The Epi-Log Newsletter (Volume 46, No. 2

The following conditions are notifiable to local health authorities in Washington in accordance with WAC 246-101. Timeframes for notification are indicated in footnotes. Immediately notifiable conditions are indicated in bold and should be reported when suspected or confirmed.

Frequently Asked Questions About Disease Reporting

What information should I include about the patient when I report a case to Public Health?

To minimize the need for a follow-up call from the disease investigation team, provide as much of the following information as possible: the patient’s notifiable condition, name, address, phone number, sex, race and ethnicity, your name and phone number, relevant clinical and laboratory data (for example, liver enzyme test results for patients with hepatitis, pregnancy status for women with acute or chronic hepatitis B), relevant epidemiological history, including suspected risk factors and/or exposures (e.g., history of intravenous drug use for chronic hepatitis B or C), travel history, information on ill family members or other contacts, and any other information you think may help the investigation. If the patient is not yet aware of the diagnosis, please indicate how long we should wait before attempting to interview the patient.

If a notifiable condition is reportable by the laboratory, does that mean I don’t have to report it?

No. Laboratory reporting explicitly does not relieve the clinician of their legal requirement to report because the laboratories don’t provide critical clinical or epidemiologic data, and laboratory reporting is not as timely as clinician reporting of suspected cases.

Should I await laboratory confirmation before reporting to Public Health?

Not necessarily. Immediately notifiable conditions, such as tuberculosis, measles, meningococcal disease, and all cases of unexplained critical illness, and rare disease of public health significance (i.e., SARS, avian influenza, suspected outbreaks or clusters of illness and suspected bioterrorism), should be reported as soon as they are suspected, without awaiting laboratory confirmation, preferably while the patient is still present. Whether or not to await laboratory confirmation depends upon several factors, including strength of clinical suspicion, length of time required to obtain a diagnosis, or the potential public health threat during the time while the diagnosis is established. The general rule is, “If in Doubt, Report it Out.”

I am not the patient’s primary care provider, does that relieve me of the reporting obligation?

Sorry. Notifiable disease reporting is legally required from specialists, subspecialists, and consultants as well as primary care clinicians unless the disease is known to have been reported. This regulation was written to ensure that cases do not slip through the net and go unreported. For this reason it is very helpful to document in the patient’s medical record when the report has been made.

Are only conditions that are mentioned by name reportable to Public Health?

No. “Unexplained critical illness or death”, “rare diseases of public health significance”, and disease clusters of suspected foodborne or waterborne origin are important notifiable conditions that are intended to trigger prompt detection and investigation of diseases due to unidentified agents, unexpected health events in the community, and new infections like SARS and avian influenza. When information from different clinicians is combined, the reporting of suspected clusters of cases can lead to recognition of larger outbreaks that cannot be recognized by any single health care provider.

Does HIPAA change the obligation to report?

No. Public Health reporting is permissible under HIPAA. HIPAA rules (in the US Code of Federal Regulations) state that “Nothing in [HIPAA] shall be construed to invalidate or limit the authority, power, or procedures established under any law providing for the reporting of disease or injury, child abuse, birth or death, public health surveillance, or public health investigation or intervention.”

Erratum

In the January 2006 issue of the EPILOG, ampicillin was incorrectly listed as an acceptable alternative antibiotic treatment for patients with leptospirosis who are allergic to penicillin. We regret the error.

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Communicable Disease and Epidemiology contact information

> 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

	Cases reported in January		Cases reported through January
	2006	2005	2006	2005
Campylobacteriosis	27	16	27	16
Cryptosporidiosis	2	5	2	5
Chlamydial infections	368	408	368	408
Enterohemorrhagic E. coli (non-O157)	0	0	0	0
E. coli O157: H7	1	0	1	0
Giardiasis	5	11	5	11
Gonorrhea	123	111	123	111
Hæmophilus influenzæ (cases <6 years of age)	0	0	0	0
Hepatitis A	4	4	4	4
Hepatitis B (acute)	3	2	3	2
Hepatitis B (chronic)	54	41	54	41
Hepatitis C (acute)	1	2	1	2
Hepatitis C (chronic, confirmed/probable)	96	78	96	78
Hepatitis C (chronic, possible)	34	21	34	21
Herpes, genital (primary)	64	54	64	54
HIV and AIDS (includes only AIDS cases not previously reported as HIV)	13	28	13	28
Measles	0	0	0	0
Meningococcal Disease	1	3	1	3
Mumps	0	0	0	0
Pertussis	16	17	16	17
Rubella	0	1	0	1
Rubella, congenital	0	0	0	0
Salmonellosis	16	18	16	18
Shigellosis	3	7	3	7
Syphilis	19	7	19	7
Syphilis, congenital	0	0	0	0
Syphilis, late	5	6	5	6
Tuberculosis	1	7	1	7

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