Epidemiology Newsletter
Office of Epidemiology November 2001 Utah Department of Health
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Utah Launches “Alliance Working for Antibiotic Resistance Education” (AWARE)

Antibiotics continue to be widely prescribed for patients with colds, influenza, acute bronchitis, otitis media, and other infections that are unresponsive to antibiotics, despite evidence that antibiotic treatment does not improve outcomes for many of these conditions. This practice is costly, may cause adverse drug reactions, and leads to the development of antibiotic resistant bacterial strains.

The U.S. Agency for Healthcare Research and Quality reported that almost two-thirds of kids with acute otitis media recover from their pain and fever within a day of diagnosis without antibiotics. Nearly 80 percent of children with middle-ear infections recover in one to seven days, again without antibiotic treatment.

A Utah study illustrated similar results with acute bronchitis patients. An algorithm was developed for patients with a new, productive cough, designed to identify acute bronchitis and reduce antibiotic prescribing. The study showed that a guideline, coupled with minimal educational intervention, could greatly reduce the use of antibiotics by nearly 50 percent without worsening clinical outcomes or patient satisfaction.

Unfortunately, the common cold is virtually unavoidable. Until the age of five years, the average child will have approximately eight colds per year, lasting from a few days to two weeks. While adults are affected less often than children, many of them may have up to three or four colds per year.

Like the common cold, the incidence of influenza is high during the winter months and accounts for a very large number of the visits made to physician offices. Influenza can have a morbidity rate ranging from 10 to 40 percent, depending on the season.

Cold and influenza symptoms can also make a patient feel so miserable that he or she may think a prescription antibiotic is necessary to alleviate the problem. Sometimes, a patient will even request an antibiotic from his or her doctor hoping it will speed the recovery from a cold or flu. As medical studies have shown that this is ineffective, still the best way to prevent a cold or influenza infection from turning into a more serious illness is simply treat the symptoms while they run their natural course.

However, many feel that a patient still wants to leave the doctor’s office with something to alleviate pain and discomfort associated with the cold or flu, though prescription options are limited. Some pharmaceutical companies have begun initiatives to provide cold and flu patients with cold/sinus management kits to reduce the use of antibiotics and still alleviate discomfort. There are two types of kits, one made specifically for adults and another for pediatric patients. Along with free samples of cough and cold preparations, the kits contain coupons to be used at a pharmacy for additional savings off selected cough and cold over-the-counter drugs. Also included in the kits is an education brochure that explains the difference between bacterial and viral infections and the appropriate treatment for both. Intermountain Health Care (IHC) distributes these kits among their primary care physicians. This year, Whitehall-Robins is giving IHC 9,000 kits and Pfizer is giving an additional 7,000 kits to the company. The program has helped to reduce antibiotic use, while not affecting clinical outcome and patient satisfaction, and prompted the development of a new alliance with the Office of Epidemiology to combat antibiotic resistance.

Utah is one of only 10 states that do not have a coalition to fight antibiotic resistance. There have been independent groups within the state working on antibiotic resistance initiatives; however, these efforts have been limited and un-coordinated. The Utah Department of Health and IHC have led the development of the Utah Alliance Working for Antibiotic Resistance Education (Utah AWARE), a statewide program designed to reduce the incidence of antibiotic resistance.

The alliance met for the first time in August 2001 and has continued to meet periodically since that time. The result of these meetings is an alliance of insurers, health care providers, pharmaceutical manufacturers and the state working together to reduce the inappropriate use of antibiotics and inhibit the spread of antibiotic resistance.

Workgroups have been identified to focus on data surveillance, education/ prevention & control, funding, media, and providers. These workgroups will collaboratively look for methods to reduce the inappropriate use of antibiotics and inhibit the spread of antibiotic resistance. This will be accomplished through education efforts geared to healthcare providers and consumers. The alliance will help mobilize communities to take action to address antibiotic resistance and develop a mechanism to track antibiotic utilization.

