Johnson County Health Department - EPI Update Newsletter

Picnics and potlucks are part of the ritual of summer. When out enjoying the warm weather, it is important to be very careful about food preparation and storage, especially while working with raw meats or foods that need to remain refrigerated. Food borne diseases are caused by consuming contaminated foods or beverages.

There are more than 250 food borne illnesses identified. They can be caused by parasites, viruses, bacteria and toxins. The most common foods associated with food borne illness are raw foods of animal origin, including raw meat and poultry, raw eggs, unpasteurized milk and raw shellfish. Raw fruits and vegetables also pose a heightened risk. Another way to spread illness is not refrigerating food properly. A food borne disease outbreak occurs when a group of people eat from the same contaminated food supply and two or more of them become sick. Often outbreaks are difficult to investigate because they can be widespread and affect large numbers of people. However, it is critical to discover the cause and scale of the outbreak so public health authorities can treat those affected and takes steps to stop the spread of the disease.

Some of the most common food borne illnesses include Campylobacter and Salmonella. These diseases are often spread by consuming undercooked chicken or improperly preparing meat. Salmonella and Campylobacter bacteria cause fever, diarrhea and abdominal cramping, and some individuals with compromised immune systems can become seriously ill.

E.coli O157:H7 is often transmitted after eating undercooked ground beef. The illness often causes severe and bloody diarrhea and painful abdominal cramps. More severe effects include temporary anemia, profuse bleeding and kidney failure.

So how can consumers protect themselves from food borne illness? There are five simple steps.

COOK meat, poultry and eggs thoroughly. Meat should be cooked to at least 160°F. Eggs should be cooked until the yolks are firm.
SEPARATE—don’t cut food on the same cutting boards, and be sure to place cooked meat on a clean platter, not the one that held raw meat. Be sure to wash your hands, utensils and cutting boards after being in contact with raw foods.
CHILL all leftovers if they are not going to be eaten within four hours. You can cool large quantities of food more quickly by separating into smaller portions and storing in several shallow containers.
CLEAN and wash all produce, removing all dirt. A good idea is to peel off the first few layers from a head of lettuce or cabbage. Also, wash your hands thoroughly throughout the cooking process. Avoid preparing food for others if you have diarrhea.
REPORT any cases of suspected or confirmed food borne illness to your local health department. Public health officials may need to talk to you even if you are not ill.

Source: www.cdc.gov/foodsafety

Smart Summer Swimming Tips

Basking in the sun at the local pool is something children and parents love to do during the summer months. But once you enter the water, how safe are you? Did you know chlorine doesn’t kill all germs?

One parasite that is resistant to chlorine is cryptosporidium, which causes diarrhea. It can be found in infected people’s stool, but is not visible to the naked eye. The parasite is protected by a thick outer shell that allows it to survive for long periods of time in water or on nearby surfaces. Some of the ways you can be exposed or infected:

Swallowing water from pools, hot tubs, Jacuzzis, fountains, lakes and other bodies of water.
By putting an object in your mouth that may have come into contact with the stool of an infected person or animal.
By swallowing crypto picked up from solid surfaces (pool lounge chairs, bathrooms, etc.) contaminated with an infected person’s feces.

There are ways to protect yourself from contracting this irritating infection.

Don’t swim when you have diarrhea, or for two weeks after.
Don’t swallow pool water.
Practice good hygiene. Take a shower before swimming and wash your hands after using the toilet or changing diapers.
Take your small child for bathroom breaks or check diapers often.
Change diapers in a bathroom facility and not near the pool.
Wash your child thoroughly, paying special attention to the rear end, with soap and water before swimming.
Check with your local pool staff to see how often the water is cleaned and how often chlorine and pH levels are checked.

Source: www.cdc.gov/crypto

With temperatures rising in the summer months, citizens should be aware of the symptoms of
heat-related illness. The three types are:

Heat stress. This includes feelings of faintness, painful muscle spasms and cramps, and a prickly heat feeling caused by a skin rash from clogged pores. This condition is caused by lack of fluids and minerals in the body to help it function properly.

