2017 Winter Communicable Disease Forum Webinar

Transcription

1 Welcome to the webinar 2017 Winter Communicable Disease Forum Webinar Today s webinar is being recorded and archived. It will be posted to the NJ Department of Health website. Tuesday, December 12, :30 11:30am NJ Department of Health Communicable Disease Service Continuing Education Credits Credits offered for this webinar: 2.0 Public Health and Nursing Credits provided to those who attend the webinar live Must also be registered on Go To Webinar and NJLMN to be eligible for credits Questions during the webinar? All attendee lines are muted. Please use the Question box to ask a question. Questions will be answered at the end of the webinar, time permitting. NOTE: Those viewing the webinar in the archived version are not eligible to receive continuing education credits. Webinar handouts Handouts (slides and resources) may be accessed in the Handouts box. Handouts only available during live webinars After the You will receive a link to the evaluation after the webinar. The evaluation link will be sent to your NJLMN address Those seeking continuing education credits MUST complete the evaluation within 5 days after receiving link. Evaluation link closes after 5 days. Once evaluation closed, certificated are ed to the address listed in NJLMN (for nurses)/attendance verified in NJLMN (for PH) Individuals who do not complete the evaluation will not receive continuing education credits. 1

2 Please note Reminder The last six (6) questions on the webinar evaluation ask about training for the new CDRSS re design Questions ask about preference for in person or webinar training and availability Best day/time for training and which browser used to access CDRSS You must be registered on both Go to Webinar and NJLMN Link to evaluation ed to NJLMN address Complete evaluation for continuing education credits Certificates for RNs ed after evaluation closes; Attendance verified for licensed PH professionals Once webinar is posted to the NJDOH website, we will notify via NJLMN Announcements Sherif Ibrahim, MD, MPH, NEW Regional Epidemiology Program Manager NJDOH is creating a Hepatitis Roadshow to assist partners with case classification using new case definition Hour long interactive in person presentation Regional Epidemiologists will present to their regional partners in early 2018 Quarterly regional reports have been sent out Please contact your regional epidemiologist if you did not get your report 2018 Winter Communicable Disease Forum Tuesday, February 13, 2018 from 9:30 11:30am 2.0 Public Health credits and Nursing contact hours available Register on BOTH Go To Webinar and NJLMN New antimicrobial resistance activities: surveillance and response Patricia M. Barrett, MSD December 12, 2017 Winter Communicable Disease Forum The link to register on Go To Webinar will be sent out soon! 2

3 Outline Carbapenem resistant Enterobacteriaceae (CRE) Surveillance Antibiotic Resistance Lab Network (ARLN) CRE Surveillance Program Response Investigating novel resistance mechanisms Carbapenem-resistant Enterobacteriaceae (CRE) Why do we care about CRE? What is CRE? Carbapenem resistant Enterobacteriaceae What is CRE? What is CRE? Carbapenem resistant Enterobacteriaceae Carbapenem resistant Enterobacteriaceae Family of gram negative bacteria, many of which are clinically significant E.g., Enterobacter, Escherichia (E. coli), Klebsiella, Proteus, Salmonella, Serratia, Shigella Class of β lactam antibiotics used for treating infections caused by bacteria resistant to other antibiotic classes (e.g., ESBL). Broad spectrum antibacterial activity E.g., imipenem, meropenem, ertapenem, doripenem 3

4 What is CRE? What is CRE? Surveillance definition Enterobacteriaceae with: (A) Resistance to imipenem, meropenem, ertapenem, or doripenem OR (B) Documentation that the isolate possesses a carbapenemase Surveillance definition Enterobacteriaceae with: (A) Resistance to imipenem, meropenem, ertapenem, or doripenem OR (B) Documentation that the isolate possesses a carbapenemase Carbapenemase producing CRE Carbapenemase genes Enterobacteriaceae CRE CP CRE Carbapenemases: Enzymes that break down carbapenems and related antimicrobials Carbapenemase genes can often transfer between different species of bacteria KPC NDM VIM IMP OXA 48 Carbapenemase genes can transfer between different species of bacteria and share resistance Most clinical laboratories do not test for carbapenemase genes Antibiotic Resistance Laboratory Network (ARLN) Developed in 2016 by the Centers for Disease Control and Prevention (CDC) Enhancing detection, response, and prevention to antimicrobial resistant (AR) threats Surveillance 4

