Bureau of Epidemiology
Bureau of Epidemiology August 2001 Utah Department of Health
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  Food Safety
  New EIS Officer
  How Can You Prepare Now for the Flu Season? Get a Pneumococcal Vaccine!
  Exceptional Efforts and Important Information
  Monthly Morbidity Summary
 
 

Food Safety

September is National Food Safety Education Month (NFSEM), an annual observance to focus attention on the importance of safe food handling in both home and commercial kitchens. In addition to drawing attention to safe food handling practices, we feel it important to focus on early identification of outbreaks and diagnosis of food borne illness in order to protect household contacts as well as members of the public as a whole. Primary care and emergency room physicians are often the first professionals to be notified of a possible food borne outbreak or disease. Cooperation between physicians, local health departments and state health departments is needed to protect individual and public health.

The most common symptoms of food borne illness are diarrhea, abdominal cramps, vomiting, head or muscle aches, and fever. Symptoms usually appear 12 to 72 hours after eating contaminated food. However, the incubation period can be as short as 30 minutes and as long as 4 weeks. Most people recover within 4 to 7 days with no antibiotic treatment, while some will have symptoms serious enough to warrant a visit to the family physician or to the emergency room. In situations where food borne disease is suspected, the following information is helpful in determining the cause of illness.

 

What is the incubation period?

 

What is the duration of illness?

 

What are the predominant clinical symptoms?

 

Are other family members or contacts ill with similar symptoms?

 

Is there a history of eating high risk foods such as raw or poorly cooked eggs, meats or shellfish, or unpasteurized milk or juice?

Clinical presentation is similar in many cases regardless of the etiologic agent. Differentiating food borne disease from other GI illness is difficult when patients have chronic diarrhea, severe abdominal pain or underlying chronic conditions. Food borne disease should be considered and laboratory testing done if any of the following signs and symptoms are present:

 

Bloody diarrhea

 

Weight loss

 

Diarrhea leading to dehydration

 

Fever

 

Prolonged diarrhea (three or more unformed stools per day, persisting several days)

 

Neurological involvement such as parasthesias, motor weakness, cranial nerve palsies

 

Sudden onset of nausea, vomiting, diarrhea

 

Severe abdominal pain

Table 1 provides a list of food borne illnesses that are notifiable in the United States. However, if an outbreak is suspected, it is not necessary to wait for laboratory confirmation before reporting to the local or state health department. Situations where two or more patients present with a similar illness that may have resulted from the ingestion of a common food, consumption of a classic outbreak-associated food within approximately 72 hours of symptom onset combined with symptoms typically seen in food borne illness should also be reported promptly to public health officials. In addition, clinical specimens should be collected for laboratory analysis.

TABLE 1. Food borne Diseases and Conditions Designated as Notifiable at the National Level, United States 2000

Notifiable Bacterial Food borne
Diseases and Conditions

Botulism
Brucellosis
Cholera
Escherichia coli O157:H7
Hemolytic Uremic Syndrome, post-diarrheal
Salmonellosis
Shigellosis
Typhoid Fever

Notifiable Viral Food borne
Diseases and Conditions

Hepatitis A

Notifiable Parasitic Food borne
Diseases and Conditions

Cryptosporidiosis
Cyclosporiasis
Trichinosis

Additional information is available at www.cste.org/reporting%20requirements.htm

 

Selection of appropriate treatment depends on identification of the responsible pathogen if possible. Most episodes of acute gastroenteritis are self limiting and require only fluid replacement and supportive care. Many antidiarrheal agents have potentially serious adverse effect in infants and young children; their routine use is not recommended in this age group. In addition, antimicrobial therapy for acute gastrointestinal illness is seldom necessary and may even have adverse effects. Treating E. coli O157:H7 with antibiotics can increase the risk of hemolytic uremic syndrome and treating salmonellosis can actually prolong carriage of the microbe.

Patients, especially children should be educated on proper hand washing procedures. In addition, consumers should be advised to prepare and store food properly. Growth of bacterial pathogens can be prevented if cold foods are properly refrigerated and hot foods are held at temperatures above 140 degrees. Avoid cross contamination by keeping raw meat, poultry and seafood away from ready to eat foods. Patients should also avoid drinking unpasteurized milk and juice. Raw fruits and vegetable should be washed thoroughly before eating.

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Now it’s time to find out how well you know your diarrheal illnesses. Match the disease with the correct scenario.

1. A business traveler who returned one month ago from Mexico is ill with fatigue, jaundice, abdominal pain and diarrhea.______

2. A patient has had chronic intermittent diarrhea for about 3 weeks. There is no vomiting and no blood in the stool. The patient camps often and may have consumed untreated water._______

3. A child is brought to your office with fever, bloody diarrhea and vomiting and has a history of drinking unpasteurized milk within the last 48 hours._______

4. A child who presents with severe bloody diarrhea, abdominal cramps which have been present for two days. No fever. The family visited a petting zoo five days before onset of symptoms._______

5. Several family members are ill with diarrhea, fever and vomiting. The common food reported was Grandpa’s home-made ice cream, prepared using raw shelled eggs._______

6. A 23 year old female reports nausea, diarrhea, fever and muscle aches. Her food history includes homemade fresh soft cheese given to her by her neighbor about 36 hours before onset of illness._______

7. A day care provider reports an outbreak of diarrhea among her class and staff. Symptoms are abdominal cramps, fever, and diarrhea containing blood and mucus._______

8. Forty-eight hours after eating home-canned green beans, patient presents with vomiting, diarrhea, blurred vision and descending muscle weakness._______

9. A family of 4 is reports symptoms including nausea, vomiting and watery diarrhea. They returned yesterday from a trip to the East Coast. They reported eating raw oysters on the last night of the trip. ________

