Johnson County Health Department - EPI Update Newsletter

More than a million Americans are living with human immunodeficiency virus or HIV, and as many as 24 to 27 percent of those individuals do not know that they are HIV-positive. Those numbers could soon change, however, with the Centers for Disease Control and Prevention (CDC) urging health care facilities to adopt the opt-out HIV testing method.

Opt-out testing means that an HIV screening test will become routine on all blood samples. The patient is notified beforehand that the test will be performed; consent for the test is inferred unless the patient declines.

“Opt-out testing is changing the way we are screening for HIV,” Amalia Almeida, Women’s/Men’s health Program Supervisor, said. “Instead of just reaching that small population of individuals that specifically request a HIV test, this opt out approach will make HIV screening more mainstream within healthcare facilities and reach a greater portion of the population. As we screen more, we will find more positive individuals, and we will be able to offer them education, awareness and medical interventions in a more timely manner.”

The opt-out procedure started in the Johnson County Health Department’s Family Planning clinics in January 2008, and began in all clinics March 1st 2008.

“We are now incorporating this opt- out screening option to anyone that comes through our Family Planning, Sexually Transmitted Disease ( STD), Drop-In and Prenatal clinics,” Almeida said.

With this new wave of screening, nationwide HIV reporting has seen a huge spike, but health officials believe the spike will level off when opt-out testing becomes routine. New testing recommendations include:

Routine, voluntary HIV screening for all persons ages 13-64 in health care settings, not based on risk
All patients with Tuberculosis (TB) or seeking treatment for STDs should be screened for HIV
Repeat HIV screening of persons with known risk(s) at least annually
Opt-out HIV screening with the opportunity to ask questions and the option to decline testing
Separate signed informed consent should not be required
Screening is voluntary
Inform patients orally or in writing that HIV testing will be performed unless they decline
Arrange access to care, prevention, support services and case management for patients with positive HIV test results

Source - research from:
Bernard M. Branson, M.D.,
Associate Director for Laboratory Diagnostics
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Center for Disease Control and Prevention

Johnson County Health Department HIV Testing Results

Year	Samples screened	Positives
2008 (through March)	972	3
2007 (pre opt-out testing method)	1,837	11

Animal bites and scratches that break the skin can cause infection. Domestic pets cause most animal bites. Bites from non-immunized domestic animals and wild animals carry the risk of rabies. Rabies is more common in raccoons, skunks, bats and foxes than in cats and dogs.

For minor wounds. If the bite barely breaks the skin and there is no danger of rabies, treat it as a minor wound. Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent infection and cover the bite with a clean bandage.

For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure with a clean, dry cloth to stop the bleeding and see your doctor.

For infection. If you notice signs of infection such as swelling, redness, increased pain or oozing, see your doctor immediately.

For suspected rabies. If you suspect the bite was caused by an animal that might carry rabies — any bite from a wild or domestic animal of unknown immunization status — see your doctor immediately.

Think Prevention! Many animal bites are preventable. Always supervise young children around animals, even pets. Teach kids to handle pets gently and to never tease them. Stay away from and don’t feed wild or stray animals.

Animal bites can also lead to tetanus, an acute, often fatal disease. It is characterized by generalized rigidity and convulsive spasms of skeletal muscles. The muscle stiffness usually involves the jaw (lockjaw) and heck and then becomes generalized.

Physicians recommend getting a Td (Tetanus/diphtheria) or Tdap (Tetanus/diphtheria/acellular pertussis) vaccination every 10 years. If the last tetanus shot was more than five years ago and the wound is deep or dirty, your doctor may recommend a booster. You should have the booster within 48 hours of the injury. Report animal bites to the Johnson County Health Department at (913) 826-1303.

Source: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf

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Noroviruses are a group of viruses that cause gastroenteritis in people. The term norovirus has been approved as the official name for this group of viruses.

Common symptoms include vomiting, diarrhea, stomach cramping, low-grade fever, chills, headache, muscle aches, nausea and tiredness.
Norovirus illness usually lasts 1-2 days.
Norovirus is found in the stool or vomit of infected people or on infected surfaces touched by ill people.
The virus often occurs more readily when there are more people in a small area, such as day cares, nursing homes, cruise ships and catered events.
Noroviruses are spread by:

Eating or drinking infected foods or liquids;
- Touching surfaces or objects infected with noroviruses and then touching your eyes, nose or mouth;
- Being present when someone with norovirus is vomiting;
- Not washing hands after using the restroom or changing diapers, or shaking hands with someone who has failed to do the same;
- Sharing food or eating with the same utensils as someone already infected; or
- Caring for a person ill with norovirus.
Noroviruses are not generally serious, but are extremely contagious. They are often associated with cruise ships because:
- Health officials closely track illness on these ships, and outbreaks are found and reported more quickly than on land.
- Close living quarters on cruise ships may increase the potential for viral contact.
- New passenger arrivals may bring the virus to other passengers and crew.
You can prevent getting norovirus by:
- Avoid shaking hands when there is an outbreak.
- Wash your hands more often if you or someone in your household is sick.
- Carry an alcohol-based sanitizer to use for those times when a hand washing station or bathroom is not available.
- Washing your hands often, especially while preparing or eating food and after using the restroom or changing diapers.

