Participatory COVID-19 Surveillance Tool in Rural Appalachia : Real-Time Disease Monitoring and Regional Response.

INTRODUCTION: Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia. METHODS: A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution. RESULTS: Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non-English-speaking groups. PRACTICAL IMPLICATIONS: This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

Practices around acute diarrheal illness diagnosis, counseling, and reporting: laboratory and health-care practitioners in North Carolina, 2004.

OBJECTIVES: To describe foodborne disease surveillance in North Carolina, particularly diagnosis, counseling, and reporting of diagnoses from health-care practitioners (HCPs) and reporting of positive laboratory results from clinical diagnostic laboratories. MATERIALS: A survey was administered on knowledge of diagnostic testing and reporting practices for foodborne disease among HCPs in western North Carolina. We also queried laboratories statewide about foodborne disease testing and reporting practices. RESULTS: HCPs in specialties likely to diagnose acute diarrheal illness (ADI) participated (319/1442, 22% response rate). Only 66% of HCPs were comfortable with their knowledge of foodborne illness, and 68% were comfortable diagnosing and treating foodborne illnesses. In the past 30 days, 29% of HCPs did not request a stool culture from their ADI patients. We estimate that, overall, 8% of ADI patients who sought care in this region have a diagnosis that is reported to the health department (HD). The laboratory response rate was 39% (42/108), and 70% gave timely foodborne diagnosis reports to the HD. In this cross-sectional study, causes of reporting behavior could not be explored. In addition, HCPs survey response rates were low. CONCLUSIONS: Many HCPs were not comfortable with their knowledge and did not adequately provide counseling on prevention of foodborne illnesses. HCPs in western North Carolina may benefit from provider training on foodborne illness counseling and reporting. Improvements in communication between laboratories, HCPs, and HDs may increase HCP confidence in diagnosing foodborne illnesses and increase counseling of patients on prevention. Increased requests for testing of stool specimens by HCPs could substantially impact foodborne disease reporting in North Carolina.

Legionnaires' disease among residents of a long-term care facility: the sentinel event in a community outbreak.

BACKGROUND: A long-term care facility (LTCF) reported an outbreak of Legionnaires' disease (LD) in September 2004. METHODS: We conducted case finding through enhanced surveillance, medical record review (n = 131), and community surveys (n = 258). We cultured water samples from the LTCF and assayed their outdoor air-intake filters for Legionella DNA. We also investigated a cooling tower, the only nearby outdoor aerosol source. RESULTS: Among 7 confirmed cases, 2 LTCF residents never exited, and 2 community residents never entered the LTCF during the incubation period. Among 63 water and biofilm samples collected from throughout the LTCF, we found no evidence of Legionella colonization, either in the potable water or air-handling systems. Conversely, we isolated a common outbreak-causing strain of Legionella pneumophila serogroup 1 from an industrial cooling tower located 0.4 km from the LTCF and recovered L pneumophila DNA from the LTCF's outdoor air-intake filters, suggesting that aerosolized Legionella from the cooling tower most likely entered the LTCF through the air-intake system or, possibly, through open windows. CONCLUSION: Residents of LTCFs can acquire LD from community sources. A cluster of LD cases among LTCF residents does not necessarily indicate transmission from within the LTCF.

Knowledge and practice of foodborne disease clinical specimen testing and reporting in North Carolina, 2004.

BACKGROUND: Detection of foodborne disease outbreaks relies on health care practitioners (HCPs), infection control practitioners (ICPs), and clinical laboratorians to report notifiable diseases to state or local health departments. METHODS: To examine knowledge and practices about notifiable foodborne disease reporting among HCPs and ICPs in western North Carolina and among clinical laboratorians statewide, participants responded to a self-administered questionnaire about foodborne pathogen testing and reporting, referencing Campylobacter, shiga-toxin producing Escherichia coli, and other organisms. RESULTS: Three hundred seventy-two of 1442 health care providers participated in this survey. Of 372 study participants, fewer than 20% knew that both the clinician and the laboratorian were legally responsible for reporting the study pathogens. Most laboratorians identified the ICP (57%) as responsible for reporting. There was a lack of understanding about which infections and test results were reportable. LIMITATIONS: The response rate was very low, particularly among HCPs; participants may have been biased towards those with a particular interest in foodborne disease or surveillance. This descriptive study cannot be used to determine rates of reporting among the medical community. CONCLUSIONS: Although not legally obliged to report, ICPs were found to play a significant role in disease reporting. Dissemination of surveillance information and training through the established network of North Carolina ICPs may be ideal for improving foodborne disease surveillance in this state.

Economic and social impacts of La Crosse encephalitis in western North Carolina.

La Crosse encephalitis (LACE), a human illness caused by a mosquito-transmitted virus, is endemic in western North Carolina. To assess the economic and social impacts of the illness, 25 serologically confirmed LACE case patients and/or families were interviewed to obtain information on the economic costs and social burden of the disease. The total direct and indirect medical costs associated with LACE over 89.6 life years accumulated from the onset of illness to the date of interview for 24 patients with frank encephalitis totaled dollar 791,374 (range = dollar 7,521-175,586), with a mean +/- SD per patient cost of dollar 32,974 +/- dollar 34,793. The projected cost of a case with lifelong neurologic sequelae ranged from dollar 48,775 to dollar 3,090,798 (n = 5). For the 25 LACE patients, 55.15 (54.83%) of the 100.59 cumulative life years (CLYs) were impaired to some degree. Disability adjusted life years (DALYs) were calculated to measure the productive life years lost to LACE. Approximately 13.00 DALYs were accumulated over 100.59 CLYs of study. Projected DALYs for case patients (n = 5) with lifelong neurologic sequelae ranged from 12.90 to 72.37 DALYs. An Impact of La Crosse Encephalitis Survey (ILCES) was used to measure the social impact of LACE over time for case patients and their families. The ILCES scores demonstrated that the majority of the social burden of the illness is borne by the five patients with lifelong neurologic sequelae. The socioeconomic burden resulting from LACE is substantial, which highlights the importance of the illness in western North Carolina, as well as the need for active surveillance, reporting, and prevention programs for the infection.