Collecting a Sexual History During Shigellosis Case Investigations: Nationwide Practices and an Assessment of Data Quality.

Shigellosis is spread through the fecal-oral route, including sexual activity. The Centers for Disease Control and Prevention recommends collecting a sexual history from people diagnosed with shigellosis to enhance the understanding of its epidemiology and outbreak detection and the design of disease prevention messaging, although individual jurisdictions decide if and how this is done. Moreover, enteric disease interviewers typically receive in-depth general interviewing training, but often not sexual history question training. The goal of this project was to inform national practices around sexual history questions asked during shigellosis interviews by collecting information from U.S. state health agencies and evaluating sexual history data from people diagnosed with shigellosis in Colorado. From November 2021 to January 2022, information on sexual history questions asked of persons with reported shigellosis and accompanying training resources were collected from U.S. state health departments. Data completeness and quality of shigellosis sexual history questions from Colorado's notifiable disease database from 2018 to 2022 were also evaluated. Of 48 states, 54% reported routinely asking all adults about their sexual history during shigellosis interviews. Of 44 states, 18% indicated having accompanying training materials for interviewers. In Colorado, the proportion of unknown/missing responses to questions about recent sexual contact with male and female partners was lower for males (3.3% unknown and 3.3% missing) than females (5.4% and 6.2%) and highest among those 66 years and older (6.7% and 10%). Among those reporting new sexual partners, 93.5% indicated how they met. The evaluation of Colorado data demonstrates that routine collection of complete, high-quality, actionable sexual history data from all adults with reported shigellosis is feasible. Nearly half of the responding states indicated not doing so, and few had training resources. We recommend training enteric disease interviewers to routinely ask all adults with reported shigellosis about their sexual history, including new partner meeting location.

Using Online Surveys for Routine Campylobacter Case Investigations in Colorado, September 2020-December 2021.

CONTEXT: Routine case investigations are critical for enteric disease control and surveillance. Given limited resources and staffing, public health agencies are exploring more efficient case investigation methods. OBJECTIVE: To identify and describe the advantages and disadvantages of using online surveys to supplement routine enteric disease case investigations. DESIGN: We evaluated routine Campylobacter interview data collected via telephone vs online by interviewers with the Colorado Department of Public Health and Environment. SETTING AND PARTICIPATION: Colorado laboratory-confirmed Campylobacter cases reported from September 1, 2020, through December 31, 2021. MAIN OUTCOME MEASURES: We calculated modality preference, response rates, and data quality (missing and unknown answers) and compared demographics (age, gender, and urban vs rural) by modality. Estimated staff time savings and investigation timeliness were compared. RESULTS: Modality preference was split among the 966 contacted Campylobacter cases (46% telephone, 50% online, and 4% refusal). Among online respondents, 57% completed the survey for an overall 63% response rate. Females and those 18 to 44 years of age were most likely to select (55%, 60%) and complete (57%, 66%) the online survey, while those under 18 and over 65 years of age were least likely to select (47%, 45%) or complete (53%, 46%). Those who identified as non-Hispanic Black were most likely to select online (62%), whereas those who identified as mixed-race non-Hispanic and non-Hispanic White had the highest completion (78%, 60%). Modality preference was comparable by geography; however, rural residents had higher completion rates (61%). Data quality and completeness were comparable between modalities. Completing the 274 online surveys via telephone would have taken an estimated 78 hours of additional staff time. CONCLUSIONS: Online surveys can increase public health efficiency and capacity while maintaining data quality. However, use should be limited to high-burden, low-resource pathogens due to reduced response rates. Understanding implementation best practices and conducting regular evaluation are critical for optimization.

Impact of the COVID-19 Pandemic on the State Enteric Disease Public Health Workforce in the Western United States, March-April 2022.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on the state-level enteric disease workforce and routine enteric disease surveillance and outbreak investigation activities in the western United States. DESIGN AND SETTING: Key informant interviews conducted using bidirectional video from March to April 2022. PARTICIPANTS: Enteric disease epidemiologists at state public health agencies in the western states served by the Colorado and Washington Integrated Food Safety Centers of Excellence. MAIN OUTCOMES: Key themes were identified using grounded theory. RESULTS: Nine themes were identified including excessive workload, shifts in local and state responsibilities, challenges with retention and hiring, importance of student teams, laboratory supplies shortages, changes to case and outbreak investigation priorities, transitioning back to enterics, adoption of new methods and technology, and current and future needs. CONCLUSIONS: The COVID-19 pandemic response had a substantial impact on state-level enteric disease activities in western states, with many staff members diverted from routine responsibilities and a de-prioritization of enteric disease work. There is a need for sustainable solutions to address staffing shortages, prioritize employee mental health, and effectively manage routine workloads when responding to emergencies.