detect i and ii training goals - alabama department of
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Alabama DETECT II Training:Foodborne Illness Response Strategies
Epidemiology Division
www.adph.org/epi
DETECT I and II Training GoalsDefine Foodborne Outbreaks (FBOs)Identify roles, responsibilities, and legal requirements in response to FBOPromote teamwork and consistency in FBO
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o ote tea wo a d co s ste cy OresponseAnswer commonly asked questions
www.adph.org/epi
DETECT I FBO Training Conducted eleven PHA 2-day trainings Trained ~250 staffImplemented FBO ProtocolsUtilized electronic standardized questionnaires
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qProvided 110 DETECT KitsProvided additional resource materialsPurchased new equipment – tablets
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www.adph.org/epi
DETECT II FBO Training Conduct three 1-day trainings Train ~230 ADPH and non-ADPH staffEducate on outbreak procedures
Foodborne Outbreak ProtocolsEpidemiology Outbreak Investigation Report (EIOR)
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Epidemiology Outbreak Investigation Report (EIOR)Environmental Assessment Report (EAR)Hypothesis generating questionnaires
Utilize electronic outbreak specific questionnairesProvide DETECT Kits suppliesProvide additional resource materials
www.adph.org/epi
Unofficial DETECT II FBO Logos
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Module 1: Surveillance
Epidemiology Division
www.adph.org/epi
Module Learning ObjectivesDefine Notifiable Disease Reporting ProcessIdentify process used to document foodborne illness.Di h h i i
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Discuss reasons whether or not to investigate complaints further.
www.adph.org/epi
Why Investigate Foodborne Outbreaks?
ADPH Mission: “To serve the people of Alabama by assuring conditions in which they can be healthy.”Prevent additional foodborne illness
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Fulfill federal grantsEpidemiology and Laboratory Capacity (ELC)Public Health Emergency Preparedness (PHEP)
Core Capability 13: Public Health Surveillance and Epidemiological Investigation
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www.adph.org/epi
Surveillance Pyramid
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www.adph.org/epi
Notifiable Diseases/ConditionsPurpose of Notifiable Diseases
Prevent diseaseAssist with medical decisionsPatient educationRequired by law
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Required by lawADPH administrative code authorizes and requires reportinghttp://www.alabamaadministrativecode.state.al.us/docs/hlth/420-4-1.pdf
ADPH is exempt from HIPAA Privacy Rules, http://www.cdc.gov/mmwr/pdf/other/m2e411.pdf
www.adph.org/epi
HIPAAADPH is a public health authority as defined bythe Health Insurance Portability and Accountability Act (HIPAA) to collect or receive protected healthinformation (PHI) for the purpose of surveillance,
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( ) p p ,investigations, and interventions of notifiable diseases, without authorization of the patient.
http://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm
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Report within 4 hours of DiagnosisImmediate, Extremely Urgent
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*Select Agents, http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html
Must request permission from Epidemiology before testing
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BotulismContact Epidemiology Division (EPI) immediately:
Arrange for lab testing of specimensTesting must be approved by the State EpidemiologistEPI and Environmental investigation can be
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ginitiatedObtain botulism antitoxin (if warranted)
National Botulism Surveillancehttp://www.cdc.gov/nationalsurveillance/botulism_surveillance.htmlCDC Resources http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/
www.adph.org/epi
Select Agents and Toxins
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*Select Agents, http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20List.html
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Report within 24 hours diagnosisExtremely Urgent
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(Not seasonal flu)
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Report within 7 days of DiagnosisStandard Notification
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EPI Investigations from 3/11-4/12
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http://adph.org/epi/Default.asp?id=5455
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www.adph.org/epi
Who Must ReportPhysiciansDentistsNursesMedical Examiners
Nursing Home AdministratorsLaboratory DirectorsSchool Principals
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Medical ExaminersHospital Administrators
Sc oo c pa sDay Care Center Directors
We expect and want multiple reports
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Minimum Data ElementsName disease or health conditionPatient namePatient DOB
Date of onset, date of lab results, and/or date of diagnosisReporter’s Name
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Patient genderPatient addressPatient phone number
Reporter’s Phone
Facility/Organization Name
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Notifiable Disease/Condition Awareness Campaign
DETECT - Decrease Epidemiological Threats with Environmental Controls and Testing TEST - Take Epidemiological Specimens Today
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p g p yREPORT - Rules for Every Provider and Organization to Report on Time
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REPORT Webpage
www.adph.org/epi
Case DefinitionThe CDC and Council of State and Territorial Epidemiologists (CSTE) determine national case definitions
http://www.cdc.gov/osels/ph_surveillance/nndss/casedf/ d fi i i h
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ef/case_definitions.htmhttp://www.cste.org/dnn/AnnualConference/PositionStatements/tabid/191/Default.aspx
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How to REPORTImmediate, Extremely Urgent W/in 4 hrs of dx
Phone -1-800-338-8374Immediate, Urgent W/in 24 hrs of dx
Standard W/in 7 days of dx
Online, REPORT Card Email to [email protected]
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Online, REPORT Card Email to [email protected] (334) 206-3734Phone 1-800-338-8374
p @ pFax (334) 206-3734In writing – Mail green “REPORT Card”
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Online REPORT Card
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Module 2:Outbreak Determinationand Investigationand Investigation
Epidemiology Division
www.adph.org/epi
Module Learning ObjectivesDescribe information to determine the source of an outbreakIdentify means for searching for additional ill persons
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Describe methods to ensure consistency of interview dataDescribe methods for overcoming interview barriers
www.adph.org/epi
Foodborne Outbreak (FBO) DefinitionCDC and IAFP Definition
An outbreak is an incident in which two or more persons havethe same disease, have similar clinical features, or have the same pathogen – thus meeting the case definition - and there
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p g gis a time, place or person association among these persons.
