Georgia epidemiology report, Vol. 24, no. 2 (Feb. 2008)

February 2008

volume 24 number 02

Georgia's Notifiable Disease Emergency Reporting Hotline 1-866-PUB-HLTH (1-866-782-4584)

Introduction

Data Analysis

1-866-PUB-HLTH (1-866-782-4584) is Georgia's Notifiable Disease Emergency Reporting Hotline. It is available for use 24 hours a day, 7 days a week for time-sensitive communication among healthcare providers, Public Health, and emergency responders. 1-866-PUBHLTH is for the reporting of immediately notifiable diseases, including those that could result from a bioterrorism event, and public health emergencies. This one easy-to-remember number is distributed to all local, state, and federal partners for use in a public health emergency.
1-866-PUB-HLTH is housed at the Georgia Poison Center (GPC) and staffed by Public Health Specialists (PHS) who respond to calls according to protocols developed by Public Health. Calls are triaged by the PHS according to urgency and public health significance, and those that require immediate notification of Public Health are passed to the Health District On-Call Representative for response. Callers can always request to speak with someone in Public Health immediately, even when reporting a non-urgent public health issue.
1-866-PUB-HLTH was initiated in 2001 as a pilot program in the metropolitan Atlanta area and was staffed by the Georgia Emergency Management Agency (GEMA). It expanded statewide in 2003, and was moved to the Georgia Poison Center on September 1, 2005. 1-866-PUB-HLTH operates under the legal authority of OCGA 31-12-2, which requires notifiable disease reporting, including those diseases that may result from "bioterrorism, epidemic or pandemic disease, or novel and highly fatal infectious agents or toxins and that may pose a substantial risk of a public health emergency."
In a 2005 disease reporting survey, 85% of Georgia physicians sampled reported that they had never heard of 1-866-PUB-HLTH. This issue of the Georgia Epidemiology Report aims to notify healthcare providers of the availability of this hotline, encourage its use, and to describe usage patterns.
What is 1-866-PUB-HLTH? Statewide hotline Healthcare providers use for reporting: o Public health emergencies o Immediately notifiable diseases o Clusters of illness Talk to District or State Public Health any time, 24/7: o Obtain management advice o Advice for prophylaxis of contacts

NumNbuermboefr oCfalClalsls

This report evaluated all calls to 1-866-PUB-HLTH between September 1, 2005 and December 31, 2006. There were 493 calls to 1-866-PUB-HLTH during the evaluation period. The majority of calls did not require an immediate call to Public Health (Figure 1). Although the purpose of the hotline is to handle public health emergencies, partners also use the hotline to report other notifiable diseases, or to report situations that may require timely but not immediate follow-up. Emergency calls represented 16% of calls during the evaluation period. The large volume of calls in April 2006 may be attributable to an article about 1-866-PUB-HLTH that appeared in the March Georgia Epidemiology Report (distributed in April to physicians around the state).
Figure 1. Number of Calls to 1-866-PUB-HLTH at the NumberGofeCoallrsgtoi1a-86P6-oPUiBs-HoLnTHCat ethenGteeorrg,iabPyoisMonoCennttehr, by Month
Non-EmNoenr-Egmeenrcgeyncy EEmmeregerngceyncy
60
50
40 Georgia Poision Center began
30 receiving all 1-866PUGBe-oHrgiLaTPoHisocnaClelnster (hobPtelUignBa-neHrLetTcrHeaivcnianlsglsfae(lhl ro1rt-l8ein6ed6-
20 fromtranGsfeErreMd fAromSGeEpMtA.) 1, 2S0ep0t.51., 2005.
10
0 May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec '05 '05 '05 '05 '05 '05 '05 '05 '06 '06 '06 '06 '06 '06 '06 '06 '06 '06 '06 '06 Month
Fifty-seven percent of calls to 1-866-PUB-HLTH were received after hours, on weekends, or on holidays when health departments were closed. Specifically, 27% of calls were made on weekdays after hours (Monday-Friday, 5 p.m.-8 a.m.), 28% of calls were made on weekends (Friday 5 p.m.-Monday 8 a.m.), and 2% of calls were made on holidays during the day (8 a.m.-5 p.m.) (Figure 2).
Most (88%) calls to 1-866-PUB-HLTH were to report a notifiable disease. Other reasons for calling 1-866-PUB-HLTH included but were not limited to: physicians needing advice about management of a patient or prophylaxis of contacts, public health workers needing to reach other public health workers immediately, laboratorians reporting critical lab results, and police officers requesting public health consults.

