But Kottke-Masocco says that the water study tested only the public water system, not wells used by families on streets closest to the mill, where clusters of illness have caused local alarm.
Re "Clusters of Illness Suggest That Most Infections Came From Two Mailings" (news article, Nov. 2): We should not overburden hospitals or expect patients to proceed through the emergency-room bureaucracy in the face of a potential anthrax epidemic.
Investigators are continuing to look at the clusters of illness to see whether any other egg producers might be linked to the outbreak.
This outbreak provides an evidence of MRSA-contaminated foods as the vehicle in the clusters of illness affecting low-risk persons within the community.
We believe such an approach to syndromic surveillance deserves a prospective validation study where such clusters of illness are systematically sampled.
A better understanding of myocarditis through enhanced diagnostic and therapeutic strategies, increased awareness of possible clusters of illness, and rapid reporting of clusters to public health departments will help improve prevention of future outbreaks.
Such lines of communication will also be important in helping public health agencies more rapidly identify emerging areas of activity (such as clusters of illness) through clinician reports of patients with risk factors for SARS.
Clinicians' reports of suspected clusters of illness remain critical for surveillance (4 ), but the application of automated statistical techniques to detect possible outbreaks that might otherwise not be recognized has become more common (5 ).
Similar to the successful PulseNet network for molecular typing of foodborne bacteria (10 ) and NoroNet in Europe (11 ), CaliciNet will enable linking of cases with identical sequence fingerprints into clusters of illness that may have a common exposure.
In summary, we have implemented a near real-time syndromic surveillance system that includes automated detection and reporting to public health agencies of clusters of illness that meet pre-specified criteria for unusualness [ 5].
