P1-135 Are Campylobacter Cases Low Risk for Public Health Follow-up?

Monday, July 29, 2013
Exhibit Hall (Charlotte Convention Center)
Marilyn Lee, Ryerson University, Toronto, Canada
Richard Meldrum, Ryerson University, Toronto, Canada
Effie Gournis, Toronto Public Health, Toronto, Canada
Monica Mitchell, Toronto Public Health, Toronto, Canada
Introduction: The high volume of gastroenteric cases reported to Toronto Public Health (TPH) requires disease investigations of foodborne agents be prioritized through a risk-based system.  Cases of diseases linked to outbreaks are followed-up with a telephone call.  A passive letter-based system with a questionnaire is used to collect information from cases deemed 'low risk', but is not returned by 40% of cases.

Purpose: This study investigated the reasons why cases of one of the most common low-risk gastroenteric diseases, Campylobacter, did not return their questionnaires and whether there were missed opportunities for public health interventions.

Methods: Clients reported between April 3 and November 5, 2012 with a confirmed Campylobacter illness and who did not respond within 30 days after a questionnaire was mailed to them were included.   These non-respondents were telephoned, to ask whether they remembered receiving a letter from TPH, the reason why they did not respond, what would have encouraged a response and whether they worked in a sensitive occupation.

Results: A total of 226 Campylobacter cases had not responded during the study period.  Of these, 172 (76.1%) were reached by phone and 162 (71.7%) agreed to participate.  The age and gender distribution of participants did not differ from cases who responded to the original letter.  The largest proportion (54.4%) of participants reported they had forgotten to return the questionnaire.  When asked what would have encouraged a response, more information on the importance of returning the questionnaire (19.1%), followed by a simpler form (15.9%) were the most common answers. Only 3 (2.4%) cases were employed in sensitive occupations; none reported working while ill.

Significance: This study validated treating Campylobacter reports as "low-risk" for public health follow-up.  Data collected suggest a reminder, simplifying the questionnaire, and underscoring the importance of responding could increase the response rate for letter-based investigations.