11

New in the Reportable New in the Reportable Disease Rule, 2007Disease Rule, 2007

Danae Bixler, MD, MPHDanae Bixler, MD, MPHInfectious Disease Epidemiology Infectious Disease Epidemiology

ProgramProgramWVDHHRWVDHHR

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ObjectivesObjectives

• Outline:Outline:– TimelineTimeline– Changes in rule:Changes in rule:

• Reporting timeframesReporting timeframes

• New diseases to be reportedNew diseases to be reported

• Diseases that are no longer reportableDiseases that are no longer reportable

• New sections that impact public health practiceNew sections that impact public health practice

– Common issues that CAN be solved by Common issues that CAN be solved by application to the ruleapplication to the rule

– Strengths and limitations of the ruleStrengths and limitations of the rule

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TimelineTimeline

• Revision began 2003-4Revision began 2003-4– Internal review / drafting 2003-4Internal review / drafting 2003-4– Statewide comment 2004Statewide comment 2004

• Legislative session 2005Legislative session 2005– Rejected because of fiscal noteRejected because of fiscal note

• Second attempt 2005-6Second attempt 2005-6– Statewide comment: 2005Statewide comment: 2005– Legislative approval 2006Legislative approval 2006– Final copy received August 2006 Final copy received August 2006

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Timeline (2)Timeline (2)

• Outstanding issuesOutstanding issues– Reporting of novel influenzaReporting of novel influenza– Further cleanup:Further cleanup:

•Eliminate reporting of occupational healthEliminate reporting of occupational health

•Name change to Shigatoxin-producing Name change to Shigatoxin-producing E coliE coli

•Eliminate provider reporting of chronic Eliminate provider reporting of chronic hepatitis Chepatitis C

– Final version received March 5, 2007Final version received March 5, 2007

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DefinitionsDefinitions

• Local Health Officer = Local Local Health Officer = Local health officer or designeehealth officer or designee

• Commissioner = Commissioner = Commissioner or designeeCommissioner or designee

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General ChangesGeneral Changes

• Five categories of reportable conditions:Five categories of reportable conditions:– ImmediateImmediate– 24 hours24 hours– 72 hours72 hours– Weekly to LHDWeekly to LHD– Weekly to stateWeekly to state

• Local health departments must report to state in Local health departments must report to state in the same timeframe as providersthe same timeframe as providers

• Electronic reporting mandated from local health Electronic reporting mandated from local health departments when the commissioner declares departments when the commissioner declares WVEDSS operational – anticipated July 2, 2007.WVEDSS operational – anticipated July 2, 2007.

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Selected DiseasesSelected DiseasesReportable Immediately to Local Reportable Immediately to Local Health Health Category ICategory I

• Category A BT agentsCategory A BT agents– AnthraxAnthrax– BotulismBotulism– PlaguePlague– SmallpoxSmallpox– TularemiaTularemia– Viral Hemorrhagic FeverViral Hemorrhagic Fever

• Novel influenza infectionNovel influenza infection• OutbreaksOutbreaks• Measles and SARSMeasles and SARS

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Figure 1Outbreaks Reported and Investigated in West

Virginia, 2001 - 2006

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2001 2002 2003 2004 2005 2006

Year of Report

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Immediately Reportable Events Immediately Reportable Events – Provider Responsibilities– Provider Responsibilities

• Immediately report by phone to the Immediately report by phone to the local health departmentlocal health department

• Include:Include:– Patient name, address, telephone number, Patient name, address, telephone number,

date of birth, sex, racedate of birth, sex, race– Physician name, address, office phone and Physician name, address, office phone and

faxfax– Any other information requested by the Any other information requested by the

commissioner commissioner

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Immediately Reportable Events Immediately Reportable Events – Laboratory Responsibilities– Laboratory Responsibilities

• Immediately report by phone to the local Immediately report by phone to the local health departmenthealth department

• Include:Include:– Patient name, address, telephone number, date Patient name, address, telephone number, date

of birth, sex, raceof birth, sex, race– Physician name, address, office phone and faxPhysician name, address, office phone and fax– Name of submitterName of submitter– Specimen source, date of collection, date of Specimen source, date of collection, date of

result, name of test, test result, normal value or result, name of test, test result, normal value or rangerange

– Laboratory name, address, phone and fax Laboratory name, address, phone and fax

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Immediately Reportable Events Immediately Reportable Events – Local Health Department – Local Health Department ResponsibilitiesResponsibilities

