Methods for determining disease burden and calibrating national surveillance data in the United Kingdom: the second study of infectious intestinal disease in the community (IID2 study).
BACKGROUND
Infectious intestinal disease (IID), usually presenting as diarrhoea and vomiting, is frequently preventable. Though often mild and self-limiting, its commonness makes IID an important public health problem. In the mid 1990s around 1 in 5 people in England suffered from IID a year, costing around pound0.75 billion. No routine information source describes the UK's current community burden of IID. We present here the methods for a study to determine rates and aetiology of IID in the community, presenting to primary care and recorded in national surveillance statistics. We will also outline methods to determine whether or not incidence has declined since the mid-1990s.


METHODS
The Second Study of Infectious Intestinal Disease in the Community (IID2 Study) comprises several separate but related studies. We use two methods to describe IID burden in the community - a retrospective telephone survey of self-reported illness and a prospective, all-age, population-based cohort study with weekly follow-up over a calendar year. Results from the two methods will be compared. To determine IID burden presenting to primary care we perform a prospective study of people presenting to their General Practitioner with symptoms of IID, in which we intervene in clinical and laboratory practice, and an audit of routine clinical and laboratory practice in primary care. We determine aetiology of IID using molecular methods for a wide range of gastrointestinal pathogens, in addition to conventional diagnostic microbiological techniques, and characterise isolates further through reference typing. Finally, we combine all our results to calibrate national surveillance data.


CONCLUSIONS
Researchers disagree about the best method(s) to ascertain disease burden. Our study will allow an evaluation of methods to determine the community burden of IID by comparing the different approaches to estimate IID incidence in its linked components.
O'Brien
Sarah J
SJ
School of Translational Medicine, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, M13 9PL, UK. sarah.o'brien@manchester.ac.uk
Rait
Greta
G
Hunter
Paul R
PR
Gray
James J
JJ
Bolton
Frederick J
FJ
Tompkins
David S
DS
McLauchlin
Jim
J
Letley
Louise H
LH
Adak
Goutam K
GK
Cowden
John M
JM
Evans
Meirion R
MR
Neal
Keith R
KR
Smith
Gillian E
GE
Smyth
Brian
B
Tam
Clarence C
CC
Rodrigues
Laura C
LC
D002138:Calibration; D015331:Cohort Studies; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D017281:Cost of Illness; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D016012:Poisson Distribution; D011159:Population Surveillance; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
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