Mandatory reporting of diseases and conditions by health care professionals and laboratories

Medicolegal aspects of domestic violence against children

The routine of the dental profession exposes dentists not only to medical challenges but also to ethical and legal ones. Compared to other physicians, dentists are more likely to encounter children who are victims of domestic violence. This reality exposes them to legal liability due to the reporting obligations and the risk of misdiagnosing injuries. This paper aims to examine the importance of dentists in diagnosing injuries to children caused by domestic violence and the inherent dangers of failing to make such a diagnosis.

Leveraging technology in public-private partnerships: a model to address public health inequities

Long-standing inequities in healthcare access and outcomes exist for underserved populations. Public-private partnerships (PPPs) are where the government and a private entity jointly invest in the provision of public services. Using examples from the Health Equity Consortium (HEC), we describe how technology was used to facilitate collaborations between public and private entities to address health misinformation, reduce vaccine hesitancy, and increase access to primary care services across various underserved communities during the COVID-19 pandemic. We call out four enablers of effective collaboration within the HEC-led PPP model, including: 1. Establishing trust in the population to be served 2. Enabling bidirectional flow of data and information 3. Mutual value creation and 4. Applying analytics and AI to help solve complex problems. Continued evaluation and improvements to the HEC-led PPP model are needed to address post-COVID-19 sustainability.

How adequate is measles surveillance in the United States? Investigations of measles-like illness, 2010-2017

Given the availability of an effective and safe vaccine, the World Health Organization (WHO) declared that global measles eradication is achievable, and measles elimination goals have since been established as interim steps toward eradication. As part of a strategy to maintain elimination, the Pan American Health Organization (PAHO) and WHO stipulate a minimum annual reporting rate of discarded non-measles cases of ≥2 per 100,000 population, in order to ensure sensitive surveillance and adequate investigative effort. With its effective vaccination program, the United States in 2000 was among the first countries to verify elimination, although subsequently, it has not routinely reported discarded rates. We estimated MLI investigation rates among insured individuals during 2010-2017, using data from the MarketScan® databases. We defined "MLI investigations" as measles serologic testing within 5 days following diagnostic codes for measles-compatible symptoms and conditions. We provide a rationale for pre-specifying three subgroups for analysis: children aged ≤15 years; males aged 16-22 years excluding data from summer months; and males aged ≥23 years. MLI investigation rates ranged from 6.6─26.4 per 100,000, remaining stable over time except during the 2015 measles outbreaks when rates increased, particularly among young children. In addition to high vaccine uptake, measles elimination requires ongoing vigilance by clinicians and high-quality, case-based surveillance. Estimated rates of MLI investigations in this U.S. population suggesting that the quality of measles surveillance is sufficiently sensitive to detect endemic measles circulation if it were to be occurring.

Public Health Surveillance for Zika Virus: Data Interpretation and Report Validity

Zika virus provides an example for which public health surveillance is based primarily on health care provider notifications to health departments of potential cases. This case-based surveillance is commonly used to understand the spread of disease in a population. However, case-based surveillance is often biased-whether testing is done and which tests are used and the accuracy of the results depend on a variety of factors including test availability, patient demand, perceptions of transmission, and patient and provider awareness, leading to surveillance artifacts that can provide misleading information on the spread of a disease in a population and have significant public health practice implications. To better understand this challenge, we first summarize the process that health departments use to generate surveillance reports, then describe factors influencing testing and reporting patterns at the patient, provider, and contextual level. We then describe public health activities, including active surveillance, that influence both patient and provider behavior as well as surveillance reports, and conclude with a discussion about the interpretation of surveillance data and approaches that could improve the validity of surveillance reports.

Global Research on Syndromic Surveillance from 1993 to 2017: Bibliometric Analysis and Visualization

Syndromic Surveillance aims at analyzing medical data to detect clusters of illness or forecast disease outbreaks. Although the research in this field is flourishing in terms of publications, an insight of the global research output has been overlooked. This paper aims at analyzing the global scientific output of the research from 1993 to 2017. To this end, the paper uses bibliometric analysis and visualization to achieve its goal. Particularly, a data processing framework was proposed based on citation datasets collected from Scopus and Clarivate Analytics’ Web of Science Core Collection (WoSCC). The bibliometric method and Citespace were used to analyze the institutions, countries, and research areas as well as the current hotspots and trends. The preprocessed dataset includes 14,680 citation records. The analysis uncovered USA, England, Canada, France and Australia as the top five most productive countries publishing about Syndromic Surveillance. On the other hand, at the Pinnacle of academic institutions are the US Centers for Disease Control and Prevention (CDC). The reference co-citation analysis uncovered the common research venues and further analysis of the keyword cooccurrence revealed the most trending topics. The findings of this research will help in enriching the field with a comprehensive view of the status and future trends of the research on Syndromic Surveillance.

Disease surveillance data sharing for public health: the next ethical frontiers

In the recent years, we have been witnessing a digital revolution in public and global health creating unprecedented opportunities for epidemic intelligence and public health emergencies. However, these opportunities created a double edge sword as access to data, quality monitoring and assurance, as well as governance and regulation frameworks for data privacy are lagging behind technological achievements.In this paper we identify three ethical challenges: sharing data across various early warning tools to support risk assessment. Secondly, define the challenges to be addressed by the legal frameworks for public health data sharing to unlock the potential of population-level datasets for research with no impact on citizens privacy. The third challenge lies with stricter regulation of the IT industry with regards to manipulating user data - such an initiative, GDPR, comes to force in the EU in May 2018.

Health Care Provider Knowledge and Attitudes Regarding Reporting Diseases and Events to Public Health Authorities in Tennessee

CONTEXT

In the United States, state laws require health care providers to report specific diseases and events to public health authorities, a fundamental facet of disease surveillance. However, reporting by providers is often inconsistent, infrequent, and delayed.

OBJECTIVE

To examine knowledge, attitudes, and practices regarding provider disease reporting and to understand current barriers to provider disease reporting.

DESIGN

A cross-sectional study was conducted via an anonymous, standardized electronic survey.

SETTING

The survey was conducted at Vanderbilt University Medical Center, a large, tertiary academic medical center in Nashville, Tennessee.

