Despite state and local laws requiring medical providers to report notifiable infectious diseases to public health authorities, reporting is believed to be incomplete. Through means of an analytical literature review, the authors synthesize current knowledge on the completeness of disease reporting and identify factors associated with reporting completeness. The review was limited to published studies, conducted in the United States between 1970 and 1999, that quantitatively assessed infectious disease reporting completeness. Thirty-three studies met the inclusion criteria. Reporting completeness, expressed between 0% and 100%, was treated as the dependent outcome variable in statistical analysis; disease, study location, time period, study design, and study size were treated as independent variables. Fifty-six distinct measures of reporting completeness were identified for 21 diseases. Reporting completeness varied from 9% to 99% and was most strongly associated with the disease being reported. The mean reporting completeness for acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis as a group was significantly higher (79%) than for all other diseases combined (49%) (p < 0.01).

/pdf/completeness-of-notifiable-infectious-disease-reporting-in-1iziupyc08.pdf

Completeness of notifiable infectious disease reporting in the United States: an analytical literature review.

Background and objectives Genital ulcer disease (GUD) has been reported to increase the risk for the acquisition of human immunodeficiency virus (HIV). Although many investigators have reported an increased risk for HIV infection in persons with concurrent or previous GUD, not all studies have been designed to determine whether GUD causes an increased risk for HIV infection or acts only as a risk marker for infection. The evidence from the literature is discussed, and the criteria for causal inference proposed by Sir Austin Bradford Hill are applied. Goal To evaluate the strength of the association between GUD and infection by HIV. Study design Case-control, cross-sectional, and cohort studies that examined the association between HIV seroconversion and GUD were chosen from the literature. Twenty-seven epidemiologic studies were selected for analysis, many of which reported separate analyses of the association between HIV infection and herpes simplex virus infection, syphilis, or nonspecified GUD. The studies were analyzed to investigate the magnitude of association between GUD and HIV, and the evidence evaluated using Hill's criteria. Results Approximately two thirds of the analyses reported a statistically significant association between GUD and HIV infection. Fourteen studies reported 29 separate analyses using a case-control design, 18 of which reported a statistically significant association between GUD (GUD, herpes, and syphilis) and HIV infection, four analyses were of varying significance depending on the analytical technique used, and seven were nonsignificant. Thirteen studies reported 23 separate longitudinal analyses that used a nested case-control or cohort design: 11 reported a significant association, 11 had nonsignificant findings, and results of one study varied. No study reported a statistically significant negative association. When applying the literature to Hill's criteria, all nine criteria for causal inference were met, providing additional evidence that genital ulcers are associated with an increased risk for the development of HIV infection. Conclusions The published evidence suggests that GUD increases the risk for HIV acquisition. Few studies, however, have examined carefully the temporal association between preexisting GUD and subsequent HIV acquisition. The analyses that simultaneously controlled for additional risks for HIV infection, such as lifetime sex partners or history of injection drug use, report a generally lower risk for HIV associated with GUD. It is likely that studies that adequately control for risk factors will find a lower risk associated with GUD than was reported in the literature earlier in the HIV epidemic. Future research needs and the problems associated with conducting these types of studies are discussed.

The causal role for genital ulcer disease as a risk factor for transmission of human immunodeficiency virus. An application of the Bradford Hill criteria.

Objective: To assess the impact of the 1993 change in the AIDS case definition on the completeness and timeframe of AIDS case reporting in San Francisco. Design: Retrospective review of records: billing records, list of selected diagnostic codes, radiology logs, ophthalmology clinic records, and patient registries at a selection of hospitals, clinics, and physician offices. Setting: Hospitals, public/community health clinics, and physician offices. Main outcome measures: The completeness of reporting and the median reporting delay was calculated for hospitals, clinics, and physician offices. Results: Reporting was 97% complete. Reporting from physician offices was less complete (75%) than from other facilities. The median reporting delay was 1 month and was shorter for persons who met the 1993 AIDS case definition (1 month) than for persons who met the 1987 case definition (3 months). Conclusions: AIDS case reporting in San Francisco is highly complete but less so for persons diagnosed at physician offices. The 1993 AIDS case definition has resulted in more timely reporting. Health departments should consider efforts to improve reporting from private physician offices and should evaluate the use of laboratory-initiated CD4 reporting.

The impact of the 1993 AIDS case definition on the completeness and timeliness of AIDS surveillance.

FUNDAMENTO: Determinar la tasa de notificacion de SIDA en Cataluna. METODO: Se utilizan como fuentes de contraste las solicitudes de las determinaciones de linfocitos T CD4+ y la prescripcion de antirretrovirales en siete hospitales universitarios de Cataluna entre el 1 de enero y el 31 de junio de 1994. Se considero que un caso no estaba declarado cuando en la historia clinica existia un diagnostico de sida (segun la definicion de Europa 93) y dicho caso no se encontraba incluido en el registro de sida de Cataluna. RESULTADOS: De los 1.370 casos analizados, se detectaron 50 casos de sida no declarados. La tasa de notificacion global fue del 98,6%, con un intervalo de confianza del 95% (IC del 95%):98,2-99,0. La mayoria de los casos no declarados eran hombres (72%) con una edad media de 37,3 anos (DS:11,8), el 52% eran usuarios de drogas por via parenteral (UDVP), siendo la tuberculosis extrapulmonar la enfermedad diagnostica mas frecuente (16%), el 81,4% presentaban un nivel de linfocitos T CD4+ menor o igual a 200 celulas /mm3. El 92% de estos casos se detectaron a partir de los registros de determinaciones de linfocitos T CD4+. CONCLUSIONES: La exhaustividad detectada se considera adecuada. Se recomienda usar los registros de determinaciones linfocitarias para este tipo de estudios.

/pdf/exhaustividad-de-la-notificacion-de-los-casos-de-sida-en-1k3i8imocu.pdf

Exhaustividad de la notificación de los casos de sida en Cataluña: un estudio basado en las solicitudes de determinaciones de linfocitos CD4 y en la prescripción de antirretrovirales

https://cdr.lib.unc.edu/downloads/k643b219p

An Evaluation of Mandatory Communicable Disease Reporting in North Carolina

Limitations of AIDS reporting under favorable circumstances.

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Limitations of AIDS reporting under favorable circumstances.