Connie Austin Division of Infectious Disease Illinois Department of Public Health

Transcription

1 Connie Austin Division of Infectious Disease Illinois Department of Public Health

2 Situations/individual interesting cases of 2012 and a few from 2013 Overall outbreak information, 2012 Interesting outbreaks, 2012 Tick-borne diseases

3 Situation 1 - Cutaneous anthrax

4 Situation 2 - Lassa fever

5 Situation 3 - Monkeypox

6 A resident of another state flew in through O Hare from a visit to India on 7/26. She had fever, weakness, altered mental status as she reached baggage claim Taken to the hospital Blood culture positive for Burkholderia pseudomallei

7 Category B select agent Endemic in India, SE Asia, China, Australia, Caribbean Transmission to people from direct contact with contaminated soil or surface waters or inhalation from dust or water. Causes localized infection-fever, ulcers, abscesses, pulmonary infection, disseminated infection

8 May 10. Reporter called IDPH to ask questions about a hantavirus case in central Illinois. Male in his sixties Hospitalized since May 1 Exposure was cleaning out a shed with a blower

9 Hantavirus is reportable Physician told reporter

10 Two previous cases in Illinois 1996 fatal case in Carroll County Rodents in home 2005 survived, Kankakee County Cleaned out a greenhouse area

11 From inhalation of mouse droppings, urine or saliva from infected white footed mice or deer mice. Virus lasts about 3-5 days in environment Incubation period is an average of 2 weeks but can range from a few days to 6 weeks

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14 July 16 Report of a person who had been bitten on the thumb and index finger by their pet rat on July 8 The pet rat subsequently died and another of his pet rats had also died previously

15 July 13 Individual became ill with fever, vomiting, diarrhea. Then developed rash. July 14 on way to hospital collapsed, renal failure, dialysis, intubation Bacterial culture from blood performed-gram neg rod growing

16 Caused by Streptobacillus moniliformis Transmitted to people by bites, scratches, rodent contact or eating food or water contaminated by infected rat excreta Incubation period 2 days to 3 wks Commensal in rats

17 Survived 30 days in hospital Amputation of thumb and part of index finger Discharged to a LTC facility for rehab

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19 Variety of reporters Review of individual case reports by local and state health departments Laboratory testing serotyping, PFGE

20 Any outbreaks of public health significance Foodborne Waterborne Laboratory acquired Animal contact Person to person Inhalation

21 Animal Contact 2% Waterborne 2% Other/ unknown 3% Foodborne 16% Personperson 77%

22 Parasites 6% Bacterial 9% Fungal 1% Unknown 3% Viral 81%

23 Bacterial Toxins 4% Fish toxin 2% Parasitic 2% Salmonella 28% Norovirus 64%

24 A 51 yr old male resident of central Illinois developed fever, muscle aches, chills, photophobia and periorbital edema with onset on Oct. 24, Sought care at an ED. 38% eosinophils in blood WBC count History of a hunting trip to Alaska Any ideas for a pathogen?

25 5 friends ate bear stew and 2 of the 5 also ate bear meat prepared medium rare on 9/22 The 2 who ate the pan seared tenderloin, medium rare, both tested positive for trichinellosis Both were treated with albendazole and recovered.

26 About 20 human cases are reported each year in the U.S. Cases decreased over time with changes in pig-raising practices and freezing of pork which reduces viability of cysts and awareness of not eating pork rare. Number of cases linked to raw or undercooked wild game has remained constant over time.

27 What problems can cause a Salmonella outbreak in a food preparation facility? Infected food handler A food product coming into the facility contaminated and either not cooked or not cooked sufficiently Cross contamination of raw and cooked foods Food surfaces or grinders that are not cleaned sufficiently

28 12 10 Restaurant could be closed on 11/16 Restaurant actually closed, 11/ Cases after recommendation but before closure Cases before recommendation

29 261 persons from 24 states with the outbreak strains of S. ser. Typhimurium and Newport In Illinois, 36 cases from 17 counties Onsets in IL from 7/8 to 9/7 Multi-state investigation linked outbreak to cantaloupe originating from an Indiana farm. 64% of Illinois cases reporting eating cantaloupe prior to illness onsets.

