2015 Communicable Disease Summary and Reporting Rule Revisions

Transcription

1 2015 Communicable Disease Summary and Reporting Rule Revisions APIC Spring Conference April 8, 2016 Joshua Clayton, PhD, MPH Deputy State Epidemiologist

2 2015 Statewide Data 2

3 Shiga-toxin producing E. coli District Count Rate* Total * Rate per 100,000 population Male 63 (47%) Female 71 (53%) 2015 Provisional Data Year Age of Cases in Years

4 Hemolytic Uremic Syndrome District Count Rate Total Provisional Data Year Age of Cases in Years Male 4 (44%) Female 5 (56%) 4 0

5 District Count Rate Total Shigella 2015 Provisional Data 1500 Year Age of Cases in Years Male 127 (46%) Female 150 (54%)

6 Hepatitis C, Acute & Chronic District Count Rate Total 3, Male 2052 (58%) Female 1500 (42%) 2015 Provisional Data Year Age of Cases in Years

7 District Count Rate Total Male 65 (55%) Female 53 (45%) Hepatitis C, Acute 2015 Provisional Data Year Age of Cases in Years

8 District Count Rate Total Meningococcal disease 2015 Provisional Data Year Age of Cases in Years Male 2 (33%) Female 4 (67%) 8 1 0

9 District Count Rate Total Male 2 (33%) Female 4 (67%) Mumps 2015 Provisional Data Year Age of Cases in Years

10 Hot Topics Mumps virus 24 cases at Butler University 17 cases at Indiana University-Bloomington 4 cases at IUPUI 5 cases at Purdue University 10

11 Hot Topics (2) Zika virus United States 346 Travel-associated cases in U.S. 32 pregnant women 7 sexual transmission 1 Guillian-Barre syndrome No locally acquired vector-borne cases Indiana 6 Travel-associated cases No sexual transmission No Guillian-Barre syndrome 11

12 Zika Virus: Transmission Routes Recently detected in the Americas A. albopictus and A. aegypti mosquito 3 patterns of spread Direct bites by infected mosquito Trans-placental Sexual 12

13 Zika Virus Infection Most people do not have symptoms Signs and symptoms are non-specific Rash Fever Joint pain Headache Reddish eyes 13

14 Zika Virus Prevention Pregnant women Follow CDC s travel guidance Do not travel to areas with Zika virus Use a condom or refrain from sex Everyone Prevent mosquito bites Use insect repellant Cover your skin 14

15 Major Outbreak Responses (2015) 15

16 Meningococcal Disease Mass Prophylaxis (Allen Co. ) 1 identified case in a school staff member (Dec. 2015) Case was a person employed at an elementary school who had intermittent close contact with many students. The Local Health Department worked with the Hospital pharmacy and school to provide prophylaxis Mass prophylaxis clinic was held at the school Approximately 500 students and staff received antibiotic postexposure prophylaxis Each of the 300+ students had to be weighed to determine appropriate dose of suspension medication. 16

17 Shigella Outbreak 2014 (Central IN) Shigellosis transmission among daycare and school attendees 854 S. sonnei cases from 9 counties were identified 749 of 854 cases (88%) were treated with antibiotics regardless of severity. Indiana daycare/school exclusion policy encouraged antibiotic treatment. CD Rule was revised to decrease antibiotic treatment requirements and decrease antibiocitc resistance emergence. 17

18 The CD Rule 18

19 CD Rule 410 IAC repealed 410 IAC enacted December 25, IAC : Reporting requirements for physicians and hospital administrators 410 IAC : Laboratories; reporting requirements 410 IAC : Disease intervention measures; responsibility to investigate and implement 19

20 Overview of the CD Rule Definitions Reporting requirements for physicians, hospitals, and laboratories Disease intervention measures (general and disease specific) Responsibilities Timeliness References 20

21 What s New to the CD Rule? 21

22 Reportable Diseases Newly reportable: Carbapenemase-producing Carbapenem-resistant Enterobacteriaceae (CP-CRE) Chikungunya virus disease Cysticercosis (Taenia solium) Varicella-zoster virus 22

23 Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Epidemiology Can cause infections associated with high mortality rates (up to 50%) due to resistant to carbapenem antibiotics and contain enzymes (carbapenemases) that make carbapenems ineffective. Transmission person to person via hands of HCPs or contact with infected stool, wounds, or contaminated environmental surfaces (e.g. medical equipment) Incubation not well defined Control Measures The facility should initiate Contact Precautions; additional precautions should be added if any other transmissible condition is present. AND Can consider screening patients to determine if they are epidemiologically linked Can consider chlorhexidine gluconate bathing Laboratory Testing Bacterial culture with antibiotic resistance susceptibility testing. 23

24 Chikungunya virus disease Epidemiology Travel to Caribbean, Central/South America, other tropical and subtropical areas Transmission Aedes aegypti and Aedes albopictus mosquitoes Incubation: 3 7 days Control measures Traveler education Mosquito bite prevention Laboratory testing: PCR, IgM/IgG serology 24

25 Taenia solium and cysticercosis Epidemiology Underdeveloped areas with poor sanitation and pork consumption US: Latin American immigrants Transmission Ingestion of undercooked pork from a pig that has ingested human feces (taeniasis) Ingestion of human feces (cysticercosis) Control measures: Cook meat to temperature Basic sanitation Laboratory testing: fecal microscopy, tissue biopsy 25

