To Register for the Monthly Disease Surveillance Trainings: - PowerPoint Presentation

To Register for the Monthly Disease Surveillance Trainings:Contact your Service Surveillance HUB to receive monthly updates and remindersLog-on or Request log-on ID/password: https://tiny.army.mil/r/zB8A/CMERegister at: https://tiny.army.mil/r/MEHsS/EpiTechFY18Confirm attendance:Please enter your full name/email into the DCS chat box to the right or email your Service HUBYou will receive a confirmation email within 48 hours with your attendance record; if you do not receive this email, please contact your Service HUB ANNOUNCEMENT

Victoria HolbrookEpidemiologistEpidemiology Consult ServiceUSAF School of Aerospace MedicineDistribution D: DoD and Contractors OnlyArmed Forces Reportable Medical Events Guidelines and Case Definitions:2017 Updates

ObjectivesDescribe removals and additions to the 2017 Reportable Medical Events GuidelinesUnderstand the major changes to existing Reportable Medical Events Recognize the effect updates to the Guidelines have on daily business processes and how to begin addressing these gaps

Reporting RequirementsAir Force: AFI 48-105 “Surveillance, Prevention, and Control of Diseases and Conditions of Public Health or Military Significance”Navy: BUMED INST 6220.12C “Medical Surveillance and Medical Event Reporting”NMCPHC-TM-PM 6220.12 “Medical Surveillance and Reporting”

Overview Summary: General Guideline UpdatesBasic updates/changes to all Reportable Medical Events (RMEs)More aligned with national reporting guidelinesLanguage more aligned with what a user would find in AHLTA or CHCSConsistent, streamlined terminologyRestructured, simpler RME page formatsAdded “Travel Risks” to indicate high risk transmission or occurrence settings

Overview Summary: General Guideline UpdatesLaboratory acronym page included“Includes”, “Excludes”, “Common Name” statements added to some diseases for guidance and clearer identification

Overview Summary: RME Format Improvements 2012 Guidelines Required the user to look in several sections of the document to know if a case met the case definition 2017 Guidelines Requirements of the case definition are all in one section

Overview Summary: RME Additions/RemovalsAdded:Chikungunya Virus DiseaseNovel and Variant InfluenzaPost-Exposure Prophylaxis (PEP) against Rabies Added 01 March 2017Zika Virus Will no longer be reported as “Any other unusual condition”Removed:Acute Rheumatic Fever Streptococcus, Group A, Invasive

Overview Summary: Disease UpdatesAmebiasis – probable case classification addedArboviral Encephalitis – non-neuroinvasive arboviral disease added; name changed to Arboviral Diseases Cold Weather Injuries – probable case classification added Cryptosporidiosis – clinical symptoms are no longer required for reporting Dengue Virus Infection – suspected case classification removed Filarial Infections – probable case classification added Hantavirus Disease – non-pulmonary disease added Heat Illness – heat injury category removed; probable case classification added for heat stroke Measles – suspected case classification removed

Overview Summary: Disease UpdatesPertussis – probable case classification for infants added Rocky Mountain Spotted Fever – reporting of other rickettsiosis species added; name changed to Spotted Fever RickettsiosisSalmonellosis – suspected case classification addedShigellosis – suspected case classification added Syphilis – entire disease updated including laboratory criteria Trichinosis – suspected and probable case classifications added Tuberculosis – suspected case classification added Typhus Fever – removed Rickettsia species which are now included in Spotted Fever Rickettsiosis Varicella – reporting of all beneficiaries added

Individual RME UpdatesThe following slides will describe significant changes between the 2012 and 2017 case classifications, however, all RMEs have been updated.

