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State of the State. APIC Meeting January 25, 2013. Agenda. 1:35 – 1:45 pm   Introduction and MEDSIS – Shoana/Sara 1:45 – 1:55 pm   Vaccine Preventable Disease – Karman Tam 1:55 – 2:05 pm   Cocci –Clarisse Tsang 2:05 – 2:15 pm   Flu – Shane Brady

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state of the state

State of the State

APIC Meeting

January 25, 2013

  • 1:35 – 1:45 pm   Introduction and MEDSIS – Shoana/Sara
  • 1:45 – 1:55 pm   Vaccine Preventable Disease – Karman Tam
  • 1:55 – 2:05 pm   Cocci –Clarisse Tsang
  • 2:05 – 2:15 pm   Flu – Shane Brady
  • 2:15 – 2:25 pm   HAI – Jason Lempp/Vinita Oberoi
  • 2:25 – 2:40 pm   Vector/RMSF – Selam Tecle and Erica Weis
  • 2:40 – 2:50 pm   Foodborne – Evan Henke
  • 2:50 – 3:05 pm   STD – Roxanne Ereth
  • 3:05 – 3:20 pm   HIV – Rick DeStephens
  • 3:20 – 3:35 pm   TB – Eric Hawkins
  • 3:35 – 4:00 pm   Questions
new year new medsis
New Year, New MEDSIS
  • Please remember to sign your new user agreement
  • For questions or MEDSIS access, please contact:
meaningful use
Meaningful Use
  • Public Health Objectives
    • Electronic Laboratory Reporting – currently accepting
    • Immunization Registry – currently accepting
    • Syndromic Surveillance – will be contacting hospitals shortly
vaccine preventable diseases apic state of the state january 25 2013

Vaccine Preventable DiseasesAPIC State of the StateJanuary 25, 2013

Karman Tam, MPH

Office of Infectious Disease Services

Arizona Department of Health Services

pertussis in arizona
Pertussis in Arizona

2012 (preliminary)


867 cases

160 confirmed

707 probable

  • 962 cases

507 confirmed

455 probable

pertussis testing
Pertussis Testing

mohave county pertussis outbreak
Mohave County Pertussis Outbreak

92 cases (72 confirmed, 20 probable) to date

calling all health care workers get vaccinated against pertussis
Calling All Health Care Workers! Get Vaccinated Against Pertussis!
  • Only 20% of HCW’s in the U.S. have received the adult vaccine for pertussis (Tdap)
  • Only ONE dose of Tdap is needed!

Protect yourself

Protect your patients and their families

Protect infants under <1 year old

  • According to the CDC, Tdap vaccination in adults:
    • Reduces incidence of pertussis in infants
    • Reduces complications in high-risk individuals
arizona partners against pertussis apap
Arizona Partners Against Pertussis (APAP)

Goal: Achieve 100% pertussis vaccination rate by April 1, 2013

Prize: Certificate of Participation, recognition on the website, and prizes/money

h flu type b hib in children 5 years
H. flu type B (Hib) in children <5 years



1 confirmed case

  • 2 confirmed cases

- 3 year old: fully immunized

- 4 month old: not vaccinated

meningococcal invasive disease
Meningococcal Invasive Disease



16 confirmed cases

  • 5 confirmed cases

3 serogroup C

1 serogroup Y

1 serogroup W135




2 confirmed cases

  • 2 confirmed cases (siblings)

7 year old:

PCR positive, not vaccinated

5 year old:

IgM positive, not vaccinated




0 cases

  • 3 confirmed cases (siblings)

9 year old:

IgM and PCR positive, not vaccinated

12 year old:

epi-linked, not vaccinated

13 year old:

epi-linked, not vaccinated


2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Guideline for infection control in health care personnel, 1998

arizona vaccines for children vfc program 2012

Arizona Vaccines For Children (VFC) Program2012

Arizona Immunization Program Office (AIPO)

