Johnson County Health Department - EPI Update Newsletter

flu map

By the end of November, several states reported low levels of influenza activity. Influenza A was the most commonly identified strain. No influenza activity was reported in either Missouri or Kansas.

http://www.cdc.gov/flu/weekly/
http://www.cdc.gov/flu/weekly/downloadimage.htm?w=48

Measles

Measles is the most deadly of all childhood rash/fever illnesses. It is an infectious viral disease that occurs most often in the late winter and spring. It begins with a fever that lasts for two to three days, followed by a cough, runny nose, and conjunctivitis.

Koplik spots, a rash present on mucous membranes, is considered to be a diagnostic marker for measles. It occurs one to two days before the rash to one to two days after the rash, and appears as punctate blue-white spots on the bright red background of the buccal mucosa.

Photo Provided by the CDC/Dr. Heinz F. Eichenwald

koplik spots

The measles rash is a maculopapular eruption that usually lasts five to six days. It begins at the hairline, then involves the face and upper neck. During the next three days, the rash gradually proceeds downward and outward, reaching the hands and feet. The maculopapular lesions are generally discrete, but may become confluent, particularly on the upper body. Initially, lesions blanch with fingertip pressure. By three to four days, most do not blanch with pressure. Fine desquamation occurs over more severely involved areas. The rash fades in the same order that it appears, from head to extremities.

Photo provided by the CDC and Barbara Rice

rash measles rash

Transmission: Measles is highly contagious with the possibility of respiratory transmission occurring from four days prior to the onset of the rash to four days after the onset. The virus normally grows in the cells that line the back of the throat and in the cells that line the lungs. The virus lives in the mucus in the nose and throat of the infected person. When that person sneezes or coughs, droplets spray into the air. The virus remains active and contagious on exposed surfaces for up to two hours. Measles spreads so easily that if one person is infected, 90 percent of the susceptible close contacts will also become infected and anyone who is not immunized will most likely become infected eventually.

Complications: Diarrhea, ear infections, pneumonia, encephalitis, seizures, and death. Approximately 20 percent of reported measles cases experience one or more complications. These complications are more common among children under five years of age and adults more than 20 years old. For every 1,000 children who contract measles, one or two will die. Measles may cause miscarriage, premature birth, or delivery of low-birth-weight babies.

Prevention: Measles vaccine can prevent the disease. The MMR vaccine is a live, attenuated (weakened), combination vaccine that protects against the measles, mumps, and rubella viruses. The vaccine causes the body to develop an immunity that, in 95 percent of children, lasts for a lifetime. A second dose of the vaccine is recommended to protect those five percent who did not develop immunity in the first dose and to give "booster" effect to those who did develop an immune response.

Testing: Isolation of measles virus is not recommended as a routine method to diagnose measles. However, if measles is suspected, virus isolates are extremely important for molecular epidemiologic surveillance to help determine the geographic origin of the virus and the viral strains circulating in the United States.

Measles virus can be isolated from urine, nasopharyngeal aspirates, heparinized blood, or throat swabs. Specimens for virus culture should be obtained from every person with a clinically suspected case of measles and should be shipped to the state public health laboratory or CDC, at the direction of the state health department. Clinical specimens for viral isolation should be collected at the same time as samples taken for serologic testing. Because the virus is more likely to be isolated when the specimens are collected within three days of rash onset, collection of specimens for virus isolation should not be delayed until serologic confirmation is obtained. Clinical specimens should be obtained within seven days, and not more than 10 days, after rash onset. A detailed protocol for collection of specimens for viral isolation is available on the CDC website at http://www.cdc.gov/ncidod/dvrd/revb/measles/ viral_isolation.htm

Serologic testing, most commonly by enzyme-linked immunoassay (ELISA or EIA), is widely available and may be diagnostic if done at the appropriate time. Generally, a previously susceptible person exposed to either vaccine or wild-type measles virus will first mount an IgM response and then an IgG response. The IgM response will be transient (one to two months), and the IgG response should persist for many years. Uninfected persons should be IgM negative and will be either IgG negative or IgG positive, depending upon their previous infection history.
Method of Control: A single case of confirmed measles is considered to be an outbreak.

