1. Epi Program Overview Disease Surveillance and Reporting

2. Functions of the Division of Surveillance and Investigation Collect and analyze reports of notifiable diseases Identify trends in disease occurrence Provide manpower and technical advice to local health departments Provide information on prevention and control measures to health care professionals and the general public

3. Goal of the Division Prevent disease and disability among the people of the Commonwealth To accomplish our goal we need to know: What diseases are occurring and where? Who’s at risk? What control measures need to be taken? Have control measures been effective in reducing or eliminating the occurrence of disease? What can we do to prevent future occurrence of disease or illness among people at risk?

4. Disease Surveillance Definition: An on-going systematic collection, analysis, interpretation of health-related data, and the dissemination of information for use in public health action

5. Public Health Surveillance Systematic, ongoing Collection Analysis Interpretation Dissemination Link to public health action

6. Uses of Surveillance Data Monitor disease trends Determine geographic distribution of illness Portray the natural history of a disease Detect outbreaks Estimate the size of a health problem Evaluate intervention activities Monitor changes in infectious agents Facilitate planning/research

7. Sales Data: McDonalds and U.S. Auto Makers

8. Regulations for Disease Reporting and Control Despite state regulations regarding disease reporting, reporting is far from complete Those who do report do so regularly Utilize this information as a baseline for defining endemic and aberrant disease activity Measures to encourage disease reporting should be ongoing

9. Regulations for Disease Reporting and Control The State Board of Health has the responsibility for promulgating regulations pertaining to the reporting and control of disease of public health importance Periodically amended in order to bring them into compliance with recent changes to the Code of Virginia and with recent changes in the field of communicable disease control and emergency preparedness that need to be implemented to protect the health of the citizens of Virginia. Effective date of last amendment – 3/28/2011

10. Reporting of Disease Reportable Disease List Those Required to Report When to Report How to Report Where to Report

11. Reporting of Disease Reportable Disease List Diseases, toxic effects and conditions to be reported Composite of the requirements for reporting Laminated version is made available to persons required to report

12. The Reporting Stream

13. Those Required to Report Physicians Directors of laboratories Persons in charge of a medical care facility (i.e., hospital or nursing home) Persons in charge of a residential or day program, service, or facility licensed or operated by any agency of the Commonwealth, or a school, child care center, or summer camp

14. Those Required to Report Local Health Directors Persons in charge of hospitals, nursing facilities or nursing homes, assisted living facilities, and correctional facilities Employees, applicants, and persons in charge of food establishments

15. Those Required to Report Physicians: Name, address, age, date of birth, race, sex, and pregnancy status for females; disease; date of onset of illness Physician’s name, address, and telephone number and medical facility where patient was examined Influenza should be reported by number of cases only (and type of influenza if available)

16. Those Required to Report Physicians: May designate someone to report, but remains responsible for reporting Report using Epi-1 form, a computer generated printout or a CDC surveillance form Report shall be made within three days of the diagnosis unless the disease requires rapid reporting (Electronic transmission may be done upon agreement with the department)

17. Those Required to Report Directors of laboratories: Report source of specimen and lab method and result Report name, address, age, date of birth, race, sex, and pregnancy status for females (if known); Report name, address, and telephone number of the physician and medical facility and medical facility for whom the examination was made When influenza virus is isolated, the type should be reported, if available

18. Those Required to Report Directors of laboratories : Report within three days of identification of evidence of disease unless the disease requires rapid reporting Report using Epi-1 form, or on the laboratory’s own form if it includes the required information, or computer generated reports Electronic transmission may be done upon agreement with the department

19. Those Required to Report Directors of laboratories: Additional Reporting Criteria A laboratory identifying evidence of certain conditions shall notify the health department and submit the initial isolate to DCLS (See12 VAC 5-90-90 B of the regulations for a complete list) Director of medical facility can assume requirements for reporting if laboratory is operating within a medical facility but must submit isolates as mandated by the regulations

20. Those Required to Report Persons in charge of a medical care facility: Report occurrence in or admission to the facility of a patient with a reportable disease unless he has evidence it was reported by a physician. The requirement to report shall include all inpatient, outpatient and emergency care departments. Report patient’s name, address, age, date of birth, race, sex, and pregnancy status for females; name of disease; admission date; chart number; date expired; attending physician.

