Johnson County Health Department - EPI Update Newsletter

The abundance of outdoor activities in the spring and summer make this time of year a prime time to be aware of ticks. In Kansas, there are three commonly recognized tick-borne diseases: Rocky Mountain Spotted Fever (RMSF), Lyme disease, and Ehrlichiosis.

RMSF symptoms include sudden onset of fever, headache, and muscle pain, followed by development of rash. The disease can be difficult to diagnose in the early stages, and without prompt and appropriate treatment it can be fatal.

Lyme disease symptoms include fever, headache, fatigue, and a characteristic skin rash that looks like a “bulls-eye.” If left untreated, infection can spread to joints, the heart, and the nervous system.

Ehrlichiosis symptoms start about five to 10 days after receiving a tick bite and generally include fever, headache, malaise, and muscle aches. Other signs and symptoms may include nausea, vomiting, diarrhea, cough, joint pains, confusion, and occasionally rash.

All three diseases are caused by bacteria and can be easily treated if caught early. The best prevention is to avoid tick bites by wearing light-colored clothing, tucking your pant legs into your socks, and applying an insect repellent that contains permethrin. Check your body for ticks after returning from a potentially tick-infested area and remove them promptly to reduce the chance of disease transmission.

Remove a tick from your skin as soon as you notice it. Use fine-tipped tweezers to firmly grasp the tick very close to your skin. With a steady motion, pull the tick’s body away from your skin. Then clean your skin with soap and warm water. Throw the dead tick away with your household trash.

Avoid crushing the tick’s body. Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria. If you accidentally crush the tick, clean your skin with soap and warm water or alcohol. Don’t use petroleum jelly, a hot match, nail polish, or other products to remove a tick.

Spotlight on Lyme Disease

Blacklegged (deer) tick (from CDC Public Health Image Library)

Between 2002-2006, Johnson County Health Department investigated 196 cases (four confirmed, 105 probable, 78 suspect, and nine not a case) of Lyme Disease.

Lyme Disease is a systemic, tick-borne disease with protean manifestations, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities. The best clinical marker for the disease is erythema migrans (EM), the initial skin lesion that occurs in 60-80% of patients. EM is a skin lesion that begins as a red macule or papule and expands over a period of days to weeks to form a large round lesion, often with partial central clearing. A single primary lesion must reach greater than or equal to 5cm in size across its largest diameter. Secondary lesions also may occur. For most patients, the expanding EM lesion is accompanied by other acute symptoms: fatigue, fever, headache, mildly stiff neck, arthralgia, or myalgia. These symptoms are typically intermittent. The diagnosis of EM must be made by a physician. Laboratory confirmation is recommended for persons with no known exposure.

EM rash on upper arm
(from CDC Public Health Image Library)

For Lyme Disease, an exposure is defined as having been in wooded, brushy, or grassy areas less than or equal to 30 days before onset of Erythema migrans in a county in which Lyme disease is endemic. Lyme Disease is endemic for surveillance purposes in Johnson County because at least two confirmed cases have been acquired in the county. The case definitions used to determine endemicity are for surveillance purposes only so that all states are using the same criteria and comparison can be made across states and territories. They are not meant to be used as definitive clinical diagnostic criteria.

For surveillance purposes, the CDC definition of a qualified laboratory assay is:

a positive culture for B. burgdorferi
two-tier testing interpreted using established criteria
single-tier IgG immunoblot seropositivity interpreted using established criteria

For more information, see:
          Lyme Disease Test Performance and Interpretation
          http://www.cdc.gov/mmwr/preview/mmwrhtml/00038469.htm

          CDC Division of Vector-Borne Infectious Diseases Lyme Disease
          http://www.cdc.gov/ncidod/dvbid/lyme/

References:
1. Lyme Disease (Borrelia burgdorferi) 2008 case definition: http://www.cdc.gov/ncphi/disss/nndss/casedef/lyme_disease_2008.htm

2. Public Health Image Library: http://phil.cdc.gov/phil/home.asp

The Johnson County Health Department (JCHD) offers a reminder on the beginning of West Nile Virus season, a disease that usually peaks in August and September.

West Nile Virus is already established in the area. As a result, birds are no longer tested for West Nile Virus in Kansas and the Health Department and the Kansas Department of Health & Environment (KDHE) will not be collecting information about dead birds. If you find a dead bird, JCHD recommends that you wear gloves, place the bird in a plastic bag, and dispose of it in the garbage.

It is important to keep yourself and your pets safe from the bites of mosquitoes that may be near or on dead birds, as this is how West Nile is spread. Never approach or touch wild birds, including those that are sick or injured.

West Nile Virus can be spread to people by mosquitoes that first bite an infected bird, but it is not contagious from person to person. Symptoms range from a slight headache and low-grade fever to swelling of the brain or brain tissue and in rare cases, death. People who have had West Nile Virus before are considered immune.
You can protect yourself and your home by taking the following steps:

Use effective insect repellent with DEET or picaridin on skin.
Wear protective clothing when practical (long sleeves and pants).
Remove standing water from flower pots and other receptacles.
Use larvicide in water that cannot be removed.
Replace water in bird baths, pet bowls and wading pools at least every three days.

