Genesee Lagioneliesis Investigation
- From
- Shannon Johnson
- To
- Unknown recipient
Greetings GCHD,
Thank you for the opportunity to speak with you this morning. After being updated on where GCHD is in the
investigation process, we have identified same items that need additional details and/or may require additional data
gathering efforts, In addition, we've listed areas where we can provide personnel to assist with data collection/analysis
4
xxxEND_PAGE:dhhs03_b1000_3700_3713_04
003704
or aid in communication between the invelved governmental departrnents during the outhreak investigation. At this
point, the priorities in the public health investigation are te determing the scope of the outhresk and to define as clearly
as possible the characteristics of the cases of Legionnaire’s Disease and Pontiac Fever. These date will be critical to help
inform and pravide direction for the environmental side of the investigation.
Data being requested by MOCH and/or suesested dats collection needs to be addressed:
1} Please provide the name of the arimary point-of-contact for the overall GCHD legionellasis investigation,
2} The current copy of the GCHD Legionnaires Disease outbreak data collection line list is requested and updates
sent to MDCK ona regular basis.
3} Onset dates or astimated onset dates need to be determined far all cases.
4} A current map of the municipal water system needs to be obtained and cases’ residences magped in relation te
the water system.
5} The investigation needs a Genesee-specific supplemental questionnaire beyond the MDCH suoplemental form
and the 6 questions in the email message dated 10/17/14.
§} All previous cases (since 5/1/14) and new cases should be re-interviewed as soon as possible with the new
outbreak-specific questionnatre. If cases are not available, then a proxy should be interviewed, ideally sameone
fro the same household.
7} To look for cases of milder liness such as Pontiac Fever, the questionnaire should ask if there are other
household members who have had a similar respiratory iiness. Any household contacts with legieneilasis-
consistent flingss should alse be interviewed with the outbreak-specific quastionnaire.
8} Ciinical culture specimens, in addition to urine antigen testing, should be collected fram: all suspect cases where
individuals are seeking medical rare.
3} Hospitals should be queried to determine whether any previously diagnosed cases had respiratory cultures
collected and whether any of these culture specimens were retained. if se, it should be requested that these
samples be held until a determination on environmental testing can be made.
Assistance that MBCH can mravide te Genesee to aid in the outbreak investigation:
3} MDCH can provide language to GCHD for distribution to the medical community regarding the request for
‘cinical respiratory culture collection on all suspect cases of legionellosis (Legionnaire’s Disease and Pantiac
Fever}.
2} MDCH staff is available to conduct medical record extraction, as needed.
3} MIOCH staff can assist with data entry inte MOSS, a5 needed.
4} MOCH staff can help with the davelanment of a Genesea-spacific outbreak questionnaire.
5} MOCH is willing to assist with supplemental questionnaire data collection by conducting case Interviews {on
previously and/or newly diagnosed cases} and alse by assisting with data analysis, as needed.
8} MOCH can assist with the coordination and communication with MOEQ for specific data requests by GCHD.
7} The MOCH PIO can werk with the GCHD PIO to develop a coordinated public health message ta respand to
sublic and media inquiries.
W there are other Issues that we have not addressed where our assistance would be helpful, please do not hesitate to
ask. We appreciate your efferts and recognize the delicate situation you are dealing during this investigation, We lack
forward to continued communication and collaboration with you,
Regards,
Shannon Johnson
Shannon Andrews Johnson, MPH
infectious Disease Epideminlogist
xxxEND_PAGE:dhhs03_b1000_3700_3713_05
003705
Michigan Dept. ef Community Fle
204 Townsend St &M sth Freer
Larne: Ml 48s
Phere: S1PSBBR 8655
Fax: STBQSRSHS
* ihe
xxxEND_PAGE:dhhs03_b1000_3700_3713_06
903706
Data being requested by MDCH and/or suggested data collection needs to be addressed:
1)
Please provide the name of the primary point-of-contact for the overall GCHD legionellosis
investigation. Shuraag Hasan is {aad on the CO investigation. Jim Henry is the lead on the water
system investigation, Qur entire COIRT team is invelved Ip both investigations.
Shannon Johnsen will serve as the primary pointcof-contact for MDCH. Shannon will coordinate
directly with Shuroag and Jim at GCHR,
The current copy of the GCND Legionnaires Disease outbreak data collection line lst is
requested and updates sent to MDCH on a regular basis. Let us know the ime fable you are
pragasing. We would {ike {9 request a regwdar meeting schedule so we can discuss our mutual
findings.
The Genesee ling list will serve as the master line list for the outbreak investigation. The
Genesee fine list should be provided to MDCH weekly and any data gathered by MBCH will be
added.
Onset dates ar estimated onset dates need ta be determined for all cases. As discussed during
aur call, we can provide estimated anset dates. We would {ee your Inpe afd you prefer we
report the anse 2 regarted by the patient, their primary care physician or the {D Fhysician
cary a? There are differences. el isase keep this [np pind when reviewing the data.
For new cases, the onset date from the patientinterview should be used. Far alder cases, the
medical record should he used ta assist in determining the estimated anset date, The Influenza
Hospitalization Surveillance Project uses the following recommendations for determining
estimated onset dates from medical recards:
“tn some cases you will need te calculate the date of onset based an notes in the Acimission
H&P or Discharge Summary that indicate that fever or cough began days earlier.
a Couple of days = 2 days
o Few days = 3 days
o Several days=5 days
Qo Week = 7 days
© For example if a patient is admitted 10/15 (Day ) and the Adrnission H&P indicates the
patient complained of fever/cough far “a few” days, then the earliest date of onset of
respiratery symptoms is 10/12:
10/14 10/15 |
Day Number: —— er ee
rset Admission
xxxEND_PAGE:dhhs03_b1000_3700_3713_07
003707
xxxEND_PAGE:dhhs03_b1000_3700_3713_08
093708
&
a
3}
ae
if date of onset is provided as a range of dates, use the earliest date as date of onset of
respiratory symptoms,
a: For example, if a date of onset is given as “3 to five days ago”, Hat the date
corresponding te 5 days age.”
Gay
Number:
Onset “Admission
A current map of the municipal water system needs te be obtained and cases’ residences
mapped | in relation te the water system. As discussed in our call, we are experiencing difficulty
t ining ¢ the infarmation we have requested OWS and MOEA. We have sent the FON
r the current mas of the municipal water iste. As Miscussed during aur call, we
have mapne aur cases fa fook far commmanalities and to identify the proximity of & SENS)
hall water advisories.
MOCH will communicate with MDEQ about obtaining the water system maz. If you have the
information, please provide to MOCH a copy of the boil water acviseries (or dates} and the areas
they caver,
The investigation needs a Genesee-specific supplemental questionnaire beyond the MOCH
Se eats form and the 6 questions in the email message dated 10/17/14. As discuss!
By ing aut ta individuals 4 ‘
ally af anyone at MOCH has §
salt with, Aisa
nce of
irrantly . Wie are reac
g of our que ; ke limited cary
daal witch nm the queshians we Ae seed t
conversations with aur MOCH calleages.
MBCH doas not have staff with expertise in type 1 water supplies, this falls under the gurview of
MDEQ and the local water authority. MDCH is able to advise specifically on legionella related to
hurnarn Hiness. The compiled data provided by the cases on the questionnaire will be vite! te
directing the focus and scape of potential future environmental tasting.
Ageneral supplemental data form developed by MDCH was pravided to Genesee on 10/17/14.
MOCH will work with GCHD to develop a Genesee-specific quastionnaire for the outbreak.
All previous cases (since 5/1/14) and new cases should be re-interviewed as soon as possible
with the new outbreak-specific questionnaire, If cases are not available, then a proxy should be
interviewed, ideally someone fram the same household. Ses me notes below.
