Disease Surveillance & Reporting Ron Klein R.N., B.S.N. Maricopa County Department of Public Health Maricopa County Department of Public Health Office of the Director Bob England, M.D Adminis trativ e Community Health Serv ic es Disease Control Clinical Services Services Professional & Community Health Office of Oral Clinical Medical Technical Nursing Health Director Services Sexually Office of Family Human Resources Epidemiology Transmitted Pharmacy Health Diseases Health Promotion Health Care for Finance/Budget Vital Registration and Laboratory the Homeless Education Procurement/ Office of Preparedness Communicable Office of Nutrition HIV/HCV Travel And Response Disease Family Planning Grants MACTUPP TB Clinic Clinic Information Special Services Technology Office of Community Health Nursing Location: 4041 N. Central Ave., Suite 600, Phoenix, AZ 85012 Our program staff consists of registered nurses and other individuals who provide a wide range of administrative services. We currently have 7 registered nurses primarily assigned to immunization services, 4 community health nurses, 5 surveillance nurses, and 7 CCNC’s. There are 3 Nurse Supervisors and 1 Nurse Manager for CHN. The Disease Surveillance Staff consists of 5 registered nurses, 1 communicable disease investigator, and 1 nurse supervisor. CHN Surveillance Staff Telly Der RN (602) 506-5003 Sun Wright RN (602) 506-8880 Karen Rose RN (602) 506-8881 Rachel De La Huerta RN (602) 506-6375 Susan Miller RN (602) 506-8365 Dolores Ravsten CDI (602) 506-6385 * Program Nurses prn for backup (crossed trained, rotate WE on call) What do Disease Surveillance Nurses do? Disease Surveillance Nurses: Investigate Communicable Disease Reports Provide health education to schools, daycare centers, health care providers, businesses, and to the general public Participate in drills such as mass immunization clinics and KI distribution in collaboration with OPR and other emergency response agencies Provide a high volume of immunizations to children in various locations throughout Maricopa County Collaborate with county, state and federal agencies regarding urgent or noteworthy events pertaining to disease surveillance. Who Knew? 111,111,111 x 111,111,111 = 12,345,678,987,654,321 12 newborns will be given to the wrong parents daily. 160 cars can drive side by side on the Monumental Axis in Brazil, the world’s widest road. A cockroach can live several weeks with its head cut off. A giraffe can go without water longer than a camel can. Overview of Communicable Disease Reporting A critical component of disease surveillance is the prompt reporting of communicable diseases. Why report communicable diseases? Communicable disease reporting is the means by which the local health departments: Provide follow-up and ensure adequate treatment of cases locate and treat exposed contacts Identify and limit the spread of outbreaks Issue public health alerts to general public Who submits Communicable Disease Reports? Arizona Administrative Code (AAC) R9-6- 202, 203, 204, and 205 mandates that communicable disease reports be submitted to local health departments by: Health care Schools and day care providers centers Health Care Shelters Institutions Pharmacies Correctional facilities Clinical Laboratories Violation of reporting rules constitute a class III misdemeanor and is subject to referral to the appropriate licensing agency or state licensing board. Which communicable diseases need to be reported? CHN Surveillance Responsibilities Amebiasis Mumps Campylobacteriosis Pertussis Cholera Poliomyelitis Conjunctivitis Rash Cryptosporidiosis Rubella and Congenital Rubella Diphtheria Salmonellosis EHEC Scabies ETEC Shigellosis Giardiasis Strep A H-Flu Strep B HUS Strep Pneumo Hep A,B,C ,D,E TSS Legionellosis Typhoid Listeriosis Varicella Measles Vibrio infection Meningococcal disease Yersiniosis Surveillance Priorities The A.A.C. “24hr & Next Day Reportables” Meningococcal, Pertussis, Measles, etc. Infections in F/H, D/C, H/C workers Outbreaks, Clusters, R/O Mening Enteric & HAV disease in children 0-6 YO, Perinatal HBV & Women <50 w/(+) HBV Labs Remaining enteric, HAV, HBV, Legionella, TSS, scabies, etc. Constant prioritization Who Knew II A “jiffy” is an actual unit of time for 1/100th of a second. A sneeze travels out your mouth at over 100 m.p.h. A toothpick is the object most often choked on by Americans! About 3000 years ago, most Egyptians died by the time they were 30. According to a British law passed in 1845, attempting to commit suicide was a capital offense. Offenders could be hanged for trying. How is a communicable disease reported? Current Chicken Pox Report Form Use of Chicken Pox Report Form This form is used to report cases weekly to MCDPH-schools & child care No need to fax form if no cases Please call if there is an outbreak at the school or child care (outbreaks are more than the expected number of cases, if unsure, give us a call) What about HIPAA? More Fun Facts America’s first nudist organization was founded in 1929, by 3 men. Clans of long ago that wanted to get rid of their unwanted people without killing them use to burn their houses down – hence the expression “to get fired.” Dueling is legal in Paraguay as long as both parties are registered blood donors. Einstein