Table of Diseases that Must be Reported to the DCDOH Within 24 Hours

Amebiasis Animal bites for which rabies   prophylaxis is given+ Anthrax Babesiosis Botulism Brucellosis California Encephalitis Campylobacteriosis Chancroid Chlamydia trachomatis Cholera Cryptosporidiosis Cyclosporidiosis Diphtheria E. Coli 0157:H7 Eastern Equine Encephalitis Ehrlichiosis (HGE,HME) Encephalitis Food borne illness Giardiasis Glanders Gonorrhea Haemophilus Influenza Hantavirus Hemolytic Uremic Syndrome (HUS) Hepatitis A (HAV) Hepatitis A in a food handler Hepatitis B (HBV) Hepatitis C (HCV)	HIV Legionellosis Listeriosis Lyme Disease Lymphogranuloma venereum (LGV) Malaria Measles Meiliodosis Meningitis (Aseptic & Viral) Meningitis (Haemophilus) Meningitis (Meningococcal) Meningitis Other (specify type) Meningococcemia Monkey Pox Mumps Pertussis Plague Poliomyelitis Powassan Viral Encephalitis (POW) Pregnant Hepatitis B infection Psittacosis Q Fever Rabies Rocky Mountain Spotted Fever Rubella (including congenital rubella syndrome)	Salmonellosis SARS Shigatoxin-producing infection Shigellosis Smallpox St. Louis Encephalitis Staphylococcal Enterotoxin B Poisoning Staphylococcal Aureus Streptococcal Infection (Group A beta-hemolytic strep) Streptococcal Infection (Group B strep) Streptococcal Infection (Invasive disease) Streptococcus pneumoniae  Syphilis (specify stage) ++ Tetanus Toxic shock syndrome Trichinosis Tuberculosis Tularemia Typhoid Vibriosis Viral Hemorrhagic Fever West Nile Virus Yellow Fever Yersiniosis
+  Animal Bites - Health care providers must immediately report suspected rabid animals and persons exposed to them to the Environmental Health Services Division, DCDOH at (845) 486-3404. The full name, age, address and telephone number must be provided of any person under care, observation or who has been exposed to any animal suspected of having ++ rabies. All pertinent facts relating to such exposure must be provided.
++  Syphilis - Report by phone any non-treponemal test ≥1:16 or any positive prenatal or delivery test regardless of titer; all others may be reported by mail.

Treatment for Active TB and LTB1

The DCDOH provides free chest X-rays, physician exams, medication and lab work for persons with LTBI or active TB who are uninsured or under insured at the monthly pulmonary clinic, held the first Wednesday of each month by appointment.

Directly Observed Therapy (DOT)

Currently the standard of care, Directly Observed Therapy is available for all cases of tuberculosis.  DOT is also provided free of charge for patients diagnosed with LTBI who are determined to be at high risk for non-compliance.  Included in the standard of care for all active cases is to provide DOT free of charge.

Mantoux Skin Test Clinics

Free walk-in clinics are available:  Mondays (except holidays) at DCDOH, 387 Main Street, Poughkeepsie from 1:30 pm to 3:00 pm.   Persons tested must return for reading on Thursday of the same week at the same time.  

REPORTING

It is a requirement of New York State Sanitary Code that all suspects and active Tuberculosis cases be reported within 24 hours.  Tuberculosis reports are mandatory if any of the following criteria are met:

• Positive AFB smear (culture pending)
• Clinically suspected pulmonary OR extrapulmonary case when isolation or treatment is initiated.

Tuberculosis reports should be called in to (845) 486-3505.
After-hours - (845) 431-6465..

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  EARLY CHILDHOOD DEVELOPMENT

PUBLIC HEALTH SERVICES 

Child Find

Child Find is to ensure that infants and toddlers at risk of developmental delays and disabilities are identified and have their development monitored.  Public Health Nurses educate parents and make referrals to community services including EIP.

Early Intervention Program (EIP)

The Early Intervention Program (EIP) helps children up to age 3 who have developmental delays or disabilities. It provides evaluation, service coordination, special instruction, speech, occupational, and physical therapy, and other services. Insurance is accessed, but families are not charged.

REFERRAL

Child Find Referral          845-486-3419

Referrals to Child Find should be made for infants and toddlers with any of the risk factors listed below.

Neonatal

Post-neonatal/ early childhood

Post-neonatal/Early Childhood Risk Factors in Children that Should Be Referred to Child Find

Parental concern about developmental status Blood lead >19 ug/dl Illness or injury with developmental implications and requiring ≥10 days in pediatric intensive care

Growth deficiency/nutritional problems Serious otitis media ≥3 months HIV infection

Additional risk criteria

Additional Risk Criteria for Children that Should Be Referred to Child Find

No prenatal care Parental developmental disability or serious and persistent mental illness

Parental alcohol or drug abuse No well child care by 6 months or significant delay in immunizations

  
Early Intervention Referral (EIP)      (845) 486-3518

With parents’ permission, physicians should refer infants and toddlers from birth through age 2 who are suspected of having a disability, developmental delay and/or diagnosed physical or mental condition that has a high probability of resulting in a developmental delay (as listed below).

If the parent prefers to self refer or if parent objects to a physician referral, the physician should give the parent the above phone number of EIP. Physician’s office should follow up with the parent within two months to seek to refer the child.

