REPORTABLE DISEASESand the Laboratorian Link to

Disease Prevention

BRETT OAKLANDDisease Intervention SpecialistOffice of Disease Prevention

South Dakota Department of Health

OBJECTIVES

Reportable Disease ListWho – What – Where – When – Why – How

Relate lab report to disease investigationThe importance of complete, accurate,

and timely reporting.

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OBJECTIVE

Reportable Disease ListWho – What – Where – When – Why – How

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Category I diseases Report immediately on suspicion of disease Send isolate to SD Public Health Laboratory

Category II diseases Report within 3 days

Send isolate or specimen to SD Public Health Laboratory

Anthrax (Bacillus anthracis)

Botulism (Clostridium botulinum)

Brucellosis (Brucella species)

Diphtheria (Corynebacterium diphtheriae)

E. coli, shiga toxin-producing (Escherichia coli), includes E. coli O157:H7, O26, O111, O103 and others.

Influenza, novel strainsMeasles (Paramyxovirus)

Meningococcal disease, invasive (Neisseria meningitidis)

Plague (Yersinia pestis)

Poliomyelitis, paralytic (Poliovirus)

Rabies, human and animal (Rhabdovirus)

Rubella and congenital rubella syndrome (Togavirus)

SARS (Severe Acute Respiratory Syndrome, Coronavirus)

Smallpox (Variola)

Tularemia (Francisella tularensis)

Viral Hemorrhagic Fevers (Filoviruses, Arenaviruses)

Yellow fever (Flavivirus)

Outbreaks of: Acute upper respiratory illness; Diarrheal disease; Foodborne disease;Illnesses in child care setting; Nosocomial illness; Rash illness; Waterborne disease.

Syndromes suggestive of bioterrorism and other public health threatsUnexplained illnesses or deaths in human or animal

Acquired immunodeficiency syndrome (AIDS)Anaplasmosis (Anaplasma phagocytophilum)Arboviral encephalitis, meningitis and infection (West Nile,

St. Louis, Eastern equine, Western equine, California, Japanese, Powassan)

Campylobacteriosis (Campylobacter species)Chancroid (Haemophilus ducreyi)Chicken pox/Varicella (Herpesvirus)Chlamydia infections (Chlamydia trachomatis)Cholera (Vibrio cholerae)Cryptosporidiosis (Cryptosporidium parvum)Cyclosporiasis (Cyclospora cayetanensis)Dengue fever (Flavivirus)Drug resistant organisms:- Methicillin-resistant Staphylococcus aureus (MRSA),

invasive-Vancomycin-resistant and -intermediate

Staphylococcus aureus (VRSA and VISA)

Ehrlichiosis (Ehrlichia species)Giardiasis (Giardia lamblia / intestinalis /

duodenalis)Gonorrhea (Neisseria gonorrhoeae)Haemophilus influenzae type b, invasiveHantavirus pulmonary syndrome (Hantavirus)Hemolytic uremic syndromeHepatitis, viral, acute A, B and C; chronic B and C; and perinatal BHuman immunodeficiency virus (HIV) infection, also

including:- CD4 counts in HIV infected persons, - HIV viral loads, and - pregnancy in HIV infected females

Influenza: including hospitalizations, deaths, lab confirmed cases (culture, DFA, PCR), weekly aggregate totals of rapid antigen positive (A and B) and total tested

Legionellosis (Legionella species)Leprosy/Hansen’s disease (Mycobacterium leprae)Listeriosis (Listeria monocytogenes)Lyme disease (Borrelia burgdorferi)Malaria (Plasmodium species)Mumps (Paramyxovirus)Pertussis (Whooping cough) (Bordetella pertussis)Polio, nonparalytic (Poliovirus)Psittacosis (Chlamydophila psittaci)Q fever (Coxiella burnetii)Rocky Mountain spotted fever (Rickettsia rickettsii)Salmonellosis (Salmonella species)Shigellosis (Shigella species)Streptococcus pneumoniae, invasiveSyphilis (Treponema pallidum) including primary,

secondary, latent, early latent, late latent, neurosyphilis, late non-neurological, stillbirth, and congenital

