Johnson County Health Department - EPI Update Newsletter

Reports of influenza cases have decreased. The map below shows reporting trends in the United States as of March 15, 2008.

Some states require flu reporting, others do not. In Kansas, the only reportable influenza is for deaths of children under the age of 18.

Revised Directions for Using Rabies Immune Globulin

According to Talecris Biotherapeutics, three lots of HyperRAB™ S/D in 2 mL uncalibrated syringes with fixed needles may not permit administration of the recommended dosage. For the revised directions and additional contact information, see the following FDA Safety Notice: http://www.fda.gov/CbER/safety/hyperrab022208.htm.

A disease that is transmitted to humans or other animals by an insect or other arthropod is called a vector borne disease. These diseases include West Nile Disease, Lyme disease and malaria. Most vector borne diseases in Kansas are transmitted through an infected tick or mosquito.

Although great advances have been made in vaccines or chemoprophylactic drugs against vector borne diseases such as yellow fever and malaria, individuals should still use repellents and other measures against mosquitoes and ticks. Exposure to these creatures can be minimized by modifying patterns of activity or behavior, including:

Staying inside during dawn and dusk when mosquitoes are most active;
Wearing long-sleeved shirts, long pants, and hats to minimize areas of exposed skin;
Applying mosquito and tick repellents to clothing, shoes, tents, etc. to enhance protection. Repellents containing DEET are the most effective.
Check yourself and any pets often for ticks if you have spent time in brushy or wooded areas.

Disease	Overview
Lyme Disease	Transmitted to human by the bite of an infected deer or western blacklegged tick. Symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. http://www.cdc.gov/ncidod/dvbid/Lyme/index.htm
Rocky Mountain Spotted Fever	RMSF is the most severe and most frequently reported rickettsial illness in the U.S. The disease is cause by Rickettsia rickettsii, a species of bacteria that is spread to humans by hard ticks. Initial symptoms include sudden onset of fever, headache, muscle pain, followed by development of rash. http://www.cdc.gov/ncidod/dvrd/rmsf/
Plague	Usually transmitted from being bitten by a rodent flea that is carrying the plague bacterium. Symptoms vary by type: bubonic, septicemic, or pneumonic plague. http://www.cdc.gov/ncidod/dvbid/plague/facts.htm
Tick-borne Relapsing Fever	Caused by bacteria acquired through the bite of infected soft ticks. Symptoms include recurring episodes of fever, with headache, muscle and joint aches and nausea. http://www.cdc.gov/ncidod/dvbid/RelapsingFever/index.htm
Tularemia	Caused by bacteria found in rodents, rabbits and hares. Symptoms include fever, chills, headaches, diarrhea, muscle aches, joint pain, dry cough, and progressive weakness. Tularemia can be used as a biological weapon. http://www.cdc.gov/ncidod/dvbid/tularemia.htm
Chikungunya	Viral disease acquired by the bite of an infected mosquito. Most often seen in west, central and southern Africa and many areas of Asia. http://www.cdc.gov/ncidod/dvbid/Chikungunya/index.htm
Eastern Equine Encephalitis	A mosquito-borne viral disease most commonly seen in the eastern half of the United States. EEE has a high mortality rate and is regarded as one of the most serious mosquito-borne diseases in the United States. http://www.cdc.gov/ncidod/dvbid/arbor/eeefact.htm
Japanese Encephalitis	Mosquito-borne disease that is the leading cause of viral encephalitis in Asia with 30,000 - 50,000 cases reported annually. There are rare outbreaks in U.S. territories in the Western Pacific. http://www.cdc.gov/ncidod/dvbid/jencephalitis/facts.htm
LaCrosse Encephalitis	Spread through infected mosquitoes, with most cases seen in the great-lakes and mid-Atlantic states. Residence in woodland habitats is an environmental risk factor. http://www.cdc.gov/ncidod/dvbid/arbor/lacfact.htm
Saint Louis Encephalitis	One of the most common mosquito-transmitted diseases in the United States. Most affected are those who engage in outdoor work and recreational activities. http://www.cdc.gov/ncidod/dvbid/sle/Sle_FactSheet.html
West Nile Encephalitis	Spread through infected mosquitoes. About one in 150 people affected with WNV will develop serious illness. Severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm
Western Equine Encephalitis	With 639 confirmed cases in the United States since 1964, this mosquito-borne virus causes mild-flu like illness to encephalitis. Mild to severe neurologic deficits in survivors may occur. http://www.cdc.gov/ncidod/dvbid/arbor/weefact.htm
Yellow Fever	Yellow fever is a mosquito borne disease that occurs in tropical regions of Africa and parts of South America. It is a very rare cause of illness in U.S. travelers. The last epidemic of yellow fever in North America occurred in New Orleans in 1905. http://www.cdc.gov/ncidod/dvbid/yellowfever/index.html
Malaria	Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Each year 350 to 500 million cases of malaria occur worldwide, and more than one million people die, most of them young children in sub-Saharan Africa. http://www.cdc.gov/malaria/
Dengue Fever	Found in Africa and Asia, dengue cases sudden onset of fever, severe headache, hemorrhagic manifestations (including tendency to bruise easily, bleeding nose or gums, and possible internal bleeding.) The capillaries become excessively "leaky", allowing the fluid component to escape from the blood vessels. Dengue Fever is transmitted through mosquito bites. http://www.cdc.gov/ncidod/dvbid/dengue/dengue-qa.htm

