August is National Immunization Awareness Month

Details

Published on Monday, 24 July 2017 12:25

Send Your Children Back to School Protected from Serious Diseases

National Immunization Awareness Month is a reminder that we all need vaccines throughout our lives.

Back-to-school season is here. It's time for parents to gather school supplies and back packs. It's also the perfect time to make sure your children are up to date on their vaccines.

To celebrate the importance of immunizations for people of all ages - and make sure children are protected with all the vaccines they need - the Andrew County health Department is joining with partners nationwide in recognizing August as National Immunization Awareness Month.

Getting children all of the vaccines recommended by CDC's immunization schedule is one of the most important things a parent can do to ensure a healthy future for their child.

Vaccines protect against a number of serious and potentially life-threatening diseases.

When children are not vaccinated, they are at increased risk for diseases and can also spread diseases to others in their classrooms and community - including babies who are too young to be fully vaccinated, and people with weakened immune systems due to cancer or other health conditions.

Talk to your child's doctor to find out which vaccines are recommended for them before going back to school.

Parents can find out more about the recommended vaccines at www.cdc.gov/vaccines/.

This project is/was funded in part by the Missouri Department of Health and Senior Services Maternal and Child Health Services Contract #DH150006012 and is/was supported by the Health Resources Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #B04MC28109, Maternal and Child Health Services for $9,095,311, of which $0 is from non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Eclipse Safety

Details

Published on Monday, 24 July 2017 10:24

What is an Eclipse and Why Prepare?

A solar eclipse occurs when the moon blocks any part of the sun. On Monday, August 21, 2017, a solar eclipse will be visible (weather permitting) across all of North America. The whole continent will experience a partial eclipse lasting 2 to 3 hours. Halfway through the event, anyone within a roughly 70‐mile‐wide path from Oregon to South Carolina (https://go.nasa.gov/2pC0lhe) will experience a brief total eclipse, when the moon completely blocks the sun’s bright face for up to 2 minutes 40 seconds, turning day into night and making visible the otherwise hidden solar corona — the Sun’s outer atmosphere — one of nature’s most awesome sights. Bright stars and planets will become visible as well.

St. Joseph is located in the path of the total eclipse for one of the longest durations of obscuration. Our communities are anticipating record numbers of visitors for this phenomenal event. Preparations are underway that involve government, businesses and organizations large and small. St. Joseph schools have been dismissed for the day (check with your school district for their schedule) and Trails West! has extended its run from three days to four in order to encompass the day of the eclipse. Our communities are getting prepared for the eclipse; are you?

Things to consider, which will be addressed in future issues of this special Total Preparation Information Series:

• Traffic – St. Joseph roads will be more congested than normal traffic patterns
• Crowd Safety – Personal comfort, safety, and injury prevention, could all be compromised if you get caught in a large crowd of people and are unable to move freely
• Viewing – Looking directly at the sun is harmful to vision; eclipse observers should use glasses with special protective lenses
• Appointments – Confirm appointments and allow additional  time to navigate to your destination
• Employment – Traditional duties at work may be affected by the influx of people
• Communications – Cell phone service will likely be interrupted or spotty
• Day Care – Younger school‐aged children will need care during a  time they would typically be in school (check with your school district for their schedule)
• Heat, Hydration & Sun Safety – Stock up on water and stay hydrated, and use sunscreen appropriately

Preparations should include planning for how to communicate, navigate and hydrate. Observers should also be aware of the potential harm to their vision and be prepared to view the eclipse with the appropriate safeguards. The event will be here soon, early preparation will allow everyone to more fully enjoy the phenomenon of the eclipse.

Eclipse Eyeglass Safety:  Don't be Blindsided

Plan ahead to decide if you’re going to make use of an indirect viewing method – more information below – or to watch the eclipse directly by using eclipse glasses. If the latter, please check the safety authenticity of viewing glasses to ensure they meet basic proper safety viewing standards.

