Bureau of Epidemiology
Bureau of Epidemiology August 1999 Utah Department of Health
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  Influenza Surveillance for the 1998-1999 Season
  Campylobacter
  HIV/AIDS Prevention Through the Community Planning Process in Utah
  Monthly Morbidity Summary

Influenza Surveillance for the 1998-1999 Season

To identify the virus type(s) associated with influenza morbidity and define the beginning and end of the influenza season, the Bureau of Epidemiology conducts surveillance each influenza season. “Influenza” is the category used in Utah’s morbidity reporting system to record cases of laboratory confirmed influenza. “Influenza-like illness” is the category used to report similar upper respiratory illnesses based on a physician’s clinical impression. Viral respiratory diseases dominate this category, with illness due to influenza, parainfluenza, respiratory syncytial virus and adenoviruses comprising the majority of morbidity. Symptoms associated with influenza and “influenza-like illnesses” include fever of 101 degrees or greater, malaise, chills, sore throat, myalgia, cough and coryza. Severity of illness varies, depending on a patient’s age and previous immunity. Surveillance for the 1998-99 influenza season began the week of October 18, 1998, and continued weekly through April 3, 1999 . Surveillance participants included physicians’ offices, clinics, and university health centers. Various schools throughout the state also reported the number of students absent per week during the surveillance period. We wish to thank all who participated in the influenza surveillance program.

There were 84 culture confirmed cases for the 1998-99 surveillance season which is an increase over last season’s 50 culture confirmed cases. Of the 84 cultures, 67 were type A and 17 were type B. One of the cultures was sub-typed as type A H3N2. Of the 50 culture confirmed cases seen during the 1997-98 season, all 50 were type A. Weekly rates of absenteeism among participating schools were calculated using student enrollment numbers and number of school days per week. Expected increases in absenteeism rates were seen during the Thanksgiving and Christmas holidays and there were no reports during the weeks of Christmas and Spring Break. Otherwise, absenteeism remained fairly consistent throughout the rest of the surveillance period. Unlike years past, absenteeism did not have the same increases that were seen in “influenza-like illness” reported by physicians.

The most effective measure for reducing the impact of influenza is vaccination of persons at high risk each year before the influenza season. Influenza vaccine is strongly recommended for any person > six months of age who, because of age or an underlying medical condition is at increased risk for complications of influenza. Health-care workers and others in close contact with persons in high-risk groups should also be vaccinated. In addition, influenza vaccine may be administered to any person who wishes to reduce the chance of becoming infected with influenza. However, those with a known anaphylactic hypersensitivity to eggs or to other components of the vaccine should not receive the influenza vaccine.

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Each year’s influenza vaccine contains virus strains representing the influenza viruses that are likely to circulate in the upcoming winter. U.S. manufacturers will use the antigenically equivalent strains of influenza vaccines because of their growth properties. Although the current influenza vaccine can contain one or more of the antigens administered in the previous year, annual vaccination with the current vaccine is necessary because immunity declines in the year following vaccination and because the current vaccine differs slightly from that of the previous year. As a result, supplies of 1998-99 vaccine should not be administered to provide protection for the 1999-00 influenza.

The trivalent influenza vaccine prepared for the upcoming season will include the following strains: A/Beijing/262/95-like (H1N1), A/Sydney/5/97-like (H3N2), and B/Beijing/184/93-like hemagglutinin antigens. For the B/Beijing/184/93-like antigen, U.S. manufacturers will use the antigenically equivalent B/Yamanashi/166/98 virus because of its growth properties and because it is representative of currently circulating B viruses. Beginning in October, when vaccine for the upcoming influenza season becomes available, health care providers who see high-risk patients, as part of routine care or in the hospital, should offer influenza vaccination. Opportunities such as these to provide vaccination should not be missed. Organized vaccination campaigns should optimally begin around mid-October to mid-November. Vaccine should not be administered too far in advance of the influenza season in such facilities as long-term care centers, because antibody levels may begin to decline within a few months of vaccination

For health care providers interested in submitting specimens for influenza testing, a standard throat swab or throat washing is acceptable. Specimens should be collected within three days of clinical onset, kept cold during transport, and received by a laboratory within 24 hours.

If you are not currently part of our surveillance program and would like to participate, please call the Communicable Disease Control Program, Bureau of Epidemiology, at 538-6191.

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Campylobacter

The Utah Department of Health state laboratory has begun using a different medium to test for a broader spectrum of Campylobacter agents. The Bureau of Epidemiology has, therefore, expected to see a moderate increase in Campylobacter disease reported. A variety of serotypes occur and their identification may be beneficial for epidemiologic purposes. Campylobacter jejuni and, less commonly, C. coli cause gastroenteritis, while other organisms, such as C. fetus and C. laridis, have also been associated with diarrhea in humans.

Campylobacter is a bacterial diarrheal illness that may cause malaise, fever, nausea, vomiting, and abdominal pain. Abdominal pain can mimic that produced by appendicitis, while fever may cause convulsions to develop in some young children. Most cases recover from the acute illness within two to five days, whereas a rare number of cases experience symptoms for more than 10 days. Transmission occurs most commonly by ingestion of the infectious agents in undercooked poultry and pork, contaminated water and food, and raw milk. Transmission of the organism may also occur by contact with infected infants, pets, or farm animals; however, person-to-person transmission of C. jejuni is uncommon.

