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Module 5 Reporting identified cases

Module 5 Reporting identified cases. Recognition of a BT Event Surveillance/Detection. Goal is to detect unusual medical events sooner rather than later Depends on ability to identify a greater than expected number of “cases” or syndromes

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Module 5 Reporting identified cases

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  1. Module 5Reporting identified cases

  2. Recognition of a BT Event Surveillance/Detection • Goal is to detect unusual medical events sooner rather than later • Depends on ability to identify a greater than expected number of “cases” or syndromes • Requires sensitivity to unusual clusters of disease syndromes compatible with naturally occurring or bioterrorism related outbreaks

  3. Syndromic Surveillance • Traditional Public Health surveillance depends on labs and doctors reporting confirmed diseases (usually laboratory confirmed) • Syndromic surveillance identifies disease syndromes prior to confirmation • Goal is to identify an increase in diseasesyndromes, not confirmed case reports

  4. Syndromic Surveillance Potential information sources • Primary care clinic visits • Emergency room visits • Calls to poison control centers • Pharmacy visits/requests • Nurse hotline calls • 911 calls

  5. Syndromic Surveillance Sensitivity to unusual clusters of disease syndromes compatible with naturally occurring or BT-related outbreaks • Influenza-like illness • Invasive bacterial disease • Encephalitis/meningitis • Unexplained critical illness or death • Rash illnesses

  6. Connecticut Initiatives To Detect Sentinel Casesand Outbreaks Earlier • Special rash illness reporting by clinicians • Special gram positive rod reporting by labs • Hospital Admissions Syndromic Surveillance System • Pilot syndromic surveillance systems in selected emergency departments, managed care practices – mostly reactive

  7. Connecticut Initiatives To Detect Sentinel Casesand Outbreaks Earlier Connecticut Electronic Disease Surveillance System (CEDDS) • Electronic laboratory reporting • Web-based electronic hospital/provider reporting • Common DPH-LHD database

  8. Recognition of a BT Event Surveillance/Detection Identify local experts to assist with evaluation/diagnosis • Infectious disease specialists • Hospital epidemiology team • Public health

  9. Disease Surveillance and InvestigationLegal Basis in Connecticut • Disease and injury surveillance, reporting and investigation are governed by state laws and regulations. • The CT Department of Public Health is the agency responsible for this oversight. • State law authorizes the CT Department of Public Health and its commissioner to promote and protect the health of the people of CT and take measures needed to prevent disease and injury (Connecticut General Statutes Sec. 19a-2a)

  10. Disease Surveillance and InvestigationLegal Basis in Connecticut • Through a network of local and regional health departments in CT local health officers are charged with promoting health and investigating reports of and remedying conditions that threat health in their jurisdictions. (CGS Sec. 19a-200) • CT state law authorizes local directors to investigate reports of a disease or laboratory finding on the Commissioner's list of reportable diseases and laboratory findings and obtain information necessary to control further spread of the disease. (CGS Sec. 19a-207) • Local laws (town charters, ordinances) in Connecticut allow local directors of health to adopt and enforce regulations for the prevention and control of disease in the local jurisdiction.

  11. Disease Surveillance and InvestigationLegal Basis in Connecticut • Under its police powers the State has the authority to require health care providers to report new cases of diseases and certain laboratory findings. • Under Connecticut State law physicians, including health care agencies and institutions, and labs must report certain diseases of public health importance to the state health department and to the local health department. • Nurses need to be current on reporting requirements that may be imposed by state and local public health authorities.

  12. Disease Reporting in CT • Under CT law the Commissioner of Public Health is required to to publish annually in January of each year a list of reportable diseases and lab findings (Connecticut General Statutes Sec. 19a-2a and Sec. 19a-36-A2 of the CT Public Health Code) • An advisory committee of public health officials, clinicians, and laboratorians assists the Department in this process. • Reporting is submitted on Laboratory Report of Significant Findings form OL-15C or on Reportable Disease Confidential Case Report form PD-23.

  13. Disease Reporting in CT There are two category of disease reporting under CT Public Health Code regulations: • Category 1 disease findings are reportable immediately by telephone on the day of recognition or strong suspicion of disease. Reports are made to the DPH and local health departments. A Confidential Disease Report (PD-23) or more disease-specific report form must then be mailed to both the DPH and local health departments within 12 hours. • Bioterrorist Diseases are categorized as Category A, B and C

  14. Disease Reporting in CT Examples of Category 1 disease or lab findings are Chickenpox, Measles, Rubella, meningococcal disease, TB and diseases that are possible indicators of bioterrorism, such as anthrax, plague, smallpox, tularemia, botulism and VHF (Category A).

