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NJDOH Communicable Disease Forum

Summer 2014 Webinar

Welcome & Overview

Kim Cervantes, Coordinator, Regional Epidemiology ProgramTel: 609-826-5964; Fax: 609-826-5972kim.cervantes@doh.state.nj.us

Overview/Highlights CD Forum Purpose, Structure & Feedback

CE Credits

EpiGram & Highlight Report

Webinar Technical Info

Questions & Feedback

Ticked Off: Managing the Burden of Lyme Disease Investigations

Shereen Semple, M.S., Vectorborne Disease Program Coordinator

Tick-borne Diseases in New Jersey•Lyme disease•Babesiosis•Anaplasmosis•Powassan•B. miyamotoi

•Erhlichiosis•Tularemia•Heartland virus

•RMSF•Tularemia

Lyme Disease Caused by spirochete Borrelia burgdorferi (Bb) Transmitted by tick Ixodes scapularis Symptoms 3-30 days post-tick bite

Erythema migrans ≥ 5 cm in diameter Flu-like symptoms Early / timely treatment is very effective

Early disseminated stage (days - weeks post tick) Late disseminated stage (months-years post tick) Post-treatment Lyme disease syndrome / PTLDS

(years)

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Life cycle is 2 years 3 feeding stages Acquires Bb from

White-footed mouse Must be attached for >

36 hours to transmit pathogen

Abundance determined by deer population

Bb infection rate varies Endemic in 21 counties

in New Jersey

Ixodes Scapularis Distribution of Lyme Disease

0

1,000

2,000

3,000

4,000

5,000

6,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Fre

qu

ency

Year of Onset

Confirmed Probable

Source: 2000-2004 NJDHSS electronic files containing aggregate data; 2005-2011 NJDHSS CDRSS historical reports limited to DHSS approved cases.

Note: In 2008, the NJDHSS / CDC surveillance case definition changed to include confirmed and probable cases.

Frequency of Lyme DiseaseNew Jersey, 2000-2013

“Acceptable” Lab Criteria for Lyme Disease

Lyme Disease Surveillance Case Definition Confirmed EM > 5 cm in diameter Lab evidence and diagnosis of musculoskeletal,

neurologic or cardiac deficiency Probable Lab evidence and non-specific symptoms and physician

diagnosis Possible Lab evidence and non-specific symptoms Lab evidence only

Lab evidence: Two-tier test: ELISA and IgM WB within 30 days

symptom onset Two-tier test: ELISA and IgG WB IgG WB only

How We Count Cases

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Lyme Disease Investigations Bull’s eye rash = confirmed case If no bull’s eye rash, there MUST be an acceptable lab

result Unacceptable labs get E-sorted / E-closed Acceptable labs go to LHD pending screen

If there is an acceptable lab, start investigation Onset date entered on patient (first) screen in CDRSS Symptoms Physician diagnosis* Outcome Other: exposure, treatment, co-morbidities, co-infection

Investigation should be closed within 3 months Cases from previous years will NOT be reopened Cases from current year will NOT be reopened if new

info will not change case status New lab test for case closed > 6 months gets new

investigation

*Physician diagnosis is used to evaluate case. It does NOT determine the public health case status!

Should Ticks Be Tested for Borrelia burgdorferi? Not recommended Positive tick ≠ human infectionNegative tick may give false sense of security Tick can transmit other pathogensBabesiosis, anaplasmosis, Powassan, Borrelia miyamotoi

Tick testing not available at NJDOH PHEL County mosquito control agency / tick ID Private laboratories: New Jersey Laboratories, IgeneX, Imugen, Analytical Services Inc, etc.

IDSA Recommendations for Prophylaxis for Lyme Disease Single dose* of doxycycline Tick is Ixodes scapularis Tick has been attached ≥ 36 hours Tick is from area with ≥ 20% Bb infectivity rateDoxy can be started within 72 hours of when tick was removedDoxy not contraindicated (e.g., pregnant women and children ≤ 8 years)

*Adult = 200 mg*Children ≥ 8 years = 4 mg/kg, up to maximum dose of 200 mg

Preventing Lyme DiseaseEcologic Measures Apply pesticide Acaracide application in May/early June & October

Create tick-free zone Remove leaf litter Keep vegetation / grass short 3 foot wide wood chip / gravel barrier between

woods and lawn Stack wood neatly, clean birdfeeder debris Keep deck, chairs, playground equipment away

from woods Consider a fence to minimize animals in yard

Community ecologic approach Four-poster acaracide-treated deer feeding station Permethrin-treated bait boxes for mice

Preventing Lyme DiseasePersonal Protective Measures Avoid contact with ticksAvoid high / dense vegetationHike on trails

Repel (or kill) ticksDEET: 20-30% on exposed skin Permethrin: 0.5% on clothing

Find and remove ticksBathe / shower within 2 hours of coming indoors Full body checkCheck pets and gear Tumble clothes in dryer for 1 hour

Questions?