Heat exhaustion. This is more serious than heat stress, and symptoms include headache, dizziness, cool and clammy skin, muscle fatigue, chest pain, breathing problems, and nausea.

Heat stroke. This is the most serious form of heat-related illness, and is life-threatening. Symptoms include headache, hot and dry skin, a temperature of 103 degrees or higher, rapid and shallow breathing, disorientation, seizures, and changes in consciousness. If an individual is showing these symptoms, cool them quickly with cold, wet sheets or a cool bath, and take them to the nearest hospital.

To stay cool during the long, hot summer months, follow these tips:

Drink plenty of fluids, such as water, juices, and sport drinks. Avoid caffeinated drinks, coffee and alcohol, as they dehydrate the body. Drink at least a gallon of water a day while spending time outdoors.
Dress children lightly, and check on them often when they play outside. They should take frequent trips indoors to cool off and drink water. Young children should wear sunscreen of SPF 50 to reduce their risk of sunburn. Infants should spend the least amount of time possible in the sun.
Check on elderly people often.
Wear loose and light-colored clothing.
Take cool showers.
Take frequent breaks to cool off.
Eat light meals with plenty of fruits and vegetables. Eat apricots, bananas, cantaloupes, oranges, beans, broccoli, potatoes, and tomatoes to increase potassium.
Schedule outdoor activities in the morning and evening, and try to stay in the shade while outdoors.

Source: http://emergency.cdc.gov/disasters/extremeheat/heat_guide.asp

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Since the beginning of 2008, animal control officers in Johnson County have investigated eight cases where coyotes have injured or killed small domestic animals.

Although coyotes will occasionally prey on free-roaming cats and small dogs, the fear of coyotes eating pets is greatly exaggerated. Investigations have shown that most of the coyote bites that occur nationally each year are directly related to coyotes being fed by humans, whether intentional or not. Coyote attacks on people are extremely rare. Unfortunately they are highly publicized.

Currently the Centers for Disease Control and Prevention (CDC), the Kansas Department of Health & Environment, and the Johnson County Health Department do not classify coyotes as a human safety risk.

According to the CDC, more than 330,000 people visit the emergency room each year for treatment of a domestic animal bite related injury, yet pets are not banished from homes. Therefore it is very important to place risk in proper perspective. The likelihood, statistically speaking of a coyote causing harm to humans is almost zero.

Individuals should be aware of important precautionary measures. They should contact their local animal control office or police department if they observe a coyote acting sick or showing abnormal behaviors such as: partial paralysis, walking in circles, staggering as if drunk or disoriented, self-mutilating, or exhibiting unprovoked aggression or unnatural tameness this could be a sign that the animal is rabid.

There are two forms of rabies:

Paralytic rabies (also called dumb rabies) Animals, especially wild ones, with dumb rabies become unusually gentle and friendly. They might appear confused and wander aimlessly. Dumb rabies causes ascending paralysis that typically starts in the hind limbs. It may be accompanied by other symptoms such as a drooping jaw and an extended tongue with extreme salivation (drooling).

Furious rabies These animals are prone to vicious unprovoked attacks, they make odd noises and have extreme salivation (drooling/foaming at the mouth).

Symptoms can appear within 10 days or up to five months depending on the point of infection. If an animal is bitten by a rabid animal the incubation period is dependent on where the bite occurred; if bitten near or on the head, the symptoms show up quicker than if the bite is on the lower extremities.

The most important advice for the public is to avoid contact with coyotes and vaccinate their pets.

If a person is bitten by a coyote they must be considered exposed to the rabies virus. Rabies is a medical urgency - not an emergency - but decisions to start post-exposure prophylaxis (PEP) should not be delayed. If the animal has already been tested and determined not to be rabid, then no PEP is warranted. If testing has not occurred or the animals’ location is unknown, then PEP should be started. If after PEP has started, the animal is found and determined by proper testing not to be rabid, the PEP can be discontinued.

