Vaccine Preventable Diseases Reporting Suspected Cases.
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Transcript of Vaccine Preventable Diseases Reporting Suspected Cases.
Vaccine Preventable Diseases
Reporting Suspected Cases
Reportable Diseases
Epidemiology Resource Center Surveillance and Investigation Contacts Reporting Fax Number: 317-234-2812 My Phone Number: 317-233-7112 My E-mail: [email protected] Alternate Fax number: 317-233-7805
*Reportable Disease List (handout)
Epidemiology Resource CenterSurveillance and Investigation Division
Communicable Disease Responsibilities2 N. Meridian Street, 5-KIndianapolis, IN 46204
Fax: 317-234-2812
Karee Buffin. MS—Vaccine Preventable Disease Epidemiologist
317-233-7112 [email protected]
DiphtheriaInvasive Haemophilus influenzae Invasive Pneumococcal Disease
MeaslesMumps
Pertussis (whooping cough)Polio
RubellaRubella, congenital syndrome
SmallpoxTetanus
Varicella/shingles (hospitalization or death and sentinel reporting)
ISDH Public Health Investigators Investigate the following: In accordance with the guidelines from the
Communicable Disease Reporting Rule Measles, Mumps, Rubella, Pertussis,
Diphtheria, Tetanus, Polio Varicella resulting in death or hospitalization Invasive Haemophilus Influenzae Invasive Pneumococcal Disease (cases less
than or equal to 5 years of age)
* The Rule is currently undergoing revisions
Communication
“A trained immunization field representative of the department in cooperation with the local health officer”
Contacting your immunization program’s public health investigators: Phone: see map (handout) E-mail• Contacting the field staff supervisor:
Sarah Murphy: 317-233-7603 [email protected]
Non-Sterile SitesNeed not be reported Saliva Ear swabs Nasal swabs Wound swab, wound culture Eye Swab Fingernail or other infected external sites
And other non-sterile sites need not be reported
Sterile SitesFluids collected from these sites
are expected to be sterile:
• Blood (venous or arterial cultures)• CSF• Pleural Fluid• Peritoneal Fluid• Pericardial Fluid• Joint or Synovial Fluid• Tympanocentesis
Haemophilus Influenzae (H.Flu)
Bacterial Isolates are required to be sent for further
evaluation. 1 type b in Indiana in 2007 How did this happen? Sensitivity reports needed for Drug Resistant
patterns. When are these required to be reported?...
Reporting Requirement
Immediately
Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf
Streptococcus Pneumoniae(Strep. Pneumo.) Bacterial Isolates are requested to be sent to ISDH lab
for patients less than or equal to 5 years old. It is important to ask this of the lab as soon as
you are aware of the case for serotyping. In 2007 ISDH lab has received 70% of the
isolates for serotyping. Sensitivity reports needed for Drug Resistant
patterns When are these cases required to be reported?...
Reporting Requirement
72 hours
Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf
Indiana Streptococcus Pneumoniae Serotypes Patients less than 5 years of age (n=30)
January-October 2007
47%
3%
3%
3%
7%
30%
7%
7F
19A
23F
33F
35B
OTHER
N/A
Drug Resistant Patterns
30 Total isolates (Collected on patients less than 5 years old)
14 typed as 19A Not in the current pneumococcal vaccine for
children Total Breakdown of 19A:
10/14 demonstrate Drug resistant Streptococcus Pneumoniae patterns
1/14 sensitive to antibiotics tested 3/14 Unknown patterns (not sent to ISDH labs)
Vaccine Preventable Disease Indiana Incidence 2006 Compared to Jan-June 2007
Year 2006 Jan-June 2007
Pertussis 280 26
Tetanus 2 0
Measles 1 0
Mumps 10 1
Rubella 0 0
Haemophilus
Influenzae 81 31
Streptococcus
Pneumoniae 721 357
Vaccine Preventable Disease Indiana Incidence Jan-June 2006-07
Year Jan-June 2006 Jan-June 2007
Pertussis 105 26
Tetanus 1 0
Measles 1 0
Mumps 10 1
Rubella 0 0
Haemophilus
Influenzae 35 31
Streptococcus
Pneumoniae 354 357
Mumps
Incidence in Indiana One counted in 2007
CDC clinical case definition: An illness with acute onset of unilateral or
bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting more than 2 days without other apparent cause.
MumpsReporting Suspected Cases: Why not wait for the test results?
