Under-reporting of notifiable infectious disease hospitalizations in a health board region in Ireland: room for improvement?

Abstract

CitationUnder-reporting of notifiable infectious disease hospitalizations in a health board region SUMMARYRapid notification of infectious diseases is essential for prompt public health action and for monitoring of these diseases in the Irish population at both a local and national level. Anecdotal evidence suggests, however, that the occurrence of notifiable infectious diseases is seriously underestimated. This study aims to assess the level of hospitalization for notifiable infectious diseases for a 6-year period in one health board region in Ireland and to assess whether or not there was any under-reporting during this period. All hospital in-patient admissions from 1997 to 2002 inclusive with a principal diagnosis relating to 'infectious and parasitic diseases ' (ICD codes 001-139) of residents from a health board region in Ireland were extracted from the Hospital In-Patient Enquiry System (HIPE). All notifiable infectious diseases were identified based on the 1981 Irish Infectious Disease Regulations and the data were analysed in the statistical package, JMP. These data were compared with the corresponding notification data. Analysis of the hospital in-patient admission data revealed a substantial burden associated with notifiable infectious diseases in this health board region : there were 2758 hospitalizations by 2454 residents, 17 034 bed days and 33 deaths. The statutory notification data comprises both general practitioner and hospital clinician reports of infectious disease. Therefore, only in cases where there are more hospitalizations than notifications can under-reporting be demonstrated. This occurred in nine out of 22 notifiable diseases and amounted to an additional 18 % of notifications (or 572 cases) which were 'missed ' due to hospital clinician under-reporting. The majority of these under-reported cases were for viral meningitis (45 %), infectious mononucleosis (27 %), viral hepatitis C unspecified (15 %) and acute encephalitis (5 . 8 %). This study has highlighted the extent of under-reporting of hospitalized notifiable infectious diseases, in a health board region in Ireland, which is a cause for concern from a surveillance point of view. If this under-reporting is similar in other health boards, then it would appear that the epidemiology of some notifiable diseases is incomplete both regionally and nationally. This under-reporting negatively impacts on the effectiveness of the notification process as a 'real-time ' surveillance tool and an early warning system for outbreaks.

Urgent Care Providers' Knowledge and Attitude About Public Health Reporting and Pertussis Control Measures

“…(7–15, 24) In our survey of providers in the urgent care setting, we found similar problems and evidence of inefficient reporting processes. The majority of Intermountain urgent care providers believed that most reportable conditions are reported to the health department, few providers believed that reporting to the health department is easy, some providers were concerned that the process does not adequately protect patient confidentiality, and 8% did not agree that reporting was allowable under HIPAA regulations.…”

“…Problems with reporting have been recognized for years (7–15) but have not been assessed in the urgent care setting, nor have factors that influence a provider’s motivation to report been adequately explored. Urgent care medicine is a growing specialty with approximately 20,000 providers currently practicing in over 10,000 dedicated urgent care clinics in the US.…”

Factors Associated with Dengue Mortality in Latin America and the Caribbean, 1995–2009: An Ecological Study

“…Therefore, we hypothesize that health care in disorderly urbanized areas and in highly populated cities is inadequate or less effective, leading to higher CFRs. Another possibility is that, in areas of high population density, it is more common for severe cases to be prioritized, 38,39 resulting in the underreporting of mild cases, which is a common bias of epidemiological surveillance. 39,40 Therefore, in highly populated regions, it is likely that the incidence of dengue is underestimated and that the dengue CFR is overestimated.…”

High Incidence of Human Rabies Exposure in Northwestern Tigray, Ethiopia: A Four-Year Retrospective Study

“…In Ethiopia, however, lack of comprehensive national epidemiological data on rabies in animals and humans [21] results in underestimating the disease, which is a stumbling block for its control and prevention. This masks the true magnitude of disease incidence and reduces the efficiency of the notification system as well as surveillance potential [22] and hence reduces the concern of policy-makers and funding agencies. Historically, the incidence of human rabies exposure in Ethiopia ranges from 1.3 to 18.6 per 100,000 populations [13, 17, 21, 23].…”