2012 GuidelinesListed as “Encephalitis, Arboviral”2017 GuidelinesName changed to aboveIncludes Non-neuroinvasive disease (Probable and Confirmed case definitions)Arboviral disease, neuroinvasive and non- neuroinvasive

2012 GuidelinesProbable case definition requires only clinical compatibility and epi link to a confirmed caseConfirmed case definition only includes a positive EIA or culture2017 GuidelinesProbable case definition adds positive lab by any method other than cultureConfirmed case definition only includes a positive cultureCampylobacteriosis (Campylobacter species)

2012 GuidelinesReportable, but no case definition2017 GuidelinesNewly added case definitionNovel and Variant Influenza (Influenza A virus)

2012 GuidelinesAdditional Considerations indicate “not all outbreaks will require separate Medical Event Reports (MERs) for each case”2017 GuidelinesComments direct reporting of all cases in an outbreak if the etiologic agent is a MER unless otherwise directedFor example, in a Salmonella outbreak all cases should be reported individually if they meet a case definition, plus the outbreak should be reported in the Outbreak ModuleOutbreak or Disease Cluster

2012 GuidelinesNot in guidelines2017 GuidelinesNewly added (1 Mar 2017)Post-Exposure Prophylaxis (PEP) against Rabies

2012 GuidelinesIncludes Probable and Confirmed case classifications2017 GuidelinesAddition of a Suspect case classificationSalmonellosis (Salmonella species)

2012 GuidelinesListed under “Rocky Mountain Spotted Fever”Includes only R. rickettsii speciesIncludes only Probable and Confirmed case classifications2017 GuidelinesName changed to aboveIncludes and lists 7 additional Rickettsia species (which were previously reportable under Typhus Fever)Includes Suspect, Probable, and Confirmed case classifications Addition of new laboratory criteria for all case classifications Spotted Fever Rickettsiosis (Rickettsia species )

2012 GuidelinesListed as “Tuberculosis, Pulmonary”Includes Probable and Confirmed case classifications 2017 GuidelinesIncludes Suspected case classificationConsolidates the Probable criteria into the Confirmed case classification Tuberculosis ( Mycobacterium tuberculosis )

2012 GuidelinesIncludes reporting only Service Member cases2017 GuidelinesLists the common nameIncludes reporting of Service Members and all beneficiariesVaricella (Varicella-zoster virus)

2012 GuidelinesNot in guidelines; used AFHSB case definition2017 GuidelinesNo longer reportable as “Any other unusual condition”Zika Virus

Effects on Daily Business ProcessesCHCS ad hocsLab personnelProviders DRSi Case Finding Module CHCS reports Lab Providers Finding RMEs at base level

Effects on Daily Business ProcessesLaboratory System Support Center (LSSC)Lt Col Warren G. Conrow: warren.g.conrow.mil@mail.mil, (703) 681-7317Comm Disease weekly standupProstaffLab

Other NotesTri-Service Document – Still report Service-specific events (i.e. pediatric lead for AF)Updates to Critical Reporting Elements and commentsImportance of Event Related Questions

Service Specific Contact InformationAir Force: Contact your MAJCOM PH or USAFSAM/PHR USAFSAM / PHR / Epidemiology Consult Service Wright-Patterson AFB, Ohio COMM: (937) 938-3207   DSN: 798-3207 usafsam.phrepiservic@us.af.mil Navy : NMCPHC Preventive Medicine Programs and Policy Support Department COMM : (757) 953-0700; DSN: (312) 377-0700 Email : usn.hampton-roads.navmcpubhlthcenpors.list.nmcphc-threatassess@mail.mil Contact your cognizant NEPMU NEPMU2: COMM: (757) 950-6600; DSN: (312) 377-6600 Email: usn.hampton-roads.navhospporsva.list.nepmu2norfolk- threatassess@mail.mil NEPMU5: COMM: (619) 556-7070; DSN (312) 526-7070 Email: usn.san-diego.navenpvntmedufive.list.nepmu5-health-surveillance@mail.mil NEPMU6: COMM: (808) 471-0237; DSN: (315) 471-0237 Email: usn.jbphh.navenpvntmedusixhi.list.nepmu6@mail.mil NEPMU7: COMM (int): 011-34-956-82-2230 (local): 727-2230; DSN: 94-314-727-2230 Email: NEPMU7@eu.navy.mil