1. EPIDEMIOLOGY AND SURVEILLANCE Southwest Florida Disaster Healthcare Coalition June 13, 2014 Jennifer Roth, MSPH Director of Epidemiology Florida Department of Health – Lee County

2. Objectives Review the disease and outbreak reporting and investigation process Identify ways DOH contacts pertinent partners during an outbreak Discuss different types of surveillance methods 2

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5. Who reports diseases in Florida? Required: Licensed medical practioners Osteopathic medicine Chiropractors Naturopathy Veterinarians Hospitals Laboratories 5

6. Who reports diseases in Florida? School nurses Nursing home and assisted living facilities Self or family reports Media Other regulatory agencies 6

7. How are diseases reported? Electronic labs Faxes Direct call from providers, school nurses etc. Concerned public Complaints to other agencies 7

8. Reporting Process Diseases can happen ANYWHERE at ANYTIME Any single case of a reportable disease Any suspected outbreak or cluster (2 or more) in a location Hospital Nursing home Neighborhood School 8

9. Reporting Process Physician, lab, hospital contacts health department by phone or fax Health department may call back requesting more information Need: Patient contact information, lab results, pertinent notes Health department may request more testing or prophylaxis Physician or laboratory sends specimens to state lab 9

10. Outbreak Investigation Steps 1. Prepare for field work 2. Establish the existence of an outbreak 3. Verify the diagnosis 4. Define and identify cases 5. Describe and orient the data in terms of time, place, and person 10

11. Case Definitions Describe the evidence needed to classify a case Laboratory Clinical Cases can be defined in many ways Confirmed Probable Suspect 11

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14. Outbreak Investigation Steps 6. Develop hypotheses 7. Evaluate hypotheses 8. Refine hypotheses and carry out additional studies 9. Implement control and prevention measures 10. Communicate findings 14

15. Response to Outbreaks Nursing homes Alert EMS shift commander Alert hospital Infection Control Practioners Schools Alert Director of Nursing at Department of Education Alert parents Correctional facilities Alert Warden 15

16. Response to Outbreaks May need to contact: Local providers Blast fax/Everbridge/EpiCom Local EOC Work with Preparedness Coordinator and Regional Emergency Response Advisor Mosquito Control State epidemiology office Coordination with state lab and CDC Media Coordinate with PIO and possibly JIC 16

17. Questions so far? 17

18. Surveillance Sentinel providers for influenza Local hospital and ERs submit weekly numbers for influenza Local hospitals submit Carbapenem-resistant enterobacteriaceae cases when found Weekly and monthly review of reportable disease cases ESSENCE ER and urgent care Poison control Death records 18

19. Surveillance 19

20. Surveillance Number of ILI patients seen in local ERs in Lee County from October 2013 to May 2014 20

21. Alcohol use in Hillsborough County January to June 2014 21

22. Rates of rash illness by zip code in Lee County from March to June 2014 22

23. Surveillance – ESSENCE Temporal Alerts 23

24. Questions? 24

25. Contact Information Jennifer Roth Florida Department of Health in Lee County 3920 Michigan Avenue Ft Myers, FL 33916 Phone: (239) 332-9657 Fax: (239) 332-9553 Email: Jennifer.Roth@flhealth.gov 25