1

Welcome to Module 2 of the Public Health Nurse Orientation Program. This module introduces Services to Prevent and Control Communicable Disease.

I’m Tim Ringhand, one of the Western Regional Public Health Nursing Consultants. This module was written by Rebecca Hovarter, the Northeast Region Public Health Nursing Consultant and myself in consultation with the other Regional Nursing Consultants and others from the WI Division of Public Health. I will be presenting this module with Marina De Pablo, from the LEAP staff at the UW-Madison School of Nursing.

2

One of the five required services of a local health department is to provide services to prevent and control communicable disease. In this module we will explore how the services are provided or assured by the local health department. We will identify the statutes that relate to the prevention and control of communicable disease, the resources available, including state and regional consultants, some of the public health intervention that are applied to communicable disease prevention and control, and what is the public health nurse’s role in this mandated service.

The four sections that will be covered in this module are communicable disease in Wisconsin, immunizations, epidemiology investigations, and public health preparedness.

3

We’ll begin now with Section I: Communicable Disease in Wisconsin.

After completing this module, participants should be able to:

• Describe key elements of communicable disease prevention and control • Identify the system for communicable disease reporting, control, and case management

in Wisconsin • Identify published, standard resources available to support communicable disease

prevention and control

4

Communicable diseases, sometimes called infectious diseases, are illnesses caused by organisms such as bacteria, viruses, fungi and parasites. Sometimes the illness is not due to the organism itself, but rather a toxin that the organism produces after it has been introduced into a human host. Communicable diseases may be transmitted either by: -one infected person to another, -from an animal to a human, or -from some inanimate object, such as doorknobs or table tops, to an individual. Some communicable diseases can be spread in more than one way. Local health departments are charged with the responsibility of prevention and control of communicable diseases in their jurisdictions. State statutes provide the authority for the services and interventions that control the spread of disease and protect the health of the population. These statutes will be discussed in more detail throughout the module, along with the resources available for guidance in performing the policies, procedures, and guidelines Public Health Nurses incorporate into communicable disease prevention and control efforts.

The first orientation session introduced you to the Public Health Intervention Model. The Intervention Model represents what public health nurses do at the individual/family, community, and systems levels to achieve the goals of public health practice. We will demonstrate how the

5

model represents what interventions public health nurses use to control and prevent communicable diseases in their communities throughout this module.

Communicable disease presents many terms that are significant to understanding its prevention and control. Some of the terms may be new to you, while you may be familiar with others. Refer to this module’s reference list for more information on these terms.

Wisconsin Statute Chapter 252 directs the local health department regarding the activities of communicable disease investigation and control. It defines the powers and duties of the health officer including compulsory vaccination during a state of emergency and isolation and quarantine, describes the immunization program, mandatory reporters of communicable disease, and more detailed information about special circumstances such as tuberculosis, HIV and AIDS, meningococcal and hepatitis B vaccine information, and sexually transmitted infections.

6

The Bureau of Communicable Disease is responsible for the prevention and control of communicable diseases in Wisconsin, and for ensuring that the public health system is fully prepared for bioterrorism, other infectious disease outbreaks and other public health threats and emergencies. The Bureau provides surveillance and epidemiological follow-up of more than 70 reportable communicable diseases. It is also responsible for monitoring scientific advances in the field of communicable disease prevention and control research and incorporating those that are appropriate into public health practice. In addition, the Bureau provides technical assistance to local health departments either directly or through the regional offices. The Bureau of Communicable Diseases has four sections: AIDS/HIV, Communicable Disease Epidemiology, Immunization, and Sexually Transmitted Diseases. A brief overview of each of the four sections follows. Preparedness Program information is included in this module due to its potential link to communicable disease.

The first section we will be discussing in the Bureau of Communicable Disease is the AIDS/HIV Section. This section is responsible for coordinating the state’s public health response to the AIDS/HIV epidemic including surveillance and epidemiologic investigation, HIV testing and referral, partner counseling and referral, life care services and intervention, the Ryan White

7

Care Act, AIDS/HIV drug assistance, health insurance premium subsidy, and education and risk reduction activities. It is also responsible for Hepatitis C prevention and control.

The Communicable Disease Epidemiology section, Bureau of Communicable Disease, is responsible for maintaining and improving the surveillance system for communicable diseases. The section has specific responsibility for the epidemiologic investigation and response to tuberculosis, food/water/vector borne diseases, zoonotic diseases, suspected communicable disease outbreaks, and emerging and re-emerging diseases. It provides infection control consultation to the health care provider community, technical assistance on health risks, and health care needs of refugees and other populations entering the United States. This is a partial list of resources the epidemiology section provides for providers and the public.

