EPIDEMIOLOGY SURVEILLANCE REPORT - njlmn2.njlincs.net Updates_FP... · 2014 2015 Number of Reports Figure 1: CDRSS Reports of Select Enteric Diseases, Northeast Region January 2014

EPIDEMIOLOGY SURVEILLANCE REPORT

NORTHEAST REGIONSPRING 2015

Namitha ReddyRegional Coordinator/Epidemiologist

North/Central West RegionNJDOH/EEOH/CDS

Overview

• Purpose/Objectives• State and Regional Highlights• Select Disease Trends and Activity • Outbreak / Cluster Reporting• Investigations

Note: This report provides a snapshot of communicable disease activity in the Northeast region. Included in this report are data from the various surveillance systems utilized by the New Jersey Department of Health - Communicable Disease Service. It is intended for use by Public Health Officials and is not intended for public distribution. All data are provisional and are subject to change.

Purpose/ObjectivesPurpose• To provide relevant information and updates to public

health partners on communicable disease activity and trends within their public health region

Objectives• Provide relevant state and regional highlights• Provide an overview of communicable disease activity • Describe quarterly trends in select communicable

diseases • Highlight interesting and/or notable outbreaks/clusters

and/or investigations

STATE AND REGIONAL HIGHLIGHTS

NORTHEAST REGION

State and Regional HighlightsEbola

Enhanced entry screening for Ebola symptoms and risk factors began at Newark Liberty airport (EWR)on October 16.Individuals who traveled from or through Guinea, Liberia, and Sierra Leone are screened at 5 US airports and followed up by public health authorities based on their risk assessment and or symptom presentation.

As of April 15, 2015 NJDOH in conjunction with local public health has successfully monitored over 600 individuals across 18 counties.

Outbreak Control Guidance for Camp settings

NJDOH has posted new guidance for controlling outbreaks in camp settings.http://www.nj.gov/health/cd/find.shtml#O (Outbreaks – Camp)

State and Regional Highlights

Clusters/outbreaks to date 2015:

• 5 multistate clusters of Salmonellosis

• 1 local outbreak of Salmonellosis associated with a restaurant

• 2 local Norovirus/suspect Norovirus outbreaks associated with restaurants

SELECT DISEASE ACTIVITY/TRENDS

NORTHEAST REGION

Select Enteric Diseases

0

10

20

30

40

50

60

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014 2015

Num

ber o

f Rep

orts

Figure 1: CDRSS Reports of Select Enteric Diseases, Northeast RegionJanuary 2014 ‐March 2015

CAMPYLOBACTERIOSIS GIARDIASIS SALMONELLOSIS ‐ NON TYPHOID SHIGA TOXIN‐PRODUCING E.COLI (STEC) SHIGELLOSIS

050

100150200250300

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014 2015

Num

ber o

f Rep

orts

Figure 1: CDRSS Reports of Select Enteric Diseases, New JerseyJanuary 2014 ‐March 2015

CAMPYLOBACTERIOSIS GIARDIASIS SALMONELLOSIS ‐ NON TYPHOID SHIGA TOXIN‐PRODUCING E.COLI (STEC) SHIGELLOSIS

Select Vaccine Preventable Diseases

0

10

20

30

40

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014 2015

Num

ber o

f Rep

orts

Figure 2. CDRSS Select Reports of Vaccine Preventable Diseases New JerseyJanuary 2014‐March 2015

HAEMOPHILUS INFLUENZAE MEASLES MENINGOCOCCAL DISEASE  (NEISSERIA MENINGITIDIS) MUMPS

0

5

10

15

20

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014 2015

Num

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f Rep

orts

Figure 2. CDRSS Select Reports of Vaccine Preventable Diseases Northeast RegionJanuary 2014‐March 2015

HAEMOPHILUS INFLUENZAE MEASLES MENINGOCOCCAL DISEASE  (NEISSERIA MENINGITIDIS) MUMPS

State/Regional TrendsRabies: Statewide

Region Raccoon Skunk Cat Total

South 16 2 18

Central East 10 10

Central West 5 1 6

Northeast 3 1 4

Northwest 9 1 1 11

TOTAL 43 4 2 49

0

3

6

9

12

15

18

RaccoonSkunkCat

State/Regional TrendsRabies: Northeast region

Region County Raccoon Skunk Cat Total

Northeast

Bergen 2 2

Essex 1 1 2

Hudson 0 0

1

2

3

Bergen Essex Hudson

RaccoonSkunkCat

State/Regional Trends

Includes total number of reports entered into the Communicable Disease Reporting and Surveillance System (CDRSS) each month for select diseases. Excludes merged and deleted reports. Includes all case statuses (i.e. CONFIRMED, PROBABLE, POSSIBLE, REPORT UNDER INVESTIGATION (RUI), NOT A CASE). Data reflect the reporting burden of disease and does not reflect the number of cases that are confirmed.

