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Module 1: Module 1: SurveillanceSurveillance
Epidemiology Division Surveillance Branch
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Module Learning ObjectivesModule Learning Objectivesg jg jDefine Bureau of Communicable Disease.Define “active” and “passive” surveillance. Identify potential sources of surveillanceIdentify potential sources of surveillance data.Identify forms used to document f db illfoodborne illness.Discuss reasons whether or not to investigate complaints furtherinvestigate complaints further. Perform group exercise
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services2
Bureau of Communicable DiseasesBureau of Communicable DiseasesBureau of Communicable DiseasesBureau of Communicable Diseases
1 T b l i1. Tuberculosis2. Sexually Transmitted Diseases3. HIV/AIDS4. Immunization4. Immunization5. Epidemiology
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services3
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services44
Why Investigate Why Investigate y gy gFoodborne Outbreaks?Foodborne Outbreaks?
ADPH Mission: “To serve the people of Alabama by assuring conditions in which they can be healthy.”Prevent Additional FB Illness
P d t Fi d d t th t h ld bProduct: Find a product that should be recalled so others don't get sick.Procedure: Determine what went wrong soProcedure: Determine what went wrong so specific instructions can be given to the food preparer to prevent a recurrence.
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
p p p
5
Foodborne Outbreak SurveillanceFoodborne Outbreak Surveillance
EpidemiologyS ill
EnvironmentalHelps identify
LaboratoryT t li i l & f dSurveillance
Outbreak determination
Helps identify suspect agent & establish case
definition
S i ll ti
Tests clinical & food samples
Determines agent
Investigation Specimen collection & submission Reports to Submitter
& Epidemiology
EpidemiologyDescriptive & analytical
l f tb k
EnvironmentalAssesses food facility
analyses of outbreak
Final outbreak report
Helps implement control measures
Serves as link to foodEpidemiology Division
Bureau of Clinical LaboratoriesBureau of Environmental Services
Serves as link to food facility
6
T T f S illT T f S illTwo Types of SurveillanceTwo Types of Surveillance
Surveillance is defined as closeSurveillance is defined as close and continuous observation or testingtesting1. Active 2. Passive
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services7
A ti S illA ti S illActive SurveillanceActive SurveillanceRegular periodic collection of caseRegular periodic collection of case reports from health care providers or facilitiesfacilities
Advantage: data is more accurate than in other types of surveillancein other types of surveillanceDisadvantage: expensive and time consumingconsuming
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services8
Foodborne Diseases Active Foodborne Diseases Active Surveillance Network (Surveillance Network (FoodNetFoodNet))Surveillance Network (Surveillance Network (FoodNetFoodNet))
15% of the U.S. population15% of the U.S. population Year Pop.*1997 16.11998 20.71999 25.92000 30.52001 34.92002 38.02003 41.52004 43 32004 43.32005 44.92006 45.52007 45 92007 45.9
*millions
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Alabama is NOT a FoodNet state. 9
F dN t S ill SitF dN t S ill SitFoodNet Surveillance SitesFoodNet Surveillance SitesFoodNet consists of active surveillance for FB diseases and related epi studies at 10 sites designed to help public health officials better
Sunderstand FB diseases in the US.California MinnesotaC l d N M iColorado New MexicoConnecticut New YorkGeorgia OregonGeorgia OregonMaryland Tennessee
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services10
Incidence* of Selected Incidence* of Selected Foodborne Diseases, USFoodborne Diseases, US
FoodNet DataHealthy PeopleHealthy People
Objectives**Objectives**FoodNet Data Objectives**Objectives**
Pathogen 1996 1998 2000 2002 20102010Campylobacter 23.5 21.7 15.4 13.3 12.312.3py
Salmonella 14.5 12.4 14.2 16.2 6.86.8
E. coli O157:H7 2.7 2.8 2.0 1.7 1.01.0E. coli O157:H7 2.7 2.8 2.0 1.7 1.01.0
Listeria 0.5 0.6 0.34 0.26 0.250.25
Total 41.2 37.5 31.94 31.46 20.420.4* per 100,000 population/year** estimated, baseline for 2000 objectives
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services11http://cdc.gov/foodnet/
Passive Surveillance*Passive Surveillance*
No
Have surveillance system in place
Review log Refer complaint Log Decide
whether to
No
Illness
gand other data for related cases
Obvious
Refer complaint to responsible
personNotification of Illness
ogcomplaint
whether to investigate
further
YesObvious outbreaks
Prepare Investigation
Yes
* Both lab confirmed cases and unconfirmed reports (illness complaints)
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services12
Passive SurveillancePassive SurveillanceInformation provided to ADPH without initiating actioninitiating action
Required routine reporting by MDs and labsR t f d itiReports from concerned citizensAdvantage: less expensive and t bl t ttroublesome to operateDisadvantage: likely to underestimate the presence of diseasepresence of disease
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services13
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services14
AL AL NotifiableNotifiable Disease RuleDisease RuleFoodborne ConditionsFoodborne Conditions
Common FB Possible FBCommon FBSalmonellosis E coli O157:H7
Possible FBShigellosisHepatitis AE. coli O157:H7
BotulismCampylobacteriosis
Hepatitis A
Outbreaks of any kindCampylobacteriosis ListeriosisTrichinellosis
Foodborne OutbreaksWaterborne Outbreaks
Trichinellosis Typhoid feverVibriosis
Biological OutbreaksChemical Outbreaks