PARTICIPANTS

Health care providers in 4 specialties (internal medicine, pediatrics, obstetrics-gynecology, and emergency medicine).

MAIN OUTCOME MEASURE(S)

Knowledge of and attitudes regarding provider reporting of diseases to public health authorities in Tennessee.

RESULTS

The majority of providers acknowledged they cared for patients with reportable diseases (362/435, 83.2%) and believed that it was their responsibility to report to public health authorities (429/436, 98.4%); however, less than half had ever reported a case (206/436, 47.2%). The median percent correct on the knowledge assessment of Tennessee reportable diseases and conditions was 81.3% (interquartile range = 68.8-87.5). Providers cited a lack of knowledge of which diseases are reportable (186/429, 43.3%) and the logistics of reporting (153/429, 35.7%) as the primary barriers for compliance.

CONCLUSION

Most providers acknowledged they cared for patients with reportable diseases and believed they had an obligation to report to public health authorities. However, a lack of knowledge about reporting was frequently described as a limitation to report effectively. Many knowledge deficits were significantly greater among residents than other providers.The policy and practice implications of these findings include a demonstrated need for education of providers about disease reporting as well as development of more convenient reporting mechanisms. Fundamental knowledge of reportable disease requirements and procedures is critical for participation in the broader public health system.

Health care providers' compliance with the notifiable diseases surveillance system in South Africa

Background

The optimal performance of a notifiable disease surveillance system (NDSS) is dependent on health care provider (HCP) compliance with communicable disease notification. HCP compliance ensures appropriate investigation and control measures by relevant health care authorities. This study examines the compliance of HCPs with the NDSS in South Africa and factors associated with their compliance.

Methods

A cross-sectional survey was carried out in three randomly selected provinces. We stratified by type of facility, and recruited clusters of HCPs on survey day to participate. All consenting HCPs in the randomly selected health care facilities on the day of the survey, completed a questionnaire that elicited information on socio-demographic characteristics and notification practices. The data were analysed using STATA^® 14, using the identifiers for stratum and cluster as well as the calculated sampling weights.

Results

The study found that 58% of 919 HCPs diagnosed a notifiable disease in the year preceding the survey. The majority of these professionals (92%) indicated that they had reported the disease, but only 51% of those notified the disease/s correctly to the Department of Health. Paediatricians were less likely to notify correctly (OR 0.01, 95% CI 0.00–0.12, p = 0.001). The factors that influenced notification were HCPs perceptions of workload (OR 0.84, 95% CI 0.70–0.99, p = 0.043) and that notification data are not useful (OR 0.84, 95% CI 0.71–0.99, p = 0.040). The study found no association between correct notification and HCPs’ willingness to notify, experience or training on the NDSS, understanding of the purpose of the NDSS, knowledge of what to notify, or perception of feedback given.

Conclusions

The compliance of HCPs in South Africa with the NDSS is suboptimal. In light of the important role of HCPs in the effective functioning of the NDSS, information on NDSS usefulness and guidelines on correct notification procedures are needed to increase their compliance.

Estimating the prevalence of infectious diseases from under-reported age-dependent compulsorily notification databases

Background

National or local laws, norms or regulations (sometimes and in some countries) require medical providers to report notifiable diseases to public health authorities. Reporting, however, is almost always incomplete. This is due to a variety of reasons, ranging from not recognizing the diseased to failures in the technical or administrative steps leading to the final official register in the disease notification system. The reported fraction varies from 9 to 99% and is strongly associated with the disease being reported.

Methods

In this paper we propose a method to approximately estimate the full prevalence (and any other variable or parameter related to transmission intensity) of infectious diseases. The model assumes incomplete notification of incidence and allows the estimation of the non-notified number of infections and it is illustrated by the case of hepatitis C in Brazil. The method has the advantage that it can be corrected iteratively by comparing its findings with empirical results.

Results

The application of the model for the case of hepatitis C in Brazil resulted in a prevalence of notified cases that varied between 163,902 and 169,382 cases; a prevalence of non-notified cases that varied between 1,433,638 and 1,446,771; and a total prevalence of infections that varied between 1,597,540 and 1,616,153 cases.

Conclusions

We conclude that the model proposed can be useful for estimation of the actual magnitude of endemic states of infectious diseases, particularly for those where the number of notified cases is only the tip of the iceberg. In addition, the method can be applied to other situations, such as the well-known underreported incidence of criminality (for example rape), among others.

Characteristics of Laws Requiring Physicians to Report Patient Information for Public Health Surveillance: Notable Patterns from a Nevada Case Study

Laws across the globe require healthcare providers to disclose patient health information to public health entities for surveillance and intervention purposes. Physicians play a unique role in such mandatory reporting regimes. However, research reveals consistent under-reporting and points to limited knowledge of mandates, perceived burdens of reporting, misaligned incentives and penalties, and a lack of streamlined processes as significant reporting barriers. These barriers suggest that how legal mandates are structured may impact compliance; yet little research systematically examines their characteristics. Law-based reporting requirements differ across jurisdictions. Thus, we conducted a case study in the U.S. State of Nevada to characterize its physician mandatory reporting laws using legal mapping methodology. Nevada is a useful case study because it has few local jurisdictions and its legislature meets biennially. First, we searched key terms to find relevant state mandates and screened them using inclusion criteria. We then scanned near included provisions for additional requirements and incorporated requirements known a priori. We also searched relevant local regulations. Next, we analyzed all included provisions. Our findings indicate wide, intra-jurisdictional variation in reporting requirements across conditions. Variability extends to physician discretion, information reported, timing, recipient agencies, reporting processes, and implications of non-compliance. Local-level variation adds further complexity. Some relevant state requirements apply only to physicians and nearly one-third were absent from our searches. Our findings support exploring the hypothesis that reporting requirements' characteristics may impact compliance and call for empirically testing such relationships to enhance compliance and public health surveillance and intervention efforts.

Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings

BACKGROUND

In malaria elimination settings, all malaria cases must be identified, documented and investigated. To facilitate complete and timely reporting of all malaria cases and effective case management and follow-up, engagement with private providers is essential, particularly in settings where the private sector is a major source of healthcare. However, research on the role and performance of the private sector in malaria diagnosis, case management and reporting in malaria elimination settings is limited. Moreover, the most effective strategies for private sector engagement in malaria elimination settings remain unclear.

