Positive Lab Tests: To Investigate or Not Investigate, That Is the Case Report Question

Laboratory testing informs decisions triggering infectious disease investigation.  Much attention has been given to surveillance for infectious diseases, and public health agencies are investing heavily in preparation for a possible pandemic H1N5 avian influenza outbreak or bioterrorist event.  Media coverage on SARS, anthrax, Salmonella, measles, mumps, Hepatitis C, and now the Novel H1N1 influenza virus fuels the fear and media coverage.

In addition to surveillance, public health agencies have statutory responsibility for investigating and controlling outbreaks of such infectious diseases.  Investigation burdens fall largely on front-line public health workers. However, of the nearly 3,000 local health departments, only the larger districts (approximately 25%) have expert epidemiologists.  What do we know about how front-line public health workers make decisions about investigations?  The Institute of Medicine 1988 report, The Future of Public Health, points out, “…data on the activities of local health departments are hard to come by.”

Nationally, the CDC, Council of State and Territorial Epidemiologists and the Association of Public Health Laboratories have agreed on a list of notifiable diseases to be reported by health care providers.  Mandated by state law some must be reported to state and local public health jurisdictions.  Positive lab results are required for confirming a case of many reportable infectious diseases.

We examined front-line public health decision-making using a pre-tested, individual, semi-structured interview protocol. Study participants included state and local public health professionals in Utah and Nevada who contribute to outbreak investigations. Interviews were digitally recorded, professionally transcribed and analyzed using qualitative research techniques.

This presentation examines the reliance on laboratory results which trigger and inform investigations. It addresses issues and challenges identified by participants and observed by interviewers which accompany use of laboratory data.  Potential solutions, including decision support tools, online school and consumer reporting, and personal health records, will be proposed and discussed.