Yolo County Health Department Communicable Disease Update

Transcription

1 Yolo County Health Department Communicable Disease Update Volume, Issue 1 3 Jan Mar 2009 In this Issue Measles Watch Foodborne Illness CME Hib Vaccine Shortage Reminder Syphilis Training Measles Watch The World Health Organization estimates that more than 20 million individuals are affected each year by measles worldwide. While measles is no longer considered endemic in the U.S., it remains a common disease in many countries of the world, including developed countries in Europe and Asia. Approximately half of all imported measles cases occur in U.S. residents returning from visits to foreign countries, therefore CDC recommends that all travelers leaving the U.S. confirm that they are adequately vaccinated or are immune to measles (born before 195, lab evidence of immunity or physician documented measles). California continues to experience sporadic measles cases associated with travel from Europe and Asia. Each of these cases involves considerable expense and resources for both public health and health care. Most recently (Jan. 2009), a measles case investigation involving travel from England was identified. Contact Us Yolo County Health Department Fax CMRs to (530) N. Cottonwood St. Woodland, CA Related Web Sites: CDC CA Dept. of Public Health World Health Organization Rapid recognition and reporting of measles cases to the Health Department by health care providers is crucial to measles control. Please call the Health Department at (530) during business hours or (530) after hours to report all suspect measles cases. Consider posting the attached measles poster in your facility, if you have not already done so. Foodborne Illness CME for Clinicians The CDC estimates that 6 million people become ill, > 300,000 are hospitalized, and 5,000 die as a result of foodborne illnesses annually. Changes in demographics, food preferences, food production and distribution systems, microbial adaptation, and lack of support for public health resources and infrastructure have led to the emergence of novel as well as traditional foodborne diseases. With increasing travel and trade opportunities, it is not surprising that now there is a greater risk of contracting and spreading foodborne outbreaks locally, regionally, and globally. A foodborne illness primer directed to primary care and emergency physicians (developed collaboratively by the AMA, ANA ANF, CDC, FDA, and USDA) is available online at This primer provides practical and concise information on diagnosis and treatment of foodborne illnesses. It includes detailed summary tables, charts, references, and resources for health care professionals. Patient scenarios, clinical vignettes and a CME component are included for self evaluation and to reinforce information presented. Physicians and other health care professionals have a critical role in the prevention, recognition, and control of food related disease outbreaks. Clinicians are encouraged to review this primer and participate in the attached continuing medical education (CME) program. Yolo County Health Department Page 1

2 Page 2 Communicable Disease Update Yolo County Communicable Diseases, Communicable disease control is a core public health function involving both the Yolo County Health Department and health care providers. The California Code of Regulations, Title 1, Section 2500 requires health care providers to report certain diseases to the local health department. Reporting guidelines may be accessed ONLINE at yolohealth.org. Communicable disease statistics for confirmed reports of disease among Yolo County residents are shown in the table below. Reportable diseases with zero cases reported from 2005 through 2008 are excluded from the table below. Diseases Reported among Yolo County Residents by Year of Diagnosis (unless otherwise noted), Disease Amebiasis Botulism, Wound (zero cases of infant botulism or foodborne botulism reported ) Brucellosis 1 0 3* 0 Campylobacteriosis Chickenpox (cases involving hospitalization or death) Chlamydial Infection Coccidioidomycosis (Valley Fever) Cryptosporidiosis * Dengue Fever E. coli O15:H / STEC / HUS Encephalitis, infectious etiology not elsewhere classified Giardiasis Gonorrhea Haemophilus influenzae (cases of invasive disease in children) Hepatitis A Infection (acute) Hepatitis B Infection : Acute 1 6 Chronic (or status unspecified) Hepatitis C Infection, Chronic (or status unspecified) ** HIV Infection: HIV Infection (no AIDS) i i 20 i 8 AIDS 2 8 Kawasaki Syndrome Legionellosis Listeriosis Lyme Disease Continued on next page. Data Source: Yolo County Health Department.

