March 16, 2010
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Benton County Health Alerts Archive

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2009

Pandemic Influenza H1N1 Virus (June 29, 2009)

Benton County received notification of its first documented case of pandemic H1N1 influenza last week.  There have been 219 cases of pandemic H1N1 confirmed in Oregon since the beginning of the outbreak with most cases occurring in the Tri-County area around Portland.  A second congregation of cases is present in Polk and Marion Counties.

Presently pandemic H1N1 influenza virus (previously known as swine flu and new or novel H1N1 influenza) appears to be the dominant influenza virus circulating in the Unites States and Oregon at this time.

In Oregon, the pandemic H1N1 influenza cases range in age from 0 to 78 years; the median age is 16. Thirty-two hospitalizations have been reported (six 0-4 year-olds, fourteen 5-24 year-olds, eleven 25-64 year-olds and one 65+ year-old). Three deaths have been reported (one child and two adults-see table below).

Nationally pandemic H1N1 hospitalization rates are highest in the 0-4 age group with the next highest rates being in the 5-24 year old age group. According to U.S. statistics, 71 % of the hospitalizations have occurred in patients that have an underlying health condition. There have been a disproportionate number of pregnant women among those who have had the infection. Vaccine prioritization for the fall flu season may reflect these data.

The Centers for Disease Control and Prevention (CDC) recommends treatment with oseltamivir or zanamivir for all patients with influenza-like illness who are: 1) hospitalized or 2) are at higher risk for seasonal influenza complications. Pandemic influenza H1N1 is resistant to the adamantine antiviral medications, amantadine and rimantadine (See Table 1).

Table 1. Antiviral medication dosing recommendations for treatment or chemoprophylaxis of Pandemic influenza A (H1N1) infection.
(Table extracted from IDSA guidelines for seasonal influenza.)

Agent, group

Treatment

Chemoprophylaxis

Oseltamivir

Adults

75-mg capsule twice per day for 5 days

75-mg capsule once per day

Children ≥ 12 months

15 kg or less

60 mg per day divided into 2 doses

30 mg once per day

16-23 kg

90 mg per day divided into 2 doses

45 mg once per day

24-40 kg

120 mg per day divided into 2 doses

60 mg once per day

>40 kg

150 mg per day divided into 2 doses

75 mg once per day

Zanamivir

Adults

Two 5-mg inhalations (10 mg total) twice per day

Two 5-mg inhalations (10 mg total) once per day

Children

Two 5-mg inhalations (10 mg total) twice per day (age, 7 years or older)

Two 5-mg inhalations (10 mg total) once per day (age, 5 years or older)

* The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses.

 

Isolates tested (n)

Resistant Viruses,
Number (%)

Isolates tested (n)

Resistant Viruses, Number (%)

 

 

Oseltamivir

Zanamivir

 

Adamantanes

Seasonal Influenza A (H1N1)

1,010

1,005 (99.5%)

0 (0)

1,012

6 (0.6%)

Influenza A (H3N2)

183

0 (0)

0 (0)

187

187 (100%)

Influenza B

550

0 (0)

0 (0)

N/A*

N/A*

Pandemic Influenza A (H1N1)

191

0 (0)

0 (0)

177

177 (100%)

 

Level 6 Pandemic Flu (June 11, 2009)

The World Health Organization (WHO) today declared a global flu pandemic, moving its official alert level to 6. The declaration recognizes that the virus has become established and is spreading in more than one WHO region - previously widespread transmission was only officially recognized in the Americas. This is the first global flu pandemic declaration since 1968. There were three flu pandemics in the 20th century: 1918, 1957 and 1968.

It is important to remember that this declaration is NOT related to changes in the severity of illness being caused by the novel H1N1 virus but by its continued person-to-person, global spread. The WHO has now documented almost 28,000 lab-confirmed cases in 74 nations causing more than 140 deaths. The Oregon public health laboratory confirmed 22 more cases last week, bringing the official Oregon case count to 168. Of those, 15 have been hospitalized, 2 were admitted to ICU, and 1 has died. Novel H1N1 (swine) flu represented 81% of the total flu cases confirmed by the Oregon public health laboratory last week.

Because this is a new (novel) virus, and because it is behaving unusually, public health authorities around the world remain vigilant for changes in severity or patterns of transmission. Public health is particularly watching the southern hemisphere as it enters its winter flu season. H1N1 cases are already rapidly increasing, especially in Australia and Chile. However a number of northern hemisphere nations continue to see new cases as well, indicating that although it is not increasing in severity, this virus is not behaving the same way as regular seasonal flu viruses.

Prepare Now For Flu Season
Locally, this declaration should serve as a reminder to everyone to review and update household and organizational preparedness plans.

Are you and your household prepared for illness or disaster with at least 2 weeks of food, water, medications and pet/animal supplies? Is your household prepared for possible closures of schools, businesses, and other routine functions? In Mexico and many American cities these types of closures this past May lasted a week or two. During a severely lethal pandemic, closures could last several weeks - are you prepared?

Is your business/employer prepared? Have you made plans to help prevent transmission of flu between staff and to your customers? Do you have a plan for sustaining your critical functions even with high absenteeism? Do you have more than one person trained to perform each critical function? Can any of your work be performed from home or off-site to reduce person-to-person transmission? Can you rearrange seating or service to reduce flu transmission?

Flu information:
World Health Organization (WHO): www.who.int
US Centers for Disease Control & Prevention (CDC): www.cdc.gov/h1n1flu
Oregon PH: http://oregon.gov/DHS/ph/index.shtml

Preparedness information:
Benton County Emergency Management: http://www.co.benton.or.us/sheriff/ems/hazard.php
American Red Cross: www.prepare.org
Ready America: www.ready.gov

Class 1 recall for ground beef products (Wednesday, June 3, 2009, 3:20 p.m.)

ATTENTION;

A class 1 recall has been issued for ground beef products that may have been potentially contaminated with E-Coli 0157-H7 and were distributed in Oregon & Washington.

The recall was announced on June 2, 2009 from the USDA. Please see enclosed information sheet for information on the manufactures & lot numbers of the recalled products. It is strongly advised that if you discover these items in your facility, that you immediately remove them from service and contact our office or your distributor for further instruction. Again, this is a class 1 recall and your immediate attention to this is required. If you can not read the attachment please contact our office at 541-766-6841.

