Local public health agency notification and detection during a multi-state e. coli O157:H7 outbreak

Syndromic surveillance systems have been implemented by some local public health agencies (LPHAs) in effort to improve early detection and warning to outbreaks or disease occurrence and transmission of public health importance. Federal initiatives such as Biosense¹ and the Electronic Surveillance System for Early Notification of Community Epidemics (ESSENCE)² have been developed to augment community-wide “situational awareness” along with the National Electronic Disease Surveillance System (NEDSS)³ to increase timeliness of disease reporting. However, these technologies have yet to be fully validated against actual outbreaks and cost-effectiveness has yet to be determined. Meanwhile, traditional public health surveillance and communication networks must remain concurrent and redundant to ensure adequate and effective notification and response.

The recent multi-state E. coli O157:H7 spinach outbreak provides a compelling example of the need to maintain strong relationships with community public health partners and underscores the importance of rapid communication to public health authorities when unusual events are detected. In this particular outbreak, the City of Milwaukee Health Department (MHD) was alerted through a variety of networks and agencies, not through emerging technologies or real-time data retrieval systems. This “early warning system” of established community partners provided the MHD the necessary epidemiologic intelligence in advance of State and Federal recognition and notification to local public health authorities.

LPHAs need to revisit and reinvent relationships that broaden the network of potential public health partners and to maintain a sufficient “strength of signal” that triggers further epidemiologic investigation of community-wide disease events