Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning surveillance in South Florida

Elizabeth M. Begier, Lorraine C. Backer, Richard S Weisman, Roberta M. Hammond, Lora E. Fleming, Donna Blythe

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective. Ciguatera fish poisoning is a potentially life-threatening disease caused by eating coral reef fish contaminated with ciguatoxins and is the most common marine poisoning. However, existing surveillance systems capture few cases. To improve regional ciguatera surveillance in South Florida, this study compared ciguatera illnesses in the Florida Poison Information Center-Miami (FPICM) call database to ciguatera cases in the Florida Department of Health (FDOH) disease surveillance systems. Methods. Univariate and multivariate logistic regression were used to identify predictors of when FPICM reported ciguatera illnesses to FDOH and whether FDOH confirmed reported ciguatera cases. Results. FPICM staff preferentially reported ciguatera illnesses that were of shorter duration (adjusted odds ratio [AOR]=0.84 per additional illness day; 95% confidence interval [CI] 0.74, 0.97); outbreak-associated (AOR=7.0; 95% CI 2.5, 19.5); and clinically more severe (AOR=21.6; 95% CI 2.3, 198.5). Among ciguatera illnesses reported to FDOH, outbreak-associated illnesses were more likely than single, sporadic illnesses to become confirmed surveillance cases (crude OR=11.1; 95% CI 2.0, 62.5). Conclusions. The over-representation of outbreak-associated ciguatera cases underestimates the true contribution of sporadic illnesses to ciguatera disease burden. This bias should be considered when evaluating surveillance systems that include both outbreak-associated and sporadic illness reports.

Original languageEnglish
Pages (from-to)658-665
Number of pages8
JournalPublic Health Reports
Volume121
Issue number6
StatePublished - Nov 1 2006

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Ciguatera Poisoning
Disease Outbreaks
Information Centers
Poisons
Confidence Intervals
Odds Ratio
Health
Ciguatoxins
Coral Reefs
Sick Leave
Poisoning
Fishes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Begier, E. M., Backer, L. C., Weisman, R. S., Hammond, R. M., Fleming, L. E., & Blythe, D. (2006). Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning surveillance in South Florida. Public Health Reports, 121(6), 658-665.

Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning surveillance in South Florida. / Begier, Elizabeth M.; Backer, Lorraine C.; Weisman, Richard S; Hammond, Roberta M.; Fleming, Lora E.; Blythe, Donna.

In: Public Health Reports, Vol. 121, No. 6, 01.11.2006, p. 658-665.

Research output: Contribution to journalArticle

Begier, EM, Backer, LC, Weisman, RS, Hammond, RM, Fleming, LE & Blythe, D 2006, 'Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning surveillance in South Florida', Public Health Reports, vol. 121, no. 6, pp. 658-665.
Begier, Elizabeth M. ; Backer, Lorraine C. ; Weisman, Richard S ; Hammond, Roberta M. ; Fleming, Lora E. ; Blythe, Donna. / Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning surveillance in South Florida. In: Public Health Reports. 2006 ; Vol. 121, No. 6. pp. 658-665.
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abstract = "Objective. Ciguatera fish poisoning is a potentially life-threatening disease caused by eating coral reef fish contaminated with ciguatoxins and is the most common marine poisoning. However, existing surveillance systems capture few cases. To improve regional ciguatera surveillance in South Florida, this study compared ciguatera illnesses in the Florida Poison Information Center-Miami (FPICM) call database to ciguatera cases in the Florida Department of Health (FDOH) disease surveillance systems. Methods. Univariate and multivariate logistic regression were used to identify predictors of when FPICM reported ciguatera illnesses to FDOH and whether FDOH confirmed reported ciguatera cases. Results. FPICM staff preferentially reported ciguatera illnesses that were of shorter duration (adjusted odds ratio [AOR]=0.84 per additional illness day; 95{\%} confidence interval [CI] 0.74, 0.97); outbreak-associated (AOR=7.0; 95{\%} CI 2.5, 19.5); and clinically more severe (AOR=21.6; 95{\%} CI 2.3, 198.5). Among ciguatera illnesses reported to FDOH, outbreak-associated illnesses were more likely than single, sporadic illnesses to become confirmed surveillance cases (crude OR=11.1; 95{\%} CI 2.0, 62.5). Conclusions. The over-representation of outbreak-associated ciguatera cases underestimates the true contribution of sporadic illnesses to ciguatera disease burden. This bias should be considered when evaluating surveillance systems that include both outbreak-associated and sporadic illness reports.",
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N2 - Objective. Ciguatera fish poisoning is a potentially life-threatening disease caused by eating coral reef fish contaminated with ciguatoxins and is the most common marine poisoning. However, existing surveillance systems capture few cases. To improve regional ciguatera surveillance in South Florida, this study compared ciguatera illnesses in the Florida Poison Information Center-Miami (FPICM) call database to ciguatera cases in the Florida Department of Health (FDOH) disease surveillance systems. Methods. Univariate and multivariate logistic regression were used to identify predictors of when FPICM reported ciguatera illnesses to FDOH and whether FDOH confirmed reported ciguatera cases. Results. FPICM staff preferentially reported ciguatera illnesses that were of shorter duration (adjusted odds ratio [AOR]=0.84 per additional illness day; 95% confidence interval [CI] 0.74, 0.97); outbreak-associated (AOR=7.0; 95% CI 2.5, 19.5); and clinically more severe (AOR=21.6; 95% CI 2.3, 198.5). Among ciguatera illnesses reported to FDOH, outbreak-associated illnesses were more likely than single, sporadic illnesses to become confirmed surveillance cases (crude OR=11.1; 95% CI 2.0, 62.5). Conclusions. The over-representation of outbreak-associated ciguatera cases underestimates the true contribution of sporadic illnesses to ciguatera disease burden. This bias should be considered when evaluating surveillance systems that include both outbreak-associated and sporadic illness reports.

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