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Immediately Notifiable Conditions in Washington State and Neighboring Jurisdictions
January 2007                                                                                                            Vol. 12, No. 1

    epiTRENDS
    P.O. Box 47812
    Olympia, WA 98504-7812


 
Mary C. Selecky
    Secretary
  Maxine Hayes, MD, MPH
    State Health Officer
  Jo Hofmann, MD
    State Epidemiologist for
    Communicable Diseases
  Deborah Todd, RN, MPH
    Managing Editor
  Marcia J. Goldoft, MD, MPH
    Scientific Editor

Communicable diseases continue to be common and serious threats to health, both for the individual and for society.  In almost all jurisdictions, selected communicable conditions are reportable to public health authorities.  The purpose of notifiable conditions reporting is to provide information which can be used to conduct timely investigations and public health control interventions with the goal of limiting morbidity and mortality.

Notifiable Conditions

In this country, states participate in a cooperative and voluntary disease  tracking system that reports to the United States Centers for Disease Control and Prevention (CDC).  A jointly established national list of notifiable conditions includes communicable diseases reported by most states.  However, each state can and typically does establish its own reporting requirements.  Disease reporting sources may include health care providers, laboratories, hospitals and others.  Reporting requirements vary by reporting source.

All disease intervention involves similar core activities for each case which include detection, reporting, and investigation in a timely manner.  The appropriate timeliness, including requirements for immediacy of reporting, depends on the disease or condition and the reason for tracking it.  A condition may be immediately notifiable for urgent case treatment (e.g., tetanus), because it is highly contagious (e.g., measles) or if there is ongoing risk to the community (e.g., bioterrorism agent).  Prompt public health interventions for immediately notifiable conditions can control spread and reduce morbidity and mortality.

The definition of an immediately notifiable condition varies from state to state and across international borders and reflects perceived risk to the population.  Factors that influence perceived risk may include severity of cases or outbreaks, ease of transmission, and the rarity or frequency of cases.  The Washington Administrative Code designates a subset of notifiable conditions (“immediately notifiable conditions”) for Washington State that are of urgent public health importance and must be reported immediately when suspected or diagnosed.

Pacific Northwest Emergency Management Agreement ("PNEMA")

In 1996-97, states in the U.S. Department of Health and Human Services Region X (Washington, Oregon, Idaho, and Alaska) and two Canadian provinces or territories (British Columbia and Yukon) signed the Pacific Northwest Emergency Management Arrangement (PNEMA).  In 1998, PNEMA was authorized by the U.S. Congress as required under the U.S. Constitution whenever a state enters into an agreement with either another state or country.  PNEMA is the first and to date only international civil emergency preparedness and response agreement that has received such congressional approval.  Most recently, PNEMA implementing procedures, called Annex B, were signed by the government leaders of Washington State and British Columbia.  It is expected that the remaining PNEMA states and Yukon will sign Annex B during 2007.

PNEMA provides for cooperative activities to improve civil preparedness and response across jurisdictional boundaries.  Response planning involves comprehensive and coordinated preparedness and response measures.   A timely regional response to a natural, technological, or intentional disaster would provide better public health intervention.  In addition to sharing warnings and notifications across boundaries, PNEMA provides for sharing of public health information, specimens, and laboratory data.  In event of a large scale emergency, mutual assistance would include sharing resources including health care personnel.  PNEMA also provides for movement of evacuees or refugees.

Cross-Border Surveillance

Like emergencies, notifiable conditions do not follow political boundaries.  Infected travelers or contaminated products can cause widespread outbreaks.  In order to respond and control an outbreak, public health activities must also cross boundaries.  In the past decade, Washington and British Columbia have cooperated on investigations of several foodborne outbreaks of Salmonella spp., E. coli O157:H7 and V. parahaemolyticus.  There also have been investigations of possible cross-border exposures to avian influenza H7N3 and poliomyelitis.

