Division of Disease Control Epidemiology and infectious disease surveillance

1. Division of Disease ControlEpidemiology and infectious disease surveillance Michelle Feist Program Manager, NDDoH

2. Outline • Surveillance and Epidemiology • Disease and Outbreak Reporting • Current and Emerging Communicable Diseases

3. Epidemiology • The study of health related events in specific human populations

4. Edward Jenner (1749-1823) • Spent his whole career as a country doctor • Research was based on careful case-studies and clinical observation (>100 years before scientists could explain the viruses themselves) • Jenner inserted pus taken from a cowpox pustule on the hand of milkmaid Sarah Nelmes and inserted it into an incision on the arm of 8 yr old James Phipps. • 1840 the British government had banned alternative preventive treatments • "Vaccination," the word Jenner invented for his treatment (from the Latin vacca, a cow), was adopted by Pasteur for immunization against any disease.

5. John Snow (1813-1858) • He graduated M.D. of the University of London on 20 Dec. 1844 • Wave of Asiatic cholera first hit England in late 1831 • He interviewed the families of the victims. His research led him to a pump on the corner of Broad Street and Cambridge Street • Following an interview with the Board of Guardians of St. James's parish, on the evening of Thursday, 7th September, the handle of the pump was removed on the following day. •At the end of September the outbreak was all but over

6. Surveillance • Ongoing, systematic collection, analysis, and interpretation of outcome specific data for use in the planning, implementation, and evaluation of public health practice • The purposes of public health surveillance are to assess public health status, define public health priorities, evaluate programs, and stimulate research

7. Surveillance Objectives What do we want/need to know?

8. Public Health Surveillance • Assess status • Situational awareness • Define priorities • Severity, frequency, preventability, communicability, emerging issue • Monitor and evaluate programs • Conduct research • Identify problems

9. Data Sources • Morbidity Reports • Local • State • National • Mortality (death certificates) • Hospital Discharge • Behavioral Risk Factor Surveillance System (BRFSS) • Cancer Registry • Syndromic Surveillance • Special Studies • Other existing data sources

10. Surveillance Plan • Surveillance objectives • Determine event you want to study • Case definition • Criteria for clinical findings • Epidemiological features • Laboratory diagnosis • Data collection • Active vs passive surveillance • Timeliness • Sentinel surveillance • Data collection instruments • Test data collection system • Data analysis • Ensure data source and collection process are adequate

11. Surveillance Plan, cont. • Interpretation • Present information clearly • Know your audience • Dissemination • Facilitate implementation of public health action • Provide recommendations • Inform decision makers • Evaluation • Is surveillance objective being met • Is information useful • Should system be continued • System enhancements or revisions

12. Collect data for action!

13. Disease and Outbreak Reporting

14. What Do We Do • Epidemiology • The study of health related events in specified human populations • Surveillance • Systematic collection, analysis, interpretation and dissemination of data • Education • Develop recommendations, guidelines, policies, etc. • Health-care providers, nurses, infection preventionists, veterinarians, etc. • General public education

15. Disease Control Programs

16. Disease Control Programs • STD and Viral Hepatitis Program • Prevent infertility in females resulting from chlamdyia and gonorrhea infections • Reduce the incidence of chlamydia and maintain low rates of gonorrhea and early syphilis • Develop prevention and control activities to reduce the incidence of new hepatitis infections • HIV/AIDS, Ryan White and TB Program • Reduce the spread of HIV and monitor trends in ND • Provide benefits and services to assist people living with HIV/AIDS in North Dakota (Ryan White) • Provide surveillance, prevention programs and supervision of TB disease case management

17. Disease Control Programs, cont. • Immunization Program • Supplies free vaccines for children who are eligible for the Vaccines For Children (VFC) program • Coordinates investigations of vaccine-preventable diseases • Provides education about immunizations and vaccine-preventable diseases • Maintains and updates the North Dakota Immunization Information System (NDIIS) • Epidemiology and Surveillance Program • Provide surveillance and prevention programs for influenza, vector-borne diseases, healthcare-associated infections, antibiotic resistance and food-borne diseases • Provide general disease surveillance, support and education in North Dakota • Maintain division’s electronic disease surveillance system (MAVEN) and syndromic surveillance program

18. 74 infectious disease reporting requirements • 3 non-infectious disease reporting requirements: • Cancer • Tumors of the CNS • blood lead levels > 10g/dL

19. Disease Reporting Symptoms Identification & Reporting Follow-Up & Investigation Review & Analysis

20. Who Needs to Report? Statutory authority NDCC 23-07-01 • 1. All health care providers, including physicians, physician assistants, nurse • practitioners, nurses, dentists, medical examiners or coroners, • pharmacists, emergency medical service providers, and local health officers. • 2. The director, principal manager, or chief executive officer of: • a. Health care institutions, including hospitals, medical centers, clinics, • LTC facilities, assisted living facilities, or other institutional facilities; • b. Medical or diagnostic laboratories; • c. Blood bank collection or storage centers; • d. Public and private elementary and secondary schools; • e. Public and private universities and colleges; • f. Health or correctional institutions operated or regulated by municipal, • county or multicounty, state, or federal governments; • g. Funeral establishments and mortuaries; and • h. Child care facilities or camps.

21. Who Needs to Report? cont. 3. The state veterinarian, if the disease may be transmitted directly or indirectly to or between humans and animals. 4. A person having knowledge that a person or persons are suspected of having a reportable disease may notify the department and provide all information known to the person reporting concerning the reportable disease or condition of the person or persons. A person making a report in good faith is immune from liability for any damages which may be caused by that act.

22. Disease Reporting • Laboratory report (mail/fax/pick-up) • Morbidity report card (mail/fax/pick-up) • Online report card • Telephone call 800.472.2180 701.328.2378

23. Outbreak Reporting • Unusual disease clusters or outbreaks are reportable to the ND Dept of Health • Report of respiratory illness associated with unusually high mortality from a LTC facility • Outbreaks of any of the mandatory reportable diseases or conditions (definition of outbreak varies by disease, timing and setting) • Two cases of salmonella in a school classroom • Nosocomial outbreaks in institutions

24. Current and Emerging Communicable Diseases

25. National Centers for Disease Control and Prevention Infectious Disease issues of special concern • Antimicrobial resistance • Chronic viral hepatitis • Food safety • Healthcare-associated infections • HIV/AIDS • Respiratory infections • Safe water • Vaccine-preventable diseases • Zoonotic and vactorborne diseases

26. Emerging Diseases • Infections that have increased recently or are threatening to increase in the near future • New diseases (e.g., SARS, MERS-CoV) • Reappearing in an area (e.g., dengue, measles) • Organisms that have become resistant to antibiotics (e.g., staph, CRE/KPC)

27. Precipitating Factors for the Emergence of Disease in People • World-wide trade • Mass movement of people (leisure, work) • Urbanization (childcares, prisons, homeless shelters) • Environmental changes • Resource consumption • Demographic changes (aging, immunocompromised)

28. Zoonotic Diseases • Approximately 75% of recently emerging infectious diseases affecting humans are diseases of animal origin; approximately 60% of all human pathogens are zoonotic.

29. Past Zoonotic Agents Identified

31. Current Disease and Emerging Disease Priorities • Foodborne illness • Infections that spread in hospitals • Infections that are resistant to antibiotics • Deadly diseases • Diseases caused by contact with animals • Disease spread by mosquitoes, ticks and fleas

32. “The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow.” Dr. Joshua Lederberg, Nobel Laureate

33. Thanks for your time! Questions are Welcomed