NACCT Platform Abstracts 2012 - The American Academy of Clinical ...

6
Incidents of Public Health Significance identified by National Surveillance of Poison Center Data
Sophia Sheikh 1 , Royal Law 1 , Alvin Bronstein 2 , Richard Thomas 2 , Henry Spiller 2 , Joshua Schier 1
1 Centers for Disease Control and Prevention, Atlanta GA USA
2 American Association of Poison Control Centers
The Centers for Disease Control and Prevention and the American Association of Poison Control Centers conduct public
health surveillance on data collected by the National Poison Data System (NPDS) to identify incidents of public health
significance (PHS). Automated surveillance algorithms run continuously in NPDS to identify instances when the number of
hourly calls to a PC (call volume incidents or CVIs), or the daily, cumulative count of any reported sign, symptom, or
laboratory abnormality (clinical effect incidents or CEIs) exceed a historical baseline. Incidents are reviewed daily by clinical
toxicologists and epidemiologists to determine if an incident is of PHS and if further public health action is needed. The
objective of this report is to characterize incidents of PHS identified by national surveillance from 1/2007 to 8/2011. Methods:
All incidents of PHS identified from 1/1/2007 to 8/1/2011 were reviewed. PHS was left to the individual judgment of the
surveillance team member. Outcome measures for CVIs included mechanism of chemical exposure, setting, and substance
type: mechanism of chemical exposure, clinical syndrome, specific illness and substance reported was reported for CEIs.
Results: A total of 830 CVIs were identified and the majority were of PHS (n=721; 86.9%). Airborne exposures (e.g., gases
and fumes) were the most reported mechanism of chemical exposure for each year, and in total (n=312; 42.2%). The most
common exposure setting for all years when combined was occupational (n=128, 27.9%), followed by school (n=126,
27.5%). The most frequently reported chemical exposure every year was carbon monoxide (n=115, 15.5%), except in 2007
(when an outbreak of Salmonella contaminated peanut butter occurred). A cumulative total of 383 CEIs were identified and
the majority were of PHS (n=339; 88.5%). Airborne exposures were the most common mechanism of exposure for all years
combined (70, 21.8%), followed by product contamination/tampering (68, 19.7%). The most common syndrome reported
was gastrointestinal (n=124, 20.9%); diarrhea was the most frequently reported illness (n=42, 7.1%). Contaminated peanut
butter (2007 and 2009 outbreaks) was the most frequently reported substance overall (n=61, 18%). Conclusions: Carbon
monoxide releases were the most frequently reported incidents of PHS and gastrointestinal syndromes and symptoms were the
most commonly reported illness manifestations. Surveillance of NPDS data can be used to characterize incidents of PHS and
possibly identify risk factors for future interventions. These surveillance strategies can be replicated at the regional level which
would be of interest to state health departments.