antimicrobial stewardship recognition program returns for ......summer 2 020 quarterly newsletter...

The NJDOH CommunicableDisease Service includes:Infectious and Zoonotic Disease Program (IZDP): 609-826-5964

Vaccine Preventable Disease Program (VPDP): 609-826-4860

We’re on the Web!www.nj.gov/health/cd

Past issues of the New Jersey Com-muni-CABLE are available online at:http://nj.gov/health/cd/pub.shtml.

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PHOTO BY: ANWAR WALKER, PUBLIC HEALTH REPRESENTATIVE

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The New JerseyDepartmentof Health

(NJDOH) iscontinuing theAntimicrobialStewardshipRecognition Programin 2020! NJDOH madea few modifications tothe application to alignwith updates toCenters for DiseaseControl andPrevention’s (CDC)Core Elements ofHospital AntibioticStewardship Programs,which were released inNovember, 2019. Asbefore, there are seven coreelements of hospital antibioticstewardship programs, however theelements have been updated toreflect both lessons learned andnew evidence from the field ofantibiotic stewardship. NJDOHmade modifications to theapplications based on CDC’supdates, and the lessons learnedafter rolling out the first year ofthe ASRP.

Modeled on the CDC’s CoreElements of Antibiotic Stewardship,the ASRP offers healthcarefacilities an opportunity to submit

and share their current efforts. In2019, the NJDOH CommunicableDisease Service launched theASRP and the first round ofwinners were announced at theNew Jersey Hospital Associationin Princeton, NJ on December 5,2019. This program invitedhealthcare facilities from varioussettings throughout the state tosubmit materials documenting thebreadth and depth of theirantimicrobial stewardship effortsin order to reward their goodwork, develop/enhance

Summer 2020 Quarterly Newsletter

Communicable DiseaseService Mission StatementOur mission is to prevent communicable disease amongall citizens of New Jersey, andto promote the knowledge anduse of healthy lifestyles to maximize the health and well-being of New Jerseyans.

We will accomplish our mission through our leadership,collaborative partnerships, andadvocacy for communicable disease surveillance, research,education, treatment, prevention and control.

Phil Murphy, Governor

Sheila Oliver, Lt. Governor

Judith M. Persichilli, RN, BSN, MACommissioner

COMMUNICABLE DISEASE SERVICEChristina Tan, MD, MPHState Epidemiologist/Assistant Commissioner

Gary Ludwig, MS, Director

Suzanne Miro, MPH, MCHESEditor, Research Scientist

C2800

Antimicrobial Stewardship RecognitionProgram Returns for Second Year!

Christina Tan, MD, MPH, State Epidemiologist/Assistant Commissioner, spoke at the 2019 program.

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Summer 2020


Regional Epidemiology Program (REP): 609-826-5964



Past issues of the New JerseyCommuni-CABLE are available online at:http://www.nj.gov/health/cd/statistics/pub/.

Legionellosis is a nationallynotifiable disease in whichcases are classified as

“confirmed” or “suspect” based onthe presence of clinicallycompatible symptoms anddiagnostic testing. Increasedexperience with diagnostic testing,along with increased confidence inthe diagnostic performance ofnucleic acid amplification testing(i.e., PCR) and its more prevalentutilization, has prompted the Council ofState and Territorial Epidemiologists andCenters for Disease Control andPrevention to update the laboratorycriteria for the diagnosis of legionellosis.Further, the clinical criteria have beenupdated to capture extrapulmonarydisease, a rare, but important, clinicalpresentation. The following sectionshighlight the updated clinical criteria,laboratory criteria, preferred diagnosticmethods, and available resources.

Clinical CriteriaLegionellosis is associated with threeclinically and epidemiologically distinctillnesses: Legionnaires’ disease, Pontiacfever, or extrapulmonary legionellosis.• Legionnaires’ disease: Legionnaires’

disease presents as pneumonia,diagnosed clinically and/orradiographically. Evidence ofclinically compatible disease can bedetermined several ways: a) a clinicalor radiographic diagnosis ofpneumonia in the medical recordOR b) if “pneumonia” is notrecorded explicitly, a description ofclinical symptoms that are consistentwith a diagnosis of pneumonia.2

• Pontiac fever: Pontiac fever is amilder illness. While symptoms ofPontiac fever could appear similar tothose described for Legionnaires’disease, there are distinguishingclinical features. Pontiac fever doesnot present as pneumonia. It is lesssevere than Legionnaires’ disease,rarely requiring hospitalization.Pontiac fever is self-limited, meaningit resolves without antibiotictreatment.

