Johnson County Health Department - EPI Update Newsletter

The Johnson County Health Department now has Zostavax available for those 60 years and older to prevent shingles.

The new vaccine was licensed in May 2006 by the Food and Drug Administration, and is given as a single dose by an injection under the skin, preferably in the upper arm. While Zostavax does not treat existing cases of shingles or post-herpetic neuralgia (pain associated with the disease after the rash has cleared), it can help prevent the painful disease.

Shingles, also called herpes zoster, is a painful skin rash caused by the varicella zoster virus. After an individual develops chickenpox, the virus continues to live in the body, sometimes for decades. Later in life, the virus can reappear, causing blisters and later a rash that causes pain, itching and tingling. Other symptoms may develop, including fever, headache, chills, and upset stomach.
Most cases of shingles occur in people 50 years and older. Those with certain medical conditions that compromise the immune system, including cancer, leukemia, and HIV, are at higher risk of developing shingles.

The new vaccine has been studied in clinical trials with thousands of adults 60 years and older, and was found to prevent shingles in 51 percent of people and post-herpetic neuralgia in 67 percent of the study participants. Zostavax was found to be most effective in individuals 60 to 69 years of age.
Zostavax vaccine is available at the health department for $165. The vaccine is administered from 8:30 a.m. – 4:00 p.m. Monday through Thursday and 8:30 a.m. – 12:00 p.m. Friday at the following locations:

Mission Clinic
6000 Lamar, Suite 140
Mission, KS 66202

Olathe Clinic
11875 S. Sunset, Suite 300
Olathe, KS 66061

Sources: http://www.cdc.gov/nip/vaccine/zoster/faqs-vacc-zoster.htm
http://www.cdc.gov/nip/diseases/shingles/faqs-disease-shingles.htm
http://www.fda.gov/Cber/products/zosmer052506qa.htm

Hepatitis C is a liver disease caused by the hepatitis C (HCV) virus. This disease is spread by contact with the blood of an infected person. While hepatitis C can cause serious health consequences for some, others can carry it throughout their lifetime and never get sick. Most of those who are infected with hepatitis C will have at least some liver damage. Others may develop cirrhosis (scarring) of the liver and liver failure many years after becoming infected.

To protect yourself from contracting hepatitis C:
• Do not share intravenous drug needles.
• Do not share toothbrushes, razors, or other personal care articles.
• If you are a health care worker, always follow routine barrier precautions and safely handle needles and other sharps. Get vaccinated against hepatitis B.
• Consider the health risks before getting a tattoo or body piercing. Make sure your tattoo artist or piercer follows good health practices.
• Practice safe sex by using latex condoms. (Although it is rare, hepatitis C can be potentially spread through unprotected sex with an infected partner.)

Many of those who are at risk for hepatitis C are also at higher risk of contracting hepatitis A and B. Check with your healthcare provider to see if you need to be vaccinated against these other two types of hepatitis.
It is important to know that hepatitis C is NOT spread through the following activities:
• Breast feeding
• Sneezing
• Hugging or kissing
• Coughing
• Sharing eating utensils or drinking glasses
• Food or water
• Casual contact

There is currently no vaccine to guard against hepatitis C, but with common sense and good hygiene, we can slow, and some day hopefully stop, the spread of this deadly disease.

Sources:
http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm
http://www.cdc.gov/ncidod/diseases/hepatitis/c/hepcprev.htm

Several cases of fifth disease were reported to the Johnson County Health Department in December 2006. Although fifth disease has been historically viewed as an unimportant rash illness of children, recent studies have shown that the virus may be responsible for serious complications in certain individuals, specifically pregnant women and those with chronic red blood cell disorders.

What is fifth disease?
Fifth disease is a viral infection which often affects red blood cells, and that results in viral exanthem – “exanthem” being another name for a rash or skin eruption. It is spread through airborne droplets from the nose and throat of infected individuals or through contact with infected blood. Fifth disease is moderately contagious and usually does not include a high fever, as seen with some other viral skin conditions.

What causes fifth disease?
Fifth disease is caused by a human parvovirus (B19), and is most prevalent in the winter and spring. It is usually seen in children 5 to 14 years of age, with outbreaks of the disease frequently occurring in school settings.

What are the clinical symptoms?
One to two weeks after exposure, some children will experience a low-grade fever and tiredness. By the third week, a red rash generally appears on the cheeks giving a “slapped face” appearance. The fifth disease rash may extend to the body and tends to fade and reappear over a period of two to four days. The rash may be lacy in appearance and may be itchy. Children with the fifth disease virus may present with vague signs of illness or no symptoms at all.

