Bureau of Epidemiology
Bureau of Epidemiology July 2001 Utah Department of Health
inside...
  Zoonotic Diseases
  Don’t Miss the Olympic Fun Because of the Flu!
  Seminar Announcement
  Exceptional Efforts In Public Health
  Important Information
  Monthly Morbidity Summary

 

Zoonotic Diseases

Each year as Summer arrives, Utahns of all ages head into the great outdoors for hiking, biking, cookouts, camping, boating and an array of other activities. While enjoying the outdoors, it is important to be aware of the infectious agents that we may be exposed to and take the precautions necessary to prevent exposure to viruses, bacteria and animal parasites that could cause infectious diseases. The following is a summary of a few of the diseases that could be encountered in the outdoors and some of the ways we can prevent exposure and detect and treat illness early. This is not a comprehensive list but includes those we might be more likely to be exposed to in Utah.

Hantavirus Pulmonary Syndrome

Hantavirus can be found in approximately 1/3 of the deer mouse population in the state of Utah. Utah has seen 17 cases of hantavirus in humans with a fatality rate of approximately 30%. The rodents shed the virus in their urine, droppings and saliva. It is most often transmitted to humans when they breathe air that is contaminated with the virus. The incubation period for Hantavirus Pulmonary Syndrome (HPS) can range from a few days to six weeks with an average of two weeks. Patients with HPS typically present in a very nonspecific way with a relatively short febrile prodrome lasting 3-5 days. In addition to fever and myalgias, early symptoms include headache, chills, dizziness, non-productive cough, nausea, vomiting, and other gastrointestinal symptoms. Malaise, diarrhea, and lightheadedness are reported by approximately half of all patients, with less frequent reports of arthralgias, back pain, and abdominal pain. Patients may report shortness of breath, (respiratory rate usually 26 - 30 times per minute). The diagnosis is seldom made at this stage, as cough and tachypnea generally do not develop until approximately day seven. Once the cardiopulmonary phase begins, however, the disease progresses rapidly, necessitating hospitalization and often ventilation within 24 hours.

Prevention is key as there is no vaccine or specific treatment other than supportive care for patients with HPS. Prevention includes the following:

 

Keep mice and rodents out of your home

 

Seal all openings into your home that are greater than 1/4 in.

 

Keep all weeds, woodpiles, and garbage at lease 100 feet from your home.

 

Keep all food, including pet food, in rodent proof containers.

 

Trap all mice within your home

 

Remember to wear gloves while handling mice.

 

Use snap traps to trap and kill mice

 

Spray mice and traps with disinfectant.

 

Place rodent in a double plastic bag for disposal.

 

Clean up after mice

 

Air out area for 30 minutes.

 

Wear rubber gloves while cleaning.

 

Do not create dust by sweeping or vacuuming.

 

Spray rodent droppings and nests with disinfectant.

 

Place rodent droppings, nests and other contaminated items in double bags for disposal.

Also, while hiking or camping, you should avoid rodents and rodent burrows. Use tents with floors. All food and trash should be stored away from rodents. Cabins, sheds, or other buildings that are only used periodically should be aired out and carefully cleaned using the same precautions as in the home.

Plague
Plague is an infection in humans and animals caused by the Yersinia Pestis bacteria. In the past 10 years, Utah has had six confirmed human Plague cases. Plague appears in one of three forms. Bubonic plague, the most common, septicemic plague and pneumonic plague. Clinical features of each are similar with fever, chills and prostration. Bubonic plague includes enlarged, tender lymph nodes called buboes. Pneumonic plague includes cough and difficulty breathing. Pneumonic plague is also considered to be the most serious since it is the only type that is communicable from person to person. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. Streptomycin is the antibiotic of choice. Gentamicin is used when streptomycin is not available. Tetracyclines and chloramphenicol are also effective. Persons who have been in close contact with a plague patient, particularly a patient with plague pneumonia or those with possible exposure to plague in animals, should be identified and considered for antibiotic prophylaxis. The incubation period from exposure to onset of symptoms is generally two to six days. The preferred specimen for microscopic examination and isolation from a bubonic case is material from the affected bubo. Blood cultures should be taken whenever possible. Specimens intended for culture should be taken before initiation of antibiotic treatment.