Signs of rabies among wildlife cannot be interpreted reliably; therefore any animal that exposes a person should be euthanized as soon as possible without damaging the head and brain. The brain will be submitted for rabies testing. If the test results are positive or unsuitable the exposed individual will require PEP. If the test result is negative the person exposed does not require PEP.

PEP consists of the exposed person that has never been vaccinated receiving a total of five injections over a period of 28 days. The vaccine is administered in the upper arm on the day of exposure (day one) and then again at three days, seven days, 14 days and 28 days after exposure. A rabies immune globulin is also injected around the site of exposure on the first day.

Someone who has been vaccinated (Veterinarians, Animal Control Officers, etc.) must receive two boosters, one on the day of exposure and the second one three days later.

Dogs, cats, and ferrets should be vaccinated at three months of age, given a booster one year later, and then vaccinated every year or every three years depending on the vaccine administered.

If a vaccinated animal is bitten, it should be revaccinated immediately and observed for 45 days. If the pet then bites someone, it will be considered unvaccinated and may either have to be euthanized or kept in a strict lengthy quarantine.

If a dog, cat or ferret is unvaccinated or not current on its vaccinations, euthanasia is highly recommended. If the owner chooses not to have the animal euthanized, then the animal must be quarantined for six months in an approved facility and revaccinated one month before it is released.

Kansas Animal Rabies Testing Results for Coyotes Provided by Kansas State University Laboratory 1995-2008
Year	Positive	Negative	Unsuitable	County
1995	0	14	0
1996	0	8	0
1997	0	4	0
1998	1	9	0	Sedgwick, KS
1999	0	11	0
2000	0	10	0
2001	0	2	1
2002	0	9	0
2003	0	3	0
2004	0	4	0
2005	0	4	0
2006	1	11	0	Kingman, KS
2007	0	4	1
2008	0	1	1

Sources:

http://www.cdc.gov/

http://www.cdc.gov/mmwr/preview/mmwrhtml/00056176.htm

http://www.kdheks.gov/epi/download/Rabies_Compendium_2008.pdf

http://www.vet.ksu.edu/depts/dmp/service/rabies/index.htm

http://www.dhss.missouri.gov/Rabies/Reports.html

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Johnson County Disease Report

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 Category	Disease Name	January 2008	February 2008	March 2008	April 2008	May 2008	Total YTD
Enteric	Calicivirus/Norwalk-like virus (norovirus)	3	1	14	1	1	20
	Campylobacter Infection (Campylobacter spp.)	8	1	5	10	0	24
	Cryptosporidiosis (Cryptosporidium parvum)	1	0	0	1	1	3
	Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	0	1	1	3
	Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	0	0	0	2
	Giardiasis (Giardia lamblia)	9	2	4	4	3	22
	Salmonellosis (Salmonella spp.)	6	0	4	6	5	21
	Shigellosis (Shigella spp.)	1	0	0	0	1	2
General	Hepatitis A	2	3	1	3	1	10
	Hepatitis B, acute	1	0	2	1	1	5
	Hepatitis B, chronic	16	16	19	10	10	71
	Hepatitis C virus infection (past or present)	14	20	51	26	17	128
	Legionellosis	0	1	2	0	0	3
	Lyme Disease (Borrelia burgdorferi)	0	1	2	3	4	10
	Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	2	1	1	5
	Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2	4	1	9
	Streptococcal pneumoniae, invasive, drug-resistant	2	2	1	2	1	8
Vaccine-Preventable Diseases	Haemophilus influenzae, invasive	0	0	0	0	0	1
	Pertussis (Bordetella pertussis) (Whooping cough)	4	6	4	2	2	18
	Varicella (Chickenpox)	24	57	38	25	26	170
Sexually Transmitted Diseases	Early Syphilis	0	1	4	2	3	10
	Gonorrhea	N/A	28*	11	5	12	56
	Chlamydia	N/A	182*	90	81	122	475

*totals are for January and February

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.