Management and Reporting of Vaccine Preventable Diseases in Schools Shirley A. Morales,MPH,CIC
Presentation Overview Overview of vaccine preventable diseases in Suburban Cook County Reporting Laws and regulations Communicable Disease Reporting Process Vaccine Preventable Diseases with potential to cause outbreaks in schools and the community Role of school nurses in reporting vaccine preventable diseases Resources for school nurses Q & A
Learning objectives Know the current trends of the most common reportable communicable diseases seen in schools, particularly pertussis, mumps, measles and chickenpox Describe the process of communicable disease reporting Know when to notify the Local Health Department about suspect cases of communicable diseases that have the potential to cause outbreaks in the school and the community (Measles, Mumps, Pertussis, Chickenpox) Understand the importance of maintaining ongoing, efficient communication between the school and the local health department Be knowledgeable about the resources available for them regarding management of health-related events in the schools
Vaccine Preventable Diseases Case Count Vaccine Preventable Diseases 2012 2013 2014 2015 2016 5-yr Median 2017-Q1* Diphtheria 0 0 0 0 0 0 0 Haemophilus Influenzae 26 26 34 33 45 33 7 Hepatitis B Acute 15 23 7 13 10 13 0 Chronic 267 371 371 321 258 321 13 Measles 0 5 0 14 0 0 0 Mumps 4 4 12 22 40 12 22 Pertussis (Whooping Cough) Pneumococcal Disease (Invasive) 461 143 188 171 191 188 23 7 8 9 8 7 8 1 Rubella 0 0 1 0 0 0 0 Tetanus 1 0 0 0 1 0 0 Varicella 123 99 85 63 73 85 15 * Provisional cases through the first quarter of 2017 Includes type B As of March 2008, reportable only in those < 5 years of age
Reported VPDs by District, 2016 160 140 145 120 100 80 60 Mumps Pertussis Varicella (Chickenpox) 40 20 0 27 29 22 21 14 8 10 14 9 1 4 North South Southwest West
Reported VPDs by Age Group, 2016 Age Group Pertussis Mumps Varicella <1 Year 8 0 0 1-4 Years 22 1 12 5-9 Years 27 1 28 10-14 Years 46 5 10 15-19 Years 59 17 8 20-29 Years 5 5 5 30-39 Years 6 2 5 40-49 Years 4 2 3 50-59 Years 4 4 2 60 Years 10 3 0
TITLE 77: PUBLIC HEALTH CHAPTER I: DEPARTMENT OF PUBLIC HEALTH SUBCHAPTER k: COMMUNICABLE DISEASE CONTROL AND IMMUNIZATIONS PART 690 CONTROL OF COMMUNICABLE DISEASES CODE SECTION 690.200 REPORTING Section 690.200 Reporting Reporting Entities Healthcare personnel (physicians, physician assistants, nurses, nursing assistants, dentists, healthcare practitioners, Emergency medical personnel, etc) Hospitals Laboratories Any institution, school, college/university, child care facility or camp personnel Researchers Veterinarians Correctional facility personnel Food service management personnel Any other person having knowledge of a known or suspected case or carrier of a reportable communicable disease or communicable disease death
Section 690.30 General Procedures for the Control of Communicable Diseases The Department or local health authority may investigate the occurrence of: Cases Suspect cases Carriers of reportable diseases Unusual disease occurrences in a public or private place Purpose: Verifying the existence of disease Identifying the source of the disease-causing agent Identifying unreported cases Locating and evaluating contacts of cases and suspect cases Identifying those at risk of disease Determining necessary control measures (isolation, quarantine) Informing the public
Disease Reporting Pathway Community Schools Hospitals Laboratories Healthcare providers Suspect, probable and confirmed cases, disease clusters. I-NEDSS Local/County Health Departments Case follow-up Local surveillance Electronic reports (I-NEDSS) Statewide surveillance National Notifiable Disease Surveillance System (NNDSS) Morbidity and Mortality Weekly Report (MMWR)
Flowchart for communicable disease reporting for schools Student/staff suspected of having a reportable disease In school Not in school Isolate Send child/staff home and advice sick staff/parent of sick student to seek medical evaluation Phone local health department (LHD) LHD investigates suspect case to determine if probable or confirmed case Letter sent to school for distribution to students and staff
Measles A single case of measles is considered a potential outbreak situation and requires prompt investigation and implementation of control measures to reduce the disease occurrence and the magnitude of the outbreak. Investigation of any suspect measles case is considered critical. Report all cases, including suspect cases, as soon as possible within 24 hours. Initiate control and prevention measures to prevent spread of disease Exclusion of sick cases for 4 days after onset of rash Vaccination is provided to susceptible contacts within 72 hours of exposure. Exclusion of susceptible contacts
Measles Exposed, susceptible contacts, who have not received vaccine within 72 hours of exposure, should: Avoid public settings and limit their exposure to susceptible individuals from day 5 of first exposure until after day 21 of the last exposure. The exposure day is counted as day 0.
