Johnson County Health Department - EPI Update Newsletter

Recreational Water Illnesses (RWIs) are caused by ingesting, inhaling vapors of, or having contact with contaminated water in swimming pools, water parks, spas, interactive fountains, ponds, lakes, rivers, or oceans. RWIs can cause a wide variety of symptoms, including gastrointestinal, skin, ear, respiratory, eye, neurologic, and wound infections. The most common symptom of RWIs is diarrhea, and this can be caused by Cryptosporidium, Giardia, Shigella, norovirus, and E.coli O157:H7.
Johnson County had its largest amount of RWI cases in 2005 with 120. The majority of those cases were Giardia and Shigella. (see additional numbers below).
The best way to prevent RWIs this summer is to keep germs out of the pool in the first place. Swimmers can protect themselves and others by taking the following steps:

Do not swim with diarrhea
Do not swallow pool water
Practice good hygiene (shower with soap before swimming and wash hands after using the toilet or changing diapers)
Take children on bathroom breaks often and change diapers often
Change diapers in a bathroom or diaper-changing area and not at poolside
Wash children thoroughly with soap before they go swimming

Chlorine does kill the germs that make people sick, but it takes time. Chlorine in properly disinfected pools kills most germs that can cause RWIs in less than an hour. Chlorine takes longer to kill some germs such as Crypto, which can survive for days in a properly disinfected pool. That is why it is so important to follow the six steps above.

2004
Cryptosporidiosis (Cryptosporidium parvum)	5
Enterohemorrhagic Escherichia coli O157:H7	7
Giardiasis (Giardia lamblia)	47
Shigelllosis (Shigella spp.)	11
TOTAL CASES	70

2005
Cryptosporidiosis (Cryptosporidium parvum)	8
Enterohemorrhagic Escherichia coli O157:H7	6
Giardiasis (Giardia lamblia)	59
Shigelllosis (Shigella spp.)	47
TOTAL CASES	120

2006
Cryptosporidiosis (Cryptosporidium parvum)	31
Enterohemorrhagic Escherichia coli O157:H7	5
Giardiasis (Giardia lamblia)	45
Shigelllosis (Shigella spp.)	9
TOTAL CASES	90

2007
Cryptosporidiosis (Cryptosporidium parvum)	30
Enterohemorrhagic Escherichia coli O157:H7	6
Giardiasis (Giardia lamblia)	58
Shigelllosis (Shigella spp.)	2
TOTAL CASES	96

2008
Cryptosporidiosis (Cryptosporidium parvum)	12
Enterohemorrhagic Escherichia coli O157:H7	3
Giardiasis (Giardia lamblia)	44
Shigelllosis (Shigella spp.)	10
TOTAL CASES	69

Sources:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5818a8.htm
http://www.cdc.gov/healthyswimming/

Bat Exposures are Difficult to Determine

According to the Centers for Disease Control and Prevention (CDC) most of the recent human rabies cases in the United States have been caused by rabies virus from bats. Awareness of the facts about bats and rabies can help people protect themselves, their families, and their pets.
Because rabies is a fatal disease, public health strives to prevent human exposure to rabies by education and prevention of the disease by anti-rabies treatment if exposure occurs.

Tens of thousands of people are successfully treated each year after being bitten by an animal that may have rabies. In the United States, deaths continue to occur from rabies, usually because the risks of rabies exposure are not recognized and no medical treatment is obtained.

Individuals are usually aware when they have been bitten by a bat. However, there are instances where medical treatment is appropriate in the absence of an obvious bite wound. Bats have small teeth which may leave marks that are not easily seen.

Bat exposures in your home are often difficult to determine. Areas, in which children, elderly and those unable to communicate are sleeping, are especially vulnerable. Local animal control officers or professional pest control companies should be contacted to remove the bats and submit them for rabies testing.

Transmission of rabies does not occur from simply observing a bat in an attic, a cave, or at a distance. In addition, touching a bat on its fur (even though bats should never be handled) or coming in contact with bat guano (feces), urine, or blood does not automatically transmit rabies.
Never wait until symptoms begin. By the time symptoms develop, it is too late for treatment and rabies becomes a fatal illness. There are currently no tests available to diagnose rabies in people prior to the onset of symptoms.

Keeping bats out of your home is easy by following a few simple steps.

