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VIENNA – Widespread foodborne infectious-disease outbreaks pose the greatest challenge for detection, according to an analysis of 101 U.S. outbreaks during 1998-2008.
Two U.S. Salmonella outbreaks took 492 days and 251 days to detect, respectively, by far the longest lag from onset to detection of any of the outbreaks analyzed, said Heather Allen, Ph.D., at the International Meeting on Emerging Diseases and Surveillance.
In contrast, the entire group of 101 human or animal outbreaks during 1998-2008 with data available for analysis took a median 13 days to detect, and a mean 32 days, with more than three quarters of the outbreaks detected within 50 days, reported Dr. Allen, a public health analyst with LMI, a consulting company in McLean, Va. The results Dr. Allen reported came from a study she ran before becoming an LMI employee.
Median time to detection among outbreaks that extended beyond a single U.S. region was 35 days, compared with medians of 8-11 days for outbreaks confined to a single U.S. region (Northeast, Midwest, South, or West).
In cases of widespread foodborne outbreaks, "the cases trickle in and take a while for the number to build to where it is detected," Dr. Allen said.
The slow lag to report some foodborne U.S. outbreaks occurred despite use of best practices in those episodes, including PulseNet, a network of public health and food regulatory labs coordinated by the Centers for Disease Control and Prevention that apply molecular fingerprinting to isolates of Escherichia coli, Salmonella, and other foodborne pathogens.
Factors that may decrease reporting of infections and delay outbreak detection include awareness of the need to report, how busy practitioners are, the ease of reporting, and privacy concerns of patients or animal owners. The delay between a positive infection result and reporting it to a state or federal agent can be significant, and results in large differences in response times, Dr. Allen said in an interview.
"All human disease reporting to the federal level is voluntary; reporting to the state is governed by state laws and regulations."
Published records from sources such as Morbidity and Mortality Weekly Report and ProMED-Mail included 440 outbreaks during 1998-2008; Dr. Allen had data for analysis from 101 of these outbreaks. About two-thirds were in people, 16% in domestic animals, and 18% in people and animals. Initial reporting of the outbreak by a laboratory happened in 46% of the episodes, practitioners gave the initial report for 34%, and state agencies first reported 20%. State agencies had the longest average delay, 29 days, compared with roughly 10 days when either practitioners or labs made the first report.
Dr. Allen had no disclosures.
On Twitter @mitchelzoler
Detecting infectious outbreaks worldwide has gotten faster, but does that make a difference for outcomes? Although it makes intuitive sense that faster is better, right now we lack evidence to prove that.
My associates and I reported results in 2010 showing that the time to detection of infection outbreaks had dropped worldwide during 1996-2008 (Proc. Nat. Acad. Sci. 2010;107:21701-6). We studied records for 281 outbreaks verified by the World Health Organization during that period, and found that the median time from outbreak start to discovery fell from 30 days in 1996 to 14 days in 2008. Dr. Allen’s results were consistent with ours, and I think this trend is very real. We are definitely getting faster in identifying and reporting outbreaks. Part of that is likely because of improved communications and automated communications.
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The problem with foodborne outbreaks is that often cases are not concentrated in one area, so you need to exceed the case threshold for the whole country before they are detected.
A big factor for outbreak detection is an astute primary-care physician who is on the lookout for an infection that doesn’t make sense. Something like severe respiratory illness in an otherwise healthy, young adult should raise a warning flag to call your local public health agency. Electronic reporting systems have been critical to reduced times for outbreak detection, but the best way to detect an outbreak is when someone recognizes something out of the ordinary, that doesn’t make sense.
Dr. Timothy F. Brewer is an infectious diseases physician and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles. He said that he had no disclosures. He made these comments in an interview.
Detecting infectious outbreaks worldwide has gotten faster, but does that make a difference for outcomes? Although it makes intuitive sense that faster is better, right now we lack evidence to prove that.
My associates and I reported results in 2010 showing that the time to detection of infection outbreaks had dropped worldwide during 1996-2008 (Proc. Nat. Acad. Sci. 2010;107:21701-6). We studied records for 281 outbreaks verified by the World Health Organization during that period, and found that the median time from outbreak start to discovery fell from 30 days in 1996 to 14 days in 2008. Dr. Allen’s results were consistent with ours, and I think this trend is very real. We are definitely getting faster in identifying and reporting outbreaks. Part of that is likely because of improved communications and automated communications.
|
|
The problem with foodborne outbreaks is that often cases are not concentrated in one area, so you need to exceed the case threshold for the whole country before they are detected.
A big factor for outbreak detection is an astute primary-care physician who is on the lookout for an infection that doesn’t make sense. Something like severe respiratory illness in an otherwise healthy, young adult should raise a warning flag to call your local public health agency. Electronic reporting systems have been critical to reduced times for outbreak detection, but the best way to detect an outbreak is when someone recognizes something out of the ordinary, that doesn’t make sense.
Dr. Timothy F. Brewer is an infectious diseases physician and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles. He said that he had no disclosures. He made these comments in an interview.
Detecting infectious outbreaks worldwide has gotten faster, but does that make a difference for outcomes? Although it makes intuitive sense that faster is better, right now we lack evidence to prove that.
My associates and I reported results in 2010 showing that the time to detection of infection outbreaks had dropped worldwide during 1996-2008 (Proc. Nat. Acad. Sci. 2010;107:21701-6). We studied records for 281 outbreaks verified by the World Health Organization during that period, and found that the median time from outbreak start to discovery fell from 30 days in 1996 to 14 days in 2008. Dr. Allen’s results were consistent with ours, and I think this trend is very real. We are definitely getting faster in identifying and reporting outbreaks. Part of that is likely because of improved communications and automated communications.
|
|
The problem with foodborne outbreaks is that often cases are not concentrated in one area, so you need to exceed the case threshold for the whole country before they are detected.