Arizona Department of Health Services

Patty Gast, M.S., Office Chief (602)364-3639

vaccines distributed in 2012
Vaccines Distributed in 2012
  • The Arizona VFC Program provided 1,596,867 vaccines ($81,119,566) to more than 850 private and public immunization providers statewide in AZ
    • VFC vaccine is for children who are on AHCCCS, Native American or uninsured
    • 317 vaccine is used in AZ for non-VFC eligible children, such as for insured children who present at County Health Departments
vaccine policy changes in 2012
Vaccine Policy Changes in 2012

Important federal vaccine policies changes were instituted in October 1, 2012, as required by VFC:

  • Federal vaccine may no longer be used for PRIVATELY insured children.
    • Most county health departments are trying to develop a private stock of vaccine and insurance billing programs in order to continue serving privately insured children. County health departments are encountering significant challenges in developing these programs, and we are concerned about where these children can get immunized in the meantime.
vaccine policy changes
Vaccine Policy Changes
  • Upcoming mid-year 2013 – our federal vaccine can not be used for underinsured children in private provider offices.
    • However, a safety net for these children is being established: county health departments and 24 providers statewide are being deputized with authority from a Federally Qualified Health Center (FQHC) to use VFC vaccine on underinsured children. FQHCs and Rural Health Centers (RHCs) already have this authority.
    • This means that starting in July 2013 (approximately) underinsured children will have to pay out of pocket at their private provider’s office or go to a county, deputized provider, FQHC or RHC to receive free vaccine.
    • For now, in the first half of 2013, all providers should continue using our vaccine on underinsured children.
    • As the Affordable Care Act rolls out in 2014, there will hopefully be fewer and fewer underinsured children.
vaccine policy changes1
Vaccine Policy Changes
  • These policies have affected hospitals’ ability to participate in the Arizona VFC Program, as we previously supplied the Hepatitis B birth dose universally, but now we are not able to do so. Several hospitals have dropped out of the VFC Program, but are offering the birth dose to privately insured children at their own expense.
  • There will always be sufficient vaccine for VFC eligible children.
additional updates
Additional Updates
  • New ADHS manual for preventing perinatal hepatitis B virus infections:  with chapters specifically aimed at OBs, hospitals, pediatricians, and health departments. It can be found on the ADHS immunization website under AIPO Program Activities—perinatal hepatitis B prevention.
  • March of Dimes sponsoring coalition of 17 health care organizations entitled Arizona Partners Against Pertussis (APAP):  Contest to have employers get staff 100% immunized with Tdap.  Deadline April 1, 2013.  Details on TAPI’s website at 
  • AIPO started doing a small pilot project with a rural pharmacy to see if a pharmacy can serve as a VFC vaccine provider in Arizona.
  • FDA has approved Varizig (varicella immune globulin) for prophylaxis in high risk individuals, and has extended use to 10 days (MMWR March 30, 2012).
additional updates1
Additional Updates
  • Waiting for MMWR to publish provisional recommendations from ACIP vote on:
    • Tdap for every pregnant woman during every pregnancy
    • Measles recommendation changes, including MMR down to 6 months old for international travel and 2 doses of MMR for > 12 months old for international travel
  • ADHS study showed risk factors for having 1st hepatitis B vaccine >14 days versus 1st in 3 days.
    • Babies born to mothers with private insurance were twice as likely to miss the HBV vaccine birth dose
    • Babies born to mothers with complications during labor or delivery were more than twice as likely to miss the HBV vaccine birth dose than when the mother experienced no complications
additional updates2
Additional Updates
  • All influenza vaccines this season are trivalent. 
    • Looking to the future.  New influenza vaccines will likely be available next season
      • Live attenuated quadrivalent vaccines: both intranasal and injection.  (H1N1, H3N2, and 2 Bs)
      • First influenza vaccine grown with cell culture technology (dog kidney cells). No risk for egg allergic patients.

Thank you!

