Tennessee Department of Health: Emerging Infections Program

About

Tennessee Department of Health
Vanderbilt University School of Medicine, Department of Preventive Medicine
Centers for Disease Control and Prevention

Welcome to the Tennessee Emerging Infections Program site! It will introduce you to the people and projects of the Tennessee EIP.

The Emerging Infections Program (EIP) is a population-based network including the Centers for Disease Control and Prevention and state health departments, working with collaborators (academic centers, local health departments, infection control practitioners, and other federal agencies) to assess the public health impact of emerging infections and to evaluate methods for their prevention and control.

Currently, the EIP Network consists of 10 sites: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon and Tennessee.

The Tennessee Emerging Infections Program (EIP) is a collaborative effort of the Communicable and Environmental Disease Services section of the Tennessee Department of Health, the Vanderbilt University School of Medicine Department of Preventive Medicine, and the Centers for Disease Control and Prevention. From December 1999 until December 2002, the following eleven counties in Tennessee were involved in the EIP: Cheatham, Davidson, Dickson, Hamilton, Knox, Robertson, Rutherford, Shelby, Sumner, Williamson and Wilson. In January 2003, the entire state became part of one major program of the EIP, the Foodborne Diseases Active Surveillance Network (FoodNet).

The core activity of the EIP is active surveillance of laboratory-confirmed cases of reportable pathogens. Laboratory directors and staff, physicians, nurses, infection control practitioners and medical records personnel are key participants in EIP. Components of the EIP in Tennessee investigate foodborne infections (FoodNet), invasive bacterial infections (ABCs) and unexplained encephalitis (TUES).

Programs

Active Bacterial Core Surveillance (ABCs)

At 10 Emerging Infections Program sites (EIPs), laboratory-based surveillance is conducted for invasive bacterial diseases due to pathogens of public health importance. For each case of invasive disease in the study population, a case report with basic demographic information is filed and, in most cases, bacterial isolates from a normally sterile site from patients are sent to CDC for laboratory study.

Objectives:

To determine the incidence and epidemiologic characteristics of invasive disease due to Group A Streptococcus, Group B Streptococcus, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus in several large populations.
To determine molecular epidemiologic patterns and microbiologic characteristics of public health relevance for isolates causing invasive infections from select pathogens.
To provide an infrastructure for further research, such as special studies aimed at identifying risk factors for disease, post-licensure evaluation of vaccine effectiveness, and monitoring effectiveness of prevention policies.

Pathogens under Surveillance:

Group A Streptococcus (GAS)
Group B Streptococcus (GBS)
Haemophilus influenzae
Neisseria meningitidis
Streptococcus pneumoniae
Methicillin-Resistant Staphylococcus aureus (MRSA)

Surveillance Catchment Area:
The total population nationwide under surveillance is approximately 39 million. Residents of Cheatham, Davidson, Dickson, Hamilton, Knox, Robertson, Rutherford, Shelby, Sumner, Williamson and Wilson coounties are included in our surveillance catchment area for all but one of the invasive pathogens listed above. For MRSA, however, Tennessee restricts the population just to Davidson county to ensure complete reporting and good audit data.

Current Projects:

Evaluation of Tetravalent Meningococcal Conjugate Vaccine Effectiveness
Among Persons Aged 11-19 years
Evaluation of Adherence to the 2002 Revised Guidelines for
the Perinatal GBS Disease
Respiratory Disease Activity

Pediatric Influenza Hospitalization Surveillance Project
Adult Influenza Hospitalization Surveillance Project
Protocol for Assessing the Effectiveness of Trivalent Inactivated Vaccine among Children Aged 6-23 months in Preventing Hospitalization with Influenza during the 2005-2006 Influenza Season

For more information, contact the ABCs Coordinator or RDA (Respiratory Disease Activity Coordinator) at (615) 322-6838.

Foodborne Disease Active Surveillance Network (FoodNet)

The Foodborne Diseases Active Surveillance Network (FoodNet) is the principal foodborne disease component of CDC's Emerging Infections Program (EIP). FoodNet is a collaborative project of the CDC, ten EIP sites (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, New Mexico, Oregon, and Tennessee ), the U.S. Department of Agriculture (USDA), and the Food and Drug Administration (FDA).
The project consists of active surveillance for foodborne diseases and related epidemiologic studies designed to help public health officials better understand the epidemiology of foodborne diseases in the United States.

