Johnson County Health Department - EPI Update Newsletter

Giardiasis (GEE-are-DYE-uh-sis) is a diarrheal illness caused by a one-celled, microscopic parasite, Giardia intestinalis. Once an animal or person has been infected, the parasite lives in the intestine and is passed in the stool. Because the parasite is protected by an outer shell, it can survive outside the body and in the environment for long periods of time. Giardia has become one of the most common causes of waterborne disease in humans in the United States.

Giardia can be spread by:

Accidentally putting something in your mouth or swallowing something that has come into contact with feces of a person or animal infected with Giardia.
Swallowing recreational water contaminated with Giardia. Recreational water includes water in swimming pools, hot tubs, Jacuzzis, fountains, lakes, rivers, springs, ponds, or streams that can be contaminated with sewage or feces from humans or animals.
Eating uncooked food contaminated with Giardia.
Accidentally swallowing Giardia picked up from surfaces (such as bathroom fixtures, changing tables, diaper pails, or toys) contaminated with feces from an infected person.

Symptoms of giardiasis include:

Diarrhea
Gas or flatulence
Greasy stools that tend to float
Stomach cramps
Upset stomach or nausea

Symptoms of giardiasis normally begin one to two weeks (seven days) after becoming infected.
For more information, go to: http://www.cdc.gov/ncidod/dpd/parasites/giardiasis/factsht_giardia.htm

Crypto

With the closing of many neighborhood pools signaling the end of summer, it is still important to remember in the next few weeks to take steps to protect yourself from water-borne illness.

One parasite that is resistant to chlorine is cryptosporidium, which causes diarrhea. It can be found in infected people’s stool, but is not visible to the naked eye. The parasite is protected by a thick outer shell that allows it to survive for long periods of time in water or on nearby surfaces. Some of the ways you can be exposed or infected:

Swallowing water from pools, hot tubs, Jacuzzis, fountains, lakes and other bodies of water.
By putting an object in your mouth that may have come into contact with the stool of an infected person or animal.
By swallowing crypto picked up from solid surfaces (pool lounge chairs, bathrooms, etc.) contaminated with an infected person’s feces.

There are ways to protect yourself from contracting this irritating infection.

Don’t swim when you have diarrhea, or for two weeks after.
Don’t swallow pool water.
Practice good hygiene. Take a shower before swimming and wash your hands after using the toilet or changing diapers.
Take your small child for bathroom breaks or check diapers often.
Change diapers in a bathroom facility and not near the pool.
Wash your child thoroughly, paying special attention to the rear end, with soap and water before swimming.
Check with your local pool staff to see how often the water is cleaned and how often chlorine and pH levels are checked.

Source: www.cdc.gov/crypto

Sporadic cases of measles have been reported throughout the United States this year in the District of Columbia, Illinois, New York, Washington, Arizona, California, Wisconsin, Hawaii, Michigan, Arkansas, Georgia, Louisiana, Missouri, New Mexico, Pennsylvania, and Virginia. Illinois tops the total counts with 32 cases reported between January 1 and July 31 of this year. The findings demonstrate that measles outbreaks can occur in communities with a high number of unvaccinated persons and that maintaining high overall measles, mumps, and rubella (MMR) vaccination coverage rates in the United States is needed to continue to limit the spread of measles.

The number of measles cases reported during January 1 to July 31, 2008 is the highest year-to-date since 1996. This increase was not the result of a greater number of imported cases, but was the result of greater viral transmission after importation into the United States, leading to a greater number of importation-associated cases. These cases have occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated. One study has suggested an increasing number of vaccine exemptions among children who attend school in states that allow philosophical exemptions. In addition, home-schooled children are not covered by school-entry vaccination requirements in many states. The increase in importation-associated cases this year is a concern and might herald a larger increase in measles morbidity, especially in communities with many unvaccinated residents.

Measles is a highly contagious, vaccine-preventable disease and most deadly of all childhood rash and fever illnesses. In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s.

Symptoms include a fever that lasts for a couple of days, followed by a cough, runny nose, conjunctivitis (pink eye), and rash. Measles is spread by droplets or direct contact with nasal or throat secretions of infected persons. The MMR (measles, mumps, rubella) vaccine, given at the correct time, is the best protection against this disease.

Measles can result in severe, sometimes permanent, complications. While the disease is no longer common in the U.S., it remains widespread in most countries of the world. These recent outbreaks in the States highlight the ongoing risk of measles importations from other countries by people who travel. These outbreaks also highlight the impact vaccination has in preventing measles.

Each school year, parents should ensure that their children's vaccinations are current, regardless of whether the children are returning to school, attending day care, or being schooled at home. Adults without evidence of measles immunity should receive at least one dose of MMR vaccine. All persons who travel internationally also should be up-to-date on all vaccinations recommended for countries they might visit.

Sources:
http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a1.htm

The Centers for Disease Control and Prevention (CDC) have introduced five new recommendations for the upcoming 2008-2009 flu season.

