Kim Cervantes, MPH, Coordinator / Regional Epidemiology Program Barbara Carothers, LPN, Public Health Representative 1

Transcription

1 Kim Cervantes, MPH, Coordinator / Regional Epidemiology Program Barbara Carothers, LPN, Public Health Representative 1

2 Overview NJDOH Outbreak Training 2013, Jan 2014 NJLMN Practice Exchange: NJACCHO Outbreak Investigation Training Presentations Spring 2014 CD Forum requested topic Today Who does what How we work together Working with school partners Resources for school outbreaks 2

3 Roles and Responsibilities Local responsibilities Health officers must ensure that personnel are available 24/7, including weekends and holidays, to receive and respond to immediately reportable disease notifications within their jurisdiction (NJAC 8: (d)) Who does what may have changed Regional Epidemiology Program Staff changes/departures Shared services Guidelines for Reporting and Investigating Immediately Notifiable Diseases & Outbreaks July

4 Partners in Outbreak Reporting and Investigation Reporting entities Healthcare providers Institutions (hospital, long term care facility, school, daycare, prisons, youth camps) Clinical laboratory directors Veterinarians, animal control officers County/Local health departments NJDOH Communicable Disease Service Other interested parties (restaurant, public) 4

5 Reporting requirements NJAC 8: requires that healthcare providers and administrators report immediately by telephone confirmed and suspected cases of the following reportable communicable diseases: Anthrax Hepatitis A Poliomyelitis Botulism Influenza, novel strains only Rabies, human illness Brucellosis Measles Rubella Diphtheria Meningococcal invasive SARS disease Foodborne intoxications Outbreaks of disease Smallpox Haemophilus influenzae Pertussis Tularemia Hantavirus Plague Viral hemorrhagic fevers 5

6 What is an outbreak? Which of the following should be reported as a possible outbreak? a. More than 15% school absenteeism b. An increase in illness over what is normally seen c. 1 case of lab confirmed scabies in a nursing home d. Both b and c e. All of the above 6

7 Labs, Providers, Veterinarians LHD State Department of Health 24/7 every day!

8 Off Hours Reporting local health departments ONLY Do hospitals, physicians, and facility administrators in your jurisdiction have a phone # to reach someone who can respond to an immediate disease report in the evenings and on weekends/holidays? a. Yes b. No c. I m not sure 8

9 Off Hours Reporting hospital/other partners ONLY Do you know how to reach your local health officer (or designee) in the evening and on weekends/ holidays? a. Yes b. No c. I m not sure 9

10 Outreach to reporting entities Don t assume! Public health partners need education on NJ reporting requirements HERCs, Regional Epidemiologists can assist LHDs need to provide business/off hours contact information to partners LINCS Coordinators Infection Preventionists Websites (internal and Office of Local Health) Local information added to magnets 10

11 CDRSS Notifications Reporting agencies are required to notify LHDs immediately by telephone However sometimes electronic laboratory reporting is the 1 st notification Where is suspected telephone call? CDRSS does not fulfill requirement of a telephone report 11

12 CDRSS E mail Alerts Local health officers and/or designee should receive e mail alerts for immediately reportable diseases Regional Epidemiologists can help set up e mail alerts Immediately reportable diseases entered into CDRSS should be immediately investigated by the LHD and reported to NJDOH 12

13 CDRSS E mail Alerts Do you personally or does someone in your health department receive CDRSS e mail alerts for immediately reportable diseases? a. Yes b. No c. I m not sure d. N/A (non LHD partners) 13

14 When reporting goes awry Reporting pathway as per regulation (24/7 response) Broken pathway Reports go directly to NJDOH NJDOH provides LHD contact information and may take initial report NJDOH will notify LHD by telephone for follow up If not reachable by telephone, an e mail will be sent to the HO and public health response actions may be taken by NJDOH 14

15 Reaching NJDOH 24/7 availability Business hours Calls are first routed to the Regional Epidemiology Program, then to disease primary staff CDS voic checked every 30 minutes Automated phone tree coming soon After hours : CDS staff rotate on call 15

16 MOVING FROM REPORTING TO INVESTIGATION 16

17 NJACCHO Performance Goals for Outbreak Tracking and Response Immediately report all suspected outbreaks to NJDOH Conduct an investigation of all suspected outbreaks within 24 hours of receipt of a report or notification Forward investigation summary reports to the NJDOH within 30 days of completion of the investigation Update the Red Book within 24 hours of change in personnel or contact information 24/7 3 by 3 (three contact persons with three contact methods) Ensure that all outbreak response team personnel are properly trained

18 Information to Collect when an Outbreak is Reported Some information varies by disease (known or unknown) and setting Investigation/ Outbreak Intake Record, Form # CDS 36 can help 18

19 Initial report to NJDOH Report and discussion of outbreak with regional epidemiologist Initial information obtained LHD investigator/point of contact identified Issues/concerns discussed Additional information needs identified Guidance and recommendations provided Frequency and method of outbreak updates determined REP next steps Issue an E# Notifications: health officer/investigator, CDS Program Staff, key external NJDOH staff (including long term care or daycare licensing staff) Consult with disease primary staff within CDS Provide additional guidance and resources 19

20 What happens after the initial report? Health officer or designee works closely with facility (or other setting) to monitor the progression and to ensure control measures are in place Frequent line lists Follow up on laboratory testing Review isolation recommendations, infection control measures, work/school exclusion policies, education, etc. Coordinate environmental response, e.g. restaurant inspection, food embargo, cleaning/disinfection procedures Modes of communication Telephone and e mail communication Site visit Updates provided to NJDOH 20

