THE communicable disease Communiqué

Transcription

1 THE communicable disease Communiqué M C H E N R Y C O U N T Y D E P A R T M E N T O F H E A L T H COMMUNICABLE DISEASE EMERGENCY NOTIFICATION INFORMATION Urgent Public Health issues shall be reported immediately (within 3 hours) to the McHenry County Department of Health and include the following: * Anthrax (suspected or confirmed) * Botulism (foodborne) * Plague * Q-fever * Smallpox * Tuleremia * Any suspected Bioterrorist threat REGULAR OFFICE HOURS (Monday Friday 8am 4:30pm) (815) Please call one of the following: Marylou Ludicky, RN, MPH Communicable Disease Coordinator Melissa Manke, RN Investigator Susan Karras, RN Investigator Barbara Birmingham, RN Investigator Blanca Trinidad, RN TB Nurse Karen Stephenson, RN TB Nurse Christina Hayes, BS CD Health Educator Amanda Reich, CD Intern AFTER OFFICE HOURS (Monday Friday 4:30pm 8am; Saturday, Sunday and Holidays) (815) Ask to speak to the Communicable Disease On-Call Person. Mission The Communiqué is a newsletter intended to prevent morbidity and mortality of infectious diseases by providing data and recommendations to clinicians, laboratories, infection control personnel and others who diagnose, treat or report infectious diseases in McHenry County. We welcome comments and suggestions. Please call if you wish to be added to our mailing list. Contact Mary Lou Ludicky at or mlludick@co.mchenry.il.us VECTOR-BORNE DISEASES J U N E W W W. M C D H. I N F O Vector-borne diseases are bacterial and viral diseases transmitted by mosquitoes, ticks, and fleas. Vector-borne diseases are among the most complex of all of the communicable diseases; it is nearly impossibly to predict the habits of the mosquitoes, ticks, and fleas carrying the diseases, as well as the other animals they may infect, including humans. The most common vector-borne disease in the United States is Lyme Disease, which is caused by the black-legged deer tick. Other vector-borne diseases include Malaria, Plague, Dengue Fever, Anaplasmosis, Erlichilous, and West Nile Virus. With temperatures heating up early this year, increased insect populations are anticipated. Increased insect activity, translates to an increased presence of both Ixodes scapularis, the tick that causes Lyme Disease, as well as the Culex Pipiens mosquito, which causes West Nile Virus. McHenry County has already had its first Lyme disease cases of the season. Neighboring Cook and DeKalb counties have had birds test positive for West Nile Virus, while Cook and nearby DuPage counties have had positive batches of mosquitoes. The Illinois Department of Public Health recently issued an official statement reminding providers that there is higher than normal West Nile activity in the state, especially for so early in the season. With both illnesses, underreporting is common. Increased awareness of prevention strategies, symptoms, and case reporting guidelines is crucial for an accurate portrait of vector-borne disease in McHenry County. Tick Identification and vectorborne disease associated with each species. Black-legged deer tick Lyme disease Monitoring these disease-causing vectors has begun; McHenry County Department of Health sets up mosquito traps (pictured left) around the county. Specimens are then collected and tested regularly for West Nile Virus, St. Louis Encephalitis, and Eastern Equine Encephalitis. Frequent testing mosquitoes allows for early detection of the presence of and more effective prevention of arboviruses, especially West Nile Virus, in the county. MCDH is also collecting deer ticks to test for Lyme Disease, more information is available on page 2. Lone-star tick STARI and Erlichiosis Table of Contents Lyme disease general information.. 2 Identification of Erythema Migrans..3 Tick-borne disease algorithm.. 4 Lyme Disease Case Report Form.. 5 West Nile Virus Information. 6 Preventing Tick borne & Mosquito borne Disease.. 6 Reportable Diseases Year-to-Date.. 6 House Mosquito West Nile Virus The Culex Pipiens, or house mosquito is identified by its striped abdomen and elongated proboscis (mouthpart). Dog Tick Rocky Mountain Spotted Fever 1

