Communicable Disease

Surveillance and

Control Kate Marishta MPH

Assistant Director/Epidemiologist Communicable Disease Program

Today’s Objectives

Surveillance responsibilities of local health departments Importance of communicable disease surveillance How public health surveillance works Reportable communicable diseases Understanding of disease transmission Selected diseases reported to Kane County Selected outbreak investigations by Kane County

Surveillance is

Information for Action

Importance of Surveillance to the

Public’s Health

Assessment is a core functions of public health. We collect, assemble, analyze, and make available information on the

health of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems.

Public health surveillance, often called the cornerstone of public health

practice, is an essential element of the assessment function. CDC Public Health Surveillance in the United States: Evolution and Challenges* MMWR July 27, 2012 / 61(03);3-9

How Public Health Surveillance Works

Ongoing collection, management, analysis, and interpretation of data followed by the dissemination of these data to public health programs to stimulate public health action.

. Use of public health surveillance data is to detect epidemics and other health problems in a

community.

Data is used to estimate the scope and magnitude of a problem, including the geographic and demographic distribution of health events that will facilitate public health planning.

Surveillance data also can be used to detect changes in health practices, monitor changes in infectious and environmental agents, evaluate control measures, and describe the natural history of a health event in a community that will generate hypotheses and stimulate applied research.

Summaries, Interpretations,

Recommendations

Reports

Health Agencies

Health Care

Providers

Public

Analysis

Information Loop of Public Health Surveillance

The Components of Surveillance and Resulting Public Health Action

What Diseases Must Be Reported?

Reportable Diseases Time Line

Class IA Report within 3 hours Class IB Report within 24hours Class II Report within 7 days

Examples of Selected Reportable Diseases

KCHD 10.26.09 Mass Vaccination Clinics – Vaccines Administered

10478

3937

3555

2986

0 2000 4000 6000 8000 10000 12000

1

St. Charles North HighSchoolLarkin HS

East Aurora High School

Total Dispensed

St. Charles

Larkin

East Aurora

Total

12,308

3,937

3,555

2,986

1,830

0 2000 4000 6000 8000 10000 12000 14000

Total (@ mass clinics)

East Aurora (10/26)

Larkin (10/26)

St. Charles North (10/26)

Cougar's Stadium (12/5)

Class IA - 3 hours- Novel Influenza H1N1 2009-2010

0

1

2

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7

KCHD 2009 H1N1 related Hospital admissions and Deaths April 2009-March 2010

By Report Date (As of August 30, 2009 reporting criteria changed to include only confirmed cases that are hospitalized >= 24 hours)

Deaths

Hospitaladmissions

Class 1B-24 hours Varicella (Chicken pox)

24 hours reportable disease Very Contagious The virus is spread in the air when an infected persons coughs or

sneezes, or by touching or breathing in the virus particles that comes from chicken pox blisters.

Incubation period 10-21 days Complications: dehydration, skin infection, encephalitis, pneumonia,

bleeding problems

Varicella

If a chicken pox case confirmed or probable: – Recommend case limit contact with susceptible individuals for duration of

communicable period; exclude from school/childcare center/work for minimum of 5 days after onset of rash or until lesions are crusted

– Assess close contacts immune status. Susceptible contacts (no history of disease or age appropriate immunization*) should be recommended to receive as indicated immunization if within 120 hours ( 5 days) after exposure Varicella-specific immune globulin (VZIG) as available if susceptible

and medically contraindicated to receive vaccine or at high risk of developing severe varicella disease and complications if within 96 hours after exposure

Kane County Varicella Cases 2009-2012

161

127

40

90

0

20

40

60

80

100

120

140

160

180

2009 2010 2011 2012

Case Count

*

Class II-7 Days HUMAN WNV SURVEILLANCE

*CDC as of December 11, 2012. Data are provisional ¶ IDPH as of April 4, 2013

US IL Kane (Case/Death) (Case/Death) (Case/Death)