Anyone can get plague, though young people under the age of 20 seem to have the greatest risk, probably because their activities are more likely to bring them in contact with the bacteria. The most common cause of plague in humans has been the bite of infected fleas. Domestic pets, particularly house cats, may carry fleas into homes and occasionally transmit infection by their bites and scratches. Prevention strategies include the following:

 

Avoid flea-infested areas during summer months.

 

Use insect repellents containing DEET on your skin or pyrethrin on your clothing. Be sure to follow the directions on the container and wash off repellents when going indoors.

 

Provide pets weekly flea treatments with flea powder (especially in areas where plague is present).

 

Wear long sleeved shirts and long pants when camping or hiking.

 

Avoid handling rodents, especially if they appear to be sick.

 

Large numbers of dead or sick rodents should be reported to the health department.

Rabies
Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals such as raccoons, skunks, bats, and foxes. Domestic animals account for less than 10% of the reported rabies cases, with cats, cattle, and dogs most often reported rabid. In Utah, bats are the only animals that have tested positive for rabies since 1995. An average of 11 bats test positive each year.

Rabies virus infects the central nervous system, causing encephalopathy and ultimately death. Early symptoms of rabies in humans are nonspecific, consisting of fever, headache, and general malaise. As the disease progresses, neurological symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hyper salivation, difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms. Rabid animals display symptoms ranging from aggression and hyper-salivation to timidness and lower jaw paralysis. Prevention of rabies includes the following:

 

Keep vaccinations up-to-date for all dogs, cats and ferrets. This requirement is important not only to keep your pets from getting rabies, but also to provide a barrier of protection to you, if your animal is bitten by a rabid animal.

 

Keep your pets under direct supervision so they do not come in contact with wild animals. If your pet is bitten by a wild animal, seek veterinary assistance for the animal immediately.

 

Call your local animal control agency to remove any stray animals from your neighborhood. They may be unvaccinated and could be infected by the disease.

 

Spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or regularly vaccinated.

 

Avoid direct contact with unfamiliar animals:

 

Enjoy wild animals (raccoons, skunks, foxes) from afar. Do not handle, feed, or unintentionally attract wild animals with open garbage cans or litter.

 

Teach children never to handle unfamiliar animals, wild or domestic, even if they appear friendly. "Love your own, leave other animals alone" is a good principle for children to learn.

 

Never adopt wild animals or bring them into your home. Do not try to nurse sick animals to health. Call animal control or an animal rescue agency for assistance.

 

Prevent bats from entering living quarters or occupied spaces in homes, churches, schools, and other similar areas, where they might come in contact with people and pets.

Giardiasis
Giardiasis is a diarrheal illness caused by Giardia intestinalis (also known as Giardia lamblia), a one-celled, microscopic parasite that lives in the intestine of people and animals. Giardia has become recognized as one of the most common causes of waterborne disease (drinking and recreational) in humans in the United States. Symptoms include diarrhea, loose or watery stool, stomach cramps, and upset stomach. These symptoms may lead to weight loss and dehydration. Some cases may be asymptomatic. Giardia can be spread by swallowing drinking water or recreational water contaminated with the parasite. Recreational water is water in swimming pools, hot tubs, jacuzzis, fountains, lakes, rivers, springs, ponds or streams that can be contaminated with sewage or feces from humans or animals. Giardia can also be contracted by eating uncooked food contaminated with Giardia. Prevention includes the following:

 

Thoroughly wash with uncontaminated water all vegetables and fruits you plan to eat raw.

 

Avoid drinking water from untreated sources including recreational water, If you are unable to avoid drinking or using water that might be contaminated, then treat the water yourself by heating the water to a rolling boil for at least 1 minute or using a filter that has an absolute pore size of at least 1 micron or one that has been NSF rated for cyst removal.

 

Practice good hand washing to avoid person to person transmission.

These are just a few examples of diseases we should be aware of as we head outside this summer. Many of the same prevention strategies listed above can be applied in prevention of other outdoor diseases such as Rocky Mountain Spotted Fever and Colorado Tick Fever which are spread by ticks and Tularemia, which can be spread through deer fly bites. It is advisable to stay away from dead or sick animals, use insect repellent and check for ticks and remove them promptly after entering areas where ticks could be present. Information on these and other diseases may be obtained on the Utah Department of Health website- http//www.health.state.ut.us/els/epidemiology/comdisease.html.

