Vol XXVI Issue No. 2 Winter 2009 Changes in the 2009 S.C. List of Reportable Conditions Julie Schlegel, MSP, Foodborne Epidemiologist Chasisity Springs, MSPH, Influenza Epidemiologist Division of Acute Disease Epidemiology Division of Acute Disease Epidemiology As authorized by South Carolina Statute #44-20- New for 2009: 10 and Regulation #61-20, DHEC updates the list • Influenza deaths (pediatric and adults.) of Reportable Conditions in January of each year. Revisions to the List of Reportable Revisions to the list of reportable conditions are Conditions: based on many factors, including: 1) the need for DHEC to conduct surveillance on new conditions or • Haemophilus influenzae, non-type b, has to increase surveillance on certain existing been changed to “Haemophilus influenzae, conditions in order to protect the health of the all types,” and has been moved to Urgently public and 2) changes in reporting requirements Reportable within 24 hours by phone. from the U.S. Centers for Disease Control and • Influenza, pediatric deaths-age < 17 years Prevention (CDC). has been changed to “influenza, deaths The following revisions have been made to the (pediatric and adults; lab confirmed only: 2008 List of Reportable Conditions: (Continued on page 2) INSIDE THIS ISSUE Ask Epi: Prevention and Treatment of Influenza during Changes in the 2009 SC List of Pregnancy Reportable Conditions Page 1 Prevention and Treatment of Influenza Eric Brenner, MD, Medical Epidemiologist during Pregnancy Page 1 Division of Acute Disease Epidemiology Varicella Reporting Page 2 1. What are guidelines for use of influenza vaccine in H. Flu Reporting Page 2 pregnancy in the upcoming flu season? Reportable Disease Charts/Card for 2009 Pages 3-6 Vaccination with trivalent inactivated influenza vaccine • 2009 Disease Report Card (TIV , or “the flu shot”) is now recommended by the US • 2009 List of Reportable Conditions Public Health Service Advisory Committee on Immunization • 2009 Lab List of Reportable Practices (ACIP) for all women who will be pregnant during Conditions (1) the influenza season (October through mid-May). • 2009 Reporting Guidelines and This recommendation is supported by other national organizations Contacts including the American College of Obstetricians and Gynecologists Vibrio Spotlight Page 7 (ACOG). (2) Table 1 (see page 8) provides historical perspective Flu Season Update Page 10 on the evolution of national recommendations over the past two Reporting with CHESS Page 12 decades which has led to current broad guideline for use of TIV in Public Health Clinical Liaisons Page 13 pregnancy. By the Numbers Page 14 Lab List Review Page 15 (Continued on page 8) www.scdhec.gov/health/disease/ Page 2 Winter 2009 Epi Notes Changes in Varicella Reporting for 2009 Marya Barker, MPH, Epidemiologist Division of Acute Disease Epidemiology The 2009 S.C. reporting requirements for varicella common setting such as school, childcare or will change slightly. other institutional setting. Rather than requiring that all cases of varicella be As of November 14, 2008, 763 cases of varicella reportable by name, DHEC will require had been reported, year to date, to DHEC. reporting of cases by name only in the event Previous years’ case counts have been similar. of outbreaks, hospitalizations and deaths. The majority of these cases were expected and Sporadic cases of varicella will not be sporadic cases in previously immunized children reportable to DHEC. and no public health intervention was necessary. Narrowing the criteria for varicella cases to be For the purposes of disease reporting, an reported will allow public health officials to reserve outbreak of varicella is defined as five or efforts for unusual events that deserve further more cases occurring within six weeks in a scrutiny and save time for busy providers. Changes in Reporting for Haemophilus influenzae for 2009 Marya Barker, MPH, Epidemiologist Division of Acute Disease Epidemiology For 2009, DHEC has combined the reporting testing indicated only a positive H. flu result. This for all types of Haemophilus influenzae (H. additional time interval between onset of disease flu), invasive disease into the “Urgently and initiation of public health response made the Reportable within 24 Hours” category. timely prophylaxis of contacts difficult and delayed or prevented the isolate from being sent to the In previous years, DHEC had required immediate DHEC Bureau of Labs for serotyping. reporting of H. flu, type b, while non-type b disease was reportable within seven days. The We hope that moving all types of H. flu into one primary reason for this change is to reduce reporting category will make reporting of H. flu confusion about reporting requirements for private easier and faster. As in the past, all Haemophilus providers and laboratorians. influenzae isolates are required to be sent to the DHEC Bureau of Labs for serotyping. These data In addition, because most private labs in South are critical not only for the treatment of the Carolina do not perform serotyping of H. flu patient but also for controlling the potential for