Dean G. Sienko

Foodborne outbreak early detection system (FOEDS)

S i127 The nation’s emergency departments (EDs) are a potential source of surveillance information. The Frontlines of Medicine Project is a collaborative effort of emergency medicine, public health, emergency government, law enforcement, and informatics to develop nonproprietary, standardized methods for reporting emergency department patient data. An initial proposal, published in April 2002, proposed a standardized message structure based on XML (Extensible Markup Language) for reporting triage information from emergency departments to regional surveillance centers and called for reader comments. Subsequently, a consensus conference, with attendees chosen through a modified nominal consensus process, was held to discuss the initial Frontlines proposal and provide recommendations for next steps. Since the consensus conference, an Internet-based Delphi survey technique has been used to refine further the Frontlines recommendations. The technique was utilized for two rounds to yield a consensus exceeding 75% acceptance of the proposed data elements and preferred International Classification of Diseases, 9th Revision (ICD-9)–coded chief complaint values. The data elements for the triage surveillance report include provider facility ID, patient ID, encounter ID, patient age, age unit, gender, date/time first documented in ED, date/time symptom onset, chief complaint, first ED responsiveness assessment, first ED systolic blood pressure, first ED diastolic blood pressure, first ED heart rate, first ED temperature, ED temperature unit, and ZIP codes for home, work, and incident site. The preferred chief complaint categories include 159 complaints arranged in 16 hierarchical categories that are expected to describe the reason for visit in greater than 99% of ED encounters. Further details are available at www.frontlinesmed.org. Foodborne Outbreak Early Detection System (FOEDS) Paul C. Bartlett, Holly Wethington, Bryan DeZeeuw, Sally Bidol, John Tilden, Theresa Bernardo, Lixin Zhang, Dean Sienko, and Mary Grace Stobierski National Center for Food Safety and Toxicology, Michigan State University, Ingham County Health Department, Department of Epidemiology, University of Michigan, Food and Dairy Division. Michigan Department of Agriculture, Bureau of Epidemiology, Michigan Department of Community Health, Information Technology, Michigan State University College of Veterinary Medicine The FOEDS (Foodborne Outbreak Early Detection System) Forum (www.RUsick2.msu .edu) is a structured, Web-based forum that collects and shares data regarding a 4-day food history, food sources, animal contact, and other risk factors that are helpful in establishing the existence of a time-space cluster of possible foodborne origin. It is a syndromic surveillance system that allows users to search the database to evaluate the possibility that a group of people became sick with the same symptoms at about the same time after eating the same food from the same source. The FOEDS Forum is designed to identify suspicious time-space disease clusters that may, at the local health department’s discretion, be worthy of further investigation. As such, it can be viewed as a “front end” to our current national system for identifying and investigating foodborne outbreaks. Data collection was scheduled to begin in October 2002 in the three-county area of Greater Lansing, Michigan. Clinic-based and population-based advertisements were to encourage people with suspected foodborne disease to visit the Web site to determine if they ate the same food that others ate before becoming ill with similar symptoms. Input screens and output reports will be presented, as will program implementation in the three-county pilot area. The FOEDS Forum was developed by epidemiologists from state and local governmental agencies and academic departments working under the umbrella of the National Food Safety and Toxicology Center at Michigan State University.

Hepatitis B vaccination programs for hospital workers: Results of a statewide survey

To assess the implementation of hepatitis B virus (HBV) vaccination programs for hospital workers, we mailed questionnaires to all 229 licensed Michigan hospitals. The response rate was 96% (221/229); of these, 68% (150/221) had vaccination programs. Although multiple hospital characteristics were associated with the presence of a vaccination program, characteristics that independently predicted the presence of a program were medical school affiliation, nonpsychiatric specialty, and the existence of a hepatitis B immune globulin protocol. The most common reason given (56%, 40/71) for the absence of a program was insufficient worker risk of hepatitis B infection; this response was frequent in psychiatric (91%, 10/11) and rural hospitals (61%, 11/18). Among high-risk workers, attending physicians were less likely than other high-risk workers to be included in vaccination programs (68% vs. 95%, respectively). Fear of vaccine-associated acquired immunodeficiency syndrome was most frequently cited as the primary reason for vaccine refusal. We conclude that unwarranted fears about the vaccines safety need to be dispelled, that high-risk physicians should be included in vaccination programs, and that rural and psychiatric hospital policies reflect their perceived risk of occupational HBV infection.

Seasonal Influenza and Tdap Vaccination Policies in Michigan Hospitals: Progress Yet Substantial Capacity to Improve

We determined the prevalence of mandatory influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination policies for staff in Michigan hospitals and factors affecting policy implementation. Forty-one percent of responders reported a mandatory influenza vaccination policy, and 11% reported a mandatory Tdap vaccination policy. The support of hospital leadership is critical to policy implementation and overcoming barriers.