detect, test and report notifiable diseases and outbreaks · 2016-07-01 · detect, test and report...
TRANSCRIPT
DETECT, TEST and REPORT Notifiable Diseases and
OutbreaksAlabama Department of Public Health (ADPH)
Bureau of Communicable DiseasesInfectious Diseases & Outbreaks Division
rev. 01/19/2016
www.adph.org/epi
Important Information
You must attend the entire program. No partial credit will be awarded
There is no commercial support or sponsorship for the program
There will be no endorsement of products displayed in conjunction with the activity
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Purpose of this Presentation Become knowledgeable of:
All divisions within the Bureau of Communicable DiseaseNotifiable Disease Rules and the diseases and conditions which requires reporting to public health Importance of DETECT-TEST-REPORT - what constitutes an outbreak and how reporting protects the public from potential outbreaks
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Purpose of this Presentation
Importance of healthcare infection control readiness (emerging infectious diseases)Healthcare-associated infections reporting & surveillanceReporting animal bites/exposures (rabies)
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ObjectivesIdentify the divisions within the Bureau of Communicable Disease and the purpose reporting Notifiable Disease/ConditionsVerbalize what the Notifiable Disease/Condition Awareness campaign means (DTR)Be knowledgeable of the Notifiable Disease Rules and identify the most accurate diagnosis and test methodsVerbalize what constitutes an outbreak and information required to investigate an outbreak
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Bureau of Communicable Diseases
Infectious Diseases & Outbreaks (ID&O), www.adph.org/epiHIV/AIDS, www.adph.org/aidsImmunization (IMM), www.adph.org/immunizationSexually-transmitted Infections (STI), www.adph.org/stdTuberculosis (TB), www.adph.org/tb
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Infectious Diseases & Outbreaks (ID&O) Mission
To protect the residents of Alabama and prevent illness byinvestigating and monitoring infectious (e.g., Salmonella,influenza, and hepatitis), Zoonotic (e.g., rabies, spottedfever rickettsiosis, and West Nile fever), and Environmental(e.g., Legionnaires’ disease, chemical, and toxin)diseases, conditions, and exposures.
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Infectious Diseases & Outbreaks (ID&O) Branches
Analysis & Reporting (A & R)SurveillanceHealthcare Infection Control & Prevention ToxicologyZoonotic
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Notifiable Diseases/ConditionsPurpose of Notifiable Diseases
Prevent diseaseEducation to providers, patients and communityConfirm disease Required by law, Code of Alabama, Section 22-11A-1, http://alisondb.legislature.state.al.us/alison/codeofalabama/1975/22-11A-1.htm
ADPH administrative code authorizes and requires reporting http://www.alabamaadministrativecode.state.al.us/docs/hlth/420-4-1.pdf
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Notifiable Diseases/ConditionsLiability – Reporters of cases or suspected cases of notifiable diseases, outbreak, or cases of public health importance will have immunity from civil or criminal liability, http://alisondb.legislature.state.al.us/alison/codeofalabama/1975/22-11A-2.htm
Penalty - failure to report is considered guilty of a misdemeanor, and upon conviction may be fined $100-$500, alisondb.legislature.state.al.us/alison/codeofalabama/1975/22-11A-6.htm
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ADPH is exempt from Health Insurance Portability and Accountability Act (HIPAA) Privacy Rules
ADPH is a public health authority as defined by HIPAA tocollect or receive protected health information (PHI) forthe purpose of surveillance, investigations, andinterventions of notifiable diseases, without authorizationof the patient.
