Investigation of Diarrheal Illness Detected Through Syndromic Surveillance After a Massive Blackout --- New York City, August 2003

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Melissa A. Marx,^1,2 C. Rodriguez,¹ J. Greenko,¹ D. Das,¹ F. Mostashari,¹ S. Balter,¹ R. Heffernan,¹M. Layton,¹ D. Weiss^{1

1}New York City Department of Health and Mental Hygiene, New York, New York; ²Epidemiology Program Office, CDC

Corresponding author: Melissa A. Marx, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 125 Worth St., Box 22A, New York, NY 10013. Telephone: 212-442-9072; E-mail: mmarx@health.nyc.gov.

Abstract

Introduction: After a massive blackout in New York City on August 14, 2003, a larger number of patients than expected visited city emergency departments (EDs) for diarrhea.

Objective: New York City Department of Health and Mental Hygiene conducted a case-control study to determine risk factors for diarrheal illness among patients who visited EDs after the blackout.

Methods: Subjects were selected from patients who visited EDs participating in syndromic surveillance during August 16--18, 2003. All persons with diarrhea syndrome were designated case-patients. Control patients were a stratified random sample of patients with other syndromes. Structured telephone interviews were used to collect information about exposures between the blackout and symptom onset. Patients whose symptom onset occurred before the blackout were excluded.

Results: Of 759 subjects selected, 287 (38%) were reached and eligible, agreed to participate, and reported their age. Approximately 68% of study participants reported consuming chicken, meat, seafood, dairy products, or deli meat between the time of the blackout and symptom onset. Although case-patients (n = 58) and control patients (n = 100) aged <13 years indicated no differences in food consumption, more case-patients (n = 58) than control patients (n = 71) aged >13 years ate seafood (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.6--14.1) or meat (OR = 2.7, 95% CI = 1.2--6.1) after the blackout. No differences existed in percentage of case- and control patients who discarded foods after the blackout. Overall, 67% of patients heard messages recommending the discarding of food; the most common sources for those messages were television (35%) and radio (28%).

Conclusions: Without refrigeration, meat and seafood spoil quickly. Diarrheal illness among adults in this study was associated with consumption of meat and seafood and might have been associated with food spoilage after the blackout. Syndromic surveillance was essential for detecting the increase in diarrhea after the blackout and for framing the study to investigate this increase.

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