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Information provided by the Centers for Disease Control and Prevention (CDC)

CDC and state health officials are investigating and responding to cases and outbreaks of measles across the U.S. Measles is a highly contagious disease spread through coughing or sneezing. Symptoms can include rash, high fever, coughing, and runny nose. The disease can also cause more serious complications, such as ear infections, pneumonia, encephalitis (inflammation of the brain) — even death.

From January 1 through April 25, 2008, CDC received a total of 64 reports of confirmed measles cases in nine states — the highest number for the same time period since 2001. In four of the states — Arizona, New York, Michigan, and Wisconsin — outbreaks (3 or more cases linked in time or place) are ongoing. Outbreaks may occur when measles cases are imported into the U.S. Ten of the recent case-patients (5 US residents and 5 visitors to the U.S.) acquired measles abroad, and the remaining cases are considered linked to the imported cases.

Of the 64 people infected by the measles virus, only 1 had documentation of prior vaccination. Among the other 63 case-patients were 14 infants who were too young to be vaccinated. Many of the cases among US children occurred in children whose parents claimed exemption from vaccination due to religious or personal beliefs, or in children too young to be vaccinated. Disease transmission occurred in a variety of community and healthcare settings, including homes, childcare centers, schools, hospitals, emergency rooms, and doctors' offices.

These cases remind us that it is important to vaccinate children and adults to protect them against measles. Even though the ongoing transmission of measles was declared eliminated in the U.S. in 2000, the disease is still common in other parts of the world and can be imported into the U.S. from many countries, including countries in Europe. Worldwide, 20 million cases of measles still occur each year, and the disease is a significant cause of vaccine-preventable death among children. In 2005, 311,000 children under age 5 died from the disease.

The measles vaccine is administered as MMR, a combination vaccine that provides protection against measles, mumps, and rubella. The MMR vaccine is strongly endorsed by medical and public health experts as safe and effective. All children should receive two doses of MMR vaccine. The first dose is recommended at 12–15 months of age and the second dose at 4–6 years of age. All adults born during or after 1957 should receive at least one dose of vaccine unless they have documented evidence of measles immunity (a blood test or a physician's diagnosis of measles). Two doses are recommended for all international travelers, healthcare personnel, and students of secondary and post-secondary educational facilities. Infants 6–11 months of age should receive one dose prior to travel abroad.

Sources: http://www.cdc.gov/Features/MeaslesUpdate/

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Hepatitis C

Almost four million Americans have been infected with the Hepatitis C virus. Hepatitis C is a disease of the liver spread through infected blood. It cannot be spread by sneezing, coughing, other casual contact, food, or water.
People at most risk for contracting it and should consider being tested are:

Injecting drug users
Recipients of clotting factors made before 1987
Hemodialysis patients
Recipients of blood and/or solid organs before 1992
People with undiagnosed liver problems
Infants born to infected mothers
Healthcare/public safety workers who have potentially been exposed to Hepatitis C
Those who have had sexual intercourse with an infected person

Symptoms of hepatitis C can include:

Yellowing of the skin and eyes
Loss of appetite
Nausea and vomiting
Fever
Extreme fatigue
Stomach pain

Hepatitis C can become a serious illness for some, but others can carry the virus for most of their lives with few symptoms. Some persons with liver damage due to Hepatitis C may develop cirrhosis (scarring) of the liver and liver failure. Others have no long-term effects.
If you have Hepatitis C, do not donate blood, plasma, body organs, other tissue, or sperm. Do not share toothbrushes, razors, or other items that could be contaminated with blood, and cover open sores or other breaks in your skin.

Sources:
www.cdc.gov/ncidod/diseases/hepatitis/c/

http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm

http://wonder.cdc.gov/wonder/prevguid/p0000004/p0000004.asp

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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	Total YTD
Enteric	Calicivirus/Norwalk-like virus (norovirus)	3	1	14	1	19
	Campylobacter Infection( Campylobacter spp.)	8	1	5	10	24
	Cryptosporidiosis (Cryptosporidium parvum)	1	0	0	1	2
	Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	0	1	2
	Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	0	0	2
	Giardiasis (Giardia lamblia)	9	2	4	4	19
	Salmonellosis (Salmonella spp.)	6	0	4	6	16
	Shigellosis (Shigella spp.)	1	0	0	0	1
General	Hepatitis A	2	3	1	3	9
	Hepatitis B, acute	1	0	2	1	4
	Hepatitis B, chronic	16	16	19	10	61
	Hepatitis C virus infection (past or present)	14	20	51	26	111
	Legionellosis	0	1	2	0	3
	Lyme Disease (Borrelia burgdorferi)	0	1	2	3	6
	Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	2	1	4
	Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2	4	8
	Streptococcal pneumoniae, invasive, drug-resistant	2	2	1	2	7
Vaccine-Preventable Diseases	Pertussis (Bordetella pertussis) (Whooping cough)	4	6	4	2	16
	Varicella (Chickenpox)	24	57	38	25	144
Sexually Transmitted Diseases	Early Syphilis	0	1	4	2	7
	Gonorrhea	N/A	28*	11	5	44
	Chlamydia	N/A	182*	90	81	353

*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.