How is the virus diagnosed?
In most cases, the disease is diagnosed based simply on the appearance of typical symptoms. A specific blood test to confirm the diagnosis has recently become available but is not necessary in healthy children.

What is the period of communicability?
A person is contagious during the early part of the illness -- before the rash appears. By the time the rash is evident, the child is probably no longer contagious and may return to school or childcare. It is generally accepted that those who have been previously infected acquire long-term or lifelong immunity; and studies have shown that more than 50 percent of adults are immune to parvovirus B19.

What is the treatment?
Because it is a viral infection, there is no specific treatment or cure for fifth disease. Physicians may manage a patient’s symptoms of the illness through increased fluid intake and acetaminophen for fever (DO NOT GIVE ASPIRIN).

What are the complications associated with fifth disease?
While there is no evidence that parvovirus B19 infection is a significant cause of fetal defects, some studies have shown that infection may increase risk of miscarriage or spontaneous abortion. In people with chronic red blood cell disorders, such as sickle-cell disease, infection may result in severe anemia. Infection has also been associated with arthritis in adults, with joint pain and swelling usually resolving in a week or two but potentially lasting several months.

What's in a name? The name "fifth disease" stems from the fact that when diseases causing childhood exanthemata (rashes) were enumerated, it was the fifth listed. The other four exanthematous childhood diseases are: varicella (chickenpox), rubella (German measles), roseola, and rubeola (measles).

With the outbreak of this nasty virus on many cruise ships, here are some fast facts on norovirus and how to keep healthy on your dream vacation.

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 sick person.

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:

Washing your hands often, especially while preparing or eating food and after using the restroom or changing diapers.
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.

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

Environmental Health Program Helps Kids With Allergies

Children’s Mercy Hospital has an environmental health assessment program that helps identify the cause of allergies in children who have exhibited chronic, health issues as a result of asthma, allergy, other health problems, or environmental exposure.
The Mercy program was developed four years ago to help children and families plagued by allergies. These chronic health problems can result in lost time from work and school, and lead to other health concerns. The Mercy program offers professional environmental health assessments, where air and dust from homes is analyzed and evaluated to see what makes houses livable and what makes them “sick”. There are three main areas of investigation:

1. A visual walkthrough and assessment of the home or facility and its mechanical components;
2. An evaluation of indoor air quality through on-site measurements; and
3. Environmental sampling and lab analyses of air, bulk, surface, and/or vacuum samples for environmental allergens and irritant particulates.

The criteria for assessment request are children who have exhibited chronic, persistent and/or recurring health symptoms as a result of asthma, allergy or other health problems. These services are available to the general public, private schools and any commercial facility where children may spend part of their day. For additional information, contact Children’s Mercy Hospital at (816) 235-6331.

Source: http://www.childrens-mercy.org/MSO/dept/lnav/view.asp?nav=272

Sarah McMeans started working with the Johnson County Health Department as the Risk Communicator in April 2006. Sarah works on press releases, brochures and other literature for the Health Department, including the Epi Update and Promoting Wellness newsletters. She also updates the websites http://health.jocogov.org and www.jocoflu.org and has developed several advertising campaigns about pandemic influenza preparedness.

Sarah is a member of the Regional Association of Public Information Officers and a co-chair of the Risk Communication Task Force, which is part of the Regional Homeland Security Coordinating Council—a bi-state organization.

Sarah Graduated from K-State in 2003 with Bachelor's of Science in Mass Communication and previously worked in non-profit sector and for an advertising firm.

December Communicable Disease Report:

DECEMBER DISEASE REPORT
Disease Category	December 2006	December 5 - yr average	YTD 2006	2005 Total	2004 Total	2003 Total
Enteric Diseases
Salmonella	3	6	60	95	85	50
Campylobacter	1	3.4	64	50	53	48
Vaccine-Preventable Diseases
Measles	0	0	1	0	0	0
Mumps+	11+	0	134+	3+	1+	2+
Pertussis	0	2	34	27	19	5
Varicella+	31+	20**	229+	299*+	51*+	N/A
M. tuberculosis, confirmed	1	0.6	10	12	6	15
HIV and AIDS (Miami and Johnson Counties)	April-June 2006	April - June 5 - yr average	YTD 2006	2005 Total	2004 Total	2003 Total
HIV	3	4.4	10	24	17	16
AIDS	3	4.2	9	20	26	18

All numbers current as of January 11, 2006
* Became reportable in June 2004
** December 2- year average
+ Includes probable as well as confirmed cases
N/A - not applicable

Disease Reporting Notes:

If you have any questions about the monthly communicable disease report, 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 us a call if you have any questions or concerns at (913) 826-1303. On behalf of the Disease Containment staff, 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.