1. 1 New in the Reportable Disease Rule, 2007 Danae Bixler, MD, MPH Infectious Disease Epidemiology Program WVDHHR

2. 2 Objectives Outline: Outline: –Timeline –Changes in rule: Reporting timeframes Reporting timeframes New diseases to be reported New diseases to be reported Diseases that are no longer reportable Diseases that are no longer reportable New sections that impact public health practice New sections that impact public health practice –Common issues that CAN be solved by application to the rule –Strengths and limitations of the rule

3. 3 Timeline Revision began 2003-4 Revision began 2003-4 –Internal review / drafting 2003-4 –Statewide comment 2004 Legislative session 2005 Legislative session 2005 –Rejected because of fiscal note Second attempt 2005-6 Second attempt 2005-6 –Statewide comment: 2005 –Legislative approval 2006 –Final copy received August 2006

4. 4 Timeline (2) Outstanding issues Outstanding issues –Reporting of novel influenza –Further cleanup: Eliminate reporting of occupational health Eliminate reporting of occupational health Name change to Shigatoxin-producing E coli Name change to Shigatoxin-producing E coli Eliminate provider reporting of chronic hepatitis C Eliminate provider reporting of chronic hepatitis C –Final version received March 5, 2007

5. 5 Definitions Local Health Officer = Local health officer or designee Local Health Officer = Local health officer or designee Commissioner = Commissioner or designee Commissioner = Commissioner or designee

6. 6 General Changes Five categories of reportable conditions: Five categories of reportable conditions: –Immediate –24 hours –72 hours –Weekly to LHD –Weekly to state Local health departments must report to state in the same timeframe as providers Local health departments must report to state in the same timeframe as providers Electronic reporting mandated from local health departments when the commissioner declares WVEDSS operational – anticipated July 2, 2007. Electronic reporting mandated from local health departments when the commissioner declares WVEDSS operational – anticipated July 2, 2007.

7. 7 Selected Diseases Reportable Immediately to Local Health Category I Category A BT agents Category A BT agents –Anthrax –Botulism –Plague –Smallpox –Tularemia –Viral Hemorrhagic Fever Novel influenza infection Novel influenza infection Outbreaks Outbreaks Measles and SARS Measles and SARS

8. 8

9. 9 Immediately Reportable Events – Provider Responsibilities Immediately report by phone to the local health department Immediately report by phone to the local health department Include: Include: –Patient name, address, telephone number, date of birth, sex, race –Physician name, address, office phone and fax –Any other information requested by the commissioner

10. 10 Immediately Reportable Events – Laboratory Responsibilities Immediately report by phone to the local health department Immediately report by phone to the local health department Include: Include: –Patient name, address, telephone number, date of birth, sex, race –Physician name, address, office phone and fax –Name of submitter –Specimen source, date of collection, date of result, name of test, test result, normal value or range –Laboratory name, address, phone and fax

11. 11 Immediately Reportable Events – Local Health Department Responsibilities Immediately report by phone to DHHR: 800-423-1271 Immediately report by phone to DHHR: 800-423-1271 File a WVEDSS report File a WVEDSS report –Required July 2, 2007 See 64-7-7 (outbreaks) See 64-7-7 (outbreaks)

12. 12 Selected Diseases Reportable at 24 Hours to Local Health Category II Animal bites Animal bites Hepatitis A, B Hepatitis A, B Meningitis (meningococcus, H flu) Meningitis (meningococcus, H flu) Pertussis Pertussis Staphylococcus aureus resistant to Vancomycin Staphylococcus aureus resistant to Vancomycin STEC (Enterohemorrhagic E coli) STEC (Enterohemorrhagic E coli) Tuberculosis Tuberculosis

13. 13 Selected Diseases Reportable at 72 Hours to Local Health Category III Amebiasis Amebiasis Campylobacteriosis Campylobacteriosis Cryptosporidosis Cryptosporidosis Cyclospora Cyclospora Giardiasis Giardiasis Listeriosis Listeriosis Salmonellosis Salmonellosis Shigellosis Shigellosis Trichinosis Trichinosis Yersiniosis Yersiniosis

14. 14 Selected Diseases Reportable at 1 Week to Local Health Category IV Arboviral infection Arboviral infection Chickenpox (aggregate total only) Chickenpox (aggregate total only) Community-acquired MRSA (invasive) Community-acquired MRSA (invasive) Death from chickenpox Death from chickenpox Influenza-like illness (aggregate only) Influenza-like illness (aggregate only) Influenza-related death (age < 18) Influenza-related death (age < 18) Legionellosis Legionellosis Lyme disease Lyme disease Invasive bacterial diseases (S pneumo, GAS, GBS) Invasive bacterial diseases (S pneumo, GAS, GBS) Tuberculosis latent infection Tuberculosis latent infection

15. 15 Selected Diseases Reportable at 1 Week to State Health Category V AIDS AIDS Chancroid Chancroid Chlamydia Chlamydia Gonococcal disease Gonococcal disease Hepatitis C Hepatitis C –Providers – acute –Laboratories – all positive test results PID PID Syphilis Syphilis

