title: Use of stool collection kits delivered to patients can improve confirmation of etiology in foodborne disease outbreaks.
abstract: BACKGROUND
  In 68% of foodborne disease outbreaks, no etiologic pathogen is identified. In two-thirds of outbreaks with no identified etiology, no stool specimens are submitted for testing.
  
  
  METHODS
  From April 2001 to March 2003, we pilot-tested use of prepackaged, self-contained stool specimen collection kits in 3 states, delivered to and from patients by courier or mail, to improve rates of specimen collection in the outbreak setting. Specimens were tested for bacterial and viral pathogens at health department laboratories, and results were correlated with epidemiological investigation data.
  
  
  RESULTS
  Specimens were returned by > or =1 person in 52 (96%) of 54 outbreaks in which kits were deployed; in total, 263 (76%) of 347 persons who received kits returned specimens. Resolution of symptoms was the most commonly cited reason for nonsubmission of kits. An etiology was confirmed in 37 (71%) of 52 outbreaks with specimens returned; 28 (76%) were attributable to norovirus, and 9 (24%) were attributed to bacterial pathogens. Stool kits were well received and cost an average of approximately 43 dollars per specimen returned.
  
  
  CONCLUSIONS
  In two-thirds of foodborne disease outbreaks in which delivered stool collection kits were successfully deployed, an etiologic organism was identified. Delivery of kits to and from patients to improve rates of stool collection in outbreaks in which specimens might otherwise not be submitted could substantially reduce the number of outbreaks with an unknown etiology.
authors.affiliation: Communicable and Environmental Disease Services, Tennessee Department of Health, Nashville, TN 37247, USA. tim.f.jones@state.tn.us
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: S N
authors.initials: SN
authors.lastname: Bulens
authors.forename: S
authors.initials: S
authors.lastname: Gettner
authors.forename: R L
authors.initials: RL
authors.lastname: Garman
authors.forename: D J
authors.initials: DJ
authors.lastname: Vugia
authors.forename: D
authors.initials: D
authors.lastname: Blythe
authors.forename: M A
authors.initials: MA
authors.lastname: Hawkins
authors.forename: S S
authors.initials: SS
authors.lastname: Monroe
authors.forename: F J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: U D
authors.initials: UD
authors.lastname: Parashar
mesh_terms: D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology*; D005516:Food Microbiology; D006801:Humans; D007239:Infections / Q000175:diagnosis* / Q000382:microbiology*; D010865:Pilot Projects; D011933:Reagent Kits, Diagnostic; D013048:Specimen Handling
chemical_list: D011933:Reagent Kits, Diagnostic