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Context: Public Health Ontario (PHO) publishes various infectious disease surveillance reports, but none have yet been formally evaluated., Objective: PHO evaluated its monthly and annual infectious disease surveillance reports to assess public health stakeholders' current perception of the products and to develop recommendations for improving future products., Design: An evaluation consisting of an online survey and a review of public Web sites of other jurisdictions with similar annual reports., Setting: For the online survey, stakeholder organizations targeted were the 36 local public health units and the Health health ministry in Ontario, Canada., Participants: Survey participants included epidemiologists, managers, directors, and other public health practitioners from participating organizations., Main Outcome Measures: Online survey respondents' awareness and access to the reports, their rated usefulness of reports and subsections, and suggestions for improving usefulness; timeliness of select annual reports from other jurisdictions based on the period from data described to report publication., Results: Among 57 survey respondents, between 74% and 97% rated each report as useful; the most common use was for situational awareness. Respondents ranked timeliness as the most important attribute of surveillance reports, followed by data completeness. Among 6 annual reports reviewed, the median time to publication was 11.5 months compared with 23.2 months for PHO., Conclusion: Recommendations based on this evaluation have already been applied to the monthly report (eg, focusing on the most useful sections) and have become key considerations when developing future annual reports and other surveillance reporting tools (eg, need to provide more timely reports). Other public health organizations may also use this evaluation to inform aspects of their surveillance report development and evaluation. The evaluation results have provided PHO with direction on how to improve its provincial infectious disease surveillance reporting moving forward, and formed a basis for future work in surveillance product development and evaluation.

Context: Rabies virus causes a fatal encephalitis and is typically acquired through the bite of an infected mammal. Rabies is preventable through administration of rabies postexposure prophylaxis (PEP), but this must be balanced with the need to avoid unnecessary PEP use. Though not nationally notifiable, some state health departments (SHDs) have made animal bites and use of PEP reportable within their jurisdictions., Objective: We evaluated whether animal bites and PEP were reportable to SHDs as of 2013 for every state in the United States., Design: The list of reportable conditions for each SHD as of 2013 was reviewed on the Internet for every state in the United States to determine whether animal bites or PEP were reportable. We then contacted an SHD representative (typically the State Public Health Veterinarian) to confirm data generated through Internet searches. Health departments in states where PEP was reportable were asked to complete a follow-up survey., Results: Animal bites and PEP both were reportable in 9 states (18%). Another 9 states (18%) mandated animal bite reporting but not PEP reporting, while 12 states (24%) mandated PEP reporting but not animal bite reporting. These events were not reportable in 20 states (40%). The benefits reported by personnel from SHDs with PEP reporting systems varied greatly., Conclusions: Additional investigations focusing on the value of information returned by PEP reporting and identifying best practices for implementation and management are needed. The lack of standardization between current animal bite and PEP reporting systems limits completeness of reporting and comparability of outcomes. National recommendations to standardize case definitions and other data elements might help jurisdictions developing new animal bite or PEP reporting systems.

Context: In 2009, the Centers for Disease Control and Prevention completed migration of all 59 surveillance project areas (PAs) from the case-based HIV/AIDS Reporting System to the document-based Enhanced HIV/AIDS Reporting System., Objectives: We conducted a PA-level assessment of Enhanced HIV/AIDS Reporting System process and outcome standards for HIV infection cases., Design: Process standards were reported by PAs and outcome standards were calculated using standardized Centers for Disease Control and Prevention SAS code., Setting: A total of 59 PAs including 50 US states, the District of Columbia, 6 separately funded cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco), and 2 territories (Puerto Rico and the Virgin Islands)., Participants: Cases diagnosed or reported to the PA surveillance system between January 1, 2011, and December 31, 2011, using data collected through December 2012., Main Outcome Measures: Process standards for death ascertainment and intra- and interstate case de-duplication; outcome standards for completeness and timeliness of case reporting, data quality, intrastate duplication rate, risk factor ascertainment, and completeness of initial CD4 and viral load reporting., Results: Fifty-five of 59 PAs (93%) reported linking cases to state vital records death certificates during 2012, 76% to the Social Security Death Master File, and 59% to the National Death Index. Seventy percent completed monthly intrastate, and 63% completed semiannual interstate de-duplication. Eighty-three percent met the 85% or more case ascertainment standard, and 92% met the 66% or more timeliness standard; 75% met the 97% or more data quality standard; all PAs met the 5% or less intrastate duplication rate; 41% met the 85% or more risk factor ascertainment standard; 90% met the 50% or more standard for initial CD4; and 93% met the same standard for viral load reporting. Overall, 7% of PAs met all 11 process and outcome standards., Conclusions: Findings support the need for continued improvement in HIV surveillance activities and monitoring of system outcomes.

