An enhanced notified enteric disease surveillance trial began on 1 July 2007 and continued until 30 June 2008. The aim of the trial was to measure the quality, timeliness and completeness of data collected and submitted by a regional Public Health Service (PHS) to the Institute of Environmental Science and Research Limited (ESR), via the national disease database (EpiSurv) for notified cases of enteric diseases. The trial evaluated two different methods of data collection: postal questionnaires and telephone interviews. Telephone interview techniques were used to improve the contact rate, timeliness and completeness of data gathered from all notified cases of campylobacteriosis in the Manawatu, Horowhenua and Tararua regions. The target set for the project was to achieve a 95% contact rate with 90% full completion of all EpiSurv data fields. For all notified cases of campylobacteriosis a 97% contact rate was achieved in a time frame of between zero to 20 days (three day median) and completeness of all the EpiSurv case report fields ranged between 96 – 100% in the final data. Prior to the commencement of the study, between 1 July 2004 to 30 June 2005, MidCentral PHS (MCPHS) made contact with around 58% of all notified cases of campylobacteriosis and 77% of all other notified enteric disease cases1 . A short pre-screen mail questionnaire, with reply-paid envelope, was sent to all notified cases of cryptosporidiosis, giardiasis, salmonellosis and yersiniosis in the MCPHS regions. EpiSurv case report fields were completed using information supplied in the returned questionnaires. Return rate, timeliness, and completeness were compared with the telephone interview group. Fifty three percent of cases we attempted to contact via mail questionnaire responded within two to 63 days (six day median) and completeness of all the EpiSurv case report fields ranged between 81 – 100%. In addition, we monitored the newly introduced ESR Early Aberration Reporting System (EARS) flags for increased levels of disease compared to historical disease rates, and assessed its usefulness as a tool to identify potential outbreaks in the region. While no outbreaks that had not already been identified by PHS staff were found by monitoring the EARS system, EARS has become an important tool in the MCPHS for comparing our rates of disease with bordering PHSs. EARS also provided a good quick reference tool for media enquiries and the graphs produced in EARS have been well utilised as visual aids for training and seminars presented during the trial period. The results of the surveillance trial initiatives were compared to the rest of New Zealand (NZ) over the same time frame and with a comparable, medium-sized, PHS. While the results of the telephone interviews from the MCPHS trial were close to the comparable PHS, they were significantly higher than for the rest of NZ. The postal questionnaires achieved a lower contact rate than the comparable PHS but similar to the rest of NZ. However, the quality of data gathered in the returned MCPHS postal questionnaire was significantly higher in most fields. Additional analysis was undertaken which indicated that those cases living in higher deprivation and rural areas were less likely to respond to a postal questionnaire. An over-representation of common enteric disease notifications from rural areas in the MCPHS was also highlighted by our research. This trial has shown the effectiveness of utilising telephone interviews and telemarketing techniques for gathering timely and complete data for human enteric disease surveillance within the MCPHS. It has also demonstrated that a short pre-screen questionnaire can be effective in collecting good quality data needed to complete the standard EpiSurv case report form.

An enhanced notified enteric disease surveillance trial began on 1 July 2007 and continued until 30 June 2008. The aim of the trial was to measure the quality, timeliness and completeness of data collected and submitted by a regional Public Health Service (PHS) to the Institute of Environmental Science and Research Limited (ESR), via the national disease database (EpiSurv) for notified cases of enteric diseases. The trial evaluated two different methods of data collection: postal questionnaires and telephone interviews. Telephone interview techniques were used to improve the contact rate, timeliness and completeness of data gathered from all notified cases of campylobacteriosis in the Manawatu, Horowhenua and Tararua regions. The target set for the project was to achieve a 95% contact rate with 90% full completion of all EpiSurv data fields. For all notified cases of campylobacteriosis a 97% contact rate was achieved in a time frame of between zero to 20 days (three day median) and completeness of all the EpiSurv case report fields ranged between 96 – 100% in the final data. Prior to the commencement of the study, between 1 July 2004 to 30 June 2005, MidCentral PHS (MCPHS) made contact with around 58% of all notified cases of campylobacteriosis and 77% of all other notified enteric disease cases1 . A short pre-screen mail questionnaire, with reply-paid envelope, was sent to all notified cases of cryptosporidiosis, giardiasis, salmonellosis and yersiniosis in the MCPHS regions. EpiSurv case report fields were completed using information supplied in the returned questionnaires. Return rate, timeliness, and completeness were compared with the telephone