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When a case of is Haemophilus influenzae invasive disease (meningitis, epiglottitis, bacteremia, or pneumonia; excluding otitis media) in children age five and under 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 on a specimen from a normally sterile site.

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 parents or legal guardians of the case. If the parents or legal guardians cannot be reached by telephone, a message is left (if possible) requesting they return the call without specifying the reason for the call. If the parents or legal guardians repeatedly cannot be reached by telephone, send a letter requesting that they 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. Informs the parents or legal guardians of the disease:

Symptoms: Vary according to the accompanying clinical syndrome. They may include fever, vomiting, extreme irritability and unresponsiveness, lethargy and meningeal irritation, with bulging soft spot on the head of infants or stiff neck and back in older children, and respiratory distress. Progressing stupor or coma is common.

Incubation period: Unknown, probably 2-4 days.

Transmission: Contact with droplets and discharges from nose and throat during the infectious period. Prevention: Primarily by immunization with Haemophilus influenzae b (Hib) conjugate vaccine, and secondarily by appropriate antibiotic treatment to suppress infection and prevent transmission. Period of communicability: As long as organism is present, becoming non-communicable 24-48 hours after starting antibiotic therapy.

Isolation: Requires respiratory isolation of the case until 48 hours after beginning antibiotic therapy. 7. Obtains list from case of all contacts from 4 days before onset of fever and vomiting until 48 hours after

starting antibiotic therapy.

8. Refers to the most current editions of the APHA ―Control of Communicable Diseases,‖ AAP Red Book, and pediatric reference texts for specific treatment recommendations.

9. Refers case to their personal health care provider for questions regarding treatment. If clinical care providers request information regarding standard treatment regimens, an epidemiologist can provide them with such general information.

10. Verifies index case has received Rifampin therapy as appropriate, as described in The Red Book. 11. Recommends case under 2 years of age be immunized against H. influenzae b even after illness

(patients under 2 years do not develop immunity).

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

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not possible, staff sends a hardcopy of the completed report to the DOH Data Compiler. (See Appendix D for address.)

MANAGEMENT OF CONTACTS

1. Recommends Rifampin treatment for all household contacts (including adults, except pregnant women) under the following circumstances:

a. In households where there are children (other than the case) less than 4 years old who are under-immunized or unimmunized with Hib vaccine.

b. In households where there are children (other than the case) less than 12 months old, regardless of whether they completed the primary series of Hib vaccine.

c. In households where there are immunocompromised children. d. For staff and children in child care centers:

e. When 2 cases occur among the children within 60 days and; f. When children less than 2 years old have been exposed. 2. Informs contacts of disease as above.

3. Advises contacts to seek care immediately from their health care provider if they become ill. 4. Maintains surveillance of contacts under age 6 (including those in household day care centers and

nurseries, especially infants) for signs of illness for one week from last exposure.

MANAGEMENT OF COMMUNITY

1. Notifies the ERC if indicated, who will coordinate agency-wide activities including any or all of the following as appropriate:

a. Consults with the SRHD Health Officer to initiate control measures if a childcare center is involved or outbreak is indicated.

b. Initiates an ERNIE Team meeting if indicated.

c. 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.

d. Coordinates with the SRHD Public Information Officer to distribute the Public Health Press Release as outlined in this manual.

e. Coordinates with SRHD Health Officer to issue Provider Alerts to ERs/Urgent Care facilities, primary care facilities, hospitals, labs, nursing homes, or other care providers, if indicated.

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