Indiana Field Epidemiologist

Fungal Meningitis Outbreak Response

APIC IN April 12, 2012

District 2 EPI, Mona Wenger (317) 439-9648mwenger@isdh.in.gov

District 1EPI, Donna Allen(317) 430-3844 dallen@isdh.in.gov

District 3EPI, Erika Pitcher(317) 412-2137epitcher@isdh.in.gov

District 4EPI, Susan Pickerill(317) 508-1675spickerill@isdh.in.gov

District 6 EPI, Stephanie English(317) 697-8683senglish@isdh.in.gov

District 5 EPI, Sandy Gorsuch(317) 430-3848sgorsuch@isdh.in.gov

District 9EPI, Jim Ignaut(317) 412-2138jignaut@isdh.in.gov

District 8EPI, Jill Stauffer

(317) 605-6829 jstauffer@isdh.in.gov

District 10EPI, Karen Gordon(317) 430-3852 kgordon@isdh.in.gov

District 7 EPI, Robert Allen(317) 430-3851rtallen@isdh.in.gov

Field Epidemiologist (FEPI) Job Duties

• Outbreak Investigations• Vaccine Preventable Disease Investigations• ISDH Liaison• Data collection/statistical analysis • EpiNewsletter/SOPs/Education/Trainings

District 2 Outbreak Response (2006-Present)

TB – (2004 – 2006)* Human Rabies (2006)* Ecoli 0157-H7 – spinach

(2006)** Norovirus –

Multi-county/multi-state/International (2006, 2008,2012)*

MRSA – (2007) Botulism – canned chili (2007) Salmonella – peanut butter

(2007) Salmonella – pot pies (2008) Salmonella – deli meat (2009) AH1N1pdm09 (2009)

Neisseria meningitis pediatric death (2009)*

Measles (2011, 2012) Rotovirus (2011)* Salmonella typhi (2011)* Varicella – School outbreaks

(2011, 2012)* H3N2v (2012) Salmonella – cantaloupe

(2012) ESBL – ecoli/urine (2012) Shigella (2012)* Botulism (2012)* Fungus meningitis (2012) Endophthalmitis Cluster

(2012)*

Fungal Meningitis Outbreak Response Timeline

10/04/2012 – District 2 Field EPI actively engaged - IHAN and ISDH Press Release - ECHD and SJCHD notified 10/05/2012 – First case identified from District - Hospital spreadsheet distributed to EGH, MSB,

SJRMC/Mishawaka . - Hospitals conduct active/passive surveillance

10/11/2012 - IN reported first death (Out of State Resident) 10/13/2012 – Hospital Spreadsheet distributed to CHB, IU Health

Goshen, SJRMC/Plymouth – Hospitals conduct active/passive surveillance 10/16/2012 – CDC EPI-AID Team District 201/04/2013 –

ISDH/ECHD/Clinic conference call on MRI + reports 01/15/2013 – ISDH/SJCHD/Clinic conference call on MRI + reports

Outbreak Response (continued)

Daily IPs reported case updates daily to FEPI by 9:30 am FEPI reported to ISDH meningitis EPI by 10:00 am Meningitis EPI reported to CDC by 11:00 am CDC updated Fungal meningitis website daily at 2:00 pm

“The Huddle” Beacon Health Care System daily conference calls f/u with clinics on all suspect cases reported

Fungal Meningitis Outbreak Spreadsheet Data

Fungus Meningitis Outbreak Spreadsheet disseminated to hospitals (11 variables) Data on clinic patients

Name DOBClinic Injection Date Number of InjectionsSite of injectionClinical: chief complaint; CSF: WBC, protein, glucose; or MRI +

Clinic patient spreadsheet disseminated to hospital IP/ED/LHD (7 variables)All the above but clinicalAddress (street, city, state)Phone number

ISDH spreadsheet developed and data entered (54 variables)

Fungal Meningitis Case Count

• US (03/28/2013)– Case Count: 730 – Deaths: 51– States: 20

• IN (03/28/2013)– Case Count: 84 (4 out of state)– Deaths: 11

• D2 (03/28/2013)– Case Count: 66 (3 out of state)– Deaths: 7 (3 out of state)