Strengthening cross-border surveillance will focus on coordination, prioritization and streamlining of surveillance activities.  As part of PNEMA activities, DOH compiled a table comparing disease reporting across PNEMA jurisdictions.  There are differences in requirements for conditions and for immediacy of reporting (Table).  The time frame for routine reporting varies from one working day in Oregon to three days in Washington, three working days in Yukon and Idaho, five working days in Alaska, and seven days in British Columbia.

In addition to routine reporting, the jurisdictions each have a list of immediately notifiable conditions.  Some conditions are immediately notifiable or reportable with 24 hours by health care providers across all PNEMA jurisdictions: anthrax, botulism, diphtheria, measles, meningococcal disease, plague, polio, and human rabies.  In contrast, a few conditions are immediately notifiable in only one jurisdiction such as cryptosporidiosis (British Columbia) and mumps (Yukon.)  Finally, there are conditions immediately notifiable in some jurisdictions and not notifiable in others, including invasive group A streptococcal disease, relapsing fever, and typhus.

Through a series of annual cross border workshops, epidemiologists in United States and Canadian Pacific Northwest jurisdictions have been working towards establishing systems to transmit information quickly and efficiently about communicable disease events to their neighbors.  One step involves identifying the commonalities and differences between notifiable condition reporting standards.  This multi-jurisdictional list of notifiable conditions was developed to assist alerting decisions to neighboring jurisdictions when cases involving these agents are encountered.  It is the responsibility of the Washington State Department of Health’s Communicable Disease Epidemiology section (DOH CDES) to notify other states and British Columbia when these conditions are identified.  To facilitate timely reporting by DOH to other states and British Columbia, Local Health Jurisdictions (LHJs) in Washington are requested to immediately notify CDES when suspected cases are identified in their jurisdiction.

Cross-border activities such as the PNEMA Agreement develop a coordinated public health response across borders.  Reciprocal notification, coordinated disease surveillance, and joint investigations will improve public health services for all involved jurisdictions.

_________

The table below compares reporting requirements across PNEMA jurisdictions.

Infectious Diseases Immediately Reportable by Health Care Providers

(for PNEMA members:  British Columbia, Yukon, Alaska, Idaho, Oregon and Washington)
 

Infectious Diseases

BC

YK

AK

ID

OR

WA

Anthrax

Immed

1 working day

Immed

Immed

Immed

Immed*

Botulism

Immed

Immed

Immed

Immed

Immed

Immed

Brucellosis

Immed

1 working day

Immed

Cholera

24 hours

1 working day

reportable as "vibriosis"

1 working day

reportable as "vibriosis"

Immed

Cryptosporidiosis

24 hours

Cyclosporiasis

24 hours

 

Diphtheria

Immed

Immed

Immed

Immed

Immed

Immed

E. coli, enterohemorrhagic

24 hours

Immed

E. coli 0157:H7 only

1 working day

Immed

Group A streptococcal disease, Invasive

24 hours

Immed

 

 

Haemophilus influenzae, invasive

24 hours

Immed

1 working day

24 hours

Immed

Hantavirus pulmonary syndrome

Immed

1 working day

 

1 working day

Hemorrhagic viral fevers

Immed

 

Immed

Extraordinary

Uncommon

Rare

Hemolytic uremic syndrome (HUS)

24 hours

 

 

1 working day

Immed

Hepatitis A

24 hours

1 working day

1 working day

Immed

Hepatitis B

1 working day

1 working day

Hepatitis E

24 hours

reportable as “hepatitis nonA, nonB, nonC"

 

 

 

reportable as "viral hepatitis, unspecified"

Legionellosis

 

1 working day

Listeriosis

24 hours

Immed

Measles (Rubeola)

Immed

Immed

Immed

1 working day

24 hours

Immed

Meningococcal disease, invasive

24 hours

Immed

Immed

1 working day

24 hours

Immed

Mumps

Immed

Norovirus

 

 

 

1 working day

 

 

