to the poison center in the Charlotte area, the greater Cities Readiness Initiative region and the entire state for infectious disease signs and symptoms, injuries and any mention of bioterrorism agents. The dashboards also included a section to view user comments on the information presented in NC DETECT. Data processing changes were also made to improve the timeliness of the EMS data received from PreMIS.

Results

The DNC dashboards added to NC DETECT streamlined the workflow by placing all syndromes and annotations of interest in one place, with the date ranges and locations already pre-selected. Graphs in the dashboards could be easily copied and pasted into situation reports. The prompt development of these user-friendly tools provided effective surveillance for this mass gathering and ensured timely control measures, if necessary.

Conclusions

Syndromic surveillance systems can be enhanced to provide detailed, specific surveillance during mass gathering events. Elements that facilitate this enhancement include strong communication between skilled users and the informatics team, in order to minimize the burden placed on the surveillance team system users, data sources and system developers during the event. The visualizations developed as part of these new dashboards will be leveraged to provide additional tools to other NC DETECT user groups, including hospital-based public health epidemiologists and local health department users.Open in a separate window     

毒物中毒信息系统研究

论述了毒物中毒信息系统的组成;毒物的分类、总编码和参考文献代码的编制:信息的收集和处理.整个系统由基础库、参考信息库和管理系统三大部分组成,每一部分又分为若干小块.毒物分为9类.每一类用一个字母代表.每一毒物用十位字母和数字编制的编码表示,编码起到系统主码(skelatal key)作用.参考文献代码是将参考文献用 6位字母、数字、符号编制,主要节省储存空间和提高检索速度.毒物信息包括名称、理化性质、用途、生产厂家、毒性毒理、临床表现、诊断治疗、诊断标准、毒物分析、参考文献.系统还包括了毒物中毒总论、专家名录、医院、中毒文献病例等参考信息.     

National poison information system: the challenge of the data standardization

Human poisoning is a serious public health issue around the world. Readily available and reliable information in this field are essential to the full implementation of epidemiological and sanitary surveillance and to establish efficient and effective strategies of control. The continuous improvement of data quality and consistency % no doubt, a permanent challenge % has a key role in the definition of public policies. To assess the accuracy of Brazilian data on human poisonings, this study explores data from a network of Toxicological Information and Assistance Centers, one of the main sources of such data in Brazil. Data are consolidated by the National Poison Information System (SINITOX). Assuming that standardization is one of the main procedures that influence the data quality collected and analyzed by SINITOX, the study assesses the operations of the Centers affiliated to the SINITOX in charge to interpret and register the events reported to them and highlights the procedures used to standardize case reports. The results show an evident insufficient degree of standardization of the data received at SINITOX. We emphasize the need to design strategies to improve standardization, aiming to develop a reliable system and to minimize the harms associated to human poisoning in Brazil.     

Surveillance of toxic exposures: the pilot experience of the Poison Control Centers of Milan, Pavia and Bergamo in 2006

Between 1 February and 31 March 2006, the Poison Control Centers (PPC) active in Lombardy collaborated with an integrated surveillance system carried out in Piedmont during the Olympic Games 2006. The collaborating PPC notified to the system 697 human cases of exposure occurred in Piedmont during the observation period. Among these cases, 70% were exposed accidentally, 40% were 6 years old or younger, and 45% reported at least a clinical effect. The agents more frequently reported were: cleaning substances (household) (110 cases), fumes/gases/vapors (63 cases, comprising 38 cases accidentally exposed to carbon monoxide), and sedative/hypnotics/antipsychotics (53 cases). Although very limited, the available observations focused the attention on specific hazards and were able to highlight the potential of a toxic exposure surveillance system based on the information reported by the Italian PPC.     

The Northwest Public Health Information Exchange’s Accomplishments in Connecting a Health Information Exchange with Public Health

In 2007 the Centers for Disease Control and Prevention (CDC) issued a Request for Proposal for the “Situational Awareness through Health Information Exchange” project. The Situational Awareness project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. During this same time period the Health and Human Services’ Office of the National Coordinator for Health Information Technology released several reports identifying the growing number of communities involved in health information exchange and outlining the requirements for a Nationwide Health Information Network (NHIN). CDC saw the possibilities of using HIEs and the NHIN to accelerate the real-time sharing of clinical and facility-based resource utilization information to enhance local, state, regional, and federal public health in responding to and managing potentially catastrophic infectious disease outbreaks and other public health emergencies. HIEs would provide a unified view of a patient across health care providers and would serve as data collection points for clinical and resource utilization data while NHIN services and standards would be used to capture HIE data of importance and send those data to public health. This article discusses how automated syndromic surveillance data feeds have proven more stable and representative than existing surveillance data feeds and summarizes other accomplishments of the Northwest Public Health Information Exchange in its contribution to the advancement of the National agenda for sharing interoperable health information with public health.     