For more information, please click on the USDA Food Safety link below:

Oregon Firm Recalls Ground Beef Products Due To Possible E. coli O157:H7 Contamination
Tue, 02 Jun 2009 21:58:16 -0500

SP Provisions, a Portland, Ore., establishment is recalling approximately 39,973 pounds of ground beef products.

 

Current Food Recalls

ATTENTION

A class 1 recall has been issued for ground beef products that may have been potentially contaminated with E-Coli 0157-H7 and were distributed in Oregon and Washington.

The recall was announced on June 2, 2009 from the USDA. Please see the link below for information on the manufactures and lot numbers of the recalled products. It is strongly advised that if you discover these items in your facility, that you immediately remove them from service and contact our office or your distributor for further instruction. Again, this is a class 1 recall and your immediate attention to this is required. If you can not read the link, please contact our office at 541-766-6841.

Click on the USDA Food Safety link below:

Oregon Firm Recalls Ground Beef Products Due To Possible E. coli O157:H7 Contamination
Tue, 02 Jun 2009 21:58:16 -0500

SP Provisions, a Portland, Oregon, establishment is recalling approximately 39,973 pounds of ground beef products.

 

H1N1 (Swine) Flu Update (Wednesday, May 6, 2009, 4:00 p.m.)

No cases of H1N1 flu have been identified so far in Benton County. Forty-five cases have been identified in Oregon. Four people have required hospitalization.

Global, federal, state and local public health workers have been carefully watching the progression of this disease because this is a new virus combining human, swine and bird genetic influenza components. Since humans have never before been exposed to such a variant, no one could predict how it might behave or the severity of disease it could cause. After deaths were reported in Mexico, virtually all other nations implemented very cautious approaches as a precaution against similar effects.

Now, after watching the behavior of the virus as it has spread globally, epidemiologists are more confident that it is causing no more severe illness than "normal" seasonal flu (which still kills over 36,000 Americans each year). As a result, yesterday afternoon the Centers for Disease Control & Prevention (CDC) recommended that no more schools close for H1N1 cases and that schools that were closed should consult with local and state public health officials regarding reopening. Public health professionals around the world are remaining watchful for potential changes in the virus or the pattern of illness it causes and we are already making plans for increased vigilance next fall when we enter our next flu season.

No schools are closed in Benton County. In our area, Central 13J school District in Monmouth has made the decision to remain closed as previously planned through May 8th. Information on school closures from the Oregon Department of Education can be found at http://www.ode.state.or.us/search/page/?=2592

PREVENTION:
From laboratory tests we know that seasonal flu is still infecting people in Oregon even though it is late in the flu season. Here are steps you should take to help prevent the flu, colds and other respiratory infections:

  • Wash Hands Frequently (Use waterless hand sanitizer when soap and warm water are unavailable)
  • Cover Your Coughs or Sneezes (Cough or sneeze into a tissue or your sleeve, not your hands. Wash your hands after coughing or sneezing.)
  • Stay Home When You Are Ill (Protect your co-workers and accelerate your recovery)

For up-to-date information on this rapidly-changing situation:
The Oregon flu hotline is operational 8 am - 5 pm, Mon-Fri at 800.978.3040

On the web: www.flu.oregon.gov
www.cdc.gov/H1N1flu

 

H1N1 (SWINE) Flu Situational Update (May 1, 2009)

The situation for the H1N1 flu is expected to continue to change rapidly.  To stay on top of most recent events and advisories, visit www.cdc.gov/flu/swine, and http://www.flu.oregon.gov/

Oregon Flu Hotline:1-800-978-3040

CDC Flu Hotline: 1-800-CDC-INFO

Increased medical and public health surveillance will likely result in the identification of additional cases of the new strain of flu so it is reasonable to expect increasing media attention. It is not possible to get swine flu from eating pork or pork products.

Steps you can take:

  • Wash Hands Frequently (Use waterless hand sanitizer when soap and warm water are unavailable)
  • Cover Your Cough (Cough or sneeze into a tissue or your sleeve, not into your hands. Wash your hands after coughing or sneezing)
  • Stay Home When You Are Ill (Protect your co-workers and accelerate your recovery)

Signs and Symptoms

What are the signs and symptoms of swine flu in people? The symptoms of swine flu in people are similar to the symptoms of regular human flu.

     • Fever greater than 100 degrees
     • Cough
     • Sore throat
     • Body aches
     • Headache
     • Chills
     • Fatigue
     • Some people have reported diarrhea    
       and vomiting associated with swine flu


If you or a family member have a fever over 100 degrees or other symptoms listed above, see your health care provider.

If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer.

If you don’t have a regular health care provider, you or your child may go to one of the local medical clinics: Call ahead of your arrival.

     • Samaritan Urgent Care, 768-4970
     • Benton Health Services, 766-6835
     • Lincoln Health Center, 766-3547

If you suspect your child is getting the flu, it is very important that he/she does not attend school or go anywhere else where other people would be exposed to flu germs.

Ill people who experience any of the following warning signs should seek emergency medical care:


In children, emergency warning signs that need urgent medical attention include:

    • Fast breathing or trouble breathing
    • Bluish skin color
    • Not drinking enough fluids
    • Not waking up or not interacting
    • Being so irritable that the child does not want to be held
    • Flu-like symptoms improve but then return with fever and worse cough
    • Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

    • Difficulty breathing or shortness of breath
    • Pain or pressure in the chest or abdomen
    • Sudden dizziness
    • Confusion
    • Severe or persistent vomiting

If you do get ill, please mention any recent travel, contact with travelers, or contact with swine to your health care provider.

The Federal Public Health Emergency declaration was made to facilitate release of standby stocks of anti-viral medications and other supplies so that states will be ready in case the situation worsens. This declaration is in keeping with the emergency public health planning that has been ongoing on the federal, state and local levels since 2001.

To prepare your home or business for public health emergencies, see the following information in English and Spanish.

Identified Two Cases of Pertussis - Whooping Cough (February 17, 2009)

One case of lab-confirmed and two presumptive cases of pertussis (whooping cough) have been identified in the Philomath community, specifically in Philomath High School. Additionally, three cases of lab-confirmed pertussis have been identified in Linn County.

