Measles

Measles is a highly contagious respiratory disease spread through the secretions of a an infected person.  Droplets can remain suspended in the air and/or remain on a desk, door knob etc. for 2 hours. Simply by breathing the air where an infected person has coughed or sneezed,  or by touching a surface they have contaminated and then touching your nose or mouth you can be infected with the measles virus if you haven’t had the measles or been vaccinated.  Measles can have serious complications such as swelling of the brain and pneumonia.  Death occurs in .2% of cases.

Time from exposure to initial symptoms (fever, runny nose, cough, sore throat, red eyes) is 10-12 days.  A rash appears at the hairline, face, and neck 3-5 days after initial symptoms and then spreads to the trunk, hands, and feet.  A measles infected person is contagious from 4 days before to 4 days after a rash appears.  They could be “spreading the virus”  before they even realize they have the measles.   1150_loresPHIL1150        The MMR vaccine is routinely given at 12 months of age with a second dose given at 4-6 years.  Babies younger than 12 months, patients whose immune systems are not functioning normally (those on chemotherapy, transplants, the elderly, HIV) and those who have not been vaccinated and who have not had the disease, are at high risk for contracting measles.  By vaccinating healthy individuals in society we can protect those people who are unable to receive the vaccine.

If you have questions regarding your immunization status please call your primary physician.  MMR is one of the vaccines the Sandwich Public Health Nursing Department offers routinely.

 

The FLU

Flu season has arrived, but it is not too late to get a flu shot.  http://www.cdc.gov/flu/weekly/WeeklyFluActivityMap.htm

CDC recommends the following:

Take everyday preventive actions to stop the spread of germs.

Take everyday preventive actions to stop the spread of germs like this mother teaching her young child to wash hands.

  • Try to avoid close contact with sick people.
  • If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
  • While sick, limit contact with others as much as possible to keep from infecting them.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.
  • See Everyday Preventive Actions[257 KB, 2 pages] and Nonpharmaceutical Interventions (NPIs) for more information about actions – apart from getting vaccinated and taking medicine – that people and communities can take to help slow the spread of illnesses like influenza (flu).

Take flu antiviral drugs if your doctor prescribes them.

Take flu antiviral drugs if your doctor prescribes them like this older woman listening to her doctor.

  • If you get the flu, antiviral drugs can treat your illness.
  • Antiviral drugs are different from antibiotics. They are prescription medicines (pills, liquid or an inhaled powder) and are not available over-the-counter.
  • Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications. For people with high risk factors[702 KB, 2 pages], treatment with an antiviral drug can mean the difference between having a milder illness versus a very serious illness that could result in a hospital stay.
  • Studies show that flu antiviral drugs work best for treatment when they are started within 2 days of getting sick, but starting them later can still be helpful, especially if the sick person has a high-risk health or is very sick from the flu. Follow your doctor’s instructions for taking this drug.
  • Flu-like symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people also may have vomiting and diarrhea. People may be infected with the flu, and have respiratory symptoms without a fever.

Confirmed Case of Enterovirus D 68

It’s not surprising that Massachusetts has its first confirmed case of Enterovirus D 68 in an 8yo girl from southeastern Mass.  The child does have asthma and has been discharged from the hospital.  Pediatric units have been full with children with respiratory distress, wheezing, cough, runny nose, fever, and rashes.  Children with asthma are at higher risk.

DPH State Epidemiologist Dr. Alfred DeMaria underscored the importance of simple, common-sense steps such as hand-washing to reduce the spread of illness. “As with any other respiratory virus, hand washing is the key to reduce spread, use soap and warm water for 20 seconds” said Dr. DeMaria.

Other tips for parents and patients include:

  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the home is sick

 

Ebola Virus

With more than 4300 cases of documented cases of Ebola and 2300 deaths the world is finally waking up to the gravity of the epidemic.  Dr. Michael Osterholm, a well known epidemiologist, issued a sobering warning in a New York Times Editorial, painting 2 grim scenarios:
http://www.nytimes.com/2014/09/12/opinion/what-were-afraid-to-say-about-ebola.html?

Today, 9/16, President Obama will visit Centers for Disease Control and Prevention where he will be briefed on the current situation.  Meanwhile, federal health officials (Drs. Bell, Fauci and Robinson) as well as Dr. Kent Brantly, will testify before a Senate committee.  The United States is now considering sending up to 3000 military personnel to West Africa to provide medical and logistical support.  USAID has a volunteer application form on its website.http://www.usaid.gov/ebola/volunteers

On 9/18 the UN Security Council will hold an emergency meeting to discuss the outbreak.