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Of the notifiable conditions reported during the evaluation period, 61% were animal bites (Figure 3). Most of these (72%) were reported from Health District 3-1 (Cobb and Douglas Counties), which asks their hospital emergency departments to report all animal bites using 1-866-PUB-HLTH as a way of conducting surveillance for animal bites. In contrast, only 9% of non-animal bite disease reports came from Health District 3-1.
Even if we exclude animal bite reports from Health District 3-1, animal bite reports still represent a large proportion (31%) of calls to 1-866-PUB-HLTH.

Figure 2. Calls to 1-866-PUB-HLTH by Time of Day (n=493)

Holiday 2%

Weekend 28%

During Office Hrs 43%

.
Weekday After Hrs 27%
Figure 3. Diseases Reported to 1-866-PUB-HLTH, September 1, 2005 to December 31, 2006 (n=493)
Other 22%

Other notifiable disease reports to 1-866-PUB-HLTH included a wide-ranging list of diseases. Diseases (excluding animal bites) were grouped and are shown as a percentage of all diseases reported to 1-866-PUB-HLTH in Figure 4 Sexually transmitted diseases (STDs) and Human Immunodeficiency Virus (HIV) was the most frequently reported disease group during the time period. No diseases in this group require an immediate call to Public Health after hours..

Most calls to 1-866-PUB-HLTH were made from hospitals, physician's offices, and workplaces (Figure 5). The workplace category may include clinicians who were calling from hospitals or physician's offices (their workplace).

Figure 4. Disease Reported to 1-866-PUB-HLTH, EXCLUDING Animal Bites, September 1, 2005 to December 31, 2006 (n=167)

Influenza 3%

MRSA 3%

Cluster 3%

Other 4%

Avian Influenza 5%
Hepatitis A, B, or C 5%

STDs/HIV 28%

Zoonotic/ Vector-borne
6%

Meningitis 7%

Foodborne 10%

TB 16%
Vaccine Preventable 10%

Figure 5. Calls to 1-866-PUB-HLTH by Caller Site (n=493)

Free-standing emergency clinic 4%
Unknown 12%

Residence 3%

Other 2%

TB 6%
STDs/HIV 11%

Animal Bites 61%

Workplace 14%
Physician's Office 15%

Hospital 50%

Division of Public Health http://health.state.ga.us
Stuart T. Brown, M.D. Director |State Health Officer
Martha N. Okafor, Ph.D. Deputy Director

Epidemiology Branch http://health.state.ga.us/epi
John M. Horan, MD, MPH State Epidemiologist Director | Epidemiology Branch

Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. Editor Kathryn E. Arnold, M.D.
Cherie Drenzek, D.V.M., M.S. John M. Horan, M.D., M.P.H.
Stuart T. Brown, M.D. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer
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Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588
Fax: (404) 657-7517

Georgia Department of Human Resources
Division of Public Health

Please send comments to: gaepinfo@dhr.state.ga.us

Health District Survey

they experienced excellent customer service from polite and friendly PHS.

In June 2007, an 11-question survey was distributed via e-mail to all 18 Health Districts with instructions to forward to all

Conclusion

District On-Call Representatives. Surveys were completed by email or anonymously by fax over a two week period. The survey purpose was to assess District satisfaction with the hotline, so only those with experience with the 1-866-PUB-HLTH hotline were instructed to respond. There were 19 survey respondents, representing 12 Health Districts. Not all respondents answered every question, and at least one District submitted answers as a joint effort among all On-Call Representatives, while most Districts submitted surveys representing individual opinions.

