The role of poison centers in public health response and toxicosurveillance

In 1953, a pediatrician in Chicago, Illinois opened the first United States (US) Poison Center (PC). Over the years, centers grew in a patch work manner across the US. At one point, there were 500-600 so called PCs in the US. Many were simply telephones in hospital emergency departments or pharmacies with little or no defined structure; no standardized data collection system and limited staff training. Today through the work of hundreds of dedicated individuals and the American Association of Poison Control Centers (AAPCC) there are 61 centers in the US. These Centers have a standardized, computerized data collection system, a nationwide toll free phone number, and toxicology training for poison specialists and physicians. The data gathering, regulatory and reporting functions of regional poison centers vary from State to State. PC data collection methods and interpretation continue to evolve nationally at the AAPCC and regionally at individual PCs. Characterize the role of national and regional PC toxicosurveillance data for public health event response. Traditionally PC data was reported via annual or quarterly reports. These retrospective reports typically go to funding agencies, state and local health departments and governmental agencies. Development and implementation of near real-time toxicosurveillance heralds a major change in how PC data is used and valued. Data from 61 centers is uploaded to the AAPCC in Washington DC every twenty minutes where daily and intra daily analysis takes place. Data analysis focuses on statistical evaluation of case volume, clinical effects, specific toxins, and syndrome definitions. Regional PCs receive "outlier" signals each day. These alerts are then evaluated and validated on a regional and local basis. Poison center data serves many roles in the public health arena. Our national database provides a wide range of information on case volume, clinical effects, and exposures. Data can be used to identify events of public health significance. Toxicosurveillance augments public health infrastructure for prevention and early event detection. Rapid identification of outbreaks/clusters facilitates implementation and evaluation of prevention and control measures, epidemiologic studies, identification of emerging hazards, and research. With world events, collection and analysis of these data has reached a new level of importance. PC toxicosurveillance at a national and regional level offers the opportunity for early detectio