21 Roles of NJDOH/REP in outbreak monitoring Assist with defining case definition for outbreak Review line lists and outbreak information with LHD Recommend/facilitate diagnostic testing Develop Epi Curve and use other tools to help analyze outbreak progression and characteristics Provide recommendations for enhanced control measures Coordinate with NJDOH staff (e.g. CDS disease primary staff, licensing, FDSP) Facilitate conference call between NJDOH, LHD, and facility Participate with LHD on site visit when necessary Conduct epidemiological studies 21

22 Surge capacity If local health department resources are overwhelmed, discuss additional investigation assistance needs with Regional Epidemiologist Agreement on clear roles and responsibilities 22

23 Is it over yet? Consultation on when victory can be declared Rule of thumb 2 incubation periods with no new cases Health officers are required to submit an outbreak summary report within 30 days of closure Regional epidemiologists can assist Summary report template under development CDS 30: long term care facilities NORS: foodborne outbreaks 23

24 Non compliance NJDOH can work with licensing partners, when necessary to help reinforce public health recommendations during an outbreak Board of Medical Examiners Licensing for long term care facilities, daycare, acute care, youth camps Health Officers have legal authority to investigate outbreaks and implement control measures 24

25 SPECIAL ISSUES WHEN WORKING WITH DAYCARE FACILITIES AND SCHOOLS ON OUTBREAKS 25

26 Schools and School Like Settings Special settings are a special concern Can spread quickly to infect a population that may be vulnerable Child care center School Youth camp 26

27 Are you familiar with the NJDOH guidance for controlling outbreaks in school settings? 1. Yes 2. No 3. I m not sure 27

28 Is there an outbreak? Can be difficult to determine Several children with similar symptoms in same classroom or wing Increase in absenteeism with parents reporting similar symptoms Two or more students diagnosed with the same reportable disease A single case of a highly infectious disease is suspected Do not wait for confirmation 28

29 Outbreak and Case Reporting Mandated by New Jersey Administrative Codes and statutes. N.J.A.C. 6A:16 2 N.J.A.C. 10:122 N.J.A.C. 8:57 1 N.J.S.A. 18 A 29

30 INVESTIGATION ISSUES 30

31 Developing a case definition Criteria that a person meets to be counted as a case Clinical signs & symptoms, physical location, specific time period Each outbreak has a unique case definition Developed jointly with LHD, NJDOH, and school/daycare Example: nausea, vomiting, and/or diarrhea on or after mm/dd/yy in classroom XYZ 31

32 Sample Line List

33 Case Study Norovirus Outbreak in a Youth Camp Summer 2014 Challenges Combination inpatient/outpatient Lack of handwashing facilities Community dining/food service Rotating nurse Lack of reporting knowledge Constant influx of campers & counselors Late notification of outbreak to LHD 33

34 Epi Curve & Case Definition Camp mixer Notification Cleaning 34

35 Controlling the Outbreak Based on the setting, what control measures would you recommend? Site visit Installing portable sinks Suspending use of salad bar and self service foods Enhanced cleaning/disinfection No more cruisers Education welcome packet Exclusion/cohorting Parental notification 35

36 Control the outbreak NJDOH and LHD discuss guidance LHD works with school/daycare/camp to educate and recommend control measures Monitor effectiveness/ensure compliance 36

37 Exclusions 37

38 How long should Johnny be kept home? Appletree school has an ongoing flu outbreak. Johnny is sent home on Tuesday at 10:00am with fever and a cough. His fever resolves Tuesday at 9pm. When should he come back to school? 1. Wednesday 2. Thursday 3. Friday 4. Next week 5. He should be expelled from school 38

39 Closure NJDOH does not recommend school closure for outbreaks of infectious disease Administrative decision After consultation with public health officials and school district medical personnel 39

40 When might a Health Officer concur with the decision to temporarily close a daycare? a. Daycare unable or unwilling to institute control measures b. Terminal cleaning because a staff member has MRSA c. Facility unable to function due to increased illness affecting staff d. Both a and c e. All of the above 40

41 What is being reported this year? Gastrointestinal 25 Norovirus Coxsackievirus 25 Respiratory 9 ILI Strep Fifths Disease 6 41

42 Hand, Foot, and Mouth (HFMD) Coxsackie A16 most common Enterovirus 71 Coxsackie A6 Generally mild illness, young children Blisters, cold symptoms, fever Respiratory, contact, fecal oral Handwashing, respiratory etiquette, disinfection, avoid close contact with infected persons Exclude until fever free, no drooling due to mouth sores or other criteria 42

43 Reported HFMD Outbreaks # Reported Outbreaks Reported HFMD Outbreaks, (as of 9/4/14) /45 total reported outbreaks occurred between April October 43

44 Summary Guidance from the NJ DOH is available Communicate Get to know your schools, youth camps and day care centers Advise on policy development be prepared! Educate schools and daycares on NJ reporting requirements

45 Resources NJ Department of Health Centers for Disease Control and Prevention American Academy of Pediatrics Red Book ications.org/site/resources/ midsheets.xhtml 45

46 MOVING FORWARD 46

47 Interest Outbreak Case Study/Training Would you be interested in participating in a local communicable disease outbreak case study discussion/ exercise? a. Very interested b. Somewhat interested c. Not very interested d. Not interested 47

48 Upcoming activities under consideration Outbreak summary report template How to Report website and related magnet/materials Fact sheets for daycare and school outbreaks Outbreak Investigation Case Study Review 48

49 Thank you! Kim Cervantes Coordinator / Regional Epidemiology Program Kim.cervantes@doh.state.nj.us Barbara Carothers Public Health Representative Barbara.carothers@doh.state.nj.us Tel: