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outbreak reporting

Office of Epidemiology and Disease Intervention ServicesFlorida Department of Health in Sarasota CountyPhone: 941-861-2873 After Hours: 941-861-2900 Fax: 941-526-1534

www.sarasotahealth.org

A Resource Guide for Long-Term Care Facilities in Sarasota County, Florida

IDENTIFY • REPORT • CONTROL

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IntroductionReporting infectious disease outbreaks is mandated by Florida Statute and Florida Administrative Code. Facilities are required to report all outbreaks to their local health department upon suspicion. This reference guide has been prepared for facilities to ensure they have the knowledge, tools and resources to effectively manage and report outbreaks.

The elderly represent a vulnerable population due to having a unique set of health problems, psychological dispositions and functional impairments. Those living in long-term care facilities (LTCFs) are at increased risk of acquiring an infectious disease due to congregate living and a consistent flow of visitors, staff and residents who bring in pathogens from hospitals and the community. Outbreaks are common, and the Florida Department of Health in Sarasota County’s (DOH-Sarasota’s) goal is to stop them quickly and safely.

In This GuidePrevention measures and instructions for outbreak identification, reporting and control will be covered in this six-part resource guide.

1 Prevention, Preparation & Surveillance ....................................2

2 Gastrointestinal Illness .............................................................4

3 Respiratory Tract Infections ......................................................7

4 Scabies ...................................................................................10

5 Antibiotic-Resistant Bacteria ...................................................12

6 Environmental Health .............................................................16

A Appendix (Forms & Resources) .............................................20

TO REPORT A DISEASE OR OUTBREAK IN SARASOTA COUNTY

Contact Florida Department of Health in Sarasota County’s Disease Investigation Services

Monday–Friday, 8 a.m.–5 p.m.: 941-861-2873 Nights, Weekends, and Holidays: 941-861-2900

Fax reportable disease/outbreaks to: 941-526-1534 HIV/AIDS REPORTS MUST BE MAILED. DO NOT FAX.

For more information, please call or visit: sarasota.floridahealth.gov/programs-and-services/infectious-disease-services/epidemiology

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1 1.1 WhatisanOutbreak?

An outbreak is the occurrence of more cases of disease than normally is expected within a specific place or group of people over a given period of time.

All outbreaks must be reported to the Florida Department of Health in Sarasota County (DOH-Sarasota) upon suspicion. It is important to note that even if you only have a small number of ill residents or the outbreak is considered “small,” DOH-Sarasota would like to be notified for surveillance purposes and to recommend control measures/precautions.

1.2 PreventionandRoutinePractices

Routine practices are fundamental in preventing the transmission of infections and should be used in all facilities and with all residents and staff to prevent microorganism transmission. Prevention methods include anything from disinfection and hand hygiene to vaccination and preparedness. Below is a web address for a comprehensive list of different infection control practices, guidelines and toolkits from the Centers for Disease Control and Prevention (CDC).

• General Guidelines

• Device-associated Infection Prevention Guidelines

• Procedure-associated Infection Prevention Guidelines

• Prevention and Control Drug-resistant Organisms in Healthcare Settings

• Healthcare Personnel Guidelines

• Antibiotic Stewardship

• Flexible Endoscope Reprocessing

1.3 Pre-OutbreakPreparation

Good planning and early detection can make the difference between a quickly contained outbreak and facility-wide infections. Below are general preparation tips for efficient outbreak response:

• Provide current and routine outbreak education and/or training to residents and staff.

• Ensure disinfection products and specimen collection containers are in stock and not expired.

• Ensure appropriate personal protective equipment is easily accessible to all staff members.

• Choose an easily accessible place to keep all records, procedures, toolkits, and report forms so they are available during an outbreak.

• Perform a risk assessment to monitor prevalence and identify hazards.

Prevention, Preparation and Surveillance

► www.cdc.gov/hicpac/pubs.html

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11.4 RoutesofTransmission

Staff: Healthcare workers and staff who maneuver through multiple healthcare settings can introduce infectious disease from different facilities. It is beneficial to have open communication with staff, especially those that work additionally in hospitals, home health or other LTCFs, to be aware of outbreaks in other places that could affect your facility.

Residents:Residents are transported between facilities and hospitals and bring with them pathogens that could lead to outbreaks in your facility. Communicate with other LTCFs about possible exposure to an outbreak when receiving new residents, and notify other facilities of an outbreak in your own facility when transporting a resident.

Community: Visitors are another route of transmission that commonly causes infection and outbreaks. It is important to make visitors aware that minor illnesses they are experiencing can lead to more serious complications and spread in residents. Refusing visitation when individuals are sick and enforcing hand hygiene can greatly reduce the risk of infection.

1.5 SurveillanceandtheRoleoftheLocalHealthDepartment

Having a designated person responsible for infection control activities is important for coordinating staff, implementing control measures, and communication. In addition, this person should be responsible for surveillance and identification of increases in illness so appropriate action can be taken.

The Florida Department of Health in Sarasota County has a responsibility to respond to outbreaks and provide guidance and also acts as a resource for all facilities in Sarasota County. The objectives during an outbreak investigation are:

• Confirm the presence of an outbreak.

• Ascertain the source and spread of the infection.

• Obtain specimen samples for organism identification (when appropriate).

• Determine and recommend appropriate control measures.

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Gastrointestinal illness (GI) is one of the most common causes of outbreaks in LTCFs. There are many causal agents for GI illnesses including: viruses like Hepatitis A and norovirus, bacteria like E. coli and Salmonella and parasites such as Giardia and Cryptosporidium.

• ModeofTransmission: Person-to-person through the fecal-oral route, but can also be transferred through contaminated food and objects

• Symptoms:

◦ Bacteria – loss of appetite, nausea and vomiting, diarrhea, abdominal pain/cramps, blood in stool, fever

◦ Virus – watery diarrhea, nausea and vomiting, headache, muscle aches

◦ OvaandParasites – diarrhea, mucous/blood in stool, nausea or vomiting, severe abdominal pain

• Duration: Less than two weeks

Gastrointestinal Illness (GI)

Gastrointestinal Illness: Any combination of diarrhea (≥ 3 loose stools in 24 hours), vomiting, abdominal pain, with or without fever

GastrointestinalIllnessOutbreak: The occurrence of more cases of GI illness in a 24-hour period than would normally be expected based on a facility’s individual surveillance data

2.1 Precautions

• Practice proper hand hygiene.

• Clean and disinfect contaminated surfaces.

• Follow the CDC’s Standard Precautions guidelines.

• Understand that any patient with foodborne illness may represent the sentinel case of a more widespread outbreak.

• Communicate with patients about ways to prevent food-related diseases.