16. 16 Eliminated Aseptic meningitis Aseptic meningitis Bacterial meningitis, other Bacterial meningitis, other Encephalitis, other Encephalitis, other Hepatitis C, chronic (from providers) Hepatitis C, chronic (from providers) Herpes Herpes Occupational illness Occupational illness Rheumatic Fever Rheumatic Fever

17. 17 Added! DiseaseTimeframe Bioterrorist event Immediate Novel influenza infection, animal or human Immediate SARS coronavirus infection Immediate Unusual condition or emerging infectious disease of potential public health significance 24 hours

18. 18 Added (2) DiseaseTimeframe Community-acquired invasive MRSA 1 week Death from chickenpox 1 week Death from influenza (age < 18) 1 week Laboratories only: enterovirus, culture confirmed, aggregate totals 1 week to state health dept

19. 19 Rabies (64-7-5) Animal bites reportable to the local health department within 24 hours Animal bites reportable to the local health department within 24 hours Ferret added to list of animals that may be quarantined. Ferret added to list of animals that may be quarantined. Language added to: Language added to: –Allow humane destruction of animals other than a domestic dog, cat or ferret, ‘especially a wild mammal or hybrid…’ –Enable reporting of rabies post-exposure prophylaxis to WVEDSS

20. 20 Immunizations (64-7-6) Reporting requirements expanded to persons 18 years of age and younger Reporting requirements expanded to persons 18 years of age and younger Newly reportable Newly reportable –Smallpox vaccination –Pandemic influenza vaccination –Immunizations of adults (voluntary)

21. 21 Disease outbreaks (64-7-7) Immediate notification of: Immediate notification of: –Local health officer –The Bureau Collaboration with Collaboration with –The Bureau –Other jurisdictions –Federal public health officials Steps in investigation outlined Steps in investigation outlined Enabling language to complete special studies (e.g., case-control, cohort), hold individually identifying data confidential Enabling language to complete special studies (e.g., case-control, cohort), hold individually identifying data confidential

22. 22 Surveillance program evaluation and special studies (64-7-8) Commissioner given the ability to do evaluation of surveillance systems or special studies, including: Commissioner given the ability to do evaluation of surveillance systems or special studies, including: –Right to request medical or laboratory records to perform audits for completeness, accuracy and timeliness of reporting –Do special studies (e.g., case-control, cohort, cross- sectional) on the health of the population for the purpose of quantifying the risk to the population or access to appropriate prevention and control services –Hold data confidential

23. 23 Bioterrorism response (64-7-9) Immediate notification Immediate notification Definition Definition Collaboration with other local health officers, state and federal officials, law enforcement Collaboration with other local health officers, state and federal officials, law enforcement Investigation as in outbreak investigation section Investigation as in outbreak investigation section

24. 24 Syndromic surveillance and electronic laboratory reporting (64-7-10) Commissioner may create a list of syndromes to be reported: Commissioner may create a list of syndromes to be reported: –Acute neurological illness –Acute vomiting and/or diarrhea –Death in the emergency room –Febrile illness with flu-like symptoms –Febrile illness with flu-like symptoms and rash –Pneumonia –Septicemia of unknown etiology –Other syndromes as defined by the Commissioner

25. 25 Syndromic surveillance and electronic laboratory reporting (64-7-10) When certified as operational by the Commissioner, laboratories with automatic reporting capability will report positive results daily, including When certified as operational by the Commissioner, laboratories with automatic reporting capability will report positive results daily, including –Patient name, address, telephone number, date of birth, sex –Submitter –Specimen source, date of collection, date of result –Test name, result, normal value or range –Laboratory name, address, phone and fax

26. 26 Syndromic surveillance and electronic laboratory reporting (64-7-10) When certified … laboratories with automatic reporting capability will report … additional conditions including: When certified … laboratories with automatic reporting capability will report … additional conditions including: –Adenovirus –Enterovirus –Influenza –RSV –Rotavirus

27. 27 Submission of Laboratory Specimens to Office of Laboratory Services: Isolates (12.2.b.1) Bacillus anthracis Bacillus anthracis Clostridium botulinum Clostridium botulinum Corynebacterium diphtheriae Corynebacterium diphtheriae Tularemia Tularemia Salmonella Salmonella Shigella Shigella Campylobacter Campylobacter

28. 28 Submission of Laboratory Specimens to Office of Laboratory Services: Isolates (12.2.b.1) (2) Listeria monocytogenes Listeria monocytogenes Suspect or confirmed ETEC Suspect or confirmed ETEC Yersinia pestis Yersinia pestis From a sterile site: From a sterile site: –N meningitidis –S pneumoniae –Haemophilus influenzae Other isolates as determined by the Commissioner Other isolates as determined by the Commissioner

29. 29 Submission of Virological, serological, EM, molecular samples … (12.2.b.2.G) LaCrosse, West Nile, Eastern equine, St Louis encephalitis viruses LaCrosse, West Nile, Eastern equine, St Louis encephalitis viruses Orthopox virus Orthopox virus Poliomyelitis Poliomyelitis Rabies Rabies Rubella Rubella Rubeola Rubeola SARS SARS Other specimens as determined by the Commissioner Other specimens as determined by the Commissioner –Novel influenza virus