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“It’s Friday and the school nurse called about a child with fever, cough, and a rash that looks like measles... Help!”

Elizabeth Zaremski, MPH, Vaccine-Preventable Disease Coordinator

NJ Reporting Requirements

Cases of measles, confirmed or suspect, must be reported immediatelyas per N.J.A.C. 8:57

Reportable directly to local health department where the patient resides

May be reported to NJDOH if unable to reach the local health department

http://nj.gov/health/cd/reporting.shtml

http://aapredbook.aappublications.org/week/iotw010504.dtl

Measles What is Measles? Measles = Rubeola ≠

Rubella Febrile rash illness

caused by measles virus Highly contagious Preventable with a

highly effective vaccine recommended in routine immunization schedules Rapidly inactivated by

heat & light

Image from http://commons.wikimedia.org/wiki/File:Measles_virus.JPG

Measles Transmission Highly contagiousAttack rate in susceptible household contacts: 75%-90%

Transmitted via respiratory droplets and aerosolSpread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretionsRemains up to 2 hours after person with measles occupied an area

Contagious from 4 days before through 4 days after rash onset

2013 ACIP recommendation: http://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

Updated Guidelines – June 2013

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MMR Vaccine Routine Recommendations In the U.S., 2 doses are recommended for

children & adolescents 1st dose at 12-15 months old 2nd dose at 4-6 years old can be given at any age as long as ≥ 28 days Catch up vaccination as needed

Adults without evidence of immunity 2 doses (HCW, post high school students, travelers) 1 dose (others)

2013 ACIP recommendation: http://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

MMR Vaccine Travel Recommendations

Persons aged ≥12 months w/o other evidence of immunity should receive 2 doses Includes providing a 2nd dose to children prior to age 4-6 yrs Includes adults who have only received one routine dose in the past

Children aged 6-11 months should receive 1 dose If vaccinated at age 6-11 months, still need 2 subsequent doses at age ≥12 months

Measles 1993-2014 Average ~60 cases per year Declared eliminated from U.S. in 2000 Record low annual total in 2004 (37

cases) In 2008, greatest annual total since 1996

(140 cases)… Until 2011… 220 cases reported Decrease to 186 cases in 2012, but… In 2014… 566 cases reported in 20 states~80% unvaccinated 98% import-associated

http://www.cdc.gov/measles/cases-outbreaks.html

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Measles in N.J.

0

2

4

6

8

10

12

14

16

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014*

# o

f m

ea

sle

s c

as

es

Year

Confirmed Measles in NJ2005 - 2014* Clinical Presentation

Prodrome (2-4 days)Stepwise increase in fever to 103°F or higher The “three C’s” cough coryza conjunctivitis Enanthem (on mucous membranes) (Koplik spots)

Koplik Spots

http://www.pathguy.com/sol/24924.jpg

Clinical Presentation Rash 2-4 days after prodrome, 14 days after exposureMaculopapular, may become confluentmacules = flat discolored spots papules = tiny bumpsBegins on face and head then progresses downward and outward Persists 5-6 days Fades in order of appearance

Measles Treatment Supportive care No antiviral treatment Appropriate antimicrobials for secondary

bacterial infections Vitamin A therapy Developing countries Therapy associated with decreased morbidity and mortality

United States Low serum Vitamin A levels in children Severe measles associated with lower Vitamin A serum

concentrations WHO recommends Vitamin A therapy for all children

with measles regardless of country

Measles Complications

More common among children <5 y.o.a. and adults >20 y.o.a. ~ 30% of cases develop at least one

complication Pneumonia Complication that is most often the cause of death in

young children Ear infections Occur in about 10% of cases and can result in

permanent hearing loss Diarrhea Reported in about 8% of cases

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Condition

DiarrheaOtitis mediaPneumoniaEncephalitisDeath

Measles ComplicationsPercent reported

87-91-60.10.2

0

5

10

15

20

25

30

<5 5-19 20+

Age group (yrs)

