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Annual Outbreak Report West Virginia, 2010

This annual report provides a comprehensive overview of the outbreaks reported in West Virginia in 2010, including a discussion of healthcare-associated outbreaks. The report highlights the types of confirmed outbreaks, such as enteric diseases, foodborne illnesses, rash illnesses, scabies outbreaks, and respiratory diseases. The report concludes with recommendations based on the findings and lessons learned from the outbreaks.

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Annual Outbreak Report West Virginia, 2010

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  1. Annual Outbreak Report West Virginia, 2010 Sherif Ibrahim, MD, MPH Division of Infectious Disease Epidemiology May, 2011

  2. Objectives • Describe 2010 Outbreaks • Discuss types of outbreak reported in 2010 • Describe healthcare-associated outbreaks (HAOs) • Conclusions and lessons learned • Recommendations

  3. Background • In WV, outbreaks are reportable immediately to local health departments(LHDs) • LHDs are required to report outbreaks to Bureau for Public Health (BPH) within 60 minutes • LHDs report and investigate outbreaks with assistance from regional epidemiologists & BPH • There was a 13-fold increase in reported outbreaks from 2001 to 2010

  4. Summary Outbreak Data - 2010 • 124 outbreaks were reported • 96 (77.4%) were confirmed • 28 (51%) counties reported outbreaks • Jurisdictions • 95 (99%) were limited to WV residents • 1 (1%) involved residents of other states

  5. Types of Confirmed Outbreaks, West Virginia, 2010

  6. Enteric Disease Outbreaks • Total: 35 • 16 (29%) counties • 1 reported multi-state outbreak (CDC: Lead) • Norovirus and acute gastroenteritis: 28 (80%) • Acute gastroenteritis outbreaks were defined as “outbreaks of illness with short duration (2-3 or fewer days) and characterized by acute onset of vomiting and /or diarrhea and no laboratory confirmation”.

  7. Outbreaks of Enteric Disease by Transmission Settings, West Virginia, 2010

  8. Outbreaks of Enteric Disease by Etiologic Agent, West Virginia, 2010

  9. Foodborne Outbreaks – Salmonellosis • Salmonella serotype Enteritidis: • Family of 10 from 3 households • 6 cases (3 confirmed and 3 probable) • Salmonella serotype Montevideo: • One WV resident among 272 US residents • Traced to salami products containing contaminated imported black and red pepper.

  10. Foodborne Outbreaks – Salmonellosis • Salmonella serotype Enteritidis • 18 confirmed and 4 probable cases. • Case control study  illness associated with eating at multiple locations of a single chain restaurant • Lab (PFGL &MLVA) 11 isolates were identical • Identical to a 2009 outbreak strain associated with multiple locations of the same chain restaurant • Recommendations to the corporate

  11. Foodborne Outbreak – Hepatitis A • First Hepatitis A Outbreak • Two family members • Epi-link to a hepatitis A outbreak in a daycare in KY • Hepatitis A is asymptomatic in children < 6 years in 70% of cases

  12. Foodborne Outbreak – Hepatitis A • Second  Hepatitis A Outbreak • 11 cases • Delayed reporting (2 months) • Retrospective identification of several cases • Transmissionperson-to-person among friends and secondary spread to households • LHD press releases, education, outreach and community-wide vaccination

  13. FoodBorne: Bacilluscereus • The outbreak • 10 family members  acute gastroenteritis • Pizza from a local restaurant • Laboratory testing of the patients was negative • Testing of the remaining pizza at OLS revealed contamination with Bacilluscereus • Bacillus cereus: • B. cereus is an aerobic, spore-forming, gram-positive rods • Food-poisoning can result from two types of toxins • Diarrheal syndrome : (incubation period of 10-12 hrs) associated with heat-labile (meat, stews, gravies) • Emetic syndrome: (incubation period of 1-6 hrs) associated with a heat-stable toxin (fried rice, meat, improper refrigeration)

  14. Rash Illness Outbreaks by Etiologic Agent/Clinical Syndrome, West Virginia, 2010

  15. Rash Illness Outbreaks – Varicella • A ten-fold increase from 2009. • Varicella Vaccine Effectiveness Project: • Hired two full-time staff • Offered free laboratory testing • Active surveillance in WV public schools • Education campaign • Change in varicella outbreak definition for schools • 19 from schools and 1 from a community. • Lab testing • 7 laboratory confirmed • 3 negative or non-contributory • 10 did not have laboratory testing.

