Newsletter September 2014 Issue 1, Vol. 1 ENTEROVIRUS D68 VIRAL MENINGITIS
VIRAL MENINGITIS viral meningitis is often less severe than bacterial meningitis and usually resolves without specific treatment. But it can be severe or fatal depending on the virus causing the infection, the person s age, or whether a person has a weakened immune system. Causes Most viral meningitis cases in the United States, especially during the summer months, are caused by enteroviruses; however, only a small number of people with enterovirus infections actually develop meningitis. Other viral infections that can lead to meningitis include: Mumps Herpes virus, including Epstein-Barr virus, herpes simplex viruses, and varicella-zoster virus (which also causes chicken pox and shingles) Measles Influenza Viruses spread through mosquitoes and other insects (arboviruses) In rare cases, LCMV (lymphocytic choriomeningitis virus), which is spread by rodents Risk Factors Viral meningitis can affect anyone. But infants younger than 1 month old and people whose immune systems are weak are at higher risk for severe infection. If you are around someone with viral meningitis, you have a chance of becoming infected with the virus that made that person sick, but you are not likely to develop meningitis as a complication of the illness. Factors that can increase your risk of viral meningitis include: Age * Viral meningitis occurs mostly in children younger than age 5. Weakened immune system * There are certain diseases and medications that may weaken the immune system and increase risk of meningitis. For example, chemotherapy and recent organ or bone marrow transplants. Transmission Enteroviruses, the most common cause of viral meningitis, are most often spread from person to person through fecal contamination (which can occur when changing a diaper or using the toilet and not properly washing hands afterwards). Enteroviruses can also be spread through respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. Other viruses, such as mumps and varicella-zoster virus, may also be spread through direct or indirect contact with saliva, sputum, or mucus of an infected person. Contact with an infected person may increase your chance of becoming infected with the virus that made them sick; however, you are not likely to develop meningitis as a complication of the illness. Signs & Symptoms Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as: Nausea Vomiting Photophobia (sensitivity to light) Altered mental status Viral meningitis is an infection of the meninges (the covering of the brain and spinal cord) that is caused by a virus. Enteroviruses, the most common cause of viral meningitis, appear most often during the summer and fall in climates with changing seasons. Viral meningitis can affect anyone at any age. It is usually less severe than bacterial meningitis and normally clears up without specific treatment, but in some cases viral meningitis can be severe or fatal. The symptoms of viral meningitis are similar to those for bacterial meningitis, which can be fatal. Because of this, it is important to see a healthcare provider right away if you think you or your child might have meningitis. Symptoms of viral meningitis may differ depending on age: Common symptoms in infants Fever Irritability Poor eating Hard to awaken Common symptoms in adults High fever Severe headache Stiff neck Sensitivity to bright light Sleepiness or trouble waking up Nausea, vomiting Lack of appetite The symptoms of viral meningitis usually last from 7 to 10 days, and people with normal immune systems usually recover completely. Viruses that cause meningitis can also cause nearby brain tissue infection (meningoencephalitis) or spinal cord infection (meningomyelitis) at the same time. Diagnosis If meningitis is suspected, naso-oropharyngeal swabs, rectal swabs, stool, cerebrospinal fluid and blood serum are collected and sent to the laboratory for testing. It is important to know the specific cause of meningitis because the severity of illness and the treatment will differ depending on the cause. The specific causes of meningitis may be determined by tests used to identify the virus in samples collected from the patient. Treatment Usually there is no specific treatment for viral meningitis, but in some instances specific treatment is available depending on the virus (such as herpes virus). Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Most patients completely recover on their own within 7 to 10 days. A hospital stay may be necessary in more severe cases or for people with weak immune systems. Prevention There are no vaccines for the most common causes of viral meningitis. Thus, the best way to prevent viral meningitis is to prevent the spread of viral infections. However, that can be difficult because sometimes people infected with a virus do not appear sick, but they can still spread it to others. You can take the following steps to help lower your chances of getting infected with a virus or passing one on to someone else: Wash your hands thoroughly and often, especially after changing diapers, using the toilet, or coughing or blowing your nose. Disinfect frequently touched surfaces, 2 American Home Health Newsletter September 2014 Continues on page 3
VIRAL MENINGITIS Continued from page 2 such as doorknobs and the TV remote control. Avoid kissing or sharing cups or eating utensils with sick people; avoid sharing with others when you are sick. Make sure you and your child are vaccinated on schedule. Vaccinations included in the childhood vaccination schedule can protect children against some diseases that can lead to viral meningitis. These include vaccines against measles and mumps (MMR vaccine) and chickenpox (varicella-zoster vaccine). Avoid bites from mosquitoes and other insects that carry diseases that can infect humans. Control mice and rats. If you have a rodent infestation in and/ or around your home, follow the cleaning and control precautions listed on CDC s website about LCMV (Lymphocytic choriomeningitis virus). ENTEROVIRUS D68 Q: What is enterovirus D68? A: Enterovirus D68 (EV-D68) is one of many non-polio enteroviruses. This virus was first identified in California in 1962, but it has not been commonly reported in the United States. Q: What are the symptoms of EV- D68 infection? A: EV-D68 can cause mild to severe respiratory illness. Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches. Most of the children who got very ill with EV-D68 infection in Missouri and Illinois had difficulty breathing, and some had wheezing. Many of these children had asthma or a history of wheezing. Q: How does the virus spread? A: Since EV-D68 causes respiratory illness, the virus can be found in an infected person s respiratory secretions, such as saliva, nasal mucus, or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces. Q: How many people have been confirmed to have EV-68 infection? A: From mid-august to September 15, 2014, a total of 104 people in 10 states were confirmed to have respiratory illness caused by EV-D68. A CDC or state laboratory confirmed these cases. Some state laboratories may have also confirmed cases, but these are not included in our total case count. Q: How common are EV-D68 infections in the United States? A: EV-D68 infections are thought to occur less commonly than infections with other enteroviruses. However, CDC does not know how many infections and deaths from EV-D68 occur each year in the United States. Healthcare professionals are not required to report this information to health departments. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections. Any data that CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC s National Enterovirus Surveillance System (NESS). This system collects limited data, focusing on circulating types of enteroviruses and parechoviruses. Q: What time of the year are people most likely to get infected? A: In general, the spread of enteroviruses is often quite unpredictable, and different types of enteroviruses can be common in different years with no particular pattern. In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We re currently in middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall. Q: Who is at risk? A: In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become ill. That s because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Among the EV-D68 cases in Missouri and Illinois, children with asthma seemed to have a higher risk for severe respiratory illness. Q: How is it diagnosed? A: EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person s nose and throat. Many hospitals and some doctor s offices can test ill patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. Some state health departments and CDC can do this sort of testing. CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear. Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse. Q: What are the treatments? A: There is no specific treatment for people with respiratory illness caused by EV-D68. 3 American Home Health Newsletter September 2014 Continues on page 4
ENTEROVIRUS D68 Continued from page 3 For mild respiratory illness, you can help relieve symptoms by taking over-thecounter medications for pain and fever. Aspirin should not be given to children. Some people with severe respiratory illness may need to be hospitalized. There are no antiviral medications currently available for people who become infected with EV-D68. Q: How can I protect myself? A: You can help protect yourself from respiratory illnesses by following these steps: Wash hands often with soap and water for 20 seconds, especially after changing diapers. Avoid touching eyes, nose and mouth with unwashed hands. Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick. Also, see an graphic that shows these prevention steps. Since people with asthma are higher risk for respiratory illnesses, they should regularly take medicines and maintain control of their illness during this time. They should also take advantage of influenza vaccine since people with asthma have a difficult time with respiratory illnesses. Q: Is there a vaccine? A: No. There are no vaccines for preventing EV-D68 infections. Q: What should clinicians do? A: Clinicians should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever. report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting. consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear. consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses. Before sending specimens for diagnostic and molecular typing: contact your state or local health department. consult with CDC by sending an email to wnix@cdc.gov. submit specimens (nasopharyngeal and oropharyngeal swabs are preferred or any other type of respiratory specimens) using CDC instructions and complete specimen submission form 50.34. complete a patient summary form for each patient for whom specimens are being submitted. Please send a printed copy of the form at the same time as specimen submission. Enterovirus D68 (EV-D68) Patient Summary Form 1 page, 508-compliant Microsoft Word file (http://www.cdc.gov/ non-polio-enterovirus/downloads/ EV68_PatientSummaryForm.doc) 1 page PDF (http://www.cdc.gov/ non-polio-enterovirus/downloads/ EV68-PatientSummaryForm.pdf ) follow infection control measures; see health alert for more information. Q: What is CDC doing about EV- D68? A: CDC is helping states with diagnostic and molecular typing for EV-D68. CDC is also working with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks, and perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance. FLU VACCINE Mandatory Influenza Vaccination Form MUST be in the completed no later than 10/11/2014. You can find a link to the form in your COMPLIANCE CORNER on our website. As with any other of our HR requirements, not complying by the deadline will prevent you from accruing PTO going forward until the requirement is met. 4 American Home Health Newsletter September 2014
SUMMER IS OVER FLU SEASON IS UPON US by Janet Fulfs, President This year our pledge is to have at least 60% of our staff vaccinated. To that end we will have influenza vaccine available during our skills fair this year. Vaccinations are not necessarily for us but for our clients. It is our (healthcare workers) duty to prevent infections in our clients. We can discuss which clients are most at risk but we know that ALL of our clients are HIGH RISK. This means the influenza virus can cause grave consequences to any one of our clients. We cannot stop there. We have an obligation to ensure that each of our clients have the opportunity to obtain a vaccination. Recommendations of the CDC are all persons over the age of 6 months should be vaccinated unless contraindicated. This goes double for our clients who are at great risk if left unprotected. Remember, this disease may spread without even having a symptom for up to 5 days. In those five days just think of how many persons have come in contact with you. For that reason alone you should be vaccinated. Also the use of proper respiratory etiquette is vitally important such as the use of tissue, hand hygiene and the wearing of personal protective equipment to prevent infection. Let s have a virus free winter, help us prevent the FLU and protect our clients 5 American Home Health Newsletter September 2014
TEST Your FLU IQ Flu IQ Widget www.ahhc-1.com/employees.php AHHC Newsletter Editors: Edward Lara Designer: Edward Lara Contributions: Jan Fulfs, Edward Lara For Contributions, Email: hr@ahhc-1.com Write: 1660 N. Farnsworth Ave., Ste.3 Aurora IL 60505 6 American Home Health Newsletter September 2014