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The Epi-Log Newsletter
Volume 45, No. 2 - February 2005
Change to Washington State Notifiable Conditions Law
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On January 11, 2005, the Washington State Board of Health filed an amendment to Washington Administrative Code (WAC) 246-101 that changed requirements for the reporting of notifiable conditions. These changes went into effect on February 15, 2005.
Changes to Notifiable Condition List Health Advisories & Resources
The following conditions were previously only provisionally notifiable. They were made permanently notifiable as of February 15, 2005:
- Neonatal and initial genital herpes simplex infections should be reported to Public Health within three days by calling (206) 744-3954.
- Chronic Hepatitis B* and Acute and Chronic Hepatitis C should be reported to Public Health within one month. Persons diagnosed with hepatitis B and C may see multiple health care professionals, each of whom may assume that the case has already been reported when it has not. A related misperception is that primary care health care professionals are more responsible for reporting than consultants, or emergency physicians. In fact, Washington law requires principal health care providers, and other physicians in attendance, to report notifiable conditions unless notification has already been made. Please routinely report all cases of hepatitis B and C, unless you are sure the case has previously been reported by another health care professional (not including laboratories).
*The reporting requirement for hepatitis B surface antigen (HBsAg) positive pregnant women has not changed. All women should be tested during each pregnancy for HBsAg, including women thought to be chronically infected with hepatitis B. All pregnant HBsAg positive women should be reported during each pregnancy within 3 days. Public Health follows up on infants born to HBsAg positive women to ensure that hepatitis B immune globulin and vaccine are administered at birth, subsequent vaccine doses are given on schedule to minimize the development of chronic hepatitis, and follow-up serologic testing to identify infected children is done.
Arboviral Disease (mosquito-borne, sandfly-borne or tick-borne), was made notifiable August 3, 2004 by an emergency order of the State Health Officer. It has now been adopted as permanently notifiable, and replaces “Encephalitis – viral”, which has been removed from the list of notifiable conditions. Arboviral disease, includes, but is not limited to Eastern equine encephalitis, Western equine encephalitis, St. Lois encephalitis, dengue, West Nile Virus disease, California encephalitis, Powassan encephalitis, Japanese encephalitis, and Colorado tick fever. Report confirmed or suspected arboviral disease within three working days to (206) 296-4774.
California encephalitis, Powassan encephalitis, Japanese encephalitis, and Colorado tick fever. Report confirmed or suspected arboviral disease within three working days to (206) 296-4774.
Streptococcus, Group A, Invasive was dropped from the list of notifiable conditions. It had been made provisionally notifiable in December 2000.
The following non-infectious conditions that were provisionally notifiable by health care providers have been made permanently notifiable and should be reported to the Department of Health, Maternal and Child Health Assessment at (360) 236-3492 within one month of diagnosis. These conditions include:
- Birth Defects – Autism Spectrum Disorder,
- Birth Defects – Cerebral Palsy,
- Alcohol Related Birth Defects
Summary of Changes to Notifable Conditions Reporting
Health Advisories & Resources:
- Keep reporting chronic hepatitis B, acute and chronic hepatitis C, herpes simplex (neonatal and initial genital infections), and arboviral disease.
- Keep reporting autism spectrum disorder, cerebral palsy and alcohol related birth defects.
- Report viral encephalitis if you suspect or have confirmed an arboviral disease.
- Stop reporting invasive group A Streptococcus.
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Please keep in mind that laboratory reporting does NOT relieve health care providers of their obligation to report.
Changes to Notifiable Conditions List for Laboratories
Laboratories and laboratory directors are now required to report the following conditions:
- Arboviral Disease: within two days of laboratory results (viral isolation, detection of viral nucleic acid or antibody) consistent with Arboviral Disease. This includes, but is not limited to Eastern equine encephalitis, Western equine encephalitis, St. Louis encephalitis, dengue, West Nile virus disease, California encephalitis, Powassan encephalitis, Japanese encephalitis, and Colorado tick fever.
- Hepatitis B and C: within one month of laboratory results consistent with hepatitis B and C.
Vaccinating High Risk Persons for Hepatitis A and B: Optimizing Insurance Reimbursement
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Persons at high risk for vaccine preventable hepatitis (hepatitis A and B) infection, including men who have sex with men (MSM),and others at-risk for transmission through sexual activity may be hesitant to ask for these vaccines due to a perception that the vaccines would not be covered by their health insurance, or reluctance to discuss high-risk behaviors.
Many insurers will provide reimbursement for hepatitis A and B vaccination of high risk persons, provided that the billing includes CPT® codes that accurately describe the vaccine administered, and an ICD-9 code explaining the reason vaccine is indicated.