2 LY M E D I S E A S E The CDC defines a county in which Lyme disease is endemic as one in which at least two confirmed cases have been acquired in the county or in which established populations of a known tick vector are infected with B. burgdorferi ; under these criterion McHenry County can be identified as an endemic area. Lyme Disease has three stages. Early Localized Stage. At this stage a red, bullseye-shaped rash, known as an Erythema Migrans (EM) -may occur. The EM occurs in approximately 70-80% of persons and appears on average seven dates following the tick bite, but can occur after only 48 hours and up to 30 days posttick bite. EM lesions can be found on any area of the body and generally expand over several days. For more information on EM lesions consult page 3.A clinical presentation of an EM larger than 5 centimeters as diagnosed by a practitioner is considered a CON- FIRMED case of Lyme Disease and should be reported to MCDH. Other symptoms of this stage can also include fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes. Early Disseminated Stage. If left untreated Lyme Disease will enter into this stage with clinical symptoms such as Facial or Bell s palsy, severe headaches and neck stiffness due to meningitis, joint pain and inflammation, shooting pains, and heart palpitations or dizziness due to irregular heartbeat. Many of these symptoms will abate with time, but if left untreated Lyme Disease can continue to progress, leading to additional health complications. Late disseminated Stage. Approximately 60% of patients who are left untreated may develop intermittent arthritis, with severe joint pain and swelling. As many as 5% of persons with untreated Lyme disease can develop advanced neurological and cardiac symptoms and possible organ degeneration. Based on recent case reports, areas of probable exposure include: Sterns Woods (Crystal Lake), Veteran's Acres (Crystal Lake), The Hollows (Cary), and Exner Marsh Nature Preserve (Lake in the Hills). For information on the prevention of Lyme Disease, please consult page 6. Cases of Lyme Disease are often underreported; in order for MCDH to better identify potential high risk areas within the county, ALL confirmed cases, including those that did not require serology (Diagnosed EM > 5 cm), should be reported to the Communicable Disease Program of MCDH at A case reporting form can be found on page 5. If a patient has a tick specimen, the Environmental Health division of MCDH is offering tick-testing. For more information, please call Testing for Lyme Disease For a case to be classified as Lyme Disease, ordering only Borrelia burgdorferi IgG/IgM ABS is not sufficient to meet case definition set by the Centers for Disease Control and Prevention and Illinois Department of Public Health. There can be a false positive serology from other diseases such as mononucleosis, multiple sclerosis, rheumatoid factor, syphilis, and systemic lupus erythematosus. Therefore, with a positive antibody serology result, a Western Blot must be ordered to confirm the diagnosis. The Western Blot will include both IgG and IgM bands. Lyme disease serology screening is twotiered. If an Enzyme Immunoassay (EIA) is performed and is positive, labs will NOT automatically run the Western Blot. In order for the lab to confirm the case as Lyme Disease, the EIA MUST be followed with the Western Blot. If a Lyme EIA Screening is ordered, the order should include Western Blot contingent on a positive EIA result, so that the same serosample can be used. To interpret if the Western Blot is positive, the Lyme IgG must have 5 of the following bands present: 18, 21-24, 28, 30, 39, 41, 45, 58, 66 or 93 kda and the Lyme IgM must have any 2 of the following bands present: 21-24*, 39, or 41 kda within 30 days of symptom onset. If the Western Blot is negative, please remember to test for Erlichiosis, another disease with similar symptoms as Lyme, and known to be present in McHenry County. For additional information on tick-borne disease case definitions and a testing algorithm for Lyme Disease, please consult page

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4 EHRLICHIOSIS (all intracellular species) ROCKY MOUNTAIN SPOTTED FEVER IDPH Case Requirements for other Tick-borne Illnesses LABORATORY TESTING CLINCAL DESCRIPTION Any reported fever and one or more of the following signs or symptoms: Rash Escher Headache Myalgia Anemia Thrombocytopenis Any hepatic transaminase elevation EXPOSURE Having been in potential tick habitats within the past 14 days before the onset of symptoms. A history of tick bite is NOT required. Serological evidence of fourfold change in IgG by Immunofluorescence Antibody (IFA) between paired serum specimens (one taken in the first week of illness and a second 2-4 weeks later) Detection of R. rickettsii by PCR assay Demonstration of spotted fever group antigen in a biopsy or autopsy specimen by Immunohistochemistry (IHC) Isolation of R. rickettsii or other spotted fever group rickettsia from a clinical specimen in cell culture. CONFIRMED A clinically compatible case (meets clinical evidence criteria) that is laboratory Acute onset of fever and one or more of the following signs or symptoms: Headache Myalgia Anemia Malaise Leucopenia Thrombocytopenia Elevated hepatic transaminases Nausea, vomiting, rash may be present in some cases Having been in potential tick habitats within the past 14 days before the onset of symptoms OR a history of tick bite. Serological evidence of a fourfold change in IgG by IFA between paired serum samples (one taken in first week of illness and a second 2-4 weeks later) Detection of E. chaffeensis by PCR assay Demonstration of ehrlichial antigen in a biopsy or autopsy sample by IHC methods Isolation of E. chaffeensis from a clinical specimen in cell culture 4 fold rise in antibody titer with compatible clinical history (single titer is only a probable case) PCR Identification of organism in blood smears (difficult to spot) Report confirmed and suspected cases of Rocky Mountain Spotted Fever and Ehrlichiosis to the McHenry County Department of Health PHONE: FAX: *Please feel free call if you have any questions regarding signs, symptoms, or testing* 4