1-866-PUB-HLTH is a hotline for use by Public Health partners to report immediately notifiable diseases and public health emergencies, 24 hours a day, 7 days a week. For public health issues that require immediate attention any time of day, calling 1866-PUB-HLTH will put partners in touch with District- or Statelevel Public Health within minutes. Notifiable diseases can also be reported electronically via SendSS, through the mail via a Notifiable Disease Report Form (form 3095), or by calling your District Health Department directly.

The majority of District respondents agreed regarding the usefulness of 1-866-PUB-HLTH. Seventeen respondents (94%)

This article was written by Laurel Garrison, M.P.H.

thought that 1-866-PUB-HLTH

was useful for maintaining communication among federal, state, and local Public Health.

Figure 6. Number of Calls to 1-866-PUB-HLTH by Caller County, September 1, 2005 to December 31, 2006

Fourteen (78%) thought that

1-866-PUB-HLTH was useful

for maintaining communication

among Public Health and private

healthcare providers. Fifteen

respondents (84%) thought

that 1-866-PUB-HLTH was

useful for reporting immediately

notifiable diseases, and 17

(94%) thought that it was useful

for reporting public health

emergencies.

Eighty-eighty percent of respondents said that GPC is appropriately contacting Public Health via telephone or FAX according to the urgency/public health significance of the report. Those who did not think GPC handled calls appropriately either had only one experience with the hotline (which was unacceptable) or had many experiences with the hotline and only one was unacceptable.

Good customer service is essential to the success of the hotline. Fifteen of 17 respondents (88%) said they have received good customer service from the Public Health Specialists (PHS) at GPC. The 2 respondents that had negative experiences stated that they either felt it was a one time occurrence, or the problem has since been rectified. Many respondents commented that

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The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186

PRESORTED STANDARD U.S. POSTAGE
PAID ATLANTA, GA PERMIT NO. 4528

February 2008

Volume24Number02

Reported Cases of Selected Notifiable Diseases in Georgia, Profile* for November 2007

Selected Notifiable Diseases
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for November 2007
2007 55 18 22 4 59 11 7 4 7 5 1 2 0 0 0 179 164 3 29 14 43 0 42

Previous 3 Months Total Ending in November

2005 130

2006 155

2007 161

8272

9314

755

57

114

83

10

14

21

212

218

208

4126

4950

364

23

25

26

31

11

12

43

50

32

15

14

14

1

1

2

3

5

7

0

0

0

10

10

3

0

0

0

714

632

797

301

605

428

40

26

21

142

144

114

110

86

52

236

258

178

1

3

0

134

127

111

Previous 12 Months Total Ending in November

2005 597

2006 582

2007 679

33106

39726

33377

150

279

248

32

43

45

746

705

690

15762

20299

13817

114

118

123

136

58

68

224

198

142

39

36

45

6

8

10

18

17

27

1

5

0

51

30

16

0

0

0

1950

1823

2038

670

1304

1656

135

124

88

547

479

510

400

379

366

971

1027

960

3

10

8

517

513

473

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.
** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.
AIDS Profile Update

Report Period
Latest 12 Months**:
2/06-1/07
Five Years Ago:
2/02-1/03

Disease

Total Cases Reported*

Classification <13yrs

>=13yrs Total

HIV, non-AIDS

29

3,322

3,351

AIDS

6

1,386

1,392

HIV,

-

non-AIDS

AIDS

7

1,703

1,710

Percent Risk Group Distribution

Female MSM

IDU

MSM&IDU HS

Unknown Perinatal

26

22

3

1

6

68

<1

26

24

3

1

7

65

<1

-

-

-

-

-

-

-

28

36

7

2

16

39

<1

Race Distribution

White Black

Hispanic

22

72

4

21

70

6

-

-

-

19

74

5

Other 2 3 2

Cumulative: HIV, non-AIDS 214

11,145

11,359

32

27

6

2

11

52

2

21

74

3

2

07/81-1/07 AIDS

238

31,884

32,122

20

44

15

5

14

21

<1

30

66

3

1

Yrs - Age at diagnosis in years

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section ** Due to a change in the surveillance system, case counts may be artificially low during this time period

***HIV, non-AIDS was not collected until 12/31/2003

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