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Melissa A. Marx, PhD, MPH, Carla V. Rodriguez, MPH, Jane Greenko, MPH, Debjani Das, MPH, Richard Heffernan, MPH, Adam M. Karpati, MD, MPH, Farzad Mostashari, MD, MSc, Sharon Balter, MD, Marcelle Layton, MD and Don Weiss, MD, MPH

At the time of the study, Melissa A. Marx, Carla V. Rodriguez, Jane Greenko, Debjani Das, Richard Heffernan, Sharon Balter, Marcelle Layton, and Don Weiss were with the Bureau of Communicable Disease, Disease Control Program, New York City Department of Health and Mental Hygiene, New York. Adam M. Karpati was with the Division of Health Promotion and Disease Prevention, New York City Department of Health and Mental Hygiene. Farzad Mostashari was with the Division of Epidemiology, New York City Department of Health and Mental Hygiene. Melissa A. Marx was also with the State Branch, Epidemiology Intelligence Service Program, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to Melissa Marx, New York City Department of Health and Mental Hygiene, 125 Worth St, Room 219, Box 22A, New York, NY 10013 (e-mail: mmarx{at}health.nyc.gov).

Objectives. We investigated increases in diarrheal illness detected through syndromic surveillance after a power outage in New York City on August 14, 2003.

Methods. The New York City Department of Health and Mental Hygiene uses emergency department, pharmacy, and absentee data to conduct syndromic surveillance for diarrhea. We conducted a case–control investigation among patients presenting during August 16 to 18, 2003, to emergency departments that participated in syndromic surveillance. We compared risk factors for diarrheal illness ascertained through structured telephone interviews for case patients presenting with diarrheal symptoms and control patients selected from a stratified random sample of nondiarrheal patients.

Results. Increases in diarrhea were detected in all data streams. Of 758 patients selected for the investigation, 301 (40%) received the full interview. Among patients 13 years and older, consumption of meat (odds ratio [OR]=2.7, 95% confidence interval [CI]=1.2, 6.1) and seafood (OR=4.8; 95% CI=1.6, 14) between the power outage and symptom onset was associated with diarrheal illness.

Conclusions. Diarrhea may have resulted from consumption of meat or seafood that spoiled after the power outage. Syndromic surveillance enabled prompt detection and systematic investigation of citywide illness that would otherwise have gone undetected.

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