Please contact Karman Tam for more information:

(602) 364-0246

clarisse tsang mph acting program manager infectious disease epidemiology apic january 25 2013

Coccidioidomycosis in Arizona

Clarisse Tsang, MPH

Acting Program Manager

Infectious Disease Epidemiology

APIC: January 25, 2013

impact of cocci on arizonans
Impact of Cocci on Arizonans
  • 60% of all reported US cases are in Arizona
  • 2nd most commonly reported infectious disease
  • Symptoms last for a median of 4 months
  • In 2007, $83 million was spent on cocci for hospital visits
surveillance cocci case definition
Surveillance: Cocci Case Definition
  • Council for State and Territorial Epidemiologists (CSTE)
    • Updated in 2007
      • Clinical case definition
      • Lab criteria*
  • Arizona Department of Health Services (ADHS)
    • Since 1997
      • No clinical symptoms required
      • Lab criteria*

*Lab criteria for diagnosis includes either detection of IgM by immunodiffusion (ID), enzyme immunoassay (EIA), latex agglutination, or tube precipitin OR IgG by ID, EIA, or complement fixation (CF) OR cultural, histopathologic, or molecular evidence of Coccispecies

rates of reported cocci cases arizona 1990 2012
Rates of Reported Cocci Cases, Arizona, 1990-2012

Change in EIA Reporting

Lab Reportable

reported cocci cases age and gender
Reported Cocci Cases, Age and Gender

*2011 Numbers are provisional and have not been finalized

n/a = have not analyzed yet

reported cocci cases by age 2007 2011
Reported Cocci Cases by Age, 2007-2011

Reported cases per 100,000

provider education
Provider Education
  • Brochures and posters about cocci testing for providers
  • CME for the PCP:
  • Annual Valley Fever Awareness Week in November
public education
Public Education
  • Brochures with cocci info for the public
  • Video:

“Valley Fever:

The Impact on Arizonans”

  • ADHS website:
  • Valley Fever Center for Excellence:
thank you
Thank you!


Clarisse Tsang


influenza 2012 2013

Influenza: 2012-2013

Shane Brady, MPH

Influenza Epidemiologist

2012 2013 season
2012-2013 Season
  • Early flu season around the country
  • First case confirmed on October 30th, 2012 with activity intensifying in the last few weeks
  • Vaccine is a good match to all three circulating strains
    • an A/California/7/2009 (H1N1)pdm09-like virus
    • an A/Victoria/361/2011 (H3N2)-like virus
    • a B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses)
school surveillance
School surveillance
  • Approx. 300 schools around the state participate in an automated surveillance program that pulls data from the school nurses’ database
    • Analyzed weekly for influenza-like illness visits to school nurses’ office
    • Seeing a small increase in activity now
  • Some counties have additional school surveillance:
    • Maricopa: Has web-based system to collect information from participating schools on student absences due to ILI, respiratory diseases, GI diseases and other reasons. Plans to expand system.
pediatric flu associated mortality
Pediatric Flu-Associated Mortality
  • One case this season:
    • Yavapai County child 5 years old
    • PCR confirmed influenza A (H3) and RSV
    • Underlying conditions
    • Not vaccinated
antiviral resistance national
Antiviral resistance (national)

*Includes specimens tested in national surveillance and additional specimens tested at public health laboratories in four states (AZ, MD, NY, and PA) who share testing results with CDC.

Neuraminidase inhibitors continue to show very little resistance (e.g., Tamiflu).

