(Please review Appendix J - ―Conducting an Epidemiologic Investigation of An Outbreak for Which The Causative Agent Is Unknown‖ in the General Procedures Section of this manual.)
When case(s) are reported to SRHD of an illness for which the causative agent is not known, an Epidemiology Investigator (EI) follows the General Disease Investigation Guidelines at the beginning of this section, with
special attention to the notes below:
MANAGEMENT OF CASE
1. Verifies the laboratory diagnostic studies that are pending. 2. Contacts the clinical care provider(s) who are managing the case to:
a. Assure they are aware of the data reported, including pending test results. b. Assure they have had the opportunity to inform the patient and patient’s family.
c. Obtain the demographic information necessary to determine whether the case is a Spokane County resident and to make contact with the case.
Note: Some unknown disease cases potentially may be bioterrorism (BT) issues. If there is a cluster of cases with an unusual distribution or presentation, or a reason to suspect intentional dissemination, EI should notify the SRHD Duty Officer, Emergency Response Coordinator, Health Officer, and WA State CD Epidemiology immediately.
3. If the case is a resident of another county or state, refers the case to the appropriate local health jurisdiction or to WA State Communicable Disease Epidemiology as necessary. Assists other investigators if the case is hospitalized in Spokane.
4. Attempts to make contact with the case(s). If the case(s) cannot be reached by telephone, a message is left (if possible) requesting the case, case guardian or household member to return the call without specifying the reason for the call. If the case(s) cannot be reached by telephone, sends a letter requesting the case or case guardian make contact with the EI.
5. Upon contacting the case or case guardian by telephone, EI will conduct an interview while assembling the data either in hard copy form or in the communicable disease database currently in use.
6. Stresses to case that all information collected is kept confidential.
7. According to the nature of signs and symptoms, addresses questions to case.
a. For symptoms suggesting gastroenteritis interviews are generally conducted by EPH staff. If unavailable, EI:
i. Questions case about food history, contact with ill pets, livestock, or other animals, contacts with other people with suspected or confirmed cases of diarrheal disease. ii. Inquires about water and sewage systems: Single-family well, community well, city water,
any problems (off odors, taste), repairs to system; is it functional, when was water last tested? On-site septic system, community sewer or city sewer; how is it functioning, any surfacing sewage?
iii. As appropriate, contacts SRHD EPH Liquid Waste program staff.
b. For symptoms suggesting systemic illness including neurologic deficits: questions case about: i. Possible arboviral disease: situations with possible exposure to mosquitoes, ticks, or
other arthropod vectors, rash illnesses, i.e., travel, camping trips, from several weeks before onset of symptoms, others in their neighborhood with similar signs and symptoms. ii. Other possible central nervous system infections: travel, exposures to other ill people,
animal exposures, sources of immune system compromise.
c. For symptoms suggesting possible viral, vaccine-preventable diseases, questions case about vaccination status, rash illnesses, exposures to other ill people, travel history.
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d. For symptoms suggesting respiratory infection, questions case about recent exposure to persons with symptoms of respiratory illness (fever, cough, difficulty breathing); recent exposure to suspect water systems, air conditioning, aerosolized water, humidifiers, hot tubs, swimming pools, and recent gardening activities.
8. As suspect pathogenic etiologies emerge, EI will shift the focus of the investigation and the provisional responses to the suspect organisms or groups of organisms. Other SRHD staff may be recruited if the investigation suggests their areas are pertinent (e.g., EPH Food Program for foodborne outbreaks, EPH Living Environments for school-based outbreaks, SRHD Clinic for hepatitis A response, and SRHD ERC if events warrant an expanded response.)
9. Refers case to their personal health care provider (HCP) for management and treatment of underlying conditions. Obtains relevant information from HCPs. If HCPs request information regarding standard treatment regimens, an epidemiologist can provide them with such general information.
10. Correlates clinical data for cases meeting the outbreak surveillance case definition to define it more precisely.
11. When a complete CD case report has been entered into PHIMS (or it is determined that one is not obtainable), the record is submitted electronically to DOH CD Epidemiology. If electronic transmission is not possible, staff sends a hardcopy of the completed report to the DOH Data Compiler. (See Appendix D for address.)
MANAGEMENT OF CONTACTS
1. Obtains a list from the case of all possible contacts according to the suspected means of transmission and estimated communicable period.
2. Interviews contacts to identify other possible cases and other sources of infection, according to the suspected means of transmission.
3. Informs contacts regarding the suspected disease as above.
4. Advises contacts to seek care immediately through their personal health care provider if they currently are symptomatic or if they become ill. Obtains relevant information from HCPs. If HCPs request information regarding standard treatment regimens, an epidemiologist can provide them with such general information.
5. In conjunction with other SRHD Program staff and other community resources, may exclude symptomatic individuals from sensitive occupations including: food handling, care of people in hospitals, custodial institutions and day care centers until potential risk of pathogen transmission is abated.
MANAGEMENT OF COMMUNITY (in an Outbreak)
1. Notifies the ERC if indicated, who will coordinate agency-wide activities including any or all of the following as appropriate:
a. Contacts the appropriate EPH staff to assist in investigating the source of infection and mode of transmission.
b. Consults with the SRHD Health Officer to initiate control measures if a common mode of transmission is indicated (e.g., water, food, respiratory exposure).
c. Initiates an ERNIE Team meeting if indicated.
d. Informs the Department of Health, Washington State Department of Agriculture, FDA, and/or USDA as indicated, if there is more widely applicable infectious source of transmission (e.g., water supply or food product, respiratory exposure at a public site or conveyance like an airplane).
e. Collaborates with the SRHD Public Information Officer to draft a Public Health Press Release if indicated, and submits it to the SRHD Health Officer for approval.
f. Coordinates with the SRHD Public Information Officer to distribute the Public Health Press Release as outlined in this manual.
g. Coordinates with SRHD Health Officer to issue Provider Alerts to ERs/Urgent Care facilities, primary care facilities, hospitals, labs, nursing homes, or other care providers, if indicated.
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