module 1: surveillance - alabama department of public … · typhoid fever vibriosis ... nursing...

Module 1: Module 1: SurveillanceSurveillance

Epidemiology Division Surveillance Branch

Epidemiology DivisionBureau of Clinical Laboratories

Bureau of Environmental Services



Module Learning ObjectivesModule Learning Objectivesg jg jDefine Bureau of Communicable Disease.Define “active” and “passive” surveillance. Identify potential sources of surveillanceIdentify potential sources of surveillance data.Identify forms used to document f db illfoodborne illness.Discuss reasons whether or not to investigate complaints furtherinvestigate complaints further. Perform group exercise


Bureau of Environmental Services2

Bureau of Communicable DiseasesBureau of Communicable DiseasesBureau of Communicable DiseasesBureau of Communicable Diseases

1 T b l i1. Tuberculosis2. Sexually Transmitted Diseases3. HIV/AIDS4. Immunization4. Immunization5. Epidemiology



Why Investigate Why Investigate y gy gFoodborne Outbreaks?Foodborne Outbreaks?

ADPH Mission: “To serve the people of Alabama by assuring conditions in which they can be healthy.”Prevent Additional FB Illness

P d t Fi d d t th t h ld bProduct: Find a product that should be recalled so others don't get sick.Procedure: Determine what went wrong soProcedure: Determine what went wrong so specific instructions can be given to the food preparer to prevent a recurrence.



p p p

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Foodborne Outbreak SurveillanceFoodborne Outbreak Surveillance

EpidemiologyS ill

EnvironmentalHelps identify

LaboratoryT t li i l & f dSurveillance

Outbreak determination

Helps identify suspect agent & establish case

definition

S i ll ti

Tests clinical & food samples

Determines agent

Investigation Specimen collection & submission Reports to Submitter

& Epidemiology

EpidemiologyDescriptive & analytical

l f tb k

EnvironmentalAssesses food facility

analyses of outbreak

Final outbreak report

Helps implement control measures

Serves as link to foodEpidemiology Division

Bureau of Clinical LaboratoriesBureau of Environmental Services

Serves as link to food facility

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T T f S illT T f S illTwo Types of SurveillanceTwo Types of Surveillance

Surveillance is defined as closeSurveillance is defined as close and continuous observation or testingtesting1. Active 2. Passive



A ti S illA ti S illActive SurveillanceActive SurveillanceRegular periodic collection of caseRegular periodic collection of case reports from health care providers or facilitiesfacilities

Advantage: data is more accurate than in other types of surveillancein other types of surveillanceDisadvantage: expensive and time consumingconsuming



Foodborne Diseases Active Foodborne Diseases Active Surveillance Network (Surveillance Network (FoodNetFoodNet))Surveillance Network (Surveillance Network (FoodNetFoodNet))

15% of the U.S. population15% of the U.S. population Year Pop.*1997 16.11998 20.71999 25.92000 30.52001 34.92002 38.02003 41.52004 43 32004 43.32005 44.92006 45.52007 45 92007 45.9

*millions



Alabama is NOT a FoodNet state. 9

F dN t S ill SitF dN t S ill SitFoodNet Surveillance SitesFoodNet Surveillance SitesFoodNet consists of active surveillance for FB diseases and related epi studies at 10 sites designed to help public health officials better

Sunderstand FB diseases in the US.California MinnesotaC l d N M iColorado New MexicoConnecticut New YorkGeorgia OregonGeorgia OregonMaryland Tennessee



Incidence* of Selected Incidence* of Selected Foodborne Diseases, USFoodborne Diseases, US

FoodNet DataHealthy PeopleHealthy People

Objectives**Objectives**FoodNet Data Objectives**Objectives**

Pathogen 1996 1998 2000 2002 20102010Campylobacter 23.5 21.7 15.4 13.3 12.312.3py

Salmonella 14.5 12.4 14.2 16.2 6.86.8

E. coli O157:H7 2.7 2.8 2.0 1.7 1.01.0E. coli O157:H7 2.7 2.8 2.0 1.7 1.01.0

Listeria 0.5 0.6 0.34 0.26 0.250.25

Total 41.2 37.5 31.94 31.46 20.420.4* per 100,000 population/year** estimated, baseline for 2000 objectives


Bureau of Environmental Services11http://cdc.gov/foodnet/

Passive Surveillance*Passive Surveillance*

No

Have surveillance system in place

Review log Refer complaint Log Decide

whether to

No

Illness

gand other data for related cases

Obvious

Refer complaint to responsible

personNotification of Illness

ogcomplaint

whether to investigate

further

YesObvious outbreaks

Prepare Investigation

Yes

* Both lab confirmed cases and unconfirmed reports (illness complaints)



Passive SurveillancePassive SurveillanceInformation provided to ADPH without initiating actioninitiating action

Required routine reporting by MDs and labsR t f d itiReports from concerned citizensAdvantage: less expensive and t bl t ttroublesome to operateDisadvantage: likely to underestimate the presence of diseasepresence of disease



AL AL NotifiableNotifiable Disease RuleDisease RuleFoodborne ConditionsFoodborne Conditions

