Gastrointestinal Disease in the Domestic Setting: What can we Deduce from Surveillance Data?

Abstract

100 000 90 000 80 000 70 000 60 000 50 000 40 000 30 000 20 000 10 000 Edited transcript of an oral presentation I have a twin interest in surveillance: as a lecturer teaching on the accredited undergraduate Environmental Health course at King’s College, London, and as research student at the London School of Hygiene and Tropical Medicine where I am undertaking a doctorate in Public Health (DrPH). My background is as an Environmental Health Officer (EHO) in the U.K., where I have contributed to the ‘active’ and ‘passive’ surveillance of, among other things, foodborne illness. For me, the key to establishing the ‘credentials’ of home hygiene is through surveillance data, but there are inherent dangers in relying on data currently collected in this country to support the hypothesis that the home is a potent source of gastrointestinal illness. We have, in England and Wales today, a system of surveillance that has at its core the statutory notification of cases of ‘food poisoning’ diagnosed by GPs and ‘formally notified’ to the Consultant in Communicable Disease Control (CCDC) of the local authority area concerned. In addition, cases of infectious intestinal disease are notified voluntarily by laboratories, identifying pathogens in clinical specimens, and by local authorities, through cases and outbreaks investigated following receipt of laboratory reports and complaints. This data is collated and compiled by the Communicable Disease Surveillance Centre (CDSC) and appears in national statistics on ‘food poisoning’ under two headings: ‘formally notified’ and ‘otherwise ascertained’. I should also point out the importance of other surveillance tools which supply data on, and inform our understanding of, gastroenteritis in the community. These include the routine use of ‘sentinel practices’ to record the cases presenting to GPs, and special studies undertaken to establish the level of under-ascertainment of infection in the community, such as the long-awaited