Internet, Public Health, and You
Access to the Internet places the whole world (or at least that part of the world
with computer access) at your fingertips. You can read the news, do your personal banking,
order products and services from a number of businesses, and have fun with new games and
other diversions. In the midst of all this excitement, you may not realize that useful
public health information is also available - right now and mostly for free - on the
To get you started, here are the addresses of some useful sites:
The Utah Department of Healths global
Internet site is full of links to important services and organizations
in Utah (health.utah.gov). The Salt Lake City/County
Health Department also has a web page with lots of useful information
and links (www.slvhealth.org/).
The MMWR is available for free the first thing Friday morning from the
CDC (no more waiting for your copy to arrive in the mail!) at (www.cdc.gov/epo/mmwr/mmrw.html/).
In addition, the CDCs web site contains information from all its Divisions at (www.cdc.gov/).
MedLine searches can be done from your own computer (from several sites
including the National Library of Medicine at www.nlm.nih.gov/). You can even order
full copies of journal articles (for a fee).
The American Academy of Family Physicians (www.aafp.org/) and
the American Academy of Pediatrics (www.aap.org/) have useful information about
both public health and general medical topics.
For up-to-date immunization information, the CDCs National
Immunization Program has an excellent web page (www.cdc.gov/nip/home.htm). More
information and great handouts for patients with questions about immunizations or
vaccine-preventable diseases are available at the Immunization Action Coalition/Hepatitis
B Coalitions web page (www.immunize.org).
The Food and Drug Administration offers food and drug safety
information from their web page (www.fda.gov/).
How can you find more useful information?
The options listed above are only a small sample of what is available.
With a little time and effort on your part, you will undoubtedly find other locations of
interest to you. Try search words such as Health, Medicine, or the name of a disease that
may be of interest to you. When the search engine you are using brings up a list of
choices, review them and go to those sites that you find interesting. Remember that
different search engines will often find different sites even if you use the same search
words. With trial and error on your part, you will find search engines you prefer to
others. Set bookmarks on those sites you have found to be useful so you
dont have to search for them again.
Is everything on the Internet to be believed?
No! Your journey on the Internet must be taken carefully. You
cant believe everything on the Internet any more than you can believe everything
that you read in the newspaper or see on television. The unique danger with the Internet
is that, while putting something into cyberspace doesnt necessarily make it true, it
may make it seem more believable! There are some simple steps you can take to protect
yourself. A good rule of thumb is to stay with sites affiliated with organizations you
recognize and respect. If you are not familiar with the organization that is responsible
for the site, look for several key bits of information. These include who authored the
site, when the information on the site was last updated, and whether the sites
sponsors are also trying to sell you something. A site that is attempting to sell a
product (for example, vitamins or books offering medical knowledge "that cannot be
obtained anywhere else") may be trustworthy, but the viewer needs to be aware of the
possible conflict of interest between providing unbiased medical information and, at the
same time, trying to sell a product. The common sense rule that "If something sounds
too good to be true, it probably is" definitely applies here.
So, do travel, but travel safely on the Internet. The world is yours
for the searching (or is that surfing?).
Fever, Utah, January 1998
In the February 13, 1998 Morbidity and
Mortality Weekly Report (Volume 47, Number 5), there is an article describing one
confirmed and one possible case of rat-bite fever. The report describes the illnesses of
two adolescent males who lived in New Mexico and became ill in late July 1996. Both boys
developed a relapsing febrile illness with other symptoms that included myalgia, chills,
and backache. The first boy was treated in the hospital with intravenous antibiotics
followed by a seven-day course of oral antibiotics and recovered completely. Blood
cultures were obtained from this boy prior to the administration of antibiotics. A gram
negative rod was isolated from an aerobic blood culture on the seventh day of incubation.
This organism was confirmed as Streptobacillus moniliformis by the New Mexico
Department of Healths Scientific Laboratory Division. The second boy was treated
empirically as an outpatient with oral antibiotics but discontinued the antibiotics after
three days. His illness relapsed seven days later. He then received a second course of
oral antibiotics and recovered completely. Blood cultures that were taken from this boy
prior to his first course of antibiotics, were discarded after five days because they were
negative. Active surveillance did not identify additional cases of a similar illness in
the area. Case investigation revealed that both boys had been licked by the same domestic
dog and both had consumed water from an open irrigation ditch. No other sources of
possible exposure to either rodents or rodent feces were identified (1).
A case of rat-bite fever resulting in death was recently reported to
the Utah Department of Health, Bureau of Epidemiology. The Bureau received a call from the
Office of the Medical Examiner in January 1998 regarding a child who had died shortly
after being taken to a Salt Lake City hospitals emergency room. Blood cultures that
had been taken from the child shortly before death were positive for S. moniliformis.
