Content area
Full text
(ProQuest: ... denotes non-US-ASCII text omitted.)
Original Papers
Gastroenteritis
INTRODUCTION
Acute gastrointestinal illness (AGI) has a huge public health impact in terms of disease incidence, prevention issues and healthcare costs. The majority of AGI is caused by infectious agents.
Over the last years the burden of AGI has been a field of research in many countries. The methodology for community surveys has improved over the years and a common case definition was established to ensure international comparability [1-3]. These efforts resulted in cross-sectional studies for estimates for the burden of AGI from various countries [4-18] and additionally a few population-based cohort studies [19-21].
In Germany, epidemiological analyses of infectious diseases often rely on data from the national notifiable infectious disease surveillance system. Laboratory-confirmed cases are notified to the local public health office. Clearly, these cases represent only the tip of the surveillance pyramid [3]. Many infections go unnoticed because not all patients seek medical care. Moreover, although medically indicated, a stool sample is not investigated from all patients for the causative agent, which is prerequisite for notification. Varying degrees of under-ascertainment by age group, sex, socioeconomic status and geographical region can result in biased comparisons of incidence estimates. Despite the fact that many of the gastrointestinal pathogens are notifiable, there is no syndromic surveillance of AGI in Germany. In this situation conducting cross-sectional surveys using a standardized syndromic case definition for AGI is a necessary alternative. These surveys provide representative population estimates of the true burden of acute gastrointestinal disease. A cross-sectional study in North Germany in 2004 verified that in a large proportion of AGI patients an infectious agent could have been detected, indicating that the majority of these are caused by infectious agents [22]. This is why cross-sectional data on the incidence of AGI can complement the system of notifiable disease surveillance while helping to unravel true differences of disease burden from under-ascertainment and reporting artefacts. Furthermore, data on baseline incidence can help to interpret the data of syndromic surveillance implemented on an ad hoc basis (e.g. in the case of large and widely dispersed outbreaks) [23]. Additionally incidence estimates may help to formulate precise case definitions differentiating between baseline disease incidence and outbreak case excess during outbreak analyses of gastrointestinal diseases...