Evaluation of electronic laboratory reporting as a contributor to the burden of Lyme disease surveillance — New Jersey, 2001-2006

Background: Lyme disease (LD) surveillance identifies cases to monitor incidence trends; no immediate interventions are indicated. New Jersey health departments cite LD surveillance as a substantial burden, highlighting increased case-report volume following introduction of electronic laboratory reporting (ELR) in 2002. We evaluated LD surveillance to determine actual burden and quantify ELR's contribution.

Methods: To evaluate burden, we analyzed 2001-2006 data and calculated overall case-report volume and ELR volume. We evaluated ELR performance by calculating predictive value positive (PVP) for different case-report types and years. We defined PVP as the percentage of total case-reports that meet the case definition. We also interviewed key personnel about investigation procedures.

Results: Report volume increased from 2,460 in 2001 to a high of 11,957 in 2004 (386%) before declining. Confirmed cases only increased 11% during the same period. Each investigation requires approximately one hour, equivalent to 5.75 full-time-equivalent (2080 hours/year) positions at the 2004 peak. Overall PVP was 96% in 2001 and dropped in the first year of ELR implementation to 65%, reaching a low of 22% in 2004 before rebounding. ELR had an aggregate PVP of 16%, while non-ELR reports had a PVP of 55%.

Conclusions: ELR is primarily responsible for the increasing burden of LD surveillance, but it is a relatively poor indicator of true cases. Increasing ELR performance is difficult, and the value of ELR for characterization of LD epidemiologic trends is uncertain. Further evaluation of ELR use will facilitate national consensus on LD surveillance to ensure continued sustainability and preserve representativeness.