Johnson County Health Department - EPI Update Newsletter

What is Staphylococcus aureus (staph)?
Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Sometimes, staph can cause an infection. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics (also known as antimicrobials or antibacterials). However, staph bacteria also can cause serious infections (such as surgical wound infections, bloodstream infections, and pneumonia).

What is MRSA (methicillin-resistant Staphylococcus aureus)?
Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Twenty-five to 30 percent of people have staph, while only one percent have MRSA infection.

Who gets staph or MRSA infections?
Staph infections occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. These healthcare-associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.

What is community-associated MRSA (CA-MRSA)?
Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.

How common are staph and MRSA infections?
Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting. Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.

What does a staph or MRSA infection look like?
Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.

Are certain people at increased risk for community-associated staph or MRSA infections?
CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners.

How can I prevent staph or MRSA skin infections?
Practice good hygiene:
1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with a bandage until healed.
3. Avoid contact with other people’s wounds or bandages.
4. Avoid sharing personal items such as towels or razors.
What should I do if I think I have a staph or MRSA infection?
See your healthcare provider.

Are staph and MRSA infections treatable?
Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.
However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.
If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.

If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?

You can prevent spreading staph or MRSA skin infections to others by following these steps:
1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider’s instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded with the regular trash.
2. Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
3. Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash soiled sheets, towels, and clothes with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
4. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.

Source: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html

The Johnson County Health Department and the Health Care Foundation of Greater Kansas City are now distributing the human papillomavirus (HPV) vaccine free of charge to qualified females nine to 26 years of age. HPV is one cause of cervical cancer.
The vaccine will be available Monday through Thursday from 8:30 a.m. – 4:00 p.m. and Friday from 8:30 a.m. – 12:00 p.m. at both Health Department clinics:

Mission:
6000 Lamar, Suite 140
Mission, KS 66202
(913) 826-1200

Olathe:
11875 S. Sunset, Suite 300
Olathe, KS 66061
(913) 294-2525

“We are happy to be one of the health departments providing free HPV vaccine to help prevent cervical cancer,” Dr. Leon Vinci, Johnson County Health Department Director, said. “These grants help to close the gap between those who have health insurance to pay for the vaccine and those who do not.”

An estimated 20 million men and women in the United States are infected with HPV. HPV has been identified as the cause of cervical cancers, pre-cancers, benign cervical lesions and genital warts. The vaccine does not prevent all types of HPV, but it targets those strains that account for 70 percent of cervical cancers and 90 percent of genital warts.

Back to top

John Wherry, an immunologist, and co-workers at the Wistar Institute in Philadelphia are working with several other labs to develop an influenza vaccination which enhances the immune response in the elderly. The labs include Hildegund Ertl's lab at the Wistar Institute. This lab is the one actually making the vaccine constructs themselves. The other labs involved are Arlene Sharpe (Harvard), Gordon Freeman (Dana Farber), Ken Schmader (Duke) and Wolfgang Weninger (University of Sydney, Australia). The team projects to have prototype created by 2011, and clinical trials started as early as 2012 all of which depends on the vaccine.
Current flu vaccine development has numerous drawbacks:
• A new formulation must be created each year that contains several different strains; and these strains are not the same year to year.
• The current vaccine uses killed or inactivated flu viruses to stimulate the body’s immune system to generate antibodies against the proteins on the surface of the viruses. This is a drawback because the body does not produce long lasting immunity to the virus sicne the proteins on the outside of the cell change.
• The current vaccine is created in eggs; causing those who are allergic to eggs to be unable to receive the vaccine.
• Many elderly people do not always produce sufficient antibodies in response to the current year’s vaccine, evidenced by the 36,000 influenza related deaths each year in the United States among the elderly who had been vaccinated.
The concept Wherry and team are working on is to use part of a live virus – a disabled cold virus with pieces of cloned flu virus inserted into it. The theory is, this method will stimulate long-lasting cellular immunity through T-cells. How this works is viruses have proteins on the surface of the cell and on the inside of the cell. The two major proteins on the surface, HA and NA, are variable causing the need for a new vaccine every year. The antibodies created from last year’s strain/vaccine do not always recognize the new strain from this year because of the variability.
The inside of the virus contains nine proteins, which are less variable then HA and NA. The proteins include nucleoprotein (NP) which binds to viral RNA and polymerases involved in replication. The internal proteins are protected from the body’s antibodies because they are within the virus cell. Once the virus starts to replicate inside of the cell the more they become visible to the immune system’s T cells. The T cell reacts to the proteins on the inside of a virus, not the outside proteins, allowing them to continue to fight a virus and destroy the influenza cells trying to colonize.
Because of the reaction created by the T cells and the protein NP inside the cell the researchers are working to create a vaccine which targets NP to provide cross-strain protection.