 

Health care providers are advised to maintain a high index of suspicion for pertussis and include it in their differential diagnosis for young children presenting with severe, persistent (particularly non-productive) cough and older children and adults with persistent or paroxysmal cough. Adults and adolescents with pertussis may lack the classic symptoms seen in young children. Take special notice of high-risk persons (infants and pregnant women in the third trimester) who have a suspicious cough.

 

Pertussis Signs and Symptoms

 

Pertussis is characterized by spasms of severe coughing (paroxysms) lasting from 6 to 10 weeks duration (in uncomplicated cases). Pertussis should be suspected as the cause of any cough lasting more than a week, or any paroxysmal cough. During the first 1-2 weeks of illness, coryza with an intermittent non-productive cough is common; this period is followed by episodes of paroxysmal coughing which frequently lasts for several weeks (i.e., paroxysmal period). The pertussis paroxysms are continuous and can be followed by post-tussive vomiting. Generally, there is little or no fever. The disease peaks in severity after one or more weeks of paroxysmal coughing and begins to taper off with an extensive convalescent period of 2-6 weeks, lasting up to 3 months in some cases.

 

New Investigative Guidelines

 

Previously, the DHS investigative guidelines for pertussis recommended prophylaxis for all close contacts of a pertussis case. The new investigative guidelines recommend prophylaxis for close contacts only if they are “high risk” (infants under age 1 and pregnant women in their third trimester). In addition, the entire household of a case or the entire childcare setting of a case should receive prophylaxis if an infant or pregnant woman is among the exposed in those settings. Other “low risk” contacts will receive education regarding signs and symptoms of pertussis; any symptomatic close contacts will be encouraged to seek medical care from their provider and inform them of their exposure.

 

Treatment

 

Early treatment (within 2 weeks of paroxysmal cough onset) is much more effective in preventing secondary spread than treatment started later. Initiating treatment more than 3 weeks after onset of paroxysmal cough is unlikely to be beneficial and should be limited to situations in which there is on-going contact with an infant or a pregnant woman in the third trimester.

  • Active Immunization. Exposed children who received their third dose of DTaP 6 months or more before exposure to pertussis should be given a fourth dose at this time. Children who received all four primary doses before their fourth birthday should receive a fifth dose of DTaP before entering school. Those over age 10 who have not received Tdap should get it at this time. Tdap may be given at an interval as short as 2 years from the last Td.
  • Chemoprophylaxis. The effort to provide antibiotic prophylaxis for pertussis must focus on infants under age 1 year since serious complications and death are limited to this group. Recommended prompt antibiotic prophylaxis for close contacts of confirmed, presumptive, and suspect cases who are:
    • Infants
    • Pregnant women in the third trimester (since they will soon have contact with an infant)
    • All household contacts of a case if there is an infant or pregnant woman in the third trimester in the household, even if the infant in the household is the case
    • All those attending or working in a childcare setting (i.e., same room) of a case if there is an infant or one of those same third trimester women in the setting
    • Other contacts at the discretion of the local health department (e.g. pediatric healthcare workers, unimmunized contacts, other pregnant women, high-risk contacts of suspect cases).

Note: Recommend prophylaxis for high-risk contacts that have been exposed within 42 days (2 maximum incubation periods).

 

Vaccination

 

Household members and close contacts of infants and pregnant women in the third trimester should be vaccinated to reduce the risk for pertussis transmission.

  • DTaP is available for children age 7 years or younger.  Three—and preferably four—doses of DTaP are necessary for protection against Diphtheria, Tetanus and Pertussis. It is recommended that DTaP vaccinations be given at 2, 4, 6 and 15 to 18 months, with a booster at 4 to 6 years of age.
  • Tdap is available for people age 11-64 years. 

 

If you have further questions, please contact Benton County Health Department at 766-6654.

 

Gastroenteritis - Norovirus (January 16, 2009)

The trend of gastroenteritis outbreaks occurring in January each year has been noted for the past three years by the Benton County Health Department. We’ve received reports of gastroenteritis from two congregate settings in recent weeks. Norovirus was laboratory confirmed in both outbreaks.

Both facilities implemented infection control measures that successfully stopped further spread of the outbreaks. Area health providers are advised to raise their index of suspicion regarding Norovirus:

Etiology:

  • Classified under Caliciviruses: Nonenveloped RNA virus.

Incubation Period:

  • 12-72 hours, average = 30-36 hours.

Signs and Symptoms:

  • Sudden onset of vomiting, diarrhea, nausea, and stomach cramps. 

  • Headache, low-grade fevers, chills, myalgia, and general fatigue are common.

  • Symptoms and side effects of dehydration may be very severe in infants and the elderly.

  • Illness is usually self-limiting and lasts no more than a day or two. 

Transmission:

  • Fecal-oral transmission.

  • Virus may be shed for up to 72 hours following the last bout of diarrhea or vomiting, leading to virus transmission.  Affected persons should not participate in food preparation or care of uninfected persons for three days following diarrhea or vomiting.

  • Sources of transmission: Direct contact with feces or vomitus or environmental surfaces contaminated with feces or vomitus. Also uncooked foods and shellfish.

 

People most at risk:

  • Day-care providers, children attending childcare, their families.

  • Residents and staff of long-term and nursing care facilities.

  • Health workers and family members caring for infected persons.

 

Diagnostic Tests:

  • Enzyme immunoassay for detection of viral antigen in stool or antibody in serum.

  • Reverse transcriptase polymerase chain reaction (RT-PCR) assay for detection of viral RNA in stool.

 

Treatment:

  • There is no specific treatment.  Rehydration may be needed when vomiting and/or diarrhea is severe. 

 

Prevention:

  • Wash hands after using the toilet and changing diapers and before eating or preparing food.

  • Hand washing with soap and water is HIGHLY RECOMMENDED – There is evidence that waterless hand cleansers may not provide full skin disinfection from Norovirus.

  • Thoroughly clean fruits and vegetables, and steam oysters before eating them.

  • Norovirus is a VERY robust and durable virus that is highly transmissible and can live for extended periods on environmental surfaces. Disinfect potentially contaminated surfaces thoroughly with diluted bleach: ½ cups of bleach in one gallon of water. (This strong solution may spot or discolor carpets, clothing and toys.)

  • Health care workers should practice scrupulous use of PPE, and meticulous disinfection of all equipment is required following every potential norovirus exposure.

