WINTER COMMUNICABLE DISEASE FORUM

Transcription

1 WINTER COMMUNICABLE DISEASE FORUM FEBRUARY 01, 2017 Overview Continuing education credits group sign-in sheet needed for persons not logged in to webinar Questions Recording Slides posted on NJLMN under Practice Exchange 1

2 CDS Training Resources Website 2

3 Programmatic Updates Updated Case definitions and new case creation timeframes for Salmonellosis (non-typhoidal), Shigellosis and Vibriosis (other than cholera) A case that tests positive by a non-culture diagnostic method (e.g. PCR) would now get classified as a probable case. Additional drop down options of Culture-Independent Diagnostic Testing and Epi-linked have been added under reason for status in CDRSS to ensure all probable cases get classified appropriately The possible case definition will no longer be used Programmatic Updates A lab result will get added to the existing case and a new case will not be created in CDRSS if laboratory results are reported; within 365 days of a previously reported infection in the same individual for Salmonella spp. within 90 days of a previously reported infection in the same individual for Shigella spp. within 30 days of a previously reported infection in the same individual for Vibrio spp. When two or more different serotypes are identified from the same individual, each would have to be manually reported into CDRSS as a separate case irrespective of the above time frames 3

4 Agenda 9:30 Welcome 9:35 Vaccine Preventable Disease Program Updates Acute Flaccid Myelitis (AFM) Susan Hannagan, MS, MPH Surveillance Specialist Haemophilus Influenzae Elizabeth Zaremski, MPH Surveillance Coordinator 10:20 Influenza Update Lisa McHugh, MPH Program Coordinator, Infectious Disease Epidemiology & Influenza Surveillance Coordinator 10:50 Zika Update Kim Cervantes, MPH Vectorborne Disease Coordinator 11:20 Feedback and questions 11:30 Adjourn Nurses... No commercial support has influenced the planning of the educational objectives and content of this event No influential relationships have been disclosed by planners or presenters which would influence the planning of this activity. If any arise, an announcement will be made at the beginning of the session There is no endorsement of any product by the NJSNA or the ANCC associated with this session 4

5 Nurses... No commercial support has influenced the planning of the educational objectives and content of this event No influential relationships have been disclosed by planners or presenters which would influence the planning of this activity. If any arise, an announcement will be made at the beginning of the session There is no endorsement of any product by the NJSNA or the ANCC associated with this session An Introduction to Acute Flaccid Myelitis (AFM) Susan E. Hannagan, MS, MPH Surveillance Specialist Vaccine Preventable Disease Program 5

6 Overview Background Review of CDC surveillance NJ surveillance efforts Case investigations [Poll question #1] 6

7 What is AFM? Acute flaccid myelitis Condition that affects the spinal cord Sudden onset of limb weakness Loss of muscle tone and reflexes Possible: Facial droop/weakness Difficulty moving the eyes Drooping eyelids Difficulty swallowing or speaking Pain in arms or legs Unable to pass urine or bowel/bladder incontinence Respiratory failure (severe) Why is CDC interested in AFM? A serious illness that we do not know the cause of or how to prevent it Appears to be increasing 7

8 Where did AFM come from? Sept 12, 2014: CDC notified by Colorado Dept. of Public Health of 9 children with neurologic illness with unknown etiology Acute focal limb weakness, lesions in the gray matter of the spinal cord on MRI Sept 26: CDC issued a national Health Advisory calling for cases 21 years AFM in the US, confirmed cases from 34 states Onset Aug 1 Dec 31, 2014 Median age 7.1 years (range 4 months 20 years) Increase in cases coincided with national outbreak of severe respiratory illness caused by EV-D68 Not consistently identified 8

9 AFM in the US,

10 What we know about AFM Most patients are children Symptoms are similar to those caused by some viruses Poliovirus, non-polio enteroviruses, adenoviruses, West Nile virus Enteroviruses can cause neurologic illness but rare Neurologic illnesses can result from a variety of causes Viruses, environmental toxins, genetic disorders What we don t know What is causing AFM? No pathogen has been consistently identified in specimens Who is at risk and why? How to prevent it? What is the best treatment? How common is AFM? 10