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Vibriosis
15
The CDC The CDC The CDC The CDC FoodNetFoodNet
S ill S ill Surveillance Surveillance PyramidPyramid
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services16
Sources of Surveillance Data Sources of Surveillance Data Sources of Surveillance Data Sources of Surveillance Data
ADPH requires each physician, dentist, nurse, medical q p y , , ,examiner, hospital administrator, nursing home administrator, laboratory director, school principal, and day care director to report certain notifiable diseasesday care director to report certain notifiable diseases and health conditions.ADPH receives potential FBO reports from
Hospitals LaboratoriesClinics Public Health (e.g., CDC)Physicians Individuals y
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services17http://www.alabamaadministrativecode.state.al.us/docs/hlth/index.html
Sources of Foodborne Sources of Foodborne Di D tDi D tDisease DataDisease Data
Laboratory-based Surveillance
FoodborneOutbreak SurveillanceSystemSystem
Epidemic ComplaintEpidemic Investigations Investigations
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services18
NetworkingNetworking
Share information w/ other health
Provide up-to-date list of key contacts in localother health
departments in regionof key contacts in local area
CDC State
Networking:Maintain
CDC State Epidemiologist
Maintain Information
FlowSt t l b t
Neighboring Health State laboratoryDepartments
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services19
Effective Local Effective Local Surveillance SystemSurveillance System
ADPH PartnersEpidemiology
Local PartnersHospitals
Environmental HealthField Surveillance StaffLaboratory
ClinicsPhysiciansFiLaboratory
Health EducatorsFirePoliceEducationEducationNursing HomesIndustry
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
y
20
Foodborne ClassificationsFoodborne Classifications
Family Case FoodborneOutbreaks ICC
Family – household members (Family ate at Burger King)
Case – reported case of illness (Case of disease such asp (salmonella)
Foodborne Outbreaks – 2 or more from different households (Group that attended a wedding reception)
ICC – isolated consumer complaint (Band-Aid found in potatosalad)
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services21
Local Public Health PreparationLocal Public Health PreparationLocal Public Health PreparationLocal Public Health Preparation
Define roles and responsibilitiesDefine roles and responsibilitiesHave needed supplies on handP d f h i i f tiProcedures for sharing information (internally and externally)Training planPeriodic meetingsg
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services22
Potential OutbreaksPotential OutbreaksPotential OutbreaksPotential OutbreaksDocument all illness reports in aDocument all illness reports in a foodborne illness complaint logInitiate appropriate steps duringInitiate appropriate steps during outbreak investigationIdentify information needsde t y o at o eedsNotify and consult with state health and/or agriculture departmentsa d/o ag cu u e depa e s
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services23
L g C l i tL g C l i tLog ComplaintLog ComplaintAssign unique sequential number toAssign unique sequential number to each complaintSystematically enter data into logy y gTransfer key information from input forms to loggEstablish retention schedule for surveillance records
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services24
Review Log and Other Review Log and Other e e og a d Ot ee e og a d Ot eData for Related CasesData for Related Cases
Who’s in charge?
Establish written procedure for reviewing surveillance data
Check expected levels of health eventsevents
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services25
Environmental Complaint LogEnvironmental Complaint LogEnvironmental Complaint LogEnvironmental Complaint Log
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services26
Refer to Responsible Refer to Responsible Person or AgencyPerson or Agency
R f l i t t ithRefer complaints to agency with regulatory authority for collaborationFollow-up complaints under your jurisdictionNotify communicable disease staff of confirmed infectionsClearly document referred incidents
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services27
Preliminary InvestigationPreliminary InvestigationPreliminary InvestigationPreliminary InvestigationObtain information from reporter
Number Ill Event InformationSymptoms Foods Served
R i ill i f tiReview surveillance information Review foodborne outbreak definitionsConsult Central Office EpidemiologyRequest Environmentalist to inspectRequest Environmentalist to inspect facility
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services28
Is it a Foodborne Outbreak ??Is it a Foodborne Outbreak ??Is it a Foodborne Outbreak ??Is it a Foodborne Outbreak ??
I i th b f tIncrease in the number of reports over expectedPossible epi association (person, place, and time)Possible laboratory linkage
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services29
Module Learning ObjectivesModule Learning ObjectivesModule Learning ObjectivesModule Learning ObjectivesDefine Bureau of Communicable DiDisease.Define “active” and “passive” surveillance.surveillance. Identify potential sources of surveillance data.Id tif f d t d tIdentify forms used to document foodborne illness.Discuss reasons whether or not toDiscuss reasons whether or not to investigate complaints further.
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services30
Group ExerciseGroup Exercise
Log Book
Group ExerciseGroup Exercise
g
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services
Epidemiology DivisionBureau of Clinical Laboratories
Bureau of Environmental Services31