METHODS

Twenty-five experts in malaria elimination, disease surveillance and private sector engagement were purposively sampled and interviewed. An extensive review of grey and peer-reviewed literature on private sector testing, treatment, and reporting for malaria was performed. Additional in-depth literature review was conducted for six case studies on eliminating and neighbouring countries in Southeast Asia and Southern Africa.

RESULTS

The private health sector can be categorized based on their commercial orientation or business model (for-profit versus nonprofit) and their regulation status within a country (formal vs informal). A number of potentially effective strategies exist for engaging the private sector. Conducting a baseline assessment of the private sector is critical to understanding its composition, size, geographical distribution and quality of services provided. Facilitating reporting, referral and training linkages between the public and private sectors and making malaria a notifiable disease are important strategies to improve private sector involvement in malaria surveillance. Financial incentives for uptake of rapid diagnostic tests and artemisinin-based combination therapy should be combined with training and community awareness campaigns for improving uptake. Private sector providers can also be organized and better engaged through social franchising, effective regulation, professional organizations and government outreach.

CONCLUSION

This review highlights the importance of engaging private sector stakeholders early and often in the development of malaria elimination strategies.

State Health Department Requirements for Reporting of Antibiotic-Resistant Infections by Providers, United States, 2013 and 2015

Due to the high burden of antibiotic-resistant infections, several US states mandate public reporting of these infections. To examine the extent to which state departments of health require reporting of antibiotic-resistant infections, we abstracted data from lists of reportable conditions from all 50 states at 2 time points, May 2013 and May 2015. Requirements varied substantially by state. In 2015, most states (n = 44) required reporting of at least 1 antibiotic-resistant infection; vancomycin-intermediate and/or vancomycin-resistant Staphylococcus aureus was the most frequently reportable infection (n = 40). Few states required reporting of methicillin-resistant S aureus (n = 11), multidrug-resistant gram-negative bacteria (n = 9), or vancomycin-resistant enterococci (n = 8). During the 2 years we studied, 2013 and 2015, 4 states removed and 9 added at least 1 reporting requirement. The changes in reporting requirements suggest flexibility in health departments' response to local surveillance needs and emerging threats. Future studies should assess how data on antibiotic-resistant infections through different sources are used at the state level to drive prevention and control efforts.

Assessment of State Perinatal Hepatitis B Prevention Laws

INTRODUCTION

Identifying pregnant women with hepatitis B virus (HBV) infection for post-exposure prophylaxis of their infants is critical to preventing mother-to-child transmission of HBV infection. HBV infection in infancy results in premature death from chronic liver disease or cancer in 25% of affected infants. Universal screening of pregnant women for HBV infection is the standard of care, and in many states is supported by laws for screening and reporting these infections to public health. No recent assessment of state screening and reporting laws for HBV infection has been published.

METHODS

In 2014, the authors analyzed laws current through December 31, 2013 from U.S. jurisdictions (50 states and the District of Columbia) related to HBV infection and hepatitis B surface antigen screening and reporting requirements generally and for pregnant women specifically.

RESULTS

All states require reporting of cases of HBV infection. Twenty-six states require pregnant women to be screened. Thirty-three states require public health reporting of HBV infections in pregnant women, but only 12 states require reporting pregnancy status of women with HBV infection.

CONCLUSIONS

This assessment revealed significant variability in laws related to screening and reporting of HBV infection among pregnant women in the U.S. Implementing comprehensive HBV infection screening and reporting laws for pregnant women may facilitate identifying HBV-infected pregnant women and preventing HBV infection in their infants.

Estimated Annual Perinatal Hepatitis B Virus Infections in the United States, 2000-2009

BACKGROUND

Ninety percent of perinatal hepatitis B virus (HBV) infections result in chronic HBV (CHBV), which carries 25% risk of premature death from progressive liver injury, cirrhosis, and liver cancer. In 1990, the Centers for Disease Control and Prevention (CDC) funded Perinatal Hepatitis B Prevention Programs (PHBPP) to ensure postexposure prophylaxis for exposed infants and accelerate elimination of perinatal CHBV in the United States. From 2000 to 2009, the annual rates of perinatal CHBV reported by PHBPP (0.8%-2.4%) were consistently lower than expected rates from CDC models (3.0%-4.1%), suggesting that rates of CHBV might be higher among infants whose outcomes were not identified by PHBPP. To better understand the factors impacting modeled expected number and rates of perinatal CHBV, we examined historic CDC models, applied updated inputs to the 2009 CDC model, and performed sensitivity analyses over a range of parameter values.

METHODS

Models employed estimates of the annual number of births to hepatitis B surface antigen (HBsAg)-positive pregnant women, and data from PHBPP and National Immunization Surveys. Published literature provided prenatal HBsAg screening rates, efficacy of postexposure prophylaxis (PEP), and perinatal HBV transmission rates.

RESULTS

The updated 2009 model predicted 952 perinatal CHBV infections, equivalent to a baseline rate of 3.84%, among infants of HBsAg-positive women. Sensitivity analyses yielded a possible range of perinatal CHBV rates between 0.60% and 15.41%. The proportion of infants receiving timely PEP, the efficacy of PEP, and perinatal HBV transmission rate were major "drivers" of CHBV rates. Three-way sensitivity analysis yielded possible perinatal CHBV rates between 0.79% and 13.64%.

CONCLUSIONS

Modeling provided useful programmatic goals for achieving elimination of perinatal CHBV in the United States. Limitations of data inputs likely contributed to discrepancies between predicted and reported rates.

An exploratory analysis of individuals with multiple episodes of different reportable diseases, Montreal, 1990-2012

OBJECTIVES

Studies of public health reporting have only examined multiple episodes of the same communicable disease within an individual. We aimed to characterize Montreal residents with multiple reportable disease episodes from 1990 to 2012, while accounting for all types of reportable diseases.

STUDY DESIGN

Retrospective cohort study.

METHODS

We performed an exploratory analysis using descriptive statistics, contingency tables, and logistic regression.

