What you need to know... Notifiable Diseases/Conditions. Alabama Department of Public Health (ADPH) Bureau of Communicable Disease - Epidemiology

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1 What you need to know... Notifiable Diseases/Conditions Alabama Department of Public Health (ADPH) Bureau of Communicable Disease - Epidemiology

2 2 Objectives Understand important updates to Notifiable Disease Rule Identify various reporting methods Recognize opportunities for interrupting disease transmission

3 3 Notifiable Diseases/Conditions Enable ADPH to... collect, manage, share, analyze, interpret, and disseminate health-related data monitor regional trends in diseases and health conditions work with other jurisdictions and partners to implement and assess prevention and control programs ADPH administrative code authorizes and requires reporting ADPH is exempt from HIPAA Privacy Rules,

4 4 Chapter Notifiable Diseases -.01 Purpose -.02 Definitions - Amended -.03 Enumeration - Amended -.04 Reporting - Amended -.05 Control Procedures - Amended -.06 HIV Testing Procedures - Amended -.07 Notification Of Pre-Hospital/Emergency Medical Service Personnel

5 5 Chapter Notifiable Diseases -.08 Notification Of Funeral Home Personnel - Repealed -.09 Investigation Of HIV/Hepatitis B Virus Infected Health Care Workers - Repealed -.10 Victims Of Sexual Offense To Request And Receive HIV Test Results Of Convicted Offender - Amended -.11 Spousal Notification Of A Known HIV-Infected Patient - Repealed -.12 Notification Of Law Enforcement, National Security Or Federal Public Health Authorities

6 6 Chapter Notifiable Diseases -.13 Notification Of Public Health And Regulatory Authorities Of The Presence Of Lead -.14 Testing Of Pregnant Women For Sexually Transmitted Diseases - Amended -.15 Dispensing Of Legend Drugs By Alabama Department Of Public Health Registered Nurses

7 7 Chapter Notifiable Diseases Appendix I Alabama Notifiable Diseases/Conditions - Amended Appendix II Routine Prenatal Screening for Sexually Transmitted Disease (STD) - Repealed

8 Definitions Added of presumptive diagnosis to 4- and 24-hr Added of diagnosis to Standard definition. Standard timeframe reduced from 7 days to 5 days. Added to Isolation, or other diseases as determined by the State Board of Health for flexibility Perinatal HIV Exposure added as the birth of an infant(s) to a woman with HIV infection.

9 Definitions Sexual offender and sexual offense changed to sex offender and sex offense section of the Code of Alabama, Removed definitions no longer referred to in Rule

10 Enumeration Disease categories updated Added of presumptive diagnosis to 4- and 24-hr Added of diagnosis to Standard definition. Standard timeframe reduced from 7 days to 5 days. Updated STD antiquated reference code

11 Reporting Required Reporters, each: Physician Dentist Nurse Medical examiner Child care center/head Start director Hospital administrator Nursing home admin Laboratory director School principal Clarified that required reporters cannot substitute reporting by laboratories.

12 Reporting Laboratories required to report electronically, and method and reference range(s) required Faxing does not qualify as electronic Submitting specimens for further testing does not qualify as reporting to EPI HL7 messaging directly from the LIMS is desirable Meanwhile, labs may enter directly into the ALNBS to meet this requirement

13 Reporting Minimum information to be reported: Disease/condition Person s name, date of birth, gender, race, ethnicity, address, phone number, and payor source Date of onset, date of laboratory result, and/or date of diagnosis Reporter s name, phone number, and facility

14 Reporting Removed specific Bacillus anthracis guidance In the Epidemiologic Study Information section, or entity was added to the part which refers to release of test results

15 15 Appendix 1 STEC and HUS moved to 24-hr category STEC reporting still includes O157:H7, although explicitly removed Hepatitis B, C, and other viral (acute only) with ALT added Clarification added to Novel influenza A Arboviral disease (any resulted test)

