Slide 1 Maricopa County

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					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
                                                                                Bob England, M.D

                  Adminis trativ e
                                                                                                      Community Health
                    Serv ic es                                Disease Control                                                          Clinical Services

 Professional &
                                       Community Health                           Office of Oral                                       Clinical Medical
                                           Nursing                                    Health                                               Director

                                                                                Office of Family
Human Resources                          Epidemiology                                                                    Transmitted                                            Pharmacy

                                                                                Health Promotion
                                                                                                                                                                              Health Care for
 Finance/Budget                        Vital Registration                              and                               Laboratory
                                                                                                                                                                               the Homeless

  Procurement/                       Office of Preparedness                                                                                                                   Communicable
                                                                                Office of Nutrition                       HIV/HCV
     Travel                               And Response                                                                                                                          Disease

                                                                                                                                                           Family Planning
     Grants                                                                        MACTUPP                                                                                                      TB Clinic

                                                                                                                                                           Special Services
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
 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 newborns will be given to the wrong parents
 160 cars can drive side by side on the
  Monumental Axis in Brazil, the world’s widest
 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

 A critical component of disease
 surveillance is the prompt reporting
 of communicable diseases.
Why report communicable
   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
   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
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
 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
 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
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
  *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

  *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
  *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
  *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:

   Hepatitis B*
   Hepatitis C
   HIV infection

   *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

 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
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),
   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
 CDC:
 Communicable Disease Flip Chart:
 AZ Admin. Code:
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!