Johnson County Health Department - EPI Update Newsletter

Beginning on June 15, 2007, the United States will add novel influenza A virus infections to the National Notifiable Diseases Surveillance System (NNDSS). The addition of novel influenza A viruses to the NNDSS list is expected to advance the following:

Timely identification and confirmation of novel influenza A virus cases;
Timely reporting of cases to the CDC; and
Early initiation of appropriate health responses to human infections with novel influenza A viruses that might have pandemic potential.

Novel influenza A viruses are those viruses against which there is little to no pre-existing immunity. Accordingly, an outbreak of infections with a new influenza A virus that demonstrates human-to-human transmission could signal the beginning of the next influenza pandemic.

Rapid reporting and early detection of an influenza virus with pandemic potential will permit identification of viral characteristics (e.g., genetic sequence, antiviral susceptibility, and virulence) that will impact clinical management and public health response measures. Rapid reporting should also facilitate development of a virus-specific vaccine and testing strategies.

The updated Notifiable Diseases reporting rules are designed to prevent and protect against the international spread of diseases, while minimizing interference with world travel and trade. It is the rapid reporting of human infections with novel influenza A viruses that will deliver the prompt detection and characterization of those influenza A viruses with pandemic potential and, in turn, hasten the implementation of effective public health response actions.

Source: http://www.cste.org/PS/2007pdfs/NovelFluANNDSSJan10final23.pdf

Eight cases of Salmonella Typhimurium and two cases of Salmonella Hadar have been identified by the Kansas Department of Health and Environment (KDHE). The affected persons all work or live in Shawnee County, Kansas, work in a medical clinic, and have a history of shared meals.
Of the 2,449 known serotypes of Salmonella, S. Typhimurium is one of the most commonly diagnosed, and is one of the most important serotypes for salmonellosis transmitted from animals to humans.
Salmonella Hadar, according to the Institute for Genomic Research, is often resistant to multiple antimicrobials. It has been associated with large outbreaks and high rates of hospitalizations, including a 2005 outbreak in Spain where more than 2,000 cases were reported. That outbreak was linked back to contaminated, pre-cooked chicken.
Symptoms of Salmonella include acute enterocolitis, headache, abdominal pain, diarrhea, nausea, and sometimes vomiting. Dehydration may become severe, especially in children and the elderly. Death is uncommon, except in the very young and very old.
The disease is often foodborne, often associated with undercooked or raw milk and eggs, meat and meat products, untreated water, or raw fruits and vegetables. Salmonella can also be transmitted from human to human through fecal – oral contact, and it can be communicable for several days to several weeks.
Some ways to reduce the transmission of Salmonella include:
• Knowledge and use of proper handwashing techniques.
• Proper refrigeration of foods.
• Maintaining a sanitary kitchen.
• Educating against eating raw, undercooked, cracked or dirty eggs.
• Knowledge of the risk on having ducks, chicks, or turtles as pets for small children.
• Excluding individuals with diarrhea from food handling, care of hospitalized persons, or children and the elderly.

Sources: The Institute for Genomic Research: http://msc.tigr.org/salmonella/salmonella_enterica_subsp__enterica_serovar_hadar_strain_ri_05p066
/index.shtml
The Centers for Disease Control and Prevention: www.cdc.gov
Control of Communicable Diseases Manual, 18th Edition
Epi-X e-mail update, Nkolika Obiesie
World Health Organization: www.who.int/en

Nicole Heim has been with the Public Health Emergency Preparedness program of the Johnson County Health Department since December 2006. She came to us from the Johnson County Environmental Department, where she worked as an Environmental Health Specialist. Nicole has a B.A. in Biology with Sociology minor from Park University and will graduate with a Master of Public Health degree from the University Of Kansas School Of Medicine in May. As a Public Health Planner, Nicole works with community partners to ensure they are planning for a pandemic. Another duty is to coordinate with businesses to request that they become Closed Point of Distribution Sites (Closed PODS) to limit the number of residents visiting the Open PODS the health department will operate during a large-scale disaster. Nicole is also responsible for making sure that special populations are considered in all of the health department plans. She looks forward to working more closely with our community partners in their planning efforts.

Nicole has been interested in the field of public health since high school and always knew that she would pursue a career and master’s degree in public health.

Drug-Resistant TB Cases Continue to be of Concern

While tuberculosis cases in the United States are at an all-time low, there are concerns with the emergence of drug-resistant TB cases. Poor treatment plans and improper use of antibiotics are often rendering two first-line therapy drugs, isoniazid and rifampin, useless.
While some forms of drug-susceptible TB can be cured with just six months of treatment, forms of drug-resistant tuberculosis can take up to two years to treat, and the drugs used are likely to cause more severe side effects. There is also extensively drug-resistant TB (XDR TB), that is resistant to the first-line drugs, as well as a second-line drug (generally a fluroquinolone) and at least one of three injectable agents. The World Health Organization (WHO) thinks as many as 50 million people worldwide are infected with drug-resistant strains of TB.
Drug-resistant tuberculosis is not yet widespread in the United States (only 49 XDR TB cases were reported to the CDC from 1993 to 2006), it is difficult and costly to treat, and can be fatal.
“Extensively drug-resistant TB is not yet a high risk in the United States,” Laurie Hermon, Johnson County Health Department Tuberculosis Nurse, said. “But active TB is highly infectious and easily spread, so it will continue to pose a danger to U.S. citizens as long as there are cases in the world.”
In 2006, a total of 13,767 cases of M.tuberculosis were reported in the United States (this number includes drug-resistant cases.) A majority of reported cases are in the minority populations, with TB rates eight times higher amongst blacks than whites, and 21 times higher for Asians than whites. Foreign-born individuals living in the United States have nearly 10 times the rate of TB as those born in the United States. Presently, TB kills almost two million individuals a year worldwide, and at this time, more than one-third of the world population is infected with TB.

Sources: American Lung Association, www.lungusa.org

World Health Organization (WHO) www.who.int/tb/dots/dotsplus/faq/en/print.html

The Centers for Disease Control and Prevention (CDC)
www.cdc.gov/od/oc/media/pressrel/2007/r070322.htm

Disease Reporting Notes:

If you have any questions about the monthly Epi Update, or any other disease surveillance or containment questions, please contact Nancy Tausz, RN, BSN, Director of the Disease Containment Division, at (913) 477-8362 or by email at: Nancy.Tausz@jocogov.org.

Communicable disease reporting is the cornerstone of public health surveillance and disease control. Please remember to maintain an index of suspicion for bioterrorism and reportable disease, and give the Disease Containment staff a call if you have any questions or concerns at (913) 826-1303. On behalf of the Johnson County Health Department, thank you for your continued support.

Johnson County government does not discriminate on the basis of race, color, national origin, gender, religion, age and handicapped status in employment or the provision of programs and services.