• Wash fruits and vegetables and cook seafood thoroughly.

• When you are sick, do not prepare food or care for others who are sick.

• Wash laundry thoroughly.

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2.2 ReportingProcess

Upon suspicion of a GI outbreak, facilities are required to notify DOH-Sarasota at 941-861-2873. Once notified, DOH-Sarasota will provide initial guidance, educational materials and two forms (listed below). These forms need to be completed by the facility. With this information, DOH-Sarasota can provide appropriate recommendations, provide control measures and perform limited laboratory testing.

1. GI Outbreak Report Form (Appendix i), which provides all pertinent information

2. Line List for GI Outbreaks (Appendix ii), a documented list of all persons with symptoms; the line list is to be continuously updated to track the duration of the outbreak

2.3 SpecimenCollection

Specimen collection is an important step allowing for identification of the causal agent so appropriate control measures can take place. For a GI outbreak, specimen collection could include stool samples collected in a sterile specimen cup, SAF vial and/or Carey Blair vial. Laboratory results are given once lab identification is complete.

This can also be done or ordered by the facility or provider. DOH-Sarasota may provide additional testing (3-5 cases), if appropriate.

1. Collect stool specimens for symptomatic residents/staff (Use clean container, do not take stool from toilet).

2. Label each specimen container with: Name, Date of Birth, Collection Date.

3. Place specimen containers for each person in a separate biohazard bag.

4. Keep specimens refrigerated (use a “dirty” refrigerator/cooler).

5. Call DOH-Sarasota to have specimens picked up.

GASTROINTESTINAL SPECIMEN COLLECTION INSTRUCTIONS

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2.4 OutbreakManagementandControlMeasures

Below are suggested control measures for a gastrointestinal illness outbreak:

• Perform increased disinfection and cleaning of frequently and commonly touched surfaces with a disinfectant that is EPA-registered as effective against norovirus or feline calicivirus (Appendix iii) or a diluted solution (Appendix iv).

• Attempt to minimize the sharing of staff between units of the facility.

• Generate a health alert notice to be posted at all entrances and around the facility to alert visitors, staff, and patients of the outbreak and hand hygiene measures.

• Regularly clean or close water fountains as needed.

• Handle soiled linens carefully, without agitating them, to avoid dispersal of pathogens.

• Discourage/restrict visitation while outbreak is ongoing for any non-essential visitors.

• Exclude persons that have vomiting or diarrhea from group settings, group activities and/or work until 48 hours after symptoms.

2.5 Treatment

Treatments for a GI illness differ depending on the causal agent, and many rely on palliative care. It is important to keep patients hydrated and to utilize medication and antibiotics when necessary. Treatment should be determined/recommended by a resident’s medical provider.

2.6 DeclaringOutbreakOver

Outbreak control measures can be lifted after two incubation periods of the suspected illness have passed without any new cases occurring in the facility. This is usually 48-96 hours but will be determined based upon specific outbreak characteristics.

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Outbreaks of respiratory tract infections in LTCFs are common and can be caused by many different organisms. Influenza viruses, pneumococci and RSV are some of the more common organisms. Once introduced, pathogens often spread rapidly.

• ModeofTransmission:respiratory droplets, direct and/or indirect contact

• Symptoms: fever, cough, sore throat, runny nose, congestion and muscle aches

• Duration: 2–10 days (individuals with flu are contagious 24 hours prior to symptom onset)

Respiratory Tract Infections

Influenza-LikeIllness(ILI): Fever ≥ 100°F (orally) AND cough or sore throat

UpperRespiratoryIllness(URI): Viral infection that affects the nose, throat, and airways

InfluenzaOutbreak: Suspected when two or more new cases of ILI occur within 72 hours, confirmed when at least one resident has a positive laboratory result for influenza.

3.1 Precautions

• Ensure vaccination and records are up-to-date and available.

◦ Vaccination reduces transmission of influenza, staff illness and absenteeism and influenza-related illness, especially among people at increased risk for severe influenza illness.

• Droplet Precautions

◦ Wear gloves if hand contact is anticipated with respiratory secretions or potentially contaminated surfaces.

◦ Wear a gown if soiling of clothes with a resident’s respiratory secretions is anticipated.

◦ Change gloves and gowns after each resident encounter and performing hand hygiene.

◦ Gloves do not replace the need for performing hand hygiene.

• Perform hand hygiene before and after touching the resident, their environment, and any respiratory secretions, whether or not gloves are worn.

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Upon suspicion of an Influenza outbreak, facilities are required to notify DOH-Sarasota at 941-861-2873. Once notified, DOH-Sarasota will provide initial guidance, educational materials and two forms (listed below). These need to be completed by the facility. With this information DOH-Sarasota can provide appropriate recommendations, provide control measures and perform limited laboratory testing.

1. ILI/Respiratory Outbreak Report Form (Appendix v), which provides all pertinent information

2. Line List for Respiratory Illness Outbreaks (Appendix vi), a documented list for all persons with symptoms that is to be continuously updated to track the duration of the outbreak


Specimen collection is an important step allowing for identification of the causal agent so appropriate control measures can take place. Specimen collection for ILI/Respiratory outbreaks may require an oropharyngeal or nasopharyngeal specimen.

Follow droplet precautions while collecting specimens from suspected residents regardless of vaccination status. This includes the use of gloves, a surgical mask and eye protection.

This can also be done/ordered by the facility or provider. DOH-Sarasota may provide additional testing (3-5 cases), if appropriate.

1. Immobilize the patient’s head tilting it slightly back, have the patient open their mouth wide.

2. Using a sterile Copan swab, insert the swab into the back of the throat, touch the soft pallet and gently rotate the swab.

3. Slowly remove swab from the mouth.

4. Place the swab into the transport tube containing pink media. Break off the swab stick and cap the tube.

5. Label the specimen tube with: Name, Date of Birth, and Date of collection.

6. Place swab in a Zip Lock Biohazard bag and refrigerate.

7. Call DOH-Sarasota to have the specimen picked up.

RESPIRATORY SPECIMEN COLLECTION INSTRUCTIONS

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Below are suggested control measures for a respiratory illness:

• Isolate or cohort ill patients in their rooms until free of fever and/or symptoms for at least 24 hours without use of medication.

• Minimize the sharing of staff between units of the facility.

• Masks should be used by all staff with contact to symptomatic patients.


• Regularly clean or close water fountains as needed.


• Discourage/restrict visitation while an outbreak is ongoing for any non-essential visitors.

• Perform environmental disinfection with a routine disinfectant (disinfectant should state it kills influenza-like illness, respiratory illnesses, RSV, etc.).