Tetanus (Clostridium tetani)Toxic shock syndrome (Streptococcal and non-Streptococcal)Transmissible spongiform encephalopathies, such as Creutzfeldt-

Jakob diseaseTrichinosis (Trichinella spiralis)Tuberculosis, active disease (Mycobacterium tuberculosis or

Mycobacterium bovis); Tuberculosis, latent infection (in certain high risk

persons: foreign-born <5 yrs in US, close contacts, diabetes, renal dialysis, children <5 yrs, and certain medical conditions)

Typhoid (Salmonella typhi)Vaccine Adverse Events

Reportable Diseases – South Dakota

How to report: Secure website: sd.gov/diseasereportTelephone: 605-773-3737 or 800-592-1861 or for communicable disease staff person during normal business hours,

or 800-592-1804 confidential answering device, After hours Category I diseases, call 605-773-3737 or 800-592-1861

Fax: 605-773-5509Mail or courier to: Infectious Disease Surveillance, Department of Health, 615 East 4th Street, Pierre, SD 57501;

marked "Confidential Disease Report"What to report: Reports must include as much of the following as known:

- Disease or condition, - Case name, age, birth date, sex, race, address, occupation,- Date of disease onset, - Attending physician’s name, address and phone number,- Relevant lab results & specimen collect date, - Name and phone number of person making report.

Effective 2 August 2011

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Category I diseases Report immediately on suspicion of disease Send isolate to SD Public Health Laboratory

Anthrax (Bacillus anthracis)

Botulism (Clostridium botulinum)

Brucellosis (Brucella species)

Diphtheria (Corynebacterium diphtheriae)

E. coli, shiga toxin-producing(Escherichia coli), includes E. coli O157:H7, O26, O111, O103 and others.

Influenza, novel strains

Measles (Paramyxovirus)

Meningococcal disease, invasive (Neisseria meningitidis)

Plague (Yersinia pestis)

Poliomyelitis, paralytic (Poliovirus)

Rabies, human and animal (Rhabdovirus)

Rubella and congenital rubella syndrome(Togavirus)

SARS (Severe Acute Respiratory Syndrome,Coronavirus)

Smallpox (Variola)

Tularemia (Francisella tularensis)

Viral Hemorrhagic Fevers (Filoviruses, Arenaviruses)

Yellow fever (Flavivirus)

Outbreaks: Acute upper respiratory illness; Diarrheal disease; Foodborne disease;Illnesses in child care setting; Nosocomial illness; Rash illness; Waterborne disease.

Syndromes suggestive of bioterrorism and other public health threats

Unexplained illnesses or deaths in human or animal

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Category II diseases Report within 3 days

Send isolate or specimen to SD Public Health Laboratory

Acquired immunodeficiency syndrome (AIDS)Anaplasmosis (Anaplasma phagocytophilum)Arboviral encephalitis, meningitis and infection

(West Nile, St. Louis, Eastern equine, Western equine, California, Japanese, Powassan)

Campylobacteriosis (Campylobacter species)Chancroid (Haemophilus ducreyi)Chicken pox/Varicella (Herpesvirus)Chlamydia infections (Chlamydia trachomatis)Cholera (Vibrio cholerae)Cryptosporidiosis (Cryptosporidium parvum)Cyclosporiasis (Cyclospora cayetanensis)Dengue fever (Flavivirus)Drug resistant organisms:- Methicillin-resistant Staphylococcus aureus(MRSA), invasive

-Vancomycin-resistant and -intermediate Staphylococcus aureus (VRSA and VISA)

Ehrlichiosis (Ehrlichia species)Giardiasis (Giardia lamblia / intestinalis / duodenalis)Gonorrhea (Neisseria gonorrhoeae)Haemophilus influenzae type b, invasiveHantavirus pulmonary syndrome (Hantavirus)Hemolytic uremic syndromeHepatitis, viral, acute A, B and C; chronic B and C; and

perinatal BHuman immunodeficiency virus (HIV) infection, also

including:- CD4 counts in HIV infected persons, - HIV viral loads, and - pregnancy in HIV infected females

