A Descriptive Analysis of Varicella Infections Among Patients Presenting to Emergency Departments in North Carolina

Varicella, or chickenpox, is a highly communicable infectious disease which, in the prevaccine era, contributed to significant morbidity and mortality among the general population, as well as resulted in substantial costs to society. Following US vaccine licensure in 1995, a significant decline in disease, hospitalizations, and deaths began and has continued. The Healthy People 2010 goal related to varicella is disease reduction; in contrast, the goal of the CDC is disease elimination. State and national vaccination rates have steadily risen since 1995, with a current national rate of 85%. Although significant decreases in disease are evident and vaccination rates have increased, cases of disease, hospitalizations, and deaths still occur. Surveillance is a necessary component of vaccination programs in order to monitor impact, identify factors that allow cases to continue to occur, and to guide state policy. The Council of State and Territorial Epidemiologists (CSTE) recommended that each state institute an ongoing surveillance system to monitor the impact of varicella vaccination on the incidence of varicella by 2005. In response to this recommendation, North Carolina implemented a sentinel ED surveillance system. The system, although efficient, has limitations, but the resulting data demonstrate a low incidence of disease in the Emergency Department setting with minimal burden on North Carolina emergency healthcare systems.Master of Public Healt

Syndromic Surveillance for Emerging Infections in Office Practice Using Billing Data

PURPOSE We wanted to evaluate the feasibility of conducting syndromic surveillance in a primary care office using billing data. METHODS A 1-year study was conducted in a primary care practice; comparison data were obtained from emergency department records of visits by county residents. Within the practice, a computer program converted billing data into de-identified daily summaries of International Classification of Diseases, Ninth Revision (ICD-9) codes by sex and age-group; and a staff member generated daily summaries and e-mailed them to the analysis team. For both the practice and the emergency departments, infection-related syndromes and practice-specific thresholds were calculated using the category 1 syndrome codes and an analyitical method based upon the Early Aberration Reporting System of the Centers for Disease Control and Prevention. RESULTS A mean of 253 ICD-9 codes per day was reported. The most frequently recorded syndromes were respiratory illness, gastrointestinal illness, and fever. Syndromes most commonly exceeding the threshold of 2 standard deviations for the practice were lymphadenitis, rash, and fever. Generating a daily summary took 1 to 2 minutes; the program was written by the software vendor for a fee of $1,500. During the 2003–2004 influenza season, trend line patterns of the emergency department visits reflected a pattern consistent with that of the state, whereas the trend line in primary case practice cases was less consistent, reflecting the variation expected in data from a single clinic. Still, spikes of activity that occurred in the practice before the emergency department suggest the practice may have seen patients with influenza earlier. CONCLUSIONS This preliminary study showed the feasibility of implementing syndromic surveillance in an office setting at a low cost and with minimal staff effort. Although many implementation issues remain, further development of syndromic surveillance systems should include primary care offices

Gastroenteritis Outbreak Associated with Unpasteurized Tempeh, North Carolina, USA

During an investigation of an outbreak of gastroenteritis caused by Salmonella enterica serovar Paratyphi B variant L(+) tartrate(+), we identified unpasteurized tempeh as a novel food vehicle and Rhizopus spp. starter culture as the source of the contamination. Safe handling of uncooked, unpasteurized tempeh should be emphasized for prevention of foodborne illnesses