title: Diarrheal illness detected through syndromic surveillance after a massive power outage: New York City, August 2003.
abstract: OBJECTIVE
  We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003.
  
  
  METHODS
  The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case-control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients.
  
  
  RESULTS
  Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR]=2.7, 95% confidence interval [CI]=1.2, 6.1) and seafood (OR=4.8; 95% CI=1.6, 14) between the power outage and symptom onset was associated with diarrheal illness.
  
  
  CONCLUSIONS
  Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected.
authors.affiliation: New York City Department of Health and Mental Hygiene, 125 Worth St, Room 219, Box 22A, New York, NY 10013, USA. mmarx@health.nyc.gov
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Marx
authors.forename: Carla V
authors.initials: CV
authors.lastname: Rodriguez
authors.forename: Jane
authors.initials: J
authors.lastname: Greenko
authors.forename: Debjani
authors.initials: D
authors.lastname: Das
authors.forename: Richard
authors.initials: R
authors.lastname: Heffernan
authors.forename: Adam M
authors.initials: AM
authors.lastname: Karpati
authors.forename: Farzad
authors.initials: F
authors.lastname: Mostashari
authors.forename: Sharon
authors.initials: S
authors.lastname: Balter
authors.forename: Marcelle
authors.initials: M
authors.lastname: Layton
authors.forename: Don
authors.initials: D
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003967:Diarrhea / Q000453:epidemiology*; D004196:Disease Outbreaks; D004560:Electricity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011210:Power Plants; D011634:Public Health; D018571:Sentinel Surveillance