Susceptible contacts: vaccinate within 72 hours. If contacts refuse vaccination, they should be restricted (quarantined) from school/daycare until 14 days after onset of rash of last case.
High risk household contacts (susceptible infants less than 12 months, unvaccinated pregnant women, immunocompromised patients, etc.) may be given Immune Globulin within 6 days of exposure.
Exclusion/isolation: Children with measles are excluded from school/daycare until four days after onset of rash. Exclude susceptible contacts refusing measles vaccine or with medical and religious exemptions until 14 days after onset of rash in the last case. Susceptible, exposed health care personnel should refrain from patient care from the fifth to the 21st day after exposure.
Follow-up: cases should be followed to determine compliance of control measures. Contacts should also be followed to determine if exposure results in infection.
Public information will be provided to the community through the media.

Resources:
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas-508.pdf
http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.htm
http://www.cdc.gov/ncidod/dvrd/revb/measles/measles_general_info.htm
http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm
http://phil.cdc.gov/phil/home.asp

When the weather is extremely cold, try to stay indoors. Make sure any outside trips are brief as possible, and remember these tips to protect your health and safety:

Dress warmly and stay dry. Adults and children should wear:

A hat
A scarf or knit mask to cover face and mouth
Sleeves that are snug at the wrist
Mitten (they are warmer than gloves)
Water-resistant coat and boots
Several layers of loose-fitting clothing

Avoid exertion – cold weather puts an extra strain on your heart. If you have heart disease or high blood pressure, follow your doctor’s advice about shoveling snow of performing other hard work in the cold. If you have to do heavy outdoor chores, dress warmly and work slowly. Don’t overdo it.
Understand wind chill – the wind chill index is the temperature your body feels when the air temperature is combined with the wind speed. As the speed of the wind increases, it can carry heat away from your body much more quickly, causing skin temperature to drop.
Avoid ice – walking on ice is extremely dangerous. Many cold-weather injuries result from falls on ice-covered sidewalks, steps, driveways, and porches. Keep your steps and walkways as free of ice as possible by using rock salt or another chemical de-icing compound. Sand may also be used on walkways to reduce the risk of slipping.
Be safe during recreation – notify someone before you go hiking, camping, or skiing.
Be cautious about travel:

Listen for radio or television reports of travel advisories issued by the National Weather Service
Do not travel in low visibility conditions
Avoid traveling on ice-covered roads, overpasses, and bridges if at all possible
If you must travel by car, use tire chains and take a mobile phone with you
If you must travel, let someone know your destination and when you expect to arrive. Ask them to notify authorities if you are late.
Don’t rely on a car to provide sufficient heat; the car may break down.
Always carry additional warm clothing appropriate for the winter conditions.

For much more information on cold weather preparedness, go to http://emergency.cdc.gov/disasters/winter/guide.asp.

Varicella Makes Its Comeback

What is varicella (chickenpox)?
Chickenpox is an infectious disease caused by the varicella-zoster virus, which results in a blister-like rash, itching, tiredness, and fever. The rash appears first on the trunk and face, but can spread over the entire body causing between 250 to 500 itchy blisters in unvaccinated persons.

How do you get chickenpox?
Chickenpox is highly infectious and spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing or from aerosolization of virus from skin lesions. A person with chickenpox is contagious one to two days before the rash appears and until all blisters have formed scabs. It takes from 10-21 days after exposure for someone to develop chickenpox.

What is the chickenpox illness like?
In unvaccinated children, chickenpox most commonly causes an illness that lasts about five to 10 days. Children usually miss five or six days of school or childcare due to their chickenpox and have symptoms such as high fever, severe itching, an uncomfortable rash, and dehydration or headache. In addition, about one in 10 unvaccinated children who get the disease will have a complication from chickenpox serious enough to visit a healthcare provider. These complications include infected skin lesions, other infections, dehydration from vomiting or diarrhea, or more serious complications such as pneumonia and encephalitis. In vaccinated children, chickenpox illness is typically mild, producing no symptoms at all other than a few red bumps.

Can a healthy person who gets varicella die from the disease?
Yes. Many of the deaths and complications from chickenpox occur in previously healthy children and adults. From 1990 to 1994, before a vaccine was available, about 50 children and 50 adults died from chickenpox every year; most of these persons were healthy or did not have a medical illness (such as cancer) that placed them at higher risk of getting severe chickenpox.

