Communicable Disease Reporting, NC, USA | CDC EID

EID Journal Home > Volume 17, Number 1–January 2011
Volume 17, Number 1–January 2011
Research
Completeness of Communicable Disease Reporting, North Carolina, USA, 1995–1997 and 2000–2006

Emily E. Sickbert-Bennett, Comments to Author David J. Weber, Charles Poole, Pia D.M. MacDonald, and Jean-Marie Maillard
Author affiliations: University of North Carolina Health Care System, Chapel Hill, North Carolina, USA (E.E. Sickbert-Bennett, D.J. Weber); University of North Carolina, Chapel Hill (E.E. Sickbert-Bennett, D.J. Weber, C. Poole, P.D.M. MacDonald); and North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA (J.-M. Maillard)

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Abstract
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.

Surveillance has been the cornerstone of public health since the US Congress authorized the Public Health Service to collect morbidity data for cholera, smallpox, plague, and yellow fever in 1878. Currently, all states conduct notifiable disease surveillance following guidelines from the Centers for Disease Control and Prevention (CDC) and the Council for State and Territorial Epidemiologists. The current list of nationally notifiable communicable diseases has expanded to >60 diseases and includes vaccine-preventable diseases (e.g., pertussis, measles), emerging infectious diseases (e.g., severe acute respiratory syndrome, West Nile virus encephalitis), foodborne diseases (e.g., Shiga toxin–producing Escherichia coli and Salmonella spp. infections), sexually transmitted diseases (e.g., syphilis, HIV), and aerosol and droplet transmitted diseases (e.g., tuberculosis, meningococcal meningitis). Active surveillance programs conducted by CDC in conjunction with certain states include Active Bacterial Core surveillance, FoodNet, and influenza-related hospitalization surveillance. Surveillance of epidemiologically important diseases provides critical information to clinicians and public health officials for use in measuring disease incidence in communities, recognizing disease outbreaks, assessing prevention and control measure effectiveness, allocating public health resources, and further clarifying the epidemiology of new and emerging pathogens (1).

Like all US states, North Carolina has state laws and regulations mandating communicable disease reporting (2–4). The state relies on physicians and laboratories to comply with the directive to report diseases and laboratory results indicative of diseases considered a threat to public health. During the periods of this study (1995–1997, 2000–2006), mandatory reporting was required for >60 diseases. Conditions and disease reports consisted of paper communicable-disease report forms that contained demographic, clinical, and risk factor data for the case-patient. These reports were required to be submitted to the health department within a specified period (i.e., immediately, within 24 hours, or within 7 days), depending on the disease. An important change to the communicable disease surveillance system of the North Carolina Department of Health and Human Services (NC DHHS) occurred when the state administrative code was amended in September 1998 to require that persons in charge of diagnostic laboratories report positive laboratory results for most diseases already reportable by physicians (2). This dual reporting mechanism was intended to improve completeness, timeliness, and accuracy of surveillance. More recently, in 2002, surveillance efforts have also expanded with the introduction of 7 regional public health teams and 11 hospital-based public health epidemiologists.

Despite the widespread use of these surveillance data, systematic data collection based on mandatory physician and laboratory reporting has never been extensively evaluated. To date, only 2 evaluations have examined reporting proportions for >5 diseases (5,6). Previous studies examining the completeness of disease reporting have differed considerably in terms of the following factors: size of geographic region (e.g., from clinics at a single university to multiple states), range of study period (e.g., several months to several years), heterogeneity of reporting systems (e.g., health care provider–based passive reporting vs. health care provider– and laboratory-based passive reporting), and various patient ascertainment methods (e.g., laboratory records, billing records, active surveillance, death certificates). This variability renders study results difficult to compare or aggregate. Therefore, we undertook a comprehensive study of reporting completeness with an analysis of 53 reportable diseases and conditions in selected health care systems across North Carolina over a 10-year period to estimate disease-specific reporting proportions, describe changes to reporting over time, and examine the variability of reporting completeness between health care facilities.

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