Ta look for cases of milder illness such as Pontiac Fever, the questionnaire should ask if there
are other household members who have had a similar respiratory illness. Any househald
contacts with legionellosis-consistent illness should alse be interviewed with the outhreak-
specific questionnaire. As discussed on the call in the review of our iwesitgadions, we have
found this and, we Nave been reperting dvs... and have regarted then iy MOS g ig the
xxxEND_PAGE:dhhs03_b1000_3700_3713_09
003709
neon
seeacnncerveretiié
xxxEND_PAGE:dhhs03_b1000_3700_3713_10
093710
Ee)
4)
i for tasting af clinical samples nat only af the patients, but, aise of their
Clinica! culture specimens, in addition to urine antigen testing, should be collected from all
suspect cases where individuals are seeking medical care. isseel in aur call, (his is what
we have requested fram MDC : IRR aad a we requeste te
aneiran
eenuieom, this may be e very be! iad
As detailed in the HAN language provided by MOCH to GCHD, hospitals should collect culture
specimens in addition to the urine antigen test. if an isolate of Legionella is found fram the
culture, the hospital will send the isolate te the MOCH Bureau of Laboratories for further
testing.
Hospitals should be queried to determine whether any previously dlagnosed cases had
respiratory cultures collected and whether any of these culture specimens were retained. If so,
it should be requested that these kee ne ae unt a determination on environmental
testing can be mada. This was di
PEGE: sting | mare in
MDCH can provide language to GCHO for distribution te the medical community regarding the
request for cilnical respiratory culture collection on all suspect cases of legionellosis
(Legionnaire’s Disease and Pontiac Fever). What we .
tasting Fotecals fers saps is cela
Faqugsted
age NE
would f
same of
Hospitals should be farniliar with testing orstonnlsd for legionella culture specimens. Ifa
legionella iselate is found by the hospital, the handling and shipment to Bot for additional
tasting is discussed in the language of the HAN.
MDCH staff is avataate te conduct medical record extraction, as needed. Medi¢al records are
attached in MOSS and we do not seed assistance with this at this time.
MDCH staff can assist with data entry into MOSS, as needed, Av this me, we do notneed
assistance with this, Mease see the naie Selow.,
MOCH staff can help with the development of a Genesae-specific authreak questionnaire, We
wefcame your participation in the revision af aur Genesee specific questionnaire. We Save
already received some helpful Faadeacicl fram our expert consultations.
We would like ta have an outhbreak-specific questionnaire finalized by the end of next week:
Friday Feb 13th. Per Shuroog, Genesee fs collaborating with Joan Rose from MSU on water
xxxEND_PAGE:dhhs03_b1000_3700_3713_11
003711
xxxEND_PAGE:dhhs03_b1000_3700_3713_12
-;, 003712
aks
system-specific questions. MDCH will begin creating a questionnaire template to be combined
with Genesee’s questions and a final version will be reviewed by both agencies.
MDCH is willing to assist with supplemental questionnaire data callectian by conducting case
interviews fon previously and/or newly diagnosed cases) and also by assisting with data analysis,
as needed. Qur CO nurses can adklrags newly dlagnased cases, We would Hite fo discuss MOCH’s
assistance for conducting imerviews with previously dlagenosedsintarsiowed cages.
MOCH staff members are available te assist with interviewing older casas. We can discuss this
issue further after the questionnaire is completed.
MBCKH can assist with the coordination and communication with MDEQ for specific data
requests by GCHD. As discussed in our call iNe are requesting MOCH assistance with obtaining
information fram MOEG, GCND has sent a FON ietter requesting the infarmation we have ot
been alts to obtain regarding fhe water syst
ather chaflenges we would request OCH a ip obtaining the information,
MDCH will communicate with MOEG about obtaining the water system map.
Eve
The MDCH PIO can werk with the GCHD PIO to develop a coordinated public health message to
respond to public and media inquiries. As discussed in our call, {he water system is an extremely
sensitive topic, We are very careful in crafting me
we Wil request it.
xxxEND_PAGE:dhhs03_b1000_3700_3713_13
003713
SLO EUE EWS SELESECEU RAE SUYECABEC EELS
xxxEND_PAGE:dhhs03_b1000_3700_3713_14