Vaccine Preventable Diseases

1. Vaccine Preventable Diseases Reporting Suspected Cases

2. 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)

3. Epidemiology Resource Center Surveillance and Investigation Division Communicable Disease Responsibilities 2 N. Meridian Street, 5-K Indianapolis, IN 46204 Fax: 317-234-2812 Karee Buffin. MS—Vaccine Preventable Disease Epidemiologist 317-233-7112 kbuffin@isdh.in.gov Diphtheria Invasive Haemophilus influenzae Invasive Pneumococcal Disease Measles Mumps Pertussis (whooping cough) Polio Rubella Rubella, congenital syndrome Smallpox Tetanus Varicella/shingles (hospitalization or death and sentinel reporting) See Handout

4. 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

5. 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

7. 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

8. 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

9. 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?...

10. Reporting Requirement • Immediately • Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf

11. 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?...

12. Reporting Requirement • 72 hours • Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf

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

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

16. Vaccine Preventable Disease Indiana Incidence Jan-June 2006-07

17. 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.

18. 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

19. 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_mumps.pdf

20. 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).

21. 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.

22. 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.

23. Reporting Requirement? • Within 72 hours • Web link to reporting rule: http://www.in.gov/isdh/publications/comm_dis_rule.pdf

24. 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

25. 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.

26. Indiana Reported Pertussis Cases 2002 - 2006

28. 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.)

29. 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.

31. 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.

32. 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

33. 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.

34. 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).

35. Acknowledgements • Wayne Staggs • Dr. Charlene Graves • Immunization Program • Special recognition to the Immunization Field Staff • Pam Pontones • Kristin Ryker