A foodborne outbreak is one that is traceable to ingestion of acontaminated food.
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Alabama Definition
An incident in which two or more persons from different households experience a similar illness resulting from the ingestion of a common food
FBO Definition
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resulting from the ingestion of a common food.
Exceptions: botulism and chemical poisoning (1 case = outbreak).
www.adph.org/epi
How to Report OutbreaksCall 1-800-338-8EPIOnline www.adph.org/epi, REPORT CardFax Green Card to 334-206-3734C t t ADPH Fi ld S ill St ff (FSS)
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Contact ADPH Field Surveillance Staff (FSS)
www.adph.org/epi
EPI Field Surveillance Staff (FSS)
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http://www.adph.org/epi/assets/FSS_Web_Map.pdf
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www.adph.org/epi
Who Has Reported Outbreaks?Serratia marcescens – Infection PreventionistsEscherichia coli (E. coli), Shiga-toxin producing (STEC) – Hospital ED
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Salmonella – Public ComplaintNorovirus – SchoolHand-Foot-Mouth (CVA6) – Pediatrician
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Case Characteristics
Preliminary information as of May 3, 2011. Subject to change.
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Total Outbreaks
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http://www.adph.org/epi/index.asp?id=5548
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ADPH Outbreak PartnersADPH programs involved in outbreak investigation:
Bureau of Communicable Diseases (BCD)Epidemiology Division
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Field Surveillance StaffBureau of Clinical Laboratories (BCL)Bureau of Environmental Services (BES)
Environmentalist
www.adph.org/epi
Private Sector PartnersADPH works closely with the community involved in outbreak investigation:
Hospitals:Infection PreventionistsLaboratorians
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LaboratoriansEmergency Department
Private ProvidersSchools/Colleges/DaycaresFood industry
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www.adph.org/epi
State & Federal Outbreak PartnersADAI - AL Department of Agriculture and IndustriesADEM - AL Department of Environmental Management
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CDC- Centers for Disease Control and PreventionFDA -Food and Drug AdministrationUSDA- United States Department of Agriculture
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Determine SourceInformation in Epidemiology Outbreak Investigation Report (EOIR)Hypothesis-generating QuestionnairesHealthcare provider medical records
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Clinical and food specimen test resultsOutbreak-specific QuestionnairesEnvironmental Assessment Report (EAR)
www.adph.org/epi
Search for Additional CasesCommunicate with CommunityExposure LocationHealth Care FacilitiesPrivate Providers
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Schools AbsenteeismALERTsNews ReleasesEpi-X
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ADPH InterviewsCompletes Hypothesis-generating or Outbreak-specific QuestionnaireFollows Case DefinitionSeeks Others to Interview
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Seeks Others to InterviewSolicits Specimens from Ill
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ADPH Questionnaire FormatDemographic information
Age, gender, address, other identifying data
Exposure history
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Exposure history Food consumption
Disease informationSymptoms/signs
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Consistent InterviewsTrain FSS in interview techniques
Be familiar with questionnairePractice with someone on teamBe specific
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Accurate and complete data requiredObtain answers for all questions, even if “unknown”Interview 3 “not ill” for every 1 “ill”
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Be SpecificLocation of facility (be specific)
Chain X store in Anytown, ALChain X store on corner of Main and Fourth in Anytown, AL
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Chain X store located at 245 Main Street in Anytown, AL
Main
Four
th
245 Main StXAnytown
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Overcome Interview BarriersAsk about food preferencesRule in/out some foods Show calendar to identify key days and j
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jog memoryReview receipts and/or checkbookIf buffet, clearly describe each foodShow the menu if available
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Think Non-FB Routes of Disease Transmission
We can’t rule out anything:Petting ZoosDay Care Centers
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Drinking WaterSwimming Pools