Vaccine Preventable Diseases

Reporting Suspected Cases

Reportable Diseases

Epidemiology Resource Center Surveillance and Investigation Contacts Reporting Fax Number: 317-234-2812 My Phone Number: 317-233-7112 My E-mail: kbuffin@isdh.in.gov Alternate Fax number: 317-233-7805

*Reportable Disease List (handout)

Epidemiology Resource CenterSurveillance and Investigation Division

Communicable Disease Responsibilities2 N. Meridian Street, 5-KIndianapolis, IN 46204

Fax: 317-234-2812

Karee Buffin. MS—Vaccine Preventable Disease Epidemiologist

317-233-7112 kbuffin@isdh.in.gov

DiphtheriaInvasive Haemophilus influenzae Invasive Pneumococcal Disease

MeaslesMumps

Pertussis (whooping cough)Polio

RubellaRubella, congenital syndrome

SmallpoxTetanus

Varicella/shingles (hospitalization or death and sentinel reporting)

ISDH Public Health Investigators Investigate the following: In accordance with the guidelines from the

Communicable Disease Reporting Rule Measles, Mumps, Rubella, Pertussis,

Diphtheria, Tetanus, Polio Varicella resulting in death or hospitalization Invasive Haemophilus Influenzae Invasive Pneumococcal Disease (cases less

than or equal to 5 years of age)

* The Rule is currently undergoing revisions

Communication

“A trained immunization field representative of the department in cooperation with the local health officer”

Contacting your immunization program’s public health investigators: Phone: see map (handout) E-mail• Contacting the field staff supervisor:

Sarah Murphy: 317-233-7603 smurphy@isdh.in.gov

Non-Sterile SitesNeed not be reported Saliva Ear swabs Nasal swabs Wound swab, wound culture Eye Swab Fingernail or other infected external sites

And other non-sterile sites need not be reported

Sterile SitesFluids collected from these sites

are expected to be sterile:

• Blood (venous or arterial cultures)• CSF• Pleural Fluid• Peritoneal Fluid• Pericardial Fluid• Joint or Synovial Fluid• Tympanocentesis

Haemophilus Influenzae (H.Flu)

Bacterial Isolates are required to be sent for further

evaluation. 1 type b in Indiana in 2007 How did this happen? Sensitivity reports needed for Drug Resistant

patterns. When are these required to be reported?...

Reporting Requirement

Immediately

Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf

Streptococcus Pneumoniae(Strep. Pneumo.) Bacterial Isolates are requested to be sent to ISDH lab

for patients less than or equal to 5 years old. It is important to ask this of the lab as soon as

you are aware of the case for serotyping. In 2007 ISDH lab has received 70% of the

isolates for serotyping. Sensitivity reports needed for Drug Resistant

patterns When are these cases required to be reported?...

Reporting Requirement

72 hours

Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf

Indiana Streptococcus Pneumoniae Serotypes Patients less than 5 years of age (n=30)

January-October 2007

47%

3%

3%

3%

7%

30%

7%

7F

19A

23F

33F

35B

OTHER

N/A

Drug Resistant Patterns

30 Total isolates (Collected on patients less than 5 years old)

14 typed as 19A Not in the current pneumococcal vaccine for

children Total Breakdown of 19A:

10/14 demonstrate Drug resistant Streptococcus Pneumoniae patterns

1/14 sensitive to antibiotics tested 3/14 Unknown patterns (not sent to ISDH labs)

Vaccine Preventable Disease Indiana Incidence 2006 Compared to Jan-June 2007

Year 2006 Jan-June 2007

Pertussis 280 26

Tetanus 2 0

Measles 1 0

Mumps 10 1

Rubella 0 0

Haemophilus

Influenzae 81 31

Streptococcus

Pneumoniae 721 357

Vaccine Preventable Disease Indiana Incidence Jan-June 2006-07

Year Jan-June 2006 Jan-June 2007

Pertussis 105 26

Tetanus 1 0

Measles 1 0

Mumps 10 1

Rubella 0 0

Haemophilus

Influenzae 35 31

Streptococcus

Pneumoniae 354 357

Mumps

Incidence in Indiana One counted in 2007

CDC clinical case definition: An illness with acute onset of unilateral or

bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting more than 2 days without other apparent cause.