Per

cen

t

Pneumonia Hospitalization

Measles Complications by Age Group

Suspected Measles: Diagnosis Many U.S. health care professionals have

never seen a case of measles Delay in diagnosis contributes to

transmission Consider measles in differential diagnosis

of febrile rash illness e.g. Kawasaki’s, Scarlet fever, Dengue, parvovirus B19 Travel history or exposure to recent travelers/measlesDocumented vaccine history

Things to Consider Vaccination status Travel or exposure to travelers or

persons with rash illness Does presentation fit? Any other possible causes?Recent receipt of antibiotics, vaccine, medsRash illnesses at school/daycare

Laboratory testingWhy did provider order tests?Any other tests ordered?

Public Health Response(for confirmed and suspect cases) Isolation of case Laboratory testingSerology for IgM & IgGViral specimen (nasopharyngeal, oropharyngeal, or nasal swab) for PCR (and genotyping)

Contact investigations and other response efforts

Notification to LHD/NJDOH

Measles Isolation Guidance If measles is suspected in a clinic, ER or

hospital setting, isolate immediately Airborne isolation room or private room

with the door closed, mask pt if feasible Do not use private room for at least 2 hours

after pt Ensure HCWs have evidence of immunity In hospital setting, respiratory

precautions including N95 masks, even for those with evidence of immunity

ACIP/CDC guidance: http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf and http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

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Measles Laboratory Diagnosis Serology Positive IgM for measles Collect serum at first encounter with suspected

measles patient 30% false negatives when collected within 72

hours of rash onset If negative and high index of suspicion remains repeat

IgM study ≥72 hours of rash onset

Paired acute and convalescent IgG studies Not appropriate for timely diagnosis

Serology may be difficult to interpret in those previously vaccinated or who received PEP vaccination or immunoglobulin

Measles Laboratory Diagnosis Isolation of measles virus Collect samples as soon as possible after rash onset Isolation most successful if specimen collected within 3 days of

rash onset Throat or nasopharyngeal swabs preferred Virus isolation or RT-PCR detection Flocked synthetic swabs (dacron) preferred

Place swabs in 2 mL of standard commercially available viral transport media (VTM) Cell culture medium can be used If VTM not available use sterile isotonic solution (e.g., phosphate buffered

saline) Place specimen in refrigerator until transport

Urine sample Sensitivity increased if both are sent

http://www.cdc.gov/measles/lab-tools/rt-pcr.html

Contact Investigation for Exposure to Measles Persons exposed during case’s infectious

period Includes exposure to area 2 hours after case left

Establish presumptive evidence of immunity for contacts

Quarantine of contacts without presumptive evidence of immunity (through 21 days after last exposure)

Postexposure prophylaxis (PEP) Vaccine or Immune globulin (IG)

Post Exposure Prophylaxis (PEP)Vaccine

MMR vaccine given within 72 hours of first exposure might prevent diseaseMay return to normal activities (except in HCW)Monitor for symptomsCan be given at age 6 monthsBe aware of possibility of vaccine rash

Post Exposure Prophylaxis (PEP)Immune Globulin (IG) IG can be given up to 6 days post-

exposure Recommended dose Intramuscular (IGIM): 0.5 mL/kg (max = 15mL) Intravenous (IGIV): 400 mg/kg

Recommended for following groups Infants < 12 months of age (IGIM) Delay giving children MMR 5-6 months after receiving

IG depending on the dose Pregnant women w/o evidence of immunity (IGIV) Severely immunocompromised individuals (IGIV)

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Exclusions

Determine if there are any un-/under-vaccinated persons exposedMedical or Religious ExemptionAge

Ensure exposure actually occurred Consult with NJDOH when considering

exclusion Every situation may be different

Notification to NJDOH

Assistance on evaluating degree of suspicion and next steps

Guidance on laboratory specimen collectionApproval for specimen submission to PHEL for forwarding to CDC

Facilitate exposure notification to other agencies (other states, DGMQ)

Guidance on exclusion recommendations

2013 Measles Clinical Case Definition

Generalized, maculopapular rash lasting ≥3 days; and

Temperature ≥101°F (>38.3°C); and

Cough or coryza or conjunctivitis

http://wwwn.cdc.gov/NNDSS/script/conditionsummary.aspx?CondID=103

Resources NJDOH - Vaccine Preventable Disease Program http://www.nj.gov/health/cd/measles/index.shtml

CDC http://www.cdc.gov/measles http://www.cdc.gov/vaccines/pubs/surv-manual/index.html http://www.cdc.gov/vaccines/pubs/pinkbook/index.html Webinar: Record High US Measles Cases:http://emergency.cdc.gov/coca/calls/2014/callinfo_070114.asp

American Academy of Pediatrics. Red Book. 2012 Report of the Committee on Infectious Diseases

THANKYOU!