couldn’t speak fluently when he was nine. His parents thought he might be retarded. If one places a tiny amount of liquor on a scorpion, it will instantly go mad and sting itself to death. What happens when a report is filed? Investigation Process Overview Gather data: Demographics, Clinical information, Lab results Interview the case Complete investigation form, looking for: Who, What, When, Where Look for possible source of exposure (How) Identify symptomatic contacts/possible spread Determine public health risk Provide education and recommendations Classify Case according Case Definition Manual Initiate contact control measures as needed per AAC Finished reports sent to ADHS and CDC What are Communicable Diseases? Communicable Disease: An illness caused by an agent or its toxic products that arises through the transmission of that agent or its products to a susceptible host, either directly or indirectly What’s that again? Something that makes you sick when you are exposed to it Includes toxins, bacteria, viruses, prions, and parasites Catch from humans, animals, insects, water, fomites Fomite: inanimate objects capable of transmitting disease How are Diseases Spread? Respiratory or Airborne Route Contact Route Direct or Indirect Contact Fecal-Oral Route Blood Contact Route Respiratory/Airborne Transmission (passing from the lungs, throat, or nose of one person to another person through the air) Illnesses spread this way include: Bacterial Influenza* Mumps* meningitis* Measles* Pertussis* Chicken pox* Rubella* Diphtheria* Pneumonia* Common Cold Strep throat Tuberculosis *Vaccines are available for preventing these diseases. Direct Contact (with infected person’s skin or body fluid) Illnesses spread this way include: Chicken pox* Head Lice Cold Sores Impetigo Conjunctivitis MRSA Cytomegalovirus Ringworm Scabies *Vaccines are available for preventing these diseases. Indirect Contact (with infected person’s skin or body fluid via fomites) Illnesses spread this way include: (same as the last slide) Chicken pox* Head Lice Cold Sores Impetigo Conjunctivitis MRSA Cytomegalovirus Ringworm Scabies *Vaccines are available for preventing these diseases. Fomites include: desk tops, toilets, toys, tissues, door knobs, shopping carts, hairbrushes, and so much more Fecal-Oral Transmission (touching feces or objects contaminated with feces and then touching your mouth, or eating/drinking) Illnesses spread this way include: Campylobacter** Hand-Foot-Mouth Polio* E. Coli O157** Disease Salmonella** Enterovirus Hepatitis A* Shigella Giardia Norovirus Pinworms *Vaccines are available for preventing these diseases. **Often transmitted from infected animals through foods or direct contact Bloodborne Transmission (Needlesticks or cuts from items contaminated with blood, or through contact of eye, nose, mouth or skin) Illnesses spread this way include: Cytomegalovirus Hepatitis B* Hepatitis C HIV infection Syphilis *Vaccines are available for preventing these diseases. One More Time Celery has negative calories. It takes more calories to eat a piece of celery than the celery has in it to begin with. Charlie Chaplin once won third prize in a Charlie Chaplin look-alike contest. It is impossible to lick your elbow. In Shakespeare's time, mattresses were secured on bed frames by ropes. When you pulled on the ropes the mattress tightened, making the bed firmer to sleep on. Hence the phrase......... "goodnight, sleep tight." Rashes in Brief Definitions Exanthem- A rash on the skin. Enanthem- An eruption on the mucous membranes of the mouth (inside). Erythematous- Red, but blanches white on finger pressure. Urticaria- “Hives”; elevated white itchy plaques on red base. Prodrome- Symptoms & Signs preceding illness. Types of lesions Macule-flat, different color Papule-elevated Maculopapular-combo of above Purpuric Lesions-hemorrhage Vesicle/Bullae-fluid filled Pustule-pus filled Some Causes of Rash Infections: Viral- Rubeola, Rubella, Varicella, Variola, Herpesvirus, Parvovirus, Coxsackievirus, etc. Bacterial- Staphylococci, Streptococci, Rickettsia, Mycoplasma, Meningococci, etc. Fungal- Dermatophytes (Ringworm, Tinea), Candida. Parasitic- Cutaneous larva migrans (Hookworm), Scabies. Causes of Rash Continued Hypersensitivity- Anti-infectives, anti- convulsants and many other medications. Contact sensitivity- Poison Ivy, Poison Oak, Bermuda grass, perfumed soaps, detergents, metals, latex, etc. Rashes Accompanied by the Following Require Immediate Attention: Fever Other signs of illness Difficulty breathing Vomiting Red, watery eyes and/or cough Itching (chickenpox? Scabies?) What Can You Do to Prevent Spread of Communicable Diseases? Handwashing/Hand sanitizing Cover coughs and sneezes Keep ill children home/stay home when YOU are sick Stay current with vaccines, including annual flu shots Important Websites MCDPH: http://www.maricopa.gov/public%5Fhealth/ ADHS: http://www.azdhs.gov/ CDC: http://www.cdc.gov/ Communicable Disease Flip Chart: http://www.azdhs.gov/phs/owch/pdf/commdis eases.pdf AZ Admin. Code: http://www.azsos.gov/public_services/Title_09 /9-06.htm Communicable Disease Reporting Maricopa County Department of Public Health Office of Community Health Nursing (602) 506-6767 Ask to speak with a Surveillance Nurse Thank You! Questions?