Transcript
ONEIDA COUNTY HEALTH DEPARTMENT
COMMUNICABLE DISEASE SPECIAL POINTS OF INTEREST:
A P R I L
It's time for Lyme
New HIV testing law removes barriers
Influenza activity sporadic in New York State
S U R V E I L L A N C E
lines for HBV Protection in HCW in postexposure events
INSIDE THIS ISSUE: Lyme
1
HBV Guidelines
2
New Vaccine Information
2
New HIV Law
2
Influenza in NYS
3
OCHD Surveillance
3
Clinic Services
4
Bicycle Safety
4
2 0 1 4
LYME DISEASE The OCHD Communicable Disease Division is reporting increased calls from the public with questions regarding ticks and Lyme Disease.
Symptoms/Diagnosis‐
New CDC Guide-
M A Y ,
of an microbial prophylaxis or serologic tes ng is not recommended. The provider may prescribe a single dose of doxycycline to adult
h p://www.cdc.gov/lyme/ healthcare/clinicians.html
Lyme disease can be difficult to diagnose for a number of reasons. Many of the com‐ mon symptoms associated with the disease, such as headaches, dizziness, and joint/body pain, also occur with other diseases. The most dis nct symptom of Lyme disease—the circular red rash known as erythema migrans (EM) does not ap‐ pear in at least one quarter of people who are actually infected with Lyme bacteria. Also, current diagnos c tests do not always detect early Lyme disease , because a pt. with a working immune system may not have an ‐ bodies for B. burgdorferi for 4‐6 weeks a er a ck bite.
cks is greater or equal to 20%. (NYSDOH reports Oneida Co. was sampled in 2013 and found the local rate of infec on in cks to be 40%.) 4) doxycycline treatment is not contraindicated
BE TICK FREE http://www.health.ny.gov/diseases/ communicable/lyme/
pa ents (200 mg dose) and to children that are 8 years old or older if all the following circumstances exist: 1) the a ached ck can be reliably iden fied as an adult or nymphal Ixodes scapularis ck that is es mated to have been a ached for at least 36 hours
Treatment
2) prophylaxis can be started within 72 hours of the me that the ck was removed
According to the Infec ous Disease Society of America, a er a ck bite, rou ne use
3) ecologic informa on indicates that the local rate of infec on of these
If a ck is found a ached, the risk of Lyme disease is greatly reduced if the ck is removed within the first 36 hours. Monitor the site for 30 days for appearance of rash and/or symptoms. An bio cs are not rou nely recommended, but may be beneficial for some individuals if taken within 3 days of the bite. For toolkit, FAQ, ck removal, etc. go to: h p://www.cdc.gov/lyme/ (See a ached DOH Health Alert regarding Tes ng and repor ng of Tick‐borne illness)
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Hepatitis B vaccine news On December 20, MMWR Recommendations and Reports published CDC Guidance for Evaluating Health Care Personnel for Hepatitis B Virus Protection and for Administering Post-exposure Management. This report contains CDC guidance that augments the 2011 ACIP recommendations for evaluating hepatitis B (HepB) protection among healthcare personnel and administering post-exposure prophylaxis. Explicit guidance is provided
Vaccine Information Sheets have been updated. Check to see if you have the most current version.
for persons working, training, or volunteering in healthcare settings who have documented HepB vaccination years before hire or matriculation (e.g., when HepB vaccination was received as part of routine infant [recommended since 1991] or catch-up adolescent [recommended since 1995] vaccination). Access the guidance document at : www.cdc. gov/ mmwr/pdf/rr/rr6210.pdf.
New and updated VISs Check the dates on your supply of Vaccine Information Statements (VISs). If any are outdated, get current versions and VISs in more than 30 languages at www.immunize.org/vis. DTaP/DT/DTP..... 5/17/07 Hepatitis A........... 10/25/11 Hepatitis B ........... 2/2/12
Hib ............................2/4/14
PCV13................2/27/13
HPV (Cervarix)...... 5/3/11
PPSV .................10/6/09
HPV (Gardasil).........5/17/13
Polio ................. 11/8/11
Influenza (LAIV).......7/26/13
Rabies .............. 10/6/09
Influenza (TIV)......... 7/26/13
Rotavirus...........8/26/13
Japan. enceph……...1/24/14
Shingles............. 10/6/09
Meningococcal…….10/14/11
Td ...................... 2/4/14
MMR............................4/20/12
Tdap ..................5/9/13
MMRV.........................5/21/10
Typhoid.............5/29/12
NEW HIV TESTING LAW On April 1, 2014 PHL Section 2781 related to HIV testing in NYS and Section 2135 related to confidentiality of HIV reports, were amended. These changes were enacted to further increase HIV testing and promote linkage and retention in care for HIV positive persons.