 

For more information:

  • Benton County Health Department Communicable Disease Program can be reached at: 541.766.6654 / 541.766.6255

Population-based Immunization Rates for 2007 (November 10, 2008)

The Oregon Immunization Program (OIP) recently released the Population-based Immunization Rates for 2007. These rates show the percentage of Oregon two-year-olds who are up to date for all recommended vaccines. Oregon calculates its population-based immunization rates by using data from the ALERT immunization information system. Since 2004 OIP has tracked immunization rates that account for mobility between counties and states and incomplete immunization records.

Tables show that Benton County’s Up-to-Date Immunization Rates decreased between 2005 and 2006. Currently only 67% of Benton County 2-year-olds are up to date with the recommended series of 4 DTaP, 3 Polio, 1MMR, 3 Hib, 3 Hepatitis B, and 1 Varicella Vaccines, which is below the state average of 74%. Up-to-Date Immunization Rates for 2-year-olds in Oregon counties ranged from 55% to 88%.

One notable problem in Benton County and throughout Oregon is a low vaccination rate for the 4th DTaP. Special attention to assuring completion of the DTaP series should be considered. Children who participated in WIC or DMAP maintained higher vaccination rates. Benton County’s religious exemption rate for school entry is 5.83%, which is higher than the state average of 3.89%.

Benton County’s Primary Care Providers deliver the overwhelming majority of vaccines for children. This keeps everything regarding the child’s health together in their primary care record, but puts more responsibility on private providers to maintain vaccination rates.

Benton County Health Department is developing programs to assist local medical practices in achieving higher vaccination rates and improving child immunization rates. These include avoiding missed vaccination opportunities and more accurate evaluation and documentation of true vaccine contraindications.

All providers of child vaccinations will receive information about available technical assistance, training opportunities and materials from Benton County Health Department’s immunization program this winter.

Rabies Vaccine (June 24, 2008)

  

Pre-exposure Prophylaxis

 

Rabies vaccine for pre-exposure prophylaxis (PreP) in the U.S. is temporarily unavailable for sale by both manufacturers. Additional rabies vaccine is anticipated to become available sometime in 2009, according to the latest information from Sanofi.

 

Arrangements have been made to make rabies vaccine (Imovax-Rabies, sanofi pasteur) available on a limited basis for workers at higher risk for rabies exposure (first responders in following order of priority: lab personnel working with rabies, animal control officers, veterinary staff, (excluding students and RVT), and wildlife workers that cannot delay vaccination until vaccine supplies for PreP become available. Vaccine doses will be prioritized on a case-by-case basis according to rabies exposure risk category and occupation type (see above).

 

Vaccine is not currently available for PreP for travelers and other persons at risk (cavers, etc.) whose activities involving possible exposure to rabies are voluntarily, not critical, and could be postponed or avoided. Vaccine is not available for a single booster of persons previously vaccinated with a less than adequate virus neutralizing titer (<1:5) as measured by rapid fluorescent focus inhibition test (RFFIT), with the exception of first responders as outlined above.

 

See attached request form. If you have a patient requesting Pre-exposure prophylaxis, complete and send this form to Emilio DeBess, DVM, Oregon Division of Public Health, 800 NE Oregon St., Suite 772, Portland, OR 97232-2196.

 

Post-Exposure Prophylaxis

 

Bat exposure is the greatest risk for rabies in Oregon . The State DHS web site provides an algorithm for decisions to provide post- exposure prophylaxis. http://oregon.gov/DHS/ph/acd/diseases/rabies/rabalg.pdf

Bat Exposures

The most common rabies virus variants responsible for human rabies in the United States are bat-related; therefore, any potential exposure to a bat requires a thorough evaluation. If possible, bats involved in potential human exposures should be safely collected and submitted for rabies diagnosis. Most submitted bats (approximately 94%) (110) will not be rabid and such timely diagnostic assessments rule out the need for large investments in risk assessments and unnecessary prophylaxis.

The risk for rabies resulting from an encounter with a bat might be difficult to determine because of the limited injury inflicted by a bat bite (compared with more obvious wounds caused by the bite of terrestrial carnivores), an inaccurate recall of a bat encounter that might have occurred several weeks or months earlier, and evidence that some bat-related rabies viruses might be more likely to result in infection after inoculation into superficial epidermal layers (111). For these reasons, any direct contact between a human and a bat should be evaluated for an exposure. If the person can be reasonably certain a bite, scratch, or mucous membrane exposure did not occur, or if the bat is available for testing and is negative for presence of rabies virus, post exposure prophylaxis is not necessary.

Other situations that might qualify as exposures include finding a bat in the same room as a person who might be unaware that a bite or direct contact had occurred (e.g., a deeply sleeping person awakens to find a bat in the room or an adult witnesses a bat in the room with a previously unattended child, mentally disabled person, or intoxicated person). These situations should not be considered exposures if rabies is ruled out by diagnostic testing of the bat or circumstances suggest it is unlikely that an exposure took place. Other household members who did not have direct contact with the bat or were awake and aware when in the same room as the bat should not be considered as having been exposed to rabies. Circumstances that make it less likely that an undetected exposure occurred include the observation of bats roosting or flying in a room open to the outdoors, the observation of bats outdoors or in a setting where bats might normally be present, or situations in which the use of protective covers (e.g., mosquito netting) would reasonably be expected to preclude unnoticed contact.

Because of the complexity of some of these situations, consultation with state and local health departments should always be sought. (MMWR, “Human Rabies Prevention—US, 2008”, vol. 57/RR-3, p. 13)

  

 

New School Immunization Requirements (April 11, 2008)

 

Starting in the fall of 2008, Oregon requires that all students entering the 7th grade need to have a Tdap vaccine. The public health school nurses are scheduling Tdap clinics at appropriate schools in Benton County. These will be held in April and May for children currently in the sixth grade.  The Vaccines For Children fund (VFC) will provide the vaccine.

These Tdap clinics are meant to reach as many 6th graders as possible. Some parents may choose to have this done at their PCP’s office. The Advisory Committee on Immunization Practices (ACIP) also recommends the following vaccines for ages 11-12:

  • meningococcal vaccine,
  • the HPV series (for girls)
  • 2 doses of varicella
  • 2 doses of hepatitis A (if not given before)

 

Also, two doses of Hepatitis A will be required for all children entering preschool, child care centers, or Head Start in the fall of 2008. Religious and medical exemptions may be obtained by the parents for all immunizations.

Please pass this information to the nurses and CMAs who give the vaccines. Here are two web sites that may be helpful reminders:

http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm

http://www.cdc.gov/vaccines/spec-grps/preteens-adol/07gallery/default.htm  

2008

Influenza Outbreak (April 22, 2008)

The Benton County Health Department (BCHD), in consultation with representatives of Oregon Public Health Division (OPHD) and Centers for Disease Control (CDC), has identified an outbreak of influenza in a Corvallis long-term care facility (LTCF). In an outbreak, the CDC recommends antiviral chemoprophylaxis be administered to all residents of a LTCF and offered to all patient care staff. The LTC facility management will be contacting the resident’s health care providers requesting orders for antiviral chemoprophylaxis.

Oseltamavir is the recommended antiviral for chemoprophylaxis. Dosage for chemoprophylaxis is 75 mg per day for ages 13 and older. No reduction in dosage is recommended on the basis of older age alone. For patients with creatinine clearance of 10-30 mL/min, a reduction in prophylaxis dosage to 75 mg every other day is recommended. Duration of prophylaxis is for a minimum of two weeks plus one week following the last case.
http://www.cdc.gov/flu/professionals/vaccination/#dosage

If influenza is suspected in any resident of a LTCF, please test for influenza and report cases to Communicable Disease Nurses at 766.6654 or 766.6255. The voicemail is confidential, so please leave a message.

Influenza Is Still Here (April 18, 2008)

Influenza is still here. Benton County Health Department has been working with a local long-term care facility (LTCF) to control an outbreak of viral upper respiratory illnesses. Today rapid test for influenza Type A was positive in one case and Type B was positive in one case. Viral cultures are pending. State epidemiologists report that the tri-county area in and near Portland are still seeing influenza cases.

If influenza is suspected in any LTCF resident, influenza testing should be done promptly. When influenza outbreaks occur in institutions, the Center for Disease Control recommends antiviral chemoprophylaxis should be administered to all residents and patient care staff, regardless of whether they received influenza vaccinations during the previous fall.

Chemoprophylaxis should be continued for a minimum of 2 weeks. If surveillance indicates that new cases continue to occur, chemoprophylaxis should be continued until approximately 1 week after the end of the outbreak. The dosage for each resident should be determined individually.

This next site lists dosages for antiviral agents depending upon age: http://www.cdc.gov/flu/professionals/vaccination/#dosage

Another CDC web site defines an influenza outbreak in an institution as “A sudden increase of acute febrile respiratory illness over the normal background rate or when any residents tests positive for influenza. One case of confirmed influenza by any testing method in a long-term care facility resident is an outbreak.
http://www.cdc.gov/flu/professionals/infectioncontrol/institutions.htm

Suspected Norovirus Cases (January 18, 2008)

Benton County Health Department is currently investigating multiple cases of suspected Norovirus infection in Corvallis. Populations affected at this time include OSU students and residents of an assisted living facility. All are ill with nausea, vomiting, and diarrhea. Stool specimens have been submitted for laboratory analysis and results are pending.

Laboratory specimens have been submitted to the Oregon Public Health Laboratory and results are pending. Local healthcare providers, the Oregon Department of Human Services, OSU Student Health Services, OSU Housing and Dining, and the OSU office of Greek Life as well as affected long-term care facilities are collaborating in this investigation.

Area health providers are advised to raise their index of suspicion regarding Norovirus:

Etiology:

  • Classified under Caliciviruses: Non-enveloped RNA virus.

Incubation Period:

  • 12–72 hours, average = 30–36 hours.

Signs and Symptoms:

  • Sudden onset of vomiting, diarrhea, nausea, and stomach cramps.
  • Headache, low-grade fevers, chills, myalgia, and general fatigue are common.
  • Symptoms and side effects of dehydration may be very severe in infants and the elderly.
  • Illness is usually self-limiting and lasts no more than a day or two.

Transmission:

  • Fecal-oral transmission.
  • Virus may be shed for up to 72 hours following the last bout of diarrhea or vomiting, leading to virus transmission – affected persons should not participate in food preparation or care of uninfected persons for three days following diarrhea or vomiting.
  • Sources of transmission: Direct contact with feces or vomitus or environmental surfaces contaminated with feces or vomitus.  Also uncooked foods and shellfish.
  • In addition, vomitus is likely to be infectious by the droplet route. It would appear that an aerosol of particles generated while vomiting, coughing or sneezing after vomiting, and perhaps diarrhea and sloppy cleaning technique can infect people directly or settle onto surfaces that then are touched with hands that sooner or later end up in the mouth.

People most at risk:

  • Day-care providers and children attending childcare.
  • Residents and staff of long-term and nursing care facilities.
  • Health workers and family members caring for infected persons.
  • Residents of communal living situations (fraternities, sororities, dormitories, co-ops).

Diagnostic Tests:

  • Enzyme immunoassay for detection of viral antigen in stool or antibody in serum.
  • Reverse transcriptase polymerase chain reaction (RT-PCR) assay for detection of viral RNA in stool.

Treatment:

  • There is no specific treatment. Rehydration may be needed when vomiting and/or diarrhea is severe.

Prevention:

  • Wash hands after using the toilet and changing diapers and before eating or preparing food.
  • Handwashing with soap and water is highly recommended – There is evidence that waterless hand cleansers may not provide full skin disinfection from Norovirus.

  • Thoroughly clean fruits and vegetables, and steam oysters before eating them.

  • Norovirus is a very robust and durable virus that is highly transmissible and can live for extended periods on environmental surfaces. Disinfect potentially contaminated surfaces thoroughly with diluted bleach: one part bleach and 9 parts water (1/3 cup bleach to 1 gallon of water).
  • Health care workers should practice scrupulous use of PPE, and meticulous disinfection of all equipment is required following every potential norovirus exposure.

For More Information:

2007

Gastroenteritis - Possible Norovirus Advisory October 11, 2007

Benton County Health Department is currently investigating an outbreak of gastroenteritis focused at a Corvallis childcare facility. Specimens collected by BCHD staff have been submitted to the Oregon Public Health Laboratory and results are pending.