5 Three ARLN Projects 1. CRE surveillance and response 2. Emerging resistance surveillance 3. Candida auris confirmation Three ARLN Projects 1. CRE surveillance and response 2. Emerging resistance surveillance 3. Candida auris confirmation ARLN network approach ARLN network approach Clinical laboratories Submit CRE isolates for testing each month Clinical laboratories Public Health and Environmental Laboratories (PHEL) Regional laboratory Public Health and Environmental Laboratories (PHEL) Regional laboratory Complete testing for CRE resistance mechanisms CDC CDC ARLN network approach ARLN network approach Clinical laboratories Public Health and Environmental Laboratories (PHEL) Regional laboratory CDC Emerging resistance and further CRE testing, colonization screening Clinical laboratories Public Health and Environmental Laboratories (PHEL) Regional laboratory CDC Provide guidance, fund all shipping and screening supplies 5

6 Seven ARLN Regions CRE Surveillance in NJ Starting 2018 Laboratories will send certain CRE isolates to PHEL Testing includes: Antibiotic susceptibility testing Check for carbapenemase production (mcim) Testing for carbapenemase genes (KPC, NDM, VIM, IMP, OXA 48) Response Public health response 1. Identify patient location 2. Implement infection control measures 3. Collect patient information 4. Identify case contacts 5. Contact screening Additional testing, follow up as needed (e.g. point prevalence 6. Prospective surveillance 7. Case rescreening *Our primary goal is to prevent future transmission* Public health response 1. Identify patient location 2. Implement infection control measures Contact precautions Single room or roommate with low risk of infection Minimize shared equipment, providers Staff reeducation and auditing Hand hygiene Personal protective equipment (PPE) Environmental cleaning Public health response 1. Identify patient location 2. Implement infection control measures Contact precautions Single room or roommate with low risk of infection Minimize shared equipment, providers Staff reeducation and auditing Hand hygiene Personal protective equipment (PPE) Environmental cleaning 6

7 Public health response Public health response 3. Collect patient information Demographics, residence Basic medical history Healthcare exposures (~2 months) Travel history (2 years) 4. Identify case contacts Was the patient on contact precautions for the entire stay? Yes: Screen roommates only No: Screen patients on unit with >3 days overlapping when the case was not on CP and any roommates 3. Collect patient information Demographics, residence Basic medical history Healthcare exposures (~2 months) Travel history (2 years) 4. Identify case contacts Was the patient on contact precautions for the entire stay? Yes: Screen roommates only No: Screen patients on unit with >3 days overlapping when the case was not on CP and any roommates Public health response 5. Contact screening (for colonization) Rectal swabs coordinated with regional laboratory If contacts are colonized, expand to additional rings E.g. All patients on the unit Public health response 6. Prospective surveillance Facility laboratory should report similar isolates identified in the future for additional testing 7. Case rescreening Periodic screening of cases until two negative screens or discharge Public health response 6. Prospective surveillance Facility laboratory should report similar isolates identified in the future for additional testing 7. Case rescreening Periodic screening of cases until two negative screens or discharge CDC s Response Tiers Tier 1: Novel resistance in United States or organisms with no treatment options VRSA, pan resistant isolates, newly identified resistance genes Tier 2: Resistance that is novel in the region OXA 48, NDM, VIM, IMP, MCR 1 (colistin resistance) Tier 3: Resistance that is established but not endemic in the region KPC 7

