1 / 55

Outbreaks 2009 Annual Summary

Outbreaks 2009 Annual Summary. Danae Bixler, MD, MPH Division of Infectious Disease Epidemiology. Objectives. Describe 2009 outbreaks Lessons learned Prompt reporting Laboratory confirmation / diagnosis Outbreak investigation as problem-solving Types of common outbreaks

felixstewart
Download Presentation

Outbreaks 2009 Annual Summary

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Outbreaks 2009 Annual Summary Danae Bixler, MD, MPH Division of Infectious Disease Epidemiology

  2. Objectives • Describe 2009 outbreaks • Lessons learned • Prompt reporting • Laboratory confirmation / diagnosis • Outbreak investigation as problem-solving • Types of common outbreaks • Enteric outbreaks • Rash illness • ‘Other’ • Vaccine preventable disease outbreaks • Respiratory outbreaks • Healthcare associated outbreaks • Relate findings to the 13 steps of outbreak investigation.

  3. Steps of Outbreak Investigation • 1. Prepare for field work • 2. Establish the existence of an outbreak • 3. Verify the diagnosis • 4. Construct a working case definition • 5. Find cases systematically and record information • 6. Perform descriptive epidemiology

  4. Steps of Outbreak Investigation (2) • 7. Develop hypotheses • 8. Evaluate hypotheses epidemiologically • 9. As necessary, reconsider, refine, and re-evaluate hypotheses • 10. Compare and reconcile with laboratory and/or environmental studies • 11. Implement control and prevention measures • 12. Initiate or maintain surveillance • 13. Communicate findings

  5. Summary Data (provisional) • 123 outbreaks reported • 98 (80%) confirmed as outbreaks or clusters • 39 (71 %) counties reported one or more outbreak-related cases • Jurisdiction • 90 (92 %) West Virginia • 3 (3 %) multi-state / West Virginia = lead investigator • 4 (4 %) multi-state / other state = lead investigator

  6. Counties Reporting Outbreak-Related Cases(provisional / includes multi-county outbreaks)

  7. Counties Reporting Outbreak-Related Cases(provisional / includes multi-county outbreaks)

  8. Timeliness of Reporting – Summary Statistics(provisional) • N = 85 observations (87 %) • Mean 42 hours • Median 1 hour • Range = 0 to 662 hours

  9. Timely reporting of outbreaks • Laboratory support • Technical support • Case definitions / diagnosis • Descriptive epidemiology • Cohort or case-control studies • Communications support

  10. Timely reporting of outbreaks • Required under: • Reportable disease rule • Threat preparedness funding stream • Program plan

  11. Timeliness of Reporting(provisional / multi-county outbreaks excluded) Counties that report more than one outbreak reported outbreaks more rapidly:

  12. Reported Outbreaks by Type, West Virginia, 2009 (provisional)

  13. Enteric Outbreaks 2009

  14. Enteric Outbreak Summary(provisional) • N = 29 • Reported by 23 (42%) counties • Jurisdiction: • 24 (83%) West Virginia • 1 (3%) multi-state; West Virginia = lead investigator • 14 cases gastroenteritis • N = 4 (14%) multi-state outbreaks; CDC / other state = lead

  15. West Virginia Enteric Outbreaks(provisional) • 24 (83%) West Virginia enteric outbreaks • 1 (4%)Salmonella enteritidis • 22 (92%) Norovirus or acute gastroenteritis • 18 (82%) in nursing homes / healthcare facilities • 17 (77%) person-to-person transmission • 1 (4%) rotavirus

  16. Acute Gastroenteritis

  17. NorovirusNEJM, 2009; 361:1776 • Acute onset vomiting and/or diarrhea • Reservoir = humans • Highly efficient transmission • 18 – 1000 viral particles • 30% secondary attack rate • Droplets • Fomites • Person-to-person • Environmental contamination

  18. Norovirus (2) NEJM, 2009; 361:1776 • Viral shedding • Precedes onset 30% • After recovery (up to 8 weeks) • Environmental stability • 0° C to 60° C • Surfaces • Recreational and drinking water • Food items such as raw oysters, fruits, vegetables • Lack of long-term immunity • Viral mutation

  19. Norovirus NEJM, 2009; 361:1776 • Prevention and Control • Isolation of ill persons • Enforce personal hygiene • Environmental decontamination • Use of alcohol-based hand sanitizer promising

  20. Acute Gastroenteritis 1. Prepare for field work 2. Establish the existence of an outbreak 3. Verify the diagnosis 4. Construct a working case definition 5. Find cases systematically and record information 6. Perform descriptive epidemiology 7. Develop hypotheses 8. Evaluate hypotheses epidemiologically 9. As necessary, reconsider, refine, and re-evaluate hypotheses 10. Compare and reconcile with laboratory and/or environmental studies 11. Implement control and prevention measures 12. Initiate or maintain surveillance 13. Communicate findings

  21. Acute Gastroenteritis2. Establish the existence of an outbreak3. Verify the diagnosis.4. Construct a working case definition

  22. Acute Gastroenteritis2. Establish the existence of an outbreak3. Verify the diagnosis.4. Construct a working case definition

  23. 6. Perform descriptive epidemiology.

