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

Abstract

Research Articles 658  Public Health Reports / November–December 2006 / Volume 121 Outbreak Bias in Illness Reporting and Case Confirmation in Ciguatera Fish Poisoning Surveillance in South Florida Elizabeth M. Begier, MD, MPHa Lorraine C. Backer, PhD, MPHb Richard S. Weisman, PharmD, ABATc Roberta M. Hammond, PhDd Lora E. Fleming, MD, PhDe Donna Blythe, MDe aPreventive Medicine Residency Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD bNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA cFlorida Poison Information Center–Miami, Miami, FL dBureau of Environmental Epidemiology, Florida Department of Health, Tallahassee, FL eNational Institute of Environmental Health Sciences Marine and Freshwater Biomedical Sciences Center, University of Miami, Miami, FL Address correspondence to: Elizabeth M. Begier, MD, MPH, Medical Director, Bureau of HIV/AIDS Prevention and Control, New York City Dept. of Health and Mental Hygiene, 40 Worth St, Rm. 1502, New York, NY 10013; tel. 678-488-1058; e-mail . ©2006 Association of Schools of Public Health SYNOPSIS 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]50.84 per additional illness d