title: From stool to statistics: reporting of acute gastrointestinal illnesses in Canada.
abstract: BACKGROUND
  Limitations associated with the under-reporting of enteric illnesses have long been recognized but the extent and variation of this under-reporting in Canada has not been examined. Given the public health value of surveillance data, a closer examination of under-reporting of enteric illnesses in Canada was warranted.
  
  
  METHODS
  Paper-based surveys were administered (a) to all laboratories in Canada licensed to process stool specimens and (b) to all local public health authorities in two provinces.
  
  
  RESULTS
  Of the laboratories surveyed, 67% (n=274) conducted on-site testing of stool specimens for enteric bacteria, 31% (n=126) for parasites and 10% (n=42) for viruses. In the year 2000, these laboratories processed 459,982 stool specimens, of which 5%, 15%, 8% and 19% were positive for enteric bacteria (excluding C. difficile), C. difficile, parasites and viruses, respectively. Variations in laboratory testing and health authority reporting protocols and policies were identified. Of the laboratory-confirmed cases of AGI reported to local public health authorities, 5% (n=846) were not reported to provincial counterparts.
  
  
  CONCLUSIONS
  A significant proportion of AGI cases submitting stool specimens are not captured in Canada's passive surveillance system due to unknown etiology. A much smaller proportion of laboratory-confirmed cases reported to local public health authorities are not captured at the provincial or national level. Given that the number of laboratory-confirmed AGI cases represents such a small fraction of all community cases, strategies to compensate for under-reporting and efforts directed at harmonizing laboratory and local public health authority policies and practices would be welcomed.
authors.affiliation: Foodborne, Waterborne and Zoonotic Infections Division, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Health Canada. flintjam@carec.paho.org
authors.forename: James A
authors.initials: JA
authors.lastname: Flint
authors.forename: Kathryn
authors.initials: K
authors.lastname: Doré
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Majowicz
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Edge
authors.forename: Paul
authors.initials: P
authors.lastname: Sockett
mesh_terms: D000208:Acute Disease; D002170:Canada / Q000453:epidemiology; D018563:Disease Notification / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000382:microbiology*; D006306:Health Surveys; D006801:Humans; D007753:Laboratories / Q000592:standards; D040442:Public Health Informatics; D018571:Sentinel Surveillance