The State of Ohio led the United States in measles in 2014, ostensibly related to international air travel (IAT), and ranked lower than 43 other states in infectious disease outbreak preparedness. We conducted a retrospective cohort study using surveillance data of the total Ohio population of 11 million from 2010 through 2014 with a nested case control of air travelers to determine the risk of malaria, seasonal influenza hospitalizations (IH), and hepatitis A (HA) disease related to international travel and to estimate the association with domestic enplanement. IAT appeared protective for HA and IH with a risk of 0.031 (.02–.04) but for malaria was 2.7 (2.07–3.62). Enplanement increased the risk for nonendemic M 3.5 (2.5–4.9) and for HA and IH 1.39 (1.34–1.44). IAT's ratio of relative risk (RRR) of malaria to HA and IH was 87.1 (55.8–136) greater than 219 times versus domestic enplanement which was protective for malaria at 0.397 (0.282–0.559). Malaria is correlated with IAT with cases increasing by 6.9 for every 10,000 passports issued.

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ObjectiveImprove disease reporting and outbreak mangement.IntroductionSpecific communicable diseases have to be reported by law withina specific time period. In Ohio, prior to 2001, most of these diseasereports were on paper reports that were reported from providers tolocal health departments. In turn the Communicable Disease Nursemailed the hardcopies to the Ohio Department of Health (ODH).In 2001 the Ohio Disease Reporting System (ODRS) was rolled out toall local public health agencies in Ohio.1ODRS is Ohio’s portion ofthe National Electronic Disease Surveillance System. ODRS shouldnot be confused with syndromic surveillance systems that are fordetecting a disease outbreak before the disease itself is detected.2Chronic disease surveillance system data has been evaluated forlong term trends and potential enhancements.3However, the use ofcommunicable disease reports vary greatly.4 However, the exportdata has not routinely been used for quality improvement purposesof the disease reporting process itself. In December 2014, GreeneCounty Public Health (GCPH) begain a project to improve reportingof communicable diseases and the response to disease outbreaks.MethodsInitial efforts were to understand the current disease reportingprocess: Quantitative management techniques including creating alogic model and process map of the existing process, brainstormingand ranking of issues. The diseases selected to study included:Campylobacteriosis, Cryptosporidiosis, E. coli O157:H7 &shiga toxin-producing E. coli, Giardiasis, Influenza-associatedhospitalization, Legionnaires’ disease, Pertussis, Salmonellosis,and Shigellosis. The next steps included creating a data collectionand analysis plan. An updated process map was created and thepre- and post-process maps were compared to identify areas toimprove. The median number of days were compared before andafter improvements were implemented. Modeling of the impact ofthe process improvements on the median number of days reportedwas conducted. Estimation of the impact in healthy number of daysderived from the reduction in days to report (if any) were calculated.ResultsProcess improvements identified: Ensure all disease reportersuse digital reporting methods preferably starting with electroniclaboratory reporting directly to the online disease reporting system,with other methods such as direct web data entry into system, faxinglab reports, orsecure emailing reports, with no or little hard copy mailing;Centralize incoming email and fax reports (eliminating process steps);Standardize backup staffing procedures for disease reporting staff;Formalize incident command procedures under the authorized personin charge for every incident rather than distribute command betweenenvironmental and clinical services; and place communicable diseasereporting under that single authority rather than clinical services. Thedays to report diseases were reduced from a median of 2 to .5 days(p<.001). All the diseases were improved except for crytosporodiumdue to an outlier report two months late. The estimated societalhealthy days saved were valued at $52,779 in the first eight monthsafter implementation of the improvements.ConclusionsImprovements in disease reporting decreased the reporting timefrom over 2 days to less than 1 day on average. Estimated societalhealthy days saved by this project during the first 9 months was$52,779. Management of early command and control for outbreakresponse was improved.