Completeness of communicable disease reporting, North Carolina, USA, 1995-1997 and 2000-2006

Despite widespread use of communicable disease surveillance data to inform public health intervention and control measures, the reporting completeness of the notifiable disease surveillance system remains incompletely assessed. Therefore, we conducted a comprehensive study of reporting completeness with an analysis of 53 diseases reported by 8 health care systems across North Carolina, USA, during 1995-1997 and 2000-2006. All patients who were assigned an International Classification of Diseases, 9th Revision, Clinical Modification, diagnosis code for a state-required reportable communicable disease were matched to surveillance records. We used logistic regression techniques to estimate reporting completeness by disease, year, and health care system. The completeness of reporting varied among the health care systems from 2% to 30% and improved over time. Disease-specific reporting completeness proportions ranged from 0% to 82%, but were generally low even for diseases with great public health importance and opportunity for interventions.     

Under-Reporting of Pelvic Inflammatory Disease in Hawaii: A Comparison of State Surveillance and Hospitalization Data

Hawaii is one of only 19 states for which pelvic inflammatory disease (PID) is a mandated notifiable disease. In order to assess the completeness of PID reporting, we compared the number of hospitalized PID cases in the state of Hawaii with the total number of PID cases reported to the Hawaii State Department of Health surveillance system from 2007 through 2010. While 828 unique PID cases were diagnosed in Hawaii hospitals, only 240 unique PID cases were reported through the state’s surveillance system. Severe PID underreporting was seen despite mandatory reporting laws.     

中国内地法定报告传染病预测和监测的ARIMA模型

目的通过对1995年1月～2004年4月中国大陆法定报告传染病逐月发病率数据的分析,研究其变化规律,建立预测与监测的ARIMA时间序列模型。方法利用时间序列模型中的自回归滑动平均混合模型ARIMA,考虑非季节效应和季节效应,分析中国法定报告传染病发病率的变化趋势和周期性,模型参数估计采用非线性最小二乘法,应用残差和赤池信息量准则（AIC）评价模型的优劣。1995～2004年我国内地法定报告传染病逐月发病率的数据用于建立模型,2005年1月～2006年4相应数据用于模型检验。结果分析结果显示,法定报告传染病发病以年为周期,一年中6～9月为高发月,尤其是8月和7月最为严重。ARIMA（0,1,0）（0,1,0）12模型是法定报告传染病拟合的最佳模型,其拟合残差的方差为2.28,外推预测的平均绝对误差为0.34。利用预测值的95%置信区间建立了我国内地法定报告传染病发病率变化的监测控制线,用于其发病情况的预测与预报。结论对传染病发病率历史数据进行时间序列分析是用于传染病监测的一个重要的工具。所建立的ARIMA模型适用于对中国大陆法定报告传染病发病率预测与监测。该模型具有一定的实用价值,并可以应用于其他传染病的监测和异常变化的检测。     

Completeness of notifiable infectious disease reporting in the United States: an analytical literature review

Despite state and local laws requiring medical providers to report notifiable infectious diseases to public health authorities, reporting is believed to be incomplete. Through means of an analytical literature review, the authors synthesize current knowledge on the completeness of disease reporting and identify factors associated with reporting completeness. The review was limited to published studies, conducted in the United States between 1970 and 1999, that quantitatively assessed infectious disease reporting completeness. Thirty-three studies met the inclusion criteria. Reporting completeness, expressed between 0% and 100%, was treated as the dependent outcome variable in statistical analysis; disease, study location, time period, study design, and study size were treated as independent variables. Fifty-six distinct measures of reporting completeness were identified for 21 diseases. Reporting completeness varied from 9% to 99% and was most strongly associated with the disease being reported. The mean reporting completeness for acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis as a group was significantly higher (79%) than for all other diseases combined (49%) (p < 0.01).     

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.     

Evaluation of the timeliness and completeness of a Web-based notifiable disease reporting system by a local health department.

