1887
Surveillance and outbreak report Open Access
Like 0

Abstract

During August 2015, a boil water notice (BWN) was issued across parts of North West England following the detection of oocysts in the public water supply. Using prospective syndromic surveillance, we detected statistically significant increases in the presentation of cases of gastroenteritis and diarrhoea to general practitioner services and related calls to the national health telephone advice service in those areas affected by the BWN. In the affected areas, average in-hours general practitioner consultations for gastroenteritis increased by 24.8% (from 13.49 to 16.84) during the BWN period; average diarrhoea consultations increased by 28.5% (from 8.33 to 10.71). Local public health investigations revealed no laboratory reported cases confirmed as being associated with the water supply. These findings suggest that the increases reported by syndromic surveillance of cases of gastroenteritis and diarrhoea likely resulted from changes in healthcare seeking behaviour driven by the intense local and national media coverage of the potential health risks during the event. This study has further highlighted the potential for media-driven bias in syndromic surveillance, and the challenges in disentangling true increases in community infection from those driven by media reporting.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2016.21.41.30368
2016-10-13
2017-12-12
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.41.30368
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/21/41/eurosurv-21-30368-1.html?itemId=/content/10.2807/1560-7917.ES.2016.21.41.30368&mimeType=html&fmt=ahah

References

  1. Shirley DA, Moonah SN, Kotloff KL. Burden of disease from cryptosporidiosis. Curr Opin Infect Dis. 2012;25(5):555-63.  https://doi.org/10.1097/QCO.0b013e328357e569  PMID: 22907279 
  2. Leoni F, Amar C, Nichols G, Pedraza-Díaz S, McLauchlin J. Genetic analysis of Cryptosporidium from 2414 humans with diarrhoea in England between 1985 and 2000. J Med Microbiol. 2006;55(Pt 6):703-7.  https://doi.org/10.1099/jmm.0.46251-0  PMID: 16687587 
  3. Lima AA, Moore SR, Barboza MS Jr, Soares AM, Schleupner MA, Newman RD, et al. Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: a prospective cohort study among children in northeastern Brazil. J Infect Dis. 2000;181(5):1643-51.  https://doi.org/10.1086/315423  PMID: 10823764 
  4. Cama VA, Bern C, Roberts J, Cabrera L, Sterling CR, Ortega Y, et al. Cryptosporidium species and subtypes and clinical manifestations in children, Peru. Emerg Infect Dis. 2008;14(10):1567-74.  https://doi.org/10.3201/eid1410.071273  PMID: 18826821 
  5. Hunter PR, Nichols G. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev. 2002;15(1):145-54.  https://doi.org/10.1128/CMR.15.1.145-154.2002  PMID: 11781272 
  6. Sallon S, Deckelbaum RJ, Schmid II, Harlap S, Baras M, Spira DT. Cryptosporidium, malnutrition, and chronic diarrhea in children. Am J Dis Child. 1988;142(3):312-5. PMID: 3344720 
  7. Mac Kenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, et al. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331(3):161-7.  https://doi.org/10.1056/NEJM199407213310304  PMID: 7818640 
  8. Chalmers RM. Waterborne outbreaks of cryptosporidiosis. Ann Ist Super Sanita. 2012;48(4):429-46.  https://doi.org/10.4415/ANN_12_04_10  PMID: 23247139 
  9. Smith S, Elliot AJ, Mallaghan C, Modha D, Hippisley-Cox J, Large S, et al. Value of syndromic surveillance in monitoring a focal waterborne outbreak due to an unusual Cryptosporidium genotype in Northamptonshire, United Kingdom, June - July 2008. Euro Surveill. 2010;15(33):19643.  PMID: 20738999 
  10. Drinking Water Inspectorate, Health Protection Agency. Drinking water safety: guidance to health and water professionals. 11 November 2015. Available from: http://www.dwi.gov.uk/stakeholders/information-letters/2009/09_2009Annex.pdf
  11. Karagiannis I, Schimmer B, de Roda Husman AM. Compliance with boil water advice following a water contamination incident in the Netherlands in 2007. Euro Surveill. 2009;14(12):19156.  PMID: 19341604 
  12. Rundblad G, Knapton O, Hunter PR. Communication, perception and behaviour during a natural disaster involving a ‘Do Not Drink’ and a subsequent ‘Boil Water’ notice: a postal questionnaire study. BMC Public Health. 2010;10(1):641.  https://doi.org/10.1186/1471-2458-10-641  PMID: 20973959 
  13. Rundblad G, Knapton O, Hunter PR. The causes and circumstances of drinking water incidents impact consumer behaviour: Comparison of a routine versus a natural disaster incident. Int J Environ Res Public Health. 2014;11(11):11915-30.  https://doi.org/10.3390/ijerph111111915  PMID: 25411725 
  14. Willocks LJ, Sufi F, Wall R, Seng C, Swan AVOutbreak Investigation Team. Compliance with advice to boil drinking water during an outbreak of cryptosporidiosis. Commun Dis Public Health. 2000;3(2):137-8. PMID: 10902259 
  15. Angulo FJ, Tippen S, Sharp DJ, Payne BJ, Collier C, Hill JE, et al. A community waterborne outbreak of salmonellosis and the effectiveness of a boil water order. Am J Public Health. 1997;87(4):580-4.  https://doi.org/10.2105/AJPH.87.4.580  PMID: 9146435 
  16. Triple STriple S Project. Assessment of syndromic surveillance in Europe. Lancet. 2011;378(9806):1833-4.  https://doi.org/10.1016/S0140-6736(11)60834-9  PMID: 22118433 
  17. Elliot AJ, Morbey RA, Hughes HE, Harcourt SE, Smith S, Loveridge P, et al. Syndromic surveillance - a public health legacy of the London 2012 Olympic and Paralympic Games. Public Health. 2013;127(8):777-81.  https://doi.org/10.1016/j.puhe.2013.05.007  PMID: 23870845 
  18. Morbey RA, Elliot AJ, Charlett A, Verlander NQ, Andrews N, Smith GE. The application of a novel ‘rising activity, multi-level mixed effects, indicator emphasis’ (RAMMIE) method for syndromic surveillance in England. Bioinformatics. 2015;31(22):3660-5. PMID: 26198105 
  19. Public Health England (PHE). PHE Health Protection Teams. London: PHE; 25 November 2015. Available from: https://www.gov.uk/guidance/contacts-phe-health-protection-teams
  20. StataCorp. Stata/SE version 13.1. 2015. StataCorp LP. Available from: www.stata.com
  21. Olowokure B, Clark L, Elliot AJ, Harding D, Fleming A. Mumps and the media: changes in the reporting of mumps in response to newspaper coverage. J Epidemiol Community Health. 2007;61(5):385-8.  https://doi.org/10.1136/jech.2005.042598  PMID: 17435202 
  22. Olowokure B, Odedere O, Elliot AJ, Awofisayo A, Smit E, Fleming A, et al. Volume of print media coverage and diagnostic testing for influenza A(H1N1)pdm09 virus during the early phase of the 2009 pandemic. J Clin Virol. 2012;55(1):75-8.  https://doi.org/10.1016/j.jcv.2012.05.013  PMID: 22710009 
  23. Brownstein JS, Freifeld CC, Reis BY, Mandl KD. Surveillance Sans Frontières: Internet-based emerging infectious disease intelligence and the HealthMap project. PLoS Med. 2008;5(7):e151.  https://doi.org/10.1371/journal.pmed.0050151  PMID: 18613747 
/content/10.2807/1560-7917.ES.2016.21.41.30368
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error