Eclipse viewing glasses and handheld solar viewers should meet all the following criteria:

• Have certification information with a designated ISO 12312-2 international standard
• Have the manufacturer’s name and address printed somewhere on the product
• Not be used if they are older than three years, or have scratched or wrinkled lenses
• Not use homemade filters or be substituted for with ordinary sunglasses -- not even very dark ones -- because they are not safe for looking directly at the Sun

Our partner the American Astronomical Society has verified that these five manufacturers are making eclipse glasses and handheld solar viewers that meet the ISO 12312-2 international standard for such products: American Paper Optics, Baader Planetarium (AstroSolar Silver/Gold film only), Rainbow Symphony, Thousand Oaks Optical, and TSE 17.

Learn more here.

Eclipse Safe Driving Tips

• Don't stop along interstates or roads and don't park on the shoulder.
• Exit the road and find a safe place to stop and watch or photograph the eclipse
• Pay attention. Distracted driving is very dangerous, particularly during this time of increased traffic on the roadways.
• Never take photographs while driving.
• See and be seen Turn your headlights on and do not rely on your vehicles auto headlight setting.
• Watch out for extra pedestrians and cyclists along smaller roads before during and after the event. People may park randomly and walk along roads, particularly in the hour before the eclipse to get the best viewing.
• Prepare for congestion especially on the interstates in the path of totality the day before, day of and day after the eclipse.
• Don't wear "eclipse glasses" while you're driving. 
• Avoid travel during the eclipse or in the area of the main path if you can. 
• In the event of a non-injury traffic crash, move your vehicles off of the roadway to a safe location.
• Check traffic conditions statewide on the Missouri Department of Transportation's online Traveler Information Map. It's also available as a free app: for iPhones and Androids.
• Get more information and resources from MoDot.

Eclipse Safe Boating Tips

• Make sure that your boat has proper lighting equipment if you will be out during the time of reduced visibility. If you are near the path of totality, it will become dark as night during the full eclipse.
• Know exactly where you are in the time leading up to the eclipse and the hazards that exist in that location so you are fully prepared.
• Keeping a safe distance from other boaters and swimmers is even more important during the eclipse since visibility virtually disappear in the minutes around the eclipse.
• Don’t wear “eclipse glasses” while you’re operating watercraft.

Eclipse Camping

So you’re going to be camping for the eclipse! Camping during the eclipse will not differ from camping any other time except for the anticipated volume of campers if you are within a roughly 70-mile-wide path from Oregon to South Carolina (https://go.nasa.gov/2pC0lhe). Because of the large number of people in the area, preparation will be the key to comfort!

If you are not a regular camper or outdoorsperson, a lot can be learned by visiting the library, getting online, or going to a sporting goods store. Visit with someone who has camping experience before embarking on your own adventure. As you make lists of things you will need, keep in mind the conditions you will face during the eclipse weekend. Bring more than enough food, water, sunscreen, insect repellent, and other supplies. Plan to be out in the heat for extended periods of time, and understand there will most likely be many other people around you. Traffic is likely to be heavy and a trip to the store to stock up on supplies may not be possible. Cell phone and internet service could be spotty.

There are several local areas where campsites have been established for the weekend. Most have restroom facilities, all are temporary campgrounds set up specifically to accommodate the influx of patrons to our region. The St. Joseph Convention and Visitors Bureau website has links to many of the camping sites, found here.

Some items to bring when camping:

• A tent or camper
• Sleeping bag, mat, or air mattress and pump
• Food preparation items - cooking utensils, coolers, etc.
• A first aid kit should include bandages, antiseptic wipes, sterile gauze pads and tape, antibiotic ointment, acetaminophen and ibuprofen, tweezers, plastic non-latex gloves, disposable instant cold packs, calamine lotion, alcohol wipes, and a first aid manual
• Lots of water: individual bottles, gallon juts, even non-potable water to rinse off 
• Insect repellent and sunscreen, and use them regularly. Tick-borne illnesses across the nation are on the increase (learn what to look for and how to remove ticks before camping trip)
• Flashlights and extra batteries
• A pair of sandals you can slip on to do what you would normally do barefoot at home
• Towels: Paper towels, hand towels, body towels, old grubby clean up the dog towels
• Four trash can liners: One for trash, one for dirty clothes, one for wet clothes (and towels), and one for all the stuff you missed when you're packing up the car to leave
• Toiletries: a toothbrush, soap, deodorant, toilet paper, other personal hygiene items
• Prescription medications

There is more to camping than just having the right items. Especially for the eclipse weekend, expect the unexpected!

