New in the Reportable Disease
Rule, 2007
Danae Bixler, MD, MPH
Infectious Disease Epidemiology
Program
WVDHHR
1
Objectives
• Outline:
– Timeline
– Changes in rule:
• Reporting timeframes
• New diseases to be reported
• Diseases that are no longer reportable
• New sections that impact public health practice
– Common issues that CAN be solved by application to
the rule
– Strengths and limitations of the rule
2
Timeline
• Revision began 2003-4
– Internal review / drafting 2003-4
– Statewide comment 2004
• Legislative session 2005
– Rejected because of fiscal note
• Second attempt 2005-6
– Statewide comment: 2005
– Legislative approval 2006
– Final copy received August 2006
3
Timeline (2)
• Outstanding issues
– Reporting of novel influenza
– Further cleanup:
• Eliminate reporting of occupational health
• Name change to Shigatoxin-producing E coli
• Eliminate provider reporting of chronic hepatitis C
– Final version received March 5, 2007
4
Definitions
• Local Health Officer = Local
health officer or designee
• Commissioner = Commissioner or
designee
5
General Changes
• Five categories of reportable conditions:
–
–
–
–
–
Immediate
24 hours
72 hours
Weekly to LHD
Weekly to state
• Local health departments must report to state in the
•
same timeframe as providers
Electronic reporting mandated from local health
departments when the commissioner declares WVEDSS
operational – anticipated July 2, 2007.
6
Selected Diseases
Reportable Immediately to Local Health
Category I
• Category A BT agents
–
–
–
–
–
–
Anthrax
Botulism
Plague
Smallpox
Tularemia
Viral Hemorrhagic Fever
• Novel influenza infection
• Outbreaks
• Measles and SARS
7
Figure 1
Outbreaks Reported and Investigated in West
Virginia, 2001 - 2006
80
73
Number of Outbreaks
70
60
50
40
28
30
18
20
10
26
13
7
0
2001
2002
2003
2004
2005
2006
Year of Report
8
Immediately Reportable Events –
Provider Responsibilities
• Immediately report by phone to the local
health department
• Include:
– Patient name, address, telephone number,
date of birth, sex, race
– Physician name, address, office phone and fax
– Any other information requested by the
commissioner
9
Immediately Reportable Events –
Laboratory Responsibilities
• Immediately report by phone to the local health
•
department
Include:
– Patient name, address, telephone number, date of
birth, sex, race
– Physician name, address, office phone and fax
– Name of submitter
– Specimen source, date of collection, date of result,
name of test, test result, normal value or range
– Laboratory name, address, phone and fax
10
Immediately Reportable Events –
Local Health Department
Responsibilities
• Immediately report by phone to DHHR:
800-423-1271
• File a WVEDSS report
– Required July 2, 2007
• See 64-7-7 (outbreaks)
11
Selected Diseases
Reportable at 24 Hours to Local Health
Category II
• Animal bites
• Hepatitis A, B
• Meningitis (meningococcus, H flu)
• Pertussis
• Staphylococcus aureus resistant to
Vancomycin
• STEC (Enterohemorrhagic E coli)
• Tuberculosis
12
Selected Diseases
Reportable at 72 Hours to Local Health
Category III
•
•
•
•
•
•
•
•
•
•
Amebiasis
Campylobacteriosis
Cryptosporidosis
Cyclospora
Giardiasis
Listeriosis
Salmonellosis
Shigellosis
Trichinosis
Yersiniosis
13
Selected Diseases
Reportable at 1 Week to Local Health
Category IV
•
•
•
•
•
•
•
•
•
•
Arboviral infection
Chickenpox (aggregate total only)
Community-acquired MRSA (invasive)
Death from chickenpox
Influenza-like illness (aggregate only)
Influenza-related death (age < 18)
Legionellosis
Lyme disease
Invasive bacterial diseases (S pneumo, GAS, GBS)
Tuberculosis latent infection
14
Selected Diseases
Reportable at 1 Week to State Health
Category V
•
•
•
•
•
AIDS
Chancroid
Chlamydia
Gonococcal disease
Hepatitis C
– Providers – acute
– Laboratories – all positive test results
• PID
• Syphilis
15
Eliminated
• Aseptic meningitis
• Bacterial meningitis, other
• Encephalitis, other
• Hepatitis C, chronic (from providers)
• Herpes
• Occupational illness
• Rheumatic Fever
16
Added!
