Overcoming Disease in Your Community

Gail Baker, RNMegan Davies, MDGina Holland, RNJenny Snow, MPH

Investigation and Controlling

Vaccine-Preventable Disease

Reporting Vaccine Preventable

Disease

GOALS– Protection– Limited spread– Reduced exposure

What diseases are reportable?

(Please see Reportable Disease Handout)

Within 24 hours? Bold Italics Within 7 days? All others

Who must report?

Physicians Medical and laboratory facilities Local health directors School principals and day care

operators

Local Health Director shall investigate...

Cases of communicable

diseases and conditions

reported to the localhealth director.

Questions on Reporting?

Implement Controls

The local health director

has the authority andresponsibility toimplement controlmeasures to prevent

thespread of reportablecommunicable

disease...

The Local Health Director has...

The authority to…IsolateIsolate

The authority to... QuarantineQuarantine

All Persons...

Shall comply with control measures, including submission to examinations, and tests, prescribed by the Commission subject to the limitations of G. S. 130A-144(f)

Please see Manual for Surveillance of Vaccine Preventable Diseases.

Do you really want to wait?

Questions regarding Implementing Controls?

Getting Started...

Report in a timely manner Don’t wait for lab confirmation All facilities - hospitals, doctor’s office,

school, college infirmary or child care nurse report to local health department immediately

Time is of the essence to interrupt the spread of disease

An Epi Team

Notify and involve early

Many steps need to be taken in a short period of time

Epi-Team is critical to meeting the needs

Your Local Health Director

Involve the Health Director early

Collaborate

Bring all agencies involved together Determine responsibilities of each

party involved Clarify roles, responsibilities and

timeframe for each activity

How do you insure that reporting occurs?

Encourage communication within healthcare community

Build relationships with local providers

Educate, educate, educate!!!

It all relates back to Clinical Description...

All that you do to investigate and to controlvaccine preventable disease, will some howrelate to a disease’s clinical description andthe natural history of the agent that causes

thatdisease.

What difference does it make...

It can heighten or lessen your Index of Suspicion

You can’t find IT unless you know what IT looks like

Knowledge can better your investigation and better your application of control measures

What difference does it make...

Knowledge of a disease’sclinical descriptionencourages you to use sound clinical judgment to determine what steps should be taken next.

Viral VPD...

Polio Measles Mumps Rubella Varicella Hepatitis B

What do you already know about viral VPD?

Most aerosolize Antibiotics won’t

help You’ll need titers to

confirm

Bacterial VPD...

Pertussis Diphtheria Tetanus Haemophilus influenzae Pneumococcal

What do you already know about bacterial VPD?

The agent is usually much larger than the viruses

Right antibiotic(s) can treat Cultures are needed to confirm

Transmission...

Airborne/Droplet/Pharyngeal Contact w/ Contaminated Articles Percutaneous Body Substances Perinatal Urine Raw Milk

Incubation Period...

Interval between exposure and first symptoms

Period of Communicability...

The period of time the disease can be transmitted

Communicable Period

The amount of time in which a person is considered “infectious” and can spread disease to someone else

Questions regarding Clinical Description?

Case Definition...

Do you report? Don’t you report?

Defining a Case

Gather disease specific information– Type of symptoms– Duration of

symptoms– Exposure to someone

with like symptoms– Recent travels

Case Classification...

Clinically compatible case: symptoms fit the clinical presentation of disease

Confirmed case: clinically compatible - lab confirmed or epi-linked

Probable case: meets the clinical case definition - not lab confirmed or epi-linked

Case Classification cont’d.

Suspect case: person whose medical history and symptoms suggest infection

Lab-confirmed case: one or more laboratory diagnosis methods present positive results

Epi-linked case: patient has had contact with a diseased person

Case Definitions...

Are disease-specific and based on symptoms and laboratory tests

Significance of Case Definition

If you don’t have lab results to confirm the case

Use the case definition to see if the symptoms rise to the level of suspicion …cont.

Or...

Lab results show “false” negative and symptoms are intense

You might still call it a case based on case definition standards having being met

Questions regarding Case Definitions?

Laboratory

Testing and Interpretation

Pertussis Measles Rubella Mumps

HiB Polio Diphtheria Tetanus Hepatitis B

Obtaining Specimens...Interpreting Results...

Specimen Collection

Collect specimen before

antibiotic therapy begins on symptomatic individuals who

meet case definition.

Questions regarding Labs?

Treatment of VPDs

Prevention is the Key...

Make every attempt to prevent and control vaccine-preventable diseases.

Even with the best attempts to vaccinate - disease is still present.

Timely Response

Timely response to the report of a VPD is of utmost IMPORTANCE.

Disease Surveillance

Goals– Predict– Observe– Minimize

Key part of disease surveillance is accurate and timely disease reporting

Immediate Use

– Immediate Use Disease control and management Contact tracing Outbreak identification

Long-Term Use

– Long-term Use Ongoing analysis Trend identification Identify at-risk populations Program improvement Rationale for funding, etc.

Data Storage

NCEDSS (NC Electronic Disease Surveillance System)

– PHIN compliant, secure web-based disease surveillance system designed to collect all communicable disease surveillance information.

– Includes functions to assist with outbreak management– Allows for easy access to data, better sharing amongst

counties, contact tracing, better tracking of lab results, co-morbidity analysis

– Includes pre-set statistical reports for better monitoring and surveillance

Pertussis

109 reported cases of

Pertussis in NC in 2011 as of week

28 (July 17th, 2011,

CDC MMWR)

Mumps

4 reported cases of

Mumps in NC in 2011 as of week

28 (July 17th, 2011,

CDC MMWR)

Meningococcal Disease (all serotypes)

12 reported cases of

Meningococcal Disease

(all serotypes) in NC in 2011 as of week

28 (July 17th, 2011, CDC

MMWR)

Hepatitis B (acute)

67 reported cases of Acute

Hepatitis B Virus in NC in 2011 as of week 28 (July 17th, 2011,

CDC MMWR)

Hepatitis A (acute)

13 reported cases of Acute

Hepatitis A Virus in NC in 2011 as of week 28 (July

17th, 2011, CDC MMWR)

Haemophilus influenzae (invasive, all serotypes)

49 reported cases of

Haemophilus influenzae

(invasive, all serotypes) in NC in 2011 as of week

28 (July 17th, 2011, CDC

MMWR)

Contact Tracing

Even though some VPD case numbers are very low (i.e. measles, mumps), the amount of time spent tracking and treating all contacts to confirmed cases can often be overwhelming. Many hours are spent ensuring that the spread of disease is limited and that all possible exposed persons are treated appropriately.

Contact tracing and treatment is a public health responsibility!

Questions about VPD Surveillance?

Key Points

Medical Providers– Call health department when you suspect– Stay in close communication with health

department Guidance on testing Connection to the entire public health system Health Dept has authority for control measures

– Vaccine : Tdap, MMR, Hep A/B, varicella– Antibiotic prophylaxis– Isolation/Quarantine

Key Points

Local Health Departments– Call NC DPH as soon as you reasonably suspect– Stay in close communication with NC DPH

Guidance on testing Connection to the entire public health system DPH can assist with providing control measures

– Vaccine : Tdap, MMR, Hep A/B, varicella– Antibiotic prophylaxis guidance– Isolation/Quarantine guidance

Test kits can be given to practices in your county

Key Points

Keep high index of suspicion– Measles and pertussis outbreaks increasing

Communicate early and often Work with partners to implement control

measures rapidly Vaccinate, vaccinate, vaccinate!