1999 NY 62/7 2000 NY,NJ,CT 21/2 2001 NY,NJ,FL 66/9 2002 IL,MI,OH 4156/284 884/67 8/1 2003 CO,NE,SD 9862/264 54/1 1/0

2004 CA, AZ, CO 2539/100 60/4 2/0

2005 CA, IL, SD 3000/119 252/12 17/0 2006 ID, CO, TX 4269/177 215/10 4/0 2007 CO, ND,SD 3630/124 101/4 13/0 2008 CA,MS,CO/AZ 1356/44 20/1 3/1 2009TX, CA, CA 720/32 5/0 0/0 2010 1021/57 61/4 5/1 2011 712/43 34/3 1/0 2012 5387/243* 290/12¶ 13/1

WNV: Basic Transmission Cycle Most important cycle is from mosquito to bird to mosquito

Amplifying hosts

“Incidental” infections: unlikely amplifying hosts

Kane County WNV Surveillance 2002-2010

Key Challenges to Surveillance

Prompt recognition Identification

Definition of Communicable Diseases

A communicable disease is an illness due to a specific infectious (biological) agent or its toxic products capable of being directly or indirectly transmitted from man to man, from animal to man, from animal to animal, or from the environment (through air, water, food, etc..) to man.

Examples of pathogens include: viruses, bacteria, protozoa, parasitic worms and fungi

Salmonellosis MRSA Flu

E. Coli Hepatitis Pertussis Tuberculosis

Mononucleosis STDs HIV/AIDS

Potential Rabies

Dynamics of Disease Transmission (Chain of Infection)

Source or Reservoir Modes of transmission Susceptible host

I II III

Transmission

Mode of transmission

Direct transmission

Indirect transmission

Direct contact

Droplet infection

Contact with soil

Inoculation into skin or mucosa

Trans-placental (vertical)

Vehicle-borne

•Vector-borne: •Mechanical •biological

Air-borne

Fomite-born Unclean hands and fingers

propagative

Cyclo-prop. Cyclo-develop.

Types of reservoirs

Reservoir

Human reservoir

Animal reservoir

Non-living reservoir

Other Surveillance in Kane County

Foodborne Non-Foodborne FLU

Outbreak Investigation Process

Outbreak investigation is an important and challenging component of public health

Identifies the source of the outbreaks and prevent additional cases

When an outbreak is over, a thorough epidemiologic and environmental investigation can increase our knowledge of a given disease and prevent future outbreaks.

Foodborne Outbreak Causes

2007 2008 2009 2010 2011 2012

Norovirus 6 2 0 2 1 2

G/I Illness 1 7 0 4 0 0

Clostridium Perfringes 2 0 0 0 0 1

Salmonella Montevideo 1 0 0 0 0 0

Salmonella typhimirium 0 0 0 0 2 0

Salmonella 1,4,5,12:i: 0 0 0 0 0 1

Scombroid 0 0 0 0 0 1

Total 10 9 0 6 3 5

Non-Foodborne Outbreak Causes 2007 2008 2009 2010 2011 2012

Number Number Number Number Number Number Norovirus 3 1 2 7 6 5 G/I Illness 3 2 2 12 1 2 Skin Lesions 9 0 0 0 0 0 MRSA C 0 2 2 2 0 0

Salmonella Montevideo 0 1 0 0 0 0 Chicken Pox 0 1 4 4 0 1 Pertussis 0 0 1 1 2 4

Influenza 0 0 0 0 4 0

Respiratory illness 0 0 0 0 1 0 MRSA 0 0 0 0 1 0

Group A Strep 0 0 0 0 0 1 HFM 7 0 1 Total 15 14 11 26 15 14

KCHD Influenza Surveillance

Influenza surveillance for Kane County Health Department includes the collection of data on influenza and influenza-like illness from:

Hospital emergency rooms Hospital laboratories Long-term care facilities Public schools.