11 What is CDC doing? Verifying reports of cases and reporting national counts monthly Encouraging reporting by clinicians and states Testing specimens Collaborating with medical institutions to review past MRIs to look for additional cases of AFM AFM in New Jersey 6 confirmed cases in 2016 Onset dates all in Aug and Sept 3 hospitalized at CHOP, 2 at CHONY, 1 Morristown Memorial Median age 4 (range 2-33) 1 probable case 11

12 Case Investigation Steps Physician reports suspect case to NJDOH Physician completes Patient Summary Form NJDOH coordinates specimen shipment to CDC lab for testing CDC neurologist reviews Patient Summary Form and MRI reports to determine case status Specimen Collection CDC would like to receive EACH of the following: CSF specimen Serum Whole blood Two stool specimens, collected 24 hours apart Instructions on website for collection, storage, and shipment Testing is not for clinical purposes 12

13 Case Definitions Confirmed Case Acute onset of focal limb weakness, AND An MRI showing a spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments. Probable Case Acute onset of focal limb weakness, AND Cerebrospinal fluid (CSF) with pleocytosis (white blood cell count >5 cells/mm 3, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present). [Poll question #2] 13

14 [Poll question #3] Communication Efforts NJDOH website: NJLINCS message Oct 24, 2016 Asking providers to report suspect cases to NJDOH Forwarded to IPs, healthcare professional organizations, school nurses/daycares 14

15 Epi-Gram 15

16 [Poll question #4] LHD s Role in AFM No public health action required from local health departments at this time Likely will change moving forward Refer any reports to NJDOH NJDOH will keep LHD informed of cases in your jurisdiction s Can view in CDRSS 16

17 CDC website: Resources Specimen collection and submission instructions FAQs for public and physicians National case counts by month Clinical management guidance document for physicians NJDOH website: NJDOH FAQs document Key Points CDC is interested in reports of suspect cases of AFM NJDOH is joining this national surveillance AFM case investigations/surveillance system is new and changing More resources may be coming soon AFM is serious, but rare (as of now) 17

18 Questions? Haemophilus influenzae surveillance updates Elizabeth F. Zaremski, MPH Surveillance Coordinator Vaccine Preventable Disease Program 18

19 Reminders Immediately reportable Haemophilus influenzae vs influenza Bacterial vs viral Invasive vs non-invasive List of normally sterile sites: Hib vs other serotypes Typeable (a through f) Nontypeable (actually a type ) No vaccines for non-b or nontypeable strains Laboratory Testing N.J.A.C. 8:57-1.7(e) requires all isolates be submitted to PHEL within 3 days of identification for serotyping Not just CSF or blood, but all isolates from normally sterile sites:

20 Watch out for Specimen source/result esp cases created by NY 20

21 Laboratory Testing N.J.A.C. 8:57-1.7(e) requires isolates be submitted to PHEL within 3 days of identification Not just CSF or blood, but all isolates from normally sterile sites Submission of isolate should be documented within lab tab Date sent/shipped Method (courier, FedEx, UPS USPS is not ideal) 21

22 Culture vs PCR Culture positive result from a normally sterile site gold standard isolate should be submitted to PHEL Polymerase Chain Reaction (PCR) positive result rapid result with high sensitivity/specificity detection despite prior antibiotic treatment Current NJ Issues w/ PCR PCR assay DOES NOT serotype Hospitals are doing more PCR PHEL is unable to perform PCR (therefore, unable to serotype) If culture does not grow (no isolate), request remaining PCR + specimen to send to CDC/reference lab for serotyping by PCR 22

23 Case Investigation Isolate submission Hospital admission & discharge dates Treatment Hib vaccination dates (not flu) Mortality Signs & symptoms Close contacts requiring prophy 23

24 Contact Investigation 2015 AAP Red Book 30 th Edition Indications for prophy (pg 371) Defines close contact Defines complete immunization Obtain/document Hib immunization dates Refer for prophy if appropriate (document referral & obtain/document prophy information) Whether to prophy - a clinician s decision 24