Annual vaccination of all children ages five to 18 years is recommended. Vaccination should begin in September or as soon as vaccine is available.
Annual vaccination of all children ages six months to four year and older children with conditions that places them at increased risk for complications from influenza. Children and adolescents at high risk for influenza complications should continue to be a focus of efforts as providers and programs transition to routinely vaccinating all children.
Either TIV or LAIV can be used when vaccinating healthy persons ages two to 49 years. Children ages six months to eight years should receive two doses of vaccine if they have not been vaccinated previously at any time with either LAIV or TIV. Two doses are required for protection in these children. Children ages six months to eight years who received only one dose in their first year of vaccination should receive two doses the following year.
The 2008-09 trivalent vaccine virus strains are A/Brisbane/59/2007 (H1NI) –like, A/Brisbane/10/2007 (H3N2) – like, and B/Florida/4/2006-like antigens.
Oseltamivir-resistant influenza A (H1N1) strains have been identified in the United States and some other countires. However, oseltamivir or zanamivir continue to be the recommended antivirals for treatment of influenza because other influenza strains remain sensitive to oseltamivir, and resistance levels to other antivirals medications remain high.

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5707a1.htm

Head Lice

The Johnson County Health Department is urging parents to watch closely for head lice this school year. The Kansas Department of Health and Environment (KDHE) and The Centers for Disease Control (CDC) have developed a series of recommendations to get rid of lice.

Treating head lice
- Use an over-the-counter medication (for more resistant strains of lice, a doctor may prescribe a treatment.)
- Before applying treatment, remove all clothing from the waist up.
- Apply treatment, according to label instructions. If your child has extra long hair, you may need to use a second bottle.
- Have the infested person put on clean clothing after treatment.
- After treatment, check hair and comb with a nit comb every two to three days to remove remaining nits and lice. Continue to check for two to three weeks until you are sure all lice and nits are gone.
- Check household contact for lice and nits every two to three days. Treat only if crawling lice or nits are found.

Treating the household
- Head lice to do not survive long off of a person.
- To kill lice and nits, machine wash all washable clothing and bed linens the infested person wore or used during the two days before treatment. Use hot water cycle (130 degree +). Dry using high heat for at least 20 minutes.
- Dry clean clothing that is not washable.
- If items cannot be washed or dry cleaned, place into a plastic bag and seal for two weeks.
- Soak combs and brushes in rubbing alcohol, Lysol or soap and hot water (at least 130 degrees).
- Vaccuum the floor and furniture.
- Do not use fumigant sprays. These can be toxic if inhaled or absorbed through the skin.

It is important to remember that having head lice is not a result of poor hygiene. Preschool and elementary school children aged three to 11 are most commonly infected and then take it home to their families. The most common way of contracting lice is through head-to-head contact such as sharing combs, hair accessories, hats and towels.

Source: www.cdc.gov

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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	Jan 2008	Feb 2008	March 2008	April 2008	May 2008	June 2008	July 2008	Total YTD
Enteric	Calicivirus/Norwalk-like virus (norovirus)	3	1	14	1	1	0	0	20
	Campylobacter Infection (Campylobacter spp.)	8	1	5	10	0	9	25	33
	Cryptosporidiosis (Cryptosporidium parvum)	1	0	0	1	1	1	2	4
	Dengue	0	0	0	0	0	0	1	1
	Dengue Hemorrhagic Fever	0	0	0	0	0	0	1	1
	Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	0	1	1	2	0	5
	Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	0	0	0	0	1	3
	Giardiasis (Giardia lamblia)	9	2	4	4	3	2	6	30
	Salmonellosis (Salmonella spp.)	6	0	4	6	5	8	9	38
	Shigellosis (Shigella spp.)	1	0	0	0	1	0	3	5
General	Amebiasis (Entamoeba histolytica)	0	0	0	0	0	1	0	1
	Ehrlichiosis, human monocytic (HME)	0	0	3	1	2	2	2	10
	Ehrlichiosis, human monocytic (HGE)	0	0	0	0	1	1	2	4
	Hepatitis A	2	3	1	3	1	4	3	17
	Hepatitis B, acute	1	0	2	1	1	2	0	7
	Hepatitis B, chronic	16	16	19	10	10	6	8	85
	Hepatitis C virus infection (past or present)	14	20	51	26	17	12	4	144
	Legionellosis	0	1	2	0	0	1	0	4
	Listeriosis (Listeria monocytogenes)	0	0	0	0	0	1	0	1
	Lyme Disease (Borrelia burgdorferi)	0	1	2	3	4	0	1	10
	Meningitis, other bacterial	0	0	1	0	1	0	0	2
	Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	2	1	1	3	2	10
	Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2	4	1	3	3	15
	Streptococcal pneumoniae, invasive, drug-resistant	2	2	1	2	1	0	1	9
	West Nile, non-neurological (includes WN Fever)	0	0	0	0	0	2	1	3
Vaccine-Preventable Diseases	Haemophilus influenzae, invasive	0	0	0	0	1	2	0	3
	Pertussis (Bordetella pertussis) (Whooping cough)	4	6	4	2	2	4	3	25
	Varicella (Chickenpox)	24	57	38	25	26	3	7	180
Sexually Transmitted Diseases	Early Syphilis	0	1	4	2	3	1	0	11
	Gonorrhea	N/A	28*	11	5	12	9	13	78
	Chlamydia	N/A	182*	90	81	122	102	120	697

*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.