Starting at about 2 years 6 months children should be referred to their school district’s Committee on Preschool Special Education.
Referrals to EIP should be made within 2 working days when any of the following conditions are present:

• Chromosomal abnormalities associated with developmental delay, such as Down Syndrome.
• Clinical evidence of central nervous system abnormality following infection of the brain or spinal injury
• Delay in cognitive, adaptive, social/emotional, physical or communication development.
• Diagnosed hearing impairment that cannot be corrected.
• Diagnosed psychiatric condition, such as reactive attachment disorder.
• Diagnosed visual impairment that cannot be corrected.
• Emotional or behavioral disorder, such as a delay in achieving emotional milestones.
• Neuromuscular disorder.
• Syndromes or conditions associated with developmental delay, such as fetal alcohol syndrome.

Dutchess County has a comprehensive plan, entitled Health Emergency Response Plan, to help prepare the community for possible public health emergencies, including those caused by natural or intentional emergencies. While the memories of September 11th and the anthrax scares are fading, the chances of such intentional attacks have not diminished.

Healthcare providers play an important role in detection and response to a public health emergency. An early detection of a cluster or an unusual illness will likely present first at the doorsteps of a healthcare provider. An alert provider would be the first to inform the health department, giving an early start to the investigation process.

Steps to Healthcare Provider Preparedness:

As a healthcare provider the following steps can help you to be better prepared:

• Become familiar with signs and symptoms of the illnesses caused by weapon is able biological agents. Resources are found at the DC website at:
  http://www.co.dutchess.ny.us/CountyGov/EShealthprofessional.htm
  
  
• Report clusters of illnesses or unusual illnesses to the DCDOH, Communicable Diseases at (845) 486-3401 (Monday–Friday 9:00 am to 5:00 pm) or After Hours Phone #   (845) 431-9111.
  
  
• Follow standard precautions
  
  
• Provide information and routine care to the patients during an event Become familiar with the emergency plans of the affiliated hospitals
  
  
• Get accurate information at the Health Alert Network by subscribing to HPN (Health Providers Network) by sending an email to: hpn_outreach@health.state.ny.us  with the subject line reading “HPN Request, <Your name>, <The County where You are located>” .
  Example: “HPN Request, John Smith, MD, Dutchess County.”  Include the following information in your email: Your full first name (DO NOT use nicknames), full middle name (not just the initial), and full last name. (For example: Elizabeth Ann Doe); your date of birth; your direct office telephone number; your office fax number; your direct e-mail address; and your mailing address.
  
  
• Consider Emergency Volunteer Opportunities by joining the Dutchess County Medical Reserved Corps, to find out more, please call (845) 486-2080.  For more information, refer to the DC website under Emergency Response -or- click HERE.
  
  
• Prepare a personal emergency preparedness plan
  
  
• Establish a business continuum of operations plan
  
  
• Join the Dutchess County Medical Reserve Corps
  
  
• Work in collaboration as a partners, with the county as and avenue for mass vaccination.

PUBLIC HEALTH SERVICES

Patient Follow-up
Physicians may request assistance from Public Health Nurses to encourage compliance with immunization schedules.

Private physicians are strongly encouraged to consult with DCDOH at the above telephone number regarding the collection, processing and shipment of:

• Certain communicable disease specimens and/or
• Clinical specimens from persons exposed to suspect bio-terrorist agents.

Bacteriologic and viral specimens for such agents as West Nile Virus, Salmonella sero-typing, e coli 0157 confirmation and others will be referred to the NYSDOH Wadsworth / Griffen Labs for confirmation.

Clinical and environmental suspect bio-terrorist agent samples will be referred to Westchester Medical Center Level 3 laboratory.

• Any violent death, whether by criminal violence, suicide or casualty.
• Any death caused by an unlawful act or an act of criminal neglect.
• Any death occurring in a suspicious, unusual or unexplained manner.
• Any death unattended by a physician, so far as can be discovered, or when a physician able to certify the death cannot be found.
• Any death of a person confined in a public institution other than a hospital, infirmary or nursing home.

REPORTING

All deaths occurring under the above mentioned circumstances should be reported promptly to the Office of the Medical Examiner at (845) 431-9177, 24 hours a day, 7 days a week and a Medico-Legal Investigator (MLI) will respond to the call.

The following information will be requested of the person reporting the death:

• Full name and telephone number of the person reporting the death.
• Name of deceased, date of birth, age, sex, and race.
• Home address and telephone number of the deceased.
• Place, date, and time of death.
• If a hospital patient, date and time patient arrived at hospital and method of arrival.
• Name of person who pronounced death.
• Name, relationship, address, and telephone number of next of kin.
• Reason for reporting death, history, and circumstances of death.
• Past medical history and primary medical doctor, if any.
• Other relevant information.

AUTOPSY POLICY

The Office of the Medical Examiner will perform an official autopsy in any death resulting from homicidal violence, criminal negligence, suicide, fire, asphyxia, vehicular and other accidents, drugs or chemical overdose, when a death is unexplained, when a death occurs in police custody or legal detention, and whenever an autopsy is deemed necessary in the interest of public health and safety.  The need for an autopsy in the evaluation of a sudden, unexplained death apparently due to natural disease is decided on an individual basis. The MLI will make arrangements for transfer of the decedent to VBMC mortuary.

An objection to autopsy based on religious beliefs will be honored, except in cases of homicide, or when public health is at stake. Objections to autopsy for personal reasons will be considered on an individual basis.

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  RABIES         (845) 486-3404