KCHD Influenza Surveillance Emergency Rooms

1.50% 0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22

Perc

ent

ILI

Week

Kane County Health Department Influenza-Like-Illness Surveillance

Emergency Room Visits

2007-08 2008-09 2009-10

2010-11 2011-12 2012-2013

KCHD Influenza Surveillance Laboratories

0

100

200

300

400

500

600

10/6

/201

210

/13/

2012

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0/20

1210

/27/

2012

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/201

211

/10/

2012

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7/20

1211

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2012

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/201

212

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012

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2012

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121/

5/20

131/

12/2

013

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31/

26/2

013

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2013

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2013

2/16

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32/

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013

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2013

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2013

3/16

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33/

23/2

013

3/30

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013

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27/2

013

Num

ber o

f Pos

itive

Spe

cim

ens

Week Ending

2012-2013 Kane County Health Department Influenza -Like-Illness Surveillance

Participating Laboratories (N=6) Positive Rapid Influenza Tests

Influenza Type A B AB Unk

2012-2013 Influenza surveillance report:

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Influenza ICU Hospitalizations By Age Group

ILI 65+

ILI 25-64

ILI 5-24

ILI 0-4

23 cases of Influenza related ICU. The mean age: 52 years. The age range: 7 months to 82 years. No Influenza-associated pediatric deaths were reported.

11 outbreaks of Influenza have been reported from Long Term Care/Assisted Living facilities.

KCHD Influenza Surveillance Schools

0.12%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

1.60%

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Perc

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ILI

Influenza-Like Illness Absenteeism Surveillance All Kane County School Districts

2009/2010 2010/2011 2011/2012 2012/2013

Responding to Communicable Diseases Reports and Questions

Kane County Health Department staff is available for consultation and investigations related to communicable disease during business hours and after hours by calling 630-208-3801.

Resources

The Pink Book, Epidemiology & Prevention of Vaccine-Preventable Diseases

http://www.cdc.gov/vaccines/pubs/pinkbook/index.html Manual for the Surveillance of Vaccine-Preventable Diseases http://www.cdc.gov/vaccines/pubs/surv-manual/index.html IDPH Administrative Codes http://www.ilga.gov/commission/jcar/admincode/077/07700690sections.html

Questions?

The Floods of 2013

Q U E S T I O N S

Animal Control’s Monthly Financial Status

Barbara Jeffers Executive Director

Prepared By: Kinnell J. Snowden

May 21, 2013

Total Revenue

Registration and Tags fees revenue is the main driver of total revenue. The Registration and Tags fees for April 2013 and 2012 are $78,822 and $54,261 respectively.

- 20,000 40,000 60,000 80,000

100,000 120,000 140,000

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

2012 2013

Total Expense

The County recorded the expense for the Liability Insurance, Workers's Compensation and Unemployment Claims ($23,020) in April 2013. In 2012 the lump sum payment was recorded in May.

- 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000

100,000

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

2012 2013

Market Plan for Summer Growth

Questions?

Goal: To educate the public on the importance of the rabies vaccination for both dogs and cats

Result: Growth in the purchase of registration tags

and vaccinations creating more revenue

Public must be made aware of the dangers of a non vaccinated pet and the costs involved when your dog or cat bites someone

Advertise in local publications (English and Spanish)

Press Releases from County Website: usable interface It’s the law: people must know their role

We must offer multiple ways in which you can get your pets the vaccination. Local veterinarians or a low cost rabies clinic i.e. Just Animals

We as the County can facilitate a location for the low cost clinics- Forest Preserves, Township Buildings, and local businesses

Part of public education is informing the public on what the consequences are if they do not get the Rabies Tag or vaccination for their pets

Tickets, fines, legal fees, animal confinement and so on

Data will be collected and used to push for the continuation of receiving the rabies vaccination and tag

Growing the database will provide future revenue