Common FB Possible FBCommon FBSalmonellosis E coli O157:H7

Possible FBShigellosisHepatitis AE. coli O157:H7

BotulismCampylobacteriosis

Hepatitis A

Outbreaks of any kindCampylobacteriosis ListeriosisTrichinellosis

Foodborne OutbreaksWaterborne Outbreaks

Trichinellosis Typhoid feverVibriosis

Biological OutbreaksChemical Outbreaks



Vibriosis

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The CDC The CDC The CDC The CDC FoodNetFoodNet

S ill S ill Surveillance Surveillance PyramidPyramid



Sources of Surveillance Data Sources of Surveillance Data Sources of Surveillance Data Sources of Surveillance Data

ADPH requires each physician, dentist, nurse, medical q p y , , ,examiner, hospital administrator, nursing home administrator, laboratory director, school principal, and day care director to report certain notifiable diseasesday care director to report certain notifiable diseases and health conditions.ADPH receives potential FBO reports from

Hospitals LaboratoriesClinics Public Health (e.g., CDC)Physicians Individuals y


Bureau of Environmental Services17http://www.alabamaadministrativecode.state.al.us/docs/hlth/index.html

Sources of Foodborne Sources of Foodborne Di D tDi D tDisease DataDisease Data

Laboratory-based Surveillance

FoodborneOutbreak SurveillanceSystemSystem

Epidemic ComplaintEpidemic Investigations Investigations



NetworkingNetworking

Share information w/ other health

Provide up-to-date list of key contacts in localother health

departments in regionof key contacts in local area

CDC State

Networking:Maintain

CDC State Epidemiologist

Maintain Information

FlowSt t l b t

Neighboring Health State laboratoryDepartments



Effective Local Effective Local Surveillance SystemSurveillance System

ADPH PartnersEpidemiology

Local PartnersHospitals

Environmental HealthField Surveillance StaffLaboratory

ClinicsPhysiciansFiLaboratory

Health EducatorsFirePoliceEducationEducationNursing HomesIndustry



y

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Foodborne ClassificationsFoodborne Classifications

Family Case FoodborneOutbreaks ICC

Family – household members (Family ate at Burger King)

Case – reported case of illness (Case of disease such asp (salmonella)

Foodborne Outbreaks – 2 or more from different households (Group that attended a wedding reception)

ICC – isolated consumer complaint (Band-Aid found in potatosalad)



Local Public Health PreparationLocal Public Health PreparationLocal Public Health PreparationLocal Public Health Preparation

Define roles and responsibilitiesDefine roles and responsibilitiesHave needed supplies on handP d f h i i f tiProcedures for sharing information (internally and externally)Training planPeriodic meetingsg



Potential OutbreaksPotential OutbreaksPotential OutbreaksPotential OutbreaksDocument all illness reports in aDocument all illness reports in a foodborne illness complaint logInitiate appropriate steps duringInitiate appropriate steps during outbreak investigationIdentify information needsde t y o at o eedsNotify and consult with state health and/or agriculture departmentsa d/o ag cu u e depa e s



L g C l i tL g C l i tLog ComplaintLog ComplaintAssign unique sequential number toAssign unique sequential number to each complaintSystematically enter data into logy y gTransfer key information from input forms to loggEstablish retention schedule for surveillance records



Review Log and Other Review Log and Other e e og a d Ot ee e og a d Ot eData for Related CasesData for Related Cases

Who’s in charge?

Establish written procedure for reviewing surveillance data

Check expected levels of health eventsevents



Environmental Complaint LogEnvironmental Complaint LogEnvironmental Complaint LogEnvironmental Complaint Log



Refer to Responsible Refer to Responsible Person or AgencyPerson or Agency

R f l i t t ithRefer complaints to agency with regulatory authority for collaborationFollow-up complaints under your jurisdictionNotify communicable disease staff of confirmed infectionsClearly document referred incidents



Preliminary InvestigationPreliminary InvestigationPreliminary InvestigationPreliminary InvestigationObtain information from reporter

Number Ill Event InformationSymptoms Foods Served

R i ill i f tiReview surveillance information Review foodborne outbreak definitionsConsult Central Office EpidemiologyRequest Environmentalist to inspectRequest Environmentalist to inspect facility



Is it a Foodborne Outbreak ??Is it a Foodborne Outbreak ??Is it a Foodborne Outbreak ??Is it a Foodborne Outbreak ??

I i th b f tIncrease in the number of reports over expectedPossible epi association (person, place, and time)Possible laboratory linkage



Module Learning ObjectivesModule Learning ObjectivesModule Learning ObjectivesModule Learning ObjectivesDefine Bureau of Communicable DiDisease.Define “active” and “passive” surveillance.surveillance. Identify potential sources of surveillance data.Id tif f d t d tIdentify forms used to document foodborne illness.Discuss reasons whether or not toDiscuss reasons whether or not to investigate complaints further.



Group ExerciseGroup Exercise

Log Book

Group ExerciseGroup Exercise

g





module 1: surveillance - alabama department of public … · typhoid fever vibriosis ... nursing...

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