Adamantanes are not usefulas high levels of resistance persist among 2009 influenza A (H1N1) and A (H3N2) viruses.

antiviral treatment
Antiviral Treatment

Clinical trials and observational data show that early antiviral treatment may do the following:

  • shorten the duration of fever and illness symptoms
  • reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, respiratory failure) and death
  • shorten the duration of hospitalization
cdc recommendations for influenza a ntiviral m edications for the 2012 2013 season
CDC Recommendations for Influenza Antiviral Medications for the 2012-2013 Season
  • Clinical benefit is greatest when antiviral treatment is administered early– ideally within 48 hours of symptom onset
  • However, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness and in hospitalized patients when started after 48 hours of illness onset
cdc recommendations cont d
CDC Recommendations (cont’d)

Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who

  • is hospitalized;
  • has severe, complicated, or progressive illness; or
  • is at higher risk for influenza complications. This list includes:

children younger than 2 years;[ii]adults aged 65 years and older;

  • persons with immunosuppression, including that caused by medications or by HIV infection;
  • women who are pregnant or postpartum (within 2 weeks after delivery);
  • persons aged younger than 19 years who are receiving long-term aspirin therapy;
  • American Indians/Alaska Natives;
  • persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40);

residents of nursing homes and other chronic-care facilities.

  • persons with the following conditions:
    • chronic pulmonary (including asthma)
    • cardiovascular (except hypertension alone)
    • renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus)
    • neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
additional updates3
Additional Updates
  • All influenza vaccines this season are trivalent. 
    • Looking to the future.  New influenza vaccines will likely be available next season
      • Live attenuated quadrivalent vaccines: both intranasal and injection.  (H1N1, H3N2, and 2 Bs)
      • First influenza vaccine grown with cell culture technology (dog kidney cells). No risk for egg allergic patients.
  • ADHS Weekly Activity Reports:

  • CDC Website:
thank you1
Thank you!

Shane Brady


healthcare associated infections program selected 2012 investigations

Healthcare Associated Infections Program:Selected 2012 Investigations

January 25th, 2013

APIC Grand Canyon

“State of the State”

Health Services Advisory Group

Jason Matthew Lempp, MPH

CDC/CSTE Applied Epidemiology Fellow

Healthcare Associated Infections Epidemiologist

Arizona Department of Health Services (ADHS)

Office of Infectious Disease Services

Jason Matthew Lempp, MPH

CDC/CSTE Applied Epidemiology Fellow

Outbreak Capacity Epidemiologist

Office of Infectious Disease Services

Arizona Department of Health Services

adhs healthcare associated infection hai program
ADHS & Healthcare Associated Infection (HAI) Program


  • Facilitate State HAI Advisory Committee
  • Provide infection prevention technical assistance
    • Education on best practices
    • Counties & facilities
  • Assist outbreak and exposure investigations
  • Monitor AZ public HAI data & reportable disease surveillance
  • Build partnerships and capacity to prevent HAIs


arizona hai advisory committee
Arizona HAI Advisory Committee
  • 2008 AZ Legislature – Infection Prevention and Control Advisory Committee (IPCAC)
  • Expanded to HAI Advisory Committee (2010)
    • Infection preventionists, Nurses, Doctors, Pharmacists, Epidemiologists, Medical industry reps, YOU?
    • Quarterly Meetings: March 18th, 2013
  • State HAI Coordinator – Vinita Oberoi – (602) 364-4561


Training & Education





Antimicrobial Stewardship

Long Term Care

2012 hai investigations
2012 HAI Investigations

~80 “outbreak” investigations initiated in HCFs

~75% GI related (typically Norovirus)

Primarily handled by county health depts

~10% Lice & Mite related (scabies)

~10% Vaccine Preventable or Respiratory

Influenza, Pertussis – Disease Specific Epis

These are some of the “Others”…

HAI “exposure investigations” ≠ “outbreaks”

mrsa pain management clinic
MRSA – Pain Management Clinic
  • Severe methicillin-resistant Staphylococcus aureus (MRSA) case led to concern of HAI by treating MD
  • 4 MRSA cases investigated at hospital, similar onsets
  • 3 received recent procedure at same outpatient clinic
    • sites of infection align with pain treatment injection sites
  • County and ADHS found infection control breaches
  • Single-dose vial of contrast media (radiologic imaging reagent) vial associated with cases seen at clinic
infection control issues
Infection Control Issues
  • Dilution of reagents:

not manufacturer’s


2) “Single-dose” vials used for more than one patient

Solution: Pharmaceutical Compounding –

Sterile preparation by licensed

pharmacy or reagent laboratory

3)Insufficient PPE (respirators) during spinal injections


Contrast Media Reagent

quick 2x2 statistical tests


Quick 2x2 Statistical Tests



28 Patients seen at clinic on same DOS as 3 cases


10 Patients received contrast media injections (*)



“Morning” versus “Afternoon” Contrast separation




  • Patient 15


  • Patient 21

Fisher exact: 0.0024*

Fisher exact: 0.073


  • Patient 26





National picture:

