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Context: Overuse of antibiotics has contributed to microbial resistance, compromising the treatment of bacterial infections. Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee. Objective: To determine the effectiveness of a community-wide intervention aimed at reducing inappropriate antibiotic use among children. Design, Setting, and Participants: The Knox County Health Department led a multifaceted year-long campaign (May 1997 through April 1998) aimed at decreasing unnecessary antibiotic use among children. Tennessee's 3 other major urban counties (Shelby, Hamilton, and Davidson) did not conduct similar campaigns and served as controls. Evaluation included white and black children (aged <15 years) enrolled in Tennessee's Medicaid Managed Care Program in the 4 study counties, representing 36% of the study counties' children (464 200 person-years observed). Intervention: Educational efforts were directed toward health care practitioners (primarily via peer leader presentations) and to the parents of young children and the public (primarily via printed materials). Main Outcome Measure: The intervention-attributable effect on antibiotic use, defined as the excess percentage change in oral antibiotic prescription rates in Knox County between the 12-month preintervention and postintervention periods, relative to that of control counties. Results: Antibiotic prescription rates declined 19% and 8% among Knox County and control county children, respectively, yielding an 11% intervention-attributable decline (95% confidence interval, 8%-14%; P<.001). The intervention-attributable decrease in prescription rates was greatest among children aged 1 to less than 5 years (among white children, 8% [P<.001]; among black children, 18% [P<.001]). Conclusions: A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County. [ABSTRACT FROM AUTHOR]

To monitor disease incidence and antibiotic resistance, effective, practical surveillance strategies are needed at the local level for drug-resistant Streptococcus pneumoniae (DRSP). Knox County, Tennessee, participates in three forms of DRSP surveillance: an active system sponsored by the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia); a novel county-sponsored system; and conventional state-mandated reporting. Ascertainment of invasive S. pneumoniae infection cases by each system in 1998 was evaluated, and completeness of reporting, antibiotic resistance patterns, costs, and other attributes were compared. The county-sponsored system collects patient identifiers and drug susceptibility data directly from hospital laboratories, whereas the CDC-sponsored system performs medical chart abstractions and reference laboratory susceptibility testing. Similar numbers of invasive S. pneumoniae cases were detected by the county-sponsored (n = 127) and CDC-sponsored (n = 123) systems; these systems held >75% of all cases in common, and each system achieved >85% sensitivity. Conventional reporting contained 88% and 76% of the DRSP cases identified by the county- and CDC-sponsored systems, respectively, but did not capture infections produced by susceptible isolates. Both the county- and CDC-sponsored systems indicated that large proportions of isolates were resistant to penicillin and extended-spectrum cephalosporins. The county-sponsored DRSP surveillance system was inexpensive, simple to execute, and relevant to local needs. [ABSTRACT FROM PUBLISHER]

Local health departments concerned with early detection of potential terrorist threats are beginning to explore novel approaches to syndromic surveillance. Using the Early Aberration Reporting System (EARS) developed by the Centers for Disease Control and Prevention, a metropolitan health department in Tennessee and five community partners have agreed to exchange data in order to implement a multifaceted syndromic surveillance system for early detection of a biological attack. This article describes how we used EARS as the foundation for implementing a surveillance system that encompasses a rich variety of data sources. We address technical requirements for operating EARS, recommend staffing and training prerequisites, describe the involvement of our data partners, and provide details related to data transfer and analysis, review, and response protocol. Other health departments may find this information useful as a general model for implementing EARS-based syndromic surveillance systems in their own jurisdictions.