  15. Disease Reporting in CT • Category 2 disease findings are reportable by mail within 12 hours of recognition or strong suspicion to both the Department of Public Health (DPH) and local health department. Telephone reports of Category 1 disease should be made to the local director of health for the town in which the patient resides and to DPH. • Examples of Category 2 disease findings are: HIV, Lyme Disease, gonorrhea and syphilis,

  16. Disease Reporting in CT • For public health emergencies in CT, a State epidemiologist can be reached nights and weekends through the DPH emergency number (860-509-8000). • If terrorism is suspected, or there is evidence of crime, the FBI and other law enforcement agencies also become involved.

  17. HIPAA and Public Health Reporting Two provisions of the HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) OF 1996 regulations exempt public health information from coverage: • HIPAA regulations permit providers to disclose protected information for public health activities and public health purposes • State law governs the disclosure of medical information for purposes of public health surveillance, investigation or intervention.

  18. Disease Surveillance, Reporting and Investigationin Connecticut Health care agencies and institutions should have policies and procedures in place to guide employee action.

  19. Overview of Infection Control Activitiesin Health Care Facilities The Association for Professionals in Infection Control and Epidemiology (APIC) in cooperation with CDC offers a Bioterrorism Readiness Plan and Template to facilitate preparation for bioterrorism and readiness planning for individual medical institutions.The information for SLIDES 22-25, 27-29 and 31-38 and is derived from that template.

  20. Overview of Infection Control Activitiesin Health Care Facilities • Hospitals and clinics may have the first opportunity to recognize and initiate a response to a bioterrorism-related outbreak. • Healthcare facilities should have infection control (IC) policies in place authorizing the health care organization’s epidemiologist, IC committee chairman, or designee to rapidly implement prevention and control measures in response to a suspected outbreak.

  21. Overview of Infection Control Activities in Health Care Facilities Should a bioterrorist event be suspected, a network of communication must be activated to involve • IC personnel, • Health care administration, • Local and state health departments, • Federal Bureau of Investigation (FBI) field office, and • CDC

  22. Overview of Infection Control Activitiesin Health Care Facilities • Existing local emergency plans should be reviewed, and a multidisciplinary approach outlined that includes: • Local emergency medical services (EMS), • Police and fire departments, and • Media relations in addition to • Healthcare providers and • IC professionals. • Annual disaster preparedness drills held can improve response capacity by incorporating a bioterrorism scenario to test and refine Bioterrorism Readiness Plans and response at each individual facility.

  23. General Categorical Recommendations for Any SuspectedBioterrorism Event • Healthcare facilities may be the initial site of recognition and response to bioterrorism events. • If a bioterrorism event is suspected, local emergency response systems should be activated. • Notification should immediately include local infection control personnel and the healthcare facility administration, and prompt communication with the local and state health departments, FBI field office, local police, CDC, and medical emergency services.

  24. Contacts for an Event INTERNAL CONTACTS (fill in for your setting) INFECTION CONTROL ___-____ EPIDEMIOLOGIST ___-____ ADMINISTRATION/PUBLIC AFFAIRS ___-____ EXTERNAL CONTACTS: LOCAL HEALTH DEPARTMENT ___-____ (fill in for your setting) STATE HEALTH DEPARTMENT 1-860-509-7994 M-F 8:30am-4:30pm * STATE HEALTH DEPARTMENT 1-860-509-8000 Nights, weekends, holidays * CT DEPT. OF EMERG. MGT./ HOMELAND SECURITY 1-860-566-3180 FBI FIELD OFFICE 1-203-777-6311 BIOTERRORISM EMERGENCY NUMBER, CDC Emergency Response Office 770-488-7100 CDC HOSPITAL INFECTIONS PROGRAM 404/639-6413

  25. Recommended Activitiesin Health Care Facilities • Bioterrorism may occur as covert events, in which persons are unknowingly exposed and an outbreak is suspected only upon recognition of unusual disease clusters or symptoms. • Bioterrorism may also occur as announced events, in which persons are warned that an exposure has occurred.

  26. Recommended Activitiesin Health Care Facilities A healthcare facility’s Bioterrorism Readiness Plan should include details for management of both types of scenarios: 1. suspicion of a bioterrorism outbreak potentially associated with a covert event and 2. announced bioterrorism events or threats. The possibility of a bioterrorism event should be ruled out with the assistance of the FBI and state health officials.

