Issue 23 - A Website for Self Reporting Foodborne Illness

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A Website for Self Reporting Foodborne Illness
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Gastroenteritis represents an interesting paradox in public health circles. It causes 76 million cases of illness in the United States, is included as one of the most common reasons for an emergency room visit, and causes 5,000 deaths annually. Yet causes are rarely identified, and only 1-2% of the cases are even reported to the health department. (1)

In order to address this problem, the National Food Safety and Toxicology Center at Michigan State University has created a unique syndromic surveillance system, which is a web-based Foodborne Disease forum. Find it on the web at:

www.RUsick2.msu.edu

This is how it works. An individual suffering from gastroenteritis logs onto this easily navigated website and clicks ‘First Time User’. They enter personal information including email address and symptoms, date and time of illness onset, a 4-day pre-illness food history (from coded lists), as well as information regarding non foodborne sources (e.g., exposure to animals, private well water). Site visitors are not able to access other visitors’ personal information, narrative testimony, or name of restaurants/stores.

The genius in the design is the feedback it gives to customers. Just as with other illness forums, it allows the customers to “share and compare pre-illness food histories.” (2) The designers clearly felt that “Surveillance systems work better when the person doing the work of reporting get something they want out of the system. Therefore, RUsick2 is designed to be driven by the visitor’s interest in determining the cause (source) of their illness.” (2)

For Public health, the website has a number of advantages. Public health is given access to all information in their jurisdiction, and they receive email messages when someone in their jurisdiction has added a record. Thus, public health can spend time selecting clusters of cases to investigate, rather than individual cases. The data provides an excellent overview of an individual's illness, and in fact an argument could be made that it does a better job of eliciting food history than a phone call would, as the customer is allowed to return to the website and complete their record (e.g., food history) after they have reviewed their calendar and other documents that might jog their memory.

A number of features of the Forum were created to prevent pseudo-outbreaks brought about by power of suggestion. Visitors must enter data before they can see reports (that might influence their own record). Visitors only view reports related to their own data entry choices. Vendors (restaurants/stores) are only identified by abbreviation not specific to any one establishment (only health departments see the entire names of vendors).

This website went live in November 2002 targeting three counties in the greater Lansing (MI) area after extensive publicity. In the first 17 weeks of the program, they averaged 5.37 cases per week, when 1.31 would have been expected. During this time, two foodborne outbreaks were recognized which would most likely have been missed.

RUsick2 has recently expanded beyond central Michigan, and now accepts records and provides reports for any city in the nation. Public health departments can request and receive passwords to access data from their jurisdiction.

Unfortunately, without extensive publicity, this site may not see the traffic it deserves. Using Google to try and access the site without the exact name, (viewing Google’s first 5 pages) with keywords: gastroenteritis, food poisoning, nausea/vomiting/diarrhea, gastroenteritis reporting, and food illness reporting did not locate the site. Thus, it is up to those in health care and public health to let their constituents know of this worthwhile project.

The RUsick2 project received funding from the Michigan Life Sciences Corridor until December 31, 2004. They hope to find funding/sponsors to help defray the cost of managing and advertising the project in the future. Use fmod@cvm.msu.edu to contact them for more information.

For those looking to setup a syndromic surveillance program, RUsick2 is a wonderful adjunct to emergency room, and or other surveillance efforts.

(1)Wethington H, Bartlett P. The RUsick2 Foodborne Disease Forum for Syndromic Surveillance. Emerg Infect Dis 2004; 10, 401-405

(2) www.RUsick2.msu.edu

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