8 Response by the tier Response activity Tier 1 Tier 2 Tier 3 Locate the patient Infection control measures Patient information Identify case contacts Contact screening Prospective surveillance Periodic rescreening What does this mean for the local health department? Why do I care? Isolates in your jurisdiction may be sent to the public health laboratory for testing Concerning results will require some level of public health response The Local Health Department and Communicable Disease Service will partner for investigations If there is a concern for transmission a site visit to the facility may be warranted The more testing we do, the more we know about local MDROs and transmission! Questions? An update on Candida auris - New Jersey, 2017 Thank you! Patricia M. Barrett, MSD Antimicrobial Resistance Coordinator Patricia.Barrett@doh.nj.gov Kathleen Ross, MPH Infectious Disease Epidemiologist New Jersey Department of Health Communicable Disease Forum December 12,

9 Acknowledgement Many of today s slides were based on previous presentations by: CDC Mycotic Disease Branch CDC Epidemic Intelligence Service New Jersey Department of Health Agenda A quick refresher Reasons for concern Candida auris in the U.S. and locally Public health response Infection prevention and control recommendations 49 Candida To refresh your memory Candida: Catch all for asexual yeast Includes hundreds of unrelated species More added each year Candida albicans vs non albicans Candida Less than half of Candida infections are caused by C. albicans, today 52 First report of Candida auris Global emergence of Candida auris First isolate identified Japan Oldest isolate identified (1996) South Korea Global emergence South Africa Kenya Kuwait India Colombia Pakistan Spain Venezuela U.S.A. Israel Germany U.K Chowdhary et al.,

10 Who is at risk for infection from Candida auris? Risk factors include: Broad spectrum antibiotic and antifungal use Immunocompromised Indwelling devices Prolonged hospitalizations Why is Candida auris a problem? 56 It s difficult to identify Candida auris identification varies by laboratory method C. auris can be misidentified as: Candida haemulonii Candida parapsilosis Candida duobushaemulonii Rhodotorula glutinis Candida famata Candida spp. after a Candida sake validated method of Candida Candida catenulate identification attempted Candida guilliermondii Candida lusitaniae It causes serious infections C. auris has been isolated from non sterile, noninvasive sites (e.g., urine, sputum) C. auris has been isolated from the bloodstream and other normally sterile, invasive body sites Invasive infections with any Candida spp. can be fatal Mizusawa et al., 2017 and CDC Mycotic Disease Branch, 2017 It s often resistant to medicines Polyenes 35% resistant to amphotericin B Azoles 93% resistant to fluconazole 54% resistant to voriconazole Echinocandins 7% resistant to echinocandins It can be difficult to control in healthcare facilities (despite intensive infection control efforts) Vast environmental contamination Continued detection more than a month after discharge Can survive on plastic surfaces for more than four weeks Fungal claims don t always work Quaternary ammonium compounds are ineffective No known decolonization regimens 41% multi drug resistant 4% resistant to all three major antifungal classes Percentages based on susceptibility testing interpretations of 68 isolates tested by CDC, courtesy of CDC Mycotic Diseases Branch Schelenz et al.,

11 Candida auris in the United States What s going on in the United States? 369 confirmed C. auris cases reported by CDC as of October 31, confirmed, clinical infections 212 colonized cases 29 probable, clinical C. auris cases U.S. Map: Clinical cases of Candida auris reported by state, United States, as of October 31, 2017 Candida auris in New Jersey 139 Candida auris cases identified as of December 4, total clinical cases: 37 confirmed 23 probable (C. haemulonii) 1 suspect (C. haemulonii) 78 surveillance cases (colonized) Candida auris in New Jersey Multiple overlaps in units, staff, equipment, specialty care, etc. Patient movement within a healthcare transfer network Surveillance cases identified at facilities with C. auris transmission Skin colonization with C. auris Public health response

