1. Overcoming Disease in Your Community Gail Baker, RN Megan Davies, MD Gina Holland, RN Jenny Snow, MPH

2. Investigation and Controlling Vaccine- Preventable Disease

4. Reporting Vaccine Preventable Disease GOALS – Protection – Limited spread – Reduced exposure

5. What diseases are reportable? (Please see Reportable Disease Handout) Within 24 hours?Bold Italics Within 7 days?All others

6. Who must report? Physicians Medical and laboratory facilities Local health directors School principals and day care operators

7. Local Health Director shall investigate... Cases of communicable diseases and conditions reported to the local health director.

8. Questions on Reporting?

9. Implement Controls The local health director has the authority and responsibility to implement control measures to prevent the spread of reportable communicable disease...

10. The Local Health Director has... Isolate The authority to… Isolate Quarantine The authority to... Quarantine

11. 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.

12. Do you really want to wait?

13. Questions regarding Implementing Controls?

14. 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

15. 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

16. Your Local Health Director Involve the Health Director early

17. Collaborate Bring all agencies involved together Determine responsibilities of each party involved Clarify roles, responsibilities and timeframe for each activity

18. How do you insure that reporting occurs? Encourage communication within healthcare community Build relationships with local providers Educate, educate, educate!!!

19. It all relates back to Clinical Description... All that you do to investigate and to control vaccine preventable disease, will some how relate to a disease’s clinical description and the natural history of the agent that causes that disease.

20. 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

21. What difference does it make... Knowledge of a disease’s clinical description encourages you to use sound clinical judgment to determine what steps should be taken next.

22. Viral VPD... Polio Measles Mumps Rubella Varicella Hepatitis B

23. What do you already know about viral VPD? Most aerosolize Antibiotics won’t help You’ll need titers to confirm

24. Bacterial VPD... Pertussis Diphtheria Tetanus Haemophilus influenzae Pneumococcal

26. 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

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

28. Incubation Period... Interval between exposure and first symptoms

29. Period of Communicability... The period of time the disease can be transmitted

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

32. Questions regarding Clinical Description?

33. Case Definition... Do you report? Don’t you report?

34. Defining a Case Gather disease specific information – Type of symptoms – Duration of symptoms – Exposure to someone with like symptoms – Recent travels

35. 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

36. 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

37. Case Definitions... Are disease-specific and based on symptoms and laboratory tests

38. 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.

39. 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

40. Questions regarding Case Definitions?

41. Laboratory

42. Testing and Interpretation Pertussis Measles Rubella Mumps HiB Polio Diphtheria Tetanus Hepatitis B

43. Obtaining Specimens... Interpreting Results...

44. Specimen Collection Collect specimen before antibiotic therapy begins on symptomatic individuals who meet case definition.

45. Questions regarding Labs?

46. Treatment of VPDs

47. 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.

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

49. Disease Surveillance Goals – Predict – Observe – Minimize Key part of disease surveillance is accurate and timely disease reporting

50. Immediate Use – Immediate Use Disease control and management Contact tracing Outbreak identification

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

52. 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

53. Pertussis 109 reported cases of Pertussis in NC in 2011 as of week 28 (July 17 th, 2011, CDC MMWR)

54. Mumps 4 reported cases of Mumps in NC in 2011 as of week 28 (July 17 th, 2011, CDC MMWR)

55. Meningococcal Disease (all serotypes) 12 reported cases of Meningococcal Disease (all serotypes) in NC in 2011 as of week 28 (July 17 th, 2011, CDC MMWR)

56. Hepatitis B (acute) 67 reported cases of Acute Hepatitis B Virus in NC in 2011 as of week 28 (July 17 th, 2011, CDC MMWR)

57. Hepatitis A (acute) 13 reported cases of Acute Hepatitis A Virus in NC in 2011 as of week 28 (July 17 th, 2011, CDC MMWR)

58. Haemophilus influenzae (invasive, all serotypes) 49 reported cases of Haemophilus influenzae (invasive, all serotypes) in NC in 2011 as of week 28 (July 17 th, 2011, CDC MMWR)

59. 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!

60. Questions about VPD Surveillance?

61. 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

62. 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

63. 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!