Occupation and Industry Data Quality in Infectious Disease Surveillance Systems

BACKGROUND:  Occupationally acquired infections may be under-recognized due to incomplete collection of occupational exposure data in infectious disease surveillance systems.  A pilot study in six states demonstrated inconsistency in how and whether state infectious disease surveillance systems allowed for the collection of occupation and industry in infectious disease cases.  A test in one state showed the potential value of collecting occupation and industry for cases of Campylobacter and Salmonella infections.

METHODS:  We conducted a survey of state infectious disease surveillance systems, to determine how they record occupational exposure data.  The survey included questions on whether the infectious disease surveillance system included data on occupation and industry, how the data were selected and recorded, whether it was coded and the system of coding, and completeness of the occupation and industry data from a sample of cases. For those consenting to more in-depth, open-ended follow-up questions, we asked about occupational infectious disease outbreak investigations in their state and, if applicable, about their state’s occupational health program’s involvement in the investigations. In one state that had collected industry and occupation data, we examined occupation and industry for all adult cases of Campylobacter and Salmonella infections diagnosed in 2013. 

RESULTS:  Many state infectious disease systems allow for collection of occupation and industry, but that information is collected infrequently and inconsistently, and generally only for a few selected occupations.  The most common occupations include health care workers, day care workers, and food handlers.  Much of the data is collected in free text fields and is inconsistently coded. Despite a lack of robust occupational infectious disease surveillance systems, many states were involved in infectious disease outbreaks that had been identified as occupationally related, highlighting the significant burden of occupational infectious diseases.  In the state where occupation and industry data was collected, 58.5% of Campylobacter cases and 77.3% of Salmonella cases contained data on occupation and industry.  Of these, 11.7% of confirmed Campylobacter cases and 4.4% of confirmed Salmonella cases worked in industries and occupations with a recognized risk of occupational exposure.

CONCLUSIONS:  There are opportunities to improve the collection of data on occupation and industry in infectious disease surveillance systems, which would increase the recognition of occupationally acquired infections in the general population.