21. Those Required to Report Persons in charge of a medical care facility: Report influenza by number of cases only and type if available Report within three days of the diagnosis unless the disease requires rapid reporting Report using Epi-1 form, a computer generated printout containing the data items requested on Epi-1 form, or CDC surveillance form that provides the same information

22. Those Required to Report Persons in charge of a medical care facility: Electronic transmission may be done upon agreement with the department May assume the reporting responsibilities on behalf of the director of the laboratory operating within the facility

23. Those Required to Report Persons in charge of a residential or day program, service, or facility licensed or operated by any agency of the Commonwealth, or a school, child care center, or summer camp: Report immediately the presence of persons who have common symptoms suggesting an outbreak situation. May report individual cases of communicable diseases that occur in their facility

24. Those Required to Report Local health directors: Forward any reports of disease made on residents of his jurisdiction to the Office of Epidemiology within three days of receipt or report immediately by the most rapid means (i.e., telephone) if the disease requires rapid communication. Written confirmation should follow within three days. Immediately forward reports on persons residing in other jurisdictions or to the Office of Epidemiology if outside of VA

25. Diagram of the Reporting Process in Virginia Physicians Labs Labs Local H.D. Regional State Epis Medical Care Facilities/Others Facilities/Others Other States CDC Health Districts Reporting from Physicians, Labs and Medical Care Facilities/Others Reporting by LHD/District Offices Reporting by Regional Epis/Central Office Other States/CDC

26. Reporting Forms and Other Surveillance Reports Epi-1 Computer generated printout containing the data items requested on Epi-1 CDC Surveillance Reports * * Used to better define the epidemiology of certain diseases

27. Requirement for Reporting The importance of reportable disease surveillance data cannot be overstated The Regulations for Disease Reporting and Control define what diseases and conditions of public health concern are reportable in VA CDC/CSTE case definitions provide the framework for uniform reporting nationally

28. Surveillance Case Definitions Case Definitions for Conditions Under Public Health Surveillance First Published October 1990 by CDC/CSTE Purpose: To establish uniform reporting What is under surveillance nationally Criteria used to define a case Updates/revisions made each year at CSTE annual meeting

29. Definition of Terms Used in Case Classifications Confirmed case: a case that meets the clinical case definition and is laboratory confirmed Probable case: a clinically compatible case with laboratory results consistent with the diagnosis but do not meet the criteria for laboratory confirmation OR a clinically compatible case that is epidemiologically linked to a confirmed case

30. Definition of Terms Used in Case Classification Suspect case: a clinically compatible case that meets a presumptive (suspect) laboratory criteria OR a positive laboratory case and clinical information is not known or not available Note for VEDSS users: Create a “Notification” when a case meets case definition and assign the appropriate “Case Status” based on case classification criteria

31. Nationally Notifiable Diseases Surveillance System CDC is responsible for the collection and publication of data concerning nationally notifiable diseases Not all conditions under public health surveillance are notifiable to the CDC This list is revised periodically Disease specific case definitions are located on the CDC web site @ http://www.cdc.gov/osels/ph_surveillance/nndss/ casedef/case_definitions.htm http://www.cdc.gov/osels/ph_surveillance/nndss/ casedef/case_definitions.htm

32. Nationally Notifiable Diseases Surveillance System Virginia contributes to the Nationally Notifiable Diseases Surveillance System through VEDSS A “Notification” must be created before a case can be sent to the CDC “Notifications” populate an approval queue for review in the central office Each case is reviewed and approved cases are transmitted to the CDC

33. No Case Definition Exists Or Status is Not a Case You may leave “Case Status” blank for cases entered in VEDSS that do not have a CDC/CSTE or Virginia case definition; however, for conditions of public health significance, you may wish to create a “Notification” in order for this case or event to come to our attention in the central office Do not create a “Notification” when a case is assigned a status of “Not a Case”

34. VEDSS Notification Page antigen positive

35. VEDSS Rejected Notifications Queue “Notifications” are rejected because they do not meet case definition Rejected notifications will remain in the queue for 30 days with a case status of “Unknown” or “Not a Case” Rejected “Notifications” will have comments Please try to obtain and enter the needed information, if available You must recreate a “Notification” if it has been rejected in order for the case to be re-reviewed and ultimately counted

36. What Happens to the Data? Black hole

37. Data Dissemination

38. MMWR Week In VEDSS Defines the “Month of the Year” case will be reported

39. MMWR Weeks Ending Log WEEKS ENDING LOG 2010-2001 Weeks Ending Saturday Weeks2010 Weeks2011 1Jan-9 1Jan-8 216 2Jan-9 323 3Jan-10 430 4Jan-11 5Feb-6 5Jan-12 613 6Jan-13 720 7Jan-14 / 46 20-Jan 46 19 4727 4726 48Dec-4 48Dec-3 4911 4910 5018 5017 5125 5124 52Jan-1 5231 December 5, MMWR Week = 49

40. MMWR Week Ending Date

41. Division of Surveillance and Investigation Internal Page

42. Division of Surveillance and Investigation External Page

43. Disease Surveillance Data External Page

44. Contact Information For help with case definitions or with generating reports from VEDSS data contact: VDH_EPI_comments@vdh.virginia.gov