RESULTS

There were 157,839 individuals with at least one disease report and a total of 179,455 disease reports. The 9.8% of subjects with more than one episode accounted for 20.7% of all reported episodes. Among subjects with four or fewer episodes, 54.0% were women, while 74.3% of subjects with five or more episodes were men. Subjects with multiple episodes were more likely to be reported for sexually transmitted infections than were persons with a single episode [difference of proportions: 10.4% (95% CI: 10.0%-10.9%)] and to reside in the neighbourhood encompassing Montreal's gay village.

CONCLUSIONS

Individuals with multiple communicable disease reports place a large burden on public health officials. These results may help guide investigation and prevention efforts to reduce the number of excess episodes.

Iatrogenic bacterial meningitis: an unmasked threat

Iatrogenic bacterial meningitis (IBM) is a rare but serious complication of neuraxial procedures, such as spinal and epidural anesthesia or lumbar puncture. We report a case of a 46-year-old female who presented to the emergency department with bacterial meningitis after spinal anesthesia. We reviewthe existing literature outlining the pathogenesis, vector hypothesis, diagnosis, treatment, and prevention as they relate to IBM. We highlight the role of the emergency physician in the rapid diagnosis of this disease, and underscore the need for sterile technique when performing lumbar punctures.

A public health approach to hepatitis C control in low- and middle-income countries

In light of new treatment regimens for hepatitis C, Amitabh Suthar and Anthony Harries outline a wider public health approach for tackling the disease.

Legal Authority for Infectious Disease Reporting in the United States: Case Study of the 2009 H1N1 Influenza Pandemic

Tracking of infectious diseases is a public health core function essential to disease prevention and control. Each state mandates reporting of certain infectious diseases to public health authorities. These laws vary by state, and the variation could affect the ability to collect critical information. The 2009 H1N1 influenza pandemic served as a case study to examine the legal authority in the 50 states; Washington, DC; and New York City for mandatory infectious disease reporting, particularly for influenza and new or emerging infectious diseases. Our study showed reporting laws to be generally present and functioning well; nevertheless, jurisdictions should be mindful of their mandated parameters and review the robustness of their laws before they face a new or emerging disease outbreak.

Legal and policy barriers to sharing data between public health programs in New York City: a case study

Integration of public health surveillance data within health departments is important for public health activities and cost-efficient coordination of care. Access to and use of surveillance data are governed by public health law and by agency confidentiality and security policies. In New York City, we examined public health laws and agency policies for data sharing across HIV, sexually transmitted disease, tuberculosis, and viral hepatitis surveillance programs. We found that recent changes to state laws provide greater opportunities for data sharing but that agency policies must be updated because they limit increased data integration. Our case study can help other health departments conduct similar reviews of laws and policies to increase data sharing and integration of surveillance data.

Description of outbreaks of health-care-associated infections related to compounding pharmacies, 2000-12

PURPOSE

Outbreaks of health-care-associated infections related to compounding pharmacies from 2000 through 2012 are described.

METHODS

PubMed and the websites for the Centers for Disease Control and Prevention and the Food and Drug Administration were searched to identify infectious outbreaks associated with compounding pharmacies outside the hospital setting between January 2000 and November 2012.

RESULTS

Between January 2000 and before the 2012 fungal meningitis outbreak, 11 outbreaks were identified, involving 207 infected patients and 17 deaths after exposure to contaminated compounded drugs. The 2012 meningitis outbreak had a similar mortality rate but increased these totals almost fivefold. Half of the outbreaks involved patients in more than one state. Three outbreaks involved ophthalmic drugs. The remaining outbreaks involved corticosteroids, heparin flush solutions, cardioplegia solution, i.v. magnesium sulfate, total parenteral nutrition, and fentanyl. The outbreaks were caused by pathogens commonly associated with health-care-associated infections, common skin commensals, and organisms that rarely cause infection. Morbidity was substantial, including vision loss. Half the outbreaks resulted in recall of all sterile drugs from the pharmacy due to systemic problems with sterile procedures.

CONCLUSION

Before the nationwide 2012 fungal meningitis outbreak, drugs produced by compounding pharmacies were associated with 11 other smaller, but equally serious, outbreaks that occurred sporadically over the past 12 years. Lapses in sterile compounding procedures led to contamination of compounded drugs, exposure to patients, and a threat to public health in these outbreaks. Recognition and subsequent public health investigation were usually triggered by the occurrence of illness among multiple patients in a single health care setting.

Experience of using information systems in public health practice: findings from a qualitative study

Objective

Data collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees.

Methods

We interviewed a purposive sample of 12 staff working in the key public health practice areas of communicable disease control, immunizations, and vital records from three LHDs in different states. Our interview questions addressed job descriptions, daily activities, and the use and perceptions of both data and IS in support of their work. A content analytic approach was used to derive themes and categories common across programmatic areas.

Results

Local public health involves the use of mix of state-supplied and locally implemented IS supported by paper records. Additionally, each LHD in this study used at least one shadow system to maintain a duplicate set of information. Experiences with IS functionality and the extent to which it supported work varied by programmatic area, but inefficiencies, challenges in generating reports, limited data accessibility, and workarounds were commonly reported.

Conclusions

Current approaches to data management and sharing do not always support efficient public health practice or allow data to be used for organizational and community decision making. Many of the challenges to effective and efficient public health work were not solely technological. These findings suggest the need for interorganizational collaboration, increasing organizational capacity, workflow redesign, and end user training.

Health Information in the Background: Justifying Public Health Surveillance Without Patient Consent

Often we think of collecting, storing, and using health data without patient consent as unethical and illegal. However, there are situations where the collection of health information without consent is not only ethical and legal, it is essential for community and public health. Public health surveillance – the ongoing, systematic collection, analysis, and interpretation of health-related data with the a priori purpose of preventing or controlling disease or injury, or identifying unusual events of public health importance, followed by the dissemination and use of information for public health action – allows the government to meet its ethical obligation to protect the health of the population. By adhering to public health ethics principles, public health surveillance systems, including pervasive information and computing technology (PICT), can be designed and implemented in ways that both honor individuals and protect communities.