http://www.cdc.gov/mmwr/pdf/other/m2e411.pdf
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Notifiable Disease Rules Amended
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See Synopsis of Rules Revisions, http://www.adph.org/epi/assets/Synopsis_Rule_Changes.pdf
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Who Must ReportPhysiciansDentistsNursesMedical ExaminersHospital Administrators
Nursing Home AdministratorsLaboratory Directors*School PrincipalsChild Care Center/Head Start Directors
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*Must submit electronicallyADPH expects multiple reports
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Minimum Data ElementsName of disease or health conditionPatient’s
NameDOBGenderRaceEthnicityAddressPhone Payor source
Date of onset, date of lab results, and/or date of diagnosisReporter’s
NamePhoneFacility
Additional Information Supplemental Investigation
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Report within 4 hours of Presumptive Diagnosis
Immediate, Extremely Urgent
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*
*Select Agents, http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html
Must request permission from Epidemiology before testing
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Report within 24 hours Presumptive Diagnosis
Immediate, Urgent
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Report within 5 days of DiagnosisStandard Notification
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How to REPORTImmediate, Extremely Urgent must be reported within 4 hrs of presumptive diagnosis by telephone
7/24/365 Phone: 1-800-338-8374
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How to REPORTImmediate, Urgent must be reported within 24 hrs of presumptive
diagnosisPhone: 1-800-338-8374 (still requires a lab report)Contact your local Area Investigator Email lab report and patient demographics to [email protected] lab report and patient demographics to (334) 206-3734 Online, REPORT Card: http://www.adph.org/epi/ will prompt a call requesting the lab report
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Best method of reporting
www.adph.org/epi
How to REPORT
Standard within 5 days of diagnosisE-mail lab report and patient demographics to [email protected] lab report and patient demographics to (334) 206-3734 Online, REPORT Card : https://www.adph.org/Extranet/Forms/Form.asp?ss=s&formID=4799
this method will prompt a call requesting lab report Phone 1-800-338-8374 (still requires a lab report)
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Best method of reporting
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Notifiable Disease/Condition Awareness Campaign
DETECT - Decrease Epidemiological Threats with Environmental Controls and Testing
TEST - Take Epidemiological Specimens Today
REPORT - Rules for Every Provider and Organization to Report on Time
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Infectious Diseases & Outbreaks Website
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DETECT, TEST, REPORT (DTR)DTR Notifiable Diseases awareness campaign emphasizesdifferent disease control actions needed to reduce the impactof Alabama's reportable diseases and create a robustnotifiable disease system.
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DETECTDETECT Notifiable Diseases involves surveillance,investigation, and recommendations for reportablediseases. Public health surveillance is the ongoing,systematic collection (i.e., reported by providers orelectronic lab systems), analysis, interpretation, anddissemination of data about a health-related event to reducemorbidity and mortality and to improve health. Public healthrecommendations are given to stop the transmission and toprevent further disease in the population.
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TEST
TEST Notifiable Disease involves obtaining a timely specimen, ordering the appropriate lab test, and utilizing theproper lab test method to determine if a patient meetsthe notifiable disease case definition
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TESTNotifiable disease specimens tested at BCL, especially during cluster/outbreak
Get specimen to County Health Department (CHD) courier service (free), call CHD for courier time Mon-Fri, except holidaysSend UPS or FedEx overnight (not free)
Send specimens to both reference labs and BCL
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REPORT
REPORT Notifiable Disease is a reminder for all reporting entities to report notifiable diseases in a timely manner.
REPORT is vital to ensure Alabama's Notifiable Diseasesare investigated quickly to reduce further possible exposureand to treat those infected.
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ID&O Investigations and Cases(previous 12 months)
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Disease Investigation ProcessID&O receives notifiable disease reports and/or labsArea Investigators investigate cases to report to CDC
Complete investigation formReview labsCall healthcare providerCall patient / parentsDocument information in Alabama NEDSS Based System (ALNBS)
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Notifiable Diseases/ConditionsSpecial Categories
Emerging Infectious DiseasesRabies ExposuresHealthcare-Associated Infections (HAI)Cases of Public Health ImportanceOutbreaks & Clusters
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Emerging Infectious DiseasesEmerging means infections that have increased recently or are threatening to increase in the near future. These infections could be: •Completely new (MERS, Middle East Respiratory Syndrome)•Completely new to an area (Chikungunya in Florida, Ebola, Avian Influenza)
•Reappearing in an area (Dengue in South Florida and Texas)•Caused by bacteria that have become resistant to antibiotics, (VRSA Vancomycin-resistant Staphylococcus aureus and drug-resistant TB)
www.adph.org/epi
Emerging Infectious DiseasesThese diseases are often travel related. Always check the latest travel health notices found on the CDC website. http://wwwnc.cdc.gov/travel/destinations/list
CDC and ADPH recommend clinicians inquire about international travel as a part of their ill patient screening.
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Example of waiting room signage
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Alabama Emergency Response Technology
ALERTsADPH has created the Alabama Emergency Response Technology (ALERT) to push Health Alert Network (HAN) messages via email to healthcare providers statewide.
MDs receive ALERTs via e-mail per the Board of Medical Examiners (BME) database. The Center for Emergency Preparedness obtain updated email addresses from the BME database monthly.
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Healthcare-associated Infections
Healthcare-associated infections (HAIs), also known as nosocomial infections, are infections that patients get while receiving treatment for medical or surgical conditions.
HAI’s occur in all settings of care, including hospitals, surgical centers, ambulatory clinics, and long-term care facilities such as nursing homes and rehabilitation facilities.