Norovirus activity--United States, 2006-2007

In late 2006, CDC began receiving requests from numerous state public health departments for information about a perceived increase in the number of outbreaks of acute gastroenteritis (AGE), especially those involving person-to-person transmission in long-term--care facilities. No national surveillance system exists for AGE outbreaks, including those caused by norovirus, unless foodborne transmission is suspected. In the absence of national surveillance data, CDC attempted to better characterize the outbreaks of AGE by analyzing information from the following sources: 1) detailed data on recent AGE outbreaks in three of the states that had contacted CDC about a possible increase (North Carolina, Wisconsin, and New York); 2) emergency department (ED) syndromic surveillance data from Boston, Massachusetts; 3) basic epidemiologic data on AGE outbreaks from a CDC survey of state health departments; and 4) laboratory data from CDC. The analysis suggests that a national increase has occurred in the frequency of AGE outbreaks caused by norovirus (including fatal cases in long-term-care facilities). Two new cocirculating GII.4 norovirus strains emerged nationwide in 2006 and likely accounted for this increase in activity. Improved national surveillance of outbreaks, including those with person-to-person transmission; development of accessible, affordable, and timely clinical tests; and increased access to a norovirus strain sequencing database at CDC will lead to more accurate assessment of the morbidity and mortality associated with norovirus and more rapid identification of newly emerging norovirus strains.     

Expert knowledge sourcing for public health surveillance: National tsetse mapping in Uganda

In much of sub-Saharan Africa, availability of standardized and reliable public health data is poor or negligible. Despite continued calls for the prioritization of improved health datasets in poor regions, public health surveillance remains a significant global health challenge.Alternate approaches to surveillance and collection of public health data have thus garnered increasing interest, though there remains relatively limited research evaluating these approaches for public health. Herein, we present a case study applying and evaluating the use of expert knowledge sources for public health dataset development, using the case of vector distributions of Human African Trypanosomiasis (HAT) in Uganda. Specific objectives include: 1) Review the use of expert knowledge sourcing methods for public health surveillance, 2) Review current knowledge on tsetse vector distributions of public health importance in Uganda and the methods used for tsetse mapping in Africa; 3) Quantify confidence of the presence or absence of tsetse flies in Uganda based on expert informant reports, and 4) Assess the reliability and potential utility of expert knowledge sourcing as an alternative or complimentary method for public health surveillance in general and tsetse mapping in particular. Information on tsetse presence or absence, and associated confidence, was collected through interviews with District Entomologist and Veterinary Officers to develop a database of tsetse distributions for 952 sub-counties in Uganda. Results show high consistency with existing maps, indicating potential reliability of modeling approaches, though failing to provide evidence for successful tsetse control in past decades. Expert-sourcing methods provide a novel, low-cost and rapid complimentary approach for triangulating data from prediction modeling where field-based validation is not feasible. Data quality is dependent, however, on the level of expertise and documentation to support confidence levels for data reporting. Results highlight the need for increased evaluation of alternate approaches and methods to data collection.     

Use of a health information telephone line, Info-santé CLSC, for the surveillance of waterborne gastroenteritis

The increasing frequency of waterborne outbreaks demonstrates that classic indicators used for the surveillance of the microbiological quality of drinking water have several gaps and that routine public health surveillance seems insufficient to allow for the rapid detection of these outbreaks. The main objective of this study was to evaluate the possibility of using a regional health information telephone line, 'Info-Santé CLSC' (Info-Health Local Community Health Centre), for the surveillance of waterborne gastroenteritis. This study measured the incidence rate of calls for acute gastrointestinal illness (AGI) placed to the Info-Santé CLSC line, investigated the relationship between the frequency of calls for AGI placed to the Info-Santé CLSC line and the turbidity of the treated water in the Quebec City drinking water plant and evaluated the relevance and the conditions of use of the Info-Santé CLSC system for the surveillance of waterborne enteric illness. A relationship between the turbidity and the calls for AGI placed to Info-Santé CLSC line was observed. Significant time lags (11, 15 and 17 days prior to the outcome) were identified in the final model derived from a Poisson model using generalized additive models (GAM) as a time series analysis. Some recommendations to improve the system were formulated even though the system already seems to be useful for the surveillance of waterborne enteric diseases.