Procedures and Responsibilities



Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

I. DISEASE SURVEILLANCE PROCEDURES AND RESPONSIBILITIES

A. Surveillance Procedures

Disease surveillance encompasses more than just reporting diseases and is an essential element in any disease prevention and control program. The CDES uses two approaches in disease surveillance:

1. Passive disease surveillance relies upon physicians and other health care providers to fulfill their statutory requirement of disease reporting.

2. Active disease surveillance is a more aggressive and labor intensive approach to identifying cases of disease. It involves the daily, weekly or monthly contacting of physicians, hospitals, schools, or other agencies to "actively" search for cases. This type of surveillance has defined objectives, and usually continues for a relatively short period until the objectives are met. Active disease surveillance coincides with periods of high disease frequency and usually yields a much higher percentage of actual identified cases. It is also used during an outbreak to find additional cases of disease.

The traditional sources of surveillance information are listed in Table A.

Table A

      1. Morbidity Reports (Acute and Communicable Diseases Case Report)

      2. Laboratory reports of infection

      3. Outbreak investigation reports

      4. Mortality reports (death certificates)

      5. Active surveillance for specific diseases

      6. Special surveys (i.e., hospital admissions, disease registers, serologic surveys)

      7. Absentee data from school or work for selected diseases

       

    Since most surveillance date are based on clinical cases, it is important to keep in mind the chain of events shown in Table B that must occur before a clinical case is confirmed.

Table B

Major Elements Needed for Surveillance of Clinical Illness:

  1. Occurrence of clinical illness

  2. Sufficient severity to seek medical care

  3. Laboratory support of diagnosis

  4. Reporting of the disease to the LHD

  5. Collection and analysis of data by LHD or CDES

  6. Reporting of the disease to the BCDP / CDES:

Physicians, clinics, hospitals, laboratories, or others aware of a person with an acute or communicable disease should notify the LHD using the Acute and Communicable Diseases Case Report

The LHD should collect missing data, initiate a disease specific epidemiologic follow-up investigation, assure that adequate prevention and control measures are taken and immediately notify the CDES and / or Regional Office.

For further information on the procedures for reporting, content of the report, urgency of the report, handling of reports by the local health officer, and categories of disease to b reported, please refer to Wisconsin Administrative Code HSS 145, Control of Communicable Diseases.

B. SURVEILLANCE RESPONSIBILITIES

1. Local Health Department responsibilities:

    Each LHD should maintain a surveillance system in its jurisdiction that is compatible with the statewide system.

    The LHD is expected to:

    1. Maintain a supply of communicable disease reporting forms for distribution to physicians, primary care practitioners, hospitals, clinics, schools, day care centers and/or others needing the forms.

    2. Receive, evaluate and transmit completed reports to the state epidemiologist.

    3. Investigate each communicable disease to gather epidemiologic and laboratory data for local, state and national surveillance.

    4. Conduct a detailed follow-up to prevent future cases, identify the etiologic agent or agents, and identify the mode of transmission or risk factors associated with transmission.

    5. Consult with the state epidemiologist or BCDP staff whenever any unusual circumstances occur regarding the disease.

    6. Implement control measures for specific diseases consistent with Section 9, Methods of Control, contained in the latest edition of Control of Communicable Diseases Manual, or with specific measures issued by the state epidemiologist.

2. Local Health Support & Emergency Medical Services Regional Office responsibilities:

Professional and support staff assistance is available at the Local Health Support & Emergency Medical Services Regional Office. It is expected that:

      1. Regional Program Consultants from the Immunization Program (IP) and Sexually Transmittable Diseases (STD) Program will respond to the majority of questions on immunizable diseases and STD surveillance for their respective geographic areas.

      2. Regional Program Consultants will remain current on the BCDP surveillance activities and communicable disease guidelines. See Epinet Introduction: Regional Staff Contacts.

      3. Nursing consultants will serve as a conduit of information from the LHD to the appropriate program staff in the region of the BCDP.

      4. Regional support staff will:

        1. Provide storage, shipping and handling for immune globulin (IG) for viral hepatitis and handling of vaccine or other biologics;

        2. Maintain a limited supply of Acute and Communicable Diseases Case Report forms for provision to LHD on an emergency basis;

        3. Refer telephone and written correspondence to appropriate regional staff, or directly to the BCDP.

3. State Epidemiologist Responsibilities:

The state epidemiologist has overall responsibility for state disease surveillance activities and is expected to:

  1. Provide consultation, technical assistance, and training regarding epidemiologic methods and disease control recommendations to LHDs.

  2. Provide guidelines consistent with state and national objectives, policies and current medical literature.

  3. Maintain a records system for receiving surveillance reports and consolidation of the information into meaningful tables, graphs and charts, provide analysis of the data, and prepare and disseminate summary reports.

  4. Act as liaison with the CDC, WSLH, and other Wisconsin laboratories, the University of Wisconsin-Madison Medical School and the Medical College of Wisconsin to assure rapid and accurate flow of information regarding disease control and specimen collection of communicable diseases throughout Wisconsin .

  5. Assign appropriate state staff to perform epidemiologic investigations where surveillance data indicate a suspected disease outbreak.

  6. Assure that appropriate forms and information are supplied to LHDs as needed.

 

III. EPIDEMIOLOGIC INVESTIGATIONS

A. Disease Outbreaks

When foodborne or waterborne outbreaks occur it is the responsibility of the LHD or Regional Office to immediately notify the BCDP / CDES office. The LHD would then consult the FOODBORNE AND WATERBORNE DISEASE OUTBREAK INVESTIGATION MANUAL found on the Health Alert Network HAN).

B. Requesting Outbreak Assistance

There is no standard formula that will answer the question of when outbreak assistance should be requested.

As a general rule, the Division of Public Health does not provide on-site assistance to LHDs for routine communicable disease outbreaks. However, if an outbreak is suspected and the LHD needs technical, material or personnel assistance for an epidemiologic investigation, the health officer should contact the state epidemiologist. Consultation with the state epidemiologist should always be sought when: (1) the pattern of illness appears to be unusual, (2) the etiology of an unusual disease occurrence is not known, or (3) severe disabling (hospitalizations, death) consequences are occurring.