Some results may take 3 weeks or more Other testing possibilities through the state lab One cannot rely solely on the accuracy of testing Time off of work, out of school Communicable Disease Reporting Rule:
Indiana still recognizes the 9-day exclusion rule
Mumps News
Proof of 2 MMRs does not guarantee 100% protection
* Evidence of disease in patients who have received 2 doses of the mumps vaccine. 1997-1998 NY outbreak Iowa outbreak (recent) Efficacy
*Source: VPD Surveillance Manual Chapter 7. Web Link: www.cdc.gov/vaccines/pubs/surv-manual/downloads/chpt07_m
umps.pdf
Importance of Exclusion of Susceptibles: The Communicable Disease Reporting Rule
for Indiana currently states: Exclude exposed susceptibles from school or the workplace from the12th to the 25th day after exposure to prevent the spread to other susceptibles.
Example: Hospital nursery, (based on a fictional event).
Mumps Testing
PCR Offered at ISDH labs: Buccal Swab (7days before – 9 days after
parotid gland swelling) Detects the presence of DNA Generally offers quick results Culture also can be obtained from swab
IgG, IgM (Offered at ISDH labs) Paired sera (Offered at ISDH labs) Clinical Picture: should be considered with
testing results due to many false + IgM tests.
Consider other apparent causes:
Oral surgery, ear surgery, surgery in general involving the jaw, ear, neck area.
Hit by a: Ball bat to the jaw Baseball to the jaw Brother’s fist to the jaw Other objects to the jaw
Other medical diagnosis consistent with parotitis.
Reporting Requirement?
Within 72 hours
Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf
Pertussis
Report a Suspected Case: Reporting Requirement: IMMEDIATELY
Problems: Consequences for waiting for lab testing and
late reporting.• Share case review with Mom’s comments:
Encouragement from a parent.(Smiley is HIPPA compliant)
Reporting: relying on labs to report
Pertussis
Testing Issues Recommended testing:
Culture and DFA: available at ISDH labs PCR: currently unavailable at ISDH lab
Serology is not recommended for pertussis diagnosis. Clinical picture is more valuable than the
serology results.
Indiana Reported Pertussis Cases 2002 - 2006
0
50
100
150
200
250
300
350
400
450
2002 2003 2004 2005 2006
years
cases
Pertussis Incidence Indiana, 1995-2006
0
50
100
150
200
250
300
350
400
450
Tdap, Tdap, Tdap
ACIP Tdap Recommendations
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm
One dose of Tdap should be used to replace a Td booster dose in adults and children of recommended age (includes wound management).
(Note: Two manufactures with different recommendations.)
Varicella
Reporting: Outbreaks
Definition: greater than or equal to 5 cases in a place in children less than 13 years old within one incubation period.
Also: greater than or equal to 3 cases related in place in persons greater that or equal to 13 years of age within one incubation period.
0
10
20
30
40
50
60
70
80
90
100
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Per
cen
t Vac
cin
ated
Varicella Vaccine CoverageNational Immunization Survey Results
Children 19-35 Months of AgeUS and Indiana, 1997-2006
US
Indiana
Varicella
Reporting: Outbreaks including ‘breakthrough’ disease
One incubation Period: 21 days A lot can happen in 21 days:
Example: School Jan 30, 5 cases By Feb 20, 31 cases
* Recommend 2 doses varicella vaccine for outbreak management and current ACIP.
Current ACIP Recommendations
Routine vaccination at 12-15 months 2nd dose recommended at 4-6 years of age; 3
months as minimum interval between doses 2nd dose recommended for person of ANY
age who has had only 1 dose 13 yrs or older, if not immune-2 doses at least
4 weeks apart.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm Current Web address
ACIP Recommendations and Vaccine Administration Current Issues:
State funding does not always match the recommendations.
Publicly funded vaccine programs should check the policy prior to administration.
Outbreak conditions: Communicate needs with the Immunization
Program. Vaccine needed, expected numbers
Initiate an outbreak response.
Varicella
Sentinel Reporting Since 2004 Breakthrough disease may decrease with
second dose of varicella introduced. Incidence of severe varicella with 2 doses of
varicella in Indiana is zero, (using sentinel surveillance data).
Acknowledgements
Wayne Staggs Dr. Charlene Graves Immunization Program
Special recognition to the Immunization Field Staff Pam Pontones Kristin Ryker