interview group. Fifty three percent of cases we attempted to contact via mail questionnaire responded within two to 63 days (six day median) and completeness of all the EpiSurv case report fields ranged between 81 – 100%. In addition, we monitored the newly introduced ESR Early Aberration Reporting System (EARS) flags for increased levels of disease compared to historical disease rates, and assessed its usefulness as a tool to identify potential outbreaks in the region. While no outbreaks that had not already been identified by PHS staff were found by monitoring the EARS system, EARS has become an important tool in the MCPHS for comparing our rates of disease with bordering PHSs. EARS also provided a good quick reference tool for media enquiries and the graphs produced in EARS have been well utilised as visual aids for training and seminars presented during the trial period. The results of the surveillance trial initiatives were compared to the rest of New Zealand (NZ) over the same time frame and with a comparable, medium-sized, PHS. While the results of the telephone interviews from the MCPHS trial were close to the comparable PHS, they were significantly higher than for the rest of NZ. The postal questionnaires achieved a lower contact rate than the comparable PHS but similar to the rest of NZ. However, the quality of data gathered in the returned MCPHS postal questionnaire was significantly higher in most fields. Additional analysis was undertaken which indicated that those cases living in higher deprivation and rural areas were less likely to respond to a postal questionnaire. An over-representation of common enteric disease notifications from rural areas in the MCPHS was also highlighted by our research. This trial has shown the effectiveness of utilising telephone interviews and telemarketing techniques for gathering timely and complete data for human enteric disease surveillance within the MCPHS. It has also demonstrated that a short pre-screen questionnaire can be effective in collecting good quality data needed to complete the standard EpiSurv case report form.

Les études dans les régions isolées de la Guyane française sont rares. L'objectif principal de ce travail est d'analyser les principales données épidémiologiques résultant de des investigations sur les maladies infectieuses et épidémiques menées dans les centres de santé des régions isolées et frontalières de la Guyane. L’étude portant sur les personnes vivant avec le VIH a mit en évidence sur le plan spatial l'importance des zones fluviales frontalières qui constituent des zones actives de l’épidémie en termes de passage et de possible propagation mais aussi en termes de prévention, dépistage et traitement. Les investigations des épidémies de shigellose, de grippe et surtout de béribéri chez les orpailleurs soulignent le lien entre conditions de vie dégradées et problématiques de santé. La description des cas groupés de cryptosporidiose chez les enfants immunocompétents amérindiens reflètent les composantes multifactorielles des épidémies en zones isolées mettant en jeux des comportements humains spécifiques au sein d’écosystèmes tropicaux. La sévérité et la diversité des co-infections associés au besoin primaire de sécurité nutritionnelle rappellent les difficultés mais aussi l’urgence de l’adaptation des politiques de santé publiques aux populations éloignées. Enfin, l’étude menée sur le paludisme autochtone a tenté de discuter d’une nouvelle approche afin d’identifier et de traiter les infections asymptomatiques dans une zone de transmission endémique. La description des enjeux sanitaires et de l'état de santé des populations isolées dans les régions éloignées est cruciale pour la mise en œuvre d'une politique de santé optimisé en Guyane. / Public health data in isolated areas of French Guiana are scarce. However, a number of different communities live in tropical forest areas.The principal objective of this study is to analyse the main epidemiological data that have resulted from clinical practice and investigations conducted at health centres in isolated areas of French Guiana and its borders. The results of HIV studies have highlighted particular events that promote the spread of outbreaks. Illegal gold miners therefore represent a significant number of cases. The importance of specific geographical border areas in epidemic dynamics has also been demonstrated. Investigations on shigellosis, influenza and, most importantly, on thiamine deficiency outbreaks in gold miners underline that precarious conditions lead to poor health. Cryptosporidiosis outbreaks among immunocompetent children also reflect the multifactorial dynamics of infectious diseases, including human behaviour and the characteristics of tropical ecosystems. The severity and diversity of parasitic, viral and bacterial co-infection associated to the need for nutrition security indicates the complexity of delivering medical care to remote populations. Finally, a study on malaria has attempted to offer a novel approach to identifying and treating asymptomatic infections in an Amerindian endemic transmission area. A description of the health status of neglected populations in remote areas is crucial to implementing a health policy in French Guiana. Considering the importance of controlling communicable disease and the severity and range of specific illnesses, new strategies are needed and should be discussed with the communities involved.