Johnson County Health Department - EPI Update Newsletter

Throughout July, Johnson County has received confirmation on new H1N1 cases, bringing the total number of confirmed cases to 19 (as of 7/21/09). The Kansas Department of Health & Environment (KDHE) decided in May to only test samples from suspect hospitalized cases in the Kansas metropolitan area. Cases in the state continue to rise steadily with 35* counties reporting at least one case. There have been no deaths in Kansas attributed to the H1N1 virus.
The symptoms of H1N1 influenza A virus are similar to the symptoms of seasonal flu and include:

Fever greater than 100 degrees
Body aches
Sore throat
Respiratory congestion
In some cases, diarrhea and vomiting

Individuals who experience the above symptoms should contact their healthcare provider, who will determine whether testing or treatment is needed. There is no vaccine available at this time to protect against the 2009 H1N1 virus, but there are effective treatments available once the infection is diagnosed.
As with any influenza virus, individuals are encouraged to take the following steps to reduce
spread:

• Wash your hands thoroughly with soap and warm water or use an alcohol-based hand
sanitizer to get rid of most germs and avoid touching your eyes, nose and mouth.

• Stay home when you are sick to avoid spreading illness to co-workers and friends.

• Cough or sneeze into your elbow or a tissue and properly dispose of used tissues.

• Stay healthy by eating a balanced diet, drinking plenty of water and getting adequate rest
and exercise.

*as of 7/21/09

Common Tick-Borne Diseases in Kansas

Ehrlichiosis
Ehrlichiosis is actually a general name to describe several bacterial illnesses that affect animals and humans. There are currently two species in the United States that cause disease in humans: Ehrlichia chaffeensis and Ehrlichia ewingii. Ehrlichiosis is caused by the bite of an infected tick, with the lone star tick being the primary vector. Symptoms of the disease include:

Fever
Headache
Fatigue
Muscle aches

Other signs and symptoms may include:

Nausea
Vomiting
Diarrhea
Cough
Joint pains
Confusion
Occasional rash

Symptoms often appear five to 10 days after the tick bite occurs. Many people never become ill or have very mild symptoms. Last year there were 14 reported cases of Ehrlichosis in Johnson County.

Lyme Disease
Johnson County had 24 probable or confirmed cases of Lyme Disease reported last year. Lyme is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through infected blacklegged (deer?) ticks. Typical symptoms include:

Fever
Headache
Fatigue
Skin rash (erythema migrans)

If left untreated, the infection can spread to joints, the heart, and the nervous system.
Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics, if identified early. If you have been in a tick-infested area, or have found a tick on your body and have any of the above symptoms, see your physician.

Rocky Mountain Spotted Fever (RMSF)
Rocky Mountain Spotted Fever (RMSF) is the most severe tick-borne illness in the United States. The American dog tick, the Rock Mountain wood tick, and the brown dog tick have all been identified as vectors of this disease. Patients infected with the illness usually visit a physician within the first week of symptoms, but the early clinical presentation of RMSF is often non-specific and may resemble other infectious and non-infectious diseases. Initial symptoms of RMSF may include:

Fever
Nausea
Vomiting
Muscle pain
Lack of appetite
Severe headache

Later signs and symptoms include:

Rash
Abdominal pain
Joint pain
Diarrhea

Three important components of the clinical presentation are fever, rash, and a previous tick bite, although one or more of these components may not be present when the patient is first seen for medical care. Rocky Mountain Spotted Fever can be a severe illness, and the majority of patients are hospitalized with the disease. Johnson County had 28 reported cases last year.

West Nile Virus (WNV) is a seasonal epidemic that flares up in the summer and fall. According to the Centers for Disease Control & Prevention, Kansas had 31 cases of West Nile Virus in 2008, with no confirmed cases in Johnson County.

WNV is contracted through the bite of an infected mosquito. The easiest and best way to avoid the disease is to avoid mosquito bites.

• When you are outdoors, use insect repellent containing DEET, Picaridin, Oil of Lemon Eucalyptus, or IR3535. Be sure to follow all of the directions on the packaging.

• Mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.

• Maintain good screens on windows and doors to keep mosquitoes out.

• Get rid of mosquito breeding sites by emptying water from flower pots, buckets, and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water can drain out. Keep children’s wading pools empty and on their sides when they aren’t being used.

Symptoms of West Nile:
• Serious symptoms in a few people. About one in 150 people infected with WNV will develop severe illness. These symptoms include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.

• Milder symptoms in some people. Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach, and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.

• No symptoms in most people. Approximately 80 percent of people (four out of five) who are infected will not show any symptoms at all.

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Johnson County Disease Report

Disease Name	Jan 09	Feb 09	Mar 09	April 09	May 09	June 09	Total YTD
Campylobacter Infection (Campylobacter spp.)	2	3	8	4	4	8	29
Cryptosporidiosis (Cryptosporidium parvum)	0	0	1	2	3	1	7
Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	1	0	0	0	2
Enterohemorrhagic Escherichia coli 0157:H7	0	0	0	1	1	0	2
Giardiasis (Giardia lamblia)	1	3	2	2	1	3	12
Salmonellosis (Salmonella spp.)	2	2	3	2	2	6	17
Shigellosis (Shigella spp.)	1	2	1	1	1	2	8
Amebiasis (Entamoeba histolytica)	0	0	0	2	1	0	3
Brucellosis	0	0	1	0	0	1	2
Ehrlichiosis, Ehrlichia chaffeensis	0	1	1	0	1	6	9
Ehrlichiosis, human other	0	0	0	0	1	1	2
Hepatitis A	1	4	3	1	3	5	17
Hepatitis B, acute	1	0	0	1	1	2	5
Hepatitis B, chronic	7	10	10	5	13	12	57
Hepatitis C virus infection (past or present)	21	14	12	18	19	21	105
Legionellosis	1	0	0	1	0	0	2
Lyme Disease (Borrelia burgdorferi)	1	1	1	2	6	4	15
Malaria (Plasmodium spp.)	1	0	0	0	0	0	1
Meningitis, Niesseria meningitidis	0	0	1	0	0	0	1
Meningitis, other bacterial	0	0	0	1	0	0	1
Q Fever (Coxiella burnetii)	0	1	1	1	0	0	3
Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	3	2	1	3	3	8	20
Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	0	5	1	3	2	3	14
Streptococcus pneumoniae, invasive, drug-resistant	2	2	2	2	0	2	10
Toxic Shock Syndrome, streptococcal and staphylococcal	0	1	1	0	0	0	2
Haemophilus influenzae, invasive	0	0	1	1	0	1	3
Mumps	1	0	2	2	2	1	8
Pertussis (Bordetella pertussis) (Whooping cough)	6	9	7	7	1	8	38
Varicella (Chickenpox)	13	23	22	27	14	8	107
Early Syphilis	2	4	1	1	0	1	9
Gonorrhea	5	25	18	9	8	20	85
Chlamydia	61	176	80	118	96	37	568
Latent Tuberculosis infection	20	29	34	23	24	34	164
Active Tuberculosis infection	2	5	7	0	0	4	18

2009 H1N1 A Influenza Virus Reported to Johnson County Health Department from 4/24/09 to 7/21/09:

Confirmed

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.