16 16 Appendix 1 Removed Histoplasmosis Toxic Shock Syndrome Viral encephalitis (covered with all Arbovirals)

17 17 Reporting Methods (4-hr) Telephone only Why? Anthrax, human Smallpox Botulism Tularemia Plague Polio, paralytic SARS-CoV disease Viral hemorrhagic fever Cases related to nuclear, biological, or chemical terroristic agents

18 18 EPI Field Surveillance Staff (FSS)

19 19 Reporting Methods (24-hr) Laboratories must report electronically Why? Lab report needed, and if faxed, has to re-entered in ALNBS by a non-laboratorian Salmonella positive Crypto O&P detected Shiga toxin isolated

20 20 Reporting Methods (24-hr) All other reporters, REPORT card or telephone Why 24 hours? Outbreak potential Cholera, STEC, Legionella, Measles, TB Food handlers Hep A, Typhoid fever Interrupt Transmission (VPDs) Invasive Haemophilus influenzae, Meningococcal Disease, Rubella, Pertussis Emerging/Re-emerging Novel influenza A virus, Yellow fever, VPDs

21 9 Changing Epidemiology Agent Recently recognized pathogens New FB modes of transmission Environment Globalization of food supply Centralization of food processing, large producers Host Increasing elderly, immunocompromised New eating habits Increasing immigration, international travel

22 22 Reporting Methods (24-hr) Outbreaks of any kind Limit spread/extent of outbreak Provide control measures Learn how to prevent similar outbreaks in future Cases of potential public health importance Prevent additional illness Learn of emerging public health threats

23 23 Outbreak: Two or more cases of a similar illness shown by an investigation to result from a common exposure, such as ingestion of a common food. An outbreak is a cluster with a clear association between cases, with or without a recognized common source or known disease agent. (Single cases of certain rare and serious conditions, such as gastrointestinal anthrax, botulism, or cholera, elicit an outbreak-like response.)

24 Outbreak Investigation Actions FSS contacts facility to gather contact information FSS interviews ill and not ill State Lab tests clinical and food specimens County environmentalist assesses the facility EPI analyzes data and reports results Report summarizes actions

25 25 Epidemiology Report Elements Context/background Information that helps to characterize the incident, including: Estimated population affected Location (e.g., setting or venue) Geographical area(s) involved Suspected or known etiology Initiation of investigation Information regarding receipt of notification and initiation of the investigation, including: Date and time initial notification was received by ADPH Date and time investigation was initiated by ADPH

26 26 Epidemiology Report Elements Investigation methods Any initial investigative activity (e.g., verified laboratory results) Data collection and analysis methods (e.g., case-finding, cohort/case-control studies, environmental investigation or testing, etc.) Tools that were relevant to the investigation (e.g., epidemic curves, attack rate tables, questionnaires) Case definitions Investigation findings/results Epidemiological results Laboratory results (as applicable) Clinical findings (as applicable) Other analytic findings (as applicable)

27 27 Epidemiology Report Elements Discussion and/or conclusions Analysis and interpretation of the investigation results, and/or any conclusions drawn as a result of performing the investigation. Recommendations for controlling disease Specific control measures or other interventions recommended for controlling the spread of disease or preventing future Key investigators and/or report authors Names and titles are critical to ensure that lines of communication with partners, clinicians and other stakeholders can be established.

28 28 Reporting Methods (5-day) Arboviral diseases Tickborne diseases Enterics Acute hepatitis B & C STIs Non-transmittable diseases tetanus, lead screening, asthma Influenza-associated pediatric mortality Etc (

29 6 Salmonella Timeline Example S M T W Th F S Patient Eats Contaminated Food Incubation time Becomes Ill Delay seeking medical care Visits Doctor (Stool Sample Collected) Specimen delivered and growing Salmonella identified Public Health receives sample Serotyping and DNA fingerprinting Uploaded Case Confirmed as Part of Outbreak Source: CDC

30 30 Peruse at Your Leisure

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