 

 

 

Ebola Virus

Update 9/3/2014

Dr. Tom Frieden, the director of the Centers for Disease Control, stated that there was a small window of opportunity to stop the Ebola epidemic.  Nearly 40% of the cases have occurred during the past 3 weeks with healthcare facilities filled beyond capacity, a devastating shortage of healthcare workers and medical supplies, and now a shortage of food.  Currently, the World Health Organization believes that the count of 3,069 cases and 1,552 deaths is an under count.

Research continues on the experimental monoclonal antibody, ZMapp, which has been used on a handful of patients.  In a Nature study, 18 monkeys infected with the virus and then given ZMapp survived.

Update 8/20/2014

The number of Ebola cases continues to increase.  The World Health Organization http://www.who.int/csr/don/2014_08_20_ebola/en/  states that between August 17th and August 18th there were 221 new cases and 106 deaths.  That brings the total number of cases to 2473 and the deaths to 1350.  Most of the new cases were attributed to lack of appropriate infection prevention when in contact with the bodily fluids of an infected patient. 

Update 8/7/2014

While the 2 American patients at Emory University seem to be improving, the overall situation in Africa is worsening, prompting the Centers for Disease Control to move its Emergency Operations Center to its highest activation level.  This may be due, in part, to the emergence of several Ebola cases in Lagos, Nigeria, a city of 20 million people.  The World Health Organization updated the Ebola numbers to 1,711 cases with 932 deaths.  

The experimental drug, ZMapp, a mixture of 3 antibodies which was given to the American medical workers in Liberia, is now part of a worldwide discussion about the ethics of giving experimental drugs, not approved by any government agencies, to critically ill patients.  To complicate the issue further, if the decision were made to give the limited number of experimental drugs available, which patients in which countries would receive them?  The World Health Organization is convening a group of ethicists to discuss these very issues.

                                                                                                                                                   Update 8/1/2014

The CDC issued a Level 3 travel warning yesterday for non essential travel to Liberia, Guinea, and Sierra Leone.  The number of cases of Ebola Virus continues to increase and the hospitals are understaffed and overwhelmed with critically ill patients.

Yesterday, the United States Centers for Disease Control and Prevention issued an advisory for US health care workers to consider Ebola virus, and possible isolation, for those patients presenting with viral symptoms and returning from affected countries within the past 21 days.Ebola_Virus

Ebola virus is an acute illness spread through blood and body fluids with an incubation period from 2-21 days.  Symptoms include headache, muscle pain, intense weakness, nausea, vomiting, impaired kidney and liver function, and in some cases, internal and external bleeding.  The disease so far has infected over 1000 people in West Africa and killed more than 660.  The fruit bat is considered a likely reservoir and infected animals, which are handled or eaten by locals, the way the virus moves from animals to humans.  Humans then contract the disease by coming in contact with bodily fluids such as blood, sweat, urine, breast milk, vomit, and diarrhea of persons who have already contracted the disease.

Guinea_Sierra_Leone_Ebola_Map_April_14_2014_png

The disease is spreading quickly in Sierra Leone, Liberia, and Guinea because of multiple issues:  lack of personal protective equipment such as masks, gloves, and gowns;  small numbers of staff and isolation-wardisolation units; and the beliefs of some locals that the medical professionals themselves are spreading the disease.

While several vaccines are being tested, none are on the market at this time and intravenous fluids and fever medications are the only treatment options.

 

Chikungunya Fever

You may have heard rumors of this virus!

320px-CDC-Gathany-Aedes-albopictus-1Chikungunya virus is transmitted by the Aedes mosquito which can be found in the northeast U.S.  The virus was originally discovered in Africa and Asia but has now found its way to the Caribbean and Florida.   Over 350,000 people in the Caribbean are infected with this virus.

UPDATE 7/18/14

As of today, there may be 2 locally acquired cases in the continental United States.

Chikungunya reported in the Boston area

by Tripp Underwood on July 8, 2014

tiger mosquitoFour people in the Boston area have been diagnosed with chikungunya, a viral disease spread to people by way of mosquitoes.

Typically, outbreaks of the disease are restricted to Africa, Asia, Europe and the Indian and Pacific Oceans. But as of late, there has been an increase in reported cases in the Caribbean islands, which some believe may eventually lead to more cases in the U.S.

“With the disease now appearing more frequently in islands neighboring the U.S., it’s quite possible we’ll begin seeing more cases of infected travelers bringing chikungunya home with them,” says Jeffrey Dvorin, MD, PhD, of Boston Children’s Hospital’s Division of Infectious Diseases. “And because the types of mosquitoes that can carry and transfer the disease are present in Massachusetts, there’s an increased risk that it could spread more easily once here, like has happened recently with the West Nile virus. There’s a good chance we’ll be hearing much more about it in the coming years.”

The virus is spread when a mosquito bites an infected patient and then bites a healthy person – passing the virus along to them.  The majority of infected people become symptomatic within 3-7 days.  Symptoms usually include acute onset fever, headache, and debilitating joint pain, which often occurs in the hands and feet.  Other symptoms may include; muscle pain, conjunctivitis, nausea and vomiting, and rash.  Although acute symptoms can resolve in 7-10 days, joint pain can last months to years.