Can you get chickenpox more than once? Can it be prevented?
Yes, but such occurrences are uncommon. For most people, one infection appears to confer lifelong immunity.
Vaccination with the recommended two-doses of varicella vaccine prevents chickenpox in most people. In Kansas, students in kindergarten through fifth grade are required to have at least one dose of the varicella vaccine. To see the state immunization requirements, go to http://www.kdheks.gov/immunize/download/School_Imm_Req_Memo_Feb_2008.pdf.

Can you get chickenpox if you've been vaccinated?
Yes. About 15%–20% of people who have received one dose of chickenpox vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters.

Chickenpox in children is usually not serious. Why not let children get the disease?
It is not possible to predict who will have a mild case of chickenpox and who will have a serious or even deadly case of disease. Now that there is a safe and effective vaccine, it is not worth taking this chance.

Resource:
www.cdc.gov

Johnson County Disease Report

Disease Name	Jan 08	Feb 08	March 08	April 08	May 08	June 08	July 08	Aug 08	Sept 08	Oct 08	Nov 08	Total YTD
Calicivirus/Norwalk-like virus (norovirus)	3	1	14	1	1	0	0	0	0	0	0	20
Campylobacter Infection (Campylobacter spp.)	8	1	5	10	0	9	25	20	4	7	1	90
Cryptosporidiosis (Cryptosporidium parvum)	1	0	0	1	1	1	2	6	0	1	0	13
Dengue	0	0	0	0	0	0	1	2	0	0	0	3
Dengue Hemorrhagic Fever	0	0	0	0	0	0	1	0	0	0	2	3
Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	0	1	1	2	0	3	0	4	0	12
Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	0	0	0	0	1	0	1	0	0	4
Enterohemorrhagic Escherichia coli 0157:H7	0	0	0	0	0	0	1	0	0	1	1	3
Giardiasis (Giardia lamblia)	9	2	4	4	3	2	6	11	3	1	3	48
Salmonellosis (Salmonella spp.)	6	0	4	6	5	8	9	5	10	7	3	63
Shigellosis (Shigella spp.)	1	0	0	0	1	0	3	1	1	2	0	9
Amebiasis (Entamoeba histolytica)	0	0	0	0	0	1	0	0	0	0	0	1
Ehrlichiosis, human monocytic (HME)	0	0	3	1	2	2	2	1	0	3	0	14
Ehrlichiosis, human monocytic (HGE)	0	0	0	0	1	1	2	0	1	1	0	6
Hepatitis A	2	3	1	3	1	4	3	5	0	3	1	25
Hepatitis B, acute	1	0	2	1	1	2	0	2	1	1	0	11
Hepatitis B, chronic	16	16	19	10	10	6	8	2	6	3	5	101
Hepatitis C virus infection (past or present)	14	20	51	26	17	12	4	9	11	10	17	191
Legionellosis	0	1	2	0	0	1	0	0	1	1	2	8
Listeriosis (Listeria monocytogenes)	0	0	0	0	0	1	0	0	0	0	1	2
Lyme Disease (Borrelia burgdorferi)	0	1	2	3	4	0	1	2	5	2	4	24
Malaria	0	0	0	0	0	0	0	1	0	0	0	1
Meningitis, other bacterial	0	0	1	0	1	0	0	0	0	1	0	3
Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	2	1	1	3	2	0	7	3	5	25
Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2	4	1	3	3	0	0	0	1	16
Streptococcal pneumoniae, invasive, drug-resistant	2	2	1	2	1	0	1	0	0	0	1	10
Transmissable Spongioform Encephalitis (TSE./CJD	0	0	0	0	0	0	0	0	2	0	0	2
West Nile, non-neurological (includes WN Fever)	0	0	0	0	0	2	1	1	0	0	0	4
Haemophilus influenzae, invasive	0	0	0	0	1	2	0	0	1	1	0	5
Measles (Rubeola)	0	0	0	0	0	0	0	0	0	1	0	1
Mumps	0	0	0	0	0	0	1	0	0	2	0	3
Pertussis (Bordetella pertussis) (Whooping cough)	4	6	4	2	2	4	3	1	5	10	11	52
Varicella (Chickenpox)	24	57	38	25	26	3	7	14	23	13	12	242
Early Syphilis	0	1	4	2	3	1	0	3	2	1	0	17
Gonorrhea	N/A	28*	11	5	12	9	13	11	10	13	13	125
Chlamydia	N/A	182*	90	81	122	102	120	99	106	95	95	1092

*totals are for January and February

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 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.