Virginia Department of Health Office of Epidemiology Susan Fischer Davis, M'D' Deputy Director Novem - PowerPoint PPT Presentation

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Virginia Department of Health Office of Epidemiology Susan Fischer Davis, M'D' Deputy Director Novem

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Title: Virginia Department of Health Office of Epidemiology Susan Fischer Davis, M'D' Deputy Director Novem


1
Virginia Department of HealthOffice of
EpidemiologySusan Fischer Davis, M.D.Deputy
DirectorNovember 1, 2006
2
Office of EpidemiologyObjectives of Talk
  • Describe organizational structure
  • Discuss Strategic Plan
  • Describe each division within office
  • Give example(s) of division activity
  • Present overview of E.coli 0157H7 and spinach
    outbreak in VA and U.S.

3
Virginia Department of HealthMission
  • To achieve and maintain optimum personal and
    community health by emphasizing health promotion,
    disease prevention, emergency preparedness, and
    environmental protection.

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6
VDH Strategic Plan
  • 2003 GA enacted legislation requiring each state
    agency to develop a Strategic Plan
  • Identified 42 service area plans
  • Divisions within Office of Epidemiology
    activities equate to a number of the service area
    plans
  • For each division, plan describes activities
    (e.g., surveillance), products (e.g., reports),
    statutory authority, and performance measures
    (e.g., decrease in HIV infection rate)

7
Major Activities Division of Surveillance and
Investigation
  • Surveillance for diseases reportable to VDH as
    required by the Code of Virginia
  • Disease control (meningococcal infection)
  • Disease policy development
  • Outbreak investigations (E. coli 0157H7)
  • Emergency preparedness and response

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Major ActivitiesDivision of Disease Prevention
  • Surveillance, investigation, prevention, and
    control of
  • STDs (chlamydia, gonorrhea, syphilis)
  • HIV/AIDS
  • Tuberculosis
  • Pharmacy services
  • Treatment/medication for individuals without
    access to care

10
VDH 35 Local Health Districts
11
Vignette Division of Disease Prevention
  • The Suffolk Health Department (SHD) is working
    with the VDH Virginia Epidemiology Response Team
    (VERT) to address the rise in syphilis infections
    in Suffolk. Syphilis is being seen in both men
    and women. In addition, syphilis can be passed
    on from pregnant women to their unborn children,
    who are at risk of developing congenital
    syphilis. Congenital syphilis can result in
    blindness or death of a baby. VDH deployed VERT
    to assist the SHD in conducting community
    syphilis screening and partner notification. The
    team also is responsible for heightening
    awareness and education in the local community
    about risk factors for syphilis.

12
Major Activities/ProgramsDivision of Immunization
  • Vaccines for children (Federal Entitlement
    Program)
  • Perinatal hepatitis B program Immunization
    registry for state
  • Surveillance, investigation, and reporting of
    vaccine-preventable diseases
  • Vaccine registry

13
CDC recommended childhood and adolescent
immunization schedule
14
Major ActivitiesDivision of Zoonotic and
Environmental Epidemiology
  • Surveillance, investigation, control, and
    prevention of zoonotic diseases
  • Rabies
  • West Nile Virus, Lyme Disease, RMSF
  • Brucellosis
  • Water quality and beach monitoring
  • Asthma

15
Geographic Distribution of Human Arbovirus Cases
Recorded in Virginia Since 1975
Human Arbovirus Infections Since 1975
WNV (64 cases)
SLE (8 cases)
LAC (27 cases)
EEE (5 cases)
16
Major Activities/ProgramsDivision of
Radiological Health
  • Radioactive Materials Program
  • X-ray Machine Program
  • Indoor Radon Program
  • Environmental Monitoring
  • Emergency Preparedness Response
  • Non-ionizing Radiation

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Major Activities/ProgramsDivision of Public
Health Toxicology
  • Lead Program
  • Surveillance for human illness due to exposure
    to toxic substances
  • Provide technical expertise and advice on
    chemical exposures posing threats to public
    health or the environment
  • Fish consumption advisories

