Public Health Week: Communicable Disease Control

Editor's Note: For National Public Health Week, the Tacoma-Pierce County Health Department is sharing stories of their work with community partners invested in the health of Pierce County. Here is Jeni Nybo, Nurse Epidemiologist, Communicable Disease Prevention.

My public health journey started in 2000 as a Family Based Nurse, but for the past two years I have been fortunate to work as a Nurse Epidemiologist within the Communicable Disease Prevention Division. Communicable diseases have always intrigued me. Some have been controlled by vaccinations, sanitation and modern technology, while others are emerging or resistant to drug treatment. Disease prevention and control is a cooperative effort involving healthcare providers, local and state health department personnel and members of the community. Our team of seven investigates all non-STD communicable diseases, and case manages all TB patients, refugee arrivals and pregnant women who are chronically infected with hepatitis B, analyzes disease reports, reviews risk factors, protects exposed individuals and families, develops guidelines for disease prevention and control, and plans and responds to communicable disease outbreaks.

Communicable Disease Control in Pierce County by the numbers

76 (# of diseases that must be reported to the Health Department)

One of the things I enjoy most about my job is that I never know what the next phone call or fax will bring. To give you an idea of what I do, here are snapshots from a day in my life, Friday, September 9, 2011.

• I arrive to work and review the faxes that have come in overnight. When a lab or healthcare provider identifies specific diseases, they report these illnesses to us. We received a report of a positive shiga toxin (e coli). We have a rotating list of staff that handle cases, so I pass this one on to the next person on the list.

• I am on-call this week, so I turn on my computer and review recent hospital data to learn if there are any unusual increases in types of illnesses or age groups seen in local emergency rooms. This information can be an indicator of what is happening in our community. I then report this data daily to the team.

• A few days ago, I received a call from a woman who had spent what was supposed to be a relaxing weekend at a cabin in the mountains but had an unexpected guest. A bat got into the cabin through a hole in the ceiling and roosted just above the bed. She did not think she had been bitten, but could not be sure.

Bats are the only known carriers of rabies in Washington and that rabies is usually fatal, so I recommend she receive preventive care and refer her to the local ER for her initial doses of prophylaxis. She called again the next day; she has no insurance, no primary care provider and limited income. She cannot afford the treatment that can run $2,000-$3,000, so today we are applying for Patient Assistance from the drug manufacturer. If approved, the company will provide the rest of the necessary preventive vaccine free of charge. She has hope.

• There’s another child pertussis case on the fax; there have been a lot of them this year. It’s my turn, so I review the electronic medical record to learn more about the case. I call the healthcare provider to confirm they have the results and ask if this is a good time to contact the parents. When I call, we talk about the illness, when the symptoms started and how the illness has progressed. These parents have made the decision not to vaccinate the child. I ask if others in the house are ill and if the child has any other health conditions. We talk about who the child has been in contact with because some people (infants and late stage pregnant women) could be at high risk for complications if they develop whooping cough. I ask how many times the child saw a healthcare provider for this illness so we can follow up with these providers to learn if they took appropriate protective steps to prevent exposure within their offices. Mom has to keep the child home and not have outside visitors until after the child has completed all five days of antibiotics. I confirm that the rest of the household has been prescribed antibiotics. After we hang up, I complete the case report and enter it into the database so it can be reviewed by the state Department of Health.

• We receive a confirmatory Lyme disease test results. This is unusual in our county, so I consult with the Department of Health Communicable Disease Epidemiology Section about this case.
• One of my co-workers has been working with a patient who was bitten by a stray cat while traveling in Cambodia. She and I discuss interactions between anti-malaria medications and rabies vaccines before leaving the office.

I close my door to leave for the day. I truly enjoy my work. I never know what is going to happen from one day to the next. Together, the CD Epi team works to prevent the emergence and spread of communicable diseases. We collect and analyze reports, study risk factors and take steps to protect exposed individuals and families. We are public health, and our phones are ringing!