Opportunities for improved disease reporting are identified by describing physicians' reporting knowledge and practices as well as reporting knowledge and specimen referral patterns among clinical laboratories in the state of Georgia. In 2005, a sample of physicians(n = 177) and all Georgia clinical laboratories (n = 139) were surveyed about reporting knowledge and practices. Knowledge was greater among physicians who received their medical degree before 1980 (P = .04), accessed e-mail (P< .01), used the Internet to obtain public health information (P < .01), and reported frequently (P= .06). Increased knowledge was not associated with training in reporting (P = .14). Physicians were often unaware of reporting procedures and mechanisms and often did not report because they believed others would report (52%). Laboratory representatives (56%) more often received training on disease reporting than physicians (32%). All laboratories sent some specimens for diagnostic testing at reference laboratories and 35% sent the specimens outside of Georgia. Physicians'characteristics may affect reporting knowledge independent of training on disease reporting, and increased knowledge is associated with increased reporting. Investigation of physician characteristics that contribute to improved reporting, such as an active engagement with public health, could help to guide changes to reporting-related training and technology. Reporting by other health care providers and physicians' perceptions that others will report both indicate that studies of all reporting stakeholders and clear delineation of reporting responsibilities are needed. Extensive specimen referral by laboratories suggests the need for coordination of reporting regulations and responsibilities beyond local boundaries.

Objectives: Disease surveillance by clinicians is critical to public health activities, yet studies have demonstrated significant underreporting of reportable diseases by clinicians. We sought to determine whether an intervention utilizing electronic media increases public health reporting by clinicians., Methods: A nonrandomized, controlled design with 24-week baseline and intervention outcome periods was used. Five intervention hospitals in the county of Philadelphia received a three-component intervention that included e-mail memoranda, a Web site, and a handheld computer program. Intervention components provided education and information to assist with reporting. Control hospitals comprised all remaining hospitals in the county., Results: E-mails were sent to more than 16500 clinicians and administrative personnel at five hospitals on each of three occasions. The Web site received 866 visits, and the handheld computer program was downloaded 130 times. Intervention hospitals had a mean increase of 5.6 reports, whereas control hospitals had a mean decrease of 3.0 reports (P = .02)., Conclusions: The electronic information-based intervention led to a significant increase in clinician reporting of reportable diseases. Considering the ease and low cost of implementing such programs, they are an attractive method for increasing clinician reporting of public health conditions.

The purpose of this study was to determine whether published reports of infectious disease outbreaks could serve as a source of evidence for public health practice, particularly in responding to bioterrorism. Such performance indicators are measures of practice and process that lead to optimal health outcomes. We collected data from 116 individual articles that described 59 outbreaks of eight different pathogens with potential for bioterrorist use. Analysis of these reports determined whether they addressed 12 process indicators and four outcome indicators--each generally recognized as a component of effective outbreak response. The results showed that outbreak reports typically included information about these process and outcome indicators, thus validating their practical importance. However, few reports had been written with specificity to document the chronology of outbreak response, or the dissemination of information to protect healthcare workers, or the communication with law enforcement and emergency operations that are important in response to bioterrorism. We conclude that the published record of infectious disease outbreaks can, in the future, be used as a source for practice-based evidence if agreed-upon measures for effective performance become standard components of outbreak reports.

Mumps, one of several once common childhood diseases, is targeted for elimination in the United States by 2010. To improve its ability to monitor mumps cases, the Texas Department of Health began requiring investigation and serologic testing of all mumps reports. During 1995-1996, of 500 mumps reports, only 14.4 percent were confirmed cases and they had a different demographic profile than unconfirmed cases. To accurately assess whether the nation achieves the Year 2010 mumps elimination goal, and to effectively direct elimination efforts, states must investigate and serologically confirm all mumps reports and use the case definition for public health surveillance.