Alison Keyser Metobo, MPH + Population- based Surveillance of Reportable Diseases in Nursing Home Facilities in Nebraska Manjiri Joshi, MPH+ Alison Keyser Metobo, MPH + +Epidemiology Surveillance Response Coordinator

Overview Background Objective Methods Results Next Steps Nursing home increased risk for infection Health outcomes in nursing home residents Baseline for Nebraska cases Objective Methods Estimated incidence rates in nursing home residents Comparing estimated incidence rates in nursing home residents and non-nursing home cases Results Next Steps

Background

Nursing Home residents are at increased risk for infection Advanced Age Group Living Comorbidities Compromised Immunity Need for hospitalization

Health outcomes for nursing home residents Clostridium Difficile infections Influenza Methicillin Resistance Staphylococcus Aureus Vancomycin resistance Enterococci

Compared Nebraska incidence rates with national incidence rates Establish baseline in Nebraska population

2010 - revised reportable disease regulations implemented in Nebraska Conditions added for laboratories reporting via Automated Electronic Laboratory Reporting (ELR) Acinetobacter spp. Streptococcus pneumoniae Enterococcus spp. Influenza Klebsiella spp. Clostridium difficile Staphylococcus aureus Meningococcal disease, invasive (Neisseria meningitidis)

Objectives Calculate estimated incidence rates among nursing home residents for selected agents for 2010 ̶ 2011 Compare estimated incidence rates for nursing home residents and non-nursing home cases who are 65 years and older

METHODS

HL-7 SAS Codes ELR (All Reportable Conditions) Nebraska’s Electronic Diseases Surveillance System (NEDSS) Different line lists with selected variables are created and exported as excel files HL-7 SAS Codes

Nursing home data “Nursing home associated case”- any lab report where patient address = Nursing home address Obtained addresses of all 231 licensed Nursing home facilities Nursing home line list - 2010 and 2011 Selected agents Clostridium Difficile Enterococcus Sp. Influenza Methicillin Resistant Staphylococcus Aureus (MRSA) Non MRSA Staph Streptococcus Pneumonia ** For influenza only positive cases were included

** For influenza only positive cases were included Non-nursing home data Lab report data (ELR) for 2010 ̶ 2011 Selected agents Clostridium Difficile Enterococcus Sp. Influenza Methicillin Resistant Staphylococcus Aureus (MRSA) Non MRSA Staph Streptococcus Pneumonia ** For influenza only positive cases were included

Estimated incidence rates for nursing home residents 2010 ̶ 2011 Total number of licensed beds in Nebraska were used as proxy for convenience as population at risk to calculate the estimated incidence rates in nursing home facilities Incidence Rate = Number of cases Number of licensed beds* * Proxy for population at risk

Compare estimated incidence rates for nursing home residents and non-nursing home cases Assumption : Majority of the population in nursing home was 65 years and above All the licensed beds in Nebraska were used by this population Incidence Rate = Number of cases in nursing home who are 65 yrs and older Total number of licensed beds Non-nursing home cases Number of cases for 65 years and above was included Age specific population for Nebraska was used to calculate the incidence (Denominator) Incidence Rate = Number of cases who are 65 yrs and older Population at risk who are 65 yrs and older

RESULTS

Number and proportion of lab reports for which patient address was available Year Total Count (n) % of available address 2010 2660 2394 90% 2011 7136 6315 88.49%

Total # of Nursing homes in Nebraska Number and proportion for Nursing homes in Nebraska identified in the Lab reports for 2010 and 2011 Total Number of Beds – 16,975 Median: 62 Range: 4 -329 Total # of Nursing homes in Nebraska # identified in 2010, 2011 Percentage % 231 48 20.77

Nursing home associated cases by age and gender -2010 and 2011 Total 2010 2011 Statewide incidence Male Total % Female % Missing gender inform. Age Median Age Range Clostridium Difficile 71 32 39 4.18 59.2 36.6 4.22 79 30-97 Enterococcus Sp. 13 11 2 0.77 38.5 30.8 30.76 67 66-91 Influenza 24 1.41 58.3 41.7 30-99 MRSA 7 4 3 0.41 71.4 28.6 74 66-81 Non MRSA -Staphylococcus Aureus 0.24 25.0 50 78.5 72-81 Streptococcus Pneumonia 10 6 0.59 60.0 40.0 58.5 26-104

Estimated incidence rates for nursing home residents using total number of licensed beds (16,975) in Nebraska

Estimated incidence rates: nursing home residents vs Estimated incidence rates: nursing home residents vs. non nursing cases (65 years and above)

Evaluation Chart Review Validate number of nursing home cases

Next Steps Add question to the investigation: “ If you are a nursing home resident?” Nursing home survey To get number of residents in each nursing home Age and gender information

Limitation Total population in nursing homes Age specific information for nursing home cases Address information No consideration for missing address

Acknowledgement Bryan Buss*, DVM, MPH, DACVPM Eryn Murphyᴪ MS Tom Safranek**, MD * CDC Career Epidemiology Field Officer (CEFO), Nebraska Department of Health and Human Services **State Epidemiologist, Nebraska Department of Health and Human Services ᴪEpidemiology Syndromic surveillance Coordinator

THANK YOU !!! Questions?! manjiri.joshi@nebraska.gov