30 Raw tuna scrape Peanut butter Mangoes

31 New techniques (non culture) for identifying enteric pathogens Advantages More rapid identification Testing for a wider number of pathogens Disadvantages May result in lack of serotype and PFGE to identify outbreaks

32 Friday August 10, LHD received a call about young people ill with cough, fever and red painful eyes after swimming at a lake

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34 Number of cases Cluster of Illnesses, LaSalle County, August Jul 25-Jul 27-Jul 29-Jul 31-Jul 2-Aug 4-Aug Aug 6 8-Aug 10-Aug 12-Aug Dates of onset Notification of LHD Group event Non group

35 Legionellosis -2 Adenovirus E. coli O111 Cercarial dermatitis

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37 N u m b e r o f c a s e s Jul 23-Jul 25-Jul 27-Jul 29-Jul 31-Jul 2-Aug 4-Aug 6-Aug 8-Aug 10-Aug Date of onset LHD notified 12-Aug 14-Aug Fountain, pool and spa drained 16-Aug 18-Aug 20-Aug 22-Aug

38 Other mode 1% Animal contact 2% Unknown mode 3% Personperson 94%

39 188 outbreaks (73 confirmed) 7,058 illnesses 218 hospitalizations 8 fatalities 80% in elder facilities

40 Number of outbreaks Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of first onset

41 Organism Infectious Dose Norovirus <100 Salmonella 100,000 E. coli >100,000,000

42 Norovirus is passed in the feces and vomit of infected persons Fecal-oral route: either by direct person-toperson spread or consumption of fecallycontaminated food/water Aerosolization of vomitus (swallow/surfaces) Environmental and fomite contamination

43 Hand hygiene Environmental disinfection with bleach solution Prudent work exclusion practices: stay home until symptom-free for 48 to 72 hours Safe food handling practices: food facility inspection should be done

44 Norovirus HealthBeat Control of Viral Gastroenteritis Outbreaks in Illinois Long-Term Care Facilities IDPH Sharepoint website

45 Both outbreaks linked to compounding pharmacies Fungal endophthalmitis Fungal meningitis

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47 8 confirmed clusters Correctional facilities (5), work sites (2) and schools (1)

48 13 outbreaks reported involving 138 cases Mostly elder facilities (9), day care(2) and DD facility (2)

49 Contact with Live poultry (3 outbreaks) Hedgehog (1) Turtles (1) Calves (1) And one due to contact with dog food Dog food (1)

50 A woman in Illinois tested positive for Salmonella ser. Typhimurium DNA pattern matched multi-state outbreak linked to pet pygmy hedgehog contact

51 Pygmy hedgehog in household Case did not handle hedgehog 8 swabs tested from hedgehog and its environment; 6 samples positive for same strain

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55 Influenza A (H3N2) viruses which have genes from avian, swine and human viruses that normally circulate in swine can sometimes infect humans When human infections occur they are called variant viruses v The first human cases of H3N2v virus occurred in This virus had acquired the M gene from the 2009 H1N1 virus.

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57 Sustained human to human transmission could result in pandemic Influenza surveillance

58 Cases started in mid-july 297 cases reported in 13 states in the U.S. Mostly in children 16 hospitalizations, 1 death Most have had direct or indirect contact with swine No evidence of sustained community transmission No vaccine available at present

59 Cass County One was a friend of a swine exhibitor One was a sibling of the swine exhibitor Logan County Multiple swine exposures-owned swine, attended two agricultural fairs with swine present and exhibited at both Ogle County Attended a county fair

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61 Lyme Ehrlichiosis/ anaplasmosis RMSF

62 Number of cses Ehrlichiosis Lyme RMSF Month

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