26 Varicella Zoster Virus (VZV) (newly LAB reportable) Epidemiology Varicella occurs worldwide. Humans are the only source of infection. Transmission Person-to-person transmission occurs via airborne route from infected respiratory tract secretions or by direct contact with or inhalation of aerosols from vesicular fluid of skin lesions. Incubation usually 14 to 16 days Control Measures school or child care setting exclusion until the rash has crusted. Laboratory Testing PCR or IgG Serology 26

27 Latent Tuberculosis Infection (LTBI) Epidemiology (Cases and Suspects still reportable) Prevalence increases with age. Estimated that 1/3 of the human population is infected (worldwide) Transmission TB is spread only by those with active TB disease, who expel tubercle bacilli via aerosolized, droplet or airborne route through coughing, singing, or sneezing. People with Latent TB infections (LTBI) cannot infect others Incubation Latent TB: 2-10 weeks from infection to primary lesion or positive TST/IGRA Control Measures Prompt diagnoses and treatment of active TB disease Treatment of LTBI before progression to active disease Screening of high-risk population, including HIV positive and homeless individuals Laboratory Testing Test for infection only, further evaluation need for distinction between TB/LTBI Tuberculin Skin Test (TST) using a purified protein derivate (PPD) Interferon Gamma Release Assay (IGRA) of blood 27

28 Reportable Diseases Scientific name change: Anaplasma phagocytophilum (formerly Ehrlichia phagocytophilum) To be removed from the reportable list: Streptococcus Group B Invasive Disease 28

29 Isolate Reportable Changes Newly required: Carbapenemase-producing Carbapenem-resistant Enterobacteriaceae (CP-CRE) Shigella species Vibrio cholerae Vibrio species (other than toxigenic Vibrio cholerae) No longer required: Nocardia 29

30 Isolate Reportable Changes Require specimen submission for organisms detected by a culture-independent diagnostic test (CIDT): Shiga toxin-producing E. coli (STEC) Salmonella species Shigella species Vibrio cholera Vibrio species (other than toxigenic Vibrio cholerae) 30

31 Timeliness Changes Laboratory: reporting timeliness now match those for disease reporting Now reportable within 24 hours: Invasive Haemophilus influenzae (previously immediately reportable) Mumps (previously reportable within 72 hours) Pertussis (previously immediately reportable) 31

32 Disease Specific Control Measures 32

33 Animal Bites ANY rabies vector species (including bats, skunks, raccoons, foxes, and other wild carnivores) must be euthanized and tested for rabies after a human bite, even if the animal is being kept as a pet and/or permitted by the Indiana DNR. Authorization to make exceptions to this section is granted to the local health officer and/or State Veterinarian. 33

34 Animal Bites (cont.) Language permitting euthanasia and rabies testing of stray or unwanted biting animals has been removed. These animals must now be quarantined for 10 days after a bite. Unhealthy or terminally injured animals may still be euthanized and tested. 34

35 Arboviral Diseases Dengue, chikungunya, EEE, SLE, WEE, West Nile virus, California serogroup viruses, and Powassan virus All will remain reportable, but will now be listed separately on the reportable disease list, as well as under the general term arboviral disease. Note: formerly Encephalitis, arboviral 35

36 Food Employee Exclusions Specific to Hepatitis A, Shiga toxin-producing E. coli (STEC), Salmonellosis, Shigellosis, and Typhoid Fever. Aligned with the Retail Food Establishment Sanitation Requirements (410 IAC 7-24) proposed revisions. 36

37 Food Employee Exclusions Some examples of the alignment between the CD Rule and the Food Code Ready-to-eat was defined and the its use was expanded to be included in Hepatitis A In regards to Shigella, the rule now clarifies when to restrict and re-instate food employees 37

38 Influenza-associated Death Definition has been expanded to include listed anywhere on the death certificate as primary, secondary, or contributory cause of death as a means by which an influenza diagnosis has been detected. Investigations by the local health officer shall now include an epidemiologic investigation. 38

39 Influenza-associated Death What the rule says: (cont.) A report is not necessary if the diagnosis of influenza is neither confirmed by laboratory testing nor listed on the death certificate as primary, secondary, or contributory cause of death on the death certificate. What the rule means: Influenza-associated death is only reportable if laboratory confirmed or listed on the death certificate as a primary, secondary, or contributory cause of death. 39

40 Measles School Exclusions Anyone who gets a first or second dose of MMR as part of an outbreak control program can return immediately to school as long as all persons without documented proof of immunity have been excluded and that vaccination occurred within 72 hours of exposure. Previous rule did not address case contacts who received vaccination as part of an outbreak response 40

41 Measles and Mumps Health Care Facility Exclusions All exposed employees without proof of immunity must be excluded from day 5-21 (for measles) and day 9-25 (for mumps) after exposure, regardless of vaccination or if IG was given after exposure. This was a clarification added to the rule, as the previous version of the rule did not directly address this 41

42 Shigella Exclusion Daycare & pre-school attendees will be able to return to school after 48 hours if they Are asymptomatic Received antibiotic treatment Submit 1 negative stool sample Healthcare workers, and daycare workers will be able to return to work after 24 hours if they Are asymptomatic; Submit 1 negative stool sample 42

43 Varicella Laboratory testing requirements for break-through and hospitalized cases have been added. PCR Culture IgG paired serology Outbreak control measures added Defines an outbreak Provides guidance on exclusions and timelines Provides guidance on contact tracing 43

44 Link to the New CD Rule 410 Indiana Administrative Code (Full): Or Visit the ISDH website: 44

45 Recorded Webinar A pre-recorded Communicable Disease Reporting Rule webinar is available at: 45

46 2015 Reportable Disease List 46

47 Questions? Josh Clayton, PhD, MPH Deputy State Epidemiologist Indiana State Department of Health