Sources: http://www.cdc.gov/nceh/vsp/pub/Norovirus/Norovirus.htm
http://www.cdc.gov/ncidod/dvrd/revb/gastro/noro-qa.pdf

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Smallpox

Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus. It is marked by fever and a distinctive progressive skin rash. Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949, and the last naturally occurring case in the world was in Somalia in 1977. With the threat of terrorism, however, the United States government is taking steps to be ready to deal with a potential bioterrorist attack using smallpox as a weapon. It has been classified by the Centers for Disease Control and Prevention as a Category A agent – believed to pose the greatest potential threat for public health impact.

Symptoms of smallpox include:

High fever
Head and body aches
Vomiting
Rash of raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks

Smallpox is acquired from contact with infected persons. Most of the time, prolonged face-to-face contact is needed to spread smallpox from one person to another. It can also be spread through direct contact with bodily fluids or contaminated objects such as bedding or clothing.

After being exposed to the smallpox virus, it usually takes between seven and 17 days for illness to appear. During this 7-17 day time period, the infected person often feels fine and is not contagious. A person is sometimes contagious with onset of fever (called the prodrome phase) but the person becomes most contagious with the onset of rash, and continues to remain highly infectious until the last smallpox scab falls off.

There is no treatment for smallpox – but it can be prevented through use of the smallpox vaccine. Currently the vaccine is not available for members of the general public, but in the event of a smallpox outbreak, there is enough smallpox vaccine housed with the CDC to vaccinate every person in the United States.

Sources:
http://emergency.cdc.gov/agent/smallpox/disease/faq.asp
http://emergency.cdc.gov/agent/smallpox/overview/disease-facts.asp

Tuberculosis Reporting

State laws and regulations require that all cases of active or latent tuberculosis infection (LTBI) be reported to the local or state health department (K.S.A. 65-128, 65-6001-65-6007, K.A.R. 28-1-2, 28-1-4, and 28-1-18). Information and forms on reporting tuberculosis (TB) cases can be found on our website at http://health.jocogov.org/ within the Disease Containment Program.

For persons identified with LTBI, the Johnson County Health Department (JCHD) is able to supply TB medications free of charge with documentation of a positive Tuberculin Skin Test (TST), a negative chest x-ray (obtained within the last 6 months), and a signed original prescription from a physician (JCHD does not have a physician on site).The Health Department will provide medication management and monthly monitoring of side effects for these individuals. Any concerns or questions during the treatment process will be directed to the prescribing provider as indicated.

Suspect or confirmed cases of active TB are managed on a case by case basis working closely with the individual’s physician. Medications are available through the Health Department.

The Primary Health Care Providers Guidelines on Tuberculin (TB) Testing and Treatment is published by the Center for Disease Control (CDC). Please note on page 13 of the guide; “CDC recommends treatment of all individuals diagnosed with latent TB infection (LTBI) regardless of age or BCG vaccine history”.

If you have questions or would like Johnson County Health Department personnel to speak with your facility regarding TB testing and treatment, please contact one of the staff listed below. We look forward to working with you to contain TB disease in our community.

Suzie Girk, RN, BSN
(913) 477-8336
FAX (913) 477-8048

Ann Hinds, RN, BS
(913) 826-1221
FAX (913) 826-1210

Jose Izaguirre, MHSA
(913) 826-1214
FAX (913) 826-1210

Johnson County Disease Report

This includes the number of reported cases investigated by JCHD (case classifications include: confirmed, probable, suspect, not a case.)

This does not list diseases for which no case has been reported.

Disease Category	Disease Name	January 2008	February 2008	March 2008	Total YTD
Enteric	Calicivirus/Norwalk-like virus (norovirus)	3	1	14	18
	Campylobacter Infection( Campylobacter spp.)	8	1	5	14
	Cryptosporidiosis (Cryptosporidium parvum)	1	0	0	1
	Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	0	1
	Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	0	2
	Giardiasis (Giardia lamblia)	9	2	4	15
	Salmonellosis (Salmonella spp.)	6	0	4	10
	Shigellosis (Shigella spp.)	1	0	0	1
General	Hepatitis A	2	3	1	6
	Hepatitis B, acute	1	0	2	3
	Hepatitis B, chronic	16	16	19	51
	Hepatitis C virus infection (past or present)	14	20	51	85
	Legionellosis	0	1	2	3
	Lyme Disease (Borrelia burgdorferi)	0	1	2	3
	Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	2	3
	Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2	4
	Streptococcal pneumoniae, invasive, drug-resistant	2	2	1	5
Vaccine-Preventable Diseases	Pertussis (Bordetella pertussis) (Whooping cough)	4	6	4	14
	Varicella (Chickenpox)	24	57	38	119
Sexually Transmitted Diseases	Early Syphilis	0	1	4	5
	Gonorrhea	N/A	28*	11	39
	Chlamydia	N/A	182*	90	272

*totals are for January and February

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.