isolates, providers often waited seven days to spread of Hib and for chronicling the changing report positive H. flu tests because the laboratory epidemiology of Haemophilus influenzae. Changes in the 2009 SC List of Reportable Conditions (Continued from page 1) Legionellosis. e.g. culture, rapid test, PCR or autopsy • Varicella death has been combined with results consistent with influenza.)” varicella and is listed as “varicella • Lead poisoning has been clarified as “lead (outbreaks and individual cases resulting in poisoning (elevated blood lead levels, all death or hospitalization.)” ages.)” • Footnote (5) has been updated to clarify • Lead tests, all, has been changed to “lead elevated lead levels. tests, all (age < 6).” • One new footnote has been added: (6) • Legionellosis isolates are now requested; defines an outbreak of varicella. footnote (7) has been added to (Continued on page 3) Epi Notes Winter 2009 Page 3 Changes in the 2009 SC List of Reportable Conditions (Continued from page 2) Revisions to the Disease Reporting Card: • Under “how to report”, 1. immediately • Several sections have been revised to reportable conditions, hours have been include an option for “Unk.” These include changed to 8:30 AM-5 PM. ethnicity, pregnant, patient status, Under “how to report”, 4. HIV and AIDS, “or symptoms for Lyme or RMSF rash and STD submit electronically via DHEC’s electronic reporting for treated patients. reporting system (call 1-800-917-2093 to • Specimen type has been changed to learn more)” has been added. “specimen source (blood, stool, etc.).” Revisions to the Laboratory Reporting List: The above changes may be found: • Haemophilus influenzae, non-type b, has • On the DHEC Web site at: been changed to “Haemophilus influenzae, http://www.scdhec.gov/ all types, and has been moved to Urgently http://www.scdhec.gov/health/ Reportable within 24 hours by phone.” http://www.scdhec.gov/health/disease/ • Francisella tularensis has been moved to index.htm Urgently Reportable within 24 hours by phone. • On the 2009 DHEC Disease Reporting Card (color is green for 2009.) • Lead tests, all other, has been changed to “lead tests, all results (ages <6).” • On the 2009 List of Reportable Conditions poster. • Serum lead levels has been changed to lead poisoning. Both the Disease Reporting Cards and the laminated Reportable Disease posters (sizes 8½ x • Footnote (5) has been updated to clarify 11 inches and 12 x 24 inches) are available from elevated lead levels. the DHEC regional public health departments or from the DHEC Division of Acute Disease Epidemiology in Columbia. 2009 DHEC Disease Reporting Card (DHEC 1129 card) Page 4 Winter 2009 Epi Notes S.C. 2009 List of Reportable Conditions Attention: Health Care Facilities, Physicians, and Laboratories South Carolina Law §44-29- 10 and Regulation §61-20 require reporting of conditions on this list to the local public health d epartment South Carolina Law §44-53-1380 requires reporting by laboratories of all blood lead values in children under 6 years of age HIPAA: Federal HIPAA legi51;lIion allows disclosure 01 p rotected health informat ion. without consent of the individual. to public he311h authorities 10 collect and receive such information lor the purpose of prev enting or controlling disease. (HIPAA 45 CFR §164.512) IMMEDIATELY REPORTABLE BY PHONE All suspected and confirmed cases, including AIDS (2) preliminary clinical and laboratory results Campylobacteriosis Chancroid "'i- Any outbrMk. unu.UfII cI_. or elu'" of ~ (1. Chlamyd ia trachomatis. genital site (L) + Any poIIMrt., bIoIogl~1, m.mlclll or fINforI.t ewont (Inducing Creutzfeldt-Jakob Disease (Age < 55 years) npoMII'M to toxin. such .. ricin, Cryptosporidiosis Animal (mammal) bites Cyclosporiasis Anthrax (7) Ehrlichiosis I Anaplasmosis Botulism Giardiasis Foodborne outbreak - unusual cluster Gonorrhea Innuenza A . Avian or Novel (Not Hl or H3) Hepatitis B. chronic Measles (rubeola) Hepatitis B Surface Antigen + (H BsAg +) with each pregnancy Meningococcal disease (7) (9) Hepatitis C. D. E ,y, Plague (1) HIV-l or HIV·2 infection (2) Poliomyelitis. Paralytic and Nonparalytic HIV CD4 co recepto r (L) SARS - Se vere Acute Respiratory Syndrome (7) HIV CD4 T-Iymphocyte countJpercentage - all results (L) (2) ,y, Smallpox HIV viral load - all results (L) (2) ,., Viral Hemorrhagic Fever HIV HLA-B5701 (L) HIV subtype. genotype, and phenotype (L) Influenza. positive rapid nu test (M) Influenza. positive virus culture isolates (L) Influenza. deaths (pediatric & adult: lab confirmed only: e.g. culture. rapid test. PCR or autopsy results consistent with influenza) Lead poisoning (elevated blood lead levels, all ages) (5) Artloviral Neuroinvasive & Non-Neuroinvasive Disease (acute Lead tests. all (age <6) (L ) in'ection . acute flaccid paralysis, or atypical Guillain-Barre Legionellosis (1) Syndrome): East ern Equine Encephalitis. LaCros se. SI. Louis Leprosy (Hansen's Disease) Encephalitis, West Nile Vi rus (7) Leptospirosis '" Bru,,".", FI Listeriosis (1) Diphtheria (1) Lyme disease Dengue Lymphogranuloma venereum E. coli. shiga toxin - producing (STEC) (7) Malaria E.