• 1.

    Calisher CH, 1994. Medically important arboviruses of the United States and Canada. Clin Microbiol Rev 7: 89116.

  • 2.

    Tennessee Department of Health, 2015. Tennessee West Nile Virus Report. Available at: http://health.state.tn.us/ceds/wnv/wnvhome.asp. Accessed July 1, 2015.

    • Search Google Scholar
    • Export Citation
  • 3.

    Council of State and Territorial Epidemiologists, 2014. Update to Arboviral Neuroinvasive and Non-Neuroinvasive Diseases Case Definition. CSTE Position Statement 14-ID-04.

    • Search Google Scholar
    • Export Citation
  • 4.

    German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN, Guidelines Working Group Centers for Disease Control and Prevention (CDC), 2001. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 50: 135.

    • Search Google Scholar
    • Export Citation
  • 5.

    Thacker SB, Choi K, Brachman PS, 1983. The surveillance of infectious diseases. JAMA 249: 11811185.

  • 6.

    Mosites E, Carpenter LR, McElroy K, Lancaster MJ, Ngo TH, McQuiston J, Wiedeman C, Dunn JR, 2013. Knowledge, attitudes, and practices regarding Rocky Mountain spotted fever among healthcare providers, Tennessee, 2009. Am J Trop Med Hyg 88: 162166.

    • Search Google Scholar
    • Export Citation
  • 7.

    Zientek J, Dahlgren FS, McQuiston JH, Regan J, 2014. Self-reported treatment practices by healthcare providers could lead to death from Rocky Mountain spotted fever. J Pediatr 164: 416418.

    • Search Google Scholar
    • Export Citation
  • 8.

    Bandura A, 1977. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84: 191215.

  • 9.

    Reimann CA, Hayes EB, DiGuiseppi C, Hoffman R, Lehman JA, Lindsey NP, Campbell GL, Fischer M, 2008. Epidemiology of neuroinvasive arboviral disease in the United States, 1999–2007. Am J Trop Med Hyg 79: 974979.

    • Search Google Scholar
    • Export Citation
  • 10.

    Weaver SC, Barrett AD, 2004. Transmission cycles, host range, evolution and emergence of arboviral disease. Nat Rev Microbiol 2: 789801.

  • 11.

    Spencer JA, Jordan RK, 1999. Learner centered approaches in medical education. BMJ 318: 12801283.

 
 
 

 

 
 
 

 

 

 

 

 

 

Challenges to Arboviral Surveillance in Tennessee: Health-Care Providers' Attitudes and Behaviors

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  • Vector-Borne Diseases Section, Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee

Surveillance of arboviruses depends on health-care providers' ability to diagnose and report human cases of disease. The purposes of this study were to assess Tennessee providers' 1) self-efficacy toward diagnosis and management, 2) clinical practices, and 3) variation in these measures by provider characteristics. A survey was e-mailed to 13,851 providers, of which 916 (7%) responded. Respondents diagnosed more arboviruses in the previous year than were recorded in surveillance records, an indication of underreporting. Respondents had low to moderate self-efficacy toward diagnosis and management of arboviruses. Although more than 70% (N = 589) used paired serology, only 46% (N = 396) asked patients to return for a convalescent specimen draw within the correct time frame. One of the most commonly reported barriers to testing was uncertainty about which tests to order. Providers working in family medicine and urgent care, nurse practitioners, and those at outpatient facilities had lower rates of high self-efficacy than their counterparts working in other settings and from other specialties. Clinical practices were influenced by specialty, designation, setting, and geography but not by years of experience. Education to improve arboviral surveillance in Tennessee is warranted. Topics could include proper diagnosis and management, appropriate testing and overcoming barriers to testing, and public health reporting.

Author Notes

* Address correspondence to Abelardo C. Moncayo, Vector-Borne Diseases Section, Tennessee Department of Health, 630 Hart Lane, Nashville, TN 37216. E-mail: abelardo.moncayo@tn.gov

Authors' addresses: Julie Shaffner, Timothy F. Jones, and Abelardo C. Moncayo, Vector-Borne Diseases Section, Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, E-mails: julia.shaffner@tn.gov, tim.f.jones@tn.gov, and abelardo.moncayo@tn.gov.

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