Communicable Disease Control and Vaccine Preventable Diseases/Update and Impact

1. Communicable Disease Control and Vaccine Preventable Diseases/Update and Impact Communicable Disease Control and Prevention Bureau (CDCP) Communicable Disease Epidemiology Section (CDEpi)

2. Agenda • Communicable Disease Epidemiology Overview • Partnering with your local health department • Montana-specific vaccine preventable diseases • Summary/Recommendations • Questions

3. Communicable Disease Epidemiology Role Conduct Communicable Disease surveillance Support/Coordinate Communicable Disease investigations If they cross a jurisdictional boundary If requested by local public health Recommend population based disease control actions Improve public health monitoring, investigation and control systems

4. Montana Code AnnotatedMontana Administrative Rules Statute • 37-2-301. Duty to report cases of communicable disease. (1) If a physician or other practitioner of the healing arts examines or treats a person who the physician or other practitioner believes has a communicable disease or a disease declared reportable by the department of public health and human services, the physician or other practitioner shall immediately report the case to the local health officer. The report must be in the form and contain the information prescribed by the department. Rule • 37.114.201 "…any person including, but not limited to a physician, dentist, nurse, medical examiner, other health care practitioner, administrator of a health care facility or laboratory, public or private school administrator, or laboratory professional who knows or has reason to believe that a case exists of a reportable disease or condition defined in ARM 37.114.203 must immediately report to the local health officer…

5. Disease ReportingProvider Poster Distributed by your local health department Immediately report to your local health department

6. The Role of a Healthcare Provider in Communicable Disease Control and Prevention • Report diseases in a timely manner to your local health jurisdictions • Let common sense be your guide • Work with local health jurisdictions regarding communicable disease control efforts by: • Participating in healthcare community based response to outbreaks (example: pertussis outbreaks) • Following recommendations for post-exposure prophylaxis for individual cases or in outbreak situations • Supporting necessary testing associated with communicable disease control efforts • Implementing and supporting local control measures

7. The Reporting Process Health Care Providers Laboratories Hospitals Local Health Department State Health Department Centers for Disease Control and Prevention

8. Vaccine Preventable Disease updates • Influenza • Pertussis • Rabies Post-Exposure Prophylaxis • Varicella • Others • Hepatitis (A/B) • Meningococcal disease (Neisseria meningitidis, invasive) • Haemophilus influenzae (invasive), Steptococcus pneumoniae (invasive) • Measles, mumps, rubella

9. Data from 2011 Source: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/impact-of-vaccines.pdf

10. Influenza

11. 2013-14 Influenza Season: U.S. http://www.cdc.gov/flu/weekly/

12. Influenza 2013-14: MT Percentage of Influenza-Like Illness (ILI) reported by sentinel providers –— Montana, Selected seasons

13. Biosense 2.0 – MT ILI Surveillance Biosen.se

14. Source: DPHHS Influenza

15. Influenza Hospitalization Rates by age group — Montana, 2013–14 Season Source: DPHHS Influenza

16. 2013-2014 Influenza Cases: MT

17. 2013-14 Influenza Rates: MT

18. Pertussis

19. Pertussis in Montana Case Counts 2013: 663 2012: 549 2005: 586 10 yr. average: 75 (outbreak years excluded)

20. !!!! #1

21. Pertussis in Montana Reported Pertussis Cases by Age Group, 2012 Reported Pertussis Cases by Age Group, 2013

22. Rabies

23. 2013 Rabies in Montana • REPORT ALL ANIMAL BITES TO YOUR LOCAL HEALTH DEPT • 81 human exposures that warranted the recommendation for PEP • Rabies Post Exposure Prophylaxis outcomes (animal and human) are reportable to LHJs – ARM 37.114.571 • Holter Lake (Lewis and Clark County) • 2 positive bats in the same weeks • Notification sent out to >2000 campers • Recommended to seek provider assessment of exposure risk • Vicious river otter attack on the Madison River

24. FOR PUBLIC HEALTH USE ONLY !!!!

25. Positive Rabies Tests By Species, 2013

26. Positive Rabies Tests By Species,2008-2013

27. Rabies Pre-Exposure Recommendations Pre-Exposure (Vaccine ONLY) Dose 1 of Vaccine: As appropriate Dose 2 of Vaccine: 7 days after Dose 1 Dose 3 of Vaccine: 21 days or 28 days after Dose 1

28. Rabies Post-Exposure Recommendations Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should clean the wound and see a doctor immediately. The doctor will determine, after consulting with local public health, if they need to be vaccinated. Unvaccinated Individual: • Dose 1 of Vaccine + HRIG: Immediately after consult with local public health • Vaccine should be injected IM, distal from bite (opposite side of body) • HRIG should be injected IM, around the bite. • If all HRIG cannot be feasibly administered at the bite site, it should be injected IM at any feasible site on the same side of the body as the bite. • Dose 2 of Vaccine: 3 days after Dose 1 • Dose 3 of Vaccine: 7 days after Dose 1 • Dose 4 of Vaccine: 14 days after Dose 1 • Dose 5 of Vaccine: 28 days after Dose 1 • ***Immunocompromised or pregnant persons receive a fifth vaccination on day 28, and should be tested for seroconversion 7 to 14 days following completion of the PEP regimen. Previously Vaccinated Individual: • Dose 1 of Vaccine: After consult with local public health, determine how long it will take to run a titer on the individual. Also, it may depend on the situation, and the location of the bite. • Dose 2 of Vaccine: 3 days after Dose 1 Human Rabies Immune Globulin is not needed!!!

29. Varicella and others

30. Varicella • Second highest incidence of VPD in MT • 84 cases in 2013 • 5 year avg: 150 cases • 85% of cases are <18 years

31. Other Less Frequent Vaccine Preventable Disease Invasive Diseases Hepatitis A and B Hep A – food handlers, travel outside US Hep B – foreign born, IDU, blood borne pathogen • Haemophilusinfluenzaetype B (Hib) - serotype B most pathogenic, especially in infants • Streptococcus pneumoniae(high risk individuals, goes hand in hand with influenza season • Age appropriate recommendations • Flu/Strep • N. meningitidis (close quarters, barracks, dorms etc). • Several outbreaks nation-wide Measles, Mumps, Rubella • Rare • Outbreak potential • Lethbridge Measles Outbreak 2013 • Midwest Mumps Outbreak 2006-2007

32. Summary/Recommendations GOAL: Minimize burden of vaccine preventable diseases in your community • Establish ongoing partnership with local health department • Identify and ensure vaccination of groups at risk for vaccine preventable diseases “An ounce of prevention is worth a pound of cure!”

33. 24/7 Contact information • Please contact your local public health jurisdiction first! • Obtain contact info from your local public health department • Communicable Disease Epi: 406-444-0273 • Speakers: Karl Milhon(Billings, Missoula), Joel Merriman (Miles City), Dana Fejes(Butte), Stacey Anderson (Great Falls)

34. THANK YOU for working with your local health departments • THANK YOU for working with your local health departments • THANK YOU for working with your local health departments • THANK YOU for working with your local health departments • THANK YOU for working with your local health departments • THANK YOU for working with your local health departments

35. Questions?