• Immediately report by phone to Immediately report by phone to DHHR: 800-423-1271DHHR: 800-423-1271

• File a WVEDSS report File a WVEDSS report – Required July 2, 2007Required July 2, 2007

• See 64-7-7 (outbreaks)See 64-7-7 (outbreaks)

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Selected DiseasesSelected DiseasesReportable at 24 Hours to Local Reportable at 24 Hours to Local Health Health Category IICategory II• Animal bitesAnimal bites• Hepatitis A, BHepatitis A, B• Meningitis (meningococcus, H flu)Meningitis (meningococcus, H flu)• PertussisPertussis• Staphylococcus aureusStaphylococcus aureus resistant to resistant to

VancomycinVancomycin• STEC (Enterohemorrhagic STEC (Enterohemorrhagic E coliE coli))• TuberculosisTuberculosis

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Selected Diseases Selected Diseases Reportable at 72 Hours to Local Reportable at 72 Hours to Local Health Health Category IIICategory III• AmebiasisAmebiasis

• CampylobacteriosisCampylobacteriosis• CryptosporidosisCryptosporidosis• CyclosporaCyclospora• GiardiasisGiardiasis• ListeriosisListeriosis• SalmonellosisSalmonellosis• ShigellosisShigellosis• TrichinosisTrichinosis• YersiniosisYersiniosis

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Selected DiseasesSelected DiseasesReportable at 1 Week to Local Reportable at 1 Week to Local HealthHealthCategory IVCategory IV

• Arboviral infectionArboviral infection• Chickenpox (aggregate total only)Chickenpox (aggregate total only)• Community-acquired MRSA (invasive)Community-acquired MRSA (invasive)• Death from chickenpoxDeath from chickenpox• Influenza-like illness (aggregate only)Influenza-like illness (aggregate only)• Influenza-related death (age < 18)Influenza-related death (age < 18)• LegionellosisLegionellosis• Lyme diseaseLyme disease• Invasive bacterial diseases (S pneumo, GAS, GBS)Invasive bacterial diseases (S pneumo, GAS, GBS)• Tuberculosis latent infectionTuberculosis latent infection

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Selected DiseasesSelected DiseasesReportable at 1 Week to State Reportable at 1 Week to State HealthHealthCategory VCategory V• AIDSAIDS

• ChancroidChancroid

• ChlamydiaChlamydia

• Gonococcal diseaseGonococcal disease

• Hepatitis CHepatitis C– Providers – acuteProviders – acute– Laboratories – all positive test resultsLaboratories – all positive test results

• PIDPID

• SyphilisSyphilis

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EliminatedEliminated

• Aseptic meningitisAseptic meningitis

• Bacterial meningitis, otherBacterial meningitis, other

• Encephalitis, otherEncephalitis, other

• Hepatitis C, chronic (from Hepatitis C, chronic (from providers)providers)

• HerpesHerpes

• Occupational illnessOccupational illness

• Rheumatic FeverRheumatic Fever

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Added!Added!

DiseaseDisease TimeframeTimeframe

Bioterrorist eventBioterrorist event ImmediateImmediate

Novel influenza infection, Novel influenza infection, animal or humananimal or human

ImmediateImmediate

SARS coronavirus infectionSARS coronavirus infection ImmediateImmediate

Unusual condition or Unusual condition or emerging infectious disease emerging infectious disease of potential public health of potential public health significancesignificance

24 hours24 hours

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Added (2)Added (2)

DiseaseDisease TimeframeTimeframe

Community-acquired Community-acquired invasive MRSAinvasive MRSA

1 week1 week

Death from chickenpoxDeath from chickenpox 1 week1 week

Death from influenza (age < Death from influenza (age < 18)18)

1 week1 week

Laboratories only: Laboratories only: enterovirus, culture enterovirus, culture confirmed, aggregate totalsconfirmed, aggregate totals

1 week to 1 week to state health state health deptdept

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Rabies (64-7-5)Rabies (64-7-5)

• Animal bites reportable to the local health Animal bites reportable to the local health department within 24 hoursdepartment within 24 hours

• Ferret added to list of animals that may be Ferret added to list of animals that may be quarantined.quarantined.

