Wan Victoria, McIntyre Lorraine, Kent Debra, Leong Dennis, Henderson Sarah B
Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.
British Columbia Drug and Poison Information Centre, Vancouver, BC, Canada.
JMIR Public Health Surveill. 2018 Feb 23;4(1):e17. doi: 10.2196/publichealth.8944.
Data from poison centers have the potential to be valuable for public health surveillance of long-term trends, short-term aberrations from those trends, and poisonings occurring in near-real-time. This information can enable long-term prevention via programs and policies and short-term control via immediate public health response. Over the past decade, there has been an increasing use of poison control data for surveillance in the United States, Europe, and New Zealand, but this resource still remains widely underused.
The British Columbia (BC) Drug and Poison Information Centre (DPIC) is one of five such services in Canada, and it is the only one nested within a public health agency. This study aimed to demonstrate how DPIC data are used for routine public health surveillance in near-real-time using the case study of its alerting system for illness related to consumption of shellfish (ASIRCS).
Every hour, a connection is opened between the WBM software Visual Dotlab Enterprise, which holds the DPIC database, and the R statistical computing environment. This platform is used to extract, clean, and merge all necessary raw data tables into a single data file. ASIRCS automatically and retrospectively scans a 24-hour window within the data file for new cases related to illnesses from shellfish consumption. Detected cases are queried using a list of attributes: the caller location, exposure type, reasons for the exposure, and a list of keywords searched in the clinical notes. The alert generates a report that is tailored to the needs of food safety specialists, who then assess and respond to detected cases.
The ASIRCS system alerted on 79 cases between January 2015 and December 2016, and retrospective analysis found 11 cases that were missed. All cases were reviewed by food safety specialists, and 58% (46/79) were referred to designated regional health authority contacts for follow-up. Of the 42% (33/79) cases that were not referred to health authorities, some were missing follow-up information, some were triggered by allergies to shellfish, and some were triggered by shellfish-related keywords appearing in the case notes for nonshellfish-related cases. Improvements were made between 2015 and 2016 to reduce the number of cases with missing follow-up information.
The surveillance capacity is evident within poison control data as shown from the novel use of DPIC data for identifying illnesses related to shellfish consumption in BC. The further development of surveillance programs could improve and enhance response to public health emergencies related to acute illnesses, chronic diseases, and environmental exposures.
中毒控制中心的数据对于长期趋势的公共卫生监测、这些趋势的短期异常以及近乎实时发生的中毒事件具有潜在价值。这些信息能够通过项目和政策实现长期预防，并通过即时的公共卫生应对措施实现短期控制。在过去十年中，美国、欧洲和新西兰越来越多地将中毒控制数据用于监测，但这一资源仍未得到充分利用。
不列颠哥伦比亚省（BC）药物与中毒信息中心（DPIC）是加拿大五个此类服务机构之一，也是唯一一个隶属于公共卫生机构的中心。本研究旨在通过其贝类消费相关疾病警报系统（ASIRCS）的案例研究，展示DPIC数据如何近乎实时地用于常规公共卫生监测。
每小时，持有DPIC数据库的WBM软件Visual Dotlab Enterprise与R统计计算环境之间建立连接。该平台用于提取、清理并将所有必要的原始数据表合并为一个单一数据文件。ASIRCS会自动且追溯性地扫描数据文件中24小时的窗口，以查找与贝类消费相关疾病的新病例。使用一系列属性对检测到的病例进行查询：来电者位置、接触类型、接触原因以及临床记录中搜索的关键词列表。警报会生成一份根据食品安全专家需求定制的报告，然后由他们对检测到的病例进行评估并做出回应。
2015年1月至2016年12月期间，ASIRCS系统发出了79例警报，回顾性分析发现有11例漏报。所有病例均由食品安全专家进行审查，58%（46/79）的病例被转介给指定的地区卫生当局联系人进行随访。在未转介给卫生当局的42%（33/79）病例中，一些病例缺少随访信息，一些病例是由对贝类的过敏引发的，还有一些病例是由非贝类相关病例的病历中出现的与贝类相关的关键词触发的。2015年至2016年期间进行了改进，以减少缺少随访信息的病例数量。
如通过DPIC数据在识别BC省与贝类消费相关疾病方面的新颖应用所示，中毒控制数据中的监测能力是明显的。监测项目的进一步发展可以改善并加强对与急性疾病、慢性疾病和环境暴露相关的公共卫生紧急情况的应对。
