Abstract
BackgroundWater utilities continue to be interested in implementing syndromic surveillance for the enhanced detection of waterborne disease outbreaks. The authors evaluated the ability of sales of over-the-counter diarrheal remedies available from the National Retail Data Monitor to predict endemic and epidemic gastrointestinal disease in the San Francisco Bay Area.MethodsTime series models were fit to weekly diarrheal remedy sales and diarrheal illness case counts. Cross-correlations between the pre-whitened residual series were calculated. Diarrheal remedy sales model residuals were regressed on the number of weekly outbreaks and outbreak-associated cases. Diarrheal remedy sales models were used to auto-forecast one week-ahead sales. The sensitivity and specificity of signals, generated by observed diarrheal remedy sales exceeding the upper 95% forecast confidence interval, in predicting weekly outbreaks were calculated.ResultsNo significant correlations were identified between weekly diarrheal remedy sales and diarrhea illness case counts, outbreak counts, or the number of outbreak-associated cases. Signals generated by forecasting with the diarrheal remedy sales model did not coincide with outbreak weeks more reliably than signals chosen randomly.ConclusionsThis work does not support the implementation of syndromic surveillance for gastrointestinal disease with data available though the National Retail Data Monitor.
Highlights
Water utilities continue to be interested in implementing syndromic surveillance for the enhanced detection of waterborne disease outbreaks
Most reported outbreaks were caused by Norovirus or by an unknown etiology of which many were suspected of being Norovirus
This study did not support the implementation of syndromic surveillance with National Retail Data Monitor Diarrheal Remedy Sales for enhanced gastrointestinal outbreak detection of waterborne or other origins
Summary
Water utilities continue to be interested in implementing syndromic surveillance for the enhanced detection of waterborne disease outbreaks. The authors evaluated the ability of sales of over-the-counter diarrheal remedies available from the National Retail Data Monitor to predict endemic and epidemic gastrointestinal disease in the San Francisco Bay Area. After the publication of reports suggesting that monitoring over-the-counter drug sales might have given advance notice of the 1993 outbreak of cryptosporidiosis in Milwaukee [3,4,5], federal agencies began to make explicit recommendations that water utilities and health departments consider implementing overthe-counter syndromic surveillance for enhanced waterborne outbreak detection [6,7,8]. To clarify the validity and representativeness of sales of over-the-counter diarrheal remedies available through the National Retail Data Monitor (NRDM) for prospective outbreak detection, we sought to determine if these data are related to known outbreaks of infectious gastrointestinal illness in the drinking water service area [10]
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