Elizabeth F. ZaremskiElizabeth.Zaremski@doh.state.nj.us

(609) 826-4861

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CDS Program Updates Infectious Disease

Rebecca Greeley, Surveillance Coordinator for Antimicrobial Resistance and Waterborne Diseases

Healthy Swimming & Recreational Water Safety (‘tis the season) Recreational water illness (RWI), mostly

commonly diarrhea, caused by Cryptosporidium, Giardia, Shigella, norovirus, E. coli

Swallowing water, even a small amount, that has been contaminated with feces can cause illness

Keep the poop, germs, and pee out of the water Don’t swim when you have diarrhea Shower before start swimming Wash hands after using toilet

Chlorine kills most but not all bacteria

Waterborne Disease Investigations Public health investigation into single cases

of reportable diseases should always include questions about water parks, pools, interactive play fountains, spray water, hot tubs, oceans lakes and rivers Look for other cases and possible links to

locations Goal to stop further disease transmission

NOTE: Legionellosis CDRSS risk factors updated

Middle East Respiratory Syndrome Coronavirus (MERS – CoV) Case count (6/26/14) 707 cases; 252 deaths

Two travel associated cases in US Indiana, Florida ~ 500 contact investigations No additional illness identified

Surveillance for travel associated cases

http://nj.gov/health/cd/mers/index.shtmlhttp://www.cdc.gov/coronavirus/mers/index.html

Hepatitis C, Past or Present Hepatitis C, Acute & Hepatitis C, Chronic (Past or Present) HCV RNA Qualitative and Quantitative PCR Serology Value >15 UI/ml – click on lab test to review test

interpretation statement i.e., HCV RNA Detected Value <15 UI/ml; HCV RNA not detected

Cases with a confirmatory HCV signal-to-cut off index and a HCV RNA not detected indicate no current infection Close as CONFIRMED Hepatitis C, Chronic (Past or Present)

meeting the PAST illness category Cases created with only a not detected HCV RNA result: If HCPs provide previous history of HCV infection with viral

clearance, close as CONFIRMED Hepatitis C, Chronic (Past or Present)

If no additional information provided, close as Hepatitis C, Chronic - NOT A CASE, DOES NOT MEET CASE DEFINTION

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Coming Soon! NJDOH Scabies Guidance Document “Management of Scabies in Long-term Care Facilities, Schools and Other Institutions”

FAQ sheets for schools and daycareQuick reference sheets Examples include coxsackie virus, lice, scabies Zoonotic Disease

Kristin Innes, Zoonotic Disease Epidemiologist

Zoonotic Disease Unit (“Zoo Team”) Rabies Update Peak season for rabies exposures: May – Sept Rabies guidance – NJLINCS April 2014: Guide to Proper Handling of Bat Exposures May 2014: NJ Guide to Post-Exposure Rabies Prophylaxis July 2014: Animal Rabies Case Summary

Laboratory testing of animal specimens Submit specimens to NJDOH Rabies Lab by 2:00 PM on a non-

holiday Thursday for results before the weekend Specimen delivery can be made 24/7 Priority testing – Requested by Health Officers

NJDOH Website, “Rabies”, “Technical Info”http://www.state.nj.us/health/cd/rabies/techinfo.shtml

Lab Rule out of Select Agents Immediately reportable select agents

-Brucella species -Francisella tularensis (Tularemia)-Burkholderia species -Yersinia pestis (Plague)-Bacillus anthracis (Anthrax)

Clinical Laboratories are required to send suspect isolates of select agents to the State Lab (PHEL)

Suspect isolate meets specific criteria for each agent: Is the isolate a Gram negative coccobacillus or small rod? Did the isolate produce poorly growing colonies after 24 hours of incubation

and better growing colonies after 48 hours on blood agar? Is the isolate oxidase positive? catalase positive? urea positive?