• Language added to:Language added to:– Allow humane destruction of animals other than Allow humane destruction of animals other than

a domestic dog, cat or ferret, ‘especially a wild a domestic dog, cat or ferret, ‘especially a wild mammal or hybrid…’mammal or hybrid…’

– Enable reporting of rabies post-exposure Enable reporting of rabies post-exposure prophylaxis to WVEDSSprophylaxis to WVEDSS

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Immunizations (64-7-6)Immunizations (64-7-6)

• Reporting requirements expanded to Reporting requirements expanded to persons 18 years of age and youngerpersons 18 years of age and younger

• Newly reportableNewly reportable– Smallpox vaccination Smallpox vaccination – Pandemic influenza vaccination Pandemic influenza vaccination – Immunizations of adults (voluntary)Immunizations of adults (voluntary)

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Disease outbreaks (64-7-7)Disease outbreaks (64-7-7)

• Immediate notification of:Immediate notification of:– Local health officerLocal health officer– The BureauThe Bureau

• Collaboration withCollaboration with– The BureauThe Bureau– Other jurisdictionsOther jurisdictions– Federal public health officialsFederal public health officials

• Steps in investigation outlinedSteps in investigation outlined• Enabling language to complete special Enabling language to complete special

studies (e.g., case-control, cohort), hold studies (e.g., case-control, cohort), hold individually identifying data confidentialindividually identifying data confidential

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Surveillance program Surveillance program evaluation and special studies evaluation and special studies (64-7-8)(64-7-8)• Commissioner given the ability to do evaluation Commissioner given the ability to do evaluation

of surveillance systems or special studies, of surveillance systems or special studies, including:including:– Right to request medical or laboratory records to Right to request medical or laboratory records to

perform audits for completeness, accuracy and perform audits for completeness, accuracy and timeliness of reportingtimeliness of reporting

– Do special studies (e.g., case-control, cohort, cross-Do special studies (e.g., case-control, cohort, cross-sectional) on the health of the population for the sectional) on the health of the population for the purpose of quantifying the risk to the population or purpose of quantifying the risk to the population or access to appropriate prevention and control servicesaccess to appropriate prevention and control services

– Hold data confidentialHold data confidential

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Bioterrorism response (64-Bioterrorism response (64-7-9)7-9)

• Immediate notificationImmediate notification

• DefinitionDefinition

• Collaboration with other local health Collaboration with other local health officers, state and federal officials, officers, state and federal officials, law enforcementlaw enforcement

• Investigation as in outbreak Investigation as in outbreak investigation sectioninvestigation section

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Syndromic surveillance and Syndromic surveillance and electronic laboratory reporting electronic laboratory reporting (64-7-10)(64-7-10)

• Commissioner may create a list of Commissioner may create a list of syndromes to be reported:syndromes to be reported:– Acute neurological illnessAcute neurological illness– Acute vomiting and/or diarrheaAcute vomiting and/or diarrhea– Death in the emergency roomDeath in the emergency room– Febrile illness with flu-like symptomsFebrile illness with flu-like symptoms– Febrile illness with flu-like symptoms and rashFebrile illness with flu-like symptoms and rash– PneumoniaPneumonia– Septicemia of unknown etiologySepticemia of unknown etiology– Other syndromes as defined by the CommissionerOther syndromes as defined by the Commissioner

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Syndromic surveillance and Syndromic surveillance and electronic laboratory reporting electronic laboratory reporting (64-7-10)(64-7-10)• When certified as operational by the When certified as operational by the

Commissioner, laboratories with Commissioner, laboratories with automatic reporting capabilityautomatic reporting capability will will report positive results daily, includingreport positive results daily, including– Patient name, address, telephone Patient name, address, telephone

number, date of birth, sexnumber, date of birth, sex– SubmitterSubmitter– Specimen source, date of collection, Specimen source, date of collection,

date of resultdate of result– Test name, result, normal value or rangeTest name, result, normal value or range– Laboratory name, address, phone and Laboratory name, address, phone and

fax fax

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Syndromic surveillance and Syndromic surveillance and electronic laboratory reporting electronic laboratory reporting (64-7-10)(64-7-10)• When certified … laboratories with When certified … laboratories with

automatic reporting capability will automatic reporting capability will report … additional conditions report … additional conditions including:including:– AdenovirusAdenovirus– EnterovirusEnterovirus– InfluenzaInfluenza– RSVRSV– RotavirusRotavirus

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Submission of Laboratory Specimens Submission of Laboratory Specimens to Office of Laboratory Services:to Office of Laboratory Services:Isolates (12.2.b.1)Isolates (12.2.b.1)