12 Candida auris case investigations Single cases of C. auris should be reported to public health Candida auris outbreak investigations Candida auris outbreak: Two or more C. auris cases linked in place in time Point prevalence survey (PPS): Surveillance testing to monitor transmission & identify unknown colonized patients Public health site visit Identification and surveillance support Point prevalence surveys Periodic reassessment for C. auris colonization C. auris confirmatory testing (isolate submission) Support includes shipping costs and screening supplies Contact the Communicable Disease Service at Infection prevention and control recommendations 70 Care of medical devices A majority of patients with C. auris infection or colonization have various types of invasive lines and tubes. E.g., central venous catheters, urinary catheters and tracheostomy tubes. Strict adherence to insertion and maintenance practices of patient devices Ensure continued assessment of need for devices and prompt removal when no longer needed Environmental cleaning and disinfection Use Environmental Protection Agency (EPA) registered hospital grade disinfectant effective against Clostridium difficile spores Follow C. diff contact time, dilution, etc. Daily and terminal cleaning of: C. auris patient room and any care areas (radiology, physical therapy, etc.) Shared equipment of the unit Common areas (handrails, nurse s stations, etc.)

13 Transmission based precautions Placement in single rooms C. auris patients can share rooms Cohort C. auris patients to one area in a facility or unit Minimize number of staff members caring for C. auris patients Standard and Contact Precautions HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) Gloves, gown, and hand hygiene every time you enter the patient s space Duration of infection control precautions Continue precautions as long as the patient is colonized with C. auris Evidence suggests that patients remain colonized for many months, perhaps indefinitely Periodic reassessments for presence of C. auris colonization (e.g., every 3 months) for patients with known C. auris colonization Axilla/groin, nares, and any sites yielding C. auris on previous cultures No antifungal medications for ~1 week; no topical antimicrobials for 48 hours (e.g. CHG) At least two, consecutive cultures with no C. auris growth from each site Supported by NJDOH and CDC upon request Discharge to lower levels of care should be based on clinical criteria and receiving facility s ability to provide care, not colonization status Candida auris patient transfer Include C. auris Transfer Sheet with transfer documentation Call ahead to receiving facility whenever possible Discuss this form with discharge planner, social worker, admission staff, etc. Notify NJDOH when possible Recommendations for laboratory diagnosis Speciate all Candida isolates from normally sterile sites Speciate Candida isolates from non sterile sites when: Clinically indicated in the care of a patient When patient is not responding to therapy When Candida auris patients have been identified in the facility or unit, during suspected outbreaks When patient had overnight stay at healthcare facility in a country with Candida auris transmission within 1 year Suspect Candida auris when there is an increase in infections of unidentified Candida spp. in a patient care unit, including isolation from urine Additional recommendations Nursing home residents Hemodialysis and infusion clinics Outpatient settings Home healthcare Home and family members infection control.html Reporting Healthcare facilities: Please report suspect or confirmed Candida auris cases to your local health department or Communicable Disease Service at Local health departments: Respond immediately to Candida auris reports Please report suspect or confirmed Candida auris cases to the Communicable Disease Service at

14 Online resources Resources Recommendations Identification Treatment Infection control Patients, family, and staff resources Fact sheet FAQ s Webinars 79 Summary Candida auris Can cause invasive infections with high mortality Is challenging to identify Is multidrug resistant It can be difficult to control in healthcare facilities Identification and infection control are needed to control its spread New Jersey has been heavily impacted by ongoing transmission of Candida auris Acknowledgements Patricia Barrett Rebecca Greeley Tara Fulton Jason Mehr Jessica Felix Julia Wells Tina Tan Faye Rozwadowski Ed Lifshitz Lisa McHugh NJDOH Regional Epidemiology Program NJDOH Public Health and Environmental Laboratories CDC Mycotic Disease Branch Sharon Tsay Snigdha Vallabhaneni Rory Welsh Meghan Bentz Brendan Jackson Shawn Lockhart Anastasia Litvintseva Katie Forsberg CDC Division of Healthcare Quality and Promotion Thank you! Questions? Kathleen Ross, MPH Kathleen.Ross@doh.nj.gov Infectious Disease Epidemiologist Communicable Disease Service New Jersey Department of Health

