BACKGROUND: Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis, which is transmitted through ingestion of contaminated food or water. Cyclosporiasis is not known to be endemic in the United States; previous U.S. foodborne outbreaks have been linked to imported fresh produce (e.g., cilantro, basil, raspberries). Molecular typing methods, which could facilitate linkage of cases of cyclosporiasis, are not yet available for C. cayetanensis. All temporally associated case-patients must be interviewed to determine if their case of Cyclosporainfection could be part of an outbreak. The Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ) was developed to improve the timeliness and consistency of data collection and thereby facilitate detection and investigation of outbreaks. The CNHGQ was first used during the 2014 spring/summer outbreak season as a fillable PDF and was also made available as an electronic survey beginning in 2015. CDC requests that jurisdictions administer the CNHGQ to all persons with laboratory-confirmed or epidemiologically linked cases of cyclosporiasis who became ill during May through August.
METHODS: For each year during 2014–2016, we classified jurisdictions that notified CDC of ≥1 case of cyclosporiasis in person(s) who became ill during May–August according to whether the jurisdiction used the CNHGQ (or a state-adapted version) for at least 1 case-patient. We determined the annual proportion of pertinent jurisdictions that used the CNHGQ at least once, as well as the aggregate annual proportion of case-patients to whom the CNHGQ was administered.
RESULTS: During the 3-year period of 2014–2016, the CNHGQ was used by 43% (13/30), 59% (19/32), and 86% (32/37), respectively, of the jurisdictions that reported cases of cyclosporiasis; the CNHGQ was administered to 17% (56/328), 28% (152/552), and 62% (254/409), respectively, of the pertinent case-patients. Among the jurisdictions that used the CNHGQ during 2015–2016, the electronic (vs. PDF) version was used at least once by 47% (9/19) and 56% (18/32) of jurisdictions, respectively, and for 53% (80/152) and 55% (140/254), respectively, of the case-patients to whom the CNHGQ was administered.
CONCLUSIONS: Use of the CNHGQ has increased each year since implementation. By administering the CNHGQ, jurisdictions can help improve outbreak detection and the identification of potential vehicles of infection. By eliminating the data entry step at CDC, the electronic CNHGQ allows CDC epidemiologists to analyze aggregate data and share relevant epidemiologic findings with health departments and FDA more quickly, thereby facilitating collaborative efforts to control and prevent outbreaks of cyclosporiasis.