186275 Development of evidence based exclusion criteria for enteric diseases

Wednesday, October 29, 2008

Glen A. Thomazin, DO , Preventive Medicine, Loma Linda University, Loma Linda, CA
Manjit Singh Randhawa, MD , School of Public Health, Office of Public Health Practice, Loma Linda University, Loma Linda, CA
Claudine Munezero Kabera , School of Public Health, Department of Epidemiology, Loma Linda University, Loma Linda, CA
David E. Dassey, MD, MPH , Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA
Hildy Meyers, MD, MPH , Orange County Health Care Agency, Santa Ana, CA
Janet C. Mohle-Boetani, MD, MPH , Infectious Diseases Branch, California Department of Health Services, Richmond, CA
Barbara Cole, RN, MSN , Disease Control, Riverside County Department of Public Health, Riverside, CA
Jesse C. Bliss, MPH , School of Public Health, Office of Public Health Practice, Loma Linda University, Loma Linda, CA
David T. Dyjack, DrPH , School of Public Health, Loma Linda University, Loma Linda, CA
Purpose: A meta-analysis of literature was conducted to provide evidence-based recommendations for exclusion and clearance of individuals with an enteric disease. Our research was predicated on the lack of standardized guidelines for individuals in sensitive occupations or situations (SOS).

Study Question: Does the peer reviewed literature support California's Code of Regulations (CCR) and other current practices regarding specific enteric disease exclusions?

Methods: A literature review was conducted in PubMed, Academic Search Premier and Ebsco databases using searches of key words, titles, and text for 13 enteric pathogens. Terms were also combined with: exclusion criteria, outbreak, prevention, management, guidelines, childcare, children, and foodborne.

Results: Exclusion recommendations and required clearance testing are summarized in an interactive matrix for symptomatic or asymptomatic adults with an enteric disease who are cases or contacts working in SOS. Children < 5 years of age in group settings are considered separately. Relevant CCRs are provided for each disease where applicable. Where no code exists, literary recommendations are given with its appropriate grade and strength as adapted from the Infectious Disease Society of America. Methodologies, definitions, summary results, and in-depth summary of individual diseases are provided.

Conclusion: The lack of high quality evidence-based literature on enteric disease control measures supports the need for further research. Our findings support continuation of the existing California enteric clearance regulations on a number of pathogens, while recommendations addressing additional pathogens are tendered. The broad applicability of the interactive reference tool developed here provides utility for environmental and public health officials.

Learning Objectives:
1)To understand the Infectious Disease Societies of America’s process for review of scientific literature, and ranking/scoring the findings. 2)To review the principles of evidenced based public health as they pertain to control of communicable enteric infections. 3)To establish a framework by which future disease control guidelines can be made through evidence based review. 4)To describe procedures suitable for updating exclusion/clearance criteria for workers in sensitive occupational settings.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Board certified in family medicine, Medical director IEHP, Masters in Public Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Environment Section Poster Session V
See more of: Environment