Johnson County Health Department - EPI Update Newsletter

Reminder: The Kansas Department of Health and Environment Laboratory (KDHEL) is only accepting H1N1 samples for confirmatory testing for those individuals that are hospitalized or as part of a post-mortem investigation where H1N1 is suspected to be the cause of death.

Currently the state laboratory, KDHEL, is not accepting any other samples from Johnson County at this time.

Also, if H1N1 samples are sent to a private laboratory for confirmatory testing and are confirmed by that private laboratory KDHE will not recognize the result of confirmed unless the H1N1 sample is forwarded to KDHEL and further testing is done.

Therefore confirmed samples from private laboratories will not be included in the total case counts for Johnson County or Kansas.

2009-2010 Influenza Guidance for Schools

The new guidance applies to any flu virus circulating during the 2009-2010 school year,
not only 2009 H1N1 flu.

Schools should take the following steps to help keep students and staff from getting sick with
flu. These steps should be followed at all times, and not only during a flu pandemic.

In the current flu conditions, students and staff with symptoms of flu should stay home for at
least 24 hours after they no longer have fever or do not feel feverish, without using fever reducing drugs. Sick people should stay at home, except to go to the doctor’s office, and should
avoid contact with others. Keeping people with a fever at home may reduce the number of
people who get infected. Because high temperatures are linked with higher amounts of virus,
people with a fever may be more contagious.

Other recommendations to help stop the spread of influenza:

Encourage respiratory etiquette by providing staff and students

education and reminders about covering coughs and sneezes, and
easy access to tissues and running water and soap or alcohol-based hand cleaners.

Remind staff and students to practice good hand hygiene and provide the time and supplies for students and staff to wash their hands when needed.

Clean surfaces and items that are more likely to have frequent hand contact with cleaning agents that are usually used in these areas. Additional disinfection beyond routine cleaning is not recommended. Some states and localities have laws about specific cleaning products used in schools. School officials should contact their state health department and department of environmental protection for additional guidance.

Move students and staff who become sick at school to a separate room until they can be sent home. Limit the number of staff who take care of the sick person and provide a surgical mask for the sick person to wear if they can tolerate it.

Encourage sick students and staff at higher risk of complications from flu to get a medical evaluation as soon as possible.

The Johnson County Health Department urges physicians to consider a diagnosis of Tuberculosis when a patient presents with TB symptoms. Early detection and treatment of Tuberculosis can quickly contain the spread of this infectious disease.
Symptoms of TB disease depend on where in the body the bacteria are growing, which is usually in the lungs (this is called pulmonary TB). Those with a history of the following should be considered for TB testing:

A bad cough that lasts three weeks or longer
Pain the chest
Coughing up blood or sputum (phlegm from deep inside the lungs)
The individual is from a country with a high incidence of TB

Other symptoms of TB are:

Weakness or fatigue
Weight loss
No appetite
Chills
Fever
Sweating at night

Not everyone infected with the TB bacteria become sick. Two TB-related conditions exist:

Latent TB Infection – in most people who breathe in TB bacteria, their body is able to fight the bacteria to stop them from growing. People with latent TB do not feel sick and do not have symptoms. The only sign of latent TB infection is a positive reaction to the TB skin test or a special TB blood test. Those individuals with latent TB cannot spread TB to others.

TB Disease (Active TB) – TB bacteria become active if the immune system can’t stop them from growing. Individuals with active TB will show the symptoms mentioned above and are infectious.

Source: http://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm

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JCHD Offers FREE Seasonal Flu Shots at Drive-Thru Flu Clinic

On September 21, 2009, the Johnson County Health Department will be offering free seasonal flu shots from 10:00 a.m. to 2:00 p.m. (or until supplies last) at the southeast corner of 97th & Metcalf, behind Sears.

The clinic will be a drive-through clinic with no walk-ups permitted. Vaccine will be given to those 18 and older only, and it is first come, first served.

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Pertussis

Pertussis is a bacterial respiratory illness characterized by severe spasms of coughing that can last for several weeks or even months. Pertussis is usually spread from person-to-person through close contact with respiratory droplets released when a person coughs or sneezes.
DTaP (Diphtheria and Tetanus Toxoids and Acellular Pertussis) vaccine is recommended for all infants at 2, 4 and 6 months of age. An additional dose of DTaP vaccine is recommended at 15-18 months of age and at 4-6 years of age. It is important that young infants start their DTaP vaccination without delay at 2 months of age. At least three DTaP doses are needed to have the maximum benefit from the vaccination. However, even one or two doses of DTaP will provide some protection against Pertussis.
There are also vaccines available for persons 10 to 64 years of age.

Boostrix is approved for persons 10-18 years of age (11-12 years of age is the preferred vaccination schedule).
Adacel is approved as a booster immunization for persons 11-64 years of age if 5 years have lapsed since their last Td/Tdap.