Objectives:

Determine the burden of foodborne illness in the United States
Monitor trends in the burden of specific foodborne illness over time
Attribute the burden of foodborne illness to specific foods and settings
Disseminate information that can lead to improvements in public health practice and the development of interventions to reduce the burden of foodborne illness

Pathogens under Surveillance:

Bacterial Pathogens

Salmonella
Shigella
Campylobacter
Shiga-toxin producing Escherichia coli, including E. coli O157 and E. coli non-O157s
Listeria
Yersinia
Vibrio

Parasitic Pathogens:

Cryptosporidium
Cyclospora

Other Condtions under Surveillance:

Hemolytic Uremic Syndrome (HUS)

Surveillance Catchment Area:
In 1995, FoodNet surveillance began in five locations: California, Connecticut, Georgia, Minnesota and Oregon. Each year the surveillance area, or catchment, has expanded, with the inclusion of additional counties or additional sites (New York and Maryland in 1998, eleven counties in Tennessee in 2000 with statewide coverage in 2003, Colorado in 2001,and New Mexico in 2002 ). The total population of the current catchment is 44.1 million persons, or 15% of the United States population.

Current Projects:

E. coli 0157:H7 Antibiotic Exposure and the Risk of Hemolytic Uremic Syndrome (HUS)
Genetic Predictors of Developing Hemolytic Uremic Syndrome (HUS) following Infection with Shiga-toxin producing Escherichia coli (STEC)
Clinical Outcomes in Multi-Drug Resistant non-Typhi Salmonella Serotypes
FoodNet Case-Control Study of Selected Salmonella Serotypes
Clostridium difficile Infection Surveillance Through the Emerging Infections Program
Application of Spatial Analysis, at Three Geographic Scales, to Detect Clustering of Humans with Campylobacteriosis Reported to the Tennessee Department of Health (conducted at the University of Tennessee, Knoxville)
FoodNet Population Survey (conducted every other year by a CDC contractor)

For more information, contact the FoodNet Coordinator at (615) 741-7247.

Tennessee Unexplained Encephalitis Study (TUES)

Encephalitis, infection of the brain parenchyma, is a potentially devastating neurologic disease. Over 100 different viral, bacterial, fungal and parasitic agents have been associated with this syndrome, however in up to 75% of cases no pathogen is ever identified [1]. One reason for the high proportion of unexplained cases is the difficulty in culturing organisms causing encephalitis from cerebrospinal fluid (CSF).

In the last decade, diagnostic tests targeting species-specific genetic sequences such as the polymerase chain reaction (PCR) have emerged as rapid, highly sensitive methods to detect pathogens in the central nervous system (CNS) [2]. In response to the development of these improved diagnostic methods, the Emerging Infections Program (EIP) initiated encephalitis surveillance at 3 sites nation-wide. The Tennessee Unexplained Encephalitis Surveillance (TUES) study began in January 2000.

Objectives:

To identify pathogens causing encephalitis
To determine the epidemiology of encephalitis
To identify clinical outcome of encephalitis at 3, 6, and 12 months following infection
To devise clinically useful testing algorithms for laboratory diagnosis
To collaborate with investigators on discovery of novel pathogens causing CNS infection

Inclusion Criteria:

Altered mental status > 24 hours
PLUS at least one of the following:
Fever (>38 C)
Seizures
Abnormal neurologic exam
Abnormal neuroimaging study (CT or MRI)
Abnormal EEG
CSF pleocytosis (>5 WBC/mm3)

Exclusion Criteria:

Age < 6 months of age
Outpatient evaluation
Immunocompromise (organ transplant, bone marrow transplant, or AIDS)

Study Protocol:
Study personnel will directly contact patients or their families to explain the study and obtain informed consent. After this is obtained, we will do the following:

Interview the patient or family member (over the phone) on possible risks or exposures related to the illness (takes approx. 10 minutes)
Call the lab to request shipment of left-over spinal fluid (CSF), serum (blood), and nasal or rectal swabs. No blood or spinal fluid is to be drawn specifically for study purposes.
Perform diagnostic testing on these specimens. Results will be communicated to the referring physician at the time they are available. A full testing report is sent to physicians involved in care of the patient and to the patient or family at completion of testing.
Mail a questionnaire asking about the patient’s recovery at 3, 6, and 12 months after hospitalization.

