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