15 Goals of Respiratory Virus Surveillance Influenza and Viral Respiratory Disease Update Lisa McHugh, MPH Infectious And Zoonotic Disease Program Communicable Disease Service New Jersey Department Of Health Track spatial and temporal spread Inform clinical community (treatment and infection control) Describe clinical infections, track epidemiologic changes, and determine groups at highest risk Monitor illness severity Detect unusual events Monitor outbreaks of disease Influenza Burden Paradigm Influenza-like Illness (ILI) Surveillance Died Hospitalized Medically attended ILI ILI cared for at home Asymptomatic persons Impossible to count all cases of influenza Use ILI to approximate true disease burden ILI Definition: Fever (>100 F, oral or equivalent) AND cough and/or sore throat (in the absence of a known cause ILI combined with other more reliable information (i.e., laboratory testing) can provide a good estimate of disease burden Limitation: casts a wide net and will capture other respiratory illness ILI Surveillance Overlay with virologic data to provide picture of influenza circulation ILI Influenza Surveillance Three primary components Virologic laboratory surveillance Influenza like illness (ILI) surveillance Disease specific surveillance Flu A Rhino RSV Flu B 15

16 Virologic Surveillance Lab Data Cases with a positive lab result Basic clinical/epidemiologic info Type and concentration of circulating virus Reported via multiple sources Influenza Lab Reporting NJAC 8: (Labs) Positive influenza laboratory reports are required to be reported CDRSS Labs with CDRSS connection (ELR*) Report all positive flu tests Aggregate rapid data in ILI Module Manual entry laboratories Enter Culture and PCR only Aggregate rapid data in ILI Module *Electronic Laboratory Reporting Sentinel Laboratory Surveillance & PHEL PHEL can test for seasonal and novel influenza (Free) Sentinel facilities submit 3-5 positives to PHEL each week Encourage submission from ALL facilities Especially important - Outbreaks Working on influenza B lineage testing Subset sent to CDC for antigenic characterization and antiviral resistance CDRSS ILI Module (Rapid Influenza & RSV) Influenza Reporting/Investigation Influenza Reporting/Investigation Influenza (AH3, AH1, B and 2009 H1N1) ELR - CONFIRMED/E-CLOSED Manual entry - RUI/PENDING (not always) No investigation needed close cases (exceptions- next slide) ELR reported (AH5 or AH7) RUI/PENDING Require investigation Conduct investigation if Pediatric influenza Less than 18, admitted to ICU or has died The laboratory report is indicative of a novel strain of influenza (e.g., AH5, AH7, A unsubtypeable). Case reports in CDRSS which do not fall into one of the above criteria DO NOT need to be investigated by the LHD 16

17 Pediatric Influenza Pediatric patients (i.e., less than 18 years of age) with laboratory confirmed influenza AND Influenza-related deaths (in which there is no period of complete recovery between illness and death); OR Influenza encephalopathy (defined as altered mental status or personality changes in patients lasting more than 24 hours and occurring within 5 days of the onset of an acute febrile respiratory illness); OR Severe illness defined as admission to an intensive care unit for influenza-related illness Pediatric Influenza CDRSS case <18 years of age with positive influenza Follow up to determine if admitted to ICU or died If yes complete pediatric survey Instructions at: Update the case - e.g., discharge date If not admitted/died Note the information in CDRSS Close case as Confirmed/LHD Closed NOTE: If you need a case re-opened in CDRSS to investigate pediatric influenza, contact influenzaadvisorygroup@doh.nj.gov Influenza-like Illness (ILI) Surveillance Emergency Department Visits and admission EpiCenter Entered by NJDOH into CDRSS School absenteeism/ili in LTCF Entity given username/password LHD and DOH assist in recruiting Influenza-like Illness (ILI) Surveillance CDC systems ILINet (outpatient) Recruited annually by LHD and NJDOH Report data to CDC directly/downloaded at NJDOH NCHS - Vital stats (deaths) Death certificate data from state vital statistics offices Evaluates pneumonia and influenza Time lag in data Influenza-like Illness (ILI) Surveillance Special project Influenza incidence surveillance project (IISP) Enhanced ILINet sites Other LTCF Outbreaks EpiCenter anomalies Outbreak Guidance (LTCF and School/Daycare) All outbreaks are immediately reportable School/daycare investigation only Review guidance for criteria on OB criteria and response One confirmed influenza test plus ILI in LTCF = confirmed OB Confirmed OB = antiviral prophylaxis of whole facility Exclusion criteria for schools (24 hours fever free) 17