3.5 TreatmentandProphylaxis

All long-term care facility residents who have confirmed or suspected influenza should receive antiviral treatment immediately and should not wait for laboratory confirmation of influenza. Antiviral treatment works best when started within the first two days of symptoms. However, these medications can still help when given after 48 hours to those that are very sick, such as those who are hospitalized, or those who have progressive illness.

When at least two patients are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should initiate antiviral chemoprophylaxis to all non-ill residents, regardless of vaccination status. Priority should be given to residents living in the same unit or floor as an ill resident. However, since staff and residents may spread influenza to residents on other units, floors or buildings of the same facility, it is recommended that all non-ill residents receive antiviral chemoprophylaxis to control influenza outbreaks.


Outbreak control measures can be lifted after two incubation periods of the suspected pathogen has passed with no new illness. A list of pathogens and incubation periods can be found in the appendix.

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Scabies is an infestation of the skin by the human itch mite. Outbreaks in LTCFs are common and can be prolonged if appropriate control measures are not implemented as early as possible. Scabies symptoms may take up to 4–6 weeks to appear, making outbreaks last 2–3 months due to the prolonged spread.

• Modeoftransmission: Prolonged, direct, skin-to-skin contact and the sharing of clothing, bedding, or towels

◦ Scabies is not spread by short-term contact such as a handshake or hug.

• Symptoms: Intense itching and a pimple-like rash

• Duration: Scabies can live on the skin for 1–2 months and on objects for 72–48 hours.

Scabies

ScabiesOutbreak: One case of infestation diagnosed by a physician or dermatologist via visual inspection or skin scraping

Crusted(Norwegian)Scabies: Crusted scabies is a severe form of scabies that can occur in those who are immunocompromised, elderly, disabled or debilitated. Persons with this form of scabies are highly contagious and require aggressive medical treatment.

4.1 Precautions

• Scabies is prevented by avoiding direct skin-to-skin contact with an infested person or with items such as clothing or bedding used by an infested person.

• Maintain a record of those previously infested with scabies as they are more prone to re-infestation.

• Incorporate skin checks for scabies into routine practices to ensure early detection, especially during an outbreak.


Upon suspicion of a scabies outbreak, facilities are required to notify DOH-Sarasota at 941-861-2873. Once notified, DOH-Sarasota will provide initial guidance, educational materials and two forms (listed below). These forms need to be completed by the facility. With this information, DOH-Sarasota can provide appropriate recommendations, provide control measures and perform limited laboratory testing.

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Reportingformstobecompleted:

1. Scabies Outbreak Report Form (Appendix vii), which provides all pertinent information

2. Line List for Scabies Outbreaks (Appendix viii); a documented list of all persons with symptoms, the line list is to be continuously updated to track the duration of the outbreak


No sample collection is needed to determine the causal agent. Diagnosis is confirmed by a dermatologist either by skin scraping or visual identification.


Below are suggested control measures for a scabies outbreak:

• Isolate or cohort ill patients in their rooms until prophylaxis and cleaning are complete.

• Discourage/restrict visitation until prophylaxis and cleaning are complete.

• Minimize the sharing of staff between units of the facility.


• Regularly clean and vacuum as needed.


4.5 Treatment

Prophylaxis or treatment of those who are not infested is highly recommended for residents and appropriate staff. It is important for treatment of multiple residents and cleaning to be synchronized to prevent re-infestation.

• Removal from body: Prescribed medication via oral consumption and/or topical ointment

• Removal from home: Wash clothing and bedding with hot water and dryer and vacuum any affected areas. Objects that cannot be washed can be placed in a bag for 72 hours.

4.6 DeclaringOutbreakOverSequential skin assessments should be implemented into routine practices for the duration of the four-week incubation period to detect reoccurrence. If no additional infestations occur during this period, control measures can be lifted and the outbreak declared over.

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The management of antibiotic-resistant organisms can be difficult in LTCFs, and many have become increasingly common. This can be attributed to the continuous reintroduction of resistant organisms commonly acquired from hospital admissions and patient transfers. A completed risk assessment is important for monitoring fluctuations in frequency and outbreak identification.

Antibiotic-Resistant Organisms

Antibiotic-ResistantOrganismOutbreak: an increase in the incidence of infected residents in a facility above normal levels or a cluster of newly identified residents

Colonization: the presence and growth of the organism without observable clinical symptoms or immune response (colonized healthcare workers rarely develop infections)

Infection: the invasion of bacteria into tissue with replication of the organism

5.1 Methicillin-ResistantStaphylococcus aureus (MRSA)

MRSA is a variant of S. aureus. It is considered resistant to many antibiotics and emerged as a predominant source of healthcare-associated infection and outbreaks in Florida.

• ModeofTransmission:person-to-person by direct contact with a purulent site of infection, person with infection of the respiratory, GI or urinary tract, and hands of personnel

• Reservoirs: colonized and infected residents and environmental surfaces including floors, sinks, work areas, etc.

• ColonizationSite: the nose, wounds, gastrostomy and tracheostomy sites, sputum, urine

5.2 Clostridium difficile (C. difficile)

C. difficile is the most common cause of healthcare-associated diarrhea in the United States. C. difficile is a spore-forming organism that can spread easily in the environment because many common disinfectants will kill the organism but not the spores.

• ModeofTransmission: fecal/oral route in which spores are carried person-to-person on the hands of healthcare workers and indirect transmission via contact with contaminated surfaces

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• Reservoirs:infected individuals and environmental contamination due to the spore

• Colonization: the gastrointestinal tract of symptomatic and asymptomatic individuals

5.3 Vancomycin-ResistantEnterococci(VRE)

VRE has become recognized as a leading cause of healthcare-associated bacteremia, surgical wound infection and urinary tract infection. Enterococci are normally found in the body, but strains resistant to vancomycin (VRE) are resistant to all presently available antibiotics.

• ModeofTransmission: person-to-person via temporary carriage on the hands of staff, residents, and family or contaminated environmental surfaces

• Reservoirs:infected individuals and contaminated environmental surfaces

• Colonization:normally found in the bowel, female genital tract and mouth; survive, multiply and reside in the bowel

5.4 Multidrug-ResistantGram-NegativeBacilli(MDR-GNB)

Gram-negative bacilli have been a source of healthcare-associated infection for years, and both colonization and infection can be found in virtually all healthcare settings. Two of the significant MDR-GNB are listed below.

• Multidrug-resistantAcinetobacter baumannii(MDRAb) infection can occur sporadically but is more commonly associated with outbreaks. Infections typically manifest as respiratory (ventilator pneumonia), urinary tract, and wound infections.