• *NEW* Extrapulmonarylegionellosis: Legionella can causedisease at sites outside the lungs (forexample, associated withendocarditis, wound infection, jointinfection, graft infection). Adiagnosis of extrapulmonarylegionellosis is made when there isclinical evidence of disease at anextrapulmonary site and diagnostictesting indicates evidence ofLegionella at that site.

Laboratory CriteriaConfirmatory laboratory evidence: • *NEW* PCR: Detection of any

Legionella species from lower

Revision of The Legionellosis SurveillanceCase Definition1

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www.nj.gov/health/cd

http://www.nj.gov/health/cd/statistics/pub/






The Advisory Committee onImmunization Practices(ACIP) is a group of medical

and public health experts whodevelop recommendations on theuse of vaccines for the UnitedStates. These recommendations areroutinely reviewed and revised.Listed below are the recentlyapproved updates to the currentrecommendations. For thecomplete ACIP vaccinerecommendations, please visit:www.cdc.gov/vaccines/hcp/acip-recs.

Human Papillomavirus (HPV)Vaccination• ACIP recommends catch-up

HPV vaccination for all personsthrough age 26 years.

• ACIP does not routinelyrecommend catch-up vaccinationfor all adults aged 27 through 45years, but recognized that somepersons who are not adequatelyvaccinated might be at risk fornew HPV infection and mightbenefit from vaccination in thisage range; therefore, ACIPrecommends shared clinicaldecision-making regardingpotential HPV vaccinationfor these persons.

Pneumococcal Vaccination• ACIP recommends

pneumococcal conjugatevaccine (PCV13) based onshared clinicaldecision-making for adults 65years or older who do not havean immunocompromisingcondition and who have notpreviously received PCV13. All

adults 65 years or older shouldreceive a dose of pneumococcalpolysaccharide vaccine (PPSV23).

Hepatitis A Vaccination• ACIP recommends that all

children and adolescents aged 2through 18 years who have notpreviously received hepatitis Avaccine be vaccinated routinely atany age (i.e., children andadolescents are recommended forcatch-up vaccination).

• ACIP recommends all personswith HIV ≥ 1 year be vaccinated.

Serogroup B Meningococcal(MenB) Vaccination*• For persons aged ≥10 years with

complement deficiency,complement inhibitor use,asplenia, or who aremicrobiologists:o ACIP recommends a MenB

booster dose 1 year followingcompletion of a MenB primaryseries followed by MenBbooster doses every 2-3 years

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Summer 2020

Get more information athttp://nj.gov/health/cd/handwashing.shtml.

Updates in Vaccine Recommendations



http://nj.gov/health/cd/handwashing.shtml







Summer 2020

On February 5, 2020, the NewJersey Department ofHealth (NJDOH) conducted

an anthrax tabletop exercise forLocal Information NetworkCommunications System (LINCS)agencies in preparation for afull-scale exercise planned for 2021.This tabletop was mainly for healtheducators/risk communicators(HERCs) and focused oncommunications surrounding apublic health emergency. HERCsand their back-ups attended theexercise and brought their agencies’risk communication plans. Thetabletop scenario was based on ananthrax release at a large concertvenue that included college bandsfrom across the state.

Attendees found the exercise helpfulfor clarifying Access and FunctionalNeeds (AFN), activation of the riskcommunication plan, and the role ofthe HERC during a public healthemergency, as the HERC typicallyhas many roles within their agencies.Discussion of internal and externalcommunications and staffing duringan event that lasts for weeks ormonths were also discussed.The exercise was led by the Trainingand Exercise Team from the NJDOHDivision of Public HealthInfrastructure, Laboratories andEmergency Preparedness.

Tabletop Exercise Prepares HealthEducators for 2021

A member of the NJDOH Training and Exercise Team leads the tabletop exercise.








thereafter, for as long asincreased risk remains.

• For persons aged ≥10 yearsdetermined by public healthofficials to be at increased riskduring an outbreak:o ACIP recommends a one-time

booster dose if it has been ≥1year since completion of aMenB primary series.

o A booster dose interval of ≥6months may be considered bypublic health officialsdepending on the specificoutbreak, vaccinationstrategy, and projectedduration of elevated risk.

Tetanus diphtheria (Td) andTetanus diphtheria and pertussis(Tdap) Vaccination• ACIP recommendations have

been updated to allow Tdap tobe substituted for Td in theregular vaccination schedule.This means either Td or Tdapvaccine can be used for theten-year booster, tetanusprophylaxis for woundmanagement, and for additionalrequired doses in the catch-upimmunization schedule.

* On June 27, 2019, the Advisory Committee on ImmunizationPractices (ACIP) voted to approve this recommendation forserogroup B meningococcal (MenB) vaccine. Thisrecommendation will be considered “official” when it is approvedby the CDC Director and published in Morbidity and MortalityWeekly Report (MMWR).

