title: Possible information bias in a waterborne outbreak investigation.
abstract: Although an investigation of a cryptosporidiosis outbreak in 1994 in Clark County, Nevada, concluded that illness was associated with consumption of municipal water, no water treatment deficiencies or breakdowns and no water quality changes were discovered during the investigation. We evaluated the strength of the evidence for waterborne transmission and conducted a sensitivity analysis to define the limitations of the epidemiological data. Our analyses suggest a spurious inference of waterborne transmission might be due to differential misclassification bias. If exposure and disease status were incorrectly classified for a relatively small number of study participants, findings of the investigation would be interpreted differently. We offer this example to illustrate the importance of assessing the stability of a relative risk estimate and effect of possible biases during an outbreak investigation.
authors.affiliation: Gunther F. Craun & Associates, 101 West Frederick Street, Suite 205, Staunton, VA 24401, USA.
authors.forename: G F
authors.initials: GF
authors.lastname: Craun
authors.forename: F J
authors.initials: FJ
authors.lastname: Frost
mesh_terms: D000328:Adult; D015982:Bias; D016022:Case-Control Studies; D003457:Cryptosporidiosis / Q000635:transmission*; D004196:Disease Outbreaks; D004781:Environmental Exposure; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment; D014881:Water Supply