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. The Georgia Epidemiology Report Via E-Mail To better serve our readers, we would like to know if you would prefer to receive the GER by e-mail as a readable PDF file. If yes, please send your name and e-mail address to Gaepinfo@dhr.state.ga.us. | Please visit, http://health.state.ga.us/epi/manuals/ger.asp for all current and past pdf issues of the GER. 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 -2 - 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 -3 - 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 - 4 -