Mumps Report all cases, including suspect cases, as soon as possible within 24 hours. Gives LHD time to verify diagnosis, arrange testing of suspect cases. Initiate control and prevention measures to prevent spread of disease Exclusion of sick cases for 5 days after onset of parotitis (the first day of parotitis is day 0) Identify close contacts Determine the immune status of exposed close contacts High risk susceptible close contacts (pregnant women, immunosuppressed persons, infants < 12 months) should be referred to their health care providers Close contacts should be educated about symptoms to watch for during the potential illness period (12-25 days after exposure) and to report symptoms to their local health departmentand health-care provider.
Mumps Susceptible close contacts who are not vaccinated shall be excluded from school, child care facilities or the workplace from the 12th through the 25th day after their last exposure. When multiple cases occur (outbreak settings), susceptibles need to be excluded through the 25th day after the onset of parotitis in the last case at the school or workplace. Local Health Department will provide recommendations guidance on exclusion process. Please contact health department before doing anything!
Pertussis Report all cases, as soon as possible within 24 hours. Cases shall be excluded from school, child care facility, or workplace until five days of appropriate antibiotic therapy has been completed. Suspect cases who do not receive antibiotics should be isolated for three weeks after onset of paroxysmal cough or until the end of the cough, whichever comes first. Cases should avoid contact with susceptible unimmunized infants and children until cases have completed at least five days of antibiotic therapy. Symptomatic contacts shall be excluded from school, child care facility, or workplace until five days of appropriate antibiotic therapy has been completed. Close contacts of cases who are incompletely immunized should complete antibiotic prophylaxis and continue or initiate the primary series. Asymptomatic close contacts are not contagious and do not need to be excluded from social/work/school settings.
Varicella (Chickenpox) Report cases to the local health department within 24 hours. Children shall be excluded from school or child care facilities for a minimum of five days after the appearance of eruption or until vesicles become dry. Adults shall be excluded from the workplace for a minimum of five days after the appearance of eruption or until vesicles become dry. Susceptible persons (those with no history of disease or vaccination) who have been exposed to varicella shall be identified. Vaccination can be offered to susceptible person within 120 hours of exposure. Varicella Ig can be offered if available to susceptible persons who are medically contraindicated to receive the vaccine and are at high risk for developing severe disease and complications. (within 96 hours of exposure.)
Role of the school nurse in public health surveillance Although laboratories and health professionals are expected to report these notifiable conditions, their reports do not include information on whether the case attends school or daycare or if the case works in a learning facility. Delayed notification of cases may preclude prompt responses to prevent illness among individuals exposed in the group setting. The school nurse or a designated staff member should always contact the local health department for the following circumstances When a student or staff member has a reportable disease For assistance in managing a suspected outbreak To develop policies and procedures for alerting staff members and families about their responsibility to report illnesses
Resources for school nurses Books Managing Infectious Diseases in Child Care and Schools. A Quick Reference Guide, 4 th Edition by The American Academy of Pediatrics Epidemiology and Prevention of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention, Atlanta, GA, 2012. Websites Centers for Disease Control and Prevention https://www.cdc.gov/ page http://www.cookcountypublichealth.org/ Healthwise. http://cookcountypublichealth.org/healthwise Resources and Information for School Nurses. http://cookcountypublichealth.org/resources/school-nurse-resources Illinois Department of Public Health page http://dph.illinois.gov/
Contact Information Shirley A. Morales, MPH, CIC Epidemiologist III Vaccine Preventable Disease Program Communicable Disease Unit (708) 836-5451; (708) 836-8699 smoralesestrada@cookcountyhhs.org cookcountypublichealth.org
References Managing Infectious Diseases in Child Care and Schools. A Quick Reference Guide, 4 th Edition by The American Academy of Pediatrics Epidemiology and Prevention of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. https://www.cdc.gov/vaccines/pubs/pinkbook/index.html. Accessed online, April 7, 2017 Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention, Atlanta, GA, 2012. https://www.cdc.gov/vaccines/pubs/surv-manual/chapters.html. Accessed online, April 7, 2017. CDC website. Last accessed online, April 07, 2017 https://www.cdc.gov/mumps/index.html https://www.cdc.gov/measles/index.html https://www.cdc.gov/pertussis/index.html. Communicable Disease Case Counts. http://www.cookcountypublichealth.org/data-reports/communicablediseases/case-counts. Accessed April 10, 2017. http://www.cookcountypublichealth.org/resources/school-nurse-resources. Accessed April 10, 2017
References Control of Communicable Disease Reporting Requirements Rule Title 77: Public Health Chapter I: Department of Public Health Subchapter k: Communicable Disease Control and Immunizations Part 690 Control of Communicable Diseases Code Section 690.200 Reporting. http://www.ilga.gov/commission/jcar/admincode/077/077006900c02000r.html. Accessed April 10, 2017 Section 690.350 Chickenpox (Varicella). http://ilga.gov/commission/jcar/admincode/077/077006900d03500r.html. Accessed April 10, 2017 Section 690.520 Measles. http://ilga.gov/commission/jcar/admincode/077/077006900d05200r.html. Accessed April 10, 2017 Section 690.550 Mumps. http://ilga.gov/commission/jcar/admincode/077/077006900d05500r.html. Accessed April 10, 2017 Section 690.750 Pertussis (Whooping Cough). http://ilga.gov/commission/jcar/admincode/077/077006900d07500r.html. Accessed April 10, 2017