MumpsReporting Suspected Cases: Why not wait for the test results?

Some results may take 3 weeks or more Other testing possibilities through the state lab One cannot rely solely on the accuracy of testing Time off of work, out of school Communicable Disease Reporting Rule:

Indiana still recognizes the 9-day exclusion rule

Mumps News

Proof of 2 MMRs does not guarantee 100% protection

* Evidence of disease in patients who have received 2 doses of the mumps vaccine. 1997-1998 NY outbreak Iowa outbreak (recent) Efficacy

*Source: VPD Surveillance Manual Chapter 7. Web Link: www.cdc.gov/vaccines/pubs/surv-manual/downloads/chpt07_m

umps.pdf

Importance of Exclusion of Susceptibles: The Communicable Disease Reporting Rule

for Indiana currently states: Exclude exposed susceptibles from school or the workplace from the12th to the 25th day after exposure to prevent the spread to other susceptibles.

Example: Hospital nursery, (based on a fictional event).

Mumps Testing

PCR Offered at ISDH labs: Buccal Swab (7days before – 9 days after

parotid gland swelling) Detects the presence of DNA Generally offers quick results Culture also can be obtained from swab

IgG, IgM (Offered at ISDH labs) Paired sera (Offered at ISDH labs) Clinical Picture: should be considered with

testing results due to many false + IgM tests.

Consider other apparent causes:

Oral surgery, ear surgery, surgery in general involving the jaw, ear, neck area.

Hit by a: Ball bat to the jaw Baseball to the jaw Brother’s fist to the jaw Other objects to the jaw

Other medical diagnosis consistent with parotitis.

Reporting Requirement?

Within 72 hours

Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf

Pertussis

Report a Suspected Case: Reporting Requirement: IMMEDIATELY

Problems: Consequences for waiting for lab testing and

late reporting.• Share case review with Mom’s comments:

Encouragement from a parent.(Smiley is HIPPA compliant)

Reporting: relying on labs to report

Pertussis

Testing Issues Recommended testing:

Culture and DFA: available at ISDH labs PCR: currently unavailable at ISDH lab

Serology is not recommended for pertussis diagnosis. Clinical picture is more valuable than the

serology results.

Indiana Reported Pertussis Cases 2002 - 2006

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Pertussis Incidence Indiana, 1995-2006

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Tdap, Tdap, Tdap

ACIP Tdap Recommendations

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm

One dose of Tdap should be used to replace a Td booster dose in adults and children of recommended age (includes wound management).

(Note: Two manufactures with different recommendations.)

Varicella

Reporting: Outbreaks

Definition: greater than or equal to 5 cases in a place in children less than 13 years old within one incubation period.

Also: greater than or equal to 3 cases related in place in persons greater that or equal to 13 years of age within one incubation period.

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1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Per

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Varicella Vaccine CoverageNational Immunization Survey Results

Children 19-35 Months of AgeUS and Indiana, 1997-2006

US

Indiana

Varicella

Reporting: Outbreaks including ‘breakthrough’ disease

One incubation Period: 21 days A lot can happen in 21 days:

Example: School Jan 30, 5 cases By Feb 20, 31 cases

* Recommend 2 doses varicella vaccine for outbreak management and current ACIP.

Current ACIP Recommendations

Routine vaccination at 12-15 months 2nd dose recommended at 4-6 years of age; 3

months as minimum interval between doses 2nd dose recommended for person of ANY

age who has had only 1 dose 13 yrs or older, if not immune-2 doses at least

4 weeks apart.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm Current Web address

ACIP Recommendations and Vaccine Administration Current Issues:

State funding does not always match the recommendations.

Publicly funded vaccine programs should check the policy prior to administration.

Outbreak conditions: Communicate needs with the Immunization

Program. Vaccine needed, expected numbers

Initiate an outbreak response.

Varicella

Sentinel Reporting Since 2004 Breakthrough disease may decrease with

second dose of varicella introduced. Incidence of severe varicella with 2 doses of

varicella in Indiana is zero, (using sentinel surveillance data).

Acknowledgements

Wayne Staggs Dr. Charlene Graves Immunization Program

Special recognition to the Immunization Field Staff Pam Pontones Kristin Ryker