Weng Hsin-Yi, Gaona Mark A L, Kass Philip H
Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA.
Enterprise Student Applications Unit of Information and Educational Technology Department, University of California, Davis, Davis, CA, USA.
PeerJ. 2020 May 7;8:e9093. doi: 10.7717/peerj.9093. eCollection 2020.
The 2007 nephrotoxicosis outbreak associated with melamine and cyanuric acid adulteration of pet foods in the United States sparked an urgent need for a nationwide companion animal surveillance program. In 2016, we introduced a syndromic surveillance system based on a novel epidemiological algorithm, the proportionate diagnostic outcome ratio (PDOR). The PDOR procedure was validated using simulated outbreaks of foodborne illness (i.e., aflatoxicosis and gastrointestinal illness) in dogs and cats. In this study, we further evaluated the PDOR procedure using the 2007 melamine-related outbreak of nephrotoxicosis. The performance of the PDOR procedure was assessed by the time to alert and positive predictive value (PPV). Electronic medical records of dogs and cats seen at networked primary care veterinary hospitals across the United States were retrieved from a centralized database. The data of four relevant syndromic components: elevated serum creatinine concentration, vomiting, anorexia, and lethargy from July 28, 2006 to May 31, 2007 were prospectively analyzed using the PDOR algorithm. The results showed that the alerts generated from the analysis of elevated serum creatinine concentration could have led to an early detection of this nephrotoxicosis foodborne outbreak and were well matched to the reported timeline of the outbreak. Additionally, we also observed variations in the performance of the PDOR procedure across age of animals and syndromic components, with the PPVs ranged from 0.61 to 1.0. Combined with the findings from previous evaluations using simulated outbreak scenarios, this study provided additional evidence that the PDOR procedure can be applied in syndromic surveillance to effectively and accurately detect various types of foodborne illness outbreaks in companion animals. However, the interpretations of and responses to alerts require an understanding of clinical veterinary medicine and relevant syndromic knowledge, and should not be based solely on quantitative measures.
2007年美国宠物食品被三聚氰胺和氰尿酸掺假引发的肾中毒事件，促使人们迫切需要建立一个全国性的伴侣动物监测计划。2016年，我们引入了一种基于新型流行病学算法——比例诊断结果率（PDOR）的症状监测系统。PDOR程序通过模拟犬猫食源性疾病（即黄曲霉毒素中毒和胃肠道疾病）爆发进行了验证。在本研究中，我们使用2007年与三聚氰胺相关的肾中毒事件进一步评估了PDOR程序。通过发出警报的时间和阳性预测值（PPV）评估PDOR程序的性能。从一个集中数据库中检索了美国各地联网的初级保健兽医医院诊治的犬猫的电子病历。使用PDOR算法对2006年7月28日至2007年5月31日期间四个相关症状组成部分的数据进行了前瞻性分析：血清肌酐浓度升高、呕吐、厌食和嗜睡。结果表明，对血清肌酐浓度升高的分析产生的警报可能导致对这次食源性肾中毒事件的早期发现，并且与报告的疫情时间线非常吻合。此外，我们还观察到PDOR程序在不同年龄动物和症状组成部分中的性能存在差异，PPV范围为0.61至1.0。结合之前使用模拟爆发场景进行评估的结果，本研究提供了更多证据表明，PDOR程序可应用于症状监测，以有效、准确地检测伴侣动物中各种类型的食源性疾病爆发。然而，对警报的解释和应对需要了解临床兽医学和相关症状知识，不应仅基于定量指标。
