DIVISION OF DISEASE CONTROLEPIDEMIOLOGY AND INFECTIOUS DISEASE SURVEILLANCE

Michelle FeistProgram Manager, NDDoH

Outline Surveillance and Epidemiology Disease and Outbreak Reporting Current and Emerging Communicable

Diseases

Epidemiology

The study of health related events in specific human populations

Edward Jenner (1749-1823)• Spent his whole career as a country doctor • Research was based on careful case-studies and

clinical observation (>100 years before scientists could explain the viruses themselves)

• Jenner inserted pus taken from a cowpox pustule on the hand of milkmaid Sarah Nelmes and inserted it into an incision on the arm of 8 yr old James Phipps.

• 1840 the British government had banned alternative preventive treatments

• "Vaccination," the word Jenner invented for his treatment (from the Latin vacca, a cow), was adopted by Pasteur for immunization against any disease.

John Snow (1813-1858)• He graduated M.D. of the University of London

on 20 Dec. 1844• Wave of Asiatic cholera first hit England in late

1831• He interviewed the families of the victims. His

research led him to a pump on the corner of Broad Street and Cambridge Street

• Following an interview with the Board of Guardians of St. James's parish, on the evening of Thursday, 7th September, the handle of the pump was removed on the following day.

•At the end of September the outbreak was all but over

Surveillance Ongoing, systematic collection, analysis, and

interpretation of outcome specific data for use in the planning, implementation, and evaluation of public health practice The purposes of public health surveillance are to assess

public health status, define public health priorities, evaluate programs, and stimulate research

Surveillance Objectives

What do we want/need to know?

Public Health Surveillance Assess status Situational awareness Define priorities

Severity, frequency, preventability, communicability, emerging issue

Monitor and evaluate programs Conduct research Identify problems

Data Sources Morbidity Reports

Local State National

Mortality (death certificates) Hospital Discharge Behavioral Risk Factor Surveillance System (BRFSS) Cancer Registry Syndromic Surveillance Special Studies Other existing data sources

Surveillance Plan Surveillance objectives

Determine event you want to study Case definition

Criteria for clinical findings Epidemiological features Laboratory diagnosis

Data collection Active vs passive surveillance Timeliness Sentinel surveillance Data collection instruments Test data collection system

Data analysis Ensure data source and collection process are adequate

Surveillance Plan, cont. Interpretation

Present information clearly Know your audience

Dissemination Facilitate implementation of public health action Provide recommendations Inform decision makers

Evaluation Is surveillance objective being met Is information useful Should system be continued System enhancements or revisions

Collect data for action!

Disease and Outbreak Reporting

What Do We Do Epidemiology

The study of health related events in specified human populations

Surveillance Systematic collection, analysis, interpretation and

dissemination of data

Education Develop recommendations, guidelines, policies, etc. Health-care providers, nurses, infection

preventionists, veterinarians, etc. General public education

Disease Control Programs

Disease Control Programs STD and Viral Hepatitis Program

Prevent infertility in females resulting from chlamdyia and gonorrhea infections

Reduce the incidence of chlamydia and maintain low rates of gonorrhea and early syphilis

Develop prevention and control activities to reduce the incidence of new hepatitis infections

HIV/AIDS, Ryan White and TB Program Reduce the spread of HIV and monitor trends in ND Provide benefits and services to assist people living with

HIV/AIDS in North Dakota (Ryan White) Provide surveillance, prevention programs and supervision of TB

disease case management

Disease Control Programs, cont. Immunization Program

Supplies free vaccines for children who are eligible for the Vaccines For Children (VFC) program

Coordinates investigations of vaccine-preventable diseases Provides education about immunizations and vaccine-preventable diseases Maintains and updates the North Dakota Immunization Information System

(NDIIS)

Epidemiology and Surveillance Program Provide surveillance and prevention programs for influenza, vector-borne

diseases, healthcare-associated infections, antibiotic resistance and food-borne diseases

Provide general disease surveillance, support and education in North Dakota

Maintain division’s electronic disease surveillance system (MAVEN) and syndromic surveillance program

74 infectious disease reporting requirements3 non-infectious disease reporting requirements:•Cancer •Tumors of the CNS•blood lead levels > 10g/dL

Disease Reporting

Identification & Reporting

Review& Analysis

Follow-Up&

Investigation

Symptoms

Who Needs to Report?

