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Overcoming Disease in Your Community
Gail Baker, RNMegan Davies, MDGina Holland, RNJenny Snow, MPH
Investigation and Controlling
Vaccine-Preventable Disease
Reporting Vaccine Preventable
Disease
GOALS– Protection– Limited spread– Reduced exposure
What diseases are reportable?
(Please see Reportable Disease Handout)
Within 24 hours? Bold Italics Within 7 days? All others
Who must report?
Physicians Medical and laboratory facilities Local health directors School principals and day care
operators
Local Health Director shall investigate...
Cases of communicable
diseases and conditions
reported to the localhealth director.
Questions on Reporting?
Implement Controls
The local health director
has the authority andresponsibility toimplement controlmeasures to prevent
thespread of reportablecommunicable
disease...
The Local Health Director has...
The authority to…IsolateIsolate
The authority to... QuarantineQuarantine
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.
Do you really want to wait?
Questions regarding Implementing Controls?
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
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
Your Local Health Director
Involve the Health Director early
Collaborate
Bring all agencies involved together Determine responsibilities of each
party involved Clarify roles, responsibilities and
timeframe for each activity
How do you insure that reporting occurs?
Encourage communication within healthcare community
Build relationships with local providers
Educate, educate, educate!!!
It all relates back to Clinical Description...
All that you do to investigate and to controlvaccine preventable disease, will some howrelate to a disease’s clinical description andthe natural history of the agent that causes
thatdisease.
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
What difference does it make...
Knowledge of a disease’sclinical descriptionencourages you to use sound clinical judgment to determine what steps should be taken next.
Viral VPD...
Polio Measles Mumps Rubella Varicella Hepatitis B
What do you already know about viral VPD?
Most aerosolize Antibiotics won’t
help You’ll need titers to
confirm
Bacterial VPD...
Pertussis Diphtheria Tetanus Haemophilus influenzae Pneumococcal
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
Transmission...
Airborne/Droplet/Pharyngeal Contact w/ Contaminated Articles Percutaneous Body Substances Perinatal Urine Raw Milk
Incubation Period...
Interval between exposure and first symptoms
Period of Communicability...
The period of time the disease can be transmitted
Communicable Period
The amount of time in which a person is considered “infectious” and can spread disease to someone else
Questions regarding Clinical Description?
Case Definition...
Do you report? Don’t you report?
Defining a Case
Gather disease specific information– Type of symptoms– Duration of
symptoms– Exposure to someone
with like symptoms– Recent travels
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
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
Case Definitions...
Are disease-specific and based on symptoms and laboratory tests
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.
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
Questions regarding Case Definitions?
Laboratory
Testing and Interpretation
Pertussis Measles Rubella Mumps
HiB Polio Diphtheria Tetanus Hepatitis B
Obtaining Specimens...Interpreting Results...
Specimen Collection
Collect specimen before
antibiotic therapy begins on symptomatic individuals who
meet case definition.
Questions regarding Labs?
Treatment of VPDs
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.
Timely Response
Timely response to the report of a VPD is of utmost IMPORTANCE.
Disease Surveillance
Goals– Predict– Observe– Minimize
Key part of disease surveillance is accurate and timely disease reporting
Immediate Use
– Immediate Use Disease control and management Contact tracing Outbreak identification
Long-Term Use
– Long-term Use Ongoing analysis Trend identification Identify at-risk populations Program improvement Rationale for funding, etc.
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
Pertussis
109 reported cases of
Pertussis in NC in 2011 as of week
28 (July 17th, 2011,
CDC MMWR)
Mumps
4 reported cases of
Mumps in NC in 2011 as of week
28 (July 17th, 2011,
CDC MMWR)
Meningococcal Disease (all serotypes)
12 reported cases of
Meningococcal Disease
(all serotypes) in NC in 2011 as of week
28 (July 17th, 2011, CDC
MMWR)
Hepatitis B (acute)
67 reported cases of Acute
Hepatitis B Virus in NC in 2011 as of week 28 (July 17th, 2011,
CDC MMWR)
Hepatitis A (acute)
13 reported cases of Acute
Hepatitis A Virus in NC in 2011 as of week 28 (July
17th, 2011, CDC MMWR)
Haemophilus influenzae (invasive, all serotypes)
49 reported cases of
Haemophilus influenzae
(invasive, all serotypes) in NC in 2011 as of week
28 (July 17th, 2011, CDC
MMWR)
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!
Questions about VPD Surveillance?
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
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
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!