Paralytic shellfish poisoning (PSP)

Immed

 

Immed

Extraordinary

Immed

Immed

Paratyphoid

24 hours

reportable as "salmonellosis"

reportable as "salmonellosis"

reportable as "salmonellosis"

reportable as "salmonellosis"

Pertussis (whooping cough)

1 working day

1 working day

Immed

Plague (Yersinia pestis)

Immed

1 working day

Immed

Immed

Immed

Immed

Poliomyelitis

Immed

Immed

Immed

1 working day

24 hours

Immed

Q Fever

 

 

1 working day

1 working day

Rabies, human

Immed

Immed

Immed

Immed

24 hours

Immed

Relapsing fever

 

 

 

reportable as "borrelia"

Immed

Rubella

1 working day

Immed

1 working day

24 hours

Immed

Salmonellosis

24 hours

1 working day

Immed

Severe acute respiratory syndrome (SARS)

Immed

Immed

Immed

1 working day

Immed

Rare

Shigellosis

24 hours

1 working day

Immed

Smallpox

Immed

Immed

Immed

Immed

Uncommon

reportable as "disease of suspected bioterrorism origin"

Streptococcus pneumoniae infection, invas.

24 hours

 

 

 

Tetanus

Immed

Tuberculosis

Immed

Immed

Tularemia

Immed

1 working day

Immed

Immed

Uncommon

Typhoid

24 hours

Immed

reportable as "salmonellosis"

reportable as "salmonellosis"

reportable as "salmonellosis"

Typhus

 

 

 

Extraordinary

reportable as "rickettsia"

Immed

Vibriosis

24 hours

 

Extraordinary

24 hours

West Nile virus infection

24 hours

1 working day

reportable as "arthropod  vector-borne"

reportable as "arboviral disease"

Yellow fever

1 working day

Extraordinary

reportable as "arthropod  vector-borne"

Immed

 

 

 

 

 

 

 

Generalized Categories

BC

YK

AK

ID

OR

WA

Foodborne illness, all causes

24 hours

1 working day

 

1 working day

 

Immed**

Waterborne illness

24 hours

 

 

1 working day

 

Immed**

Gastroenteritis outbreaks (bacterial; parasitic; viral)

24 hours

Immed

 

 

 

 

Meningitis /Encephalitis (bacterial, viral  or other)

24 hours***

1 working day

 

 

 

Disease of suspected bioterrorism origin (Washington)

 

 

 

 

 

Immed

Extraordinary occurrence of illness (Idaho) including  syndromic clusters with or without etiologic agent

 

 

 

1 working day

 

 

Rare diseases of public health significance (Washington)

 

 

 

 

 

Immed

Uncommon illness of potential public health    significance (Oregon)

 

 

 

 

Immed

 

Unexplained critical illness or death (Washington)

 

 

 

 

 

Immed

Unusual number or clustering of diseases or other conditions of public health importance

 

 

Immed

 

 

 

Shaded boxes denote “accelerated” reporting timelines (i.e., reported immediately, within 24 hours, or within 1 working day, depending upon jurisdiction and/or condition).

√ = Reportable within routine reporting timeline (see below for timelines by jurisdiction)

* Suspected bioterrorism only

** Clusters only

*** With the exception of viral encephalitis which is reportable within routine reporting timeline

R = May be reportable as "Rare disease of public health significance" (immediately reportable)

U = May be reportable as "Uncommon disease of public health significance" (immediately reportable)

E = May be reportable as "Extraordinary occurrence of illness…" (reportable within 24 hours)

Blank space = not specifically mentioned as reportable condition in health care provider reporting guidelines for this province, territory or state.  May be reportable by laboratories instead or reportable by health care providers under a more general category such as "Uncommon disease of public health significance."

       Routine reporting timelines by jurisdiction:
       BC: 7 days    YK: 3 working days    AK: 5 working days    ID: 3 working days    OR: 1 working day    WA: 3 days
 


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