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
Use snap traps to trap and kill mice
Spray mice and traps with disinfectant.
Place rodent in a double plastic bag for
Clean up after mice
Air out area for 30 minutes.
Wear rubber gloves while cleaning.
Do not create dust by sweeping or
Spray rodent droppings and nests with
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
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
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 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
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 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
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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Dont Miss the Olympic Fun
Because of the Flu!
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
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
Children and teenagers, 6 months to 18
years old, receiving long-term aspirin therapy (could develop Reyes syndrome after
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
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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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,
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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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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When Reporting a
Call: (801) 538-6191
Fax: (801) 538-9923
The July 2001 Newsletter is the most current
For Information on Fact Sheets for Diseases or Annual
Report Information, as well as The
Epidemiology Newsletter, you can browse our website:
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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary
July 2001 - Provisional Data
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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