Review of Outbreaks in West Virginia, 2001-2013

BACKGROUND:   From 2001 through 2013, confirmed outbreaks increased 22-fold in West Virginia (WV); from 7 in 2001 to 164 in 2013.   During 2014, WV allocated resources to review outbreaks, evaluate the reasons for the increase and make recommendations for the future. 

METHODS:   Outbreak data collected from 2001 to 2013 were compiled using Microsoft Excel (2010) and analyzed using SAS 9.3 (Cary, NC). Data examined in the analysis include outbreak type, transmission setting, etiology, clinical diagnoses, and county, region, month, and year of reporting. Changes to reporting legislation (RL) were tracked on the WV Secretary of State website; infrastructure changes were also evaluated.   

RESULTS:   Of 1,030 confirmed outbreaks reported from 2001 to 2013, outbreaks of acute gastroenteritis (220 (21%)), influenza (183 (18%)), norovirus (123 (12%)), and acute respiratory syndrome (90 (9%)) were most common. Healthcare associated outbreaks (HAO) contributed 547 (53%) outbreaks, most commonly from long term care facilities (LTCFs), representing 490 (90%) HAOs. HAOs accounted for 15% of outbreaks in 2002 and 75% in 2013.    WV RL was modified to make outbreaks reportable to the LHDs within 24 hours in 1999;  then immediately reportable to LHDs in 2006; and reportable from all settings in 2013.   A standardized outbreak tracking form was implemented at the state level in 2006; and a standardized outbreak log in 2009. Major improvements in staffing occurred at the state level in 2002, 2006 and 2010, funded with state, Epidemiology and Laboratory Capacity and Public Health Emergency Response funding, allowing for the creation of an outbreak response team.  Regular trainings were provided to LHD staff and outbreak toolkits were created and posted online to support outbreak investigation.   Since 2002, annual outbreak reports were written and published on-line; a section on HAOs was added in 2009; and performance metrics were added in 2013.  Investigation of HAOs have increased dramatically after being listed as a priority in the state Healthcare Associated Infections Plan in 2009.

CONCLUSIONS:   Improvements in outbreak reporting and investigation can be attributed to policy changes; improvements in staffing, training, and outbreak tracking, data feedback and evaluation.  The increasing proportion of HAOs highlights the need to target healthcare facilities, particularly LTCFs, for education and training.