Note: samples meeting the testing criteria may be ruled-out as a select agent

Labs with suspect isolates immediately notify NJDOH, Communicable Disease Service CDS approves specimen and notifies PHEL

Office of Animal Welfare (OAW)

Animal-Related Resources and Guidance for LHDs Concise information to assist LHDs with animal-related

issues Over 20 short chapters (1-5 pages) Includes links to guidance documents and other useful

resources Will be posted NJDOH website

Animal Facility Licensure and inspection All facilities are licensed by municipalities in June annually Annual inspection by LHD required for licensure Must be in full compliance with all laws, regulations and

ordinances Reminder – The public is very knowledgeable and reactive

to animal welfare issues!

NJDOH OAW: http://www.state.nj.us/health/animalwelfare/index.shtml

Vectorborne Disease

Shereen Semple, Vectorborne Disease Coordinator

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Chikungunya Virus (CHIKV)

Alphavirus Aedes aegypti and

Aedes albopictus are primary vectors

Humans are primary host

Outbreaks with high attack rates

Often co-circulates with dengue

Fever and polyarthralgia December 2013

outbreak in the Caribbean

Map: http://www.cdc.gov/chikungunya/geo/caribbean.html

Countries and territories in the Caribbean where chikungunya cases have been reported

(as of July 1, 2014)

Chikungunya Virus (CHIKV)IZDP Vectorborne Disease Program

Reportable within 24 hours under “Arboviral Disease”

Lab testing available at Focus Diagnostics and the CDC (pre-approval by NJDOH required)

Counsel cases to avoid mosquito bites for one week following symptom onset

80%

15%

5%

Potential for Local Transmission

Full viremicperiod in NJ

Partialviremicperiod in NJ

No viremicperiod in NJ

N=20

Heartland VirusIZDP Vectorborne Disease Program

Phlebovirus Amblyomma americanum Investigational test at CDC Age ≥ 18 years Fever ≥ 38° C Leukopenia Thrombocytopenia Acute onset ≤ 3 weeks Negative results for other tickborne diseases /

underlying conditions Contact (609) 826-5964 or

shereen.semple@doh.state.nj.us

Vaccine-Preventable Disease (VPD)

Elizabeth Zaremski, Vaccine-Preventable Disease Coordinator

Case Definitions Case definitions enable public health to classify and count cases

consistently across reporting jurisdictions, and should not be used by healthcare providers to determine how to meet an individual patient’s health needs

Every year, case definitions are updated using CSTE’s Position Statements. They provide uniform criteria of nationally notifiable infectious and non-infectious conditions for reporting purposes

The NJDOH Vaccine Preventable Disease Program follows the most current case definition as published on the NNDSS website

To search for notifiable diseases’ case definitions by name and by year, use the search tools on the left side of the NNDSS website: http://wwwn.cdc.gov/nndss/ 2014 Pertussis 2013 Measles, Rubella 2012 Hepatitis B (acute & chronic), Mumps 2010 CRS, Diphtheria, Meningococcal disease, Polio, Tetanus, Varicella

Pertussis case definition changed, effective January 2014 Affects infants <12 m.o.a. Apnea added as a symptom Cough of any duration w/ any sx AND w/ PCR+ OR epi-link to confirmed case = Probable

http://wwwn.cdc.gov/NNDSS/script/conditionsummary.aspx?CondID=113

Limitations of laboratory diagnostics make the clinical case definition essential to pertussis surveillance Important to determine duration of cough, specifically whether it

lasts 14 days or longer, in order to determine if a person’s illness meets clinical case definition

Do not wait until day 14 to begin investigation as it is important to institute public health measures to prevent spread of disease

Since the 1980s, there has been an increase in the number of reported cases of pertussis in the U.S. In 2010, an increase in reported cases among 7-10 y.o. was seen Similar trends in 2012; slight increase in cases among 13 & 14 y.o. Increase in NJ pertussis cases seen 2011-2013, but numbers have

approached normal in 2014

Pertussis

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Meningitis outbreak 9 cases of N. meningitidis associated with Princeton

University March 2013 through March 2014 No common activities or direct epi-link identified 1 fatality; 2 permanent sequelae

All 9 cases were caused by serogroup B meningococcal disease Identical strain in 8/9 cases confirmed by genetic testing 1 case had similar strain characteristics

IND expanded access for emergency use of Bexsero vaccine Campaigns held December 2013 – May 2014 Of those eligible to receive vaccine, 95% received 1st dose; 89%

received 2nd dose Incoming Freshman to be vaccinated upon arrival to campus

NJDOH continues to work very closely with local health officials, CDC, and Princeton University to monitor the situation