• Klebsiella pneumoniae is caused by bacteria normally found in the GI tract. Of concern is the high level of resistance and the inability of detection by standard susceptibility testing. Those most at risk are residents receiving treatment for other conditions whose care requires devices like ventilators or IV catheters and those taking long courses of certain antibiotics.

◦ ModeofTransmission: patient-to-patient via hand carriage from residents, healthcare workers and family members and contact with contaminated surfaces and equipment

◦ Reservoirs: infected and colonized individuals serve as the main reservoir for MDR-GNB; environmental surfaces are another potential reservoir

◦ Colonization: the skin, bowel and respiratory tract of both healthcare workers and residents

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5.5 Precautions

It is recommended that each facility develop a comprehensive, strategic plan to detect, prevent and control infection and colonization. Take these precautions:

• Screen all admitted or transferred residents for antibiotic-resistant organisms, if possible.

• Prescribe antibiotics correctly—get cultures, start the right drug, and dose correctly for the right duration. Reassess the prescription within 48 hours based on tests and a patient exam.

• Document the dose, duration and indication for every antibiotic prescription.

• Follow hand hygiene and other infection control measures with every patient.

• Cohort residents or utilize single occupant rooms when possible.

• Use barrier protection for contact with infected or colonized patients.

• Offer education about antibiotic resistance and improving prescribing practices.

► www.cdc.gov/features/antibioticresistance


Upon suspicion of an antibiotic-resistant organism outbreak, facilities are required to notify DOH-Sarasota at 941-861-2873. Once notified, DOH-Sarasota will provide initial guidance and educational materials, and the facility must complete two forms (listed below). With this information, DOH-Sarasota can provide appropriate recommendations, provide control measures and perform limited laboratory testing.

1. Antibiotic-Resistant Organism Outbreak Report Form (Appendix ix), which provides all pertinent information

2. Line List for Antibiotic-Resistant Organism Outbreaks (Appendix x), a documented list of all persons with symptoms. The line list is to be continuously updated to track the duration of the outbreak

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• Conduct increased cleaning and disinfecting with a registered EPA disinfectant of commonly touched surfaces.

• Communicate between facilities, residents and family members.

• Isolate infected individuals.

• Instruct visitors that items should not be shared with infected residents unless they can be appropriately cleaned.

• Healthcare facilities that share patients are interdependent upon one another with regard to their MRSA experience.

• Minimize the sharing of staff between units of the facility with ongoing outbreak of infected residents.

• Generate a health alert notice to be posted at all entrances and around the facility to alert visitors, staff and patients of the outbreak and hand hygiene measures.


Control measures can be lifted once the incidence or risk of contracting the disease has decreased to levels considered normal for the facility.

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Environmental Health is the area of public health concerned with all aspects of the natural and built environment affecting human health. DOH-Sarasota’s Environmental Health division protects health in the community by:

• Inspecting and licensing facilities that may impact health.

• Improving environmental hazards, which may be biological (like red tide or bacteria in water) or chemical (like pollution).

• Promoting healthy living spaces that encourage people to live healthier lives.

6.1 FoodborneOutbreaks

IllnessesandOutbreaks

Many outbreaks result from food contaminated by improper storage or preparation or inadequate hand hygiene. More than 250 pathogens, including viruses, parasites, bacteria, chemicals and toxins, are known to cause foodborne illness, and nearly all of them can cause an outbreak.

Environmental Health

FoodborneIllness: occurs by eating contaminated food resulting in illness

FoodborneOutbreak: two or more persons with the same disease, clinical symptoms or pathogen and associated with ingesting a common food

Symptoms

Symptoms of foodborne gastrointestinal illnesses can include the following:

• Nausea

• Diarrhea

• Vomiting

• Abdominal cramps

• Gas

• Headache

• Muscle aches

• Unusual fatigue

• Fever

• Chills

• Blood in stools

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Prevention

Prevention of foodborne illness is the interruption of the possible transmission pathways. Remembering the basic tips below and having a prevention policy available to food handlers can greatly reduce the risk of illness.

Clean

• Wash hands, utensils and surfaces before and after food preparation.

• Specifically wash after preparation of meat, poultry, eggs or seafood.

CooktoProperTemperatures

• Cook food to proper internal temperatures.

• Check for doneness with a food thermometer.

ProperRefrigeration

• Refrigerate or freeze perishables, prepared food and leftovers within two hours.

• Ensure the refrigerator is set to no higher than 40° F and the freezer is set to 0° F.

Time/TemperatureControl

• Ensure potentially hazardous foods are received and held at the required hot or cold temperature.

• Ensure potentially hazardous foods are cooled to and maintained at the proper temperature.

• Ensure potentially hazardous foods are reheated to the required temperature and maintained.

PreventCrossContamination

• Keep raw meat, poultry, eggs and seafood and their juices away from ready-to-eat food.

ExclusionofIllFoodWorkers

• Ensure a policy exists to exclude ill food workers from preparing food.

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6.2WaterborneOutbreaks

There can be a number of different pathogens, including viruses, bacteria, protozoa and chemicals that can contribute to waterborne illness and subsequent outbreaks. A waterborne outbreak follows the same outbreak definition as described above but is traceable to the ingestion of or contact with contaminated water. Many outbreaks are tied to recreationally treated venues, such as pools and whirlpool spas. A few important steps to help prevent these outbreaks include:

Prevention

• Maintaining adequate disinfectant levels and regularly monitoring.

• Ensuring optimum filtration.

• Maintaining pool/hot tub equipment.

• Enforcing showering before entering pools and spas.

• Ensuring children wear swim diapers if not toilet trained.

Legionella

One important pathogen to be aware of and develop a surveillance and prevention plan for in a long term care facility is Legionella. Legionella bacteria thrive in warm, aquatic environments and can cause Legionnaires’ disease and Pontiac fever. Legionnaires’ disease is similar to other types of pneumonia on a chest x-ray, and it includes symptoms of cough, shortness of breath, fever, muscle aches and headaches. The incubation period is typically two to ten days for Legionnaires’. Not all individuals are susceptible to developing an infection, but health conditions and personal behaviors that reduce the effectiveness of the immune system are risk factors.

• Transmission: water mist or vapor is inhaled that is contaminated with Legionella.

• Reservoirs: contaminated aerosols coming from cooling towers, showers, faucets, whirlpool spas, and decorative fountains

• Prevention: focus on designing, maintaining, and monitoring all potential sources of water mist and vapor in a healthcare facility.

► Resources for waterborne outbreak prevention can be found in Appendix xi.

