title: Monitoring over-the-counter medication sales for early detection of disease outbreaks--New York City.
abstract: BACKGROUND
  Over-the-counter (OTC) medications are frequently used during the initial phase of illness, and increases in their sales might serve as an early indicator of communitywide disease outbreaks. Since August 2002, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has tracked OTC medication sales to enhance detection of natural and intentional infectious disease outbreaks.
  
  
  OBJECTIVE
  This report describes the surveillance system and presents results from retrospective analyses and a comparison between citywide trends in OTC medication sales and emergency department (ED) visits.
  
  
  METHODS
  Sales data transmitted daily to DOHMH are categorized into two groups: influenza-like illness (ILI), which includes cough and influenza medications, and gastrointestinal illness (GI), which includes major brand and generic antidiarrheals. Cyclical, linear regression models were used to identify significant (p<0.05) increases in the daily ratio of ILI to analgesics sales (analgesics are used as a denominator in the absence of total sales). Daily and weekly average ratios of GI to analgesic sales were analyzed. Citywide trends in OTC ILI and GI medication sales were compared with ED visits for fever/influenza and diarrhea syndromes.
  
  
  RESULTS
  Citywide ILI drug sales were highest during annual influenza epidemics and elevated during spring and fall allergy seasons, similar to trends in the ED fever/influenza syndrome. ILI sales did not consistently provide earlier warning than the ED system of communitywide influenza. GI drug sales increased during the fall and peaked during early winter and after the blackout of August 2003. Unlike ED diarrheal visits, GI medication sales did not substantially increase during late winter (February-March).
  
  
  CONCLUSIONS
  Citywide OTC medication sales can provide indications of communitywide illness, including annual influenza epidemics. Antidiarrheal medication sales were more sensitive to increases in GI caused by norovirus and influenza than illness caused by rotavirus. OTC medication sales can be considered as an adjunct syndromic surveillance system but might not be as sensitive as ED systems.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York, USA. ddas@health.nyc.gov
authors.forename: Debjani
authors.initials: D
authors.lastname: Das
authors.forename: K
authors.initials: K
authors.lastname: Metzger
authors.forename: R
authors.initials: R
authors.lastname: Heffernan
authors.forename: S
authors.initials: S
authors.lastname: Balter
authors.forename: D
authors.initials: D
authors.lastname: Weiss
authors.forename: F
authors.initials: F
authors.lastname: Mostashari
mesh_terms: D003132:Commerce / Q000706:statistics & numerical data*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City / Q000453:epidemiology; D004366:Nonprescription Drugs; D011159:Population Surveillance / Q000379:methods*; D040442:Public Health Informatics; D012189:Retrospective Studies
chemical_list: D004366:Nonprescription Drugs