Area health providers are advised to raise their index of suspicion regarding Norovirus,

Etiology:

  • Classified under Caliciviruses: Nonenveloped RNA virus

Incubation Period:

  • 12–72 hours, average = 30–36 hours

Signs and Symptoms:

  • Sudden onset of vomiting, diarrhea, nausea, and stomach cramps.
  • Headache, low-grade fevers, chills, myalgia, and general fatigue are common.
  • Symptoms and side effects of dehydration may be very severe in infants and the elderly.
  • Illness is usually self-limiting and lasts no more than a day or two.

Transmission:

  • Fecal-oral transmission
  • Virus may be shed for up to 72 hours following the last bout of diarrhea or vomiting, leading to virus transmission. Affected persons should not participate in food preparation or care of uninfected persons for three days following diarrhea or vomiting.
  • Sources of transmission: Direct contact with feces or vomitus or environmental surfaces contaminated with feces or vomitus. Also uncooked foods and shellfish.

People most at risk:

  • Day-care providers, children attending childcare, their families.
  • Residents and staff of long-term and nursing care facilities.
  • Health workers and family members caring for infected persons.

Diagnostic Tests:

  • Enzyme immunoassay for detection of viral antigen in stool or antibody in serum.
  • Reverse transcriptase polymerase chain reaction (RT-PCR) assay for detection of viral RNA in stool.

Treatment:

  • There is no specific treatment.  Rehydration may be needed when vomiting and/or diarrhea is severe.

Prevention:

  • Wash hands after using the toilet and changing diapers and before eating or preparing food.
  • Hand washing with soap and water is highly recommended – There is evidence that waterless hand cleansers may not provide full skin disinfection from Norovirus.

  • Thoroughly clean fruits and vegetables, and steam oysters before eating them.

  • Norovirus is a very robust and durable virus that is highly transmissible and can live for extended periods on environmental surfaces. Disinfect potentially contaminated surfaces thoroughly with diluted bleach: ½ cups of bleach in one gallon of water. (This strong solution may spot or discolor carpets, clothing and toys.)

  • Health care workers should practice scrupulous use of PPE, and meticulous disinfection of all equipment is required following every potential norovirus exposure.

For More Information:

West Nile Virus Detected in Benton County – Jay Bird Tests Positive Aug. 30, 2007

Health Officials give recommendations for residents to take simple steps in protecting themselves from mosquito bites (read more... [PDF]).

Toy Lead Poisoning Hazard

Fisher-Price recalls licensed character toys due to lead poisoning hazard (read more... [PDF]).

Measles Health Advisory June 5, 2007

On May 30, 2007, Lane County confirmed a case of measles in an adult traveler who acquired the infection in Japan. The individual, a man in his 20s, had not been immunized. His period of potential communicability was May 19–29.

A second case of measles has been reported in Lane County on June 4, 2007. This case is an unimmunized friend of the index case. He had dinner with the index case on May 22, 2007. The case's rash was first noted on June 1. His period of potential communicability was May 28–June 5. Lane County Public Health Department is working to identify anyone who may have had contact with this person locally. Please be on the lookout for suspect cases.

Incubation period ranges from 7–18 days (average 10–12 days) from exposure to the onset of prodromal symptoms. Measles is most communicable during the 3–4 days preceding rash onset. Persons with measles have been shown to shed virus between 4–5 days after the rash has appeared.

Signs and Symptoms:

  • The symptoms appear in two stages:
    • The prodrome stage begins with a runny nose, cough, slight fever, and conjunctivitis (pink eye) that last for several days. The fever will continually rise each day.
    • In the second stage the fever rises to 103o F to 105o F as the rash appears. A maculopapular rash, lasting for 4 to 7 days will appear that usually begins on the neck, behind the ears and the cheeks. Then it spreads over the entire body. Kuplik’s spots (seen only for a day or two before and after onset of rash) are bluish-white specks on a rose-red background appearing on the buccal and labial mucosa usually opposite the molars.

Laboratory confirmation of measles may be obtained, absent measles immunization within the previous 45 days, by one or more of the following tests:

  • Measles virus isolated from body fluids or tissues;
  • IgM antibodies to measles virus; or
  • A four-fold or greater increase in measles IgG antibody titer between acute and convalescent sera (example: acute titer of 1:16 and convalescent titer >1:64), drawn six weeks apart.

The Oregon Immunization Program recommends collecting blood for IgM and IgG testing and a clean-catch urine for viral culture that will be stored until IgM results are available (and discarded when the results are negative). The viral culture should be sent to the Public Health Lab for genotyping if acute measles is confirmed.

Clinical specimens for viral isolation should be collected at the same time as samples taken for serologic testing. Specimens should be properly collected and stored while waiting for case confirmation; see the guidelines available at http://www.cdc.gov/ncidod/dvrd/revb/measles/viral_isolation.htm

Because other susceptible persons may have been exposed, we encourage Oregonians to be aware of their measles immune status. This is especially true of healthcare workers, who in recent outbreaks have been at high risk. All healthcare workers should have evidence of immunity to measles.

Oregon Administrative Rule 333-018-0015(4)(b) requires physicians and laboratories to report suspected measles to the local health department within 24 hours.

2006

Mumps Health Update June 19, 2006

Determining mumps immunity has brought up some questions by providers. These are CDC’s recommendations from MMWR, June 9, 2006, Vol. 55/no. 22, pp 629-30.

Acceptable Presumptive Evidence of Immunity to Mumps includes the following:

1.   In non-outbreak settings:

  • Documented physician-diagnosed mumps, or
  • Serologic evidence of immunity (Positive titer indicates immunity; Negative titer indicates not immune), or
  • Documented receipt of
    1. One dose of mumps vaccine if born before 1957.
    2. Two doses of mumps vaccine if born during or after 1957.

 2.  During an outbreak:

  • Documented physician-diagnosed.
  • Serologic evidence of immunity.
  • Documented receipt of two doses of mumps vaccine regardless of birth date.