• Bacillus anthracisBacillus anthracis

• Clostridium botulinumClostridium botulinum

• Corynebacterium diphtheriaeCorynebacterium diphtheriae

• TularemiaTularemia

• SalmonellaSalmonella

• ShigellaShigella

• CampylobacterCampylobacter

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Submission of Laboratory Specimens Submission of Laboratory Specimens to Office of Laboratory Services:to Office of Laboratory Services:Isolates (12.2.b.1) (2)Isolates (12.2.b.1) (2)

• Listeria monocytogenesListeria monocytogenes• Suspect or confirmed ETECSuspect or confirmed ETEC• Yersinia pestisYersinia pestis• From a sterile site:From a sterile site:

– N meningitidisN meningitidis– S pneumoniaeS pneumoniae– Haemophilus influenzaeHaemophilus influenzae

• Other isolates as determined by the Other isolates as determined by the CommissionerCommissioner

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Submission of Virological, Submission of Virological, serological, EM , molecular serological, EM , molecular samples … (12.2.b.2.G)samples … (12.2.b.2.G)• LaCrosse, West Nile, Eastern equine, St Louis LaCrosse, West Nile, Eastern equine, St Louis

encephalitis virusesencephalitis viruses• Orthopox virusOrthopox virus• PoliomyelitisPoliomyelitis• RabiesRabies• RubellaRubella• RubeolaRubeola• SARSSARS• Other specimens as determined by the Other specimens as determined by the

CommissionerCommissioner– Novel influenza virusNovel influenza virus

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FAQ # 1FAQ # 1 ‘I’m not sure I have ‘I’m not sure I have jurisdiction…’jurisdiction…’• For local health departments, jurisdiction For local health departments, jurisdiction

==– Your countyYour county

• Schools, camps, vessels and department-Schools, camps, vessels and department-operated health care facilities are required operated health care facilities are required to:to:– Report …. 64-7-12.3.a.1Report …. 64-7-12.3.a.1– Assist with investigation …. 64-7-12.3.a.2Assist with investigation …. 64-7-12.3.a.2– Follow methods of control … 64-7-12.3.a.2Follow methods of control … 64-7-12.3.a.2

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FAQ # 2FAQ # 2‘Dr. C wants written permission ‘Dr. C wants written permission from the patient to report…’from the patient to report…’• Pg 17: …Providers and … facilities … Pg 17: …Providers and … facilities …

shall:shall:– Report …. 64-7-12.1.a.1Report …. 64-7-12.1.a.1– Assist … in … investigation 64-7-Assist … in … investigation 64-7-

12.1.a.212.1.a.2– Submit specimens … 64-7-12.1.a.3Submit specimens … 64-7-12.1.a.3

• HIPAA letterHIPAA letter– http://www.wvdhhr.org/idep/PDFs/http://www.wvdhhr.org/idep/PDFs/

IDEP/HIPPA_Letter_11-05.pdfIDEP/HIPPA_Letter_11-05.pdf

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FAQ # 3FAQ # 3‘… I need to rule out this case, ‘… I need to rule out this case, but negative results aren’t but negative results aren’t reportable ….’reportable ….’

• … … Providers and … facilities … shallProviders and … facilities … shall– ‘‘assist the … local health officer in ruling assist the … local health officer in ruling

out previously reported cases … by out previously reported cases … by submitting copies of negative laboratory submitting copies of negative laboratory tests … 16-7-12.1.a.7tests … 16-7-12.1.a.7

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FAQ # 4FAQ # 4‘ … Dr. B won’t help me with ‘ … Dr. B won’t help me with contact investigation …’contact investigation …’• Pg 17-18: Health care providers and … Pg 17-18: Health care providers and …

facilities … shall …facilities … shall …– Assist … in any necessary contact investigation Assist … in any necessary contact investigation

… 64-7-12.1.a.2… 64-7-12.1.a.2– … … advise … the patient … members of the advise … the patient … members of the

patient’s household and other patient contacts patient’s household and other patient contacts …64-7-12.1.a.4…64-7-12.1.a.4

– Follow a method of control specified by the Follow a method of control specified by the commissioner in established protocols … 64-7-commissioner in established protocols … 64-7-12.1.a.512.1.a.5

– Assist … the local health officer by promoting Assist … the local health officer by promoting implementation of the control method … implementation of the control method … specified in the protocol … 64-7-12.1.a.6specified in the protocol … 64-7-12.1.a.6

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FAQ # 5FAQ # 5“Dr. A won’t report.’ “Dr. A won’t report.’