Do not leave unscreened doors or windows open to the outside. Make sure all doors that open to the outside close tightly.
Make sure doors and windows are screened, chimneys are capped, and electrical and plumbing openings in the structure are plugged.
Seal openings larger than ¼ inch by ½ inch square that would allow access into the attic, basement, walls, or living areas of a structure.
Utilize materials to seal or cover gaps and holes including spray-on expanding foam, wire mesh, netting, caulk, or tight-fitting wood. Steel wool or caulking can be utilized around pipes that enter buildings.

The Johnson County Health Department suggests extreme caution in dealing with all animals, especially unfamiliar ones, to reduce the risk of being bitten.

http://www.cdc.gov/rabies/bats.html

Follow these tips to ensure picnics stay healthy and fun this summer:

Wash your hands with hot, soapy water before and after handling food.
When marinating meats or vegetables for long periods of time, keep the foods refrigerated. Don’t use sauce that was used to marinate raw meat or poultry on cooked food. Boil used marinade before applying to cooked food, or throw the marinade out altogether.
When grilling foods with a charcoal grill, preheat the coals on your grill for 20 to 30 minutes, or until the coals are lightly covered with ash.
Use a meat thermometer to ensure food reaches a safe internal temperature. Hamburgers should be cooked to 160 degrees Fahrenheit, while large cuts of beef such as roasts or steaks may be cooked to 145 degrees for medium rare or 160 degrees for medium. Cook ground poultry to 165 degrees and poultry parts to 170 degrees. Fish should be opaque and flake easily.
When taking foods off of the grill, do not put cooked food items back on the same plate that previously held raw food.
Make sure coolers are full of ice to maintain cold temperatures longer than one that is partially filled. Make sure to pack plenty of extra ice or freezer packs to ensure a constant cold temperature. Be sure to keep refrigerators at 40 degrees or below. Use a thermometer to monitor.

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Johnson County Disease Report

Disease Name	Jan 09	Feb 09	Mar 09	April 09	May 09	Total YTD
Campylobacter Infection (Campylobacter spp.)	2	3	8	4	4	21
Cryptosporidiosis (Cryptosporidium parvum)	0	0	1	2	3	6
Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	1	0	0	2
Enterohemorrhagic Escherichia coli 0157:H7	0	0	0	1	1	2
Giardiasis (Giardia lamblia)	1	3	2	2	1	9
Salmonellosis (Salmonella spp.)	2	2	3	2	2	11
Shigellosis (Shigella spp.)	1	2	1	1	1	6
Amebiasis (Entamoeba histolytica)	0	0	0	2	1	3
Brucellosis	0	0	1	0	0	1
Ehrlichiosis, Ehrlichia chaffeensis	0	1	1	0	1	3
Ehrlichiosis, human other	0	0	0	0	1	1
Hepatitis A	1	4	3	1	3	12
Hepatitis B, acute	1	0	0	1	1	3
Hepatitis B, chronic	7	10	10	5	13	45
Hepatitis C virus infection (past or present)	21	14	12	18	19	84
Legionellosis	1	0	0	1	0	2
Lyme Disease (Borrelia burgdorferi)	1	1	1	2	6	11
Malaria (Plasmodium spp.)	1	0	0	0	0	1
Meningitis, Niesseria meningitidis	0	0	1	0	0	1
Meningitis, other bacterial	0	0	0	1	0	1
Q Fever (Coxiella burnetii)	0	1	1	1	0	3
Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	3	2	1	3	3	12
Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	0	5	1	3	2	11
Streptococcus pneumoniae, invasive, drug-resistant	2	2	2	2	0	8
Toxic Shock Syndrome, streptococcal and staphylococcal	0	1	1	0	0	2
Haemophilus influenzae, invasive	0	0	1	1	0	2
Mumps	1	0	2	2	2	7
Pertussis (Bordetella pertussis) (Whooping cough)	6	9	7	7	1	30
Varicella (Chickenpox)	13	23	22	27	14	99
Early Syphilis	2	4	1	1	0	8
Gonorrhea	5	25	18	9	8	65
Chlamydia	61	176	80	118	96	531
Latent Tuberculosis infection	20	29	34	23	24	130
Active Tuberculosis infection	2	5	7	0	0	14

2009 H1N1 A Influenza Virus Reported to Johnson County Health Department from 4/24/09 to 6/4/09:

Not a case	106
Suspect	22
Confirmed	11

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.