Electronic Laboratory Reporting of Rabies Results and Associated NEDSS Surveillance Activities —
Nebraska, August 2011 to March 2012
Bryan F Buss, DVM MPH DACVPM
Career Epidemiology Field Officer (CEFO)
Nebraska Department of Health and Human Services
Office of the Director
Office of Public Health Preparedness and Response
Presentation Overview
Background information and overview of electronic laboratory reporting (ELR) of rabies test results
NEDSS system processes Case management of rabies laboratory reports
Case management of exposed humans
Contact tracing to link exposed persons to associated animal test results
Daily-generated NEDSS data extracts (line-lists)
ELR rabies test results
Discussion
Kansas State University Rabies Laboratory (KSU-RL)
Performs majority of rabies testing for Nebraska
Contracted to perform state-funded testing of samples
with human exposure reported
Test results and limited exposure information
captured electronically
Daily results securely messaged to DHHS via PHINMS
for Rhapsody processing and migration into NEDSS
Both positive and negative rabies test results captured
New investigation page for managing exposure cases
Electronic Laboratory Reporting of Rabies Results
Jurisdiction and Program Area assigned
Program Area = Vet/EPI (for all animal rabies tests)
NEDSS User permission (Vet/EPI role) must be enabled
to view rabies laboratory reports
Currently all LHD surveillance staff identified for
managing rabies exposures have access
Email notification generated automatically for
identified users in LHDs
Line listing of rabies reports and human exposure
investigations extracted from NEDSS daily using SAS
NEDSS Rabies Result Processing
NEDSS Alert – Email Notification
Alert provides notice that a test was received but does
not provide result
LHD staff must view report to see test result
“Upstream” Rhapsody alert for positive results being
considered
Search Based on Observation Identifier in Email
CASE MANAGEMENT OF RABIES LABORATORY REPORTS
NEDSS Documents Requiring Review
Sample Rabies Laboratory Report
Species and Breed = First and Middle Name
Point Location = Patient Address
Vaccination and Exposure History = Result Comment
Managing the Rabies Laboratory Report
Negative tests
marked as reviewed
after viewing
If investigation of exposed human will be created,
NEDSS animal patient last name is used to establish
link for contact tracing
Examples = RAB-POSITIVE-NE2012-01-25_52
RAB-NEG-NE2012-02-01_67
All positive rabies tests require an investigation,
confirmation, and electronic notification to CDC
Investigation for Positive Rabies Result
Investigation created from the ELR record by LHD
Condition = “Rabies, animal”
Positive Animal Rabies Investigation Data Captured
Investigation Start Date
Investigation Status
Investigator
Reporting Source = “Laboratory”
Earliest Date Reported to both County and State
Diagnosis Date
Confirmation Method and Date
Case Status
Comments as appropriate
Condition Specific Custom Field to report species
Positive Animal Rabies Investigation Data Captured
Completing Positive Animal Rabies Investigation
Investigation saved in NEDSS by LHD
LHD then “Creates Notification” from investigation page
Notification box then viewable at bottom of page
At this point, the process for managing an animal rabies case is complete!
MANAGING EXPOSED HUMANS Patient investigation separate from animal test result
NEDSS Animal Exposure Investigation Page Bites and Non-Bite Exposures
Patient file is created in NEDSS for exposed person
Basic demographic data collected as appropriate
Condition Selected
“Animal Exposure”
Animal Exposure Investigation Page*
*NEDSS human exposure investigation page template developed and provided by Rhode Island Department of Health
Captures demographic and clinical patient data
Seven separate tabs for collection of case information Patient
Administrative
Human Exposure or Incident Information
Animal and Wound Information
Treatment
Laboratory
Contact Records
Animal Exposure Investigation
Case Status – Administrative Tab Definitions
Confirmed – Animal exposure defined as 1) any penetration of the
skin by the teeth or any contamination of mucous membranes or
fresh, open cuts in the skin with saliva or brain material or 2) a bat
in the same room as a human who was not alert and awake the
entire time the bat was in the room or who was an unattended
young child or other individual who cannot otherwise say with
certainty “I know I wasn’t bitten.”
Probable/Suspect – Never used, values could not be removed
Event is either confirmed or not a case
Unknown – Used only when
a determination is not possible
Human Exposure or Incident Information
Captures event specific report information
Date and location of incident
Date of report and description of incident
Human Exposure or Incident Information
Additional Human Exposure Information
Index Case Question
“No” selected if only one exposed person to a single animal
“Yes” selected if additional persons exposed to same animal Number of additional persons entered and separate investigations for each individual created
Animal and Wound Information
Exposing Animal Information
Species and associated information
Wound Information
Treatment Tab
Documentation of immunosuppression if appropriate
Drop-down selections/comments to describe treatment
recommendations
Laboratory Tab
LHD clicks “Submit” when done to save the Investigation
CONTACT TRACING To link exposed persons to associated animal test results
Contact Tracing
**Note: Before a contact record is added, a message would appear in this space as below stating “Nothing Found to Display.”
“Contact Records” tab selected to “Add New Contact Record”
Search for Contact Record
“Name” search looks for text strings contained in Last or First Name
LHD searches by animal’s “NEDSS Patient Last Name” or Laboratory Observation ID (from email alert)
LHD Selects Contact Record
Green “Check Mark” is selected for the appropriate record for contact tracing.
