1. Vaccine Preventable Diseases
Reporting Suspected Cases

2. Reportable Diseases
Epidemiology Resource Center Surveillance and Investigation Contacts
Reporting Fax Number:
My Phone Number: My
Alternate Fax number:
*Reportable Disease List (handout)

3. Karee Buffin. MS—Vaccine Preventable Disease Epidemiologist
Epidemiology Resource Center
Surveillance and Investigation Division
Communicable Disease Responsibilities
2 N. Meridian Street, 5-K
Indianapolis, IN
Fax:
Karee Buffin. MS—Vaccine Preventable Disease Epidemiologist
Diphtheria
Invasive Haemophilus influenzae
Invasive Pneumococcal Disease
Measles
Mumps
Pertussis (whooping cough)
Polio
Rubella
Rubella, congenital syndrome
Smallpox
Tetanus
Varicella/shingles (hospitalization or death and sentinel reporting)
See Handout

4. ISDH Public Health Investigators Investigate the following:
In accordance with the guidelines from the Communicable Disease Reporting Rule
Measles, Mumps, Rubella, Pertussis, Diphtheria, Tetanus, Polio
Varicella resulting in death or hospitalization
Invasive Haemophilus Influenzae
Invasive Pneumococcal Disease (cases less than or equal to 5 years of age)
* The Rule is currently undergoing revisions

5. Communication
“A trained immunization field representative of the department in cooperation with the local health officer”
Contacting your immunization program’s public health investigators:
Phone: see map (handout)
Contacting the field staff supervisor:
Sarah Murphy:

7. Non-Sterile Sites Need not be reported
Saliva
Ear swabs
Nasal swabs
Wound swab, wound culture
Eye Swab
Fingernail or other infected external sites
And other non-sterile sites need not be reported

8. Sterile Sites Fluids collected from these sites are expected to be sterile:
Blood (venous or arterial cultures)
CSF
Pleural Fluid
Peritoneal Fluid
Pericardial Fluid
Joint or Synovial Fluid
Tympanocentesis

9. Haemophilus Influenzae (H.Flu)
Bacterial
Isolates are required to be sent for further evaluation.
1 type b in Indiana in 2007
How did this happen?
Sensitivity reports needed for Drug Resistant patterns.
When are these required to be reported?...

10. Reporting Requirement
Immediately
Web link to reporting rule:

11. Streptococcus Pneumoniae (Strep. Pneumo.)
Bacterial
Isolates are requested to be sent to ISDH lab for patients less than or equal to 5 years old.
It is important to ask this of the lab as soon as you are aware of the case for serotyping.
In 2007 ISDH lab has received 70% of the isolates for serotyping.
Sensitivity reports needed for Drug Resistant patterns
When are these cases required to be reported?...

12. Reporting Requirement
72 hours
Web link to reporting rule:

14. Drug Resistant Patterns
30 Total isolates (Collected on patients less than 5 years old)
14 typed as 19A
Not in the current pneumococcal vaccine for children
Total Breakdown of 19A:
10/14 demonstrate Drug resistant Streptococcus Pneumoniae patterns
1/14 sensitive to antibiotics tested
3/14 Unknown patterns (not sent to ISDH labs)

15. Vaccine Preventable Disease Indiana Incidence 2006 Compared to Jan-June 2007
Year
2006
Jan-June 2007
Pertussis
280 26
Tetanus 2
Measles 1
Mumps 10
Rubella
Haemophilus
Influenzae 81 31
Streptococcus
Pneumoniae
721
357

16. Vaccine Preventable Disease Indiana Incidence Jan-June 2006-07
Year
Jan-June 2006
Jan-June 2007
Pertussis
105 26
Tetanus 1
Measles
Mumps 10
Rubella
Haemophilus
Influenzae 35 31
Streptococcus
Pneumoniae
354
357

17. Mumps Incidence in Indiana CDC clinical case definition:
One counted in 2007
CDC clinical case definition:
An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting more than 2 days without other apparent cause.