Single-dose vials & HAI education campaigns

Medication shortage of appropriate doses/concentrations

hepatitis b dialysis ward
Hepatitis B – Dialysis Ward
  • Hepatitis B virus (HBV) infected, dialysis patient
    • out of state visitor to AZ, no medical records
  • Admitted at hospital, received 9 sessions of dialysis
    • Initial unknown HBV status = received testing
    • Upon blood borne pathogen (BBP) lab results, HBV+ not communicated – no dedicated machine/HCW
  • 13 dialysis patients used shared dialysis machine
infection control issues1
Infection Control Issues
  • Unknown BBP status should (ideally) receive lab results prior to receipt of hemodialysis
  • Unknown hepatitis status requiring dialysis should have dedicated station, machine and HCW
  • Increased terminal cleaning for unknown & HBV+
  • BBP results not communicated to nursing staff





ADHS Infection Control Technical Assistance Visit:

Division of Licensing Services Surveyors with

Office of Infectious Disease Services Epidemiologists

Improved practices with facility

No resultant seroconversions





hepatitis c multi state investigation
Hepatitis C – Multi-State Investigation
  • National investigation of hepatitis C virus (HCV) infected traveling HCW, alleged drug diverter
  • 8 states affected, with 17 facilities (AZ = 2)
  • Thousands of patients since 2005 notified
  • Over 30 patients with linked genotypes (NH, KS)
infection control issues2
Infection Control Issues
  • Protocols/systems to monitor narcotics
    • Automated dispensing cabinets
    • Limited access to non-essential staff
  • Other issues brought to light:
    • Employee screening?
    • Background checks?
    • National registry for HCWs?


Results of HCV testing of two Arizona facilities for patients with exposure to injectable narcotics and cardiac cathiterization lab or other high-risk units

*Positive patient not same genotype as HCW – not linked to NH cluster

** 132 patients calls made by ADHS and LHD – many disconnected #’s

No evidence to support that HCV transmission

occurred due to traveling HCW exposure

National investigation is still ongoing

blood borne pathogen exposure laryngoscope processing
Blood Borne Pathogen Exposure &Laryngoscope Processing
  • LHD contacted ADHS about a outpatient clinic identified by “parent” HCF of gap in infection control
  • Laryngoscopes are semicritical items, requiring “high-level” disinfection – this scope was reportedly cleaned with alcohol but did not routinely receive this level of cleaning.
  • Procedural gap 2008 – 2012
  • +500 patients exposed

high level disinfection
High Level Disinfection
  • High-level disinfection: complete elimination of all microorganisms in or on an instrument, except for small numbers of bacterial spores.
  • The FDA definition: a sterilant used for a shorter contact time to achieve a 6-log10 kill of an appropriate Mycobacterium species. Cleaning followed by high-level disinfection should eliminate enough pathogens to prevent transmission of infection.

why bbp testing
Why BBP Testing?
  • Last DOS 7/12 – most bacterial infections would present by now, leaving primary BBPs – Hepatitis B, Hepatitis C, and HIV
  • Over 200 patients have been tested to date. A small number of patients (< 1%) have been identified with HCV antibody positive results – indicating past or current HCV infection.
  • Investigation ongoing to identify presence or absence of HCV prior to DOS
  • ~3.25% of birth cohort 1945-1965 are anti-HCV (+) = 2.74 million
  • ~75% of which have chronic HCV infection = 2.0 million

contaminated mpa x 2
Contaminated MPA x 2

National Recall: New England Compounding Center

Contaminated methylprednisolone (MPA) –

None distributed or “used” in AZ

Patients receiving injections in other states (n = 4)

