EPIDEMIOLOGY AND SURVEILLANCESouthwest Florida Disaster Healthcare Coalition

June 13, 2014

Jennifer Roth, MSPH

Director of Epidemiology

Florida Department of Health – Lee County

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Objectives

• Review the disease and outbreak reporting and investigation process

• Identify ways DOH contacts pertinent partners during an outbreak

• Discuss different types of surveillance methods

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4

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Who reports diseases in Florida?• Required:

• Licensed medical practioners• Osteopathic medicine• Chiropractors• Naturopathy

• Veterinarians• Hospitals• Laboratories

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Who reports diseases in Florida?

• School nurses• Nursing home and assisted living facilities• Self or family reports• Media• Other regulatory agencies

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How are diseases reported?

• Electronic labs• Faxes• Direct call from providers, school nurses etc.

• Concerned public• Complaints to other agencies

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Reporting Process

Diseases can happen ANYWHERE at ANYTIME

• Any single case of a reportable disease• Any suspected outbreak or cluster (2 or more) in a location• Hospital• Nursing home• Neighborhood• School

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Reporting ProcessPhysician, lab,

hospital contacts health department

by phone or fax

Health department may call back

requesting more information

Need: Patient contact information, lab results, pertinent

notes

Health department may request more

testing or prophylaxis

Physician or laboratory sends

specimens to state lab

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Outbreak Investigation Steps

1. Prepare for field work

2. Establish the existence of an outbreak

3. Verify the diagnosis

4. Define and identify cases

5. Describe and orient the data in terms of time, place, and person

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Case Definitions

• Describe the evidence needed to classify a case

• Laboratory• Clinical

• Cases can be defined in many ways• Confirmed• Probable• Suspect

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Outbreak Investigation Steps

6. Develop hypotheses

7. Evaluate hypotheses

8. Refine hypotheses and carry out additional studies

9. Implement control and prevention measures

10. Communicate findings

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Response to Outbreaks

• Nursing homes• Alert EMS shift commander• Alert hospital Infection Control Practioners

• Schools• Alert Director of Nursing at Department of Education

• Alert parents

• Correctional facilities• Alert Warden

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Response to Outbreaks

May need to contact:

• Local providers• Blast fax/Everbridge/EpiCom

• Local EOC• Work with Preparedness Coordinator and Regional Emergency

Response Advisor

• Mosquito Control• State epidemiology office

• Coordination with state lab and CDC

• Media• Coordinate with PIO and possibly JIC

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Questions so far?

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Surveillance• Sentinel providers for influenza• Local hospital and ERs submit weekly numbers for influenza

• Local hospitals submit Carbapenem-resistant enterobacteriaceae cases when found

• Weekly and monthly review of reportable disease cases• ESSENCE

• ER and urgent care • Poison control• Death records

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Surveillance10

/5/2

013

10/1

0/20

1310

/15/

2013

10/2

0/20

1310

/25/

2013

10/3

0/20

1311

/4/2

013

11/9

/201

311

/14/

2013

11/1

9/20

1311

/24/

2013

11/2

9/20

1312

/4/2

013

12/9

/201

312

/14/

2013

12/1

9/20

1312

/24/

2013

12/2

9/20

131/

3/20

141/

8/20

141/

13/2

014

1/18

/201

41/

23/2

014

1/28

/201

42/

2/20

142/

7/20

142/

12/2

014

2/17

/201

42/

22/2

014

2/27

/201

43/

4/20

143/

9/20

143/

14/2

014

3/19

/201

43/

24/2

014

3/29

/201

44/

3/20

144/

8/20

144/

13/2

014

4/18

/201

44/

23/2

014

4/28

/201

45/

3/20

145/

8/20

14

0

20

40

60

80

100

120

140

Total Number of Flu Labs Reported in Lee County from October 2013 to May 2014

Influenza Report Week

Nu

mb

er o

f P

osi

tive

Flu

Lab

s R

epo

rted

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SurveillanceNumber of ILI patients seen in local ERs in Lee County from

October 2013 to May 2014

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Alcohol use in Hillsborough County January to June 2014

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Rates of rash illness by zip code in Lee County from March to June 2014

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Surveillance – ESSENCE Temporal Alerts

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Questions?

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Contact Information

Jennifer RothFlorida Department of Health in Lee County

3920 Michigan AvenueFt Myers, FL 33916

Phone: (239) 332-9657Fax: (239) 332-9553

Email: Jennifer.Roth@flhealth.gov