Two of the most important communicable disease investigative resources you will use are:

• The Wisconsin Disease Surveillance Manual, called the EpiNet, and • The Control of Communicable Disease Manual, by David Heymann MD, Editor

EpiNet is accessible on-line, providing the most up-to-date information. The Heymann book is available in hard copy. Every agency in the state should have a copy of this manual by statute. The manual is updated about every 3-5 years.

8

The next section we will discuss, the Sexually Transmitted Diseases Section, is responsible for prevention and control of chlamydia, gonorrhea, genital herpes and the elimination of syphilis. This section provides direct patient services and partner referral for syphilis statewide. Section staff provide consultation and technical assistance to local health departments and private health care providers on diagnosis, treatment and follow up of patients infected with sexually transmitted diseases. The section maintains a statewide educational effort to reduce risky sexual behavior and the risk of infection with sexually transmitted diseases. The last of the four Bureau of Communicable Disease sections, the Immunization Section, will be covered in more detail later in this orientation.

Before we talk about immunizations, let’s talk a little about how communicable diseases are reported in Wisconsin. Currently, communicable disease reports are submitted to the local health department on paper forms. The 4151 report form is used for all communicable diseases except sexually transmitted infections. The 4243 is used for sexually transmitted diseases. WEDSS, the Wisconsin Electronic Disease Surveillance System, is being implemented statewide in 2008. WEDSS will allow laboratories to electronically transfer reportable disease information into the system and directly alert the health department that they have an infectious disease on which to do follow up. The system should eliminate the need for paper 4151 or 4243 reporting forms and also provides a case management system for more complex cases such as TB or Hepatitis C.

9

As Wisconsin transitions to WEDSS, it is important to clarify what WEDSS does and what it does not do. WEDSS is a disease reporting mechanism for infection control practitioners, laboratories, and other providers. WEDSS is a system for communicable disease surveillance and case management documentation. WEDSS is not a substitute for a phone call. Personal contact always has been and always will be an important part of communicable disease investigation and follow-up.

Access to WEDSS is secure and encrypted. PHIL and ARNOLD are acronyms for components of the software and hardware system. Access is based on role and location, and audits occur to assure the security of the system. I will describe the process of how a communicable disease is reported, from the initial laboratory results, to reporting to the Center for Disease Control and Prevention in the next slide.

10

Each case that is entered into WEDSS is unique in many ways, but the flow of information typically follows a common path. WEDSS will greatly improve the reporting, investigation and surveillance of reportable diseases in Wisconsin! Here’s a case example. A patient with symptoms consistent with a reportable disease such as pertussis infection visits a local doctor’s office. During the patient’s visit, specimens are collected and sent to the lab for analysis. A positive lab result prompts the lab to report the case to the local health department, using either manual lab reporting or an automatic feed to the WEDSS reporter from their laboratory information system. The health care provider is notified of the positive results through WEDSS. This prompts the provider to alert the local health department by creating a new case using WEDSS Reporter. Due to Wisconsin state law, both the lab and the doctor’s office should be in contact with the health department. For diseases requiring immediate reporting, Category 1, a phone call is also made to the health department Once the new case is created, the local public health department is contacted by e-mail through the WEDSS notification system, alerting the health department that a new case has been entered. When a case is complete, its data is securely stored in the WEDSS Reporter database for study by local and state health department staff. Nationally notifiable case data is also sent to the CDC for epidemiological study.

11

Since 1903, Wisconsin citizens have depended on the Wisconsin State Laboratory of Hygiene (WSLH) to help maintain the high quality of life in Wisconsin. As the state's public health and environmental laboratory, it helps:

• maintain the public health of all Wisconsin's citizens; • safeguard the state's environment; • educate state residents on public health issues.

The Wisconsin State Laboratory of Hygiene has two locations in Madison. The main facility is located on the University of Wisconsin campus. A new facility was dedicated in June 1999 on Agricultural Drive, and is home to the Environmental Health Division. The Wisconsin State Lab of Hygiene is an important public health partner for local health departments. WSLH provides clinical, environmental, and industrial hygiene analytical services, specialized public health procedures, reference testing, training, technical assistance and consultation for private and public health agencies. The WSLH performs research and instruction related to public and environmental health protection as part of the University of Wisconsin-Madison. The WSLH touches the life of every Wisconsin citizen directly or indirectly through their wide range of activities.

12

All Local Health Departments that meet the requirements of Chapter 251 Wisconsin Statutes as a Level 1 health department are eligible to request and receive fee exempt testing from Wisconsin State Lab of Health based on oversight and authority of Division of Public Health and adherence to policies and procedures. Information on the policy and procedures on how to obtain the service for diseases of public health concern, such as hepatitis, HIV, ova and parasites, and rabies are available through the Wisconsin State Lab of Health resource listed on the screen. You can find this on the module resource list.