Flu seasons are unpredictable in a number of ways. Although epidemics of flu happen every year, the beginning, severity, and length of the epidemic depends on many factors, including the different types and strains of influenza viruses circulating and whether the viruses in the vaccine match flu viruses that are circulating.

CDC recommends a yearly flu vaccine as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine is designed to protect against the three main flu strains that research indicates will cause the most illness during the flu season. The vaccine can protect you from getting sick from these three viruses or it can make your illness milder if you get a different flu virus.

Flu activity typically does not reach its peak in the U.S. until January or February. Getting the flu vaccine soon after it becomes available each year is always a good idea, and the protection you get from vaccination will last throughout the flu season. However, flu activity can occur as late as May so getting a vaccine later in the season, including in December, January or even later, and even if flu activity has already started in your area, can still offer protection in most years.

Good Health Habits for Prevention

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
Stay home when you are sick if possible. You will help prevent others from getting sick.
Cover your mouth and nose with a tissue when coughing or sneezing, or cough/sneeze into your upper arm.
Clean your hands. Washing your hands often will help protect you from germs.
Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

New Tuberculosis (TB) Technical Instructions for those Applying for Change of Status

The United States Department of Health and Human Services has released the new TB Component of the Technical Instructions for the Medical Examination of Aliens in the United States. These went into effect May 1, 2008. Changes include:

Sputum cultures for M. tuberculosis, and drug susceptibility testing for positive cultures, are required for applicants with chest radiograph findings suggestive of active TB disease.
A chest radiograph is required for all applicants with a tuberculin skin test (TST) reaction of 5 mm or greater of induration, including pregnant (or possibly pregnant) women. (Previously, the chest radiograph could be waived for a pregnant applicant if she had a scar or other evidence of BCG vaccination and denied having any TB-related symptoms. This exception is no longer permissible.)
A chest radiograph is now required for applicants with a TST reaction of less than 5 mm of induration (including no induration) who have :

Signs or symptoms consistent with active TB disease
Immunosupression for any reason (e.g. HIV infection)

Updates and full copy of the Technical Instructions are posted at : http://www.cdc.gov/ncidod/dq/updates.htm

Whether you're traveling across town or around the world, help ensure your trip is safe. Don’t drink and drive. Wear a seat belt. Always use a child safety seat, booster seat, or seat belt according to your child’s height, weight, and age. Avoid traveling in low-visibility conditions and on ice-covered roads, overpasses, and bridges.

Whether traveling domestically or internationally, travelers may be subject to certain stresses that may lower resistance to disease, such as crowding, disruption of usual eating and drinking habits, and time changes with "jet lag" contributing to a disturbed pattern of the sleep and wakefulness cycle. These conditions of stress can lead to nausea, indigestion, fatigue, or insomnia.

Be sure to wash your hands frequently with soap and warm water for at least 20 seconds. If they are not available, use an alcohol-based hand sanitizer.

Every year more and more Americans are traveling internationally. Whatever your reason for traveling, the information on this page will help you to be proactive, prepared, and protected when it comes to your health—and the health of others—while you are traveling.

BE PROACTIVE!
Take steps to anticipate any issues that could arise during your trip.

Learn about your destination.
See a doctor before you travel.
Think about your health status.

Are you too sick to travel? (Recent illnesses, injuries, or surgeries)
Do you have any special health needs? (Babies and small children, pregnant women, people with disabilities, people with weakened immune systems)

Stay home when you are sick!

BE PREPARED!
No one wants to think about getting sick or hurt during a trip, but sometimes these things happen. You may not be able to prevent every illness or injury, but you can plan ahead to be able to deal with them.

Pack smart.
Plan ahead for illnesses or injuries during your trip.
Know what to do if you become sick or injured on your trip.
Know and share important information about your trip.

BE PROTECTED!
It is important to practice healthy behaviors during your trip and after you return home.
Pay attention to your health during your trip.

Use sunscreen and insect repellent as directed.
Be careful about food and water.
Limit alcohol intake, and do not drink alcohol and drive.
Wear a seatbelt.
Wear protective gear during adventure activities.
Respect your host country and its people by following local laws and customs.

