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Volume 6, Number 2—April 2000

Dispatch

The Impact of Health Communication and Enhanced Laboratory-Based Surveillance on Detection of Cyclosporiasis Outbreaks in California

Janet C. Mohle-Boetani*Comments to Author , S. Benson Werner*, Stephen H. Waterman*, and Duc J. Vugia*†
Author affiliations: *California Department of Health Services, Berkeley, California, USA; and †The California Emerging Infections Program, Berkeley, California, USA

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Table

Event-associated outbreaks of cyclosporiasis, California, 1997

Outbreak number, type month/day of event Event to symptoms Symptoms to medical care Seeking of medical carea Timing of stool collection Stool testinga Stool collection to Cyclospora verification Method of outbreak detectionb
1, Banquet, 4/1 7 days None–patient was physician No 39 days after onset No 2 days Report of illness cluster by patientd
2, Conference, 4/17 7 days None–patient was physician No 19 days after onset No 6 days Report of illness cluster by physiciand
3, Wedding, 5/3 7 days 18 days Yes (I) bride sent information 1 day after visiting physician Yes (I) patient requested 1 day Interview of index patient identified through ELBf surveillance, 4 days
4, Barbecue, 5/10 8 days 1 day and repeat phone calls for 2 weeks No 15 days after visiting physician Yes (M) patient requested 1 day Interview of index patient identified through ELBf surveillance, 6 days
5, Picnic, 5/11 7 days 18 days Yes (M and I) Internet searches after media reports 1 day after visiting physician Yes (I) patient requested 4 days Interview of index patient identified through ELBf surveillance, 41 days
6, Card Party, 5/14 7 days 14 days No 24 days after visiting physician Yes (M) patient notified health dept., which recommended testing 3 days Report of illness cluster by patientd
7, Dinner, 5/21 5 days 3 days No 1 day after visiting physician Yes (M) physician saw TV show on outbreaks 3 days Interview of index patient identified through ELBf surveillance, 3 days
8, Luncheon, 5/24 6 days 1 day Yes (M, and I) Internet searches after media reports 2 days after visiting physician Yes (I) patient requested 1 day Interview of index patient identified through ELBf surveillance, 3 days
Median 7 days 8.5 days 2 days 2.5 days 4 days
(range) (5-8 days) (1-18 days) (1-24 days) (1-6 days) (3-41 days) For ELB surveillance notifications for all outbreaks

aPrompted by Internet (I) or Media (M) information.
bBy local health department, time from laboratory verification to notification of the health department (if applicable).
cTesting was requested by the patient based on her knowledge of tropical medicine.
dThe health department was aware of pending test results and the index patient was known to the health department prior to laboratory verification.
eSpecific testing was not requested by a physician but was conducted by a laboratorian who had just read a journal article about Cyclospora.
fELB denotes enhanced laboratory-based surveillance.

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