10/20/11 — Health Department seeks quicker reporting on outbreaks

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Health Department seeks quicker reporting on outbreaks

By Phyllis Moore
Published in News on October 20, 2011 1:46 PM

Ever since an outbreak of hepatitis B claimed six lives at GlenCare assisted living facility in Mount Olive a year ago, Health Director James Roosen has advocated for better reporting to public health agencies.

He primarily targeted adult care homes and assisted living facilities, but says the scope is much broader.

In addition to cases of food-borne illnesses, there was a recent outbreak of conjunctivitis, or pink-eye, at a day care center, which the Health Department did not learn about until after it was over.

"Here in Wayne County -- this is true in most counties -- you have had major outbreaks that don't pop up until the week or two after the outbreak has disappeared," he said.

That was almost the case with GlenCare.

"We didn't find out about that outbreak until the second person had died," Roosen said. "What's interesting is the fact that it took so long to report to the Health Department. Actually, it was the hospital who reported it to us."

The health director said he wasted no time lobbying for a more expedient reporting system.

"The first thing I did after I got knowledge about this is I went to the state and said we need to pass a law. We need to pass a rule," he said. "Their answer was, we have tried this before and it didn't work.

"I said, we haven't had six deaths before. Well, it has, it just hasn't been publicized."

Roosen said he was told that efforts had previously been made to pass similar laws but the proposals had never passed legislation. That was not the case this time. Roosen recently learned that House Bill 474 made it through and goes into effect in January 2012.

"It's already been voted in, will be in effect Jan. 1," he said. "That means I think it's environmental health that will be out there enforcing it."

The bill -- which primarily focuses on increasing education, training and evaluation requirements for adult care home aides and infection control requirements -- can only do so much at the reporting end, Roosen said.

"We want to increase business and public knowledge about illnesses and when to report them," he said. "I think statewide it's a common problem everywhere. First of all, if you're an owner or a manager of a place, you don't want it written in the paper that there's an illness outbreak, and there's also a lot of liability involved."

The Health Department is designed to respond to public health issues, and typically does -- from increased school absences due to flu, to an increase in cases of tuberculosis or syphilis in the community.

Problems arise, though, when the department is uninformed.

"It's a resource that's not being used," said Shane Smith, program coordinator for food and lodging. "We're not finding out. We'll get calls from someone who ate somewhere and we're getting called a week later."

"And if you get a lab report, it's a week after," added Josa Raynor-Vaughn, communicable diseases program manager.

"It's impossible to do any research at that point, and the facilities are supposed to report to us," Smith said.

Food-borne illnesses are not a unique problem, he noted, with one in six Americans affected a year.

"Maybe they just don't think about it," he said. "It's not reported by the individual a lot of times or a lot of times it's just ignored."

"If they don't go to the doctor, we don't find out about it," Ms. Raynor-Vaughn said.

Timing is definitely a contributing factor, officials say, and might be one reason for the delay in reporting to public health agencies.

"We just had a pretty major pink-eye (conjunctivitis) outbreak at a day care center," Roosen said. "The problem is, it was pretty painful and long-lasting. Mainly what the child care center should have done is tell Mom and Dad to keep the child home.

"What was amazing, we didn't find out about it until there'd been 10 cases all in the same place."

And while it was something that was treatable, he said, it is also very contagious.

"The teacher in that room, she was confined with pink-eye and the bad thing was, due to the staff ratio that they had, they couldn't separate the children," Smith said. "When they went to the doctor's, they would send them a note to come back to school.

"A lot of these kids were coming back with a doctor's note. It was not getting any better."

Part of the education process might include ways to get out information, especially in terms of what constitutes an outbreak and at what point to alert the Health Department.

"The law requires principals -- elementary, middle and high schools -- to report illnesses to the Health Department," Roosen said. "The law requires restaurants, food stands to report to the Health Department. The law requires physicians, there's a lot of rules in terms of when these illnesses should be reported to the Health Department."

"The schools are very good about reporting," Ms. Raynor-Vaughn said.

The health director said it might sound like a lot of work, but if it increases public knowledge, that's half the battle.

"The other half is we're going to send a letter to everybody that we impact, everybody that we write the license to," he said.

In the case of food-borne illnesses, though, it's not limited to restaurants and food vendors, said Smith.

"It's the home, church fundraisers, family reunions," he said.

The bottom line, Roosen said, is finding the best way to position the Health Department to do its job.

"I would like to see quicker reporting to the Health Department, so we could go out there and get a sample to the state," he said.

"We're going to be working on making the public more aware of reporting communicable disease so that we can report it in a timely manner before there's an outbreak," Ms. Raynor-Vaughn told the Board of Health this week.