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CONTACTING ENVIRONMENTAL HEALTH

Phone: 941-861-6133 Fax: 941-861-6152

Email: [email protected]

SarasotaOffice1001 Sarasota Center Blvd

Sarasota FL 34240

VeniceOffice4000 Tamiami Trl S Rm 121

Venice FL 34293 941-861-3310

OutbreakReportingandManagement

Once a foodborne or waterborne outbreak is suspected, facilities should notify DOH-Sarasota at 941-861-2873. Early reporting leads to lower acquisition of the illness among staff and residents as well as a shorter outbreak duration. If samples are requested, please review specimen collection in Section 2.3 and attempt to obtain specimens when individuals are still symptomatic.

Environmental Health has services to help locate the source of the pathogen and identify exposure risks to ensure procedures are up-to-date and provide recommendations.

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On the following pages, you will find forms and other resources useful in responding to disease outbreaks at long-term care facilities.

ListofAppendices:

i. GI Outbreak Report Form

ii. Line List for GI Outbreaks

iii. EPA’s Registered Antimicrobial Products Effective Against Norovirus

iv. Bleach Disinfection

v. ILI/Respiratory Outbreak Report Form

vi. Line List for Respiratory Illness Outbreaks

vii. Scabies Outbreak Report Form

viii. Line List for Scabies Outbreaks

ix. Antibiotic-Resistant Organism Outbreak Report Form

x. Line List for Antibiotic-Resistant Organism Outbreaks

xi. Resources for Waterborne Outbreak Prevention

xii. Specimen Collection Instructions – ILI/Influenza/URI

xiii. Specimen Collection Instructions – Enteric (Gastrointestinal Illness)

xiv. Foodborne Illness-Causing Pathogens

xv. Reportable Diseases/Conditions in Florida – Practitioner List

xvi. CDC Environmental Checklist for Monitoring Terminal Cleaning

Appendix

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Gastrointestinal Illness (GI) Outbreak Report Form for LTCF/ALF GI Illness: Any combination of diarrhea (≥ 3 loose stools in 24 hrs), vomiting, abdominal pain, with or without fever. GI Illness Outbreak: The occurrence of more cases of GI illness in a 24 hours period than would normally be expected based on a facility’s individual surveillance data.

Report all suspected or confirmed outbreaks to the

DOH-Sarasota

Facility name:

Name and title of reporter:

Date of report:

Address:

Phone:

Fax:

Total number of ill residents:

Total number of ill staff:

Total number of residents in facility at time of outbreak:

Total number of staff:

Date of symptom onset/detection of first GI Illness case:

Type of facility: Skilled nursing Assisted living Combined care Other

Have specimens been sent to a laboratory for confirmation of illness: Yes No Name of laboratory:

Type of test:

Test results:

Number of positives:

Number of negatives:

Fax to DOH-Sarasota / Disease Intervention Services

Fax (941) 526-1534* Phone (941) 861-2873

Thank you for your continued cooperation in reporting any grouping or clustering of persons having similar diseases, symptoms, or syndromes, as specified by Chapter 64D-3.002, Florida Administrative Code.

* Fax line is confidential and secure

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Lab Results

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iii

US Environmental Protection Agency Office of Pesticide Programs

List G: EPA Registered Hospital Disinfectants Effective Against Norovirus (Norwalk-like virus)

October 29, 2014



October 29, 2014



October 29, 2014



October 29, 2014

EPA Registration No. PrimaryProductName

777-99 BRACE1677-21 MIKRO-QUAT1677-216 EXSPOR BASE CONCEN-

TRATE1677-226 VIRASEPT1677-238 PEROXIDE MULTI SURFACE

CLEANER AND DISINFEC-TANT

1677-241 HYDRIS1839-79 NP 4.5 DETERGENT/DISIN-

FECTANT1839-95 NP 4.5 (D & F) DETERGENT/

DISINFECTANT1839-188 AEROSOL SDAS5741-28 TUMULT5813-100 PUMA6659-3 SPRAY NINE6836-77 LONZA FORMULATION S-186836-78 LONZA FORMULATION R-826836-139 LONZA FORMULATION R-

82F6836-140 LONZA FORMULATION S-21F6836-152 LONZA FORMULATION DC-

1036836-245 CSP-466836-266 BARDAC 205M-106836-333 MMR-4U6836-346 LONZAGARD RCS-2566836-347 LONZAGARD RCS-1286836-348 LONZAGARD RCS-128 PLUS6836-349 LONZAGARD RCS-256 PLUS9480-8 PDI SANI-CLOTH BLEACH

WIPES10324-58 MAQUAT 12810324-81 MAQUAT 7.5-M10324-214 MAGUARD 5626

EPA Registration No. PrimaryProductName

34810-36 CLEAN-CIDE WIPES46781-12 CAVICIDE 156392-7 DISPATCH HOSPITAL

CLEANER DISINFECTANT WITH BLEACH

65402-3 VIGOROX SP-15 ANTIMI-CROBIAL AGENT

67619-12 CPPC TSUNAMI67619-13 CPPC STORM67619-17 SHIELD67619-24 BLONDIE67619-25 DAGWOOD67619-30 GNR70060-19 ASEPTROL S10-TAB70271-13 PURE BRIGHT GERMICIDAL

ULTRA BLEACH70271-24 TECUMSEH B70590-1 HYPE-WIPE70590-2 BLEACH-RITE DISINFECT-

ING SPRAY WITH BLEACH70627-56 OXIVIR TB70627-58 OXY-TEAM DISINFECTANT

CLEANER70627-60 OXIVIR WIPES71654-7 VIRKON71847-2 KLOR-KLEEN72977-3 AXEN(R) 3073232-1 ALPET D274559-1 ACCEL TB74559-8 Accel 5 RTU74986-4 SELECTROCIDE 2L50082972-1 VITAL-OXIDE84526-1 SANOSIL S01087518-1 HSP2O88089-4 PERIDOX RTU (TM)

iv

Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Rick Scott Governor

Celeste Philip, MD, MPH

State Surgeon General

Vision: To be the Healthiest State in the Nation

Florida Department of Health in Sarasota County 2200 Ringling Blvd. ●Sarasota FL 34237 PHONE: 941-861-2900 ● FAX: 941-526-1533 FloridaHealth.gov

Bleach Disinfection Use soapy water to wash high-touch surfaces, such as door knobs, toilet handles, faucets, sinks, commodes, bath rails, phones, counters, chairs (including backs), tables, hand rails, elevator buttons, light switches, keyboards, mattress covers, aprons, uniforms, linens, bedding and ice machines. Disinfect surfaces by applying a chlorine bleach solution. Steam cleaning may be preferable for carpets and upholstery.

Warning: Chlorine bleach could permanently stain these.