Disease
Timeframe
Bioterrorist event
Immediate
Novel influenza infection, animal
or human
SARS coronavirus infection
Immediate
Unusual condition or emerging
infectious disease of potential
public health significance
24 hours
Immediate
17
Added (2)
Disease
Timeframe
Community-acquired invasive
MRSA
Death from chickenpox
1 week
Death from influenza (age < 18)
1 week
Laboratories only: enterovirus,
culture confirmed, aggregate
totals
1 week to state
health dept
1 week
18
Rabies (64-7-5)
• Animal bites reportable to the local health
•
•
department within 24 hours
Ferret added to list of animals that may be
quarantined.
Language added to:
– Allow humane destruction of animals other than a
domestic dog, cat or ferret, ‘especially a wild mammal
or hybrid…’
– Enable reporting of rabies post-exposure prophylaxis
to WVEDSS
19
Immunizations (64-7-6)
• Reporting requirements expanded to
persons 18 years of age and younger
• Newly reportable
– Smallpox vaccination
– Pandemic influenza vaccination
– Immunizations of adults (voluntary)
20
Disease outbreaks (64-7-7)
• Immediate notification of:
– Local health officer
– The Bureau
• Collaboration with
– The Bureau
– Other jurisdictions
– Federal public health officials
• Steps in investigation outlined
• Enabling language to complete special studies
(e.g., case-control, cohort), hold individually
identifying data confidential
21
Surveillance program evaluation
and special studies (64-7-8)
• Commissioner given the ability to do evaluation
of surveillance systems or special studies,
including:
– Right to request medical or laboratory records to
perform audits for completeness, accuracy and
timeliness of reporting
– Do special studies (e.g., case-control, cohort, crosssectional) on the health of the population for the
purpose of quantifying the risk to the population or
access to appropriate prevention and control services
– Hold data confidential
22
Bioterrorism response (64-7-9)
• Immediate notification
• Definition
• Collaboration with other local health
officers, state and federal officials, law
enforcement
• Investigation as in outbreak investigation
section
23
Syndromic surveillance and electronic
laboratory reporting (64-7-10)
• Commissioner may create a list of syndromes to
be reported:
–
–
–
–
–
–
–
–
Acute neurological illness
Acute vomiting and/or diarrhea
Death in the emergency room
Febrile illness with flu-like symptoms
Febrile illness with flu-like symptoms and rash
Pneumonia
Septicemia of unknown etiology
Other syndromes as defined by the Commissioner
24
Syndromic surveillance and electronic
laboratory reporting (64-7-10)
• When certified as operational by the
Commissioner, laboratories with automatic
reporting capability will report positive
results daily, including
– Patient name, address, telephone number,
date of birth, sex
– Submitter
– Specimen source, date of collection, date of
result
– Test name, result, normal value or range
– Laboratory name, address, phone and fax
25
Syndromic surveillance and electronic
laboratory reporting (64-7-10)
• When certified … laboratories with
automatic reporting capability will report
… additional conditions including:
– Adenovirus
– Enterovirus
– Influenza
– RSV
– Rotavirus
26
Submission of Laboratory Specimens to
Office of Laboratory Services:
Isolates (12.2.b.1)
• Bacillus anthracis
• Clostridium botulinum
• Corynebacterium diphtheriae
• Tularemia
• Salmonella
• Shigella
• Campylobacter
27
Submission of Laboratory Specimens to
Office of Laboratory Services:
Isolates (12.2.b.1) (2)
•
•
•
•
Listeria monocytogenes
Suspect or confirmed ETEC
Yersinia pestis
From a sterile site:
– N meningitidis
– S pneumoniae
– Haemophilus influenzae
• Other isolates as determined by the
Commissioner
28
Submission of Virological, serological,
EM , molecular samples … (12.2.b.2.G)
• LaCrosse, West Nile, Eastern equine, St Louis
•
•
•
•
•
•
•
encephalitis viruses
Orthopox virus
Poliomyelitis
Rabies
Rubella
Rubeola
SARS
Other specimens as determined by the Commissioner
– Novel influenza virus
29
FAQ # 1
‘I’m not sure I have jurisdiction…’
• For local health departments, jurisdiction =
– Your county
• Schools, camps, vessels and department-
operated health care facilities are required to:
– Report …. 64-7-12.3.a.1
– Assist with investigation …. 64-7-12.3.a.2
– Follow methods of control … 64-7-12.3.a.2
30
FAQ # 2
‘Dr. C wants written permission
from the patient to report…’
• Pg 17: …Providers and … facilities …
shall:
– Report …. 64-7-12.1.a.1
– Assist … in … investigation 64-7-12.1.a.2
– Submit specimens … 64-7-12.1.a.3
• HIPAA letter
– http://www.wvdhhr.org/idep/PDFs/IDEP/HIPP
A_Letter_11-05.pdf
31
FAQ # 3
‘… I need to rule out this case, but
negative results aren’t reportable ….’