  16. Scabies Outbreaks By transmission Settings, West Virginia , 2010

  17. Scabies Outbreak • Incubation period: 2-6 weeks • Outbreak definition: 2 or more cases of scabies among residents/staff within 4-6 week • Confirm the diagnosis consult a dermatologist • Isolation /exclusion of ills  a day after effective treatment • Offer treatment to contacts /families • Provide education • Environmental measures

  18. Respiratory Disease Outbreaks • Total 26 (27%) • Reported by 14 (25%) counties. • In 2009 53 respiratory disease outbreaks • No influenza outbreaks in 2010

  19. Respiratory Outbreaks by Clinical Syndrome, West Virginia, 2010

  20. Upper Respiratory Illness (URI) • 16 outbreaks • 15 from LTCFs and one from a school • Case definition: new onset of at least two of the following symptoms: • Runny nose or sneezing • Stuffy nose / congestion • Sore throat / hoarseness • Difficulty swallowing • Dry cough, and/or cervical lymphadenopathy • Rule out allergy • Rule out influenza  fever of 100 or more

  21. Pertussis Outbreaks • Total # 5 • Reported by 4 Counties • 4 Communities and 1 daycare • No pertussis-related deaths • All outbreaks were PCR confirmed • Cyclical pattern every 3-5 years • Vaccine is not 100% effective

  22. “Other” Outbreaks • 2 outbreaks of conjunctivitis (pink eye) • Reported from schools • Laboratory testing • 1 was not done • 1 negative or non-contributory • Testing can be done for these outbreaks • Hand washing and environmental cleaning

  23. Vaccine Preventable Diseases by Etiologic Agent or Clinical Syndrome, West Virginia, 2010

  24. Healthcare-Associated Outbreaks(HAOs) • Outbreaks where exposure / transmission is associated with healthcare facility(ies) • 43 (45%) • 16 Counties (29%) • 41 (95%) from LTCFs and 2 (5%) from hospitals. • 33 in 2009 • 55 in the first 3 months, 2011(90% from LTCFs)

  25. Healthcare-Associated Outbreaks by Type of Outbreak, West Virginia, 2010

  26. Outbreak of Human Metapneumovirus • URI outbreak in a LTCF complicated by pneumonia • AR: 47% and Death rate 1% • HMPV: • Identified in 2001 • RNA virus related to RSV and PIV • Transmission: droplet and contact • Seasonality: winter and spring • IP: 2-8 days • At-risk populations: infants, children, elderly and LTCFs • Clinical presentation: URI, pharyngitis, pneumonia, bronchiolitis • CXR findings: diffuse interstitial infiltrates, hyperinflation • Precautions: standard and contact (droplet if indicated)

  27. Timeliness of Outbreak Reporting Summary • 81 (81.4%) outbreaks with complete data on date and time of reporting • Mean= 35.8 hours • Median= 1 hours • Range= 0 to 864 hours • 71 (88%)  same day notification •  15 (15.6%) outbreaks were missing info on date and/or time of reporting

  28. Timely Reporting of Outbreaks • LHD is required to report outbreaks within 60 minutes under • Reportable disease rules • Threat preparedness funding • Program plan

  29. Timely Reporting of Outbreaks • Scientific and technical support • Case definition • Diagnosis and prevention measures • Descriptive epidemiology • Special studies if needed • Laboratory support • Resources support • Communication support

  30. Conclusions • Marked improvement in reporting and management of outbreaks in WV • Outbreak investigation requires: • Problem-solving skills, training and experience • Collaboration between epidemiology, laboratory and environmental • Collaboration between local, regional, healthcare providers, state, and CDC • Most HAOs are reported from LTCFs

  31. Recommendations • Report outbreaks to DIDE within 60 minutes • Use DIDE’s guidelines for outbreak investigation • Consult and get assistance from your regional epidemiologist (Field investigation, Training) • Training and education • Plan to improve your communication with LTCFs • Feedback information on outbreaks to reporting sources and other partners • Outbreaks = opportunities for improvements

  32. Outbreak Report, West Virginia, 2010 http://www.wvidep.org/Portals/31/PDFs/IDEP/Outbreaks/2010_Final_%20Outbreak%20Report.pdf Contact Information: 304-558-5358 OR 800-423-1271 (24/7) Office:304-356-4074 Cell: 304-553-9165 sherif.m.ibrahim@wv.gov

  33. Questions

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