Privacy and anonymity challenges when collecting data for public health purposes

Two contemporary problems face public health professionals in collecting data from health care providers: the de-identification of geospatial information in a manner that still allows meaningful analysis, and ensuring that provider performance data (e.g., infection or screening rates) is complete and accurate. In this paper, we discuss new methods for de-identifying geographic information that will allow useful de-identified data to be disclosed to public health. In addition, we propose privacy preserving mechanisms that will likely encourage providers to disclose complete and accurate data. However, this must be accompanied by steps to grow trust between the providers and public health.

Willingness to share personal health record data for care improvement and public health: a survey of experienced personal health record users

BACKGROUND

Data stored in personally controlled health records (PCHRs) may hold value for clinicians and public health entities, if patients and their families will share them. We sought to characterize consumer willingness and unwillingness (reticence) to share PCHR data across health topics, and with different stakeholders, to advance understanding of this issue.

METHODS

Cross-sectional 2009 Web survey of repeat PCHR users who were patients over 18 years old or parents of patients, to assess willingness to share their PCHR data with an-out-of-hospital provider to support care, and the state/local public health authority to support monitoring; the odds of reticence to share PCHR information about ten exemplary health topics were estimated using a repeated measures approach.

RESULTS

Of 261 respondents (56% response rate), more reported they would share all information with the state/local public health authority (63.3%) than with an out-of-hospital provider (54.1%) (OR 1.5, 95% CI 1.1, 1.9; p = .005); few would not share any information with these parties (respectively, 7.9% and 5.2%). For public health sharing, reticence was higher for most topics compared to contagious illness (ORs 4.9 to 1.4, all p-values < .05), and reflected concern about anonymity (47.2%), government insensitivity (41.5%), discrimination (24%). For provider sharing, reticence was higher for all topics compared to contagious illness (ORs 6.3 to 1.5, all p-values < .05), and reflected concern for relevance (52%), disclosure to insurance (47.6%) and/or family (20.5%).

CONCLUSIONS

Pediatric patients and their families are often willing to share electronic health information to support health improvement, but remain cautious. Robust trust models for PCHR sharing are needed.

Evaluation of knowledge resources for public health reporting logic: Implications for knowledge authoring and management

To control disease, laboratories and providers are required to report conditions to public health authorities. Reporting logic is defined in a variety of resources, but there is no single resource available for reporters to access the list of reportable events and computable reporting logic for any jurisdiction. In order to develop evidence-based requirements for authoring such knowledge, we evaluated reporting logic in the Council of State and Territorial Epidemiologist (CSTE) position statements to assess its readiness for automated systems and identify features that should be considered when designing an authoring interface; we evaluated codes in the Reportable Condition Mapping Tables (RCMT) relative to the nationally-defined reporting logic, and described the high level business processes and knowledge required to support laboratory-based public health reporting. We focused on logic for viral hepatitis. We found that CSTE tabular logic was unnecessarily complex (sufficient conditions superseded necessary and optional conditions) and was sometimes true for more than one reportable event: we uncovered major overlap in the logic between acute and chronic hepatitis B (52%), acute and Past and Present hepatitis C (90%). We found that the RCMT includes codes for all hepatitis criteria, but includes addition codes for tests not included in the criteria. The proportion of hepatitis variant-related codes included in RCMT that correspond to a criterion in the hepatitis-related position statements varied between hepatitis A (36%), acute hepatitis B (16%), chronic hepatitis B (64%), acute hepatitis C (96%), and past and present hepatitis C (96%). Public health epidemiologists have the need to communicate parameters other than just the name of a disease or organism that should be reported, such as the status and specimen sources. Existing knowledge resources should be integrated, harmonized and made computable. Our findings identified functionality that should be provided by future knowledge management systems to support epidemiologists as they communicate reporting rules for their jurisdiction.

Changes in fluoroquinolone use for gonorrhea following publication of revised treatment guidelines

OBJECTIVES

We evaluated the impact of revised national treatment recommendations on fluoroquinolone use for gonorrhea in selected states.

METHODS

We evaluated gonorrhea cases reported through the Sexually Transmitted Disease Surveillance Network as treated between July 1, 2006 and May 31, 2008, using interrupted time series analysis. Outcomes were fluoroquinolone treatment overall, by area, and by practice setting.

RESULTS

Of 16,126 cases with treatment dates in this period, 15,669 noted the medication used. After revised recommendations were released, fluoroquinolone use decreased abruptly overall (21.5%; 95% confidence interval [CI] = 15.9%, 27.2%), in most geographic areas evaluated, and in sexually transmitted disease clinics (28.5%; 95% CI = 19.0%, 37.9%). More gradual decreases were seen in primary care (8.6%; 95% CI = 2.6%, 14.6%), and in emergency departments, urgent care, and hospitals (2.7%; 95% CI = 1.7%, 3.7%).

CONCLUSIONS

Fluoroquinolone use decreased after the publication of revised national guidelines, particularly in sexually transmitted disease clinics. Additional mechanisms are needed to increase the speed and magnitude of changes in prescribing in primary care, emergency departments, urgent care, and hospitals.

A secure protocol for protecting the identity of providers when disclosing data for disease surveillance

BACKGROUND

Providers have been reluctant to disclose patient data for public-health purposes. Even if patient privacy is ensured, the desire to protect provider confidentiality has been an important driver of this reluctance.

METHODS

Six requirements for a surveillance protocol were defined that satisfy the confidentiality needs of providers and ensure utility to public health. The authors developed a secure multi-party computation protocol using the Paillier cryptosystem to allow the disclosure of stratified case counts and denominators to meet these requirements. The authors evaluated the protocol in a simulated environment on its computation performance and ability to detect disease outbreak clusters.

RESULTS

Theoretical and empirical assessments demonstrate that all requirements are met by the protocol. A system implementing the protocol scales linearly in terms of computation time as the number of providers is increased. The absolute time to perform the computations was 12.5 s for data from 3000 practices. This is acceptable performance, given that the reporting would normally be done at 24 h intervals. The accuracy of detection disease outbreak cluster was unchanged compared with a non-secure distributed surveillance protocol, with an F-score higher than 0.92 for outbreaks involving 500 or more cases.

CONCLUSION

The protocol and associated software provide a practical method for providers to disclose patient data for sentinel, syndromic or other indicator-based surveillance while protecting patient privacy and the identity of individual providers.