Foodborne Disease

Michelle Malavet, Foodborne Disease Coordinator

3 norovirus outbreaks associated with local restaurants 14 multistate clusters of salmonellosis

under investigation by CDC, state and local health departments 1 in-state cluster of salmonellosis 1 multistate cluster of STEC under

investigation by state health departments

Foodborne Outbreaks/Clusters April-Present

Interview case using CDC surveillance form(COVIS): www.nj.gov/health/cd/forms.shtml

Types of Specimens: Stool: consumption of seafood (shellfish) Food and Drug Safety Program will follow-up with local

health department environmental staff on seafood product implicated

Wound: exposure to salt water Ear infection: swimming salt water

Fax COVIS form to NJDOH @ 609-826-5972

Vibriosis Case Follow-up

Checklist and interview worksheets for salmonellosis and shigellosis case investigation by local health departments are now available on “technical” section of web page for each disease

Salmonellosis and Shigellosis

Healthcare Associated Infections (HAI)

Jason Mehr, HAI Coordinator

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Healthcare Associated Infections

New Healthcare Associated Infections Coordinator:

Jason Mehr, MPHJason.mehr@doh.state.nj.us609-826-5964

Jason will be your contact for any healthcare associated infection related inquiry

Healthcare Associated Infections

Multidrug resistant organisms in long term care facilities Colonized individuals? CDC Guidelines: Vary by site,

organism, and overall prevalence at the facilityGeneral rule: If able, implement contact precautions Full guidelines can be viewed at: http://www.cdc.gov/hicpac/pdf/MDRO/MDROGuideline2006.pdf

Injection Safety Update One & Only Campaign: One needle, one

syringe, only one time Two new videos just released: one for

providers and another for office managers Direct access to all video content:

www.oneandonlycampaign.org These videos will be posted to NJ

website shortly

Surveillance Programs

Teresa Hamby, Data Analyst

CDRSS Re-design update Still accepting suggestions; send to

cdrsadmin@doh.state.nj.us Prototype in testing at state level Local User Working Group being established

2013 case close-out Final submission completed

Reports CDRSS report function redesign; training available CDRSS weekly alert report discontinued; awaiting

new format

Influenza Surveillance Official CDC reporting ended May 17,

2014 NJDOH will continue to conduct year

round surveillance, including laboratory testing

Recruitment efforts ◦ ILINet providers ◦ Sentinel Laboratories◦ Schools and Long Term Care Facilities

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2013-2014 Influenza Season Unusual two peak season◦ One at end of January (A 2009 H1N1)◦ Second in mid-April (B)

ILI activity continued well into late May Vaccine components did match circulating

strains

EpiCenter New Jersey Syndromic Surveillance

System >97% NJ Emergency Departments participate Local health access available upon request

Alert summary reportsWeekly & Quarterly

Local users may sign up for alert emails Alerts based on hospital and county Local users may also choose zip code level

EpiCenter Alert - ExampleWhat type of visits alerted?

The number of interactions as

compared to the baseline/threshold

Summary of Details about the anomaly

Options for viewing the data

When printed, this slide is best viewed as a full page.

Example - Continued- Details of Alert- Disposition- Option to open investigation

Map

Graphic Representations

Double-click on this graph to pull up a linelistA one-hour webinar is available to

all users. Contact CDS or HMS.

BioSense 2.0

National Syndromic Surveillance System

CDC Funding Data feed from EpiCenter to Biosense >85% NJ Emergency Departments

Working group on hold – no topics currently

CDC requesting weekly MERS-CoV data via BioSense; NJ participating (no action required by facilities)

Questions

October 2nd – Northeast Paramus Life Safety Building, Jockish Square,

Paramus, NJ 07652

October 6th – Northwest Township of Hanover Community Center, 15 North

Jefferson Road, Whippany, NJ 07981

October 16th – Central West Hunterdon County Complex, 314 State Route 12,

Building #1, Flemington, NJ 08822, 1st floor conference room

October 21st – South (date may change) The Government services building, 1200 North

Delsea Drive, Clayton NJ 08312, auditorium

October 30th – Central East CentraState Medical Center, 901 W Main St,

Freehold, NJ 07728, auditorium

Fall 2014 Communicable Disease Forums (in-person)

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Thank you! Remember – if you are watching as a

group, to have the webinar included on your NJLMN transcript, send a sign-in sheet to kim.cervantes@doh.state.nj.us or fax to 609-826-5972