There is no specific vaccine or treatment for this virus but rest, fluids, and NSAIDS (aspirin, Aleve, Ibuprofen) can ease the pain.  The best protection is to:  remain indoors at dawn or dusk when mosquitoes are most active; wear long sleeves and long pants; apply DEET to bare skin http://www.cdc.gov/malaria/toolkit/DEET.pdf ;  empty containers and drain standing water, and keep window screens in good repair.

West Nile Virus and Eastern Equine Encephalitis

West Nile Virus and EEE are arboviruses spread by infected mosquitoes.  http://www.mass.gov/eohhs/docs/dph/cdc/arbovirus/mosquito-species-ma.pdf

West Nile Virus

The WNV was first detected in North America in 1999.  Symptoms may occur 2-6 days after being bitten.  (70% of people infected do not go on to develop symptoms).  Those who do have symptoms may have fever, headache, body aches, vomiting, diarrhea, and rash.  Although most people recover, fatigue and weakness can last weeks to months.  See a health care provider if you have any of the above symptoms.

There are no vaccines or medications to specifically treat this virus but over the counter pain relievers can reduce fever and relieve pain.

As in all mosquito borne illnesses:  avoid being outside dusk to dawn; wear long sleeves and long pants; use insect repellants such as DEET; empty standing water in the yard; and repair screens

Eastern Equine Encephalitis

EEE is also spread through the bite of an infected mosquito.  Those who contract the disease have a 30%-50% mortality rate.  Symptoms are:  high fever 103F-106F; stiff neck; headache; and lack of energy 3-10 days after a bite.  Inflammation and swelling of the brain is a serious complication and symptoms can worsen quickly.  Because of the seriousness of this disease prevention is key! http://www.mass.gov/eohhs/docs/dph/cdc/factsheets/eee.pdf

Hepatitis C

Aside

800px-Anatomy_of_liver_and_gall_bladderHepatitis C is a contagious liver disease caused by a virus. It is spread primarily through contact with the blood of an infected person. It is classified as either acute or chronic. Acute disease can lead to chronic disease 75% of the time. Testing has been available since 1990.

In the United States over 3 million people have chronic Hepatitis C and aren’t aware of it because they do not feel sick. Hep C is spread when the blood from an infected person enters the body of a non-infected person:

A)   Sharing needles/syringes
B)   Needle stick injuries in the health care setting
C)   Being born to a Hep C mother
D)   Sharing razors, toothbrushes that may have been used by a Hep C infected person
E)   Before 1992 blood screening was initiated, Hep C could be spread through blood transfusions and organ transplants

If symptoms do appear, they may occur 2-6 months after exposure. Even if you don’t have symptoms you can spread the virus. Symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay colored bowel movements, joint pain, and yellow skin or eyes. People with chronic Hepatitis C can go on to develop chronic liver disease or liver cancer. You should be tested for Hep C if:

There are several new drugs which can be used for treatment. Medication | Treatment | The American Liver Foundation

H7N9 Virus (Avian Influenza A)

This new bird flu was first reported in China in March 2013.  The main cause of infection is from contaminated poultry (there is now limited human to human spread).  There are no cases in the United States.

The symptoms are cough, high fever, pneumonia, shock, and multisystem failure.  

If you travel to China or surrounding countries:

  • Stay away from live bird markets
  • Do not have contact with sick people
  • Practice good hand hygiene
  • Before you travel, register with the US government Smart Traveler Enrollment Program.  https://step.state.gov/step/

There is currently no vaccine available.  If you should become ill after returning home, inform your doctor of your recent trip.

Middle East Respiratory Syndrome (MERS)

This respiratory virus was first noticed in Saudi Arabia in 2012.  It is caused by a virus nih-imagebank-1450-72similar to the virus which caused the SARS outbreak in China in 2003.  Currently, it is mainly found in the Arabian Peninsula with some cases in 21 other countries.  There have been 2 U.S. cases, both in healthcare workers who had been working in hospitals in Saudi Arabia.  Both cases are doing well.  Initial symptoms are fever, cough, and shortness of breath.
The cause is unknown but research has shown that camels and bats may play a role.  There is no vaccine available.

If you travel to Saudi Arabia or neighboring countries there are a few things you can do to protect yourself.

  • Register with the US government  Smart Traveler Enrollment  Program  https://step.state.gov/step/
  • Avoid contact with sick people
  • Do not visit camel farms or have close contact with camels
  • Do not drink unpasteurized milk or undercooked meat
  • Wash your hands frequently with soap and water and use alcohol based hand sanitizer when soap and water are not available

If you become ill within 2 weeks of returning home, inform your physician of your travels.