OBJECTIVE: To evaluate the completeness and timeliness of the Colorado statewide Web-based system for reporting notifiable diseases, called the Colorado Electronic Disease Reporting System. This project demonstrates how a local health department can conduct a surveillance evaluation to identify areas of improvement. METHODS: Reports received by Colorado for 2004 were categorized as Tri-County Health Department (TCHD) reports and reports received for the rest of Colorado. Report completeness and timeliness were compared for all diseases routinely followed up by TCHD for both datasets. A data field was considered complete if there was data entry for that field. Timeliness in this study was defined as the interval between "specimen collection date" and "report date" for each record. RESULTS: Six of 12 selected data fields were 95% or more complete for both datasets. Twenty-four-hour notifiable diseases were reported a median of 2.0 days for reports in the TCHD dataset and a median of 3.0 days for reports in the dataset for the rest of Colorado. Seven-day notifiable diseases were reported a median of 4.0 days for both datasets. CONCLUSIONS: Both Colorado datasets were found to be relatively complete and timely. Improved data collection by interviewers will help better determine demographic information of reported cases and timeliness of reports.     

我国医疗机构传染病疫情报告质量调查分析

目的了解我国实行传染病网络直报后医疗机构传染病疫情报告的质量。方法使用分层抽样的方法在全国范围内抽取250家医疗机构开展大规模调查。结果全国医疗机构传染病总的漏报率为23．1％，传染病疫情报告的及时率为76．0％，纸质传染病报告卡填写的完整率为75．9％，网络录人报告卡上关键指标与纸质传染病报告卡上相应指标的一致率仅为50．3％。结论我国医疗机构传染病疫情报告的质量不容乐观，传染病疫情报告管理工作亟待加强。     

The reporting of race and ethnicity in the National Notifiable Diseases Surveillance System

The authors used 1987 data from the Epidemiologic Surveillance Project (ESP) of the Centers for Disease Control to examine the completeness of race-ethnicity reporting in the National Notifiable Diseases Surveillance System. And, to the extent possible, they used ESP to assess racial and ethnic disparities in the occurrence of selected notifiable infectious diseases. For the 30 reporting areas (29 States and the District of Columbia) that provided data to ESP for all of calendar year 1987, approximately 60 percent of case reports were accompanied by specified race-ethnicity for affected persons. This percentage varied widely by disease and State. In general, non-Hispanic whites had morbidity rates (cases per 100,000 population per year) that were among the lowest compared with rates for other groups, and Native Americans commonly had rates that were among the highest. The ranking of morbidity rates among blacks, Hispanics, and Asians and Pacific Islanders varied by disease, although the last group had strikingly higher rates for malaria and tuberculosis. The age distribution of persons with cases was often lower among minority groups than among non-Hispanic whites, but the authors were unable to calculate age-specific or age-adjusted rates. Potential biases that limit interpretation of the findings are reviewed. Efforts to eliminate racial-ethnic disparities in the occurrence of infectious diseases would be aided by effective surveillance data. For the ESP to meet its potential in this regard, however, substantial improvements in the reporting of race-ethnicity for notifiable diseases are needed.     

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.     

Timeliness of national reporting of communicable diseases: the experience of the National Electronic Telecommunications System for Surveillance.

The timeliness of reporting four nationally notifiable diseases was examined using data reported via the National Electronic Telecommunications System for Surveillance. Timeliness of reporting varied by disease (bacterial meningitis: median 20 days; salmonellosis: median 22 days; shigellosis: median 23 days; and hepatitis A: median 33 days) and by state. These findings indicate a need to standardize surveillance definitions and to account for reporting differences between states in interpreting regional disease trends or detecting multistate disease outbreaks.     

Reporting race and ethnicity data--National Electronic Telecommunications System for Surveillance, 1994-1997

Reporting accurate and complete race and ethnicity data in public health surveillance systems provides critical information to target and evaluate public health interventions, particularly for minority populations. A national health objective for 2000 is to improve data collection on race and ethnicity in public health surveillance and data systems. To determine progress toward meeting this goal in CDC's National Electronic Telecommunications System for Surveillance (NETSS), the percentage of case reports of selected nationally notifiable diseases reported through NETSS with information regarding a patient's race and ethnicity was calculated for 1994-1997. The findings of this study indicate these data were received for approximately half of the cases, and the completeness of reporting of race and ethnicity data to NETSS had not improved.     

