title: Factors associated with seeking medical care and submitting a stool sample in estimating the burden of foodborne illness.
abstract: Laboratory-based surveillance is a foundation for public health and is essential for determining the incidence of most foodborne diseases caused by bacterial pathogens; however, reported cases represent a subset of infections in the community. To identify the factors associated with seeking medical care and submitting a stool specimen among persons with acute diarrheal illness, we used multivariate logistic regression to analyze data from two 12- month population-based telephone surveys conducted in the Foodborne Diseases Active Surveillance Network (FoodNet) from 2000 to 2003. Of 31,082 persons interviewed, 5% reported an acute diarrheal illness in the four weeks prior to the interview; of these, 20% sought medical care. On multivariate analysis, among persons with an acute diarrheal illness, factors associated with seeking medical care included: male sex; age <5 or >or=65 years; household income <25,000 dollars; having health insurance; diarrhea duration >or=3 days; having bloody diarrhea, fever, vomiting, sore throat, or cough. Of those seeking medical care, 19% provided a stool sample. Bloody diarrhea (odds ratio [OR] 3.35; 95% confidence interval [CI] 1.18-9.51) and diarrhea duration >or=3 days (OR 3.81; 95% CI: 1.50-9.69) were the most important factors associated with submission of a stool specimen. Cases of acute diarrheal illness ascertained through laboratory-based public health surveillance are likely to differ systematically from unreported cases and likely over-represent those with bloody diarrhea and longer diarrhea duration.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. escallan@cdc.gov
authors.forename: Elaine
authors.initials: E
authors.lastname: Scallan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: Alicia
authors.initials: A
authors.lastname: Cronquist
authors.forename: Stepy
authors.initials: S
authors.lastname: Thomas
authors.forename: Paul
authors.initials: P
authors.lastname: Frenzen
authors.forename: Dina
authors.initials: D
authors.lastname: Hoefer
authors.forename: Carlota
authors.initials: C
authors.lastname: Medus
authors.forename: Fredrick J
authors.initials: FJ
authors.lastname: Angulo
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003967:Diarrhea / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology*; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018571:Sentinel Surveillance; D012737:Sex Factors; D014481:United States