Key changes to 1998 ACIP recommendations on mumps—May 17, 2006

Acceptable Presumptive Evidence of Immunity

  • Documentation of adequate vaccination is now 2 doses of a live mumps virus vaccine instead of 1 dose for:
    • School-aged children (i.e., grades K-12).
    • Adults at high risk (i.e., persons who work in health-care facilities, international travelers, and students at post-high school educational institutions).
  • Routine Vaccinations of Health Care Workers
    • Persons born during or after 1957 without other evidence of immunity: 2 doses of a live mumps virus vaccine.
    • Persons born before 1957 without evidence of immunity: consider recommending 1 dose of a live mumps virus vaccine.
  • For Outbreak Settings
    • Children aged 1-4 years and adults at low risk: if affected by the outbreak, consider a second dose* of live mumps virus vaccine.
    • Health-care workers born before 1957 without other evidence of immunity: strongly consider recommending 2 doses of live mumps virus vaccine.

* Minimum interval between doses = 28 days

Mumps Health Update June 8, 2006

Options Regarding Mumps Prevention For Health Care Workers

Following the May 31, 2006 Mumps Health Update issued by BCHD, we have received questions about availability of MMR and single-antigen mumps-only vaccine as health care facilities work to protect their staff from mumps.

One concern is that a national rush to order MMR for health care workers could theoretically create a shortage of MMR vaccine for children.

Another concern is that single-antigen vaccine targets the organism of interest with lower potential side effects than MMR. According to the 2003 AAP Red Book, “Adverse reactions to live-virus mumps vaccine are rare…reactions that occur after immunization with MMR are attributable to the measles and rubella components of the vaccine.” (Red Book, AAP, 2003 26th ed., p.441).

Oregon DHS Immunization Program has reported the following to BCHD:

Merck has reported no shortages or delays in shipment of MMR vaccine at this point, though they have coordinated with CDC when they have received extremely large volume orders.

Single antigen mumps vaccine can be ordered directly from Merck's vaccine order management center. Minimum order is 10 doses; maximum is 30 (per month). Reportedly they will tell you it is back ordered, but technically that simply means they have an approval process that can take a few days and will ship within one week. To order, call the Merck Order Management Center at 1.800.MERCKRX (1.800.637.2579).

Current Mumps Outbreak Situation

As of Tuesday June 6th, 33 confirmed and presumptive mumps cases have been reported in 5 Oregon counties.

To date, BCHD has received two reports of suspected mumps in Benton County, one patient has been tested and test results were negative.

Although at this time mumps is not a mandatory reportable disease in Oregon, the DHS Acute and Communicable Disease Program is tracking cases and requests that providers report suspected cases.

Contact Benton County Health Department Communicable Disease nurses at 541.766.6654 or 6255.

Mumps Health Update May 31, 2006

As of May 31st at least seventeen cases of mumps have been confirmed in Lane County. Cases have been confirmed in at least three other Oregon counties. CDC defines a mumps outbreak as 5 or more cases. This information provides guidelines for laboratory tests and for preventing transmission of mumps in a health care setting. Note: There are new recommendations for immunization.

Control of Mumps in Healthcare Settings
Oregon State Public Health Guidance

19 May 2006

Preventing transmission of mumps in healthcare settings consists of the following:

  • Assessing the immune status of those who work in healthcare settings and vaccinating those without it.
  • Suspecting mumps in patients and healthcare workers with the appropriate symptoms and exposure histories.
  • Reporting cases to the local health department.
  • Collection of appropriate diagnostic specimens from persons with suspected mumps.
  • Isolation of patients in whom mumps is suspected.
  • Isolation (exclusion from work) of employees with mumps for 9 days after the onset of symptoms.
  • Quarantine (exclusion from work) of non-immune employees who are exposed to confirmed, probable, or suspected mumps from the 12th day after the first exposure through the 26th day after the last exposure.
  • Case follow-up

These preventive measures are discussed in more detail below.

Assessing immune status

The following are considered evidence of immunity to mumps for healthcare workers.

1.  In non-outbreak settings:

  • Documented physician-diagnosed mumps
  • Serologic evidence of immunity
  • Documented receipt of
  • 1 dose of mumps vaccine if born before 1957*
  • 2 doses of mumps vaccine if born during or after 1957

2.  During an outbreak:

  • Documented physician-diagnosed mumps
  • Serologic evidence of immunity
  • Documented receipt of two doses of mumps vaccine regardless of birth date

 

*  New recommendation of Advisory Commission on Immunization Practices (ACIP): “health-care facilities should consider recommending 1 dose of MMR vaccine to unvaccinated health-care workers born before 1957 who do not have other evidence of mumps immunity.” MMWR, May 26, 2006; 55: p 559.

Suspecting mumps:

In general, mumps should be suspected in any patient with:

  • Unexplained parotitis lasting >2 days; or
  • Unexplained fever and a history of contact with a mumps case within an incubation period  (14–25 days) before onset.

The prodromal symptoms are nonspecific and include myalgia, anorexia, malaise, headache, and low-grade fever.

Parotitis is the most common manifestation and occurs in 30%–40% of infected persons. Parotitis may be unilateral or bilateral, and any combination of single or multiple salivary glands may be affected. Parotitis tends to occur within the first 2 days and may present as an earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after 1 week and usually resolve after 10 days.

Note: Swelling of the salivary glands can also be caused by infection with cytomegalovirus, parainfluenza virus types 1 and 3, influenza A, Coxsackie A, echovirus, lymphocytic choriomeningitis virus, HIV, and non-infectious causes such as drugs, tumors, immunologic diseases, and obstruction of the salivary duct.

Fever when present may persist for 3–4 days. As many as 20% of mumps infections are asymptomatic and, as a result, the diagnosis is easily missed. An additional 40%–50% may have only nonspecific or primarily respiratory symptoms.

Reporting cases:

  • Notify the local health department for the jurisdiction wherein the suspected case resides.
  • Report the usual demographic and clinical information, as well as how to contact the suspected case.
  • Obtain specimens from the patient.

Laboratory testing:

Because there are many causes of fever and parotitis other than mumps, attempts should be made to confirm suspected mumps through laboratory testing. Obtain specimens as soon as possible after symptom onset.