Influenza: including hospitalizations, deaths, lab confirmed cases (culture, DFA, PCR), weekly aggregate totals of rapid antigen positive (A and B) and total tested

Legionellosis (Legionella species)Leprosy/Hansen’s disease (Mycobacterium leprae)Listeriosis (Listeria monocytogenes)Lyme disease (Borrelia burgdorferi)Malaria (Plasmodium species)Mumps (Paramyxovirus)Pertussis (Whooping cough) (Bordetella pertussis)Polio, nonparalytic (Poliovirus)Psittacosis (Chlamydophila psittaci)Q fever (Coxiella burnetii)Rocky Mountain spotted fever (Rickettsia rickettsii)Salmonellosis (Salmonella species)Shigellosis (Shigella species)Streptococcus pneumoniae, invasiveSyphilis (Treponema pallidum) including primary,

secondary, latent, early latent, late latent, neurosyphilis, late non-neurological, stillbirth, and congenital

Tetanus (Clostridium tetani)Toxic shock syndrome (Streptococcal and non-

Streptococcal)Transmissible spongiform encephalopathies, such as

Creutzfeldt-Jakob diseaseTrichinosis (Trichinella spiralis)Tuberculosis, active disease (Mycobacterium

tuberculosis or Mycobacterium bovis); Tuberculosis, latent infection (in certain high risk

persons: foreign-born <5 yrs in US, close contacts, diabetes, renal dialysis, children <5 yrs, and certain medical conditions)

Typhoid (Salmonella typhi)Vaccine Adverse Events

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Who reports-- by law --

The South Dakota Department of Health is authorized by SDCL 34-22-1 and ARSD 44:20 to collect and process mandatory reports of communicable diseases by physicians, hospitals, laboratories, and other institutions. Health care facilities defined in SDCL 34-12-1.1;

Medical laboratories;

Diagnostic laboratories;

Blood bank, collection, or storage centers;

Public and private elementary and secondary schools;

Public and private universities and colleges;

Health and correctional institutions operated or regulated by municipal, county, state, or federal governments;

Funeral establishments and mortuaries;

Child-care facilities defined in SDCL chapter 26-6; and

Food service, lodging, and campground establishments defined in SDCL 34-18-1.7

How to report Secure website: sd.gov/diseasereport – growing majority

Telephone:

605-773-3737 or 800-592-1861 or for communicable disease staff person during normal business hours,

After hours Category I diseases, call 605-773-3737 or 800-592-1861 or cell phone 605-280-4810

or 800-592-1804 confidential answering device,

Fax: 605-773-5509

Mail or courier to: Infectious Disease Surveillance, Department of Health, 615 East 4th Street, Pierre, SD 57501; marked "Confidential Disease Report"

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Confidential DiseaseReporting Website

sd.gov/diseasereportPatient Information Report Type: New Update Report Date: 2/28/2012

*Last Name: *First Name: *Gender:

Street Address:

Mailing Address: (if different from Street Address) Zip:

City: State: County:

Home Phone: Other Phone: Work Cell Pager

Race: Ethnicity:

Occupation: Date of Birth: (mm/dd/yyyy)

Disease Information*Disease or Condition:

Date of Onset: (mm/dd/yyyy)

Diagnosis confirmed by Lab Test? Yes No Name of Lab:

Lab Test Name: Lab Report Date: (mm/dd/yyyy)

Specimen Source: Date Collected: (mm/dd/yyyy)

Lab Test Result:

Facility Ordering Test:

Was Patient Hospitalized? Yes No Date Admitted: (mm/dd/yyyy)

Name of Hospital: Date Discharged: (mm/dd/yyyy)

Hospital Address: Outcome: Survived Expired

Hospital Phone: Date of Death: (mm/dd/yyyy)

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Confidential DiseaseReporting Website

Treatment Information

Was this person treated? Yes No Unknown

Treatment Provided: Treatment Dosage:

Treatment Duration: Treatment Date Initiated: (mm/dd/yyyy)

Additional Lab Information

Specimen Submitted Is: Original material Serum Pure Isolate

Specific Agent Identified:

Is Isolate resistant to any Antimicrobial Agent? Yes No Not Done

Type of Antimicrobial:

Attending Health Care Provider

First Name: Last Name: Suffix:

Phone: Ext:

Comments:

Person Reporting

*First Name: *Last Name: Suffix:

*Phone: Ext: Email:

*Facility Name: 11

South Dakota Department of HealthOffice of Disease Prevention

Regional Offices (toll free) Aberdeen: 1-866-805-1007

Dupree: 1-866-778-5757

Pierre: 1-866-229-4927

Rapid City: 1-866-474-8221

Sioux Falls: 1-866-315-9214

Watertown: 1-866-817-4090

State Main Office (Pierre): 1-800-592-1861

Immunization Program (Pierre): 1-800-592-186112

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What to reportReports must include as much of the following as known: Disease or condition diagnosed or suspected, Case name, age, birth date, sex, race, address, occupation, Date of onset or diagnosis of illness and whether the person

is hospitalized and, if so, where, Attending physician’s name, address and phone number, Relevant lab results & specimen collect date, Public health measures given Name and phone number of person making report.

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Why are diseases & conditions reportable?

Diseases and conditions may have significance on a world-wide, national, or state level and may be reportable accordingly.

Generally, diseases are notifiable because they represent a serious public health threat or the potential for such a threat.

Diseases may be reportable because… Under world-wide surveillance – malaria, dengue fever, typhoid

Zoonotic or vector-borne

Contact with animals – brucellosis, Q fever, tularemia

Bite exposure – West Nile, Lyme, Rocky Mountain spotted fever15

Why are diseases & conditions reportable?

Diseases may be reportable because… Foodborne or Waterborne – E. coli, Salmonella, Legionella, Giardia

Contagious/Infectious – person-to-person – influenza, measles, enterics, STD

Vaccine-preventable – pertussis, Haemophilus influenzae type b (Hib),

High mortality – meningococcal, hantavirus, rabies

Bioterrorism threat

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Bioterrorism DiseasesCategory A – these high-priority agents include

organisms or toxins that pose the highest risk to the public and national security:

Anthrax (Bacillus anthracis)

Botulism (Clostridium botulinum toxin)

Plague (Yersinia pestis)

Smallpox (Variola major)

Tularemia (Francisella tularensis)

Viral Hemorrhagic Fevers (VHFs) – (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo])

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Bioterrorism Diseases

Category B – these agents are the second highest priority:

Brucellosis (Brucella species)

Epsilon toxin of Clostridium perfringens Food safety threats (e.g., Salmonella sp., E. coli O157:H7, Shigella)

Glanders (Burkholderia mallei)

Melioidosis (Burkholderia pseudomallei)

Psittacosis (Chlamydia psittaci)

Q Fever (Coxiella burnettii)

Typhus Fever (Rickettsia prowazekii)

Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

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Bioterrorism Diseases

Category C – these third highest priority agents include emerging pathogens that could be engineered for mass spread in the future:

Emerging infectious diseases such as Nipah virus and Hantavirus

Chemicals Ricin toxin from Ricinus communis (castor beans)

Cyanide

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OBJECTIVE

Relate lab report to disease investigation

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InvestigationOffice of Disease PreventionSouth Dakota Electronic Disease

Surveillance SystemCentral Office Regional Field Office

Sioux Falls, Aberdeen, Watertown, Pierre, Dupree, Rapid City

Case Definition?Chart reviewClient/Parent interview

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InvestigationClient/Parent Interview

Onset of illness

Signs/Symptoms/Treatment

Contacts – household, sexual, daycare, workplace, etc.

