Department of Health s4

Department of Health FY12 Oversight Questions

Q9: Response

During FY12 and to-date in FY13, the Division of Epidemiology- Disease Surveillance and Investigation (DE-DSI), in the Center for Policy, Planning and Evaluation (CPPE) has made great strides in continuing and improving communicable disease surveillance in the District. DE-DSI activities include: Bioterrorism Surveillance, Seasonal Influenza Surveillance, Healthcare Associated Infections (HAIs), Surveillance and Investigation of Reportable Diseases (excluding HIV/AIDS, Hepatitis, STDs, and Tuberculosis), Investigation and Control of Outbreaks, and Surveillance and Investigation of Foodborne-related Illnesses and other conditions of public health importance. DE-DSI collects, analyzes, interprets and disseminates data, and provides expertise and information on disease management. Reports of disease are received from various sources including, but not limited to: commercial and hospital laboratories, hospital infection control practitioners, primary care providers, and school nurses. Reported cases are investigated and in some instances specimens are collected for laboratory analysis. Epidemiological data are monitored routinely to detect changes in disease occurrence and identify possible outbreaks. When relevant, DE-DSI consults and collaborates with the United States Food and Drug Administration (FDA), the United States Department of Agriculture (USDA) and the Centers for Disease Control and Prevention (CDC) in investigating local and multi-state outbreaks. DE-DSI works with HEPRA and the DOH Public Information Officer to disseminate information to providers, hospitals and the public.

During FY12, DE-DSI received 2,263 case reports. During FY13, to date, DE-DSI has received 569 case reports. During FY12, DE-DSI investigated 28 potential outbreaks and clusters (Table 1). In FY 2013, to date, DE-DSI has investigated 3 potential outbreaks (Table 2).

In order to accomplish effective surveillance and mitigation, DE-DSI strongly collaborates with other DC government administrations. In regard to West Nile Virus surveillance, a strong collaboration exists between DE-DSI, the Health Regulation and Licensing Administration (HRLA) and the DC Public Health Laboratory (DC PHL). Additionally, Influenza surveillance is accomplished through collaboration between DE- DSI and the DC PHL. For Foodborne Illness, DE-DSI collaborates with the Food Safety Division within HRLA. For example, in preparation for the 57th Presidential Inauguration, DE-DSI joined Food Safety in foodborne illness prevention activities including food sample collection and kitchen inspections at the Inaugural balls. Further, DE-DSI epidemiologists participated in the creation of the first Foodborne Illness Response Strike team; the mission of this team was to investigate and respond to any suspected accidental or intentional foodborne outbreak during the official events associated with the 57th Presidential Inauguration. Participants of this team included the Virginia Department of Health, the DC Department of Health, the USDA Food Safety and Inspection Service (FSIS), the United States Army, and the CDC. DE-DSI actively collaborates in Bioterrorism agent surveillance through the ESSENCE Enhanced Surveillance Operating Group (ESOG); this group is comprised of public health stakeholders from the entire National Capital Region (NCR), including state level and Department of Health FY12 Oversight Questions

local public health practitioners from the District, Maryland and Virginia, as well as the John’s Hopkins University Applied Physics Laboratory (JHU/APL). Members of the ESOG assisted DOH in syndromic surveillance monitoring and reporting for the 57th Presidential Inauguration.

Effective surveillance in the District by DE-DSI requires the use of the NEDSS Base System, used for sentinel surveillance, as well as the ESSENCE syndromic surveillance system. During FY12, DE-DSI upgraded the system by six versions to ensure optimal use of its capabilities. Additionally, DE-DSI also upgraded the ESSENCE system by 13 versions and through PHEP funds was able to secure new servers with the capacity to hold the data.

Table 1: Reported Disease Outbreaks in the District of Columbia, FY 2012 (Updated February 11, 2013)

Outbreak Dates of # Probable # Lab- Cause of Disease Setting/Event Outbreak Cases Confirmed (first case- Cases last case) Salmonella Bovismorbificans August – 0 23 Salmonella November, Bovismorbificans 2011 Pneumonia Cluster at GWU July 19, 0 49 Unknown 2011 – December 8, 2011 Kirov Ballet Academy GI November 32 0 Unknown Cluster 14-18, 2011 Norovirus at Chevy Chase December 46 3 Norovirus House 8, 2011 – December 21, 2011 Elsie Whitlow Stokes GI December 18 0 Unknown cluster 13 -14, 2011 Norovirus at Washington January 3, 101 5 Norovirus Hospital Center 2012 – January 30, 2012 Norovirus at Carroll Manor January 13, 23 4 Norovirus 2012 – February 2, 2012 Department of Health FY12 Oversight Questions

Outbreak Dates of # Lab- Setting/Event Outbreak # Probable Confirmed Cause of Disease (first case- Cases Cases last case) Norovirus at Georgetown January 20, Retirement Community 2012 – 34 4 Norovirus January 30, 2012 Howard University Hospital Child January 24, 6 0 Unknown Development Center GI Cluster 2012 Norovirus at Latin PCS January 22, 2012 – 46 0 Unknown February 9, 2012 Ingleside at Rock Creek GI February 4- 8 0 Unknown Outbreak 5, 2012 GWU Norovirus February 7, 2012 – 136 5 Norovirus March 28, 2012 Trichinosis Cluster January 24 – February 0 3 Trichinosis 15, 2012 Friendship Southeast Elementary February 15 10 0 Unknown Academy GI Cluster -16, 2012 Norovirus at Stoddert Baptist February Nursing Home 13, 2012 – 46 8 Norovirus February 21, 2012 GI Cluster at Janney ES February 16 16 0 Unknown -17, 2012 Georgetown Norovirus Cluster January 12, 2012 – 0 9 Norovirus February 25, 2012 February Arts and Technology Academy GI 9 0 Unknown Cluster 23-28, 2012 Norovirus Outbreak At Howard February University 22, 2012 – 57 5 Norovirus February 26, 2012 Friendship Collegiate Academy February 17 0 Unknown PCS GI Cluster 28, 2012 Department of Health FY12 Oversight Questions

Outbreak Dates of # Lab- Setting/Event Outbreak # Probable Confirmed Cause of Disease (first case- Cases Cases last case) Walker Jones Education February 28 Campus GI Cluster – March 7, 36 0 Unknown 2012 Calvert County Residents MRSA/Influenza Respiratory Illness Cluster- March 2012 co-infection Assisted Maryland DOH Salmonella Bareilly National Salmonella Cluster- Assisted CDC Bareilly GAP Community Childcare May 6, Hand, Food and Center- Hand Food and mouth 2012 – May 21 0 Mouth Disease Disease 20, 2012 Hostelling International GI May 16, 4 0 Unknown Outbreak 2012 Stoddert Baptist Nursing May 27 – Home Respiratory Cluster June 18, 13 0 Unknown 2012 George Mason University Norovirus Norovirus - Assisted VA DOH Listeria Multi-state Outbreak March – Listeria October, 22 monocytogenes 2012 Ballou Senior High School - September 11 Unknown Vomiting 24, 2012

Table 2: Reported Disease Outbreaks in the District of Columbia, FY 2013 (Updated February 11, 2013)

Outbreak Dates of # Lab- Setting/Event Outbreak # Probable Confirmed Cause of Disease (first case- Cases Cases last case) Takoma Education Campus GI October 19 11 Cluster - 24, 2012 CDC Multi-state Salmonella Outbreak Related to Turtles - 5/23/2011 Salmonella CDC Ongoing Investigation Norovirus at Sibley Hospital 12/11/2012 1 4 Norovirus