Check out wonderful places to camp throughout our great state at these Missouri websites.

• https://nature.mdc.mo.gov/discover-nature/activities/camping
• https://mostateparks.com/activity/camping
• https://www.visitmo.com/places-to-stay/campgrounds-and-rv-sites.aspx

Be Safe in the Dangerous Heat

Details

Published on Monday, 03 July 2017 15:09

Andrew County Health Department Tips to Prevent Heat-Related Illness

• Drink more fluids (nonalcoholic), regardless of your activity level. Don’t wait until you’re thirsty to drink. Warning: If your doctor generally limits the amount of fluid you drink or has you on water pills, ask your doctor how much you should drink while the weather is hot.
• Don’t drink liquids that contain alcohol or large amounts of sugar–these actually cause you to lose more body fluid. Also, avoid very cold drinks, because they can cause stomach cramps.
• Stay indoors and, if at all possible, stay in an air-conditioned place. If your home does not have air conditioning, go to the shopping mall or public library–even a few hours spent in air conditioning can help your body stay cooler when you go back into the heat. The Andrew County Senior Center is a heat-relief shelter.
• Electric fans may provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness. Taking a cool shower or bath, or moving to an air-conditioned place is a much better way to cool off.
• Wear lightweight, light-colored, loose-fitting clothing.
• NEVER leave anyone in a closed, parked vehicle.
• Although any one at any time can suffer from heat-related illness, some people are at greater risk than others. Check regularly on: 
• Infants and young children
• People aged 65 or older
• People who have a mental illness
• Those who are physically ill, especially with heart disease or high blood pressure.
• Visit adults at risk at least twice a day and closely watch them for signs of heat exhaustion or heat stroke. Infants and young children, of course, need much more frequent watching. 
• Be aware of medications that may impair the body's response to heat, including antihistamines, tranquilizers and some medications for heart disease

This project is/was funded in part by the Missouri Department of Health and Senior Services Maternal and Child Health Services Contract #DH150006012 and is/was supported by the Health Resources Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #B04MC28109, Maternal and Child Health Services for $9,095,311, of which $0 is from non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government

Tick-borne Illnesses in Missouri

Details

Published on Monday, 03 July 2017 10:29

Tick-borne Illnesses in Missouri

By Randall W. Williams, MD, FACOG Director

Summary

The Missouri Department of Health and Senior Services (DHSS) alerts health care providers that reports of many tick-borne illnesses are higher than normal in 2017. Each year, Missouri experiences a substantial disease burden due to a variety of tick- borne illnesses including tularemia, ehrlichiosis, and Rocky Mountain spotted fever (RMSF) and other spotted fevers. Other tick-borne illnesses have also been reported in Missouri, including Lyme disease and Heartland virus disease, but the number of cases identified for these diseases remains low. 

Tick-borne Rickettsial Diseases (TBRD)

Ehrlichiosis and RMSF are transmitted primarily through the bites of the lone star and American dog tick, respectively. Tick-borne disease agents from the Rickettsiales order most frequently reported in Missouri are Ehrlichia chaffeensis (ehrlichiosis); E. ewingii (ehrlichiosis); and Rickettsia rickettsii and other Rickettsia species (RMSF and other spotted or eschar-associated illnesses).

In 2016, Missouri reported nearly 600 cases of TBRDs. As of June 24, 2017, reports of ehrlichiosis are 18% higher, on average, than the same period for the years 2012 through 2016. Reports in 2017 of Rocky Mountain and other spotted/eschar fevers are 90% higher than the same five-year time period.

TBRDs can cause acute illness similar in initial presentation to many viral and bacterial febrile infections. Peak transmission of these tick-borne agents can continue into early August. Active transmission in Missouri typically is observed from late March through early October. TBRDs can cause severe illness and death in otherwise healthy adults and children. Diagnosis and treatment of these illnesses must be made on the basis of clinical signs and symptoms, and can later be confirmed using molecular and serological laboratory tests.