1. Prepare a chlorine bleach solution - Make bleach solutions fresh daily; keep out of reach of children; never mix bleach solution with other cleaners

2. Air dry surfaces unlikely to have food or mouth contact OR…

3. Rinse all surfaces intended for food or mouth contact with plain water before use

3 Wash your hands thoroughly with soap and water NOTE: Open bottles of concentrated chlorine bleach will lose effectiveness after 30 days.Change bottles of bleach every 30 days for accurate concentrations. Prepare a dilution of fresh bleach every day of use and discard unused portions.

v

ILI/Respiratory Outbreak Report Form LTCF

F:\BRADBRYAN Work\SCHD\Design Projects\Epi\Long-Term Care Facilities Outbreak Response Toolkit\Appendix Source Documents\5_Report Form - ILI-Respiratory (LTCF).doc/Rev. 6/12/14

Influenza-like Illness (ILI): Fever ≥ 100° F (orally) AND cough or sore throat Influenza Outbreak: suspected when 2 or more new cases of ILI occur within 72 hours, confirmed when at least one resident has a positive laboratory result for influenza

Facility name:


Date of report:

Address:

Phone:

Fax:

Total number of residents in facility at time of outbreak: Total ill:

Total number of staff: Total ill:

Date of symptom onset/detection of first ILI/influenza case:


Have specimens been sent to a laboratory for confirmation of influenza:

□ Yes □ No

Name of laboratory:

Type of influenza detected:



Type of influenza test:

Control Strategies/Comments:

Fax to: Florida Department of Health in Sarasota County

Disease Intervention Services

Secure Fax line: (941) 526-1534


vi

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Services: 941-526-1534 (S

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Sex

Room #

Date of onset

Shift of onset

Duration of illness

Fever (highest temp.)

Cough

Sore throat

Runny nose

Congestion (nasal)

Congestion (chest)

Muscle aches

Vomiting or diarrhea

Pneumonia

X-ray results (if taken)

Influenza vaccine And date

Hospitalized

Date of Death

Lab results

Pneumococcal vaccine Y/N

vii

F:\BRADBRYAN Work\SCHD\Design Projects\Epi\Long-Term Care Facilities Outbreak Response Toolkit\Appendix Source Documents\7_Scabies Outbreak Report Form LTCF-ALF.DOC/9/18/2013

Scabies Outbreak Report Form for LTCF/ALF Scabies: an infestation of the skin by the human itch mite Scabies Outbreak: One case of infestation diagnosed by a physician or dermatologist via visual inspection or skin scraping

Report all suspected or confirmed outbreaks to the DOH-Sarasota

Facility name:


Date of report:

Address:

Phone:

Fax:

Total number of ill residents:

Total number of ill staff:

Total number of residents in facility at time of outbreak:

Total number of staff:

Date of symptom onset/detection of first Scabies case:


Have specimens been sent to a laboratory for confirmation of illness: Yes No Name of laboratory:

Type of test:

Test results:




Fax (941) 526-1534* Phone (941) 861-2873



viii

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Na

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cabies.doc/Rev. 6/25/14

N

ame

Age

Sex

Room Number

Treatment (Date) Medication

Location of Rash

Rash Onset Date

Skin Scraping Status (Y/N)

Results

Comments

ix

F:\BRADBRYAN Work\SCHD\Design Projects\Epi\Long-Term Care Facilities Outbreak Response Toolkit\Appendix Source Documents\9_Antibiotic-Resistant Organism Outbreak Report Form - LTCF.DOC/9/18/2013

Antibiotic-Resistant Organism Outbreak Report Form LTCF Antibiotic-Resistant Organism Outbreak: an increase in the incidence of infected residents in a facility above normal levels or a cluster of newly identified residents.

Report all suspected or confirmed outbreaks to the

DOH-Sarasota Facility name: Name and title of reporter: Date of report: Address: Phone: Fax: Total number of ill residents: Total number of ill staff: Total number of residents in facility at time of outbreak: Total number of staff: Date of suspected increase in residents: Type of facility: Skilled nursing Assisted living Combined care Other Have specimens been sent to a laboratory for confirmation of illness: Yes No Name of laboratory: Type of test: Test results: Number of positives: Number of negatives:


Fax (941) 526-1534*

Phone (941) 861-2873 Thank you for your continued cooperation in reporting any grouping or clustering of persons having similar diseases, symptoms, or syndromes, as specified by Chapter 64D-3.002, Florida Administrative Code.


x

Line List for Antibiotic – Resistant O

rganism O

utbreaks LTCF

List for: R

esident __ Staff __

Fax to: DO

H-Sarasota / D

isease Intervention Services 941-526-1534 (Secure Fax) Phone: 941-861-2873

Nam

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Address:

_______________________ C

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Phone:

___________

Nam

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DO

B

M/D

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Sex

Room # (if patient)

Date of onset

Shift of onset

Duration of illness

Hospitalized

Date of Death

Lab Results

Com

ments

For ill staff, list job title

xi

Resources for Waterborne Outbreak Prevention

A new Practical Guide for Developing a Water Management Plan to Reduce Legionella Growth and Spread in Buildings is available as a tool to help implement industry standards for water management:

► www.cdc.gov/legionella/maintenance/wmp-toolkit.html

ASHRAE is an industry organization that developed Guideline 12-2000 Minimizing the Risk of Legionellosis Associated with Building Water Systems with input from public health professionals:

This document can be purchased for a fee at ► www.ashrae.org

Or downloaded for free from ► www.baltimoreaircoil.com

ASHRAE Standard 188-2015 provides a framework for proactively managing building water systems and reducing the potential for Legionella colonization of these systems, which should prevent many cases of legionellosis:

► www.cdc.gov/legionella/health-depts/ashrae-faqs.html

Standard 188 can also be purchased for a fee at ► www.ashrae.org

xii

DOH-Sarasota Disease Intervention Services Procedures Manual

F:\BRADBRYAN Work\SCHD\Design Projects\Epi\Long-Term Care Facilities Outbreak Response Toolkit\Appendix Source Documents\12_Specimen Collection Instructions - ILI-URI.DOC/Rev. 6/25/14

Specimen Collection Instructions – ILI/Influenza/URI

Steps for collecting an oropharyngeal specimen:

Follow droplet precautions


while collecting the specimen from a suspected case of ILI/influenza/URI, regardless of their vaccination status. This includes the use of gloves, a surgical mask and eye protection.

2. Using a sterile Copan swab, insert the swab into the back of the throat, touch the soft pallet and gently rotate the swab. This procedure will likely induce a gag and coughing.



5. Label the specimen tube with:

Full first and last name (printed)

Date of birth

6. Place swab in a Zip Lock Biohazard bag.

Date of collection

7. Refrigerate specimen until picked up by DOH-Sarasota

.