A big factor for outbreak detection is an astute primary-care physician who is on the lookout for an infection that doesn’t make sense. Something like severe respiratory illness in an otherwise healthy, young adult should raise a warning flag to call your local public health agency. Electronic reporting systems have been critical to reduced times for outbreak detection, but the best way to detect an outbreak is when someone recognizes something out of the ordinary, that doesn’t make sense.
Dr. Timothy F. Brewer is an infectious diseases physician and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles. He said that he had no disclosures. He made these comments in an interview.
VIENNA – Widespread foodborne infectious-disease outbreaks pose the greatest challenge for detection, according to an analysis of 101 U.S. outbreaks during 1998-2008.
Two U.S. Salmonella outbreaks took 492 days and 251 days to detect, respectively, by far the longest lag from onset to detection of any of the outbreaks analyzed, said Heather Allen, Ph.D., at the International Meeting on Emerging Diseases and Surveillance.
In contrast, the entire group of 101 human or animal outbreaks during 1998-2008 with data available for analysis took a median 13 days to detect, and a mean 32 days, with more than three quarters of the outbreaks detected within 50 days, reported Dr. Allen, a public health analyst with LMI, a consulting company in McLean, Va. The results Dr. Allen reported came from a study she ran before becoming an LMI employee.
Median time to detection among outbreaks that extended beyond a single U.S. region was 35 days, compared with medians of 8-11 days for outbreaks confined to a single U.S. region (Northeast, Midwest, South, or West).
In cases of widespread foodborne outbreaks, "the cases trickle in and take a while for the number to build to where it is detected," Dr. Allen said.
The slow lag to report some foodborne U.S. outbreaks occurred despite use of best practices in those episodes, including PulseNet, a network of public health and food regulatory labs coordinated by the Centers for Disease Control and Prevention that apply molecular fingerprinting to isolates of Escherichia coli, Salmonella, and other foodborne pathogens.
Factors that may decrease reporting of infections and delay outbreak detection include awareness of the need to report, how busy practitioners are, the ease of reporting, and privacy concerns of patients or animal owners. The delay between a positive infection result and reporting it to a state or federal agent can be significant, and results in large differences in response times, Dr. Allen said in an interview.
"All human disease reporting to the federal level is voluntary; reporting to the state is governed by state laws and regulations."
Published records from sources such as Morbidity and Mortality Weekly Report and ProMED-Mail included 440 outbreaks during 1998-2008; Dr. Allen had data for analysis from 101 of these outbreaks. About two-thirds were in people, 16% in domestic animals, and 18% in people and animals. Initial reporting of the outbreak by a laboratory happened in 46% of the episodes, practitioners gave the initial report for 34%, and state agencies first reported 20%. State agencies had the longest average delay, 29 days, compared with roughly 10 days when either practitioners or labs made the first report.
Dr. Allen had no disclosures.
On Twitter @mitchelzoler
VIENNA – Widespread foodborne infectious-disease outbreaks pose the greatest challenge for detection, according to an analysis of 101 U.S. outbreaks during 1998-2008.
Two U.S. Salmonella outbreaks took 492 days and 251 days to detect, respectively, by far the longest lag from onset to detection of any of the outbreaks analyzed, said Heather Allen, Ph.D., at the International Meeting on Emerging Diseases and Surveillance.
In contrast, the entire group of 101 human or animal outbreaks during 1998-2008 with data available for analysis took a median 13 days to detect, and a mean 32 days, with more than three quarters of the outbreaks detected within 50 days, reported Dr. Allen, a public health analyst with LMI, a consulting company in McLean, Va. The results Dr. Allen reported came from a study she ran before becoming an LMI employee.
Median time to detection among outbreaks that extended beyond a single U.S. region was 35 days, compared with medians of 8-11 days for outbreaks confined to a single U.S. region (Northeast, Midwest, South, or West).
In cases of widespread foodborne outbreaks, "the cases trickle in and take a while for the number to build to where it is detected," Dr. Allen said.
The slow lag to report some foodborne U.S. outbreaks occurred despite use of best practices in those episodes, including PulseNet, a network of public health and food regulatory labs coordinated by the Centers for Disease Control and Prevention that apply molecular fingerprinting to isolates of Escherichia coli, Salmonella, and other foodborne pathogens.
Factors that may decrease reporting of infections and delay outbreak detection include awareness of the need to report, how busy practitioners are, the ease of reporting, and privacy concerns of patients or animal owners. The delay between a positive infection result and reporting it to a state or federal agent can be significant, and results in large differences in response times, Dr. Allen said in an interview.
"All human disease reporting to the federal level is voluntary; reporting to the state is governed by state laws and regulations."
Published records from sources such as Morbidity and Mortality Weekly Report and ProMED-Mail included 440 outbreaks during 1998-2008; Dr. Allen had data for analysis from 101 of these outbreaks. About two-thirds were in people, 16% in domestic animals, and 18% in people and animals. Initial reporting of the outbreak by a laboratory happened in 46% of the episodes, practitioners gave the initial report for 34%, and state agencies first reported 20%. State agencies had the longest average delay, 29 days, compared with roughly 10 days when either practitioners or labs made the first report.
Dr. Allen had no disclosures.
On Twitter @mitchelzoler
AT IMED2013
Major finding: Infection outbreaks in multiple U.S. regions took a median 35 days to detect compared with about 10 days for localized outbreaks.
Data source: Data came from analysis of published reports on 101 U.S. infection outbreaks during 1998-2008.
Disclosures: Dr. Allen had no disclosures.
