Sounding the Alarm
A notifiable infectious disease or condition necessitates regular, frequent, and timely information about individual cases of this disease in order to prevent and control it.
Notifiable Infectious Disease
A notifiable infectious disease or condition necessitates regular, frequent, and timely information about individual cases of this disease in order to prevent and control it. The list of nationally notifiable infectious diseases and conditions is periodically revised based on the emergence of new pathogens. For example, the Zika virus and congenital infection were recently added to this list as the epidemic progressed and cases were identified in the United States. A disease can also be removed from the list if its incidence declines. The list of nationally notifiable diseases is developed collaboratively by the Council of State and Territorial Epidemiologists (CSTE), local and state health departments, and the US Centers for Disease Control and Prevention.
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An important distinction between reporting an infectious disease to local/territorial/state health departments and their subsequent notification of the CDC is that the former is mandated and the latter is voluntary. This means that health care providers, hospitals, and laboratories are required to report cases to their appropriate departments of health. The information identifies the patient but is confidential. Proper identification (ensuring confidentiality according to the Health Insurance Portability and Accountability Act) is necessary at the local and state levels to ensure adequate protection of public health by providing treatment to those already ill; tracing contacts who might need vaccines, treatment, quarantine, or education; enabling the necessary investigation to stop disease outbreaks; eliminating environmental hazards; and closing premises where disease transmission may be ongoing. In contrast, the information reported to the CDC doesn’t include the patient’s identification. Only age, sex, and location are included in the report, in addition to the disease/condition; case status (confirmed, probable, or suspected); and the earliest event date (exposure or disease onset, diagnosis date, laboratory test or result date, or the date of report to the public health system).
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Notification TypesDepending on the nature of the infectious agent, the danger to the public, and the likelihood that it will develop into an epidemic, nationally notifiable infectious diseases are noted as extremely urgent, urgent, and standard when reporting to the CDC. According to the stage in infectious disease diagnosis, the cases are classified as suspected, probable, and confirmed.
- All cases prior to classification, such as possible bioterrorism or especially dangerous infectious agents (eg, anthrax, botulism, plague, tularemia, severe acute respiratory syndrome [SARS], diphtheria, Haemophilus influenzae, tetanus, and trichinellosis)
- Confirmed, probable, or suspect cases (eg, Lyme disease, malaria)
- Confirmed and probable cases (eg, chronic hepatitis B, hepatitis C, mumps, and salmonellosis) must be reported to the CDC according to their urgency classification
- Only confirmed cases (eg, cholera, rubella, rabies, and measles) must be reported to the CDC according to their urgency classification
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To report an infectious disease case that requires extremely urgent notification, representatives of public health agencies must call the CDC Emergency Operations Center at 770-448-7100 within 4 hours and submit an electronic case notification report the next business day. The CDC strongly encourages early communication, which should not be delayed if information is not yet verified or missing. The CDC official will follow up on the extremely urgent notification within 1 hour. In some situations, clinicians call the CDC directly, bypassing their local or state departments of health, to notify it of the infectious disease on the immediately notifiable list. In such cases, the CDC immediately informs the local or state department of health. As of January 1, 2016, infectious diseases that require extremely urgent notification are anthrax, botulism, plague, paralytic poliomyelitis, SARS, smallpox, tularemia, and viral hemorrhagic fever.
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Universal PrecautionsAll patients should be treated as though they have an infectious disease. As such, patients with diagnosed infectious conditions do not need special accommodations. Rather, universal precautions must be implemented when treating all patients. Following are a few strategies for the safe treatment of patients.
Follow the CDC Guidelines for Infection Control in Dental Health-Care Settings—2003; the CDC’s recently published Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care; and the Occupational Safety and Health Administration’s Bloodborne Pathogens Standard.
- Prevent occupational exposure to blood through the use of intraoral fulcrums and sharp instruments to ensure stability during scaling and root planing; donning personal protective equipment such as masks, gloves, eyewear, and a protective garment; limiting the use of fingers for retracting tissue; and implementing devices such as instrument cassettes and recap needles to avoid sharps injuries.
- Keep all immunizations up to date.
- Ensure the office has an exposure control plan.
- Remain up to date on infection control standards. The CDC and the Organization for Safety, Asepsis and Prevention (OSAP) are excellent resources.