Allen, A. (2007, Fall). Flu Fighter, with a possible pandemic in our future. Smithsonian.

Tips For Holiday Travel Health

When traveling domestically or internationally, travelers – especially during the holidays – can be subject to certain stresses that may lower resistance to disease – such as crowding, disruption of usual eating and drinking habits and time changes. These conditions of stress can lead to nausea, indigestion, fatigue, or insomnia.
Hand washing is paramount. Be sure to wash your hands frequently with soap and warm water. Wash for at least 20 seconds. If soap and water are not available and hands are not visibly dirty, use an alcohol-based hand sanitizer.
Excessive cold affects persons who may be improperly dressed for the weather, and particularly the elderly; it can lead to hypothermia and to frostbite of exposed parts of the body. Traveling in high altitudes may lead to insomnia, headache, nausea, and altitude sickness, even in young and healthy persons, and can cause distress to those with cardiac or pulmonary conditions.
If traveling internationally, use care in choosing foods and drinks to consume. In areas with poor sanitation or where chlorinated tap water is not available, travelers should be advised that only the following may be safe to drink: beverages, such as tea and coffee, made with boiled water; canned or unopened bottled beverages, including water, carbonated mineral water, soft drinks, beer, and wine. Drinks with ice (which may be contaminated) are not recommended.
It is safer to drink a beverage directly from the can or bottle than from a questionable container. If water is on the outside of the can or bottle, it should be considered contaminated. Be sure to dry wet cans or bottles before they are opened and wipe clean surfaces with which the mouth will have direct contact.
To avoid food illness, travelers should choose food items with care. All raw food is subject to contamination. In areas where hygiene and sanitation is in question, travelers should avoid salads, uncooked vegetables, and unpasteurized milk and milk products such as cheese, and to eat only food that has been cooked and is still hot. It is also recommended that travelers only eat fruit that has been washed in clean water and peeled personally.

Sources: www.cdc.gov/od/oc/media/pressrel/r981123.htm

http://wwwn.cdc.gov/travel/contentSafeFoodWater.aspx

Holiday Food Safety Guidelines

Follow these simple steps from the Department of Health and Human Services and the Food and Drug Administration (FDA) to have a holiday that creates happy memories.

• Clean: Wash hands and food-contact surfaces often. Bacteria can spread throughout the kitchen and get onto cutting boards, knives, sponges and counter tops.

• Separate: Don’t cross-contaminate. Don’t let bacteria spread from one food product to another .This is especially true for raw meat, poultry and seafood. Experts caution to keep these foods and their juices away from ready-to-eat foods.

• Cook: Cook foods to proper temperatures. Food are properly cooked when they are heated for a long enough time and at a high enough temperature to kill the harmful bacteria that cause foodborne illness. Turkeys should be cooked to 180 degrees, with stuffing at 165 degrees.

• Chill: Refrigerate promptly. Public health officials advise consumers to refrigerate foods quickly because cold temperatures keep most harmful bacteria from growing and multiplying. Refrigerators should be set at 40 degrees F and the freezer at 0 degrees F, and the accuracy of the settings should be checked occasionally with a thermometer.

During the holiday season, it is also important to remember that with celebrations come extra calories. Showing moderation at the table and engaging in physical activity can help fight holiday weight gain.

More information on foodborne illness can be found at:

http://www.cfsan.fda.gov/list.html
http://www.hhs.gov/news/press/2005pres/20051123a.html

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.