18 Non-influenza Surveillance ILI captures more than just influenza See increase in ILI and ask If it s not influenza, what is it? Use non-influenza data to better answer this question Non-influenza Surveillance Respiratory Syncytial Virus # positive and # tested CDRSS ILI Module entered directly by facility NREVSS* CDC system Flu plus 6 non-flu viruses Facilities report directly, NJDOH downloads data PHEL Respiratory Panel Testing Test for flu plus 5 non-flu viruses Algorithm used to select specimens from routine respiratory specimens sent to PHEL Outbreaks *National Respiratory and Enteric Virus Surveillance System Report Additions stats/ Novel Disease Season Novel Influenza H7N9 (China), H5N1 (Southeast Asia), H3N2v (US) MERS Majority of cases in Saudi Arabia Too early to determine type of season Too early to determine vaccine effectiveness Increase in flu activity observed end of November (typical) B and H3N2 RSV at 15% positivity (typical) 18

19 Questions? Season Overview Lisa McHugh, MPH Program Coordinator, Infectious Disease Epidemiology Influenza Surveillance Coordinator Phone: Fax: Reach all influenza surveillance staff at: Timing of Season Typical Peak Second Week February Nationally H3N2 predominated overall New Jersey H3N2 circulated early in the season B very high April through May Majority of viruses were similar to those contained in vaccine Severity indicators similar to what would be seen with H3N Vaccine Composition Vaccine Effectiveness (preliminary) Vaccine Effectiveness Hepatitis B/C Surveillance Cooperative Agreement DECEMBER 12, WINTER COMMUNICABLE DISEASE FORUM WEBINAR

20 Hepatitis B/C Surveillance Hepatitis B/C Surveillance Core Activities Purpose of the Cooperative Agreement (CA) is to support and improve surveillance of acute and chronic hepatitis B and C Competitive 4 year CA 14 states selected to participate in core surveillance activities and optional surveillance activities Incorporate new CSTE HCV case definition, including perinatal HCV Increase case surveillance data, including using other data sources Develop/Maintain a registry of HBV and HCV cases Develop and share surveillance data Detect and investigate HBV and HCV outbreaks Develop/Purchase technology to improve surveillance Hepatitis B/C Surveillance Core Outcomes Case completeness Continued commercial lab and PH clinic reporting Incorporate external data sources to determine true burden of HCV Increase knowledge of HBV and HCV among prevention programs Reduce cases of HBV and HCV due to interrupted transmission in identified outbreaks Hepatitis B/C Case Completeness Outcome for Year 1 2: Complete demographic and risk information 90% for age and gender 70% race/ethnicity 60% county and zip code of residence 50% source of testing 70% complete risk information Current NJ HBV/HCV Case Completeness Age and gender Race/ethnicity County and Zip code of residence Source of testing Complete risk information NJDOH activities for Case Completeness Matching electronic birth certificate (EBC) data for HBV and HCV + mothers STD cases in CDRSS External data sites: Medicare/Medicaid, BRFSS, hospital discharge data NJDOH Subject Matter Experts (SMEs) monitor HBV and HCV cases in CDRSS New HCV investigation form (CDS 17) to collect demographic data

