1. Pasadena Public Health Department Disease Surveillance and Investigation Presented by Dr. Ying-Ying Goh, MD, MSHS Health Officer for the City of Pasadena November 17, 2014

2. Pasadena Public Health Department Disease Surveillance and Investigation Communicable diseases occur regularly in our community… Influenza virus B. pertussis (whooping cough) M. tuberculosis Scabies mite Photos from: U.S. Centers for Disease Control and Prevention 2

3. Pasadena Public Health Department Disease Surveillance and Investigation Some diseases are not present, but we would want to know immediately if they did occur… Ebola virus (filovirus) Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Photos from: U.S. Centers for Disease Control and Prevention 3

4. Pasadena Public Health Department Essential Public Health Functions How do we know which diseases are present in our community?  The Public Health Department conducts disease surveillance through mandated reporting How do we prevent spread of these diseases?  Case investigation  Treatment and prophylaxis  Epidemiologic investigation and follow-up 4

5. Pasadena Public Health Department Disease Surveillance 5

6. Pasadena Public Health Department Disease Reporting is Mandated Pursuant to Title 17, California Code of Regulations §2500, §2593, §2641.5-2643.20 and §2800-2812: >‘It is the duty of every health care provider….to report to the health officer… an individual having or suspected to be suffering from one of the conditions listed’ >‘[an] administrator…may know of a case… and be responsible for administrative procedures to report’ >‘health care provider means physician and surgeon, veterinarian, podiatrist, nurse practitioner, physicians assistant, registered nurse, midwife, infection control practitioner, coroner, dentist’ 6

7. Pasadena Public Health Department Over 90 Diseases/Conditions Are Reportable 7 Health care providers must report all suspected and confirmed cases listed on the “Reportable Diseases and Conditions List” available at: http://cityofpasadena.net/PublicHealth/For_Providers/ http://cityofpasadena.net/PublicHealth/For_Providers/ List includes:  Sexually Transmitted Infections  Foodborne illness (e.g., Salmonella, E.coli)  Vector borne diseases (e.g., West Nile, rabies)  Outbreaks of any type…and many more Reporting timeline varies by disease/condition  Immediately by telephone  Within one working day  Within seven calendar days

8. Pasadena Public Health Department 8

9. Methods of Reporting 9 Health care providers can report cases to the Health Department by:  Calling a 24/7 disease reporting line for conditions that require immediate reporting  Reporting phone number: (626) 744-6043  Filling out a Confidential Morbidity Report (CMR) and faxing or mailing  Note: Confidential Case Report (CCR) for HIV/AIDS  Entering data directly online, at the provider portal of the disease reporting database (CalREDIE)

10. Pasadena Public Health Department Disease Investigation 10

11. Pasadena Public Health Department Investigation Procedures Confirm the case, based on CDPH/CDC case definitions  Interpret laboratory values  Utilize clinical history Investigate further, based on accepted disease-specific guidelines  Utilize LA County Acute Communicable Disease Manual and CA Tuberculosis Controllers Association  Contact case(s) by phone, mail, in person  Contact doctors, employers, family members, as needed  Contact other jurisdictions and health departments, as needed Once the immediate public health risk is removed and appropriate actions have been taken (including reporting to state), case is closed 11

12. Pasadena Public Health Department Epidemiologic Databases Automated Vital Statistics System – births Electronic Death Record System (EDRS) – death certificate data CalREDIE - communicable diseases (except HIV/AIDS) HIV/AIDS Case Reporting System vCMR - LAC DPH’s reporting system 12

13. Pasadena Public Health Department Epidemiologic Databases 13

14. Pasadena Public Health Department Disease Prevention is the Key Vaccines Good hygiene  Cover your cough  Wash your hands often with soap and water for 20 seconds or more  Stay home when you are sick  Avoid contact with people who are acutely sick 14

15. Pasadena Public Health Department Monitoring of Travelers (Ebola) 15

16. Pasadena Public Health Department Monitoring of Travelers (Ebola) Travelers from Ebola-affected countries* are screened at U.S. airports  Those who pass screening return home  CDPH notifies the local health department (LHD) LHD contacts traveler, conducts assessment, and determines risk level Based on risk level, a monitoring plan is implemented  Active/self monitoring, frequency, duration, location of individual, movement restrictions  Quarantine order if necessary  Inform appropriate City/County and medical partners * As of 11/16/14: Guinea, Liberia, and Sierra Leone 16

17. Pasadena Public Health Department Questions?