19
VDH Fish Consumption Advisories
20
Tennessee and Big Sandy River Basin
21
Office of Epidemiology Spending - 58,000,000
per year
22
Office of EpidemiologySpending by Division
23
Multistate Outbreak of Escherichia coli (E.
Coli) serotype 0157H7 Infections Associated with
Consumption of Fresh Spinach, U.S., 2006
24
BackgroundVDH email - 9/14/06
  • I received information today via a CDC/FDA
    teleconference regarding a multistate E. coli
    0157H7 PFGE cluster that will probably garner
    some national media attention in the next couple
    of days. Forty cases (in 12 states) are part of
    the cluster, including one in VA, and this is
    believed to be an ongoing outbreak. WI has
    reported 20 cases in this cluster (including 12
    hospitalizations, 4 HUS cases, and a death). OR,
    UT, and NM also each have several cases, each
    with potentially additional cases pending via
    their respective PFGE lab. In a large majority
    of interviews conducted with cases, spinach was
    mentioned as a consumed item (majority of
    respondents mentioned bagged baby spinach).

25
E. coli 0157H7 and Spinach Outbreak Case
Definition
  • Confirmed case a culture-confirmed E. coli
    0157H7 infection in a person residing in the
    U.S. with illness onset from August 1 to present
    and a PFGE pattern that matches the pattern of
    the outbreak strain.

26
E. Coli 0157H7 Technical Information
  • Clinical features acute bloody diarrhea and
    abdominal cramps fever uncommon last 1 week
    complications HUS, death
  • Gram-negative rod-shaped bacterium
  • Sources ground beef, unpasteurized milk and
    juice, sprouts, lettuce, contact with cattle,
    easily transmitted from person-to-person
  • 73,000 cases, 61 deaths annually, U.S.
  • Children lt5 years old and elderly more likely to
    develop serious complications

27
Epidemiologic Investigation, Virginia
  • 9/14/06
  • DSI contacted by DCLS about a specimen from VA
    resident that matched outbreak strain
  • DSI worked with LHD to investigate case and
    administer questionnaire, no spinach consumption
  • 9/15/06
  • CDC reported 1st VA case
  • 9/22/06
  • DSI contacted by DCLS about a specimen from
    another VA resident that matched outbreak strain
  • Questionnaire administered, no spinach
    consumption
  • CDC reported 2nd VA case

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Timeline for Reporting Cases
33
How do you know a specimen matches the outbreak
strain?
  • State public health labs report results to CDC
    Pulsenet a national PFGE database
  • Pattern type is compared to reports from other
    states
  • CDC contacts states when clusters identified

34
Environmental Investigation
  • 9/14/06 FDA Center for Food Safety and Applied
    Nutrition advised consumers not to eat bagged
    fresh spinach
  • 9/15/06 CA company announced voluntary recall
    of all their fresh spinach-containing products
  • 9/16/06 FDA expanded warning and advised
    consumers not to eat fresh spinach or fresh
    spinach-containing products
  • 9/21/06 FDA announced only spinach from 3 CA
    counties implicated in outbreak

35
Environmental Investigation
  • E. coli 0157 isolated from 13 packages of spinach
    supplied by patients living in 10 states
  • DNA fingerprints of all 13 E. coli isolates
    matched outbreak strain
  • DNA fingerprints of samples of cattle feces
    from one implicated ranch matched outbreak strain
    (10/12/06)

36
FDA Advice for Consumers10/20/06
  • Consumers should not eat, retailers should not
    sell, and restaurants should not serve spinach
    implicated in the E. coli 0157H7 outbreak (i.e.,
    spinach products from Natural Selection Foods
    with a use-by date of 10/1/06 or earlier)
  • Cook spinach to 160 degrees F
  • Store perishable fresh fruits and vegetables at
    40 degrees F or below
  • Not necessary to further wash pre-washed bagged
    produce
  • Note processed spinach (frozen and canned) not
    implicated in outbreak

37
Epidemiologic Investigation, U.S. 10/20/06
  • 204 persons infected from 26 states
  • 70 female
  • 104 (51) hospitalized
  • 31 (15) developed HUS
  • 3 deaths (2 elderly patients, 1 child)

38
Resources
  • www.vdh.state.va.us (Strategic Plan and Office of
    Epidemiology websites)
  • www.cdc.gov/foodborne/ecolispinach
  • www.fda.gov/oc/opacom/hottopics/spinach
  • susanfischer.davis_at_vdh.virginia.gov
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