Vaccines, continued from page 3Summer 2020

Bernice Carr – Bernice joins theCDS and Viral Hepatitis Team asthe hepatitis C epidemiologist,working on the surveillance,guidance, technical consultationand dissemination of hepatitis Cdata. Bernice has been working atCDS as an epidemiologist since2016. She comes to this positionwith several years of experienceand earned her Master of PublicHealth degree from The GeorgeWashington University ofWashington D.C. She also holds aMaster of Science degree in FoodScience from Rutgers University.

Aaron Rosenbaum – Aaron joinsthe CDS as a statistical analyst inthe Vaccine Preventable DiseaseProgram. He began working atCDS in 2019 as an intern with theVector-borne Disease Team to

develop a risk index to measurehuman transmission risk of WestNile virus disease in NJ counties.Aaron earned a Ph.D. inpsychology from Penn State andworked in marketing research as aproject director and data analystprior to joining CDS.

Patricia Zinna – Patricia joins theCDS as a veterinarian working withthe Zoonotic Team on a part-timebasis focusing on the VeterinaryPublic Health Program, rabies andother zoonotic diseaseconsultations. She spent the firstpart of her career in clinicalmedicine and now focuses on publichealth. Patricia earned her degreefrom Cornell University ofVeterinary Medicine and last yearearned a Master of Science degree inVeterinary Forensic Science.

CDS Welcomes New Staff!








Summer 2020

collaborative relationships, andidentify best practices. Facilitieswere awarded with a gold, silver, orbronze recognition level based upon

whether they perform tasksthat tackle the seven core

elements: LeadershipCommitment,Accountability, Action,Drug Expertise,Reporting, Tracking, andEducation. Due to CDS

staff work related toCOVID-19, the 2020 ASRP has

been modified to allow returningwinners to maintain their 2019award status via a letter ofattestation. Facilities applying forthe first time were permitted to doso by August 5, 2020. Awards will beannounced in November 2020.

The ASRP enables NJDOH toboth promote antimicrobialstewardship best practices toprevent development ofdrug-resistance and collect moredetailed information onantimicrobial stewardship andresistance to guide futureinitiatives. Outpatient healthcarefacilities can be recognized with ageneral award. In addition torecognizing the achievements ofawardees, the program is alsointended to encourage facilities toenhance existing programs andinfluence facilities without robuststewardship programs to developthem. The ASRP ultimately seeksto better preserve the power ofantimicrobial drugs and preventthe spread of antimicrobial-resistant germs.

Antimicrobial, continued from page 1

CDS Staff Selected for MinorityLeadership ProgramCongratulations to Ayiasha Pratt, a public healthrepresentative within the Vaccine PreventableDisease Program (VPDP) on being selected toparticipate in the National Alliance of State andTerritorial AIDS Directors’ (NASTAD), 2020Minority Leadership Program (MLP).

The MLP, launched in 2010, is a leadershipdevelopment and investment program for personsof color working at various levels in state or Centers for Disease Controland Prevention-funded health department positions in HIV/AIDS or viralhepatitis programs. During this 10-month program, Ayiasha will havethe opportunity to enhance her leadership and communication skills,and build productive working relationships. She will be able to usethese valuable skills in her role within the VPDP’s Perinatal Hepatitis BPrevention Program where she works to reduce the transmission ofhepatitis B to infants. Congratulations again to Ayiasha on thiswonderful opportunity!








September 2020 will markthe second time the NewJersey Department of

Health (NJDOH), CommunicableDisease Service will participate insepsis awareness month. Led bythe national Sepsis Alliance,SEPTEMBER SEPSIS, is anawareness campaign dedicated toincreasing knowledge amonghealthcare professionals and thepublic regarding sepsis and theimportance of early detection.The Sepsis Alliance is the leadingsepsis organization in the UnitedStates working in all 50 states tosave lives and reduce sufferingfrom sepsis.

Sepsis is the body’s overwhelmingand life-threatening response toinfection that can lead to tissuedamage, organ failure, and death.

Some people are at higher risk ofdeveloping sepsis because theyare at higher risk of contractingan infection. These include thevery young, the very old, thosewith chronic illnesses, and thosewith a weakened or impairedimmune system. Approximately30% of patients diagnosed withsevere sepsis do not survive andup to 50% of survivors suffer frompost-sepsis syndrome. Earlydetection and treatment areessential to increase chances ofsurvival and to minimize disabilityfor those who survive.

In recognition of SEPTEMBERSEPSIS 2020 NJDOH will obtaina signed Governor’s proclamationdeclaring the month ofSeptember to be Sepsis AwarenessMonth.