  27. The Laboratory Response Network (LRN) • A multilevel network of local, state, and federal laboratories • Laboratories identified by increasing level of sophistication (A – D) • Facilitates sample collection, transport, testing, and training for laboratory readiness for bioterrorism

  28. The Laboratory Response Network for BT • Public and Private Labs • Test According to Consensus Protocols • Timely and Accurate Testing and Reporting • Linked with Local, State, and Federal Agencies

  29. Laboratory Criteria for Processing BT Agents To evaluate laboratory capacity laboratories are categorized into one of four levels, according to their ability to support the diagnostic needs presented by an event. • Level A: Clinical laboratories – minimal identification of agents • Level B: County/ State/ other laboratories identification, confirmation susceptibility testing ·

  30. Laboratory Criteria for Processing BT Agents (cont’d) · • Level C: State and other large facility laboratories with advanced capacity for testing – some molecular technologies • Level D: CDC or select Department of Defense laboratories, such as U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) – BioSafety Level (BSL) 3 and 4 labs with special surge capacity and advanced molecular typing techniques.

  31. LRN Laboratory Levels LEVEL D: CDC LEVEL C: Typing Labs, Public Health Labs LEVEL B: Public Health Labs LEVEL A: Clinical Labs

  32. LRN Laboratory Levels Archive. Perform high level characterization. Probe for universe of agents. Level D Labs- Work at BSL-4 Rapid identification. Rule-in and Refer. Level C Labs - Work at BSL-3 Perform susceptibility testing. Isolate. Identify.Rule-inandRefer. Level B Labs - BSL-3 Recommended Detect early (presumptive cases). Rule-out or Refer. Level A Labs - Assess Risks for Aerosols - Use BSL-2

  33. Laboratory Diagnosis of Category A Agents Resources for Testing and Referral The DPH State Laboratory is a Level C lab. Specimen packaging and transport • General information available at: 860-509-7994 Mon-Fri or 860-509-8000 evenings, weekends, or holidays • Specific information available from the state public health laboratory

  34. Laboratory Support and Confirmation Health care facilities should work with local, state and federal public health services to tailor diagnostic strategies to specific events. • Currently the Bioterrorism Emergency Number at CDC is at the Emergency Response Office, NCEH, (770) 488-7100 or the CT DPH Laboratory at (860) 509-8500 • In all cases of suspected bioterrorism, collect an acute phase serum sample to be analyzed, aliquotted, and saved for comparison to a later convalescent serum sample.

  35. Laboratory support and ConfirmationTransport Requirements • Specimen packaging and transport must be coordinated with local and state health departments, and the FBI. • A chain of custody document should accompany the specimen from the moment of collection. • For specific instructions, contact the Bioterrorism Emergency Number at the CDC Emergency Response Office, Tele. 770-488-7100 or the CT State Lab at (860) 509-8500 • Advance planning may include identification of appropriate packaging materials and transport media in collaboration with the clinical laboratory at individual facilities.

  36. Potential Nursing Rolesand Activities • Identification of cases • Time/place/person characteristics • Implementation of prevention and control procedures • Identification of possible outbreaks • Triage

  37. Potential Nursing Rolesand Activities (cont’d) • Interviewing and data collection • Data entry and analysis • Case contact tracing and identification • Case follow-up • Gather and package evidence • Observation, documentation, and preservation of evidence

  38. Resources CT Department of Public Health (860) 509-7994, Mon.-Fri. (860) 509-8000 Emergency Number - evenings, weekends and holidays http://www.dph.state.ct.us/ Reportable Diseases and Lab Findings Required by CT State Law (2004) http://www.dph.state.ct.us/BCH/infectiousdise/pdf/vol24no1.pdf Public Health Laboratory http://www.dph.state.ct.us/Laboratory/state_laboratory.htm

  39. Resources Centers for Disease Control and Prevention (CDC) http://www.bt.cdc.gov/ CDC Disease Surveillance http://www.bt.cdc.gov/episurv/index.asp#recognition CDC Laboratory Response Network http://www.bt.cdc.gov/lrn/factsheet.asp Outbreak Investigations-Field Epidemiology http://www.sph.unc.edu/nccphp/focus/issuelist.htm http://www.sph.unc.edu/nccphp/focus/issue1/index.htm

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