The standard for diagnosis of rickettsial infection is to perform an immunoglobulin G (IgG) indirect immunofluorescence antibody assay (IFA) on paired acute and convalescent phase specimens taken 2 to 4 weeks apart. During the first week of illness, when most patients seek medical care, antibodies are unlikely to be elevated. As the illness progresses past 7 days, however, the sensitivity of the IFA IgG assay increases in tandem with pathogen-specific antibody production. Serologic confirmation of TBRD in patients with compatible clinical illness is determined by a four-fold or greater increase in IgG antibody titers. Because of its longevity and problems with cross-reaction, use of IgM antibody assays for TBRDs should not be used as a stand-alone method for diagnosis of these conditions.

Polymerase chain reaction (PCR) tests can be used to diagnose ehrlichiosis during acute illness. This test is less sensitive for detecting RMSF infection. While treatment should not be delayed, antibiotic use will reduce the sensitivity of PCR testing. To minimize the risk of obtaining false negatives, specimens should ideally be collected prior to administration of doxycyline.

Delay in diagnosis and treatment is associated with more severe illness and death. Case fatality rates for immunocompromised patients are characteristically higher than rates reported for the general population. Care providers should include TBRD in the differential diagnosis of summertime febrile patients with known or potential tick exposure.

Tularemia

Tularemia is a highly infectious disease caused by Francisella tularensis. There are two subspecies known to cause human illness; F. tularensis tularensis (Type A) and F. tularensis holarctica (Type B). Both types have been isolated from Missouri patients; Type A typically presents with more virulence and commonly occurs naturally in rabbit and rodent populations. In addition to tick-bite transmission, tularemia can be contracted through other means, including ingestion of contaminated water and undercooked meat, inhalation of aerosolized soils or blood, and direct contact with mucous membranes and broken skin. As of June 24, 2017, reported tularemia cases in Missouri are 90% higher than the five- year median for years 2012 through 2016.

Depending on the type of exposure, symptoms of tularemia will vary but generally start out as a flu-like illness and lymphadenopathy. Fever, sometimes high, is likely to accompany all forms. Severity of illness among the different forms of tularemia can range from mild to life threatening.

Diagnosis of tularemia is often made using serological antibody tests such as an enzyme-linked immunosorbent assay (ELISA). Antibody tests are most useful in the second week of infection, but may detect antibodies sooner. Some cross-reactivity may occur with Brucella spp., Legionella spp., and Yersinia spp., usually at low titers. Tularemia can also be diagnosed using a PCR test, immunofluorescence, slide agglutination, or by isolating F. tularensis from blood, sputum, or other exudates.

Because the symptoms of tularemia can be easily mistaken for other illnesses, diagnosis can be challenging. Without treatment, the case fatality rate can be as high as 30%. Prompt treatment with antibiotics, either tetracyclines or quinolones, can reduce the likelihood of complications related to illness. With treatment, the case fatality rate falls to 1-3%.

Lyme disease

Lyme disease, caused by Borrelia burgdorferi, is the most common tick-borne disease in the United States. It is transmitted through the bite of the blacklegged tick. Most North American cases of Lyme disease occur in the northeastern, mid-Atlantic, and northcentral parts of the United States.

In 2016, Missouri reported 10 cases of Lyme disease that met the national reporting criteria. In Missouri, most reported cases have a travel history to a Lyme endemic area described above. Cases were most likely exposed during travel and became ill and were tested upon return. It is important to note that Lyme bacteria have never been isolated from any of Missouri’s cases. As of June 24, 2017, reported cases are elevated compared to the five-year median, but many are still under investigation and may not meet national reporting criteria once investigation is complete.

In about 80% of Lyme disease patients, early symptoms include a “bull’s eye” skin lesion, typically appearing at the site of a tick bite. This characteristic lesion is also called “erythema migrans” (EM). Some patients with EM also have flu-like symptoms, which can include headache, fatigue, arthralgias, and brief arthritis of <2 weeks duration. Patients treated with antibiotics in early B. burgdorferi infection usually recover rapidly and completely. If Lyme disease is not treated, infection can spread to joints, the heart, and the nervous system.

