Fifty Shades of Grey Infectious Diseases: Surveillance and Management for Public Health - September 15, 2014 Jill Fediurek, Manager, Immunization ...
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Fifty Shades of Grey
Infectious Diseases: Surveillance and Management
for Public Health - September 15, 2014
Jill Fediurek, Manager, Immunization and Vaccine
Preventable Diseases
1Disclaimer • For those who signed up hoping this was an overview of the 2011 erotic romance novel by British author E.L. James – what were you thinking? PublicHealthOntario.ca 2
Breakout Session Learning Objectives • Apply the concepts from the “Reportable Disease Case and Contact Management Process Flow” to establish an “index of suspicion” for a reportable disease case investigation • Evaluate the risk of potential disease transmission based on community involved, causative agent, susceptibility and occupational factors • Identify and discuss factors that impact decisions around public health actions • Summarize key learning from the case study in large group discussion PublicHealthOntario.ca 3
Reportable Disease Case and Contact Management Roles and Responsibilities Complex process due to involvement of: • Multiple healthcare providers and healthcare sectors • Multiple government agencies • Varied roles and responsibilities of healthcare and other agencies • Different healthcare disciplines PublicHealthOntario.ca 4
Health Care Providers (HCPs)
• Relationship between HCP and patient/client (duty to care) defined
• HCP’s professional practice guided by standards of care/standards of practice
• Focus on the individual/case
• HCP’s role is assessment, differential diagnosis (including appropriate specimen collection and
ordering appropriate diagnostic test) and treatment (as indicated)
• Clinical responsibility for the patient
• Duty to report to the medical officer of health
PublicHealthOntario.ca 5Public Health Units (PHUs) Mandated to protect the public through: • Mitigating disease transmission through public health management of cases and their contacts • Identifying and mitigating health hazards • Communicating to multiple individuals • Provincial Reporting Requirements PublicHealthOntario.ca 6
Public Health Ontario (PHO) • Provides scientific and technical advice • Responsible for Provincial Surveillance • Identifies and investigates multijurisdictional outbreaks • Reports back on surveillance analysis • Contributes to further research to address findings PublicHealthOntario.ca 7
Public Health Ontario Laboratories (PHOL)
• Provide timely and relevant clinical and environmental testing on outbreak-related
submissions
• Perform unusual tests that require “critical mass” of specimens or have special
safety concerns
• Reference testing services including typing
• Provide expert medical and scientific advice
• Scientific and Research Group outbreak-related activities
PublicHealthOntario.ca 8Ministry of Health and Long Term Care (MOHLTC) • Develops provincial policy and strategic frameworks • Oversees the public health sector • Ensures vaccines/antitoxins/drugs are accessible • Coordinates provincial outbreak response • Collaborates with other government agencies/stakeholders • Communicates with MOHs/ AMOHS and other health care providers/stakeholders • Issues province-wide public communications PublicHealthOntario.ca 9
Index of Suspicion
• Clinical signs and symptoms
• Appendix B identifies clinical criterial for the provincial case definitions and what is required for a
confirmed or probable case classification for surveillance reporting
• Laboratory test results
• Suggestive results requiring interpretation or supplementary testing to clarify (e.g IgM reactive or
PCR positive)
• Epidemiology (i.e. exposure to a laboratory confirmed case, travel to or visitors from
an area where known outbreaks are occurring, environmental exposures to food
water or animals or other substances)
• Susceptibility of case (i.e. age, immunization status)
PublicHealthOntario.ca 10Interpreting laboratory results – Black, White or Grey?
• Antibody response
• Serology –indirect detection
• Specificity and sensitivity (false positives/negatives)
• Prevalence and positive/negative predictive value
• Timing of antibody response
• Availability of testing – e.g. no Flu serology
• Microbiology (isolation/detection of organism)
• Culture, molecular methods –direct detection
• Some organisms don’t grow in culture or have special requirements/safety issues
• The organism detected may be serendipitous
• Molecular methods detect both “live” and “dead” organisms
PublicHealthOntario.ca 11PublicHealthOntario.ca 12
Case Scenario
How does the : [insert from below] affect case investigation process?
• reporting source [patient reports versus HCP reports], “positive” lab results
• suspected causative organism [novel versus familiar]
• attitudes/beliefs/culture [religious, philosophical]
• public /media HCP
Collaboration and understanding of roles essential!
PHUs
PHO/MOHLTC
PublicHealthOntario.ca 13Case Scenario Rules of Engagement • Each table will work through a disease specific scenario • All members of the group need to share in the discussion and decision-making process • Rationale for recommendations/decisions should be explicitly stated • Key questions will be posed for sharing back with the larger group PublicHealthOntario.ca 14
Acknowledgements • PHO : Michelle Uy, Margaret McIntyre, Michelle Policarpio, Shelley Deeks, Yvonne Whitfield, Bryna Warshawsky, Emily Karas, Jennifer Pritchard, Anne-Luise Winter, Alison Downer, Erik Kristjanson • MOHLTC : Elizabeth Choi, Joanne Rey-Reiter, Melissa Helferty • PHU: Elaine Reddick, Cara Lee Coghill (Oxford County), Regina Elliott (Durham Region), Donna Stanley (Northwestern) PublicHealthOntario.ca 15
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