3 Volume, Issue 1 3 Page 3 Diseases Reported among Yolo County Residents by Year of Diagnosis (unless otherwise noted), (cont d). Disease Malaria Meningitis, bacterial (does not include meningococcal meningitis) Meningitis, viral/aseptic (does not include WNV meningitis) Meningococcal Infection (includes meningococcal meningitis and meningococcemia) Pertussis Rabies (bats only) Relapsing Fever Salmonellosis (non-typhoid) Shigellosis Syphilis, Congenital Syphilis, Primary or Secondary Taeniasis/Cysticercosis Tuberculosis Typhoid Fever (acute) Vibrio Infection (non-cholera) West Nile Virus Infection Yersiniosis Data Source: Yolo County Health Department. = Counts for these chronic diseases are shown by the year they were reported to the Yolo County Health Department, rather than the year of onset/diagnosis. = Illnesses acquired while traveling abroad. * = Increase in cases due to a known outbreak of this disease. ** = Increase in reported hepatitis C cases attributed to a change in statewide laboratory reporting regulations. Prior to this change, laboratories were not required to report hepatitis C lab results to local health departments. = Increase in rabid bat cases attributed to testing of several dead rabid bats collected from a single rural bat roosting site after human exposure to the site. Approximately 15 25% of all bats tested annually by the Yolo County Public Health Lab are positive for rabies. = Increase in primary/secondary syphilis cases is consistent with a significant increase in cases observed throughout the Sacramento Region and in the Bay Area. This is the highest annual count of primary/secondary syphilis cases recorded among Yolo County residents since = One of these reported cases was multidrug resistant tuberculosis (MDR TB). This was the second MDR TB case diagnosed in Yolo Co. The first known MDR TB case was diagnosed in More recently, a third MDR TB case was diagnosed in Yolo Co. January i = Statewide regulation mandating name based HIV surveillance took effect July 1, The number of cases shown in 200 reflects this change in surveillance and is not indicative of a true increase in disease incidence. Since AIDS surveillance began in 1983, 316 Yolo County HIV/AIDS cases have been identified (as of December 31, 2008).

4 Public Health Update,Volume, Issue 1 3 (January March 2009) Yolo County Health Department Health Director/Public Health Officer Joseph P. Iser, MD, DrPH, MSc Editor Tim Wilson, DVM, MPH Hib (Haemophilus influenzae type b) Vaccine Shortage A nationwide shortage of Hib vaccine began in December 200 and is ongoing. The shortage resulted in a recommendation by CDC to defer the Hib booster (routinely recommended at 12 through 15 months) for children who are NOT at high risk of Hib infection temporarily, until supplies are restored. This recommendation is still in effect. Health care providers must be vigilant about ensuring that all young children are appropriately vaccinated with the 3 dose primary series of Hib vaccine. There is enough Hib containing vaccine for all U.S. children to receive the primary series. All children should complete the primary series by months of age; high risk children should continue to receive the full primary series and the booster dose. Completion of the primary series with currently available vaccine products (manufactured by sanofi pasteur) requires a total of 3 doses of Hib containing vaccine (2, 4, and 6 months). Certain children are at increased risk for Hib disease, including children with asplenia, sickle cell disease, human immunodeficiency virus infection and certain other immunodeficiency syndromes, and malignant neoplasms. CDC recommends that providers continue to vaccinate these children with available Hib conjugate vaccines according to the routinely recommended schedules, including the 12 through 15 month booster dose. If Hib vaccine is not available in the office at the time of a visit, children who are unable to receive one of the primary series doses should be tracked and recalled to schedule an appointment to receive their dose as soon as vaccine becomes available in the office. There is potential to see increases in cases of Hib disease. Invasive Hib disease in children should be reported to the Yolo County Health Department. For more information about Hib disease, Hib vaccine or to report a case of illness, contact Yolo County Immunization Coordinator, Lynne Foster at (530) (Source: CDC Health Advisory, Mar. 18, 2009) Syphilis Training for Clinicians in Stockton June 2, 2009 A special one day course entitled STD Update: Emphasis on Syphilis will be offered in Stockton on Tuesday, June 2nd. This course covers epidemiology, diagnosis, treatment, and management of STDs for the practicing clinician. This day long course is presented in an interactive format and incorporates case discussions. Co sponsors include the CA STD/HIV Prevention Training Center, San Joaquin County Public Health Services, Health Plan of San Joaquin, and UC Davis AIDS Education & Training Center. Register online at or call (510) Yolo County Health Department Page 4

5 Measles Health Alert 2009 Measles cases continue to be identified in California in returning international travelers. Measles is highly contagious. Please protect patients, visitors, and staff! Keep an eye out for measles symptoms: Suspect measles in patients with: fever and rash history of international travel or contact with international visitors in the prior 3 weeks. Note: A history of 2 doses of MMR vaccine does not exclude a measles diagnosis. Prodrome Mild to moderate fever Cough Coryza Conjunctivitis Rash onset Fever spikes, often as high as 104º to 105º F Red, maculopapular rash that may become confluent typically starts at hairline, then face, and spreads rapidly down body Koplik's spots (tiny blue/white spots on the bright red background of the buccal mucosa) may be present Act immediately if you suspect measles: Implement airborne infection control precautions immediately, mask and isolate patient negative pressure room, if available. Expedite measles serologic testing (IgM and IgG) at a public health lab; use of commercial labs may delay diagnosis. Permit only staff immune to measles to be near the patient. Safeguard other facilities: assure airborne infection control precautions before referring patients. Notify your local health department immediately. Do not use any regular exam room for at least 2 hours after a suspected measles patient has left the room. Visit for more information A message from California Department of Public Health, Immunization Branch IMM-908 (2/09)