Consider Pertussis if the cough lasts at least 2 weeks or the suspect case reports close contact
with a case of pertussis or

1st symptoms appear like a cold with runny nose, sneezing, cough and low grade fever. This is the most contagious stage.
Irritating cough persists for 1-2 weeks
Cough becomes more severe with repeated attacks of violent coughing with no inhalation between coughs. Occasionally vomiting may occur.
Crowing or a inhalation whoop follows a series of coughs

Testing

Nasopharyngeal test for Pertussis (culture on either Regan-Lowe or Bordet-Gengou media) and PCR (polymerase chain reaction).
No single serologic testing is diagnostic of Pertussis.

Treatment is recommended for of suspect, probable, and confirmed cases as well as contacts of confirmed cases. Goal is to prevent additional cases of Pertussis. This includes family members, close friends and visitors in the home.

Erythromycin or
Zithromax (Azithromycin) or
Biaxin (Clarithromycin) or
Bactrim (Septra)

Exclusion

5 days of antibiotics must be completed for suspect clinical cases and symptomatic contacts before return to day care, school, work etc. This includes having company in the home. No contact with others except for physician’s appointments.
If not treated a Pertussis case is communicable for approximately 3 weeks after the onset of illness. Immunizations
If any children (under 7 years of age) are contacts to the case, check their immunization record. Close contacts under 7 years of age who have not received 4 doses of DTaP/DTP doses (Diphtheria, Tetanus, Acellular Pertussis vaccine or Diphtheria, Tetanus or Pertussis vaccine) or have not received a DTP/DTaP within 3 years should be given a dose as soon after exposure as possible.

http://www.cdc.gov/doc.do/id/0900f3ec80228696
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/pertussis_t.htm
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf

The increases are greatest among adolescents (aged 10-19 years), but an increase is also seen among infants younger than 5 months old. Infants under the age of 12 months have more serious illness from Pertussis, are more likely to have complications, and be hospitalized. Infants also are at greatest risk of dying from Pertussis.

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Johnson County Disease Report

Disease Name	Jan 09	Feb 09	Mar 09	April 09	May 09	June 09	July 09	Total YTD
Campylobacter Infection (Campylobacter spp.)	2	3	8	4	4	8	9	38
Cryptosporidiosis (Cryptosporidium parvum)	0	0	1	2	3	1	3	10
Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	1	0	0	0	0	2
Enterohemorrhagic Escherichia coli shiga toxin positive (serogroup non-O157)	0	0	0	0	0	0	2	2
Enterohemorrhagic Escherichia coli 0157:H7	0	0	0	1	1	0	2	4
Giardiasis (Giardia lamblia)	1	3	2	2	1	3	0	12
Salmonellosis (Salmonella spp.)	2	2	3	2	2	6	5	22
Shigellosis (Shigella spp.)	1	2	1	1	1	2	1	9
Amebiasis (Entamoeba histolytica)	0	0	0	2	1	0	1	4
Brucellosis	0	0	1	0	0	1	0	2
Ehrlichiosis, Ehrlichia chaffeensis	0	1	1	0	1	6	3	12
Ehrlichiosis, human other	0	0	0	0	1	1	1	3
Hepatitis A	1	4	3	1	3	5	4	21
Hepatitis B, acute	1	0	0	1	1	2	1	6
Hepatitis B, chronic	7	10	10	5	13	12	7	64
Hepatitis C virus infection (past or present)	21	14	12	18	19	21	13	118
Legionellosis	1	0	0	1	0	0	0	2
Lyme Disease (Borrelia burgdorferi)	1	1	1	2	6	4	15	30
Malaria (Plasmodium spp.)	1	0	0	0	0	0	0	1
Meningitis, Niesseria meningitidis	0	0	1	0	0	0	0	1
Meningitis, other bacterial	0	0	0	1	0	0	1	2
Q Fever (Coxiella burnetii)	0	1	1	1	0	0	0	3
Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	3	2	1	3	3	8	6	26
Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	0	5	1	3	2	3	0	14
Streptococcus pneumoniae, invasive, drug-resistant	2	2	2	2	0	2	1	11
Toxic Shock Syndrome, streptococcal and staphylococcal	0	1	1	0	0	0	0	2
Haemophilus influenzae, invasive	0	0	1	1	0	1	0	3
Measles	0	0	0	0	0	1	2	3
Mumps	1	0	2	2	2	1	0	8
Pertussis (Bordetella pertussis) (Whooping cough)	6	9	7	7	1	8	10	48
Varicella (Chickenpox)	13	23	22	27	14	8	2	109
Early Syphilis	2	4	1	1	0	1	0	9
Gonorrhea	5	25	18	9	8	20	11	96
Chlamydia	61	176	80	118	96	37	127	695
Latent Tuberculosis infection	20	29	34	23	24	34	18	182
Active Tuberculosis infection	2	5	7	0	0	4	6	24

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

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) 826-1222 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.