New guidance for investigating non-infectious disease clusters from potential environmental causes
PHE ePoster Library. Crabbe H. Apr 9, 2019; 257511; 15417
Helen Crabbe
Helen Crabbe
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Abstract Background:
Putative clusters of diseases associated with an environmental exposure are often reported to public health agencies. Residents are concerned that local pollution may be linked to apparent similar cancers, chronic diseases, congenital anomalies or other unusual illnesses found in close proximity in either time or space. PHE responds to reports of disease clusters and public health practitioners investigate infectious disease outbreaks on a regular basis. This investigation follows a well-established process following national guidance. Guidance for investigating non-infectious disease clusters is lacking. Aim: Guidelines for addressing non-infectious disease clusters are needed to assist practitioners involved in these investigations. A framework for thorough investigation of any clusters of non-infectious diseases is proposed.
: The guidance is based on a staged approach with comprehensive steps. At stage 1, a screening process is undertaken to make a decision on whether a cluster should be investigated further. Stage 2 involves the assessment of both the health outcomes and exposure validation, including risk perceptions. Stage 3, if reached, triggers an aetiological investigation with quantitative analysis of the relationship between the health outcomes and the environmental exposure..
: Practitioners can use these guidelines to investigate the logical and statistical validity of disease clusters and explore linkage to environmental exposures. This guidance framework describes resources that can be utilised such as computer software packages, space-time analysis and GIS. Cluster investigation teams roles, responsibilities and membership are proposed.
Investigating potential clusters can be difficult and time-consuming and we propose a systematic, integrated approach for responding to such clusters. Collection of practitioner feedback on the suitability and use of the guidance in the field is currently underway. Funding This work was part funded by the National Institute for Health Research Health Protection Research Unit in Health Impact of Environmental Hazards at Imperial College London, in partnership with PHE.
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