Reportable Disease Update

Local Health Department Nurses Meeting

June 20, 2013

T.J. Sugg, MPH

ObjectivesDiscuss Middle East Respiratory Syndrome

Coronavirus (MERS CoV)Describe current clusters of Salmonella and

explain investigation and reporting criteriaDescribe current cases of STEC (Shiga toxin-

producing E. coli) and explain investigation and reporting criteria

Discuss Campylobacter activity and laboratory testing

Discuss enteric disease investigation guidelines

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)Novel coronavirus

that emerged in 2012

Causes severe acute respiratory illness

First cluster of 2 cases occurred near Amman, Jordan April 2012

MERS-CoV SymptomsSevere acute respiratory illness:

FeverCoughShortness of breath

Illness onsets were from April 2012 through June 2013

Some cases have had atypical presentations:Initially presented with abdominal pain and

diarrhea and later developed respiratory complications

MERS-CoV TransmissionAirborneIncubation period is 10-14 daysThe following have been observed:

Transmission between close contactsTransmission from infected patients to healthcare

personnelEight clusters of illnesses have been reported by

six countriesSo far, all cases have a direct or indirect link to

one of four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates

MERS-CoV CasesMERS Cases and Deaths, April 2012 - Present

Countries Cases (Deaths)

France 2 (1)

Italy 3 (0)

Jordan 2 (2)

Qatar 2 (0)

Saudi Arabia 49 (32)

Tunisia 2 (0)

United Kingdom (UK) 3 (2)

United Arab Emirates (UAE)

1 (1)

Total 64 (38) = 59% MR

Median Age = 56

All patients were aged ≥ 24 yrs except for a 2yo and a 14yo

Number of confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (N = 55) reported as of June 7, 2013, to the World Health Organization, by month of illness onset — worldwide, 2012–2013

MMWR. June 14, 2013 / 62(23);480-483

Confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (N =55) reported as of June 7, 2013, to the World Health Organization, and history of travel from the Arabian Peninsula or neighboring countries within 14 days of illness onset — worldwide, 2012–2013

MMWR. June 14, 2013 / 62(23);480-483

Patient Under Investigation (PUI)Any PUI should be reported to state and local

health departments immediatelyPUI Criteria:

1. Acute respiratory infection, may include fever ≥ 100.4°F and cough

2. Suspicion of pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence

3. History of travel to the Arabian Peninsula or neighboring countries within 14 days

4. Symptoms not already explained by any other infection or etiology

Patient Under Investigation (PUI)The following persons may be considered for

evaluation of MERS-CoV:Persons who develop severe acute lower respiratory

illness of known etiology within 14 days after traveling from the Arabian Peninsula or neighboring countries, but who do not respond to appropriate therapy

ORPersons who develop severe acute lower respiratory

illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 14 days of traveling from the Arabian Peninsula or neighboring countries

Close ContactAny person who provided care for the

patient, including a healthcare worker or family member, or had similarly close physical contact

Any person who stayed at the same place (lived with, visited) as the patient while the patient was ill

Recommendations for PUIAll clusters of severe acute respiratory illness

(SARI) should be investigated. If no obvious etiology is identified, local public health officials should be notified and testing for MERS-CoV conducted if indicated

Local health departments should notify DPH immediately of SARI clusters and PUIs

Local health departments should collect data on the PUI using the form available at: http://www.cdc.gov/coronavirus/mers/guidance.html and fax to RDS secure fax 502-696-3803

Probable Case DefinitionA probable case is any person who:

Meets PUI criteria and has clinical, radiological, or histopathological evidence of pneumonia or ARDS, but no possibility of lab confirmation exists, either because patient or samples are unavailable or no testing available for other respiratory infections, AND

Is a close contact with a laboratory confirmed case, AND

Has illness not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia

OR any person with:SARI with no known etiology, ANDAn epidemiologic link to a confirmed MERS case

Confirmed Case Definition A confirmed case is any person with

laboratory confirmation of infection with MERS-CoV (PCR)

Infection Control RecommendationsStandard, contact, and airborne precautions

are recommended for management of hospitalized patients with known or suspected MERS-CoV infection.Airborne Infection Isolation Room (AIIR)

If unavailable, transport to another facility Place facemask on patient and isolate in a single-

patient room with door closed. Air should not recirculate without HEPA filtration

Collection of Laboratory SpecimensDetermine if patient meets PUI criteriaCollect:

An upper respiratory specimen: Nasopharyngeal AND oropharyngeal swab

A lower respiratory specimen: Broncheoalveolar lavage, OR Tracheal aspirate, OR Pleural fluid, OR Sputum

Serum for eventual antibody testing (tiger top tube) Should be collected during acute phase during first week

after onset, and again during convalescence ≥ 3 weeks later

MERS ResourcesMERS overview:

http://www.cdc.gov/coronavirus/mers/index.html

Case definitions and guidance: http://www.cdc.gov/coronavirus/mers/case-def.html

Additional MERS resources: http://www.cdc.gov/coronavirus/mers/related-materials.html

Salmonellosis Clusters

Salmonellosis Epi Curve

Salmonellosis InvestigationComplete the Enteric Disease Investigation Form

for each case of Salmonella, regardless of specimen type.

Enter the data into NEDSSFood and beverage form will be added to NEDSS

production soon.Currently investigating 2 major clusters:

S. enteritidis JEGX01.0004 (24 KY cases) S. enteritidis JEGX01.0005 (10 KY cases)

Until the food and beverage form is in NEDSS, DPH will request a faxed copy if, and only if, a Salmonellosis case is identified as being from one of these clusters.

Shiga Toxin-Producing E. coli Investigation

STEC Epi Curve

STEC InvestigationComplete the Enteric Disease Investigation

Form for each case of STEC, regardless of specimen type.

Enter the data into NEDSSFood and beverage form will be added to

NEDSS production soon.Notify DPH immediately of any case of HUS

Campylobacter Investigation

Campylobacter Epi Curve

Campylobacter InvestigationComplete the Enteric Disease Investigation

Form for each case of CampylobacteriosisEnter the data into NEDSS for all suspect,

probable, and confirmed casesFood and beverage form will be added to

NEDSS production soon.Work with local laboratories to ensure

isolates are sent to DLS

Enteric Disease Investigation Guidelines

Enteric Disease Investigation GuidelinesEnteric season has begunSee email distributed by Stacy Davidson,

DPH Nurse Consultant, regarding:Investigation and reporting of all enteric

pathogensCommunity mitigation guidelines.

Questions?

Thank you!!