30. 30 FAQ # 1 ‘I’m not sure I have jurisdiction…’ For local health departments, jurisdiction = For local health departments, jurisdiction = –Your county Schools, camps, vessels and department- operated health care facilities are required to: Schools, camps, vessels and department- operated health care facilities are required to: –Report …. 64-7-12.3.a.1 –Assist with investigation …. 64-7-12.3.a.2 –Follow methods of control … 64-7-12.3.a.2

31. 31 FAQ # 2 ‘Dr. C wants written permission from the patient to report…’ Pg 17: …Providers and … facilities … shall: Pg 17: …Providers and … facilities … shall: –Report …. 64-7-12.1.a.1 –Assist … in … investigation 64-7-12.1.a.2 –Submit specimens … 64-7-12.1.a.3 HIPAA letter HIPAA letter –http://www.wvdhhr.org/idep/PDFs/IDEP/HIPP A_Letter_11-05.pdf

32. 32 FAQ # 3 ‘… I need to rule out this case, but negative results aren’t reportable ….’ … Providers and … facilities … shall … Providers and … facilities … shall –‘assist the … local health officer in ruling out previously reported cases … by submitting copies of negative laboratory tests … 16-7- 12.1.a.7

33. 33 FAQ # 4 ‘ … Dr. B won’t help me with contact investigation …’ Pg 17-18: Health care providers and … facilities … shall … Pg 17-18: Health care providers and … facilities … shall … –Assist … in any necessary contact investigation … 64- 7-12.1.a.2 –… advise … the patient … members of the patient’s household and other patient contacts …64-7-12.1.a.4 –Follow a method of control specified by the commissioner in established protocols … 64-7- 12.1.a.5 –Assist … the local health officer by promoting implementation of the control method … specified in the protocol … 64-7-12.1.a.6

34. 34 FAQ # 5 “Dr. A won’t report.’ If … a … provider,… facility, laboratory … failed to report … the local health officer … shall request an explanation …64-7-14.6 If … a … provider,… facility, laboratory … failed to report … the local health officer … shall request an explanation …64-7-14.6 The local health officer shall report to the commissioner the … provider, … facility, laboratory … and his or her reason for failure to comply … 64-7-14.7 The local health officer shall report to the commissioner the … provider, … facility, laboratory … and his or her reason for failure to comply … 64-7-14.7 (Call us first) (Call us first)

35. 35 FAQ # 6 ‘Attorney X is requesting a disease report – can I give it to him?’ Pg 21: … the local health officer may release confidential information … to: Pg 21: … the local health officer may release confidential information … to: –The patient 64-7-18.2.a –The patient’s physician …. 64-7-18.2.d –Any individual with the written consent of the patient and of all other individuals identified …64-7-18.2.e

36. 36 Limitations Isolation and quarantine Isolation and quarantine –Operational plans require court orders Owned dog, cat or ferret: Owned dog, cat or ferret: –Only option: ‘… shall direct owner to confine …’ 64-7.5.3 Keeping the rule up to date … Commissioner … Keeping the rule up to date … Commissioner … –… may…add or delete a disease or condition … 64-7-3.1.a –… may require same day reporting …

37. 37 Strengths of the Rule Clear responsibilities for providers, laboratories, health officials, schools, vessels… Clear responsibilities for providers, laboratories, health officials, schools, vessels… –Reporting –Investigating –Outbreak investigation –Contact investigation –Surveillance evaluation and special studies –Confidentiality –Electronic reporting

38. 38 Strengths of the Rule Reportable Disease Protocol Manual Reportable Disease Protocol Manual –The commissioner shall establish specific protocols …64-7-3.2.a –… providers and … facilities … 64-7-12.1.a.5 – … laboratories …64-7-12.2.b.1 –… local health officers … 64-7-14.3.a and 64-7-14.3.b –… schools, camps, vessels, and department-operated health care facilities …. 64-7-12.3.a.3

39. 39 Myth: ‘… I don’t have the authority to...’ 64-7-14 Responsibilities of Local Health Officers: 64-7-14 Responsibilities of Local Health Officers: –Comply with rule –Maintain records –Investigate/collect specimens/manage contacts/report to BPH Reportable disease protocol manual Reportable disease protocol manual Consultation with the Commissioner Consultation with the Commissioner –Investigate providers who don’t report

40. 40 Always … advise appropriately and document… You (the local health officer) can have tremendous influence (authority) in your jurisdiction …

41. 41 Conference Call on the Reportable Disease Rule and WVEDSS WHO: Local Health Departments, Hospital Infection Control Professionals, Hospital Laboratory Directors WHO: Local Health Departments, Hospital Infection Control Professionals, Hospital Laboratory Directors WHEN: Wednesday, May 30 and Friday, June 8, 2007; 12:00 to 1:30 PM WHEN: Wednesday, May 30 and Friday, June 8, 2007; 12:00 to 1:30 PM HOW: dial 1-888-819-5079; passcode = 586900 HOW: dial 1-888-819-5079; passcode = 586900 CAUTION: Only 125 lines each call CAUTION: Only 125 lines each call