  24. 6. Perform descriptive epidemiology. 7. Develop hypotheses.

  25. Multi-state Salmonella outbreaks

  26. Salmonella • Bacterial cause of diarrhea, fever, abdominal cramps • Most persons recover without treatment. • Severe illness: • Elderly • Infants and young children • Immunocompromised persons • Multi-state outbreaks • Widely distributed • Commercial food products • Produce • Detection by pulse-net

  27. Multi-state Salmonella Outbreaks • Pulsenet • Send isolates to OLS for PFGE • 2008 Salmonella typhimurium / peanut butter • National update • 2009 • March: Salmonella typhimurium / Virginia • April: Salmonella St. Paul / multistate • June: Salmonella enteritidis / Virginia • June: Salmonella oranienburg / Louisiana

  28. Salmonella typhimuriumoutbreakMMWR, 2009; 58:85-90. • Nov 25, 2008 investigation started. • Multiple institutional outbreaks … traceback demonstrated one common food: King Nut peanut butter • Step 7: Develop hypotheses • Case-control implicated peanut butter • Step 8: Evaluate hypotheses epidemiologically. • Jan 9, 2009, Minnesota Department of Agriculture isolated the outbreak strain from King Nut Peanut Butter. • Step 10: Compare and reconcile with laboratory and/or environmental studies.

  29. Ongoing investigationMMWR, 2009; 58:85-90. • Multiple institutional outbreaks … King Nut peanut butter was distributed to institutions. • Many ill persons did not eat peanut butter in institutions. • Step 9. As necessary, reconsider, refine and re-evaluate hypotheses. • Second series of case-control studies: pre-packaged peanut butter crackers. • Step 8: Evaluate hypotheses epidemiologically. • Intact packages of crackers yielded the outbreak strain • Step 10: Compare and reconcile with laboratory and/or environmental studies.

  30. MMWR, 2009; 58:85-90.

  31. MMWR, 2009; 58:85-90.

  32. Number of infections (N = 226*) with the outbreak strain of Salmonella Saintpaulassociated with eating alfalfa sprouts, by date of illness onset --- United States, February--April 2009*as of May 1, 2009 MMWR, 2009; 58:500-503

  33. Number of infections (N = 228*) with the outbreak strain of Salmonella Saintpaul, associated with eating alfalfa sprouts, by state --- United States, February--April 2009*as May 1, 2009 MMWR, 2009; 58:500-503

  34. Rash Illness 2009

  35. Rash Illness Outbreaks(provisional) • 4 Human parvovirus B-19 (“Fifth Disease”) • schools • 3 scabies • Nursing home • Detention center • Homeless shelter • 2 varicella • schools

  36. ErythemaInfectiosum (Parvovirus B-19) (“Fifth Disease”) • Mild prodrome • Fever 15-30% • ‘Slapped face’ rash • Rash • Symmetric, maculopapular, reticular, often pruritic • Trunk • Moves peripherally to arms, buttocks, thighs • Fluctuates / recurs

  37. Parvovirus B-19 (“Fifth Disease”)

  38. Parvovirus B-19 (“Fifth Disease”)Hardin MD/University of Iowa and CDC http://www.lib.uiowa.edu/hardin/Md/cdc/fifthdisease/4507.html

  39. Parvovirus B-19adapted from 2009 Redbook

  40. Parvovirus B-19ErythemaInfectiosum • Transmission: contact with respiratory tract secretions • Secondary spread • 50% in household contacts • 20% in school and daycare • Infectious period • Prior to rash onset • No exclusion of children with rash

  41. Parvovirus B-19ErythemaInfectiosum • Control • Hand hygiene • Dispose of tissues • Counsel pregnant women • Low risk • Exclusion not recommended • Evaluation per OB/GYN

  42. Parvovirus B-19 Outbreaks 1. Prepare for field work 2. Establish the existence of an outbreak 3. Verify the diagnosis 4. Construct a working case definition 5. Find cases systematically and record information 6. Perform descriptive epidemiology 7. Develop hypotheses 8. Evaluate hypotheses epidemiologically 9. As necessary, reconsider, refine, and re-evaluate hypotheses 10. Compare and reconcile with laboratory and/or environmental studies 11. Implement control and prevention measures 12. Initiate or maintain surveillance 13. Communicate findings

  43. Scabies Cleaveland Clinic J Med, 2008; 75:474-478. • Papules • Excoriations • Burrows • Nodules

  44. Atypical ScabiesN Engl J Med, 2006; 345:1718-27.

  45. Management of Scabies Outbreaks • Nosocomial / institutional outbreaks: • Contact precautions • 24 hours after treatment • 10 days after treatment of crusted scabies • Make a secure diagnosis • Consider dermatology consultation • Identify infested persons • Treat infested persons and contacts • Patients and staff • Environmental control measures

  46. Environmental Management of Scabies Infestation(CDC) • Insecticide sprays and fumigants NOT recommended • Mites do not survive more than 3 days away from human skin

More Related