The disease generally incubates for two to five days, with a range of 1-10 days, depending on dose ingested. The illness may remain communicable throughout the entire course of infection which may last from several days to several weeks. However, those not treated with antibiotics may shed the organism for up to seven weeks. When given early in the course of infection, erythromycin shortens the duration of illness and prevents relapse. Treatment with the antibiotic usually eradicates the organism from stool within two to three days. Ciprofloxacin is an alternative agent that is effective, but is not approved by the Food and Drug Administration for persons younger than 18 years.

Campylobacter contamination can be prevented by thoroughly cooking all animal-derived foodstuffs, especially those from poultry. Cross-contamination can be avoided by handwashing after handling animals or raw poultry and thoroughly washing cutting boards and utensils with soap after contact with the food. Pasteurization of milk and chlorination of water supplies are also important in hampering infection. Infected food handlers and hospital employees who are asymptomatic pose no known hazard for disease transmission and need not be excluded from work if proper personal hygiene measures are maintained. Outbreaks are uncommon in child care centers, however, infants and children in diapers with symptomatic C. jejuni infection should be excluded from child care or cared for in a separate protected area until diarrhea has subsided.

Case Definition for Public Health Surveillance

Clinical description: A bacterial infection that may result in diarrheal illness of variable severity.
Laboratory criteria for diagnosis: Isolation of Campylobacter from any clinical specimen.
Case classification: Probable: a clinically compatible case that is epidemiologically linked to a confirmed case. Confirmed: a case that is laboratory confirmed.

MMWR/May 2, 1997/Vol. 46/RR-10

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HIV/AIDS Prevention Through the Community Planning Committee Process In Utah

HIV Prevention Community Planning Committee is looking for volunteers. Dedicated volunteers are needed to develop an HIV prevention plan for Utah. We need representatives from all backgrounds who care about preventing HIV. The committee meets twice each month to discuss issues and make recommendations to the health department. Help with child care and out-of-town travel costs is available. If you want to nominate a friend or volunteer yourself, CALL 538-6096 or 800-537-1046, or visit http://161.119.100.19/els/hivaids/eduprogram.html for a nomination form and criteria. Please respond as soon as possible before September 24.

BACKGROUND

In March 1993, a Federal legislation project known as the “Comprehensive HIV Prevention Act” was presented to the United States Congress. This project mandated the creation of HIV prevention programs through local planning councils.

By November, the Centers for Disease Control and Prevention (CDC) introduced the project nationwide. In 1994, the Bureau of HIV/AIDS, at the Utah Department of Health, initiated the process in Utah.

With the help of representatives throughout the state, a structure was developed for the future Community Planning Committee (CPC) including nomination requirements for new members.

It was determined that Utah would have one statewide planning committee. The majority of CPC members are from areas of the state most heavily impacted, but rural areas are also represented. The CPC is comprised of 26 members with representation from:

 

State & local health agencies.

 

Populations impacted by the epidemic present and future.

 

Community based service and religious organizations.

 

Experts in behavioral science, epidemiology, evaluation and research.

WHAT IS COMMUNITY PLANNING?

HIV prevention community planning is a dynamic collaborative process through which health departments work in partnership with community planning group(s) to design local prevention plans that best represent the needs of the various communities at risk for, or infected with, HIV.

The major goals of HIV prevention community planning are to improve the effectiveness of HIV prevention programs through:

 

Participation by individuals infected with and affected by HIV

 

Application of sound scientific methods that will halt the spread of HIV disease.

THE WORK OF THE COMMITTEE IS BASED ON THE PRINCIPLES OF:

Parity: that all members are provided opportunities for orientation and skills building, have an equal voice in voting and other decision-making activities.

Inclusion: the assurance that the views, perspectives, and needs of all affected communities are included and involved in a meaningful manner in the community planning process.

Representation: the assurance that those who are representing a specific community truly reflect that community’s values, norms and behaviors.

THE NINE STEPS OF COMMUNITY PLANNING

  Develop an Epidemiologic Profile.
  Conduct a Needs Assessment.
  Assemble a Resource Inventory.
  Conduct a Gap Analysis.
  Identify Potential Strategies and Interventions.
  Prioritize Target Populations and Interventions.
  Develop a Plan.
  Evaluate the Planning Process.
Update the Plan.

WHAT DO CPCs DO?

The simple answer is: they plan! The main product that CPC members create is a comprehensive HIV prevention plan.

ROLES/RESPONSIBILITIES

Community Members:

Make a commitment to the process and its results.
Participate in all decision-making and problem-solving.
Serve on committees or in work groups and complete identified tasks.
Gather data and information, as required.
Make a commitment to serve for two years.

Health Department Staff:

Provide leadership, guidance and support.
Furnish necessary data and information.
Develop a work plan with completion dates.
Manage the logistics of the CPC meeting and dissemination of materials to members.

HIV PREVENTION RESOURCES

Bureau of HIV/AIDS, TB Control/Refugee Health web Page: http:health.utah.gov/hivaids
CDC web page: www.cdc.gov/hiv
CDC National Prevention Information Network: 1-800-458-5231, web page: www.cdcnpin.org
American Psychological Association (APA) Office on AIDS: www.apa.org/pi/aids.html
APA Resolutions Related to HIV/AIDS Issues: www.apa.org/pi/reshiv.html
Center For AIDS Prevention Studies, University of California, San Francisco: www.caps.ucsf.edu/capsweb
National Minority AIDS Council: www.nmac.org
National Native American AIDS Council: www.nnaapc.org
Advocates for Youth Home Page: www.advocatesforyouth.org
National Association of People with AIDS (NAPWA): www.napwa.org
Policy Action Network for Women Living with HIV/AIDS: www.apa.org/ppo/brochure.html

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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary - August 1999 - 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
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Cristie Chesler, BA, Managing Editor

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