U.S. - Mexico Binational Infectious Disease Case and Outbreak Notification Communication Pathway Pilot

BACKGROUND:  Incidence of infectious diseases such as foodborne and zoonotic diseases is high on the U.S. - Mexico border and binational outbreaks affect both countries beyond the border. In June 2011 CSTE endorsed a binational pilot project for binational case and outbreak notifications using a communication pathway developed by the U.S. - Mexico Binational Technical Work Group Infectious Disease Section. The pilot is a step to implementation of a previously CSTE endorsed guidelines document for cooperation on epidemiologic events of mutual importance. The team developed a common list of binationally notifiable conditions and a protocol was implemented by Texas, New Mexico, Arizona, Sonora, CDC, and the Mexico Directorate of Epidemiology (DGE) in late November, 2011. Alabama and Washington State joined in July, 2012. Additional non-border states from Mexico have been solicited for the pilot, which will continue at least through May, 2013. METHODS:  U.S. binational reports are documented by the CDC Division of Global Migration and Quarantine and shared with DGE when appropriate. Binational reports for the first year of the pilot are summarized. An evaluation of the pilot looking at timeliness, acceptability, and completeness was performed 6 months after implementation and will be done again at 18 months. RESULTS:  During the first year all participating states made notifications to CDC. Fifty-five notifications met pilot inclusion criteria. Notifications included 5 outbreaks and 22 cases of salmonellosis, 11 cases of shigellosis, 5 cases of pertussis, 3 cases of brucellosis, 3 cases of dengue, 2 cases of West Nile Virus, 2 cases of listeriosis, and 1 case each of botulism and murine typhus. Reported outbreaks included an outbreak of salmonellosis associated with mangoes grown in Mexico, an outbreak of cryptosporidiosis among a U.S. wedding party that travelled to a resort in Baja California Sur, Mexico, and a border outbreak of Rocky Mountain Spotted Fever. Additional outbreaks included an apparent shigellosis outbreak among travelers from multiple U.S. states to a tourist destination in Jalisco, Mexico and a West Nile Virus outbreak throughout the state Texas. All participating states found pilot communication lines to be “easy” and indicated that communication benefits were worth the time invested. CONCLUSIONS:  Binational notifications using the pilot communication protocol improve documentation of binational morbidity. In addition, results from pilot participation suggest that binational reporting is both feasible and beneficial to communication between public health partners. Binational notifications facilitate the complete sharing of information for appropriate public health action when traditionally there was little.