Title: Virginia Department of Health Office of Epidemiology Susan Fischer Davis, M'D' Deputy Director Novem
1Virginia Department of HealthOffice of
EpidemiologySusan Fischer Davis, M.D.Deputy
DirectorNovember 1, 2006
2Office 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.
3Virginia Department of HealthMission
- To achieve and maintain optimum personal and
community health by emphasizing health promotion,
disease prevention, emergency preparedness, and
environmental protection.
4(No Transcript)
5(No Transcript)
6VDH 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)
7Major 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
8(No Transcript)
9Major 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
10VDH 35 Local Health Districts
11Vignette 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.
12Major 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
13CDC recommended childhood and adolescent
immunization schedule
14Major 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
15Geographic 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)
16Major Activities/ProgramsDivision of
Radiological Health
- Radioactive Materials Program
- X-ray Machine Program
- Indoor Radon Program
- Environmental Monitoring
- Emergency Preparedness Response
- Non-ionizing Radiation
17(No Transcript)
18Major 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
19VDH Fish Consumption Advisories
20Tennessee and Big Sandy River Basin
21Office of Epidemiology Spending - 58,000,000
per year
22Office of EpidemiologySpending by Division
23Multistate Outbreak of Escherichia coli (E.
Coli) serotype 0157H7 Infections Associated with
Consumption of Fresh Spinach, U.S., 2006
24BackgroundVDH 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).
25E. 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.
26E. 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
27Epidemiologic 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
28(No Transcript)
29(No Transcript)
30(No Transcript)
31(No Transcript)
32Timeline for Reporting Cases
33How 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
34Environmental 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
35Environmental 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)
36FDA 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
37Epidemiologic 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)
38Resources
- 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