Sheryl A. Kluberg

Online reports of foodborne illness capture foods implicated in official foodborne outbreak reports

OBJECTIVE Traditional surveillance systems capture only a fraction of the estimated 48 million yearly cases of foodborne illness in the United States. We assessed whether foodservice reviews on Yelp.com (a business review site) can be used to support foodborne illness surveillance efforts. METHODS We obtained reviews from 2005 to 2012 of 5824 foodservice businesses closest to 29 colleges. After extracting recent reviews describing episodes of foodborne illness, we compared implicated foods to foods in outbreak reports from the U.S. Centers for Disease Control and Prevention (CDC). RESULTS Broadly, the distribution of implicated foods across five categories was as follows: aquatic (16% Yelp, 12% CDC), dairy-eggs (23% Yelp, 23% CDC), fruits-nuts (7% Yelp, 7% CDC), meat-poultry (32% Yelp, 33% CDC), and vegetables (22% Yelp, 25% CDC). The distribution of foods across 19 more specific food categories was also similar, with Spearman correlations ranging from 0.60 to 0.85 for 2006-2011. The most implicated food categories in both Yelp and CDC were beef, dairy, grains-beans, poultry and vine-stalk. CONCLUSIONS Based on observations in this study and the increased usage of social media, we posit that online illness reports could complement traditional surveillance systems by providing near real-time information on foodborne illnesses, implicated foods and locations.

Mortality Risk Factors for Middle East Respiratory Syndrome Outbreak, South Korea, 2015

As of July 15, 2015, the South Korean Ministry of Health and Welfare had reported 186 case-patients with Middle East respiratory syndrome in South Korea. For 159 case-patients with known outcomes and complete case histories, we found that older age and preexisting concurrent health conditions were risk factors for death.

Digital surveillance for enhanced detection and response to outbreaks.

JSB reports funding from Epidemico outside the submitted work. All other authors declare no competing interests. This work was supported by the National Library of Medicine, National Institutes of Health (R01LM010812), Bill & Melinda Gates Foundation (OPP1093011), and the Canadian Institutes of Health Research. AA and KK acknowledge support from the Canadian Institutes of Health Research. SIH is funded by a Senior Research Fellowship from the Wellcome Trust (095066), which also supports AM, and a grant from the Bill & Melinda Gates Foundation (OPP1093011). AJT is supported by funding from National Institutes of Health and National Institute of Allergy and Infectious Diseases (U19AI089674) and the Bill & Melinda Gates Foundation (OPP1106427 and OPP1032350).

2014 ebola outbreak: media events track changes in observed reproductive number.

In this commentary, we consider the relationship between early outbreak changes in the observed reproductive number of Ebola in West Africa and various media reported interventions and aggravating events. We find that media reports of interventions that provided education, minimized contact, or strengthened healthcare were typically followed by sustained transmission reductions in both Sierra Leone and Liberia. Meanwhile, media reports of aggravating events generally preceded temporary transmission increases in both countries. Given these preliminary findings, we conclude that media reported events could potentially be incorporated into future epidemic modeling efforts to improve mid-outbreak case projections.

Searching the Web for Influenza Vaccines: HealthMap Vaccine Finder

OBJECTIVES The goal of the HealthMap Vaccine Finder is to provide a free, comprehensive, online service where users can search for locations that offer immunizations. In this article, we describe the data and systems underlying the HealthMap Vaccine Finder (HVF) and summarize the projects first year of operations. METHODS We collected data on vaccination services from a variety of providers for 2012-2013. Data are used to populate an online, public, searchable map. RESULTS In its first year, HVF collected information from 1256 providers representing 46 381 locations. The public Web site received 625 124 visits during the 2012-2013 influenza vaccination season. CONCLUSIONS HVF is a unique tool that connects the public to vaccine providers in their communities. During the 2012-2013 influenza season, HVF experienced significant usage and was able to respond to user feedback with new features.

Global Capacity for Emerging Infectious Disease Detection, 1996-2014.

Timeliness of global outbreak discovery and public communication have gradually improved, but progress has slowed in recent years.

County-level assessment of United States kindergarten vaccination rates for measles mumps rubella (MMR) for the 2014–2015 school year

United States kindergarten measles-mumps-rubella (MMR) vaccination rates are typically reported at the state level by the Centers for Disease Control and Prevention (CDC). The lack of local MMR data prevents identification of areas with low vaccination rates that would be vulnerable to the spread of disease. We collected county-level vaccination rates for the 2014-2015 school year with the objective of identifying these regions. We requested county-level kindergarten vaccination data from state health departments, and mapped these data to visualize geographic patterns in achievement of the 95% MMR vaccination target. We aggregated the county-level data to the state level for comparison against CDC state estimates. We also analyzed the relationship of MMR vaccination level with county-level and state-level poverty (using U.S. census data), using both a national mixed model with state as a random effect, and individual linear regression models by state. We received county vaccination data from 43 states. The median kindergarten MMR vaccination rate was 96.0% (IQR 89-98) across all counties, however, we estimated that 48.4% of the represented counties had vaccination rates below 95%. Our state estimates closely reflected CDC values. Nationally, every 10% increase in under-18 county poverty was associated with a 0.24% increase in MMR vaccination rates (95% CI: -0.07%; 0.54%), but the direction of this relationship varied by state. We found that county data can reveal vaccination trends that are unobservable from state-level data, but we also discovered that the current availability of county-level data is inadequate. Our findings can be used by state health departments to identify target areas for vaccination programs.

Disparities in digital reporting of illness: A demographic and socioeconomic assessment

Although digital reports of disease are currently used by public health officials for disease surveillance and decision making, little is known about environmental factors and compositional characteristics that may influence reporting patterns. The objective of this study is to quantify the association between climate, demographic and socio-economic factors on digital reporting of disease at the US county level. We reference approximately 1.5 million foodservice business reviews between 2004 and 2014, and use census data, machine learning methods and regression models to assess whether digital reporting of disease is associated with climate, socio-economic and demographic factors. The results show that reviews of foodservice businesses and digital reports of foodborne illness follow a clear seasonal pattern with higher reporting observed in the summer, when most foodborne outbreaks are reported and to a lesser extent in the winter months. Additionally, factors typically associated with affluence (such as, higher median income and fraction of the population with a bachelors degrees) were positively correlated with foodborne illness reports. However, restaurants per capita and education were the most significant predictors of illness reporting at the US county level. These results suggest that well-known health disparities might also be reflected in the online environment. Although this is an observational study, it is an important step in understanding disparities in the online public health environment.