1. All health care providers, including physicians, physician assistants, nurse practitioners, nurses, dentists, medical examiners or coroners, pharmacists, emergency medical service providers, and local health officers.

2. The director, principal manager, or chief executive officer of:a. Health care institutions, including hospitals, medical centers, clinics, LTC facilities, assisted living facilities, or other institutional facilities;b. Medical or diagnostic laboratories;c. Blood bank collection or storage centers;d. Public and private elementary and secondary schools;e. Public and private universities and colleges;f. Health or correctional institutions operated or regulated by municipal, county or multicounty, state, or federal governments;g. Funeral establishments and mortuaries; andh. Child care facilities or camps.

Statutory authority NDCC 23-07-01

Who Needs to Report? cont.3. The state veterinarian, if the disease may be transmitted directly or indirectly to or between humans and animals.

4. A person having knowledge that a person or persons are suspected of having a reportable disease may notify the department and provide all information known to the person reporting concerning the reportable disease or condition of the person or persons.

A person making a report in good faith is immune from liability for any damages which may be caused by that act.

Disease Reporting Laboratory report (mail/fax/pick-up) Morbidity report card (mail/fax/pick-up) Online report card Telephone call

800.472.2180701.328.2378

Outbreak Reporting Unusual disease clusters or outbreaks

are reportable to the ND Dept of Health Report of respiratory illness associated with

unusually high mortality from a LTC facility Outbreaks of any of the mandatory

reportable diseases or conditions (definition of outbreak varies by disease, timing and setting) Two cases of salmonella in a school

classroom Nosocomial outbreaks in institutions

Current and Emerging Communicable Diseases

National Centers for Disease Control and Prevention Infectious Disease issues of special concern

Antimicrobial resistance Chronic viral hepatitis Food safety Healthcare-associated infections HIV/AIDS Respiratory infections Safe water Vaccine-preventable diseases Zoonotic and vactorborne diseases

Emerging Diseases Infections that have increased recently

or are threatening to increase in the near future New diseases (e.g., SARS, MERS-CoV) Reappearing in an area (e.g., dengue,

measles) Organisms that have become resistant to

antibiotics (e.g., staph, CRE/KPC)

Precipitating Factors for the Emergence of Disease in People

World-wide trade Mass movement of people (leisure, work) Urbanization (childcares, prisons,

homeless shelters) Environmental changes Resource consumption Demographic changes (aging,

immunocompromised)

Zoonotic Diseases Approximately 75% of recently

emerging infectious diseases affecting humans are diseases of animal origin; approximately 60% of all human pathogens are zoonotic.

Past Zoonotic Agents Identified1970 Monkey pox Pustular

lesions/scarring1977 Ebola virus Hemorrhagic fever1977 Hanta virus HFRS1977 Camplobacter sp. Entercolitis1982 E coli O157 Entercolitis1982 Borellia burgdorferi Lyme disease1992 Bartonella henselae Cat-scratch fever1993 Sin Nombre virus HPS1999 West Nile virus Encephalitis1999 Nipah virus Encephalitis2003 SARS Respiratory syndrome2003 H5N1 influenza Respiratory virus

Current Disease and Emerging Disease Priorities

Foodborne illness Infections that spread in hospitals Infections that are resistant to antibiotics Deadly diseases Diseases caused by contact with animals Disease spread by mosquitoes, ticks and

fleas

“The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow.” Dr. Joshua Lederberg, Nobel Laureate

Thanks for your time!Questions are Welcomed