8. Call the DOH-Sarasota at 941-861-2873 to have the specimen picked-up.

xiii

DOH-Sarasota Disease Intervention Services Procedures Manual

F:\BRADBRYAN Work\SCHD\Design Projects\Epi\Long-Term Care Facilities Outbreak Response Toolkit\Appendix Source Documents\12_Specimen Collection Instructions - ILI-URI.DOC/Rev. 6/25/14

Specimen Collection Instructions – ILI/Influenza/URI

Steps for collecting an oropharyngeal specimen:

Follow droplet precautions


while collecting the specimen from a suspected case of ILI/influenza/URI, regardless of their vaccination status. This includes the use of gloves, a surgical mask and eye protection.

2. Using a sterile Copan swab, insert the swab into the back of the throat, touch the soft pallet and gently rotate the swab. This procedure will likely induce a gag and coughing.



5. Label the specimen tube with:

Full first and last name (printed)

Date of birth

6. Place swab in a Zip Lock Biohazard bag.

Date of collection

7. Refrigerate specimen until picked up by DOH-Sarasota

.

8. Call the DOH-Sarasota at 941-861-2873 to have the specimen picked-up.

Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Rick Scott Governor

Celeste Philip, MPH

State Surgeon General

Vision: To be the Healthiest State in the Nation

Florida Department of Health in Sarasota County 2200 Ringling Blvd.• Sarasota, FL 34237-3102 PHONE:941/861-2900

www.FloridasHealth.com TWITTER:HealthyFLA

FACEBOOK:FLDepartmentofHealth YOUTUBE: fldoh

Florida Department of Health in Sarasota County Disease Intervention Services

Specimen Collection Instructions - Enteric

1. Collect stool specimens for symptomatic residents/staff o Use clean container, do not take stool from toilet

2. Label each specimen container with:

o First and Last Name o Date of Birth o Collection Date

3. Put specimen container for each person in a separate biohazard bag

4. Keep specimens (in biohazard bags) in a “dirty” refrigerator/cooler

5. Call the Health Department at 941-861-2873 when the specimens are ready for

pick up

xiv

While the American food supply is among the safest in the world, the Federal government estimates that there are more than 76 million cases of foodborne illness annually, resulting in 325,000 hospitalizations and 5,000 deaths — meaning that roughly 13 men, women and children die every day because of foodborne illness.

The chart below includes foodborne disease-causing organisms that frequently cause illness in the United States. As the chart shows, the threats are numerous and varied, with symptoms ranging from relatively mild discomfort to very serious, life-threatening illness. While the very young, the elderly, and persons with weakened immune systems are at greatest risk of serious consequences from most foodborne illnesses, some of the organisms shown below pose grave threats to all persons.

ORGANISM COMMON NAME OF ILLNESSONSET TIME

AFTER INGESTINGSIGNS & SYMPTOMS DURATION FOOD SOURCES

Bacillus cereus B. cereus food poisoning

10-16 hrs Abdominal cramps, watery diarrhea, nausea

24-48 hours Meats, stews, gravies, vanilla sauce.

Campylobacter jejuni

Campylobacteriosis 2-5 days Diarrhea, cramps, fever, and vomiting; diarrhea may be bloody

2-10 days Raw and undercooked poultry, unpasteurized milk, contaminated water.

Clostridium botulinum

Botulism 12-72 hours Vomiting, diarrhea, blurred vision, double vision, difficulty in swallowing, muscle weakness. Can result in respiratory failure and death.

Variable Improperly canned foods, especially home-canned vegetables, fermented fish, baked potatoes in aluminum foil, bottled garlic.

Cryptosporidium Intestinal cryptosporidiosis

2-10 days Diarrhea (usually watery), stomach cramps, upset stomach, slight fever

May be remitting and relapsing over weeks to months

Uncooked food or food contaminated by an ill food handler after cooking, contaminated drinking water.

Cyclospora cayetanensis

Cyclosporiasis 1-14 days, usually at least 1 week

Diarrhea (usually watery), loss of appetite, substantial loss of weight, stomach cramps, nausea, vomiting, fatigue

May be remitting and relapsing over weeks to months

Various types of fresh produce (imported berries, lettuce, basil)

E. coli (Escherichia coli) producing toxin

E. coli infection 1-3 days Watery diarrhea, abdominal cramps, some vomiting

3-7 or more days

Water or food contaminated with human feces

E. coli O157:H7 Hemorrhagic colitis or E. coli O157:H7 infection

1-8 days Severe (often bloody) diarrhea, abdominal pain and vomiting. Usually, little or no fever is present. More common in children 4 years or younger. Can lead to kidney failure.

5-10 days Undercooked beef (especially hamburger), unpasteurized milk and juice, raw fruits and vegetables (e.g. sprouts), and contaminated water

Hepatitis A Hepatitis 28 days average (15-50 days)

Diarrhea, dark urine, jaundice, and flu-like symptoms, i.e., fever, headache, nausea, and abdominal pain

Variable, 2 weeks-3 months

Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters.

Listeria monocytogenes

Listeriosis 9-48 hrs for gastro-intestinal symptoms, 2-6 weeks for invasive disease

Fever, muscle aches, and nausea or diarrhea. Pregnant women may have mild flu-like illness, and infection can lead to premature delivery or stillbirth. The elderly or immunocompromised patients may develop bacteremia or meningitis.

Variable Unpasteurized milk, soft cheeses made with unpasteurized milk, ready-to-eat deli meats

Noroviruses Variously called viral gastroenteritis, winter diarrhea, acute non- bacterial gastroenteritis, food poisoning, and food infection

12-48 hrs Nausea, vomiting, abdominal cramping, diarrhea, fever, headache. Diarrhea is more prevalent in adults, vomiting more common in children.

12-60 hrs Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters.

Salmonella Salmonellosis 6-48 hours Diarrhea, fever, abdominal cramps, vomiting

4-7 days Eggs, poultry, meat, unpateurized milk or juice, cheese, contaminated raw fruits and vegetables

Shigella Shigellosis or Bacillary dysentery

4-7 days Abdominal cramps, fever, and diarrhea. Stools may contain blood and mucus.

24-48 hrs Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler.

Staphylococcus aureus

Staphylococcal food poisoning

1-6 hours Sudden onset of severe nausea and vomiting. Abdominal cramps. Diarrhea and fever may be present.

24-48 hours Unrefrigerated or improperly refrigerated meats, potato and egg salads, cream pastries

Vibrio parahaemolyti-cus

V. parahaemolyticus infection

4-96 hours Watery (occasionally bloody) diarrhea, abdominal cramps, nausea, vomiting, fever

2-5 days Undercooked or raw seafood, such as shellfish

Vibrio vulnificus V. vulnificus infection 1-7 days Vomiting, diarrhea, abdominal pain, bloodborne infection. Fever, bleeding within the skin, ulcers requiring surgical removal. Can be fatal to persons with liver disease or weakened immune systems.