10. A cluster of illness characterized by cramping, abdominal pain, watery diarrhea, fever and vomiting appears among neighbors soon after their public water supply is changed. ________

A. Botulism
B. Campylobacter
C. Hepatitis A
D. Salmonella
E. Giardia Lamblia
F. E Coli O157:H7
G. Shigellosis
H.  Listeria Monocytogenes
I.  Norwalk-like virus
J.  Cryptosporidium

KEY: 1-C, 2-E, 3-B, 4-F, 5-D, 6-H, 7-G, 8-A, 9-I, 10-J

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New EIS Officer

The Utah Department of Health was successful in recruiting Maryam B. Haddad, MPH, MSN, an EIS Officer for a two-year assignment. EIS stands for ‘Epidemic Intelligence Service’ and is a two-year program for epidemiologic training. The EIS Program, managed by the Centers for Diseases Control and Prevention (CDC), has been training epidemiologists for 50 years. Maryam just completed her MPH and MSN degrees at Emory University in Atlanta.

Maryam will be assisting with epidemiologic investigations and analyses and preparation for the 2002 Winter Olympics. We are fortunate to have an EIS Officer and would like to welcome Maryam to Utah.

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How Can You Prepare Now for the Flu Season? Get a Pneumococcal Vaccination!

Pneumococcal disease is the leading cause of serious illness in children and adults throughout the world, and typically results in more deaths in the United States each year than all other vaccine-preventable diseases combined. The disease is caused by a common bacterium, Streptococcus pneumoniae and can affect anyone, primarily children under two years of age and adults over 65. Each year in the United States, pneumococcal diseases account for approximately 50,000 cases of bloodstream infection (bacteremia), 3,000 cases of meningitis (infection of the tissues and fluids surrounding the brain and spinal cord), and 100,000 to 175,000 hospitalizations from pneumonia.

Pneumococcal pneumonia is the most common clinical illness among adults. It is also a common bacterial complication of influenza and measles. Between 20,000 and 40,000 deaths are attributed to flu and pneumonia in the United States each year, with more than 90 percent of these deaths occurring in people age 65 and older. Symptoms of pneumococcal pneumonia may include an abrupt onset of fever, shaking chills, a productive cough, and stabbing chest pains that increase with breathing and coughing. The symptoms of meningitis include stiff neck, fever, mental confusion and photophobia. Bacteremia may include a combination of the symptoms of pneumonia and meningitis along with arthritis.

Who should receive pneumococcal vaccine and when?

Because of the complications associated with pneumococcal disease, the polysaccharide pneumococcal vaccine is recommended for high-risk children >2 years of age and for adults, specifically those over 65 and with chronic medical conditions. A single dose of the pneumococcal polysaccharide vaccine protects against 23 types of pneumonia bacteria. Unlike the annual flu vaccine, pneumococcal vaccine can be given at any time during the year and is generally a lifetime vaccination. Revaccination is only recommended under certain conditions, depending upon the person’s age and other high-risk factors. A recently licensed pneumococcal conjugate vaccine is now available for children under 2 years of age.

General Pneumococcal Polysaccharide Vaccine Recommendations:

 

Adults age 65 and older

 

Adults with normal immune systems who have chronic illness

 

Immunocompromised adults (including those with HIV infection)

 

Persons in environments or settings with increased risk

 

Children age 2 or older at high risk of invasive disease:

 

Splenic absence

 

Sickle cell disease

 

Nephrotic syndrome

 

CSF leaks

 

Immunosuppression, including HIV infection

References:

  1. National Immunization Program (NIP) www.cdc.gov/nip

  2. National Foundation for Infectious Diseases (NFID) www.nfid.org

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    EXCEPTIONAL EFFORTS IN PUBLIC HEALTH

         On July 24, a pediatric infectious disease physician at Primary Children’s Medical Center reported a case of Haemophilus Influenzae meningitis in a child who had been flown in from the Southwestern part of the state. The physician was very concerned because the child’s family reported an infant cousin who was hospitalized in a Southwestern County with similar symptoms. As it was a Utah holiday, government offices were closed, so Kay Whetstone, a public health nurse with the Southwest Health District, was notified at home. She went right to work identifying the second case and following through to ensure all close contacts were prophylaxed. The situation was complicated by the fact that the cases were from very close large families, philosophically opposed to immunizations. The cases were later identified as residents of a bordering state that worked with Kay to complete the investigation. Haemophilus Influenzae isolates from both patients’ CSF specimens were later confirmed as type B. Kay deserves special acknowledgment for recognizing the urgency of the situation and spending her entire holiday working on this investigation.

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    Important Information

    When Reporting a Communicable Disease:

    Call: (801) 538-6191
    Or:
    Fax: (801) 538-9923

    Or in an emergency:

    24 hour Pager: (801) 241-1172

    The August 2001 Epidemiology Newsletter is the most current Newsletter online.

    For Information on Fact Sheets for Diseases or Annual Report Information, as well as The Epidemiology Newsletter, you can browse our website:

    http://health.utah.gov/epi/

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    Utah Department of Health, Bureau of Epidemiology
    Monthly Morbidity Summary
    August 2001 - Provisional Data

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The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Office of Epidemiology, to disseminate epidemiologic information to the health care professional
and the general public.

Send comments to:  The Office of Epidemiology, Box 142104,Salt Lake City, UT 84114-2104, or call (801) 538-6191

Approval 8000008:  Appropriation 3705

Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Director, Division of Epidemiology and Laboratory Services
Gerrie Dowdle, MSPH, Manager, Surveillance and Disease Control Program, Managing Editor
Connie Dean, Community Health Technician, Surveillance and Disease Control Program, Production Assistant

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