The alliance will launch the AWARE program December 27, 2001 and will take advantage of a variety of methods to communicate its message. These include but are not limited to:

  • Provider guidelines

  • Educational materials for patients

  • Distribution of cold/sinus management kits

  • Letters to healthcare providers, child care providers, community groups

  • Radio advertisements

  • Posters and pamphlets in waiting rooms, community buildings

  • Internet web site (UtahAWARE.org)

  • Association newsletters (i.e., Utah Pharmacy Association Digest Publication, Utah Medical Association Bulletin)

Millions of antibiotic prescriptions have been given unnecessarily, causing many strains of bacteria to become resistant or immune to the drugs that were once effective against them. Steps can be taken to stem the rise of bacterial resistance through improved education and awareness to better understand the symptoms and treatments of colds and influenza. The Office of Epidemiology expresses gratitude to all project team members that have participated in this new alliance.

Project Team Members include the following:  Abbot Laboratories, Altius Health Care, Bayer Corporation, Bristol-Myers Squibb, Cigna Health Care of Utah, DMBA, GlaxoSmithKline, HealthInsight, Intermountain Health Care, Merck-Medco, Pfizer Consumer Healthcare, Regence BlueCross BlueShield of Utah,Roche Laboratories, Salt Lake Valley Health Department, University of Utah, Utah Department of Agriculture & Food, Utah Department of Health, United Health Care, Utah Academy of Family Practice, Utah Academy of Physician Assistants, Utah Medical Association, Utah Pharmacy Association, and Whitehall Robins.

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Exceptional Efforts in Public Health

    On October 12, the Utah Department of Health responded to the first of many perceived or possible anthrax exposures. In the weeks that followed, all twelve of the Local Health Departments throughout Utah responded to over 200 anthrax events. These events ranged from individuals who had visited a known contaminated site, to white powder found in a bag containing candy (yup, it was sugar). The responders to bioterrorist threats include physicians, microbiologists, epidemiologists, emergency medical providers, and law enforcement. All of us in public health at the state and local level would like to recognize our partners for the exceptional efforts they made in addressing these events.

     Of special note, we are very grateful to Dr. Evan Nelson, Local Health Officer, Weber/Morgan Health Department, for bringing to our attention that not one call was received regarding the 16 inches of white powder that fell over the Thanksgiving weekend.

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The List server Wants You!

For the past several years, the Division of Epidemiology and Laboratory Services has maintained an infectious disease list server. This has been used to provide timely information about disease outbreaks, unusual diseases, product and food recalls, and very timely (i.e., once a week or more) updates on influenza activity during influenza season. We have a number of health care providers and laboratorians on the list server (and we appreciate all of these people), but we want to have more! By the time our Olympics start (and continuing after that), we would like to have as many health care providers as possible and people from every one of Utah’s laboratories. You do need a computer and email access to receive the list server messages.

For those of you who are not sure about whether to sign up or not, here’s a list of Why’s and Why Not’s to help you.

Why Join the Infectious Disease List server?

You get timely information about infectious diseases in Utah by email for free.

You can read the email at your leisure.

The volume of email you will receive from the list server is very manageable – one to three messages per week as a rule. (During the Olympics we will be sending out a daily update and other notices as needed, but this is an exceptional situation.)

You can instantly (OK, almost instantly) send email messages about infectious diseases to health care providers and labs throughout the state of Utah.

If you are not interested in a particular message, you can delete it without even opening it and no one’s feelings will be hurt.

Why Not Join?

You don’t want to have timely information about infectious diseases in Utah.

You are afraid there will be too much email on your computer – if so, please see above under Why Join the Infectious Disease List server.

If you decide to join us (and we hope you do), what do you need to do?

Email a request to lyris@list.state.ut.us and type "subscribe microbiology" in the subject line. (To unsubscribe, send a message to the same address and type "unsubscribe microbiology" in the subject line.)

If you are on the list server and want to post a message to the list server, send your email to microbiology@list.state.ut.us and please include a relevant subject line.

One last thing... We do have a few common sense ground rules for our list server. We think you’ll find them very acceptable.

1) Messages posted to the list must not violate patient confidentiality. In other words, don’t write something that would allow others to identify an individual patient. 2) Messages should not contain disparaging remarks about persons, including other health care providers, who are not involved in an ongoing discussion. In other words, if you don’t like something another individual has done or said, contact them directly. 3) Finally, the list server is not a mechanism for reporting diseases to the state of Utah. Please use normal reporting channels to let us know of a reportable disease.