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Don’t Miss the Olympic Fun Because of the Flu!

Preparation for the 2001/2002 influenza season in Utah will present unique challenges due to the influenza season coinciding with the 2002 Winter Olympics. Olympic activities will increase the possibility for importation of influenza viruses and increase the possibility of exposure through crowd settings. Therefore, it will be more important than ever to attain high levels of vaccination coverage with influenza and pneumococcal vaccines.

The Utah State Immunization Program encourages all providers to follow uniform guidelines to assure that available vaccine reaches the highest risk populations first. Preliminary information from vaccine manufacturers suggest that more influenza vaccine will be available this year than last year, but delays in the distribution of influenza vaccine will occur. The Advisory Committee on Immunization Practices (ACIP) recommends that providers should actively target persons at highest risk of influenza-related complications and health-care workers for vaccination with the available vaccine in September and October. Providers should continue vaccinating patients, especially those at high risk and contacts of high risk patients, through December and later, as long as vaccine is available.

People at High Risk of Complications:

 

65 years old, or older

 

Residents of nursing homes and other chronic-care facilities that care for people of any age who have chronic medical conditions

 

Adults and children having chronic disorders of the pulmonary or cardiovascular systems, including asthma

 

Adults and children who have had medical treatment or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus)

 

Children and teenagers, 6 months to 18 years old, receiving long-term aspirin therapy (could develop Reyes syndrome after influenza infection)

 

Women in the second or third trimester of pregnancy during the influenza season

 

People between 50 and 64 years old (due to increased prevalence of high risk conditions)

People Who Can Transmit Influenza to Those at High Risk:

 

Physicians, nurses, and other personnel in both hospitals and outpatient-care settings, including emergency response workers

 

Employees of nursing homes and chronic-care facilities who have contact with patients or residents

 

Employees of assisted living and other residences for people in high-risk groups

 

People who provide home care to people in high-risk groups

 

Household members, including children, living with people in high-risk groups

In the United States, seasonal influenza activity can begin to increase as early as November or December but has not reached peak levels in the majority of recent seasons in Utah until January through February. Adults develop peak antibody protection against influenza infection two weeks after vaccination. Therefore vaccine administered after November is likely to be beneficial in most influenza seasons. Persons who are not at high risk are encouraged to seek influenza vaccine in November and later when additional vaccine supply becomes available.

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Seminar Announcement

The Utah Association of Local Health Officers and the Utah Department of Health announce an upcoming workshop entitled, “Seminar in Public Health Communications and Response”. This three-day workshop will unite public health stakeholders to formulate communication networks and plans for emergency preparedness and response. Participants will have the opportunity to work with other response organizations within their communities to discuss planning efforts. Various local, state, and federal experts will also speak about current efforts in preparation and response. Participants will also have the opportunity to perform case studies in epidemiology and surveillance.

Dates: August 28th, 29th, and 30th, 2001
Place: Inn at Prospector Square, Park City, Utah

Registration Information: On-line registration and workshop information is available at http://www.health.state.ut.us/hanconf/. For further information, please contact Susan Lester or Lee Anne Wessol at 801-370-8737.

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Exceptional Efforts In Public Health

      We would like to recognize Ruth Christensen, infection control nurse at Ashley Valley Medical Center for her “Exceptional Efforts” in the investigation of an outbreak of Coccidiodomycosis in Tri-County Health District. Ruth put in countless hours assisting the investigation team, including spending the 4th of July Holiday at the Hospital working on the investigation. We would also like to thank the Lab tech, Dave Mardo, at Ashley Valley Medical Center who originally notified the Bureau of Epidemiology of the outbreak. Details of the outbreak investigation will be included in a future edition of the Epidemiology Newsletter.

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Important Information

When Reporting a Communicable Disease:

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

The July 2001 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:

health.utah.gov/epi/

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Utah Department of Health, Bureau of Epidemiology Monthly Morbidity Summary
July 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, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.

Send comments to:  The Bureau 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., Division of Epidemiology and Laboratory Services
 Gerrie Dowdle, MSPH, Managing Editor
Connie Dean, Production Assistant

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