Legionellosis

OUTBREAKS/CLUSTERSNORTHEAST REGION

Outbreak/Cluster Type

Thirty two(32) outbreaks were reported this quarter in the Northeast region

Most outbreaks (43%) were influenza followed by GI related (27%) and respiratory outbreaks (17%)

Gastroenteritis27%

Hepatitis C6%

Influenza43%

Influenza‐like illness

7%

Respiratory17%

Outbreak/Cluster TypeNortheast Region, 1st quarter 2015

Outbreak/Cluster Setting

Thirty two (32) outbreaks were reported this quarter in the Northeast region

Most outbreaks (72%) occurred in long-term care settings followed by school/university settings (19%) Healthcare 

facility other than hospital or oncology facility6%

Hospital3%

Long‐term care facility

72%

School or university

19%

Outbreak/Cluster SettingNortheast Region, 1st quarter, 2015

CASE INVESTIGATIONNORTHEAST REGION

Case Investigation3/4 AM• Call from LHD about a suspect case of meningococcal disease. • Additional information requested (clinical information including symptom onset and

lab test information), exposures 10 days before symptom onset.

3/4 PM Clinical picture:• Patient reported headache for about 15 days prior (about 02/16)

• 2/28 developed fever 100.6, nausea, vomiting.

• Sought care at ED twice on 2/28 and 3/1 – Dx viral infection. No medications prescribed. Tylenol recommended.

• 3/2 : fever spiked to 103, developed altered mental status and a purpuric and petechial rash located on the legs and soles of the feet.

– Admitted to hospital and treated with Ceftriaxone

Lab tests and results: • 3/3: LP:

– Low glucose, elevated proteins, was cloudy in appearance, elevated RBC’s and WBC’s. – Gram stain and cultures had no growth (previously treated with Ceftriaxone)

Initial Assessment?

Case Investigation Contd.Cerebrospinal Fluid Analysis Findings

CSF Characteristic Normal Range Suggestive of Bacterial Meningitis

Suggestive of Viral Meningitis

Color Clear Cloudy Cloudy

Red blood cell count None None None

Gram stain Negative Usually Positive Usually Negative (60%-90%)

Pressure Less than 200 mm H2O Above normal Normal

Protein 15-45 mg/dL Above normal Above normal

Glucose 50-75 mg/dL Below normal Usually normal or below normal

Lymphocytic pleocytosis

None Positive with neutrophilicpleocytosis

Positive with lymphocytic pleocytosis

Case Investigation Contd.3/4Assessment:• Labs indicate bacterial meningitis but unknown if Neisseria

meningitidis. Recommendation:• Proceed as if it was Neisseria meningitidis and determine any and

all activities/close contacts for the 10 days prior to illness onset– Family, friends, school

• Identify close contacts at the hospital and advise prophylaxis– 6 contacts identified and Prophylaxed

3/5• NJDOH and school were closed due to inclement weather• Close family contacts identified and advised prophylaxis by LHD

Case Investigation Contd.3/6• LHD contacted school superintendent, principal and school nurse

• Child expired

• School reported that the child did not attend school during infectious period

• School sent letter to parents informing of the passing away one of their students after experiencing flu-like symptoms. School advised that parents contact a doctor if someone exhibits symptoms

3/7-3/8 (weekend)• Additional family members identified/received prophylaxis• Lab results (from tests done on 03/03): CSF negative for

Haemophilus influenzae Ag, Streptococcus pneumoniae Ag, GBS Ag

Case Investigation Contd.3/9 AM• Requested CSF to be shipped to NJPHEL for

additional testing• Star Ledger reports two student deaths at a school

– LHD determined the death of the other child was unrelated• The school reported to LHD that the child was out of

school for 10 days due to flu-like illness– Last day in school was 2/23 / absent all other days while

infectious– School nurse had clinically evaluated every student in the

classroom and all were free of ILI symptoms so no recommendation or public health action had been taken

Case Investigation Contd.3/09 PM:• Conflicting information received at NJDOH that the child was in school

before onset • LHD asked to obtain attendance record from school• Community meeting scheduled for 3/10

3/10:

• CSF specimen received at NJPHEL for shipping to CDC Meningitis Laboratory on 3/11

• Attendance record from the school indicated that the child had been in school during the infectious period

– Onset date was 2/28 and the infectious period was 2/18-3/3

• Community meeting held with school and LHD– News reports have confusing messages (e.g., viral meningitis diagnosis, screening for

students of the school)

Case Investigation Contd.Follow-Up Plan:• Conduct contact investigation at the school• Guidance on identification and prophylaxis of close

contacts • LHD set up PEP clinic for close contacts on 3/12 and

3/13

Outcome:• 20 students and 1 teacher from the school given PEP; 4

parents refused PEP• 3/16: Lab results from CDC was PCR negative for H. flu,

S. pneumo, and N. meningitis• 3/23: PHEL lab result for Influenza is negative

Case Investigation Contd.Post Investigation Assessment

What worked well:• LHD follow-up and investigation• Investigation coordination with NJDOH

Challenges:• Sensitive situation• Incorrect information• Conflicting messages• Media involvement

Questions?