An intervention to improve notifiable disease reporting using ambulatory clinics

Strong notifiable disease surveillance systems are essential for disease control. We sought to determine if a brief informational session between clinic and health department employees followed by reminder faxes and a newsletter would improve reporting rates and timeliness in a notifiable disease surveillance system. Ambulatory clinics were randomized to an intervention group which received the informational session, a faxed reporting reminder and newsletter, or to a control group. Among intervention and control clinics, there were improvements in the number of cases reported and the timeliness of reporting. However, there were no statistically significant changes in either group. Despite improved communication between the health department and clinics, this intervention did not significantly improve the level or the timeliness of reporting. Other types of interventions should be considered to improve reporting such as simplifying the reporting process.     

Varicella surveillance practices--United States, 2004

Varicella became a reportable disease in the United States in 1972, with states reporting weekly aggregate data to the National Notifiable Disease Surveillance System (NNDSS). In 1981, varicella reporting was removed from the national notifiable diseases list because reporting of this common disease was becoming a burden in the absence of a vaccine. This action was followed by additional changes in varicella surveillance practices. In 1995, varicella vaccine was licensed and added to the routine childhood vaccination schedule. In 2002, the Council of State and Territorial Epidemiologists (CSTE) recommended that varicella casebased surveillance be implemented in all states by 2005; in 2003, varicella again was added to the national notifiable diseases list to allow for monitoring of the effect of varicella vaccine on varicella incidence. In 2004, to assess the progress in varicella surveillance in the United States, CDC surveyed immunization program managers in selected public health jurisdictions. This report describes the results of that survey, which indicated that substantial progress has been made toward the implementation of case-based surveillance as recommended by CSTE in 2002. As of 2004, however, 28 jurisdictions still had not implemented case-based surveillance. To monitor the effect of the vaccination program on the changing epidemiology of varicella disease, every state should now be conducting case-based surveillance for varicella. This is particularly important in light of the 2006 recommendation by the Advisory Committee on Immunization Practices for a routine second dose of varicella vaccine for children aged 4-6 years because enhanced surveillance is needed to further monitor varicella epidemiology.     

Evaluation of the National Notifiable Disease Surveillance System in Taiwan: an example of varicella reporting

Despite the mandatory reporting by laws, the incompleteness of notifiable infectious disease reporting is well-documented in many countries for various diseases. The purpose of this study is to investigate the completeness of varicella reporting in Taiwan. Annual reports of National Notifiable Disease Surveillance System in Taiwan were compared to the annual outpatient claims of National Health Insurance (NHI) in the years of 2000, 2001, and 2002. Age and area-specific reporting rates of varicella were calculated by dividing the respective reported cases by the number of incidence cases. The reporting rate was the highest in aged 0 year in all years, followed by the 20-29- and 30-39-year groups. The reporting rate in each age group increased gradually during the study period. Other than Taipei City, the reporting rates in all regions were below 9% during this period. This study suggested that varicella reporting rate is very low in Taiwan. In addition, the reporting rates were inconsistent in 2000-2002, making the estimation of prevalence and vaccine efficacy using data from the National Notifiable Disease Surveillance System almost impossible. This study indicated that the physicians in Taiwan should improve their knowledge and attitude toward notifiable infectious diseases.     

Automated detection and reporting of notifiable diseases using electronic medical records versus passive surveillance--massachusetts, June 2006-July 2007

Electronic medical record (EMR) systems have the potential to improve reporting of notifiable diseases beyond either traditional clinician-initiated or automated laboratory-based reporting systems. Traditional clinician-initiated passive surveillance is burdensome to clinicians and often incomplete and delayed. Electronic laboratory reporting addresses these limitations but often lacks information needed for public health purposes (e.g., patient signs and symptoms, prescribed treatments, and pregnancy status). Laboratory systems also do not integrate multiple laboratory tests to satisfy a case definition. Many EMRs, however, contain this information and store it in a form that is amenable to electronic analysis and reporting. Consequently, EMR-based reporting has the potential to provide active notifiable disease surveillance that is more timely, complete, and clinically detailed. This report summarizes findings from a pilot EMR-based electronic surveillance system in Massachusetts, which documented increases of 39% in reported chlamydia and 53% in reported gonorrhea for the period June 2006-July 2007, compared with the existing passive surveillance system. Eighty-one instances of pregnancy not identified by passive surveillance were reported by the electronic system in patients with chlamydia or gonorrhea. In addition, the electronic system identified 20 cases of pelvic inflammatory disease and four cases of acute hepatitis A, compared with none and one, respectively, reported via the passive system. Improved reporting can help public health departments better allocate limited resources for targeted investigations and interventions.     