18. Mumps Reporting Suspected Cases:
Why not wait for the test results?
Some results may take 3 weeks or more
Other testing possibilities through the state lab
One cannot rely solely on the accuracy of testing
Time off of work, out of school
Communicable Disease Reporting Rule:
Indiana still recognizes the 9-day exclusion rule

19. Mumps News Proof of 2 MMRs does not guarantee 100% protection
* Evidence of disease in patients who have received 2 doses of the mumps vaccine.
NY outbreak
Iowa outbreak (recent)
Efficacy
*Source: VPD Surveillance Manual Chapter 7. Web Link:

20. Importance of Exclusion of Susceptibles:
The Communicable Disease Reporting Rule for Indiana currently states: Exclude exposed susceptibles from school or the workplace from the12th to the 25th day after exposure to prevent the spread to other susceptibles.
Example: Hospital nursery, (based on a fictional event).

21. Mumps Testing PCR Offered at ISDH labs:
Buccal Swab (7days before – 9 days after parotid gland swelling)
Detects the presence of DNA
Generally offers quick results
Culture also can be obtained from swab
IgG, IgM (Offered at ISDH labs)
Paired sera (Offered at ISDH labs)
Clinical Picture: should be considered with testing results due to many false + IgM tests.

22. Consider other apparent causes:
Oral surgery, ear surgery, surgery in general involving the jaw, ear, neck area.
Hit by a:
Ball bat to the jaw
Baseball to the jaw
Brother’s fist to the jaw
Other objects to the jaw
Other medical diagnosis consistent with parotitis.

23. Reporting Requirement?
Within 72 hours
Web link to reporting rule:

24. Reporting Requirement: IMMEDIATELY
Pertussis
Report a Suspected Case:
Reporting Requirement: IMMEDIATELY
Problems:
Consequences for waiting for lab testing and late reporting.
Share case review with Mom’s comments:
Encouragement from a parent.
(Smiley is HIPPA compliant)
Reporting: relying on labs to report

25. Pertussis Testing Issues Recommended testing:
Culture and DFA: available at ISDH labs
PCR: currently unavailable at ISDH lab
Serology is not recommended for pertussis diagnosis.
Clinical picture is more valuable than the serology results.

26. Indiana Reported Pertussis Cases 2002 - 2006

28. Tdap, Tdap, Tdap ACIP Tdap Recommendations
One dose of Tdap should be used to replace a Td booster dose in adults and children of recommended age (includes wound management).
(Note: Two manufactures with different recommendations.)

29. Varicella Reporting: Outbreaks
Definition: greater than or equal to 5 cases in a place in children less than 13 years old within one incubation period.
Also: greater than or equal to 3 cases related in place in persons greater that or equal to 13 years of age within one incubation period.

31. Varicella Reporting: Outbreaks including ‘breakthrough’ disease
One incubation Period: 21 days
A lot can happen in 21 days:
Example: School Jan 30, 5 cases
By Feb 20, 31 cases
* Recommend 2 doses varicella vaccine for outbreak management and current ACIP.

32. Current ACIP Recommendations
Routine vaccination at months
2nd dose recommended at 4-6 years of age; 3 months as minimum interval between doses
2nd dose recommended for person of ANY age who has had only 1 dose
13 yrs or older, if not immune-2 doses at least 4 weeks apart.
Current Web address

33. ACIP Recommendations and Vaccine Administration
Current Issues:
State funding does not always match the recommendations.
Publicly funded vaccine programs should check the policy prior to administration.
Outbreak conditions:
Communicate needs with the Immunization Program.
Vaccine needed, expected numbers
Initiate an outbreak response.

34. Varicella Sentinel Reporting Since 2004
Breakthrough disease may decrease with second dose of varicella introduced.
Incidence of severe varicella with 2 doses of varicella in Indiana is zero, (using sentinel surveillance data).

35. Acknowledgements Wayne Staggs Dr. Charlene Graves Immunization Program
Special recognition to the Immunization Field Staff
Pam Pontones
Kristin Ryker