Evaluation of a communications campaign to increase physician reporting to a surveillance system

While all states have regulations requiring reporting of diseases from healthcare professionals and facilities, underreporting is substantial. To improve reporting to the New York State (NYS) Occupational Lung Disease Registry (OLDR), the NYS Department of Health's Bureau of Occupational Health initiated a multimedia campaign to increase case ascertainment and establish communication channels and partnerships for conducting prevention. The outreach campaign was successful in raising physician awareness about the OLDR, familiarizing physicians with reporting forms and procedures, and increasing physician reporting. It also raised awareness of the contribution of occupational factors to respiratory illness and other conditions. However, while our evaluation indicated it is possible to affect short-term outcomes, such as knowledge, attitudes, and behavior among health-care providers, the campaign was not as successful in promoting sustained reporting.

Use of hospital discharge data to evaluate notifiable disease reporting to Colorado's Electronic Disease Reporting System

OBJECTIVE

Notifiable disease surveillance systems are critical for communicable disease control, and accurate and timely reporting of hospitalized patients who represent the most severe cases is important. A local health department in metropolitan Denver used inpatient hospital discharge (IHD) data to evaluate the sensitivity, timeliness, and data quality of reporting eight notifiable diseases to the Colorado Electronic Disease Reporting System (CEDRS).

METHODS

Using IHD data, we detected hospitalized patients admitted from 2003 through 2005 with a discharge diagnosis associated with one of eight notifiable diseases. Initially, we compared all cases identified through IHD diagnoses fields with cases reported to CEDRS. Second, we chose four diseases and conducted medical record review to confirm the IHD diagnoses before comparison with CEDRS cases.

RESULTS

Relying on IHD diagnoses only, shigellosis, salmonellosis, and Neisseria meningitidis invasive disease had high sensitivity (> or = 90%) and timeliness (> or = 75%); legionellosis, pertussis, and West Nile virus infection were intermediate; and hepatitis A and Haemophilus influenzae (H. influenzae) invasive disease had low sensitivity (> or = 25%) and timeliness (< or = 33%). Medical record review improved the sensitivity to > or = 90% and timeliness to > or = 80% for H. influenza invasive disease, legionellosis, and pertussis; however, hepatitis A retained suboptimal sensitivity (67%) and timeliness (25%).

CONCLUSIONS

Hospital discharge data are useful for evaluating notifiable disease surveillance systems. Limitations encountered by using discharge diagnoses alone can be overcome by conducting medical record review. Public health agencies should conduct periodic surveillance system evaluations among hospitalized patients and reinforce notifiable disease reporting among the people responsible for this activity.

Pelvic inflammatory disease among privately insured women, United States, 2001-2005

BACKGROUND

We explored the utility of using insurance claims data for surveillance of pelvic inflammatory disease (PID). PID rates are an important indicator of population level trends in reproductive morbidity; however, data available to monitor PID trends are limited. National survey data are currently used to estimate PID rates in the United States, but a declining number of cases threaten their future usefulness.

METHODS

We performed a retrospective analysis of PID diagnosis rates using administrative claims data from 2001 to 2005. Diagnostic codes were used to identify women aged 15 to 44 in the study population that were diagnosed with acute PID as inpatients, in emergency departments, and in outpatient ambulatory settings.

RESULTS

Rates of PID diagnoses among privately insured women declined significantly from 2001 to 2005 among all age groups examined and within all geographic regions. Annual PID diagnosis rates decreased from 317.0 to 236.0 per 100,000 enrollees, representing a 25.5% decline over the study period. The highest rates of PID were among 25- to 29-year-olds (352.8 per 100,000 in 2005) and among those residing in the South (314.3 per 100,000 in 2005). Most women (70.1%) received PID care through physician offices and other outpatient facilities; of these women, approximately 40% were treated by an obstetrician/gynecologist.

CONCLUSIONS

The decline in PID diagnoses corresponds with previous reports from national surveys. Claims data offer a much needed new data source that will allow for continued monitoring of PID among a broad population in both inpatient and outpatient clinical settings.

Urgent care providers' knowledge and attitude about public health reporting and pertussis control measures: implications for informatics

OBJECTIVES

We assessed urgent care providers' knowledge about public health reporting, guidelines, and actions for the prevention and control of pertussis; attitudes about public health reporting and population-based data; and perception of reporting practices in their clinic.

METHODS

We identified the 106 providers (95% are physicians) employed in 28 urgent care clinics owned by Intermountain Healthcare located throughout Utah and Southern Idaho. We performed a descriptive, cross-sectional survey and assessed providers' knowledge, attitudes, beliefs, and behaviors associated with population-based data and public health mandates and recommendations. The online survey was completed between November 1, 2007, and February 29, 2008.

RESULTS

Among 63 practicing urgent care providers (60% response rate), 19 percent knew that clinically diagnosed pertussis was reportable, and only half (52%) the providers correctly responded about current pertussis vaccination recommendations. Most (35%-78%) providers did not know the prevention and control measures performed by public health practitioners after reporting occurs, including contact tracing, testing, treatment, and prophylaxis. Half (48%) the providers did not know that health department personnel can prescribe antibiotics for contacts of a reported case, and only 22 percent knew that health department personnel may perform diagnostic testing on contacts. Attitudes about reporting are variable, and reporting responsibility is diffused.

CONCLUSION

To improve our ability to meet public health goals, systems need to be designed that engage urgent care providers in the public health process, improve their knowledge and attitude about reporting, and facilitate the flow of information between urgent care and public health settings.

How do Iranian physicians report notifiable diseases? The first report from Iran

BACKGROUND

Epidemiologic surveillance through notifiable diseases is an essential component of a public health program. Surveillance systems relay mostly on physicians to report notifiable diseases The aim of this study was to identify physicians' knowledge about reporting of notifiable diseases as well as their self-reported practices and perceptions regarding disease reporting barriers and ways to improve compliance.

METHOD

A validated, reliable self-administered questionnaire addressing knowledge of notifiable diseases, self-reported practices, reasons for noncompliance with reporting requirements, and suggestions to improve compliance with reporting was distributed to 400 general physicians (GPs) attending medical conferences in Shiraz, Iran between March and July 2006. Knowledge was quantified by evaluating the answers to 45 questions (with 1 point awarded for each correct answer). Associations between the independent variables and physician knowledge were modeled using analysis of covariance.