• … Providers and … facilities … shall
– ‘assist the … local health officer in ruling out
previously reported cases … by submitting
copies of negative laboratory tests … 16-712.1.a.7
32
FAQ # 4
‘ … Dr. B won’t help me with contact
investigation …’
• Pg 17-18: Health care providers and … facilities
… shall …
– Assist … in any necessary contact investigation … 647-12.1.a.2
– … advise … the patient … members of the patient’s
household and other patient contacts …64-7-12.1.a.4
– Follow a method of control specified by the
commissioner in established protocols … 64-712.1.a.5
– Assist … the local health officer by promoting
implementation of the control method … specified in
the protocol … 64-7-12.1.a.6
33
FAQ # 5
“Dr. A won’t report.’
• If … a … provider,… facility, laboratory … failed
•
•
to report … the local health officer … shall
request an explanation …64-7-14.6
The local health officer shall report to the
commissioner the … provider, … facility,
laboratory … and his or her reason for failure to
comply … 64-7-14.7
(Call us first)
34
FAQ # 6
‘Attorney X is requesting a disease
report – can I give it to him?’
• Pg 21: … the local health officer may
release confidential information … to:
– The patient 64-7-18.2.a
– The patient’s physician …. 64-7-18.2.d
– Any individual with the written consent of the
patient and of all other individuals identified
…64-7-18.2.e
35
Limitations
• Isolation and quarantine
– Operational plans require court orders
• Owned dog, cat or ferret:
– Only option: ‘… shall direct owner to confine …’
64-7.5.3
• Keeping the rule up to date … Commissioner …
– … may…add or delete a disease or condition …
64-7-3.1.a
– … may require same day reporting …
36
Strengths of the Rule
• Clear responsibilities for providers, laboratories,
health officials, schools, vessels…
–
–
–
–
–
–
–
Reporting
Investigating
Outbreak investigation
Contact investigation
Surveillance evaluation and special studies
Confidentiality
Electronic reporting
37
Strengths of the Rule
• Reportable Disease Protocol Manual
– The commissioner shall establish specific protocols
…64-7-3.2.a
– … providers and … facilities … 64-7-12.1.a.5
– … laboratories …64-7-12.2.b.1
– … local health officers … 64-7-14.3.a and 64-7-14.3.b
– … schools, camps, vessels, and department-operated
health care facilities …. 64-7-12.3.a.3
38
Myth:
‘… I don’t have the authority to ...’
• 64-7-14 Responsibilities of Local Health
Officers:
– Comply with rule
– Maintain records
– Investigate/collect specimens/manage
contacts/report to BPH
• Reportable disease protocol manual
• Consultation with the Commissioner
– Investigate providers who don’t report
39
Always … advise appropriately
and document…
You (the local health officer) can
have tremendous influence
(authority) in your jurisdiction …
40
Conference Call on the Reportable
Disease Rule and WVEDSS
• WHO: Local Health Departments, Hospital
Infection Control Professionals, Hospital
Laboratory Directors
• WHEN: Wednesday, May 30 and Friday,
June 8, 2007; 12:00 to 1:30 PM
• HOW: dial 1-888-819-5079; passcode
= 586900
• CAUTION: Only 125 lines each call
41