Download her special presentation

Proposal to Amend
Health Code Articles 11 & 13
Marci Layton, MD
New York City Department of Health and Mental Hygiene
Articles 11 & 13
• Article 11 regulates surveillance and
control activities for the diseases,
conditions, and events that providers
and labs must report to the Department
• Article 13 regulates the manner in which
lab tests must be performed and
reported to the Department
Amendments to
Articles 11 & 13
The requirements for reportable diseases,
conditions, and events periodically need
updating as:
•
•
•
•
New diseases emerge
Monitoring is no longer necessary for others
NYS Public Health Law is updated
Testing technologies evolve
7 Proposed Amendments to
Articles 11 & 13
• 1 will reduce unnecessary reporting
burden on providers and labs
• 2, 3 and 4 will update requirements for
reporting and case isolation
• 5 and 6 will augment testing and reporting
by providers and labs
• 7 will maintain critical lab testing capacity
in NYC
Amend Diseases Reportable
by Providers & Labs
1. Remove Hepatitis D and E and “other
suspected viral hepatitides” from list
• Hepatitis D is uncommon in the U.S. and can
only exist in the presence of hepatitis B
• Hepatitis E is uncommon in the U.S., usually
linked to foreign travel, and has no treatment
• Other infectious hepatitis strains are
extremely rare
7 Proposed Amendments to
Articles 11 & 13
• 1 will reduce unnecessary reporting
burden on providers and labs
• 2, 3 and 4 will update requirements for
reporting and case isolation
• 5 and 6 will augment testing and reporting
by providers and labs
• 7 will maintain critical lab testing capacity
in NYC
Clarify Requirements for
Disease Reporting
2. Add Zika virus to the list of named acute
arboviral infections
• Suspected and confirmed cases of acute
arboviral infections are reportable
• Currently, 13 viruses are named including
chikungunya and dengue
• Addition of Zika is for clarity
• No change in reporting obligations for
providers and labs
Update Requirements for
Immunization Reporting
3. Allow non-written consent for reporting
of adult immunizations
• Written consent is a barrier to reporting
• New York State Public Health Law was
amended in 2013 to allow non-written
consent for immunization reporting to State
and City registries
Clarify Requirements for
Isolation of Cases
4. Add varicella to list of diseases for
which isolation of cases is required in
hospitals and other clinical facilities
• Currently, 16 diseases are named, including
measles, mumps, smallpox, TB
• Varicella can be spread through the air
• In June 2016, a one-year-old baby developed
varicella after being exposed to infected
patients at a medical facility
7 Proposed Amendments to
Articles 11 & 13
• 1 will reduce unnecessary reporting
burden on providers and labs
• 2, 3 and 4 will update requirements for
reporting and case isolation
• 5 and 6 will augment testing and reporting
by providers and labs
• 7 will maintain critical lab testing capacity
in NYC
Augment Reporting for
TB in Children under 5 Years
• Providers are currently required to
report positive tests for TB infection for
this age group
• Young children have increased risk of
developing active TB and lifethreatening forms of TB
• From 2014-2015, 205 children < 5 years
were reported with latent TB infection
Augment Reporting for
TB in Children under 5 Years
5a. Require providers to submit positive
radiology reports and report initiation of
treatment for TB infection
5b. Require labs to report blood-based or
other tests positive for TB infection
• Will improve surveillance for high-risk group
and reduce burden of seeking radiology reports
• Will ensure providers rule out active disease
and start children on treatment
Augment Lab Reporting for
Syphilis
• Syphilis tests can be indeterminate
• Reporting of these not mandated
• If reported, indeterminate = positive
– Ensures that no case is missed
– Case and field investigation activities initiated
for many patients
– Providers, patients, partners contacted
• In 2015, 1968 indeterminate results were
reported in NYC  558 cases (33%)
Augment Lab Reporting for
Syphilis
6. Require labs to report indeterminate
syphilis results and perform a second test
on the same specimen, then report the
results of that test (if also indeterminate,
additional testing is not required)
• Will enable prompt treatment and reduce risk of
disease progression and transmission
• Will allow for the focus of resources on patients
with confirmed infections and those exposed
7 Proposed Amendments to
Articles 11 & 13
• 1 will reduce unnecessary reporting
burden on providers and labs
• 2, 3 and 4 will update requirements for
reporting and case isolation
• 5 and 6 will augment testing and reporting
by providers and labs
• 7 will maintain critical lab testing capacity
in NYC
Cultures vs. CultureIndependent Diagnostic Tests
• Labs are increasingly using cultureindependent diagnostic tests (CIDTs) to
test for enteric pathogens, instead of
performing culture testing
• At least 2 labs in NYC no longer have
the capacity to perform culture testing
• Unlike CIDTs, culture testing produces
samples of the pathogen (“isolates”)
Cultures vs. CultureIndependent Diagnostic Tests
• Isolates are necessary for cluster and
outbreak detection, and especially for
controlling enteric diseases
• Continued use of culture testing of
enteric specimens is strongly
encouraged by:
– Association of Public Health Laboratories
– Centers for Disease Control and
Prevention
Require Labs to do Culture
Testing for Enteric Diseases
7. Require labs to perform culture testing
when a CIDT test is positive for
Campylobacter, Listeria monocytogenes,
Salmonella, Shigella, Vibrio, or Yersinia
and submit that isolate; for Shiga toxinproducing Escherichia coli (STEC), the lab
must submit an isolate or a Shiga toxinpositive broth and stool
• Will ensure labs in NYC maintain the capacity
to conduct these important tests
Require Labs to do Culture
Testing for Enteric Diseases
• At least 2 states (CT, CA) now mandate
reflex to culture testing and isolate
submission for select enteric diseases
• No negative feedback or payment issues
reported