RESULT

The response rate was 75%. The overall mean score was 17.03 +/- 7.45 (range, 4 to 31). Knowledge of the location of the posted notifiable diseases list was positively associated with score on knowledge questions (F = 4.431; P = .036). Fully 88% of the participants stated that they had never reported a notifiable disease. There was no significant association between the participants' self-reported practices and knowledge question scores. The major barriers to reporting notifiable diseases were the extra time required for reporting and poor knowledge of the list of reportable diseases and reporting requirements. The most frequent suggestions for improving physicians' compliance with disease reporting were to simplify the reporting process and to shift the responsibility for notification to another person, such as a secretary or a nurse.

CONCLUSION

Our findings suggest poor knowledge of disease notification requirements among GPs. Modifying physisicans' knowledge and motivation, eliminating barriers to disease reporting, and promoting some facilitating factors could help reduce the underreporting of notifiable diseases.

Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru): a prospective evaluation

Background

A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy.

Methods

40 Alerta reporting units (18 clinics and 22 ships) were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively.

Results

Timeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p < 0.001) and from 46.9% to 77.3% on ships (+30.4 [95% CI, +16.9 to +43.8]; p < 0.001). Visit and control groups did not show significant changes in timeliness. Error rates decreased in the visit group from 7.1% to 2% in clinics (-5.1 [95% CI, -8.7 to -1.4]; p = 0.007), but only from 7.3% to 6.7% on ships (-0.6 [95% CI, -2.4 to +1.1]; p = 0.445). Phone and control groups did not show significant improvement in data quality.

Conclusion

Regular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.

Electronic Support for Public Health: validated case finding and reporting for notifiable diseases using electronic medical data

Health care providers are legally obliged to report cases of specified diseases to public health authorities, but existing manual, provider-initiated reporting systems generally result in incomplete, error-prone, and tardy information flow. Automated laboratory-based reports are more likely accurate and timely, but lack clinical information and treatment details. Here, we describe the Electronic Support for Public Health (ESP) application, a robust, automated, secure, portable public health detection and messaging system for cases of notifiable diseases. The ESP application applies disease specific logic to any complete source of electronic medical data in a fully automated process, and supports an optional case management workflow system for case notification control. All relevant clinical, laboratory and demographic details are securely transferred to the local health authority as an HL7 message. The ESP application has operated continuously in production mode since January 2007, applying rigorously validated case identification logic to ambulatory EMR data from more than 600,000 patients. Source code for this highly interoperable application is freely available under an approved open-source license at http://esphealth.org.

Impact of electronic laboratory reporting on hepatitis A surveillance in New York City

BACKGROUND

The New York City Department of Health and Mental Hygiene (DOHMH) coordinates the administration of timely postexposure prophylaxis (PEP) to contacts of hepatitis A cases, making prompt disease reporting especially valuable. Electronic laboratory reporting (ELR) has been shown to improve timeliness of infectious disease reporting, and DOHMH began receiving hepatitis A reports via ELR in 2002.

OBJECTIVES

(1) to quantify the increase in the proportion of hepatitis A reports received electronically, (2) to assess how implementation of ELR affected the reporting time of hepatitis A, and (3) to assess how changes in reporting time impacted the ability to offer timely prophylaxis to contacts.

METHODS

We evaluated the proportion of reports received via ELR and the annual reporting time of all hepatitis A reports and quantified the individuals who received PEP from 2000 to 2006. The specific impact of ELR on laboratory reporting time was assessed for nine laboratories certified as of July 2006.

RESULTS

The proportion of hepatitis A reports received via ELR increased during the study period to 35 percent in 2006. Electronic laboratory reporting improved the reporting time for most of the laboratories certified to report electronically, with a median decrease of 17 days. In 2006, DOHMH administered PEP to 299 individuals; a fourfold increase from 2000.

CONCLUSIONS

Electronic laboratory reporting provides timely disease data to health departments. Increased utilization of ELR can have a remarkable impact on public health surveillance and response.

A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions

OBJECTIVES

We examined whether automated electronic laboratory reporting of notifiable-diseases results in information being delivered to public health departments more completely and quickly than is the case with spontaneous, paper-based reporting.

METHODS

We used data from a local public health department, hospital infection control departments, and a community-wide health information exchange to identify all potential cases of notifiable conditions that occurred in Marion County, Ind, during the first quarter of 2001. We compared traditional spontaneous reporting to the health department with automated electronic laboratory reporting through the health information exchange.

RESULTS

After reports obtained using the 2 methods had been matched, there were 4785 unique reports for 53 different conditions during the study period. Chlamydia was the most common condition, followed by hepatitis B, hepatitis C, and gonorrhea. Automated electronic laboratory reporting identified 4.4 times as many cases as traditional spontaneous, paper-based methods and identified those cases 7.9 days earlier than spontaneous reporting.

CONCLUSIONS

Automated electronic laboratory reporting improves the completeness and timeliness of disease surveillance, which will enhance public health awareness and reporting efficiency.

Incidence of neonatal herpes simplex virus infections in a managed-care population

OBJECTIVE

To determine the incidence of possible neonatal herpes simplex virus (HSV) infections, HSV infection status of women with infected infants, and use of measures to reduce risk of HSV transmission to the neonate in a large US managed-care population.

STUDY DESIGN

Retrospective analysis of administrative claims from the Integrated Health Care Information Services National Managed Care Benchmark database.

RESULTS

Of 233,487 infants born to 252,474 mothers from January 1997 to June 2002, the numbers assigned an ICD-9 code reflecting possible neonatal HSV infection </=30 and </=90 days of birth were 178 (0.08%) and 338 (0.15%), respectively. Of the 338 mothers delivering infants with possible neonatal HSV </=90 days postnatally, 12% had a prior HSV diagnosis, 5% were prescribed an antiviral medication during the study period, and 3% used antiviral medication and had a cesarean delivery.

CONCLUSION

These results support national surveillance of neonatal HSV to better define its incidence, strengthen health policies, and improve prevention and treatment.

