White J, Noonan-Toly C, Lukacik G, Thomas N, Hinckley A, Hook S, Backenson P B
New York State Department of Health, Albany, NY, USA.
Centers for Disease Control and Prevention, Fort Collins, CO, USA.
Zoonoses Public Health. 2018 Mar;65(2):238-246. doi: 10.1111/zph.12307. Epub 2016 Sep 10.
Despite the mandatory nature of Lyme disease (LD) reporting in New York State (NYS), it is believed that only a fraction of the LD cases diagnosed annually are reported to public health authorities. Lack of complete LD case reporting generally stems from (i) lack of report of provider-diagnosed cases where supportive laboratory testing is not ordered or results are negative (i.e. provider underreporting) and (ii) incomplete case information (clinical laboratory reporting only with no accompanying clinical information) such that cases are considered 'suspect' and not included in national and statewide case counts (i.e. case misclassification). In an attempt to better understand LD underreporting in NYS, a two-part study was conducted in 2011 using surveillance data from three counties. Case misclassification was assessed by obtaining medical records on suspect cases and reclassifying according to the surveillance case definition. To assess provider underreporting, lists of patients for whom ICD-9-CM code 088.81 (LD) had been used were reported to NYS Department of Health (NYSDOH). These lists were matched to the NYSDOH case reporting system, and medical records were requested on patients not previously reported; cases were then classified according to the case definition. When including both provider underreporting and case misclassification, approximately 20% (range 18.4-24.6%) more LD cases were identified in the three-county study area than were originally reported through standard surveillance. The additional cases represent a minimum percentage of unreported cases; the true percentage of unreported cases is likely higher. Unreported cases were more likely to have a history of erythema migrans (EM) rash and were more likely to be young paediatric cases. Results of the study support the assertion that LD cases are underreported in NYS. Initiatives to increase reporting should highlight the importance of reporting clinically diagnosed EM and be targeted to those providers most likely to diagnose LD, specifically providers treating paediatric patients.
尽管纽约州（NYS）规定必须报告莱姆病（LD）病例，但据信每年诊断出的LD病例中只有一小部分会报告给公共卫生当局。LD病例报告不完整通常源于：（i）医生诊断的病例未报告，这些病例未进行支持性实验室检测或检测结果为阴性（即医生漏报）；（ii）病例信息不完整（仅临床实验室报告，无附带临床信息），导致病例被视为“疑似”，未纳入国家和全州的病例计数（即病例错误分类）。为了更好地了解纽约州LD病例报告不足的情况，2011年利用三个县的监测数据进行了一项分为两部分的研究。通过获取疑似病例的医疗记录并根据监测病例定义重新分类来评估病例错误分类。为了评估医生漏报情况，向纽约州卫生部（NYSDOH）报告了使用国际疾病分类第九版临床修订本（ICD-9-CM）代码088.81（LD）的患者名单。将这些名单与NYSDOH病例报告系统进行匹配，并要求提供之前未报告患者的医疗记录；然后根据病例定义对病例进行分类。当将医生漏报和病例错误分类都考虑在内时，在这三个县的研究区域中，发现的LD病例比通过标准监测最初报告的病例多约20%（范围为18.4-24.6%）。这些额外的病例代表了未报告病例的最低比例；未报告病例的实际比例可能更高。未报告病例更有可能有游走性红斑（EM）皮疹病史，且更有可能是小儿病例。该研究结果支持了纽约州LD病例报告不足的说法。增加报告的举措应强调报告临床诊断的EM的重要性，并针对最有可能诊断LD的医生，特别是治疗儿科患者的医生。