For the CDC traveler’s website, go to: http://wwwn.cdc.gov/travel/.

Chlamydia is a common sexually transmitted disease (STD) – the most frequently reported bacterial STD in the United States. Even though symptoms are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur “silently” before a woman ever recognizes a problem. Chlamydia can also cause discharge from the penis of a man.
In 2006, more than one million chlamydial infections were reported to the Centers for Disease Control and Prevention (CDC) from the 50 states and the District of Columbia. There are still many more cases not reported as most people infected are not aware of their symptoms and do not seek testing. Women are frequently re-infected if their partners are not treated.
Chlamydia can be transmitted during vaginal, anal, or oral sex. It can also be passed from an infected mother to her baby during vaginal childbirth. Any sexually active person can be infected – the greater the number of partners, the greater the risk of infection.
Symptoms:

Abnormal vaginal discharge or burning sensation when urinating (women)
Burning sensation from penis or while urinating, or burning or itching around the opening of the penis (men)
Lower abdominal pain
Low back pain
Nausea
Fever
Pain during sexual intercourse
Bleeding between menstrual periods

The surest way to avoid transmission of STDs is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia. Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles could mean an STD infection. If a woman has any of these symptoms, she should stop having sex and consult a health care provider immediately.
The Johnson County Health Department currently is working to educate people about the prevention of Chlamydia. Hundreds of posters and brochures have been distributed to businesses and schools in Johnson County and a large poster kiosk will be displayed at the Town Center shopping area in Leawood during the middle of November and December urging people to know the facts about Chlamydia.

Pertussis

Pertussis is a bacterial respiratory illness characterized by severe spasms of coughing that can last for several weeks or even months. Pertussis is usually spread from person-to-person through close contact with respiratory droplets released when a person coughs or sneezes.

DTaP (Diphtheria and Tetanus Toxoids and Acellular Pertussis) vaccine is recommended for all infants at 2, 4 and 6 months of age. An additional dose of DTaP vaccine is recommended at 15-18 months of age and at 4-6 years of age. It is important that young infants start their DTaP vaccination without delay at 2 months of age. At least three DTaP doses are needed to have the maximum benefit from the vaccination. However, even one or two doses of DTaP will provide some protection against Pertussis.
There are also vaccines available for persons 10 to 64 years of age.

Boostrix is approved for persons 10-18 years of age (11-12 years of age is the preferred vaccination schedule).
Adacel is approved as a booster immunization for persons 11-64 years of age if 5 years have lapsed since their last Td/Tdap.

Consider Pertussis if the cough lasts at least 2 weeks or the suspect case reports close contact
with a case of pertussis or

1st symptoms appear like a cold with runny nose, sneezing, cough and low grade fever. This is the most contagious stage.
Irritating cough persists for 1-2 weeks
Cough becomes more severe with repeated attacks of violent coughing with no inhalation between coughs. Occasionally vomiting may occur.
Crowing or a inhalation whoop follows a series of coughs

Testing

Nasopharyngeal test for Pertussis (culture on either Regan-Lowe or Bordet-Gengou media) and PCR (polymerase chain reaction).
No single serologic testing is diagnostic of Pertussis.

Treatment is recommended for of suspect, probable, and confirmed cases as well as contacts of confirmed cases. Goal is to prevent additional cases of Pertussis. This includes family members, close friends and visitors in the home.

Erythromycin or
Zithromax (Azithromycin) or
Biaxin (Clarithromycin) or
Bactrim (Septra)

Exclusion

5 days of antibiotics must be completed for suspect clinical cases and symptomatic contacts before return to day care, school, work etc. This includes having company in the home. No contact with others except for physician’s appointments.
If not treated a Pertussis case is communicable for approximately 3 weeks after the onset of illness. Immunizations
If any children (under 7 years of age) are contacts to the case, check their immunization record. Close contacts under 7 years of age who have not received 4 doses of DTaP/DTP doses (Diphtheria, Tetanus, Acellular Pertussis vaccine or Diphtheria, Tetanus or Pertussis vaccine) or have not received a DTP/DTaP within 3 years should be given a dose as soon after exposure as possible.

http://www.cdc.gov/doc.do/id/0900f3ec80228696
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/pertussis_t.htm
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf

The increases are greatest among adolescents (aged 10-19 years), but an increase is also seen among infants younger than 5 months old. Infants under the age of 12 months have more serious illness from Pertussis, are more likely to have complications, and be hospitalized. Infants also are at greatest risk of dying from Pertussis.