2 “cases”; 2 “non-cases” with similar Sx

Regional Recall: Nevada compounding center

“Contaminated” methyprednisolone – AZ MDs contacted

0 infections; NV investigation = lab contaminant?

thank you2
Thank You

HAI Advisory Committee and Subcommittee Members

Counties helping our prevention and education campaigns

Counties and facilities who worked with us on these investigations (you know who you are!)

CDC – Division of Healthcare Quality Promotion

Division of Viral Hepatitis

ADHS – Office of Infectious Disease Services



Jason Matthew Lempp

(602) 364-0780

2012 arizona vector zoonotic diseases update

2012 Arizona Vector/Zoonotic Diseases Update

Selam Tecle, MPH

VBZD Epidemiologist

Office of Infectious Disease Services

Arizona Department of Health Services

2012 brucellosis cases
2012 Brucellosis Cases
  • 6 cases reported
    • 5 Maricopa County, 1 Pinal County
  • Demographics
    • 4 female, 2 male
    • Age range: 30 – 69 years; mean: 51 years
  • 4 cases reported consumption of unpasteurized cheese produced out of the country
    • One case had past exposure to livestock in Guatemala
  • No local high risk exposures reported
2012 hantavirus cases
2012 Hantavirus Cases
  • 1 case (fatal) reported
      • Apache County resident
  • Demographics
    • Male
    • 62 years old
  • Reported exposure to mouse droppings at different locations all within the county
  • Important to remind residents to take precautions when cleaning rodent infested areas
2012 lyme disease cases
2012 Lyme Disease Cases

13 cases of Lyme Disease were reported in Arizona by following counties:

  • 2 Cochise
  • 1 Coconino
  • 2 Maricopa
  • 1 Mohave
  • 1 Navajo
  • 3 Pima
  • 3 Yavapai

All cases had travel history to one of the following endemic areas:

  • Minnesota
  • New York
  • California
  • Maine
  • Rhode Island
  • Massachusetts
  • Pennsylvania
  • Germany
  • Canada

*Lyme Disease is not endemic to Arizona. Evidence of the vector (Ixodespacificus)has only been found in Mohave County at the top of the Hualapai Mountains.

2012 q fever update
2012 Q Fever Update
  • 4 cases reported
    • 2 Maricopa County
    • 2 Pima County
  • Demographics
    • All male
    • Age range: 32-70; median age: 34
  • No local high risk exposures reported
2012 rabies update
2012 Rabies Update

Exposure to Lab Confirmed Rabid Animals:

  • 7Humans
  • 25 Domestic Animals

0 Human cases

0 Domestic animal cases

rocky mountain spotted fever update
Rocky Mountain Spotted Fever Update
  • 43 cases (3 deaths) reported in 2012
      • 287 suspect cases still under investigation
  • Statewide plan
  • CDC best practices for prevention and spread
  • In-service training at hospitals
  • Ensure continuity of care for transfer cases from tribal health facilities
2012 west nile virus update
2012 West Nile Virus Update
  • 132 human cases (7 deaths) reported in Arizona
    • La Paz, Maricopa, Mohave, Pima, Pinal, Yuma
    • 82 (62%) reported were neuroinvasive
  • 5,387 cases reported nationally (243 deaths)
  • 189 positive mosquito pools
    • Apache, La Paz, Maricopa, Pima, Pinal, Yavapai, Yuma

Contact Information:

