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BACKGROUND: On June 28, 2013, two cases of cyclosporiasis were reported to the Iowa Department of Public Health (IDPH); only 10 cases had previously been reported in Iowa. By July 31, 145 cases were reported in Iowa, in addition to cases reported in several other states. Of Iowa’s interviewed cases, 106/136 (78%) reported eating a specific salad mixture served at one of two national chain restaurants (under the same ownership). Throughout July, IDPH needed to keep the public informed, as well as educate health care providers and public health professionals about Cyclospora symptoms, laboratory testing, and treatment options.
METHODS: Information was provided via 3 regularly-scheduled and 3 mid-week “Alert” Epi Updates (a weekly newsletter on diseases reaching over 4 thousand primarily health care professionals), 4 Health Alert Network (HAN) messages, a CDC Epidemic Information Exchange (Epi-X) message, 9 press releases, 16 tweets (each reaching 5,282 followers), and daily updates to the IDPH website.
RESULTS: The effect of these messages was investigated by 1) comparing the number of Cyclospora-specific tests (at Iowa’s State Hygienic Laboratory in July) before (0 tests) and after the messaging (1,460 tests), and 2) determining the number of hits to case count updates posted during July on the IDPH website (3,247 hits). This messaging led to more people being diagnosed, treated, reported and completing interviews. In one example, a patient, hospitalized for 5 days with vomiting and diarrhea, was diagnosed after discharge and effectively treated when his physician read an Epi Update article on Cyclospora. A survey of all Epi Update readers in November asked respondents (n=711) to rate from 1=worst to 5=best, 1) preferred site for receiving Cyclospora information (Epi Update=4.56, IDPH press release=4.34), and 2) site where this information was actually received (Epi Update=4.38, IDPH press release=3.75). Of respondents, 95% (586/618) said that IDPH’s Cyclospora information was timely. Also, the information was used by readers to educate the community (51%, 366/717) and individual patients (42%, 299/717), as well as directing laboratory testing (17%, 120/717), treatment (10%, 75/717), and diagnosis (10%, 69/717).
CONCLUSIONS: Outbreaks of rare diseases often require public health to quickly disseminate information, and using a variety of formats can have a large impact on patient diagnosis and treatment, in addition to aiding outbreak investigations by increasing the number of reported cases.