No other plausible cause of death was identified. The only history known at the time of
death was that the child had traveled to SLC on a bus, and had arrived in SLC gravely ill.
Case investigation revealed that, immediately prior to traveling to SLC, the child had
been staying with extended family members who owned two pet rats. There was a history of
the rats escaping "for a couple of days," and when the rats were recaptured they
had reportedly bitten three people, including this child. The Bureau then notified the
health department of the state the child had been living in of this event so they could
alert the family of the childs diagnosis. The health department reported back to the
Bureau that the childs family was traveling across country with the rats to a
second state where the childs funeral was to be held. The health department of the
second state was then notified. They were able to locate the family, and the rats were
delivered to health officials for testing. Other family members who had been bitten by the
rats were offered prophylactic antibiotics. The CDC was contacted and asked to further
characterize the bacterial isolate.
Rat-bite fever (RBF) is a rare disease that is caused either by S.
moniliformis or by Spirillum minus (the latter is extremely uncommon in the
United States). RBF is transmitted to humans typically through the bite of an
infected animal (e.g., a rat, squirrel, mouse, cat or weasel), although transmission can
occur by ingestion of food or milk products that have been contaminated with rodent
droppings, or by direct contact with an infected animal. The incubation period for S.
moniliformis is usually 3-10 days but may be as long as three weeks; for S. minus
it is 7-21 days (2). Disease onset is characterized by an acute onset of chills, relapsing
fever, headache and muscle pain. A rash that is most marked on the extremities develops
1-3 days after the onset. The most common history is that of a rat bite within the past 10
days that healed unremarkably. The case-fatality rate is 7-10% (3). Human-to-human
transmission has only been documented where an infected person gave blood for a
transfusion. The attack rate of S. moniliformis after a rat bite is 10%, and some
experts recommend that penicillin be given prophylactically to any person reporting a rat
Several important messages can be gleaned from this unfortunate event.
First, while RBF is not listed as a reportable disease in the Communicable Disease Rule,
please notify your health department of the occurrence of any unusual illness. Such
notification in this instance allowed the health departments of three states to find this
childs family and alert them of the possible health risk posed by the rat bites they
had received. Second, all three of these cases highlight the importance of obtaining blood
cultures prior to administering antibiotics. Had this step not been taken, culture
results would have been impossible to interpret. (Also, if you suspect RBF, please notify
the laboratory because S. moniliformis has unique growth requirements.) Finally,
these cases highlight the importance of obtaining thorough histories from patients,
particularly when no obvious cause of illness can be ascertained.
1. CDC. Morbidity and Mortality Weekly Report 1998; 47 (5):
2. American Academy of Pediatrics. Rat-Bite Fever. In: Peter G, ed. 1997 Red Book:
Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL:
American Academy of Pediatrics; 1997: 442-443.
3. American Public Health Association. Rat-Bite Fever. In: Benenson AS, ed. Control of
Communicable Diseases Manual. 16th ed. Washington, DC: American Public Health
Association; 1995: 391-392.
Invitation to Join Our New Listserver
Are you a health care provider or public
health worker who is interested in issues surrounding infectious diseases? Do you have
e-mail access? If you can answer yes to both questions, then youre
invited to join the Utah Department of Health, Division of Epidemiology and Laboratory
This listserver has been created to serve health care providers and
public health workers, and to give them a timely forum for the discussion of issues such
-antibiotic resistant bacteria
-problem cases and/or unique or unusual pathogens
-laboratory tests and results
-unusual clusters of cases or outbreaks
What is a listserver? A listserver is an
automated e-mail message center. People subscribe to the listserver via e-mail and can
then post messages to everyone who is subscribed.
How do I join? Send
an e-mail to firstname.lastname@example.org and type "subscribe microbiology" in
the subject line. You will receive a confirmation of your subscription. (To unsubscribe,
send a message to the same address with the message "unsubscribe microbiology"
in the subject line.)
What are the rules? The rules are quite simple!
1) Messages posted to the list must not violate patient confidentiality. In other words,
dont 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
dont like something another health care provider has done (or has not done, as the
case may be), contact them directly. 3) Finally, the listserver 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 ever been a member of a listserver, you know that these can
be fun, informative, and a great opportunity to talk with people you
dont see every day. We hope you will join us!
Dr. Susan Mottice, Director, Bureau of
Microbiology (801-584-8400) and Dr. Jenifer Lloyd, Epidemiologist, Communicable Disease
Control Program, Bureau of Epidemiology (801-538-6191) are administering the list. Please
contact either of them directly with questions or comments about the list.
Report of Diseases of Low Frequency Year-to-Date January
1 - March 31, 1998
(including a comparison for same time period 1994 -1997)
Utah Department of Health, Bureau of
Monthly Morbidity Summary - March
1998 - Provisional Data
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