To find out more about the TUES study, or to enroll a patient, please call the TUES Study Coordinators at (615) 322-1519 or toll-free (877) 756-5800.

REFERENCES:

[1] Glaser CA, Gilliam S, Schnurr D, Forghani B, Honormand S, Khetsuriani N, Fischer M, Cossen CK, Anderson LJ. In Search of Encephalitis Etiologies: Diagnostic Challenges in the California Encephalitis Project, 1998-2000. Clin Infect Dis 2003; 6:731-42.
[2] Tang YW, Hibbs JR, Tau KR, Qian Q, Skarhus HA, Smith TF, Persing DH. Effective use of polymerase chain reaction for diagnosis of central nervous system infections. Clin Infect Dis 1999;29:803-6.

Publications

EpiNews

EPI-News is a newsletter which is published quarterly by Communicable and Environmental Disease Services to inform the public health community, the private medical community, and the general public on issues related to occurrence of diseases and notifiable conditions within the state.

To be placed on the mailing list for this publication, call 800-404-3006 or e-mail. To read the newsletter online, select an issue below:

News and Events

The Tennessee Food Safety Task Force is sponsoring a one-day session (February 19, 2009) on Food Recalls in Nashville. Representatives from state and federal public health agencies, the beef industry, food manufacturing and retail will provide their perspective on the steps leading to initiation of food recalls, as well as the implementation and impacts of food recalls. Speakers will participate in a panel discussion focusing on ways to improve communication, data sharing and decision making. In addition, panel members will discuss their perspective on interaction with the media and release of public information. For more details, please visit www.foodsafetytaskforce.org.

The Annual Tennessee EIP Scientific Sessions are held yearly in Nashville. Featured speakers will present FoodNet and ABCs data gathered via active surveillance. Laboratorians, infection control practitioners, health information specialists, physicians, nurses, pharmacists, and other interested health care professionals are invited. There is no registration fee, but registration is required. Call Terry McMinn at 615-322-5874 to register. Watch this website for details about speakers and topics.

Related Sites

Tennessee Department of Health

Health programs and services. Health, data, and much more.

Tennessee.gov/health

Centers for Disease Control and Prevention

Search the CDC's website for health information, publications, data and statistics, traveler's information, employment opportunities, and much more.

http://www.cdc.gov
http://www.cdc.gov/foodnet
http://www.cdc.gov/abcs
http://www.cdc.gov/mmwr

Vanderbilt University

An introduction to the university's colleges and schools, the Medical Center, research and libraries.

http://www.vanderbilt.edu

Contact

Foodnet

FoodNet Coordinator
Tennessee Department of Health
Tennessee Emerging Infections Program
Communicable and Environmental Disease Services Section
1st Floor, Cordell Hull Building
425 5th Avenue North
Nashville Tennessee 37243
Phone: 615-741-7247
Fax: 615-741-3857

FoodNet Logo

Active Bacterial Core Surveillance (ABCs)

ABCs Coordinator
Tennessee Emerging Infections Program
Vanderbilt University Medical Center
Preventive Medicine
Village at Vanderbilt
1500 21st Avenue South, Suite 2600
Nashville, Tennessee 37212
Phone: 615-322-6838
Fax: 615-343-8722

ABCs Logo

Tennessee Unexplainted Encephalitis Study (TUES)

TUES Coordinator
Tennessee Emerging Infections Program
Vanderbilt University Medical Center
Preventive Medicine
Village at Vanderbilt
1500 21st Avenue South, Suite 2600
Nashville, Tennessee 37212
Phone: 615-322-1519
Fax: 615-343-8722

Respiratory Disease Activity (RDA)

RDA Coordinator
Tennessee Emerging Infections Program
Vanderbilt University Medical Center
Preventive Medicine
Village at Vanderbilt
1500 21st Avenue South, Suite 2600
Nashville, Tennessee 37212
Phone: 615-322-6838
Fax: 615-343-8722

Department of Health
Susan R. Cooper, MSN, RN, Commissioner

About

Welcome to the Tennessee Emerging Infections Program site! It will introduce you to the people and projects of the Tennessee EIP.

Programs

Active Bacterial Core Surveillance (ABCs)

Foodborne Disease Active Surveillance Network (FoodNet)

Tennessee Unexplained Encephalitis Study (TUES)