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Use of the Web by State and Territorial Health Departments t

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  • Use of the Web by State and Territorial Health Departments t

    Use of the Web by State and Territorial Health Departments to Promote Reporting of Infectious Disease

    To the Editor: The threat of emerging infections and bioterrorism has heightened the need for timeliness and completeness of disease reporting. However, physicians frequently encounter barriers that undermine notification, including lack of information about what, when, how, or where to report.1-2 Because nearly 80% of US physicians use the Web,3 the Web offers an unprecedented opportunity to facilitate disease reporting. We evaluated use of the Web by state and territorial health departments to promote infectious disease reporting.


    In the summer of 2003, we surveyed state epidemiologists in the 57 health jurisdictions that participate in the National Notifiable Diseases Surveillance System (NNDSS).4 This e-mail and telephone survey assessed the availability of an up-to-date reportable disease list on the Web and of Web-based reporting for physicians. Additionally, for each jurisdiction's Web site we recorded the presence or absence of critical elements defining why, what, when, how, and where to report diseases, and assessed reporting requirements of diseases caused by the 6 bioterrorism agents classified as "Category A" by the US Centers for Disease Control and Prevention (CDC).5


    Epidemiologists from 56 of the 57 jurisdictions responded to the survey. Forty-seven (84%) reported that they had current reportable disease lists on the Web, and 5 (9%) indicated they had secure Web-based capability for physician reporting.

    We located Web-based disease reporting information on 48 (84%) of the NNDSS jurisdictions' Web sites, including all 47 sites indicated by the epidemiologists. The presence of various types of information important in facilitating disease reporting and the percentage of sites requiring reporting of the 6 CDC Category A diseases appear in Figure 1. Of the sites we located, 46 (96%) specified time frames to report specific diseases (eg, "immediately," "within 7 days"), and 43 (90%) designated a telephone number for immediate reporting. Case-reporting forms were present on 20 sites (42%). Twenty-one (44%) of the 48 jurisdictions with Web-based information mandated reporting of all 6 diseases caused by Category A bioterrorism agents. Examining each of the 6 diseases individually, the percentage of jurisdictions that mandate reporting ranged from a low of 44% (viral hemorrhagic fevers) to a high of 100% (anthrax, botulism).

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    Figure. Presence of Disease Reporting Information on Health Department Web Sites: United States, 2003
    *Percentage of health jurisdiction Web sites for which the listed information type was found on the site, based on 48 sites having disease reporting information. CDC indicates US Centers for Disease Control and Prevention.


    To our knowledge, this is the first description of the use of the Web by states and territories for reporting of infectious diseases. Our results indicate that while most jurisdictions maintain Web sites, many did not clearly describe what, when, how, and where health care providers should report diseases. We also found considerable variation in Web-based information on reporting requirements for diseases potentially related to bioterrorism. Including explicit requirements to report all Category A diseases on a jurisdiction's reportable disease list not only reduces uncertainty about what is reportable, but also raises awareness of these threats.5-6

    Because most jurisdictions already maintain Web sites, updating them to provide complete, accessible disease reporting information should be relatively inexpensive. More effective use of the Web could strengthen the partnership among clinicians and local public health officials that is vital for recognition of and response to disease outbreaks and bioterrorism-related events.

    Acknowledgment: We thank Samuel Groseclose, DVM, MPH, of the US Centers for Disease Control and Prevention for his assistance with the contacts for the 4 US territories that participate in the National Notifiable Disease Surveillance System. We also thank James T. Rankin, DVM, PhD, of the Pennsylvania Department of Health for his comments on the survey instrument.

    Nkuchia M. M'ikanatha, DrPH, MPH
    [email protected]
    Division of Infectious Disease Epidemiology
    Pennsylvania Department of Health

    David P. Welliver, MS, MBA
    Penn State Milton S. Hershey Medical Center

    Dale D. Rohn, MPH
    Maryland Department of Health and Mental Hygiene

    Kathleen G. Julian, MD
    Penn State Milton S. Hershey Medical Center

    Ebbing Lautenbach, MD, MPH, MSCE
    Center for Clinical Epidemiology and Biostatistics
    University of Pennsylvania School of Medicine

    1. Chorba TL, Berkman RL, Safford SK, Gibbs NP, Hull HF. Mandatory reporting of infectious diseases by clinicians. JAMA. 1989;262:3018-3026. ABSTRACT
    2. Konowitz PM, Petrossian GA, Rose DN. The underreporting of disease and physicians' knowledge of reporting requirements. Public Health Rep. 1984;99:31-35. ISI | MEDLINE
    3. American Medical Association. New AMA study shows physicians' use of Internet steadily rising. Available at: Accessed July 19, 2002.
    4. Centers for Disease Control and Prevention. Bioterrorism Agents/Diseases. Available at: Accessed December 30, 2003.
    5. Centers for Disease Control and Prevention. National Notifiable Disease Surveillance System. Available at: Accessed December 29, 2003.
    6. Horton HH, Misrahi JJ, Matthews GW, Kocher PL. Critical biological agents: disease reporting as a tool for determining bioterrorism preparedness. J Law Med Ethics. 2002;30:262-266. ISI | MEDLINE

    Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

    JAMA. 2004;291:1069-1070.
    \"No, I think Space is a dimension of Time. My theory is that Time is a field and that Space exists as an aspect of Time.\" Michael Moorcock

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