There are over 10,000 people living with HIV in NYS who are unaware of their HIV status. A key provision of the legislation is:
Elimination of the requirement for written consent prior to ordering an HIV-related test in any
circumstance outside of correctional facilities.
For the remainder of information, see attached Dear Colleague letter from the Commissioner of Health.
APRIL
SURVEILLANCE
STATEWIDE INFLUENZA SURVEILLANCE REPORT
FOR THE WEEK ENDING May 24, 2014:
Lab confirmed cases in 37 coun es plus NYC
50% decrease over the previous week.
Reports of ILI visits below regional baseline
51% decrease of hospital admis‐ sions with influenza
No pediatric deaths (flu), there have been 6 pediatric deaths related to flu this season.
For informa on on mask legisla on: http://www.health.ny.gov/diseases/communicable/influenza/seasonal/providers/ prevention_of_influenza_transmission/
ONEIDA COUNTY COMMUNICABLE DISEASE SURVEILLANCE DISEASE
APRIL 2014
YTD 2014 YTD 2013
DISEASE
APRIL, 2014 APRIL 2014
YTD 2014
YTD 2013
Tuberculosis
0
0
4
Influenza A
61
746
91
Giardia
5
21
13
Influenza B
412
505
93
Rabies Exposure
4
15
9
Lyme
2
2
2
Salmonella
1
7
7
Pertussis
1
5
6
Chlamydia
56
244
248
Cryptosporidiosis
0
2
3
1
4
3
Campylobacter
Influenza numbers reflect all confirmed cases from October 1, 2013 YTD– Year to date
CLINIC SERVICES
ONEIDA COUNTY HEALTH DEPARTMENT
STD
MOMS/Maternal Child Health
Clinical Services 406 Elizabeth Street Utica, New York 13501 Phone: 315-798-5747 Fax: 315-798-1057 E-mail:
[email protected] or
[email protected] IMMUNIZATIONS Hours: 8:30am-4:00pm, Monday through Friday
All previous newsle ers are posted at h p://www.ocgov.net Go to Health Department then click on For Providers
OCHD PUTS SAFETY FIRST All bicyclists under the age of 14 years in New York State are required to wear a helmet. Oneida County has been awarded grant funding from the Governor’s Traffic Safety Committee to offer bicycle helmets at no cost to residents of Oneida County.
For more information on car seat and helmet safety laws go to: www.safeny.ny.gov
In addition to the free helmets, information on bicycle safety is also presented in an effort to promote safety. Call Rose Ann Clemente RN @ 315-798-5747 for upcoming events where OCHD Bicycle Helmet and Safety Program will be distributing helmets.
HAVE A SAFE SUMMER!
Caption describing picture or graphic.
May 28, 2014
TO:
Healthcare Providers, Hospitals, Local Health Departments (LHDs)
FROM: NYSDOH Bureau of Communicable Disease Control HEALTH ADVISORY: TESTING AND REPORTING OF ARBOVIRAL AND TICK-BORNE ILLNESSES For healthcare facilities, please distribute immediately to the Infection Control Department, Emergency Department, Infectious Disease Department, Director of Nursing, Medical Director, Laboratory Service, and all patient care areas. The New York State Department of Health (NYSDOH) is advising physicians on the procedures to test and report suspected cases of mosquito-borne illnesses, including West Nile virus (WNV) and eastern equine encephalitis virus (EEEv), and tick-borne illnesses including Lyme disease, babesiosis, anaplasmosis, ehrlichiosis, and Rocky Mountain Spotted Fever. SUMMARY Mosquito-borne (arboviral) illnesses: o During the mosquito season, health care providers should consider mosquito-borne infections in the differential diagnosis of any adult or pediatric patient with clinical evidence of viral encephalitis or viral meningitis. o All cases of suspected viral encephalitis should be reported immediately to the local health department. o Wadsworth Center, the NYSDOH public health laboratory, provides testing for a number of domestic, exotic, common and rare viruses. The tests performed will depend on the clinical characteristics and status of the patient. Health care providers should contact the LHD of the patient’s county of residence prior to submission of specimens. Tick-borne illnesses: o Tick-borne disease symptoms vary by type of infection and can include fever, fatigue, headache, and rash. o Clinicians are encouraged to make use of the attached ’Tickborne Diseases of the U.S.: A Reference Manual for Providers, published by the Centers for Disease Control and Prevention (CDC) in 2013. The manual contains information on tick identification, tick-borne disease symptoms, laboratory testing, and recommended treatment. o While Lyme disease continues to be the most prevalent tick-borne disease in New York State (NYS), other tick-borne diseases such as babesiosis and anaplasmosis, are spreading geographically within the state. o An article in the December 12, 2013 Morbidity and Mortality Weekly Report (MMWR) describes three cases, which involve sudden cardiac deaths from Lyme carditis in individuals who did not know they had Lyme disease. NYSDOH has been working with its counterparts in Massachusetts and Connecticut and the Centers for Disease Control and Prevention (CDC) on myocarditis associated with Lyme disease. o Testing for tick-borne diseases should be conducted by commercial labs.
