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Annual Outbreak Report West Virginia, 2010. Sherif Ibrahim, MD, MPH Division of Infectious Disease Epidemiology May, 2011. Objectives. Describe 2010 Outbreaks Discuss types of outbreak reported in 2010 Describe healthcare-associated outbreaks (HAOs) Conclusions and lessons learned

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annual outbreak report west virginia 2010

Annual Outbreak Report West Virginia, 2010

Sherif Ibrahim, MD, MPH

Division of Infectious Disease Epidemiology

May, 2011

objectives
Objectives
  • Describe 2010 Outbreaks
  • Discuss types of outbreak reported in 2010
  • Describe healthcare-associated outbreaks (HAOs)
  • Conclusions and lessons learned
  • Recommendations
background
Background
  • In WV, outbreaks are reportable immediately to local health departments(LHDs)
  • LHDs are required to report outbreaks to Bureau for Public Health (BPH) within 60 minutes
  • LHDs report and investigate outbreaks with assistance from regional epidemiologists & BPH
  • There was a 13-fold increase in reported outbreaks from 2001 to 2010
summary outbreak data 2010
Summary Outbreak Data - 2010
  • 124 outbreaks were reported
  • 96 (77.4%) were confirmed
  • 28 (51%) counties reported outbreaks
  • Jurisdictions
    • 95 (99%) were limited to WV residents
    • 1 (1%) involved residents of other states
enteric disease outbreaks
Enteric Disease Outbreaks
  • Total: 35
  • 16 (29%) counties
  • 1 reported multi-state outbreak (CDC: Lead)
  • Norovirus and acute gastroenteritis: 28 (80%)
  • Acute gastroenteritis outbreaks were defined as “outbreaks of illness with short duration (2-3 or fewer days) and characterized by acute onset of vomiting and /or diarrhea and no laboratory confirmation”.
foodborne outbreaks salmonellosis
Foodborne Outbreaks – Salmonellosis
  • Salmonella serotype Enteritidis:
    • Family of 10 from 3 households
    • 6 cases (3 confirmed and 3 probable)
  • Salmonella serotype Montevideo:
    • One WV resident among 272 US residents
    • Traced to salami products containing contaminated imported black and red pepper.
foodborne outbreaks salmonellosis15
Foodborne Outbreaks – Salmonellosis
  • Salmonella serotype Enteritidis
    • 18 confirmed and 4 probable cases.
    • Case control study  illness associated with eating at multiple locations of a single chain restaurant
    • Lab (PFGL &MLVA) 11 isolates were identical
    • Identical to a 2009 outbreak strain associated with multiple locations of the same chain restaurant
    • Recommendations to the corporate
foodborne outbreak hepatitis a
Foodborne Outbreak – Hepatitis A
  • First Hepatitis A Outbreak
    • Two family members
    • Epi-link to a hepatitis A outbreak in a daycare in KY
    • Hepatitis A is asymptomatic in children

