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Disease Surveillance Bioterrorism and Beyond

State and Local Public Health A Very Brief History. State Health Departments1855, Louisiana (quarantine in New Orleans)1869, Massachusetts responds to

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Disease Surveillance Bioterrorism and Beyond

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    1. Disease Surveillance Bioterrorism and Beyond Jeffrey Engel, MD Stephanie Kordick, DVM, MPH General Communicable Disease Control Epidemiology Section, DPH

    2. State and Local Public Health A Very Brief History State Health Departments 1855, Louisiana (quarantine in New Orleans) 1869, Massachusetts responds to “The Shattuck Report” of 1850 smoke control, food safety, health education Local health departments formed to combat “sanitary nuisances” Port cities: Yellow Fever, Malaria Guilford County, NC 1911: Hookworm

    3. Hookworm in Guilford County NC 1911 First County Health Department Created

    4. NC Public Health Law NC Statutes Laws passed by the legislature and signed by the governor Chapter 130A, NC Public Health Laws Article 6: most communicable disease law NC Rules Elaboration and explanation of statutes Force of law, easier to modify NCAC Title 15A, Chapter 19, Subchapter A

    5. NC Statutes www.ncleg.net

    6. NC Rules www.oah.state.nc.us

    7. Communicable Disease Reporting Passive Surveillance

    10. Who Reports? Physicians (GS 130A-135). School principals & DCC operators (GS 130A-136). Medical facilities may report (GS 130A-137).

    11. Who Reports? (continued) Operators of restaurants & other food or drink establishments (GS 130A-138): Outbreak or suspected outbreak. Infected food handler. Must call LHD within 24 hours. Not required to send CD report card.

    12. Who Reports? (continued) Laboratories: Report direct to DPH rather than LHD. May report electronically. List of reportable positive tests expanded considerably in 1998.

    13. Laboratory Surveillance 50 reportable communicable diseases Contributing Laboratories Local: Hospital, office, etc. State: SLPH Regional: Reference labs (LabCorps, ARUP, etc.) National: CDC Redundancy with GCDC (a good thing!)

    14. Laboratory Surveillance Expanded Capacity 2002 PHRSTs Regional Labs BT Response SLPH Foodborne bacterial illnesses PulseNet Enhanced arbovirus capacity Arbonet: West Nile, EEE, SLE Enhanced influenza capacity

    15. Remember…. A disease does NOT have to be reportable to be investigable!

    16. Communicable Disease Reporting Sentinel (Voluntary) Surveillance National Influenza Surveillance System 32 volunteer physician practices report to State weekly ILI: “influenza-like illness” fever >100° F sore throat and/or cough not explained by other causes Report: Ratio of ILI/Total visits (%)

    18. Planned NC Surveillance Enhancements Addition of new personnel Additional epidemiologic training Addition of new data sources New reporting and communications systems NEDSS HAN

    19. Surveillance Strategies Personnel Regional surveillance teams Public Health Epidemiologists in Health Care Systems NCDA Field Response Specialists (collaborators) State-level epidemiologists for surveillance

    20. Surveillance Strategies Training Combined detection/investigation training EpiInfo 2000 UNC course availability Ongoing updates in surveillance and outbreak investigation activities Information on diseases/conditions with BT potential

    21. Surveillance Strategies New Reporting Agencies Hospitals - IC, ED, ICU, etc. EMS providers Veterinarians Medical examiners Pharmacies Day care centers School nurses

    23. Surveillance Strategies Information Technology Health Alert Network (HAN) National Electronic Disease Surveillance System (NEDSS) Emergency Response Decision Support System/Data Warehouse (ERDSS) Other web-based, active systems for surveillance from multiple sources

    24. BT Information Technology-HAN Rapid reporting of events with BT potential or any event with public health significance Built in system for immediate notification of all responders (including non-public health)

    25. BT Information Technology-HAN Escalation pathway with independence at each level Will be extended to hospitals, private physicians, emergency responders, etc. in future phases

    26. BT Information Technology-NEDSS Initially Will be similar to our current system But will be electronic, not paper-based Future applications: Will allow for integration of active, syndromic, and other types of reporting modules Will connect with the HAN and send automated messages when unusual disease patterns emerge

    27. Emergency Department Data North Carolina Emergency Department Data project Based on CDC’s DEEDS data standards Linkages hospital discharge database trauma registries PreMIS database Daily data transfer initially

    28. EMS Data Prehospital Medical Information System Web-based electronic medical record system (currently fax also) Used by EMS providers 57 counties currently trained to use 27 counties actively using

    29. EMS Data Data immediately available for use and report-generating upon entry Data used for many purposes syndrome surveillance (public health) additional data for trauma care quality management outcomes data for EMS

    30. NC Public Health Response To Bioterrorism Surveillance System Enhancements: Additional personnel More training and exercises Rapid communication systems New reporting agencies Better reporting systems To create a more flexible, more sensitive, more timely, global surveillance system

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