Abstract
In March 2000, a large outbreak of gastroenteritis occurred in a community where a regional computer network provides free Internet access for 42% of the households. We conducted an epidemiologic investigation using the Internet for data collection. Norovirus was identified in stool samples of nine patients but not in the municipal water supply. Of households with access to the network, 19% participated in the survey. The overall attack rate by household was 63%. Drinking water from the nonchlorinated community water system was associated with illness (relative risk [RR] 1.6; 95% confidence interval [CI] 1.1 to 2.2); drinking water only from a private well was associated with decreased likelihood of illness (RR 0.3; 95% CI 0.1 to 0.8). Data collection through the Internet was efficient. Internet surveys may become more common in epidemiologic investigations and have the potential to provide data rapidly, enabling appropriate public health action. However, methods should be developed to increase response rates and minimize bias.
Highlights
The Internet is increasingly influencing the practice of epidemiology
In municipality A, the demographic characteristics of respondents were different from the population of the municipality: the proportion of young adults 15–28 years of age was higher, and the proportion of persons >65 years of age was much lower than in the general population (Table 1)
The attack rate by household was highest (63%) in municipality A compared with that in municipalities B (17%) and C (29%) (RR 2.8; 95% confidence intervals (CI) 2.0 to 3.9)
Summary
The Internet is increasingly influencing the practice of epidemiology. It has been used for disseminating health information, providing access to journals, and managing multicenter randomized controlled trials [1]. During an investigation of a syphilis outbreak [2], the Internet was used to notify patients’ sex partners and to increase community awareness. Use of the Internet has been evaluated as a risk factor for sexually transmitted diseases [3]. The Internet provides advantages in data collection and collation, which can reduce the resources and workload required for questionnaire studies [4]. There are no reports of community-based outbreak investigations conducted by using the Internet
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