Johnson County Health Department - EPI Update Newsletter

The Johnson County Health Department (JCHD) is urging local physicians and other health care providers to accurately document the vaccine they administer. Documenting the exact vaccine administered will help other health care providers in the region ensure multiple doses of the same vaccine are not administered. It will also help ensure that children are meeting the requirements for school entry.

The most frequent time a vaccine is questioned is when a record shows a “tetanus shot” rather than a tetanus/diphtheria (Td). The Td is the school requirement.

An example:

Td or Tetanus/Diphtheria

*NOT*

Tetanus

Liz Ticer, Public Health Emergency Program Coordinator, was deployed to Greensburg, Kansas from May 31 to June 8 to help with recovery efforts in that area following the May tornado that devastated the town. Ticer spent her time working as the Logistics Section Chief, which helped to coordinate logistical issues for the entire county response, including assisting in demobilizing federal assets, acquiring temporary storage and building facilities for county agencies, and ordering all supplies needed in the area.
Ticer had seen the photos of the devastation, but still was not prepared for what she saw when she drove into town.
“Pretty much every structure in the town that wasn’t completely destroyed in the tornado will have to be torn down. The only structure that’s functional and safe is the grain elevator.”
Severe weather has still continued to wreak havoc on the cleanup efforts in the area. More than once operations had to be shut down and workers had to evacuate the town. Only essential personnel stayed behind, the roofless courthouse filling in as their emergency shelter.
“We were working out of trailers, RVs, buses and tents. They were definitely not safe places to be in a storm,” Ticer said.
During Ticer’s deployment, fifty percent of the town had water services restored, but debris and destruction were still evident everywhere. FEMA had ordered 300 single-family trailers for families to live in as they rebuild their lives in the new Greensburg. Many are never moving back, evident in the number of ‘For Sale’ signs that could be found in the vacant lots all over town.
But cleanup continues, and the faithful citizens still return to Greensburg even a month later to sift through rubble and pick up the pieces left behind. Thousands of “white items” (refrigerators, washers, dryers, and other appliances,) dotted the landfill, waiting to be destroyed. Cars have been towed and sit in a nearby field, the twisted metal and broken glass bearing silent witness to what they had seen.
Different non-profit groups set up tents all over town, providing food, water, ice, or just a place to relax for a while. Near the food tent, multiple signs told workers to wash their hands at mobile hand washing stations before entering the tent to get their meals.
“They had 18 sinks in the food area. Every single person that came up for a meal washed their hands before getting near the food line,” Ticer said.
Other precautions were taken to ward off the spread of disease. One of the first goals the Kiowa County Health Department had was to give Td vaccinations to everyone working in the town. The health department also is working out of its new location – a double-wide trailer placed in the center of town.
It will be a long time before Greensburg is back to the “new normal.”
“The people of that town are dedicated in trying to build a new Greensburg – a bigger and better version of what was there. And I am hoping they will be successful.”

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Melissa Henrich began working with the Johnson County Health Department as a Risk Communicator in January 2007. She specializes in creating public health emergency preparedness messages, and is also the volunteer coordinator for the Public Health Emergency Program. She has worked to canvass the Johnson County community with information about pandemic flu and disaster preparedness.
Melissa is a member of Metropolitan Official Health Agencies of the Kansas City Area's (MOHAKCA) Education subcommittee and is a member of the Johnson County Hispanic Task Force.
Before coming to Johnson County, Melissa was a Public Information Officer and Health Educator for the Kansas City Missouri Health Department for four years. She received her bachelor’s degree in Kinesiology from Kansas State University in 1997, a Master’s in Alternative Medicine from Clayton College of Natural Health in 2000, and is currently working on her MBA in Healthcare Management through the University of Phoenix.

Plague in the Midwest

Naturally-Occurring Plague in the United States
No cases of plague have ever been reported in Johnson County or in Kansas, but there has been a resurgence of the disease in Colorado and New Mexico. A three-year old boy in New Mexico died of septicemic plague in June. A monkey at the Denver Zoo died in May of the bubonic form, and more than 20 animals (mostly tree squirrels) in the surrounding park have tested positive for the disease.

What is plague?
Plague is a disease caused by Yersinia pestis (Y. pestis), a bacterium found in rodents and their fleas in many areas around the world.

Plague Types
All types of plague are caused by Yersinia pestis, but they are transmitted differently and their symptoms differ. Septicemic and pneumonic plague progress rapidly and are usually fatal without prompt treatment; bubonic plague has a mortality rate of 50 percent – 90 percent if untreated.

• Bubonic plague is transmitted through the bite of an infected flea or exposure to infected material through a break in the skin. Symptoms include swollen, tender lymph glands called buboes. If bubonic plague is not treated, however, the bacteria can spread through the bloodstream and infect the lungs, causing a secondary case of pneumonic plague.
• Septicemic plague results in gastrointestinal symptoms, including nausea, vomiting, diarrhea, and abdominal pain.
• Pneumonic plague can be transmitted from person to person. Pneumonic plague affects the lungs and is transmitted when a person breathes in Y. pestis particles in the air. Buboes are not present in pneumonic plague.

Does plague occur naturally?
Yes. The World Health Organization reports 1,000 to 3,000 cases of plague worldwide every year. An average of 5 to 15 cases occur each year in the western United States. These cases are usually scattered and occur in rural to semi-rural areas.

Who is at risk?
In the United States, those most at risk for contracting plague are those persons exposed to rodent fleas, wild rodents, or other susceptible animals. Most cases occur in New Mexico, Arizona, Colorado and California.

Prevention
To eliminate the number of fleas and rodents that can possibly spread plague, here are a few measures to take:
• Eliminate food and shelter for rodents in and around homes, workplaces, and recreation areas by making buildings rodent-proof, and by removing brush, rock piles, junk and food sources (such as pet food) from properties.
• Treat pets for fleas.
• Do not handle or allow pets to play with injured, sick or dead wild animals.
• Use rubber gloves to pick up a dead animal and place it in a double-layered garbage sack, then throw the sack and gloves away.

References:
http://www.bt.cdc.gov/agent/plague/faq.asp
http://www.promedmail.org/pls/promed/f?p=2400:1001:18101699033870112446::::F2400_P1001_
BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1202,20060826.2431,Y
http://www.cdc.gov/MMWR/preview/mmwrhtml/mm55d825a1.htm
www.cdc.gov/ncidod/dvbid/plague/facts.htm
www.cdc.gov/ncidod/dvbid/plague/info.htm
http://www.denverpost.com/ci_5952320

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.