Selam Tecle,

o: (602) 364-3890

foodborne disease outbreaks what we d o with your r eports

Foodborne Disease Outbreaks:What We Do with Your Reports

Evan Henke, PhD, MPH

Arizona Department of Health Services

APIC 2013

January 25, 2013

reportable food and waterborne diseases
Reportable Food and Waterborne Diseases
  • Amebiasis
  • Botulism
  • Campylobacteriosis
  • Cholera
  • Cryptosporidiosis
  • Cysticercosis
  • Encephalitis, parasitic
  • Enterohemorrhagic E. coli
  • Enterotoxigenic E. coli
  • Giardiasis
  • Hemolytic Uremic Syndrome
  • Hepatitis A
  • Hepatitis E
  • Listeriosis
  • Salmonellosis
  • Taeniasis
  • Trichinosis
  • Typhoid Fever
  • Vibrio infection
  • Yersiniosis
why we collect disease reports
Why we collect disease reports
  • To study trends, measure success, and identify opportunities
  • To detect and stop outbreaks
  • To prevent future food safety failures
what we do with your hard work
What we do with your hard work

Healthcare Providers/Labs


ADHS Epidemiology

ADHS State Lab

counties interview cases you see
Counties Interview Cases You See

ADHS Epidemiology

County Health Dept.

state lab fingerprints the pathogen
State Lab Fingerprints the Pathogen

ADHS State Lab

Pattern: JEGX01.0004

  • PFGE Lab
  • Salmonella
  • Shiga-toxin producing E. coli
  • Listeria

ADHS Epidemiology

clusters of illness are defined
Clusters of Illness are Defined

Salmonella Enteriditis JEGX01.004

Summer 2010


Clusters of Illness are Defined

Salmonella Saintpaul JN6X01.0048

Summer 2008

clusters of illness are defined1
Clusters of Illness are Defined

Salmonella Poona JL6X01.0018

Fall 2012

clusters of illness are defined2
Clusters of Illness are Defined

Salmonella Poona JL6X01.0018

epidemiology investigates clusters
Epidemiology Investigates Clusters

ADHS Epidemiology

Case 1:


Case 2:


Case 3:


our challenges
Our Challenges


  • Capture all cases
  • PFGE all specimens
  • Interview all individuals

BIG Challenges:

  • Non-culture methods
  • Staffing
  • Complex Food Supply Chain
arizona case definitions and exclusion rules http www azdhs gov phs oids pdf casedefinitions pdf


Arizona case definitions and exclusion rules

Evan Henke, PhD, MPH

Foodborne Disease Epidemiologist

arizona department of health services std control program

Arizona Department of Health Services STD Control Program

2013 APIC State of the State

January 25, 2013

std reporting requirements
STD Reporting Requirements
  • Reportable sexually transmitted diseases to local health department/ADHS (within 5 working days):
    • Chlamydia (genital)
    • Gonorrhea
    • Syphilis
    • Herpes genitalis
    • Chancroid
program responsibilities
Program Responsibilities
  • Monitor, control, and prevent sexually transmitted diseases through education of those at risk.
  • Detect asymptomatic and symptomatic infected individuals.
  • Diagnosis and treat those who are infected.
  • Evaluate, treat and counsel sex partners of persons who have a sexually transmitted disease.   
program targets
Program Targets
  • Adolescents and Young Adults
  • Men Who have Sex With Men
  • Multi-Drug Resistant Gonorrhea
  • Congenital Syphilis
ChlamydiaAnita Betancourt, Epidemiologist/IPP Coordinator/Chlamydia SurveillanceAnita.Betancourt@azdhs.gov602-540-9595
cdc recommendation

CDC Recommendation

CDC recommends annual screening of chlamydia for all sexually active females 25 and under and for women older than 25 with risk factors such as a new sex partner or multiple partners.