If you have questions and would like them answered by a human, call Jenifer Lloyd, Susan Mottice or Gerrie Dowdle at (801) 538-6191.

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What Would You Do to Avoid the Flu? Just Get Vaccinated!

Almost everyone will benefit from a flu shot. But some people have a greater need, and they should make a special effort to get this protection each year. High-risk individuals should receive the influenza vaccine as soon as the vaccine is available. However, if high-risk persons were unable to obtain the vaccine in October this year, it is not too late. It takes only 1 to 2 weeks after vaccination for antibody against influenza to develop and provide protection. Therefore, the vaccine is recommended throughout the flu season to anyone who is at high-risk and has not yet received it. These groups include:

  • persons aged 65 years or older;

  • residents of nursing homes and other chronic-care facilities;

  • adults and children who have certain high-risk conditions (for a detailed list go to http://www.cdc.gov/nip/flu/public.htm#Q&As); &

  • women who will be in the second or third trimester of pregnancy during the influenza season.

Contacts of high-risk individuals can also have an impact on those at high-risk. These people may not be in one of the high-risk categories, but should make a special effort to get a flu shot so they will remain healthy and prevent spreading influenza to high-risk individuals. The following people should also receive the flu vaccine:

  • health care workers;

  • adults and children who live with or care for others who are at high-risk of complications from the flu; and

  • volunteers for Olympic activities.

People 50-64 years old have been added to the list of those recommended to receive the flu vaccine. Based on age alone, they are not at high risk of flu-related complications--yet. However, approximately 10-13 million adults (24%-32%) in this age group have one or more high-risk medical conditions. Even if they are in excellent health, they should be sure to get a flu shot in order to avoid missing work because of the flu and to prevent additional medical visits and medication. The flu shot is among the preventative measures people over 50 need to take to stay healthy.

Travelers are another group that are recommended to receive the flu vaccine. Travelers who are at risk of complications from the flu, should get a flu shot if they plan to:

  • visit the tropics at any time of year;

  • travel with a large organized tourist group at any time of year;

  • visit any part of the Southern Hemisphere during April-September.

Influenza vaccine can be administered to any person who wishes to reduce the chance of becoming infected with influenza, including all children 6 months of age or older. No one wants to be sick and the easiest way to avoid influenza is simply to be vaccinated!

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Revisions to School Rule Official

A revised immunization rule for students is now official. The revisions include the addition of Varicella and Hepatitis A to kindergarten entry requirements. Although these requirements will not officially go into affect until July 1, 2002, they are written in the current school rule with that official effective date of July 1, 2002. When these requirements go into affect, a parent will be able to sign a child’s school immunization record verifying the child has had the “chickenpox” disease and does not need the Varicella vaccine. This parental verification will apply only to Varicella. Written proof of receiving all other immunizations is required.

The entire school rule was revised for clarity. The rule was shortened and each individual antigen requirement incorporated into a guidebook, which is a companion to the school rule. This guidebook explains the schedule and requirements for each antigen. It will help school nurses and other school officials, who must interpret immunization records to ensure a student’s compliance for school attendance. A copy of this guidebook is now available.

Utah continues to make progress in protecting children from many vaccine-preventable diseases. For the 2000-2001 school year, 93.2% of all kindergarten students were immunized for DTaP, Polio, Measles, Mumps, Rubella, and Hepatitis B. For students, kindergarten through twelfth grade, 97.8% had two doses of Measles. This progress has been made in part with the combined efforts of many dedicated physicians, other health care professionals, school nurses, and school officials who strive to ensure Utah’s children have happy and healthy lives.

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The STD Control Program Has Moved to
The Bureau of Communicable Disease

Address:

Bureau of Communicable Disease
STD Control Program
288 N. 1460 W.
P.O. Box 142105
Salt Lake City, Utah 84114-2105

Phone: (801) 538-6096
Fax: (801) 538-9913

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Important Information

When Reporting a Communicable Disease:

Call (801) 538-6191 or
Call toll free (888) EPI UTAH (374-8824)
Or you can Fax it to (801) 538-9923

AND AFTER HOURS
In a Public Health emergency call (801) 241-1172

The November 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, Office of Epidemiology
Monthly Morbidity Summary - November 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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