Differences among U.S. states in estimating the number of people living with HIV/AIDS: impact on allocation of federal Ryan White funding

OBJECTIVE

We assessed the impact of differing laboratory reporting scenarios on the completeness of estimates of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) in the U.S., which are used to guide allocation of federal Ryan White funds.

METHODS

We conducted a four-year simulation study using clinical and laboratory data on 1,337 HIV-positive women, including 477 (36%) who did not have AIDS at baseline. We estimated the completeness of HIV (non-AIDS) case ascertainment for three laboratory reporting scenarios: CD4 < 200 cells/microL and detectable viral load (Scenario A); CD4 < 500 cells/microL and no viral load reporting (Scenario B); and CD4 < 500 cells/microL and detectable viral load (Scenario C).

RESULTS

Each scenario resulted in an increasing proportion of HIV (non-AIDS) cases being ascertained over time, with Scenario C yielding the highest by Year 4 (Year 1: 69.0%, Year 4: 88.1%), followed by Scenario A (Year 1: 63.3%, Year 4: 84.5%), and Scenario B (Year 1: 43.0%, Year 4: 67.7%). Overall completeness of PLWHA ascertainment after four years was highest for Scenario C (95.8%), followed by Scenario A (94.5%), and Scenario B (88.5%).

CONCLUSIONS

Differences in laboratory reporting regulations lead to substantial variations in the completeness of PLWHA estimates, and may penalize jurisdictions that are most successful at treating HIV/AIDS patients or those with weak or incomplete HIV/AIDS surveillance systems.

Pulmonary and cardiac infections in athletes

Pulmonary and cardiac infections in the athlete can have a wide range of presentations and complications. These infections may present few problems for the training athlete or become life threatening. The team physician must be able to make an accurate diagnosis, give the appropriate treatment, understand the potential complications, and ensure proper follow-up and return-to-play protocols.

Gonorrhea prevention and clinical care in the private sector: lessons learned and priorities for quality improvement

We reviewed literature on gonorrhea prevention and clinical care in the private sector, the setting where most gonorrhea cases in the United States are now diagnosed. Although most private-sector health settings had a low prevalence of gonorrhea (0.1-2.5%), some private emergency departments and specialty clinics that serve a large number of high-risk or infected patients had prevalences ranged from 1.7% to 11.0%. Studies of diverse settings and populations suggest that, in general, diagnostic testing of symptomatic patients (69-83%), appropriate treatment (61-100%), and case reporting (64-94%) are delivered more commonly than risk assessment for asymptomatic patients (15-28%), routine screening of pregnant women (31-77%), risk-reduction counseling (35-78%), and sex partner management (0-82%). To sustain the recent declines in gonorrhea incidence in the United States, private-sector providers and health systems must continue to offer gonorrhea prevention and clinical services and consider implementing interventions to improve delivery of risk assessment, risk-reduction counseling, and partner management services.

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.

Adequacy of surveillance to detect endemic rubella transmission in the United States

BACKGROUND

Reported rubella cases in the United States are at the lowest numbers since the introduction of vaccine, suggesting that endemic transmission may have been interrupted. It is necessary to validate that the observed absence of rubella is due to the disappearance of disease rather than a failure of rubella surveillance.

METHODS

Adequate rubella surveillance to detect ongoing transmission is characterized by evidence that rubella investigations are being conducted, detection of importations, and lack of spread from confirmed cases. We reviewed rubella surveillance data and activities from 5 sources: (1) data reported to the national surveillance system; (2) a survey of health departments and public health laboratories, including questions regarding any links between measles and rubella surveillance; (3) enhanced rubella surveillance activities in California and in New York City; (4) sentinel surveillance along the US-Mexico border; and (5) case detection in 8 large health maintenance organizations (HMOs).

RESULTS

During 2002-2004, 35 cases of rubella were reported to the national system, including 12 (34%) imported cases. The 39 programs that responded to our survey reported conducting 1482 investigations for rubella; according to another national survey, 1921 investigations were conducted for measles. Forty-one laboratories responded to our survey and reported conducting 6428 tests for acute rubella. No previously undetected (or unreported) cases of rubella or congenital rubella syndrome were identified by our survey or reviews of surveillance in California, New York, and along the US-Mexico border, and no additional cases were detected in the HMO database.

CONCLUSIONS

No previously unrecognized spread cases or outbreaks of rubella were detected. Surveillance in the United States is sufficiently sensitive to identify indigenous cases of rubella, if they were occurring, supporting the contention that rubella has been eliminated from the United States.

Incorporating vaccine-preventable disease surveillance into the National Health Information Network: leveraging children's hospitals

OBJECTIVE

Development of national biosurveillance systems to advance regional and national data exchange among sites of clinical care and public health authorities is a top federal priority, creating the opportunity to develop a unified national network for tracking and responding to cases of vaccine-preventable diseases. The purpose of this study was to assess the current practice and feasibility of developing a nationwide network of children's hospitals to conduct surveillance for vaccine preventable diseases.

METHODS

In 2004-2005, Web-based surveys were sent to 506 key hospital personnel from 119 pediatric hospitals, identified by the National Association of Children's Hospitals and Related Institutions. Surveys measured attitudes toward public health initiatives, willingness to join a surveillance network of children's hospitals, knowledge of mandated reporting requirements, methods of disease detection and reporting, and data sources available for surveillance.

RESULTS

A total of 395 (78%) respondents from 119 hospitals completed the survey. Surveillance at pediatric hospitals is largely passive and driven by unreimbursed efforts of infection control staff. It is vulnerable to missing cases that occur in the outpatient setting and are diagnosed clinically without laboratory confirmation or are never diagnosed by clinicians. Nearly 90% of hospital leaders are interested in participating in public health programs, and most are interested in a national network to conduct active surveillance for vaccine-preventable diseases, dependent on the provision of sufficient funding. Pediatric hospitals store records relevant to surveillance in an electronic fashion accessible to query, but <20% of these hospitals use automated methods to report cases of disease.

CONCLUSIONS

There is both the will and capability to create a robust active pediatric hospital-based reporting system for vaccine preventable diseases. This effort would dovetail well with the national priority to bolster surveillance, as well as with the goal of reducing morbidity and mortality from vaccine-preventable diseases.