Joe Mireles, Epidemiologist/Syphilis Surveillance




Kunuwo Fokong, Epidemiologist/Gonorrhea Surveillance


treatment of suspected resistance
Treatment of Suspected Resistance
  • The Centers for Disease Control and Prevention (CDC) and the Arizona STD Control Program recommend the following in cases of suspected cephalosporin treatment
    • If the patient has not already been treated with ceftriaxone 250 mg, then treat with ceftriaxone 250 mg IM x 1 AND azithromycin 1 gram orally in a single dose.
    • Perform a test of cure with culture and antibiotic susceptibility testing (before re-treating).
    • Inform your local health department.
    • For clinical consultation call the STD Program's Medical Epidemiologist at (602) 372-2544
    • In patients who have already been treated with the recommended ceftriaxone regimen whose symptoms do not resolve after treatment, please call (602) 372-2544 for clinical consultation.
  • Emphasize that patients should abstain from oral, vaginal, or anal sex until one week after the patient and all of his/her partners are treated.
  • Roxanne Ereth, Manager
    • 602-364-3661
  • Melanie Taylor, MD
    • mdt7@CDC.GOV
    • 602-372-2544
  • Kerry Kenney, CDC Senior PHA/Syphilis Coordinator
    • 602-364-2124
  • Arshad Aziz, Epidemiologist/Data Manager
    • 602-364-4759
  • Anita Betancourt, Epidemiologist/IPP Coordinator/Chlamydia Surveillance
    • 602-540-9595
  • Joe Mireles, Epidemiologist/Syphilis Surveillance
    • 602-364-4565
  • Kunuwo Fokong, Epidemiologist/Gonorrhea Surveillance
    • 602-364-4761

To the incredible staff in the ADHS STD Control Program.


arizona hiv aids data january 2013

Arizona HIV/AIDS DataJanuary 2013

Rick DeStephens

HIV Epidemiology


Arizona Prevalent HIV, AIDS Cases

December 2004 – June 2012


Arizona Emergent HIV/AIDS Rate by County 2006-2010

State Emergence Rate = 10.96

Correctional Dx:

*68% of Pinal County

**36% of Graham County


Arizona Emergent HIV/AIDS Cases, by County 2006-2010

Correctional Dx:

*68% of Pinal County

**36% of Graham County


Arizona 5-Year New HIV/AIDS Rate by Race/Ethnicity, 1990-2011

*Non-Hispanic, A/PI/H=Asian/Pacific Islander/Native Hawaiian, AI/AN=American Indian/Alaska Native


Female United States and Arizona Estimates of New HIV Infections, By Transmission Category

IDU = Injection Drug UserNRR =No Risk Reported

az hiv epi on the web
AZ HIV Epi On the Web

how you can help
How you can help:
  • Race
  • Risk
  • Earliest positive HIV test dates
  • Latest negative test date
this data brought to you by
This data brought to you by…

Your friendly state disease investigators.

Julia (Capacity)

Mersija (Core)


tuberculosis in arizona

Tuberculosis in Arizona

Tuberculosis Control Program

Arizona Department of Health Services

interferon gamma release assays
Interferon-Gamma Release Assays
  • Two IGRAs available and FDA approved
    • QuantiFERON-TB Gold In-Tube test (QFT-GIT)
    • T-SPOT.TB (T-Spot)
  • Each of the tests measure different aspects of the immune response
    • Results might not be interchangeable
    • Different tests can yield different results
general recommendations for use of igras
General Recommendations for Use of IGRAs
  • Used as aids in diagnosing infection with M. tuberculosis
  • Should not be used for testing those at low risk for both infection and progression
    • Same recommendation for TST
  • IGRA lab testing availability should be determined prior to testing
test selection
Test Selection
  • An IGRA may be used in place of (but not in addition to) a TST in all situation in which CDC recommends a TST
  • Even in special circumstances, either test is considered acceptable medical and public health practice
either tst or igra
Either TST or IGRA
  • Contacts to an active case
  • Periodic screenings for occupation exposures
    • Healthcare workers
    • Two-step testing not needed with IGRA
      • IGRAs do not have booster effect
    • IGRAs may produce more conversions
new ltbi treatment
New LTBI Treatment
  • 3HP
    • Combination of Isoniazid & Rifapentine
  • Once weekly dose for 12 weeks
    • Must be given by DOT
    • Healthy patients ≥ 12 years of age