When a case of yersiniosis (Yersinia enterocolitica gastroenteritis) is reported to SRHD, an Epidemiology Investigator (EI) follows the General Disease Investigation Guidelines at the beginning of this section, with
special attention to the notes below: MANAGEMENT OF CASE 1. Verifies the diagnosis with the laboratory that performed the test. 2. Contacts the clinical care provider(s) who made the diagnosis to:
a. Assure they are aware of the test results.
b. Assure they have had the opportunity to inform the patient.
c. Obtain the demographic information necessary to determine whether the case is a Spokane County resident and to make contact with the case.
3. Refers the case to the appropriate local health jurisdiction or to WA State CD Epidemiology if necessary. Assists other investigators if case is hospitalized in Spokane.
4. Attempts to make contact with the case. If the case cannot be reached by telephone, a message is left (if possible) requesting the case or case guardian to return the call without specifying the reason for the call. If the case repeatedly cannot be reached by telephone, send a letter requesting the case or case guardian to make contact with the EI.
5. As information to complete the CD case report is gathered, it is entered into the PHIMS electronic database system. If PHIMS is not available, Epidemiology staff records information on the appropriate form available at Disease Reporting Forms.
6. Questions case regarding:
a. Food history (especially rare pork and pork products)
b. Contacts with other people with suspected or confirmed cases of diarrheal disease
c. Contacts with pets or other potential animal vectors (e.g., birds, kittens, puppies, livestock, etc.) d. Travel history
7. Inquires about water and sewage systems:
a. Single-family well, community well, city water, any problems (of odors, visual appearance, or taste); repairs to system; is it functional, when was water last tested?
b. On-site septic system, community sewer or city sewer; how is it functioning, any surfacing sewage?
c. If any concerns, contact SRHD EPH Liquid Waste program staff. 8. Informs case of disease:
Symptoms: Acute diarrhea (bloody in children), abdominal pain mimicking appendicitis, and fever. See APHA ―Control of Communicable Diseases‖ for possible additional symptoms.
Transmission: Fecal-oral route; by eating contaminated foodstuffs, especially undercooked pork or pork products; or by direct contact with infected persons or animals.
Incubation period: Usually from 3-7 days, generally less than 10 days.
Period of communicability: With appropriate antibiotic treatment, fecal shedding continues for several weeks, as long as symptoms remain. Without treatment, cases may shed organisms in stool for several months, often without symptoms.
Prevention: By thorough hand washing and by thoroughly washing and/or cooking all foodstuffs. The organism is able to multiply under refrigeration. (See APHA ―Control of Communicable Diseases‖ for complete preventive measures.)
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120 9. In conjunction with SRHD EPH Food Program staff and others as needed, excludes symptomatic cases
or symptomatic contacts from sensitive occupations including: food handling, care of people in hospitals, custodial institutions and day-care centers. Cases may return to work when treatment is completed and they have three consecutive negative stool samples 24 hours apart, at least 24 hours after last treatment and/or as advised by consulting epidemiologist.
NOTE: There is no specific exclusion for yersiniosis in the WA food code. The statement says "Food workers who have any symptom of gastrointestinal illness such as diarrhea, vomiting, or jaundice red, sold, or offered for sale m of gastrointestinal infectionted by the person they are transferred to.l be removed from the nmust not work in or around any place where unwrapped or unPACKAGED FOOD or BEVERAGE products are prepared, sold, or offered for sale."
10. Stresses importance of thorough, careful hand washing with soap and warm water after using the bathroom and before preparing and serving food.
11. Refers case to their personal health care provider if cases have questions regarding treatment. If clinical care providers request information regarding standard treatment regimens, an epidemiologist can provide them with such general information.
12. When a complete CD case report has been entered into PHIMS (or it is determined that one is not obtainable), the record is submitted electronically to DOH CD Epidemiology. If electronic transmission is not possible, staff sends a hardcopy of the completed report to the DOH Data Compiler. (See Appendix D for address.)
MANAGEMENT OF CONTACTS
1. Obtains a list from the case of all possible contacts from 10 days before onset of diarrhea until antibiotic treatment is completed.
2. Interviews contacts to identify possible contaminated food—especially pork products, water, or other sources.
3. Informs contacts regarding the disease as above.
4. Advises contacts to seek care immediately through their personal health care provider if they currently are symptomatic or if they become ill.
5. In conjunction with EPH Food Program staff and others, may exclude symptomatic individuals from sensitive occupations including: food handling, care of people in hospitals, custodial institutions and day care centers until antibiotic treatment is completed and/or fecal bacterial shedding is confirmed absent.
MANAGEMENT OF COMMUNITY (In outbreak circumstances)
1. Notifies the SRHD ERC, who will coordinate agency-wide activities as appropriate.
2. Contacts the appropriate EPH staff to assist in investigating the source of infection and mode of transmission.
3. Consults with the SRHD Health Officer to initiate control measures if a common mode of transmission is indicated (i.e. water or food).
4. Initiates an ERNIE Team meeting if indicated.
5. Informs the Department of Health, Washington State Department of Agriculture, FDA, and/or USDA as indicated, if a water supply or food product is indicated as source.
6. Collaborates with the SRHD Public Information Officer to draft a Public Health Press Release if indicated, and submits it to the SRHD Health Officer for approval.
7. Coordinates with the SRHD Public Information Officer to distribute the Public Health Press Release as outlined in this manual.
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