Michigan Communicable Disease Outbreak Surveillance and Investigation Regional Epidemiology Unit (REU), Michigan Department of Health and Human Services Wenwen Jiang; Tiffany Henderson Created in 2001, the REU’s core functions and services including: • Disease surveillance • Support to local public health • Regional bioterrorism planning • Data analysis, material distribution • Local epidemiology activities Regional Epidemiology Unit To develop a manual to systematically summarize roles of MDHHS in response to communicable disease (CD) outbreaks. The manual should cover each process of an epidemiological investigation. A CD is an illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal or inanimate reservoir to a susceptible host. Internship Objective The manual clarified roles and responsibilities of the MDHHS in initiatives to multilevel communicable disease outbreaks. Specific response to health threats with emerging / re-emerging diseases and bioterrorism components were also specified. • Weekly Lab-Epi teleconferences • Epi and Surveillance Workgroups • CDC Morbidity and Mortality Weekly Report (MMWR) Review • 16th Annual Michigan Communicable Disease Conference • Shadowing the Ingham County Health Department • District 1 Regional Medical Response Coalition Meeting Internship Highlights • Verify the diagnosis to the initial notification of an outbreak. • Develop a surveillance case definition specific to the outbreak. • Make a working hypothesis on risk factors for the infection. • Find additional cases by enhancing surveillance and follow-up commonly exposed cohorts. • Interrupt the transmission or reduce exposure. Outbreak Confirmation Diagnosis Verification Environmental Assessment Epidemiologica l Investigation Prevention and Control Communicatio n and report • The members of MDHHS Regional Epidemiology Unit and the Surveillance and Infectious Disease (SIDE) Section • The Certificate in Healthcare Infection Control (CHIP) program at the University of Michigan School of Public Health Acknowledgement https://www26.state.nj.us/doh-shad/indicator/CatInfec.html • Michigan Disease Surveillance System (MDSS) Use national data standards. Alerts can be set to notify epidemiologists when specific single case or cluster notification are submitted. • Michigan Syndromic Surveillance System (MSSS) Emergency and urgent care submit pre-diagnostic data of nonspecific health indicators. MSSS sends syndromic alerts to the MDHHS. • Laboratory-based Surveillance • Compliant-based Surveillance Self-reported illness calls from citizens will be re-directly referred to the local health department where the individual resides Disease Surveillance www.michigan.gov/cdinfo www.michigan.gov/mdss 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 2007 2008 2009 2010 2011 2012 Number MDSS System Use Statistics Referrals Individual Case Reports Transactions 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 2006 2007 2008 2009 2010 2011 2012 Number of Electronic Lab Reports MDSS Electronic Messaging Quest Diagnostic – Auburn Hills Sparrow Labs LabCorp Mayo Labs Hurley Hospital Lab Garcia Labs ARUP Labs DMC Labs MDCH Labs 2009-2013 Michigan Tuberculosis Epidemiologic Trends Report, MDHHS Annual Michigan HIV Surveillance Report New Diagnoses and Prevalence (2015), MDHHS https://www.mailman.columbia.edu/become-student/departments/epidemiology Outbreak Response