• If … a … provider,… facility, laboratory … If … a … provider,… facility, laboratory … failed to report … the local health officer … failed to report … the local health officer … shall request an explanation …64-7-14.6shall request an explanation …64-7-14.6

• The local health officer shall report to the The local health officer shall report to the commissioner the … provider, … facility, commissioner the … provider, … facility, laboratory … and his or her reason for laboratory … and his or her reason for failure to comply … 64-7-14.7failure to comply … 64-7-14.7

• (Call us first)(Call us first)

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FAQ # 6FAQ # 6‘Attorney X is requesting a ‘Attorney X is requesting a disease report – can I give it to disease report – can I give it to him?’him?’• Pg 21: … the local health officer may Pg 21: … the local health officer may

release confidential information … to:release confidential information … to:– The patient 64-7-18.2.aThe patient 64-7-18.2.a– The patient’s physician …. 64-7-18.2.dThe patient’s physician …. 64-7-18.2.d– Any individual with the written consent Any individual with the written consent

of the patient and of all other individuals of the patient and of all other individuals identified …64-7-18.2.e identified …64-7-18.2.e

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LimitationsLimitations

• Isolation and quarantineIsolation and quarantine– Operational plans require court ordersOperational plans require court orders

• Owned dog, cat or ferret:Owned dog, cat or ferret:– Only option: ‘… shall direct owner to confine …’ Only option: ‘… shall direct owner to confine …’

64-7.5.364-7.5.3

• Keeping the rule up to date … Commissioner Keeping the rule up to date … Commissioner ……– … … may…add or delete a disease or condition … may…add or delete a disease or condition …

64-7-3.1.a64-7-3.1.a– … … may require same day reporting … may require same day reporting …

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Strengths of the RuleStrengths of the Rule

• Clear responsibilities for providers, Clear responsibilities for providers, laboratories, health officials, schools, laboratories, health officials, schools, vessels…vessels…– ReportingReporting– InvestigatingInvestigating– Outbreak investigationOutbreak investigation– Contact investigationContact investigation– Surveillance evaluation and special studiesSurveillance evaluation and special studies– ConfidentialityConfidentiality– Electronic reportingElectronic reporting

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Strengths of the RuleStrengths of the Rule

• Reportable Disease Protocol ManualReportable Disease Protocol Manual– The commissioner shall establish specific The commissioner shall establish specific

protocols …64-7-3.2.aprotocols …64-7-3.2.a– … … providers and … facilities … 64-7-12.1.a.5providers and … facilities … 64-7-12.1.a.5– … … laboratories …64-7-12.2.b.1laboratories …64-7-12.2.b.1– … … local health officers … 64-7-14.3.a and 64-7-local health officers … 64-7-14.3.a and 64-7-

14.3.b14.3.b– … … schools, camps, vessels, and department-schools, camps, vessels, and department-

operated health care facilities …. 64-7-12.3.a.3operated health care facilities …. 64-7-12.3.a.3

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Myth:Myth:‘… I don’t have the authority ‘… I don’t have the authority to ...’to ...’• 64-7-14 Responsibilities of Local 64-7-14 Responsibilities of Local

Health Officers:Health Officers:– Comply with ruleComply with rule– Maintain recordsMaintain records– Investigate/collect specimens/manage Investigate/collect specimens/manage

contacts/report to BPHcontacts/report to BPH•Reportable disease protocol manualReportable disease protocol manual•Consultation with the CommissionerConsultation with the Commissioner

– Investigate providers who don’t reportInvestigate providers who don’t report

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Always … advise Always … advise appropriately and appropriately and

document…document…

You (the local health officer) You (the local health officer) can have tremendous can have tremendous

influence (authority) in your influence (authority) in your jurisdiction …jurisdiction …

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Conference Call on the Conference Call on the Reportable Disease Rule and Reportable Disease Rule and WVEDSSWVEDSS• WHO: Local Health Departments, WHO: Local Health Departments,

Hospital Infection Control Hospital Infection Control Professionals, Hospital Laboratory Professionals, Hospital Laboratory DirectorsDirectors

• WHEN: Wednesday, May 30 and WHEN: Wednesday, May 30 and Friday, June 8, 2007; 12:00 to 1:30 PMFriday, June 8, 2007; 12:00 to 1:30 PM

• HOW: dial HOW: dial 1-888-819-5079; 1-888-819-5079; passcode = 586900passcode = 586900

• CAUTION: Only 125 lines each callCAUTION: Only 125 lines each call