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6 West Nile Virus West Nile Virus is a flavivirus of the arthropod-borne virus family, and is included in the Abroviruses for reporting. Although several species can carry West Nile Virus (WNV), in McHenry County, WNV is primarily transmitted by the species Culex pipiens, or the house mosquito. The house mosquito prefers stagnant water for breeding, such as catchbasins, old tires, poorly draining ditches, clogged gutters, and bird baths. The virus must be present in the mosquito s salivary glands for transmission to occur. An infected Culex mosquito transmits the virus during a blood meal and so only female house mosquitoes can transmit WNV; the virus can then be transmitted from the host to another mosquito as it gathers its meal. Ticks Avoid wooded and brushy areas with high grass and leaf litter. Tuck your pants into your socks or boots, and tuck your shirt into your pants to keep ticks on clothing. Put clothing in the dryer on high heat for 60 min. to kill any remaining ticks. Take a shower as soon as you can after coming indoors Use a handheld mirror to check your body for ticks. Ticks can hide behind the knees and in the armpits, hair, and groin. Both Use insect repellent that contains 20-30% DEET. Apply permethrin to clothing and outdoor gear prior to wearing; do NOT apply to skin directly Wear a hat and long pants, long sleeves, and socks. Most individuals infected with WNV will not develop any symptoms or clinical illness. Only about 20% of infected individuals do develop symptoms, with most people only developing the milder flu-like illness, West Nile Fever. West Nile Fever symptoms include fever, headache, body aches, skin rashes, and swollen lymph nodes. Less than one percent of infected individuals express severe symptoms, including encephalitis, ataxia, myelitis, optic neuritis, polyradiculitis, and seizures. Individuals over 50 or otherwise immunocompromised are at higher risk for developing severe symptoms. West Nile Virus can be diagnosed using a blood sample or a sample of cerebrospinal fluid, for more information on diagnosing West Nile Virus, visit the CDC s WNV website. Laboratory testing for WNV is available through the Illinois Department of Public health through October 31st, or until two weeks following the first killing frost. There is no specific treatment available for West Nile Virus. Preventing Tick and Mosquito Related Illnesses Mosquitoes Avoid outdoor activities when mosquitoes are most active (dawn and dusk). Eliminate areas where water can collect and create ie. old tires, bird baths, garbage cans, wheelbarrows, clogged gutters, etc Make sure door and window screens are tight fitting and in good condition. McHENRY COUNTY COMMUNICABLE DISEASES DISEASE # OF CASES YTD 2012 YTD 2011 Bacterial Meningitis 1 1 Brucellosis 1 0 Chlamydia Creutzfeldt-Jakob Disease 1 0 Cryptosporidiosis 4 0 E.Coli 2 3 Ehrlichiosis 1 0 Giardia 2 5 Gonorrhea 21 8 Group A Streptococcus 2 3 H1N1 Hospitalizations 0 2 Haemophilius Influenza 5 3 Hepatitis A 1 0 Hepatitis B 12 9 Hepatitis C HIV 0 4 Histoplasmosis 0 1 Legionellosis 0 2 Lyme Disease 9 3 Malaria 0 1 MRSA, infants < 61 days 0 1 Non-Cholera Vibriosis 1 0 Pertussis Rabies (potential exposure) 9 3 Salmonella Syphilis 1 7 Step Pneumonia ( 4 years) 0 2 Toxic Shock Syndrome 0 1 Tuberculosis 1 2 Varicella (Chicken Pox) West Nile Virus 0 0 YTD: Through May 31,

7 BECOME PART OF OUR BROADCAST FAX NETWORK Receive the latest health alerts on topics such as: West Nile Virus Flu Updates Bioterrorism Area Outbreaks MCDH Website: Other emerging infectious diseases From: Centers for Disease Control Illinois Department of Health McHenry County Department of Health Name Organization Specialty Address Phone Fax Mail to: McHenry County Department of Health CD Program Annex B 2200 N Seminary Ave Woodstock IL Fax to: Or to: mlludick@co.mchenry.il.us 7