**Note: More than one record might appear depending on the narrowness of the search.
Create Contact Record
Contact demographic information self-populates
No additional information needed in “Contact” tab
Create Contact Record
• “Contact Record” tab
• Red Asterisk on required fields
• “Jurisdiction” self-populates
• Select/assign “Investigator”
Create Contact Record
• “Status” and “Disposition” values selected
• If “Status” = “Closed” then “Disposition” is required
Contacts Named By Patient
Click “Name” to view a named Contact’s Patient File
Patient Named By Contacts View at Bottom of Animal Patient File’s Event Tab
Note: If an animal laboratory test result record is named by two or more exposed persons’ investigations, a contact record for each will be displayed here.
DAILY-GENERATED NEDSS DATA EXTRACTS (LINE-LISTS) Laboratory reports and human exposure investigations
NEDSS Rabies Laboratory Data Extract
NEDSS Rabies Laboratory Data Extract
NEDSS Human Exposure Investigation Data Extract
NEDSS Human Exposure Investigation Data Extract
ELR RABIES TEST RESULTS August 1, 2011 to March 30, 2012
Number of Rabies Tests Reported via ELR (N=768) by MMWR Week—Nebraska, August 2011–March 2012
Animal Species Total
Tested (N)
(%) (n/768)
Positive (n)
(%) (n/N)
Unsuitable (n)
(%) (n/N)
BAT 499 (65.0) 8 (1.6) 9 (1.8)
CAT 107 (13.9) 1 (0.9) 0 (0.0)
DOG 66 (8.6) 0 (0.0) 0 (0.0)
RACCOON 37 (4.8) 0 (0.0) 1 (2.7)
BOVINE 21 (2.7) 1 (4.8) 0 (0.0)
OTHER 17 (2.2) 0 (0.0) 2 (11.8)
SKUNK 12 (1.6) 7 (58.3) 0 (0.0)
SQUIRREL 5 (0.7) 0 (0.0) 0 (0.0)
HORSE 4 (0.5) 1 (25.0) 0 (0.0)
768 (100.0) 18 (2.3) 12 (1.6)
Number and Percent of Rabies Tests Reported via ELR (N=768) by Result and Species—Nebraska, August 2011–
March 2012
Total Number of Rabies Test Results (N=768) Reported via ELR—Nebraska, August 2011–March 2012
Number of Rabies Tests Reported via ELR (N=768) by Result and Species—Nebraska, August 2011–March 2012
Positive Rabies Cases (N=18) Reported via ELR by Animal Species—Nebraska, August 2011–March 2012
Proportions of Rabies Test Results Reported via ELR by Species—Nebraska, August 2011–March 2012
Vaccination Status
Dogs (%)
(n/66) Cats
(%) (n/107)
Total (%)
(n/173)
Current 23 (34.9) 11 (10.3) 34 (19.7)
None 10 (15.1) 28 (26.2) 38 (22.0)
Not current 14 (21.2) 16 (14.9) 30 (17.3)
Unknown 19 (28.8) 52 (48.6) 71 (41.0)
Totals 66 (100.0) 107 (100.0) 173 (100.0)
Vaccination Status of Rabies-Tested Dogs (n=66) and Cats (n=107)—Nebraska, August 2011–March 2012
Vaccination Status of Rabies-Tested Dogs (n=66) and Cats (n=107)—Nebraska, August 2011–March 2012
Nature of Human Exposure by Rabies-Tested Animal Species—Nebraska, August 2011–March 2012
Nature of Human Exposure (%) by Rabies-Tested Animal Species—Nebraska, August 2011–March 2012
Human Exposure by ELR-Reported Rabies Positive Animal Species (N=18)—Nebraska, August 2011–March 2012
Report of Other Animal Contact with Rabies-Tested Animals—Nebraska, August 2011–March 2012
Other Animal Contact Reported
N %
No 448 58.3
Yes 235 30.6
Unknown 85 11.1
768 100.0
Report of Other Animal Contact with Rabies-Tested
Animals by Nature of Human Exposure—Nebraska, August 2011–March 2012
Discussion
NDHHS and KSU-RL have successfully established automated ELR of animal rabies testing results
Nebraska LHDs have ready access to rabies testing results via NEDSS for managing human exposures
Anticipated enhancements include an Internet-based test requisition to electronically capture more robust exposure-related data for subsequent messaging to NDHHS NEDSS and availability for case management
We are also considering automated ELR capture of other animal laboratory results for surveillance of additional zoonotic diseases among animal populations
QUESTIONS?
Acknowledgments
• Nebraska Department of
Health and Human Services
• Thomas J Safranek
• Alison Keyser-Metobo
• Mike Nuss
• Curt Safranek
• KSU Veterinary Diagnostic
Laboratory
• Mike Moore
• Rolan Davis
• Rob McGaughey
• Cathleen Hanlon
Thanks to all local health department surveillance staff throughout Nebraska
who have indicated willingness to help manage animal exposures after the
State Public Health Veterinarian position in Nebraska was lost. Special thanks
to Anne O’Keefe and Tim Timmons for pilot work and helpful suggestions.
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Likewise, the authors’ findings and conclusions do not necessarily represent the views of the Nebraska Department of Health and Human Services.
Office of the Director
Office of Public Health Preparedness and Response
Thank-you
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