Others ill or Risk Factors for possible exposure

Recommendations Exclusion – retesting if necessary

Food History questionnaire

Hand Washing techniques

STD Protection

Education 22

Analysis Outbreak

Daycare – E. coli, Shigella

City – Legionella

Regional – Mumps

Foodborne E. coli – lettuce, spinach

Salmonella – peanut butter, tomatoes, alfalfa sprouts

Investigations help trace back to common food source

Food Regulations

Need for Vaccines

Progression of Disease – endemic region – Lyme disease

Public Education and Prevention23

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Numbers (list) and rates (map) of South Dakota County Gonorrhea cases, 2011

Pennington 145Shannon 129Minnehaha 84Corson 40Todd 28Dewey 23Codington 21Brown 9Lyman 9Walworth 7Bennett 6Charles Mix 6Hughes 6Brookings 5Meade 5Lawrence 4Lincoln 4Yankton 4Beadle ≤3Davison ≤3Tripp ≤3Ziebach ≤3Brule ≤3Clay ≤3Custer ≤3Day ≤3Lake ≤3Roberts ≤3Stanley ≤3Union ≤3Buffalo ≤3Butte ≤3Fall River ≤3

Grant ≤3Hutchinson ≤3Jackson ≤3Kingsbury ≤3Mellette ≤3Moody ≤3Spink ≤3Aurora 0Bon Homme 0Campbell 0Clark 0Deuel 0Douglas 0Edmunds 0Faulk 0Gregory 0Haakon 0Hamlin 0Hand 0Hanson 0Harding 0Hyde 0Jerauld 0Jones 0Marshall 0McCook 0McPherson 0Miner 0Perkins 0Potter 0Sanborn 0Sully 0Turner 0

N = <555Highest number of cases 2000-2010 for any one year – 468 in 2010.

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OBJECTIVE

The importance of complete, accurate, and timely reporting.

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CompleteReports must include as much of the following as known: Disease or condition diagnosed or suspected, Case name, age, birth date, sex, race, address, occupation, Date of onset or diagnosis of illness and whether the person is

hospitalized and, if so, where, Attending physician’s name, address and phone number, Relevant lab results & specimen collect date, Public health measures given, Name and phone number of person making report. If case is a child, Parents’ names.

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Accurate

“NO BRAINER” – must have accurate information on reportMale or Female

Correct spelling

Etc.

Drop-down boxes on Electronic Report website Select the right “answer”

Gonorrhea or Giardia??

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Timely

Category I diseases Report immediately on suspicion of disease Neisseria meningitidis – usually physician already suspects and

has reported. Immediate reporting is absolutely critical!!

E. coli – shiga toxin Recommend shiga toxin test if only culture is ordered

Report the Shiga toxin positive result

Do not wait for culture or serotype results

Forwarding sample to State Health Lab for serotyping is NOT an acceptable means of “reporting”

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Neisseria meningitidis--Meningococcal meningitis--

CDC photo

Temporary Exclusion: Upon suspicion of disease. Readmit when child is cleared to return by a physician.

household contacts;

child care contacts at any time during 7 days before onset of illness;

direct exposure to patient’s secretions at any time during 7 days before onset of illness.

Management of Contacts: Antibiotic prophylaxis recommended for all close contacts:

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Outbreak of shiga toxin-producing E. coli in a childcare center, SD 2009

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• 26 people sick with E. coli O111, including 17 children, 6 staff and 3 family members (15 confirmed cases, 11 probable cases).

• Ages of children: median 17 months, range 0-5 years.• Person-to-person transmission.• Rapid implementation of control measures could have prevented much of this

outbreak.

DOH notified

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Timely

Category II diseases – Report within 3 days Salmonella

Do not wait for serotype results

Forwarding sample to State Health Lab for serotyping is NOT an acceptable means of “reporting”

2010 Avera outbreak

Shigella – possible daycare implications

Bordetella pertussis Formerly Category I disease

Often reported by physician on suspicion, but not always

Contact investigation – recommendations and treatment

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Conclusion Making diseases notifiable can play an important role in

their control. Disease reporting is an incredibly useful tool for public health officials, who use the data for everything from trying to limit exposure to a contaminated food product to attempting to understand a new infectious disease and keep it from spreading across the country or around the world.

Laboratorians often have the first role in the public heatlhresponse to reportable disease. Through complete, accurate, and timely reporting, laboratorians play an intregal part in identifying a source of contamination, stopping the spread of disease, and ultimately saving lives.

THANK YOU for the work you do!!!33

QUESTIONS

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