< 6 years in 70% of cases

foodborne outbreak hepatitis a17
Foodborne Outbreak – Hepatitis A
  • Second  Hepatitis A Outbreak
    • 11 cases
    • Delayed reporting (2 months)
    • Retrospective identification of several cases
    • Transmissionperson-to-person among friends and secondary spread to households
    • LHD press releases, education, outreach and community-wide vaccination
foodborne bacillus cereus
FoodBorne: Bacilluscereus
  • The outbreak
    • 10 family members  acute gastroenteritis
    • Pizza from a local restaurant
    • Laboratory testing of the patients was negative
    • Testing of the remaining pizza at OLS revealed contamination with Bacilluscereus
  • Bacillus cereus:
    • B. cereus is an aerobic, spore-forming, gram-positive rods
    • Food-poisoning can result from two types of toxins
    • Diarrheal syndrome : (incubation period of 10-12 hrs) associated with heat-labile (meat, stews, gravies)
    • Emetic syndrome: (incubation period of 1-6 hrs) associated with a heat-stable toxin (fried rice, meat, improper refrigeration)
rash illness outbreaks varicella
Rash Illness Outbreaks – Varicella
  • A ten-fold increase from 2009.
  • Varicella Vaccine Effectiveness Project:
    • Hired two full-time staff
    • Offered free laboratory testing
    • Active surveillance in WV public schools
    • Education campaign
    • Change in varicella outbreak definition for schools
  • 19 from schools and 1 from a community.
  • Lab testing
    • 7 laboratory confirmed
    • 3 negative or non-contributory
    • 10 did not have laboratory testing.
scabies outbreak
Scabies Outbreak
  • Incubation period: 2-6 weeks
  • Outbreak definition: 2 or more cases of scabies among residents/staff within 4-6 week
  • Confirm the diagnosis consult a dermatologist
  • Isolation /exclusion of ills  a day after effective treatment
  • Offer treatment to contacts /families
  • Provide education
  • Environmental measures
respiratory disease outbreaks
Respiratory Disease Outbreaks
  • Total 26 (27%)
  • Reported by 14 (25%) counties.
  • In 2009 53 respiratory disease outbreaks
  • No influenza outbreaks in 2010
upper respiratory illness uri
Upper Respiratory Illness (URI)
  • 16 outbreaks
  • 15 from LTCFs and one from a school
  • Case definition: new onset of at least two of the following symptoms:
      • Runny nose or sneezing
      • Stuffy nose / congestion
      • Sore throat / hoarseness
      • Difficulty swallowing
      • Dry cough, and/or cervical lymphadenopathy
  • Rule out allergy
  • Rule out influenza  fever of 100 or more
pertussis outbreaks
Pertussis Outbreaks
  • Total # 5
  • Reported by 4 Counties
  • 4 Communities and 1 daycare
  • No pertussis-related deaths
  • All outbreaks were PCR confirmed
  • Cyclical pattern every 3-5 years
  • Vaccine is not 100% effective
other outbreaks
“Other” Outbreaks
  • 2 outbreaks of conjunctivitis (pink eye)
  • Reported from schools
  • Laboratory testing
    • 1 was not done
    • 1 negative or non-contributory
  • Testing can be done for these outbreaks
  • Hand washing and environmental cleaning
healthcare associated outbreaks haos
Healthcare-Associated Outbreaks(HAOs)
  • Outbreaks where exposure / transmission is associated with healthcare facility(ies)
  • 43 (45%)
  • 16 Counties (29%)
  • 41 (95%) from LTCFs and 2 (5%) from hospitals.
  • 33 in 2009
  • 55 in the first 3 months, 2011(90% from LTCFs)
outbreak of human metapneumovirus
Outbreak of Human Metapneumovirus
  • URI outbreak in a LTCF complicated by pneumonia
  • AR: 47% and Death rate 1%
  • HMPV:
    • Identified in 2001
    • RNA virus related to RSV and PIV
    • Transmission: droplet and contact
    • Seasonality: winter and spring
    • IP: 2-8 days
    • At-risk populations: infants, children, elderly and LTCFs
    • Clinical presentation: URI, pharyngitis, pneumonia, bronchiolitis
    • CXR findings: diffuse interstitial infiltrates, hyperinflation
    • Precautions: standard and contact (droplet if indicated)
timeliness of outbreak reporting summary
Timeliness of Outbreak Reporting Summary
  • 81 (81.4%) outbreaks with complete data on date and time of reporting
    • Mean= 35.8 hours
    • Median= 1 hours
    • Range= 0 to 864 hours
    • 71 (88%)  same day notification
  •  15 (15.6%) outbreaks were missing info on date and/or time of reporting
timely reporting of outbreaks
Timely Reporting of Outbreaks
  • LHD is required to report outbreaks within 60 minutes under
    • Reportable disease rules
    • Threat preparedness funding
    • Program plan
timely reporting of outbreaks39
Timely Reporting of Outbreaks
  • Scientific and technical support
    • Case definition
    • Diagnosis and prevention measures
    • Descriptive epidemiology
    • Special studies if needed
  • Laboratory support
  • Resources support
  • Communication support
conclusions
Conclusions
  • Marked improvement in reporting and management of outbreaks in WV
  • Outbreak investigation requires:
    • Problem-solving skills, training and experience
    • Collaboration between epidemiology, laboratory and environmental
    • Collaboration between local, regional, healthcare providers, state, and CDC
  • Most HAOs are reported from LTCFs
recommendations
Recommendations
  • Report outbreaks to DIDE within 60 minutes
  • Use DIDE’s guidelines for outbreak investigation
  • Consult and get assistance from your regional epidemiologist (Field investigation, Training)
  • Training and education
  • Plan to improve your communication with LTCFs
  • Feedback information on outbreaks to reporting sources and other partners
  • Outbreaks = opportunities for improvements
slide42

Outbreak Report, West Virginia, 2010

http://www.wvidep.org/Portals/31/PDFs/IDEP/Outbreaks/2010_Final_%20Outbreak%20Report.pdf

Contact Information:

304-558-5358 OR 800-423-1271 (24/7)

Office:304-356-4074

Cell: 304-553-9165

sherif.m.ibrahim@wv.gov