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Healthcare-associated InfectionsThe Healthcare Infection (HAI) Reporting Rules mandate Alabama hospitals to report certain HAIs to ADPH using the National Healthcare Safety Network
catheter-associated urinary tract infections (CAUTI) central line-associated blood stream infections (CLABSI) surgical site infections (SSIs) associated with colon surgeries and abdominal hysterectomies
For more information related to HAI visit our website at http://adph.org/hai/
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RabiesRabies is a deadly viral disease that infects the central nervous system of mammals. It is almost always fatal to humans.It is transmitted through saliva or other direct contact with infected neural tissue.It is preventable if proper post-exposure treatment protocol is followed before a person becomes symptomatic.
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Reporting Of ExposuresADPH ADMINISTRATIVE CODE CHAPTER 420-4-4
RABIES CONTROL PROGRAM
420-4-4-.03 Reporting Of Exposures. Suspected exposures to humans by animals capable of transmitting the rabies virus shall be reported to the county health department.
Must be reported within 48 hours.
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How to Report Rabies ExposuresNotify your local County Health Department
ORComplete an ADPH Rabies Exposure Report located online at: http://adph.org/epi/. Click on Rabies (left side of page) and scroll to Rabies Resources.
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Rabies Exposure InvestigationExposure investigations are performed by the Bureau of Environmental Services at the county health department.
Exposures can only be confirmed by a licensed physician or a licensed medical professional (PA, CRNP)
Provider resources are available online at http://adph.org/epi/.
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Outbreaks, Clusters, Cases of Public Health Importance, & Environmental
Exposures1. Outbreak: two or more cases of a similar illness, from different households, shown by
an investigation to result from a common exposure.2. Cluster: an unusual aggregation of cases grouped in time or space. The purpose of
identifying clusters is to trigger further investigations to determine whether theymight represent an outbreak.
3. Case of public health importance: an unusual individual case determined by a reporting healthcare provider.
4. Environmental Exposure: any serious human exposure to an environmentalcontaminant.
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OutbreaksAn outbreak is defined as 2 or more similarly ill people, fromseparate households, with a common exposure.
Single cases of certain rare and serious conditions will be investigated, such as gastrointestinal anthrax, botulism, or nosocomial legionella.
Outbreaks of Any Kind are reportable within 24 hours andinclude both notifiable diseases and diseases not requiredindividually to be reported (e.g., norovirus, head lice, flu).
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Outbreak InvestigationsMultiple ADPH Internal Partners may be involved in an outbreak investigation:
Bureau of Communicable Diseases (BCD)Bureau of Clinical Laboratories (BCL)Bureau of Environmental Services (BES)General Counsel (GC)Office of Radiation Control (ORC)Center for Emergency Preparedness (CEP)
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Outbreak Investigation ActionsDisease Reporter notifies Infectious Diseases & Outbreaks (ID&O) 1-800-338-8374 or local Area Investigator (AI) AI contacts facility to gather contact information and request specimensAI interviews (ill and not ill) and provides education to the facilityBureau of Clinical Laboratories (BCL) tests clinical and food specimensCounty environmentalist assesses the facility; if applicable Epidemiologists develop questionnaires, perform data analyses, and produce reports
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Outbreak Investigation ToolsEpidemiology Investigation Report Surveillance Line ListHypothesis Generating QuestionnaireSpecific Outbreak QuestionnaireEnvironmental Assessment FormsDisease Investigation FormsSpecimen kit
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Surveillance Line List
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Facilities may be directed to complete a surveillance line list or the AI may request information to complete the line list.
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Hypothesis Generating Questionnaire
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SpecimensStoolStoolMore StoolBloodSputumNasal
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ADPH DTR One-page Flyers
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Outbreak Investigations2012 2013 2014 2015 2016*
PathogenUndetermined
26 36 33 59 20
PathogenIdentified
60 52 101 175 83
Total Outbreaks
86 88 134 234 103
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DTR has helped to get the word out to report outbreaks timely!!!
*2016 Outbreak Investigations as 4/29/2016
More information can be found on the ADPH Web pagehttp://www.adph.org/epi/Default.asp?id=5548
www.adph.org/epi
ADPH Contact Information
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County Health Department (CHD)http://adph.org/administration/assets/countylist.pdf
Area Investigators (AI)http://www.adph.org/epi/default.asp?id=1438
Infectious Diseases & Outbreaks (ID&O)1-800-338-8374 http://www.adph.org/epi/
www.adph.org/epi
Questions?
Thank you
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