BACKGROUND: Kentucky Epi Rapid Response Teams have been used locally to investigate outbreaks of illness. Teams are not generally deployed for a large, regional investigation. Influenza testing using PCR methods has been performed sporadically in Kentucky during past influenza seasons. The total PCR confirmed cases for Kentucky in 2014-2015 were 1,046 with the Fivco Region having 20 PCR confirmed cases.
METHODS: Beginning January 2016 a large medical system in the Fivco Region of Northeastern Kentucky began exclusively using PCR testing for influenza. This change created a massive influx of cases for the four local health departments located in the region. Per state reportable disease regulation, these cases had to be investigated and entered into electronic reporting system. A regional response was initiated on February 19, 2016. The four local health departments initiated a coordinated response to report case data, increase vaccination rates, investigate cases, gather pharmaceutical stock data and gather school/work attendance data. This coordination was accomplished by use of local health department Epi Rapid Response Teams. These are teams of health department employees who have been trained in basic epidemiology principles by the Kentucky Department of Public Health. Teams include registered sanitarians, public health nurses, health department directors and public health preparedness coordinators.
RESULTS: In total, 1,522 cases were reported for the Fivco Region and 58% of the cases were interviewed for data collection. 24.4% of the total cases were vaccinated and 54.4% of cases were 0-18 years old. The Fivco Area identified three long term care facility outbreaks, two childcare center outbreaks and two school closures for illness during the investigation time period. In total the Fivco Region health departments spent a total of 1,500 hours on this investigation and spent an estimated $45,000 on staff time and resources.
CONCLUSIONS: The Regional Epidemiologist and local health department Epi Rapid Response Teams were able to coordinate information exchange and contact investigation for the outbreak. As PCR technology becomes less costly, it should be anticipated that additional facilities in the state will switch to PCR testing for influenza. The use of Epi Rapid Response Teams, or similar teams, should be explored to increase local epidemiology capacity.