2008年法定传染病监测报告管理工作抽样调查

目的了解医疗卫生机构法定传染病监测报告现状,发现我国传染病监测工作中存在的问题,分析问题存在的原因并提出相应的解决办法。方法以分阶段分层随机抽样方法抽取东部、中部和西部各2个省的168家医疗卫生机构作为受检单位,开展法定传染病监测报告质量调查。结果法定传染病监测报告质量在东部、中部和西部以及在不同级别的医疗机构之间的差异均有统计学意义(均有P<0.05)。结论法定传染病监测报告质量与东部、中部和西部的经济发展水平及专业人员培训情况有关。     

湖南省2005-2011年15岁以下人群乙肝流行病学监测分析

目的 通过分析、比较疾病监测信息报告管理系统（NNDRS）与中国免疫规划监测信息管理系统报告的＜15岁人群乙肝发病、诊断、发病因素等指标和信息,进一步了解目前湖南省乙肝报告工作的现况及可能存在的问题,推算湖南省乙肝流行的实际情况,为今后乙肝监测工作的改进和提高提供依据. 方法 利用Excel分析软件对两个系统报告的＜15岁人群乙肝的发病指标及相关信息进行分析和比较. 结果 湖南省15岁以下乙肝病例的流行病学监测质量逐年提高；乙肝病例诊断主要在县级及以上医疗单位；监测病例中仅有32.56％的病例符合疑似急性乙肝诊断标准；乙肝病例流行病学监测尚存在信息不完善的现象. 结论 对＜15岁人群乙肝病例进行监测、分析有利于准确掌握实施新生儿乙肝疫苗免疫策略以来取得的成效；法定传染病报告人对乙肝诊断标准掌握不够,诊断不明是造成乙肝疫情高估的重要原因之一.加强各级法定传染病报告人的乙肝诊断标准培训和疾控人员的乙肝监测培训及规范乙肝实验室诊断是今后湖南省提高乙肝疫情报告质量和监测水平的重要工作.     

Laboratory reporting and disease surveillance.

Disease surveillance is an important tool which is used to identify diseases that are hazardous to public health. Historically, surveillance systems were created to capture physician reports of notifiable diseases. However, state evaluations of surveillance systems found inadequacies with systems based solely on physician reporting. To improve these systems, most state health departments have required reports of laboratory tests used to diagnose notifiable diseases. This article has a brief summary of the benefits and limitations of laboratory reporting.     

The surveillance of communicable disease in Vermont: who reports?

The Vermont Department of Health reviewed 2,035 reports of selected notifiable diseases received from January 1, 1986, through December 31, 1987. Laboratories provided 1,160, or 71 percent, of the initial reports on 1,636 confirmed cases. This demonstrates that laboratories, when required by law and when part of active surveillance, can make a significant contribution to surveillance of infectious disease. A survey of primary care physicians indicated that 18 percent always reported notifiable diseases. The most frequently mentioned reason for lack of reporting was an assumption that the laboratory would report the cases.     

Sensitivity of the Swedish statutory surveillance system for communicable diseases 1998-2002, assessed by the capture-recapture method

To assess the sensitivity of the Swedish surveillance system, four notifiable communicable diseases in Sweden were examined during 1998-2002 with the two-sources capture-recapture method, based on parallel clinical and laboratory notifications. The sensitivity (proportion of diagnosed diseases actually being notified) was highest for salmonellosis (99.9%), followed by meningococcal infection (98.7%), and tularaemia (98.5%). For penicillin-resistant pneumococci, introduced as a notifiable disease in 1996, the overall sensitivity was 93.4%--increasing from 86.5% in 1998 to 98.5% in 2002. The system benefited from parallel reporting, with a sensitivity of clinical and laboratory notifications alone (all diseases combined) of 91.6% and 95.9% respectively. The sensitivity of both clinical and laboratory notifications was markedly higher in counties using the national electronic reporting system, SmiNet. Thus, sensitivity was higher for diseases with a long tradition of reporting, and there is a run-in period after a new disease becomes notifiable.