NJDOH Participates in SEPTEMBER SEPSIS 2020

Summer 2020



www.sepsis.org






The Centers forDisease Controland Prevention

has developed a newcontinuing educationprogram entitled “HowNurses and MedicalAssistants Can FosterSupport for Vaccination inPediatric and FamilyPractices.” Researchshows that healthcareprofessionals are themost trusted source ofinformation for parentswhen it comes tovaccines for their child.Nurses and medicalassistants have a key roleto play in improvingvaccine acceptance andfostering a culture ofimmunization in thepractice as they are incontact with parentsthroughout the officevisit. The continuingeducation activityfeatures practicalstrategies to improve vaccinationrates in the practice, includinghow to deliver clear and concisevaccine recommendations andaddress parents’ frequently askedquestions. All practice staff,including non-clinical staff, have akey role to play in improving

vaccine acceptance. This module isavailable athttps://www2.cdc.gov/vaccines/ed/imz_practice/ce.asp. Continuingeducation credit will be availablethrough December 4, 2021.

Improving Vaccine AcceptanceSummer 2020

Get more information athttp://nj.gov/health/cd/handwashing.shtml.





https://www2.cdc.gov/vaccines/ed/imz_practice/ce.asp

https://www2.cdc.gov/vaccines/ed/imz_practice/ce.asp






Legionellis, continued from page 2Summer 2020

respiratory secretions, lung tissue,pleural fluid, or extrapulmonary siteby a validated nucleic acidamplification test (PCR)

• Culture: Isolation of any Legionellaorganism from lower respiratorysecretions, lung tissue, pleural fluid,or extrapulmonary site

• Urine: Detection of Legionellapneumophila serogroup 1 antigen inurine using validated reagents

• Serum: Fourfold or greater rise inspecific serum antibody titer toLegionella pneumophila serogroup 1using validated reagents

Preferred Diagnostic Tests Presently the majority (>95%) oflegionellosis cases are diagnosed byurinary antigen testing, which is specificfor Legionella pneumophila serogroup 1(Lp1) and may not detect otherLegionella pneumophila serogroups orLegionella species that also may causeillness. Therefore, it is stronglyencouraged that a culture on lowerrespiratory secretions be performed inconcert to allow for detection ofnon-Lp1 Legionella. However, culture forLegionella is a lengthy process, requiresspecialized media, has decreasedsensitivity when collected after antibiotictreatment has begun, and must beperformed by laboratorians trained inthe technique. As a supplement toculture, PCR can also detect non-Lp1Legionella, can be performed in far lesstime by most laboratorians, does notrequire specialized reagents, and is lessaffected by antibiotic use. Clinicallycompatible cases with detection ofLegionella species by a validated nucleicacid assay (PCR) will now be classified asconfirmed cases.

During outbreak investigations, localhealth departments may need torequest respiratory specimens to beforwarded to a public health laboratoryfor further characterization, such asLegionella culture and whole genomesequencing. Culture is useful forgenerating isolates that can be furthercompared to environmental isolates toconfirm an outbreak source. Theurinary antigen test and PCR test alonedo not allow for molecular comparisonof clinical to environmental isolates.

ResourcesFor more information regarding thelegionellosis case definition, please referto the Council of State and TerritorialLegionellosis Position Statementaccessible at: https://cdn.ymaws.com/www.cste.org/resource/resmgr/2019ps/final/19-ID-04_Legionellosis_final.pdf

For additional resources regardinglegionellosis, please visit the New JerseyDepartment of Health’s LegionellosisWebpage accessible at: https://www.nj.gov/health/cd/topics/legion.shtml

For any other questions or concernsregarding legionellosis, please contactKathleen Ross([email protected]) or RebeccaGreeley ([email protected])from the Communicable Disease Service.

1. A surveillance case definition is a set of uniform criteria used todefine a disease for public health surveillance. Surveillance casedefinitions enable public health officials to classify and countcases consistently across reporting jurisdictions. Surveillancecase definitions are not intended to be used by healthcareproviders for making a clinical diagnosis or determining how tomeet an individual patient’s health needs.

2. Clinical symptoms of pneumonia may vary but must includeacute onset of lower respiratory illness with fever and/or cough.Additional symptoms could include myalgia, shortness of breath,headache, malaise, chest discomfort, confusion, nausea,diarrhea, or abdominal pain.



https://cdn.ymaws.com/www.cste.org/resource/resmgr/2019ps/final/19-ID-04_Legionellosis_final.pdf

https://cdn.ymaws.com/www.cste.org/resource/resmgr/2019ps/final/19-ID-04_Legionellosis_final.pdf

https://www.nj.gov/health/cd/topics/legion.shtml

https://www.nj.gov/health/cd/topics/legion.shtml






Summer 2020

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