BACKGROUND Mosquito-borne diseases, such as EEEv and WNV, continue to occur annually in NYS. EEEv is regarded as one of the most serious mosquito-borne diseases in the United States because of its high mortality rate. NYS has had fatal human cases of EEEv in prior years. WNV continues to be detected across NYS, occasionally resulting in human fatalities. In partnership with LHDs, NYSDOH continues to conduct surveillance activities for EEEv and WNV; a critical component of these efforts is the rapid detection and timely reporting of cases of viral encephalitis and viral meningitis by medical providers. Lyme disease continues to be the most prevalent tick-borne disease in NYS with over 120,000 cases having been reported since 1986. The tick that carries the bacteria that causes Lyme disease (black-legged/deer tick) can also carry pathogens that cause babesiosis and anaplasmosis. Disease surveillance trends for both of these diseases show an expanding geographic range beyond the Hudson River valley to areas further north and west than they have been seen in previous years. Lyme carditis occurs when Borrelia burgdorferi, infects the tissues of the heart. The most common cardiac manifestation of Lyme disease is atrioventricular block (AV). Seconddegree or third-degree atrioventricular block occurs in approximately 0.8% of all reported Lyme disease cases. Lyme carditis usually presents in conjunction with other symptoms of Lyme disease such as erythema migrans (EM), arthritis or neurologic disease, although it can present independently. The seasonal pattern seen in Lyme disease is also true of ehrlichiosis which is transmitted by the Lone Star tick. Rocky Mountain Spotted Fever (RMSF), transmitted by the American dog tick, is rarer than other tick-borne diseases however cases continue to be reported across NYS annually. Powassan encephalitis, a tick-borne viral illness that can cause encephalitis or meningitis, is found in low, but increasing, numbers in the State. REPORTING CASES OF ARBOVIRAL AND TICK-BORNE ILLNESS Under NYS Public Health Law 2012 and 10NYCRR 2.10, health care providers should immediately report by telephone any patient with suspected viral encephalitis. The report should be made to the LHD of the patient’s county of residence. Viral meningitis is also reportable under public health law but immediate notification is not required. Providers should report cases of tick-borne disease to the LHD as soon as possible after diagnosis. This includes patients who are diagnosed and treated based solely or in part on clinical presentation and history. Reporting forms can be found at https://www.health.ny.gov/forms/doh-389.pdf and LHD contact information is available at http://goo.gl/FB7HWb. TESTING AND COLLECTION OF SPECIMENS Wadsworth Center offers testing for mosquito-borne viruses, including WNV and EEEv. Cerebrospinal fluid (CSF) testing by polymerase chain reaction (PCR) may be less sensitive than testing serum by serology. Therefore, ideally, both CSF and acute/convalescent serum specimens should be submitted for testing. Convalescent specimens should be drawn at least 3 weeks after acute specimens. Instructions on the collection and submission of clinical specimens and a detailed algorithm about which tests will be conducted on submitted specimens, and the Viral Encephalitis/Meningitis Case Report and History Forms can be found on the Wadsworth Center website at: http://www.wadsworth.org/divisions/infdis/enceph/form.htm. Wadsworth Center also offers testing for tick-borne diseases. Depending upon the disease, testing can involve whole blood smear examination, PCR, or serologic testing. Confirmation of cases of tick-borne disease via collection of both acute and convalescent specimens is necessary. Further information on accessing noncommercial, public health testing for tick-borne disease at the Wadsworth Center can be obtained by calling your LHD or the NYSDOH.
Providers are reminded to utilize commercial laboratories for routine testing of patients with suspected Lyme disease. A two-tier testing protocol is recommended for Lyme disease; an EIA or IFA should be performed first, followed by a Western blot if the EIA or IFA is positive or equivocal. It is important to note that serologic tests for Lyme disease are insensitive during the first few weeks of infection. During this stage, patients with an erythema migrans rash may be diagnosed clinically. ADDITIONAL INFORMATION Additional information on mosquito and tick-borne diseases can be found at: http://www.health.ny.gov/diseases/west_nile_virus/ http://www.health.ny.gov/diseases/communicable/lyme/index.htm If you have any questions regarding this information, please contact your LHD or the NYSDOH Bureau of Communicable Disease Control at (518) 473-4439 or via email at:
[email protected]
