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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.

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The table below compares reporting requirements across PNEMA jurisdictions.