21 Surveillance Outcomes NJDOH hepatitis epidemiologists analyze trends to determine hotspots by county/region Analyze cases in CDRSS to identify increases in cases and recognize trends that may indicate an outbreak Case Completeness Asking LHDs to complete CDRSS case reports for HBV and HCV cases Age and gender Race/Ethnicity County and zip code of residence Source of testing Complete risk information Investigation by LHDs of priority populations will help identify acute cases Race/Ethnicity and risk information are often not completed CDC priority: acute cases Activities HBV Pilot in Essex Co Collaborative effort with Suburban Essex Co Nursing Supervisors (SENSA) to increase case completeness, esp. for household and sexual contacts of HBV+ individuals 11 municipalities and 1 private physician practice 1 year pilot project to determine if increased case completeness and education/prevention of contacts and to promote vaccination and linkage to care of contacts May 2017 May 2018 Education materials developed and translated in multiple languages for household and sexual contacts HBV Pilot in Essex Co Quarterly data submissions from the 11 participating municipalities and private practice about materials distribution and referrals for care/immunization After the pilot: Determine which materials most useful and post to NJDOH website and whether additional languages need to be included Run case reports to determine completeness List of linkage to care referrals Vaccination and Treatment HCV New Case Definitions and Guidance NJDOH adding new CSTE case definitions for HCV in CDRSS New case definitions includes probable case classification and perinatal Guidance document includes algorithms, laboratory tests, and new investigation forms Identifies priority groups for investigation

22 HCV Priority Populations Suspected acute HCV cases, of any age Individuals <30 and >70 years of age Perinatal; children less than 36 months old, born to an HCV infected mother Individuals who are patients of a healthcare setting, e.g., hemodialysis HCV New Case Definitions and Guidance NJDOH working to have new case definition incorporated into CDRSS by January 2018 Webinar featuring new guidance and case definition held on November 14 Webinar, slides, and new guidance posted on the NJDOH website NJDOH is creating a Hepatitis C Roadshow to assist partners with case classification using new case definition Hour long interactive in person presentation Regional Epidemiologists will present to their regional partners in early Opioid Treatment Program Surveillance Opioid Treatment Program (OTP) Hepatitis B/C Surveillance Optional Project NJDOH also applied for separate optional funding to collaborate with OTPs to conduct HBV/HCV surveillance Intention is to have OTPs provide data about hepatitis status, testing, treatment, and linkage to care The data being collected will be shared with public health partners OTP may be able to provide LHD demographic data about the case for the investigation OTPs may/may not have ever worked with a LHD OTP Hepatitis Surveillance Request for Proposal (RFP) was posted on NJDOH website; other promotion in coordination with then Division of MH and Addictions OTPs Hepatitis Surveillance Limited to licensed non profit OTPs in NJ Received a total of nine applications; five facilities were selected to participate OTPs receive $10k/yr (for four years; total $40k) to collect and provide aggregate data

23 OTPs and LHDs OTPs will not have access to CDRSS OTP Grantees/Partners South: John Brooks Recovery Center (Atlantic Co) If there is a positive case of HBV/HCV and the address is one of the OTPs, they have been requested to provide LHD with information LHD has the authority to investigate positive HBV/HCV cases of those living in their jurisdiction Central East: JSAS Healthcare (Monmouth Co) Central West: Somerset Treatment Services (Somerset Co) LHD may notice an uptick in cases due to increase testing/screening for HBV/HCV among PWID at the OTP facilities Northeast: Straight & Narrow (Bergen Co) North West: Paterson Counseling Center (Passaic Co) OTP Initiative Activities Provide OTP staff with technical assistance Collect information electronically about the PWID population in NJ Goal is testing and linkage to care Work with LHD to identify testing and linkage to care resources in county/region (Is the LHD aware of these resources?) Determine if increase in testing among PWID/at risk individuals Work with LHD for case ascertainment Determine if positive HBV/HCV clients are linked to care (15% Yr 1; 33% Yr 2) Updates The OTP initiative is a four year project As there are updates with the Optional OTP project, NJDOH will provide to public health partners Reminder Thank you You must be registered on both Go to Webinar and NJLMN Link to evaluation ed to NJLMN address Complete evaluation for continuing education credits Certificates for RNs ed after evaluation closes; Attendance verified for licensed PH professionals Once webinar is posted to the NJDOH website, we will notify via NJLMN

24 2018 Winter Communicable Disease Forum Tuesday, February 13, 2018 from 9:30 11:30am 2.0 Public Health credits and Nursing contact hours available Register on BOTH Go To Webinar and NJLMN The link to register on Go To Webinar will be sent out soon!! 24