2 Reportable DiseasesEpidemiology Resource Center Surveillance and Investigation ContactsReporting Fax Number:My Phone Number:MyAlternate Fax number:*Reportable Disease List (handout)
3 Karee Buffin. MS—Vaccine Preventable Disease Epidemiologist Epidemiology Resource CenterSurveillance and Investigation DivisionCommunicable Disease Responsibilities2 N. Meridian Street, 5-KIndianapolis, INFax:Karee Buffin. MS—Vaccine Preventable Disease EpidemiologistDiphtheriaInvasive Haemophilus influenzaeInvasive Pneumococcal DiseaseMeaslesMumpsPertussis (whooping cough)PolioRubellaRubella, congenital syndromeSmallpoxTetanusVaricella/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 RuleMeasles, Mumps, Rubella, Pertussis, Diphtheria, Tetanus, PolioVaricella resulting in death or hospitalizationInvasive Haemophilus InfluenzaeInvasive 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 SalivaEar swabsNasal swabsWound swab, wound cultureEye SwabFingernail or other infected external sitesAnd 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)CSFPleural FluidPeritoneal FluidPericardial FluidJoint or Synovial FluidTympanocentesis
9 Haemophilus Influenzae (H.Flu) BacterialIsolates are required to be sent for further evaluation.1 type b in Indiana in 2007How did this happen?Sensitivity reports needed for Drug Resistant patterns.When are these required to be reported?...
10 Reporting Requirement ImmediatelyWeb link to reporting rule:
11 Streptococcus Pneumoniae (Strep. Pneumo.) BacterialIsolates 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 patternsWhen are these cases required to be reported?...
12 Reporting Requirement 72 hoursWeb link to reporting rule:
14 Drug Resistant Patterns 30 Total isolates (Collected on patients less than 5 years old)14 typed as 19ANot in the current pneumococcal vaccine for childrenTotal Breakdown of 19A:10/14 demonstrate Drug resistant Streptococcus Pneumoniae patterns1/14 sensitive to antibiotics tested3/14 Unknown patterns (not sent to ISDH labs)
17 Mumps Incidence in Indiana CDC clinical case definition: One counted in 2007CDC 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 moreOther testing possibilities through the state labOne cannot rely solely on the accuracy of testingTime off of work, out of schoolCommunicable 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 outbreakIowa 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 DNAGenerally offers quick resultsCulture also can be obtained from swabIgG, 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 jawBaseball to the jawBrother’s fist to the jawOther objects to the jawOther medical diagnosis consistent with parotitis.
23 Reporting Requirement? Within 72 hoursWeb link to reporting rule:
24 Reporting Requirement: IMMEDIATELY PertussisReport a Suspected Case:Reporting Requirement: IMMEDIATELYProblems: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 labsPCR: currently unavailable at ISDH labSerology is not recommended for pertussis diagnosis.Clinical picture is more valuable than the serology results.
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 daysA lot can happen in 21 days:Example: School Jan 30, 5 casesBy Feb 20, 31 cases* Recommend 2 doses varicella vaccine for outbreak management and current ACIP.
32 Current ACIP Recommendations Routine vaccination at months2nd dose recommended at 4-6 years of age; 3 months as minimum interval between doses2nd dose recommended for person of ANY age who has had only 1 dose13 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 numbersInitiate 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 StaffPam PontonesKristin Ryker