A number of ICD-9 (diagnosis) codes can be used to identify the VPH high-risk population. To protect the patient’s confidentiality, you may wish to discuss using a code that indicates a specific risk factor/group with the patient prior to contacting the insurer.
In collaboration with a national CDC campaign to increase the immunization rates for hepatitis A and B among MSM, and others at high risk for infection, the American Medical Association (AMA), has developed coding guidelines for those seeking reimbursement for providing hepatitis vaccines.
The CDC has also created several materials, including a pocket guide, poster, and booklet with concise guidelines for immunizing MSM, and other high risk groups for hepatitis A and B to further the campaign.
The complete AMA coding guidelines for seeking reimbursement of hepatitis vaccines is available in both leaflet and brochure formats, and can be downloaded at: www.ama-assn.org/ama/pub/category/13757.html
The CDC pocket guide, poster, and booklet, and other related materials can be downloaded at: www.cdc.gov/ncidod/diseases/hepatitis/msm
There’s a New Kid in Town: Influenza A/California/7/2004 (H3N2)
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As of the week ending February 12th, 2005, King County sentinel influenza surveillance providers had submitted to the King County Public Health Laboratory 286 clinical specimens from persons with influenza-like-illness. Of these, 75 (26%) have been influenza A, and 18 (6%) have been influenza B. The proportion of influenza B isolates typically increases in the latter part of the influenza season.
Of the seven influenza A isolates that have been antigenically characterized by the CDC, six have been identified as A/Fujian/411/2002-like (H3N2), which is included in the 2004-2005 influenza vaccine, and one has been identified as A/California/7/2004 (H3N2), which is not included in this season’s vaccine, but which has been recommended for next season’s vaccine. CDC reports that, as of the week ending February 5th, 45 percent of all influenza A isolates antigenically characterized, so far, have been A/California/7/2004-like (H3N2). As of January 5th, 2005, only 5 percent of isolates had been characterized as A/California/7/2004-like (H3N2).
For more information about influenza in King County see:
www.metrokc.gov/health/immunization/fluactivity.htm
For more information about influenza throughout the US
www.cdc.gov/flu/weekly/fluactivity.htm
Communicable Disease and Epidemiology contact information
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> Disease reporting
| AIDS |
(206) 296-4645 |
| Sexually Transmitted Diseases |
(206) 744-3954 |
| Tuberculosis |
(206) 744-4579 |
| Other Communicable Diseases |
(206) 296-4774 |
| Automated 24-hour reporting line for conditions not immediately notifiable |
(206) 296-4782 |
> Hotlines
| Communicable Disease Hotline |
(206) 296-4949 |
| HIV/STD Hotline |
(206) 205-7837 |
> For health providers:
- Health Provider homepage
Resources to fact sheets, updated news, vaccine information, health educational materials and external links.
www.metrokc.gov/health/providers
Reported Cases of Selected Diseases in Seattle and King County
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Cases reported
in January
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Cases reported through January
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2005
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2004
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2005
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2004
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| Campylobacteriosis |
16
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17
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16
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17
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| Cryptosporidiosis |
4
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1
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4
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1
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| Chlamydial infections |
402
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388
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402
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388
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Enterohemorrhagic
E. coli (non-O157) |
0
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0
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0
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0
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| E. coli O157: H7 |
1
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0
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1
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0
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| Giardiasis |
11
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13
|
11
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13
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| Gonorrhea |
111
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112
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111
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112
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| Hæmophilus influenzæ (cases <6 years of age) |
0
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0
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0
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0
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| Hepatitis A |
4
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0
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4
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0
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| Hepatitis B (acute) |
2
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2
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2
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2
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| Hepatitis B (chronic) |
38
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34
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38
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34
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| Hepatitis C (acute) |
1
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0
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1
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0
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| Hepatitis C (chronic, confirmed/probable) |
87
|
111
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87
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111
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| Hepatitis C (chronic, possible) |
24
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34
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24
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34
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| Herpes, genital (primary) |
54
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54
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54
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54
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| HIV and AIDS (includes only AIDS cases not previously reported as HIV) |
39
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17
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39
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17
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| Measles |
0
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0
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0
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0
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| Meningococcal Disease |
3
|
4
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3
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4
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| Mumps |
0
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0
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0
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0
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| Pertussis |
17
|
22
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17
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22
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| Rubella |
1
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0
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1
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0
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| Rubella, congenital |
0
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0
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0
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0
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| Salmonellosis |
18
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17
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18
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17
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| Shigellosis |
7
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16
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7
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16
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| Syphilis |
6
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5
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6
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5
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| Syphilis, congenital |
0
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0
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0
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0
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| Syphilis, late |
6
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4
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6
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4
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| Tuberculosis |
8
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8
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8
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8
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