Monitoring infectious diseases using routine microbiology data. I. Study of gastroenteritis in an urban area

Sources of information for monitoring infectious disease are routine data, special surveys and ad hoc investigations. In practice much use is necessarily made of routine notifications and laboratory records although this reporting is often incomplete and may therefore be biased. In a retrospective study of a 16-year series (up to 1968) of routine records concerning the diagnosis of gastroenteritis at one Public Health Laboratory we found it possible to identify biases. During school outbreaks of dysentery, laboratory investigation of diarrhoea increased appreciably and such response to publicity affects the use of routine data in surveillance. Although the patients examined were probably representative diagnostically, their selection may not have reflected the age incidence of disease. Valid geographical comparisons within the urban area were not feasible because medical practitioners differed in their use of laboratory facilities and in their habits of notification. Nevertheless, as far as can be established retrospectively, these data did reflect time trends in disease incidence and so had value for monitoring purposes. Several of the biases defined are likely to apply to other sets of routine data. A further communication will describe a statistical method of correcting for quantifiable bias.