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	Jan 2008	Feb 2008	March 2008	April 2008	May 2008	June 2008	July 2008	Aug 2008	Sept 08	Oct 08	Total YTD
Enteric	Calicivirus/Norwalk-like virus (norovirus)	3	1	14	1	1	0	0	0	0	0	20
	Campylobacter Infection (Campylobacter spp.)	8	1	5	10	0	9	25	20	4	7	89
	Cryptosporidiosis (Cryptosporidium parvum)	1	0	0	1	1	1	2	6	0	1	13
	Dengue	0	0	0	0	0	0	1	2	0	0	3
	Dengue Hemorrhagic Fever	0	0	0	0	0	0	1	0	0	0	1
	Enterohemorrhagic Escherichia coli shiga toxin positive (not serogrouped)	0	1	0	1	1	2	0	3	0	4	12
	Enterohemorrhagic Escherichia coli toxin positive (serogroup non-O157)	2	0	0	0	0	0	1	0	1	0	4
	Enterohemorrhagic Escherichia coli 0157:H7	0	0	0	0	0	0	1	0	0	1	2
	Giardiasis (Giardia lamblia)	9	2	4	4	3	2	6	11	3	1	45
	Salmonellosis (Salmonella spp.)	6	0	4	6	5	8	9	5	10	7	60
	Shigellosis (Shigella spp.)	1	0	0	0	1	0	3	1	1	2	9
General	Amebiasis (Entamoeba histolytica)	0	0	0	0	0	1	0	0	0	0	1
	Ehrlichiosis, human monocytic (HME)	0	0	3	1	2	2	2	1	0	3	14
	Ehrlichiosis, human monocytic (HGE)	0	0	0	0	1	1	2	0	1	1	6
	Hepatitis A	2	3	1	3	1	4	3	5	0	3	25
	Hepatitis B, acute	1	0	2	1	1	2	0	2	1	1	11
	Hepatitis B, chronic	16	16	19	10	10	6	8	2	6	3	96
	Hepatitis C virus infection (past or present)	14	20	51	26	17	12	4	9	11	10	174
	Legionellosis	0	1	2	0	0	1	0	0	1	1	6
	Listeriosis (Listeria monocytogenes)	0	0	0	0	0	1	0	0	0	0	1
	Lyme Disease (Borrelia burgdorferi)	0	1	2	3	4	0	1	2	5	2	20
	Malaria	0	0	0	0	0	0	0	1	0	0	1
	Meningitis, other bacterial	0	0	1	0	1	0	0	0	0	1	3
	Rocky Mountain Spotted Fever (Rickettsia rickettsii) (RMSF)	0	1	2	1	1	3	2	0	7	3	20
	Streptococcal Disease, Invasive, Group A (Streptococcus pyogenes)	1	1	2	4	1	3	3	0	0	0	15
	Streptococcal pneumoniae, invasive, drug-resistant	2	2	1	2	1	0	1	0	0	0	9
	Transmissable Spongioform Encephalitis (TSE./CJD	0	0	0	0	0	0	0	0	2	0	2
	West Nile, non-neurological (includes WN Fever)	0	0	0	0	0	2	1	1	0	0	4
Vaccine-Preventable Diseases	Haemophilus influenzae, invasive	0	0	0	0	1	2	0	0	1	1	5
	Mumps	0	0	0	0	0	0	1	0	0	2	3
	Pertussis (Bordetella pertussis) (Whooping cough)	4	6	4	2	2	4	3	1	5	10	41
	Varicella (Chickenpox)	24	57	38	25	26	3	7	14	23	13	230
Sexually Transmitted Diseases	Early Syphilis	0	1	4	2	3	1	0	3	2	1	17
	Gonorrhea	N/A	28*	11	5	12	9	13	11	10	13	112
	Chlamydia	N/A	182*	90	81	122	102	120	99	106	95	997

*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.