Many have heard the phrase “If you hear hooves, it’s probably horses, not zebras”. For many physicians, this turn of phrase is taught in medical school to look to the most common sense answer when diagnosing illness. However, with recent events in our area and the world, it’s important to be on the lookout for the occasional “zebra”, whether it be a naturally-occurring disease outbreak or a man-made event.

Naturally-occurring events
Diseases that young doctors may have only read about in textbooks have been reported in recent months, including mumps and measles. Advances in vaccine technology and immunization requirements have almost eradicated these diseases in the United States , but disease is no more than a 24-hour plane ride from anywhere in the world.

A recent example was that of a seven-year old unvaccinated California boy who traveled to Switzerland with his family in January. He became ill and was suspected to have scarlet fever (a form of strep characterized by a skin rash). It was when his condition worsened that blood samples were tested for measles antibodies. In the time he was ill, 11 additional measles cases were identified in infants and children 10 months to nine years, including both of the patient’s siblings, five children in his school, and four additional children who had been in a pediatrician’s office at the same time as the index patient. One of the infected children traveled by airplane to Hawaii while infectious. For additional information on this specific case, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

Another measles case from September 2007 involved an international youth sporting event. Read about that case here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5707a1.htm

Many diseases are reportable to the health department. Please visit the following link to see which diseases are reportable in Kansas.
http://health.jocogov.org/documents/KANSAS_NOTIFIABLE_DISEASE_FORM%202006.pdf

Man-made events
In a post 9-11 and anthrax letter world, it’s easy to remember that intentional and non-intentional threats do exist. At the forefront of the news is the Las Vegas man hospitalized for exposure to ricin. The man had been in the hospital for almost two weeks before ricin was found in his hotel room.
http://www.cnn.com/2008/US/02/29/ricin.hotel/index.html?iref=newssearch

In today's world, it is imporant to look at a mysterious, sudden-onset illness in a broader view. With the many biological and chemical agents in the world, a terrorist can strike at any time and it might not be evident for days or weeks after exposure when people start to become ill. Be sure not to get wrapped up in the "what" that a mystery illness brings, but also ask "why" and "how" it happened.

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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	Total YTD
Enteric	Calicivirus (Norwalk-like virus (norovirus)	3	1	4
	Campylobacter Infection( Campylobacter spp.)	8	1	9
	Cryptosporidiosis (Cryptosporidium parvum)	1	0	1
	Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	1
	Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	2
	Giardiasis (Giardia lamblia)	9	2	11
	Salmonellosis (Salmonella spp.)	6	0	6
	Shigellosis (Shigella spp.)	1	0	1
General	Hepatitis A	2	3	5
	Hepatitis B, acute	1	0	1
	Hepatitis B, chronic	16	15	31
	Hepatitis C virus infection (past or present)	14	20	34
	Legionellosis	0	1	1
	Lyme Disease (Borrelia burgdorferi)	0	1	1
	Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	1
	Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2
	Streptococcal pneumoniae, invasive, drug-resistant	2	1	3
Vaccine-Preventable Diseases	Pertussis (Bordetella pertussis) (Whooping cough)	4	6	10
	Varicella (Chickenpox)	24	56	80
Sexually Transmitted Diseases	Early Syphilis	0	1	1
	Gonorrhea	N/A	28*	28
	Chlamydia	N/A	182*	182

* 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.