2-8 days Undercooked or raw seafood, such as shellfish (especially oysters)

In addition, FDA wants you to be aware that the best way to avoid foodborne illness is to prevent it. First, practice safe food handling at home:

Second, if you have a food product that is recalled, don’t take chances! Follow the recall instructions to return it, or throw it away. It isn’t worth risking your health or the health of your family.

CLEAN Wash hands and surfaces often.

SEPARATE Don’t cross-contaminate!

COOK Cook to proper temperatures.

CHILLRefrigerate promptly, using an appliance thermometer to be sure that your refrigerator is at 40°F or below and your freezer is at 0°F or below.

Foodborne Illness-Causing Organisms in the U.S. WHAT YOU NEED TO KNOW

For more information, contact: The U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition Food Information Line at 1-888-SAFEFOOD (toll free), 10 AM to 4 PM ET, Monday through Friday. Or visit the FDA Web site at www.cfsan.fda.gov.

xv

Birth Defects + Congenital anomalies

+ Neonatal abstinence syndrome (NAS)

Cancer + Cancer, excluding non-melanoma

skin cancer and including benign and borderline intracranial and CNS tumors

HIV/AIDS

+ Acquired immune deficiency syndrome (AIDS)

+ Human immunodeficiency virus (HIV) infection

HIV, exposed infants <18 months old born to an HIV-infected woman

STDs Chancroid Chlamydia Conjunctivitis in neonates <14 days old Gonorrhea Granuloma inguinale Herpes simplex virus (HSV) in infants

<60 days old with disseminated infection and liver involvement; encephalitis; and infections limited to skin, eyes, and mouth; anogenital HSV in children <12 years old

Human papillomavirus (HPV), associated laryngeal papillomas or recurrent respiratory papillomatosis in children <6 years old; anogenital papillomas in children <12 years old

Lymphogranuloma venereum (LGV) Syphilis

Syphilis in pregnant women and neonates

Tuberculosis Tuberculosis (TB)

All Others ! Outbreaks of any disease, any case,

cluster of cases, or exposure to an infectious or non-infectious disease, condition, or agent found in the general community or any defined setting (e.g., hospital, school, other institution) not listed that is of urgent public health significance

Amebic encephalitis

! Anthrax Arsenic poisoning Arboviral diseases not otherwise listed

! Botulism, foodborne, wound, and unspecified

Botulism, infant

! Brucellosis California serogroup virus disease Campylobacteriosis Carbon monoxide poisoning Chikungunya fever

Chikungunya fever, locally acquired

! Cholera (Vibrio cholerae type O1) Ciguatera fish poisoning Creutzfeldt-Jakob disease (CJD) Cryptosporidiosis Cyclosporiasis Dengue fever

Dengue fever, locally acquired

! Diphtheria Eastern equine encephalitis Ehrlichiosis/anaplasmosis Escherichia coli infection, Shiga toxin-

producing Giardiasis, acute

! Glanders

! Haemophilus influenzae invasive disease in children <5 years old

Hansen’s disease (leprosy)

Hantavirus infection

Hemolytic uremic syndrome (HUS)

Hepatitis A Hepatitis B, C, D, E, and G Hepatitis B surface antigen in pregnant

women or children <2 years old Herpes B virus, possible exposure

! Influenza A, novel or pandemic strains

Influenza-associated pediatric mortality in children <18 years old

Lead poisoning Legionellosis Leptospirosis

Listeriosis Lyme disease Malaria

! Measles (rubeola)

! Melioidosis Meningitis, bacterial or mycotic

! Meningococcal disease Mercury poisoning

Mumps

Neurotoxic shellfish poisoning

Pertussis Pesticide-related illness and injury,

acute ! Plague

! Poliomyelitis Psittacosis (ornithosis) Q Fever

Rabies, animal or human

! Rabies, possible exposure

! Ricin toxin poisoning Rocky Mountain spotted fever and

other spotted fever rickettsioses ! Rubella St. Louis encephalitis Salmonellosis Saxitoxin poisoning (paralytic shellfish

poisoning) ! Severe acute respiratory disease

syndrome associated with coronavirus infection

Shigellosis

! Smallpox

Staphylococcal enterotoxin B poisoning

Staphylococcus aureus infection, intermediate or full resistance to vancomycin (VISA, VRSA)

Streptococcus pneumoniae invasive disease in children <6 years old

Tetanus Trichinellosis (trichinosis)

! Tularemia

Typhoid fever (Salmonella serotype Typhi)

! Typhus fever, epidemic

! Vaccinia disease Varicella (chickenpox)

! Venezuelan equine encephalitis Vibriosis (infections of Vibrio species

and closely related organisms, excluding Vibrio cholerae type O1)

! Viral hemorrhagic fevers West Nile virus disease

! Yellow fever

! Report immediately 24/7 by phone upon initial suspicion or laboratory test order

Report immediately 24/7 by phone Report next business day + Other reporting timeframe

*Section 381.0031 (2), Florida Statutes (F.S.), provides that “Any practitioner licensed in this state to practice medicine, osteopathic medicine, chiropractic medicine, naturopathy, or veterinary medicine; any hospital licensed under part I of chapter 395; or any laboratory licensed under chapter 483 that diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.” Florida’s county health departments serve as the Department’s representative in this reporting requirement. Furthermore, Section 381.0031 (4), F.S. provides that “The department shall periodically issue a list of infectious or noninfectious diseases determined by it to be a threat to public health and therefore of significance to public health and shall furnish a copy of the list to the practitioners…”

Reportable Diseases/Conditions in Florida Practitioner List (Laboratory Requirements Differ) Effective June 4, 2014

Florida Department of Health in Sarasota County - Disease Intervention Services Mon - Fri, 8 am - 5 pm: 941-861-2873; Nights, weekends, holidays: 941-861-2900

Fax reportable diseases to: 941-526-1534 (EXCEPT BIRTH DEFECTS & CANCER) ** MAIL HIV/AIDS REPORTS (DO NOT FAX)

http://www.sarasotahealth.org/services/epidemiology-reportable.htm

(850) 245-4444 x2198

(850) 245-4401

(941) 861-2873

(941) 861-2873

(941) 861-2873

(941) 861-2873

Office of Epidemiology and Disease Intervention ServicesFlorida Department of Health in Sarasota County

2200 Ringling Blvd, Sarasota, FL 34237

Phone: 941-861-2873After Hours: 941-861-2900

Fax: 941-526-1534

www.sarasotahealth.org