Infectious Disease Epidemiology Program
Infectious Disease Outbreak Investigation and Management
In Arizona, healthcare providers, healthcare institutions, correctional facilities, and administrators of schools and shelters are required to report outbreaks of infectious diseases to their local health department under Arizona Administrive Code (A.A.C.) R9-6-202 and 203 and Arizona Revised Statutes (A.R.S.) Title 36. Hotels, motels and resorts are also required to report contagious or epidemic diseases occuring in their establishments within 24 hours under A.R.S. Title 36, Chapter 6, Article 2.
The Office of Infectious Disease Services provides support for local health departments in outbreak investigations by coordinating clinical and environmental specimen testing at the Arizona State Public Health Laboratory (ASL); and managing statewide outbreak related data. ADHS also works closely with the Centers for Disease Control and Prevention (CDC), the Arizona Department of Agriculture, the Food and Drug Administration (FDA) and the US Department of Agriculture (USDA) for support and collaboration on multistate investigations.
Outbreaks are reportable to ADHS within one working day after a local health department receives a report (A.A.C. R9-6-206F). The information provided at time of report includes:
- Location/setting of outbreak
- Number of ill cases and susceptible cases
- Date the outbreak reported to local and state health
- Infectious disease etiology suspected
- Contact information
The goals of outbreak investigation and management in Arizona are to:
- Decrease the number of outbreaks by improving outbreak response and prevention
- Identify specific areas of improvement for outbreak investigation and reporting
- Collate data on all reported outbreaks in a centralized and standardized manner
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Arizona Outbreak Performance Goals
Arizona has defined three performance goals for outbreak tracking and response. These are:
- >90% of reported outbreaks will have an investigation initiated within 24 hours of receipt of report
- >95% of outbreaks will be reported to ADHS by the local health department within 24 hours of receipt of report
- Reports of 100% of investigations will be forwarded to ADHS within 30 days after completion of investigation
What is an Outbreak?
An outbreak is defined as an increase in cases of disease in time or place that is greater than expected. If a condition is rare (e.g. measles) or has serious public health implications (e.g. bioterrorism agent), an outbreak may involve only one case. When two or more cases in the same outbreak have a laboratory result involving the same etiologic agent, the outbreak is considered to be laboratory confirmed.
Local and state epidemiologists are responsible for outbreak investigations involving Arizona residents regardless of where they were exposed. Outbreaks involving residents from multiple states are usually coordinated by CDC. Investigations into the source of an outbreak can depend on the etiology involved (viral, bacterial, parasitic or chemical), the mode of transmission (foodborne, waterborne, environmental, person-to-person), or the outbreak setting (restaurant, hospital or assisted living facility, school or community).
A prioritization matrix has been developed that ranks the investigation priority for a single case and for an outbreak of each morbidity, and includes supporting notes. This document serves as a reference health departments when multiple simultaneous investigations occur and can help determine the urgency for which investigations must be initiated and the priority for which staff should be assigned to assist with each investigation.
Infectious Disease Outbreak Categories
Most infectious disease outbreaks can be classified into the following categories. These are:
- Foodborne or Waterborne Outbreaks
- Vectorborne or Zoonotic Disease Outbreaks
- Respiratory or Influenza-Like Illness Outbreaks
- Vaccine Preventable Disease Outbreaks
- Healthcare-associated Infection Outbreaks
To monitor Arizona’s progress in detecting and responding to reported outbreaks, ADHS and the local health departments developed a standardized outbreak summary form based on the CDC performance indicators.
The Outbreak Summary Form consists of the following sections:
- Reporting agency (including outbreak report date and completion of final report)
- Outbreak demographics (number of cases, outbreak dates, age/sex, severity, symptomatology, incubation period and duration of illness)
- Implicated agent, toxin or chemical and case definitions used
- Exposure and transmission (type of outbreak, setting, mode of transmission, source of outbreak)
- Outbreak investigation methods
- Reporting of outbreak to National Outbreak Reporting System (NORS)
Local health departments are required to complete an outbreak summary form for 100% of outbreak investigations and forward it to ADHS with 30 days after completion of investigation. The health departments are also encourgaed to enter outbreak information into CDC’s National Outbreak Reporting System (NORS)
The Outbreak Summary Form - Outbreak Summary Form
Any cluster of illnesses regardless of etiology should be reported to the local health departments
Specimen Collection Information (for use by local health agency only)
- Outbreak Specimen Collection- Quick Sheets:
- Sample Patient Instructions on collection of specimens
- Outbreak Lab Manual
Arizona State Public Health Laboratory Resources and Forms