Lyme disease diagnosis should be made using the two-tier reflex testing process on the same specimen. The first tier of the process is to conduct an enzyme immunoassay (EIA) or IFA, which are screening tests. If a screening test is negative, no further Lyme testing is recommended. If a screening test is equivocal or positive, then the second tier Western Blot testing should be done. Requesting a Western Blot without first doing a screening test increases the frequency of false positives and can lead to misdiagnosis and improper treatment for the patient.

Missouri public health surveillance data indicate that risk of locally-transmitted Lyme disease is low. In cases where presentation includes an EM lesion and other characteristic symptoms (headache, fatigue, arthralgias, and brief arthritis of <2 weeks duration) but no out-of-state travel history, the diagnostic uncertainty should be resolved using both acute-phase and convalescent-phase (i.e., 2 weeks after the acute-phase) serum samples tested using the 2-tier testing algorithm.

Heartland and Bourbon Viruses

In the last few years, two previously unknown viruses have been found in Missouri patients. There is evidence to suggest that both viruses are transmitted by the bite of an infected tick. DHSS is working with our partners at the Centers for Disease Control and Prevention (CDC) to gather more information about how people get infected, which types of ticks or other insects may carry the viruses, and how to prevent illness from occurring.

To date, more than 20 cases of Heartland virus disease have been identified in the Southeast and South Central United States (i.e., Missouri, Tennessee, and Oklahoma). There have been fewer cases of Bourbon virus disease identified, but the geographic distribution of those cases is similar to Heartland virus. At this time, it is unknown whether either of these viruses is found in other parts of the United States.

Case patients with Heartland or Bourbon virus disease identified to date have had a flu-like illness with high fever, fatigue, anorexia, and diarrhea. Patients were found to have leukopenia and thrombocytopenia on presentation to the hospital and later developed elevated liver transaminases. Several patients required hospitalization and some died due to their infection with either Heartland virus or Bourbon virus. Most deaths have been in persons who are older and/or have underlying medical conditions. The majority of patients with Heartland or Bourbon virus disease, however, have recovered.

CDC is conducting an investigation that provides diagnostic testing for Heartland and Bourbon virus infections in patients with a clinically compatible illness. Because the laboratory tests are investigational, however, consent is needed from a patient to allow testing to be performed. Any patient meeting the inclusion criteria is eligible for the study regardless of where they live or sought care.

For more information about obtaining testing for Heartland or Bourbon viruses, please call the Office of Veterinary Public Health at (573) 526-4780 during regular business hours, or call the Emergency Response Center (ERC) at (800) 392-0272 after regular hours or on weekends. All requests for testing will be evaluated by a DHSS or CDC epidemiologist.

Tick Bite Prevention

The best way to avoid getting a tick-borne disease is to prevent tick bites from occurring. Encourage patients to take the following steps to protect themselves and their families:

• Use an insect repellent on exposed skin that contains at least 20% DEET, picaridin, or IR3535. Protection time will depend upon the repellent ingredient and concentration. Repellent should always be applied according to package instructions.
• The American Academy of Pediatrics and CDC recommends use of insect repellent containing up to 30% DEET for infants over 2 months of age.
• Clothing and gear can be sprayed with a repellent product called permethrin. Items should be sprayed and allowed to dry completely before use. Permethrin-treated items will remain effective for multiple washings. Permethrin should only be applied to clothing or gear, not to skin.
• Wear light colored clothing to make it easier to spot ticks that are crawling up. When possible, tuck clothing in to prevent ticks from crawling under clothing and attaching to the skin.
• After spending time in tick infested areas, do a thorough check for ticks. Showering soon after coming indoors is also recommended to more easily locate crawling or attached ticks. Remove ticks as soon as possible.
• Clothing worn outdoors can be placed in a dryer on high heat for at least 10 minutes to kill any ticks on the clothing. If the clothing is damp, additional time may be needed. If clothing needs to be washed immediately, wash in hot water and then dry on high heat until no longer damp.

For More Information:

1. Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States. MMWR Recomm Rep 2016;65(No. RR-2):1–44. DOI: http://dx.doi.org/10.15585/mmwr.rr6502a1
2. Centers for Disease Control and Prevention. (2017). Tickborne Diseases of the United States: A Reference Manual for Health Care Providers. Fourth edition. Retrieved from https://www.cdc.gov/lyme/resources/TickborneDiseases.pdf.