For viral culture:

  • Culture of urine or parotid gland fluid for mumps virus will be performed by the Oregon State Public Health Laboratory (OSPHL) at no cost for patients with
  • Unexplained parotitis lasting >2 days; or
  • Unexplained fever and a history of contact with a mumps case within an incubation period (14–25 days) before onset.
  • Positive cultures are reported as they are identified; results will be reported as “negative” if there is no viral growth after 14 days. If you have a patient who meets either of these criteria, please contact the patient’s local health department for approval before sending in specimens. Patients who don’t fit these criteria can have viral culture performed at OSPHL for $35.
  • Virus may be isolated from the buccal mucosa from 7 days before until 9 days after the onset of parotitis and from urine during the period from 6 days before to 15 days after the onset of parotitis.
  • Parotid gland/buccal swab may provide the best viral sample. A commercial product designed for collection of throat cultures or a plain Dacron or cotton-tipped swab can be used. Massage the parotid gland area (the space between the cheek and teeth just below the ear) for about 30 seconds prior to collection of the buccal secretions. The parotid duct (Stensen’s duct) drains in this space near the upper rear molars. A throat swab (oropharyngeal or nasopharyngeal swab) can also be collected and added together with the buccal swab. Place the swabs in a tube containing 2–3 ml of viral transport medium or cell culture medium (MEM or Hanks Balanced Salt Solution) or other sterile isotonic solution (phosphate buffered saline).
  • Urine: collect 5–10 ml of a clean-catch specimen and store in a screw-top sterile container, preferably a 15 ml centrifuge tube. Upon receipt at a facility equipped to centrifuge the urine sample, the urine is centrifuged at 4°C for 10 minutes at 400 x g and the sediment re-suspended in 2–3 ml of viral transport medium.
  • Keep samples cold (4°C). If there is more than 1-day delay in shipping the samples to the state public health lab for testing, the buccal swab or throat swab is best preserved at -70°C. The sediment of urine can be frozen at -70°C; but bulk urine should be kept cold (4°C) but not frozen. Ship the viral specimens using ice packs or dry ice. If a shipment contains both serum and viral samples, ship together by overnight service on cold packs (do not freeze serum). Avoid freeze-thaw cycles.

Serologic testing is not done at OSPHL, but it is available at commercial laboratories for both IgM and IgG. As with measles and rubella, mumps IgM may be transient or missing in persons who have had any doses of mumps containing vaccine.

Isolation & Quarantine:

  • Patient isolation. Patients should be placed on droplet precautions for the duration of their hospitalization. Droplet precautions should be maintained for 9 days after onset of symptoms.
  • If an employee or healthcare worker develops a suspected case of mumps, exclude the person from work until 9 days after the onset of symptoms.
  • Healthcare workers without evidence of immunity who have had unprotected exposures to mumps (defined as being within three feet of a patient with mumps without the use of a surgical mask).
    • Exposed healthcare workers with no documentation of mumps vaccination should be excluded from work during the 12th through the 26th day after exposure. Meanwhile, attempts should be made to vaccinate the healthcare worker.
    • Exposed healthcare workers with documentation of a single dose of mumps vaccine may work following an exposure to mumps, but they should be given a second dose as soon as possible, but no sooner than 28 days after the first.
  • Healthcare workers with evidence of immunity do not need to be excluded from work following an unprotected exposure. However, because 1 dose of MMR vaccine is about 80% effective in preventing mumps and 2 doses are about 90% effective, some vaccinated personnel may contract mumps. Therefore, healthcare workers should be educated about symptoms of mumps, including non-specific presentations, and should notify employee health if they develop these symptoms.

Prevention of spread:

Good personal hygiene

  • Proper hand hygiene, disposal of used tissues, not sharing eating utensils.
  • Suspected cases should be separated from other patients and wear surgical masks if in a waiting room.

Case follow-up:

Public health staff will contact the case and probably the case’s healthcare provider, as well, and collect information about symptoms, laboratory tests, mumps immunization history, recent history of travel, and whether there was any recent contact with anyone with similar symptoms.

Why might some people born before 1957 need to be vaccinated with MMR?
MMWR article Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome & Control of Mumps: Recommendations of ACIP, May 22, 1998 / 47(RR-8);1-57)

Norwalk-Like Virus (Norovirus) April 27, 2006

Benton County Health Department is currently investigating an outbreak of Norovirus focused at the childcare facility of North Albany Community Church. Oregon Public Health Laboratory has isolated Norovirus from specimens collected by BCHD staff. Local healthcare providers, the Oregon Department of Human Services, and Linn County Health Department are collaborating on this investigation.

Area health providers are advised to raise their index of suspicion regarding Norovirus:

Etiology:

  • Classified under Caliciviruses: Nonenveloped RNA virus.

Incubation Period:

  • 12–72 hours, average = 30–36 hours.

Signs and Symptoms:

  • Sudden onset of vomiting, diarrhea, nausea, and stomach cramps.
  • Headache, low-grade fevers, chills, myalgia, and general fatigue are common.
  • Symptoms and side effects of dehydration may be very severe in infants and the elderly.
  • Illness is usually self-limiting and lasts no more than a day or two.

Transmission:

  • Fecal-oral transmission
  • Virus may be shed for up to 72 hours following the last bout of diarrhea or vomiting, leading to virus transmission – affected persons should not participate in food preparation or care of uninfected persons for three days following diarrhea or vomiting.
  • Sources of transmission: Direct contact with feces or vomitus or environmental surfaces contaminated with feces or vomitus. Also uncooked foods and shellfish.

People most at risk:

  • Day-care providers and children attending childcare.
  • Residents and staff of long-term and nursing care facilities.
  • Health workers and family members caring for infected persons.

Diagnostic Tests:

  • Enzyme immunoassay for detection of viral antigen in stool or antibody in serum.
  • Reverse transcriptase polymerase chain reaction (RT-PCR) assay for detection of viral RNA in stool.

Treatment:

  • There is no specific treatment. Rehydration may be needed when vomiting and/or diarrhea is severe.

Prevention:

  • Wash hands after using the toilet and changing diapers and before eating or preparing food.
  • Handwashing with soap and water is highly recommended. There is evidence that waterless hand cleansers may not provide full skin disinfection from Norovirus.
  • Thoroughly clean fruits and vegetables, and steam oysters before eating them.
  • Norovirus is a very robust and durable virus that is highly transmissible and can live for extended periods on environmental surfaces. Disinfect potentially contaminated surfaces thoroughly with diluted bleach: one part bleach and 9 parts water.
  • Health care workers should practice scrupulous use of PPE, and meticulous disinfection of all equipment is required following every potential norovirus exposure.

For More Information:

Norovirus Health Advisory April 24, 2006

Health officials advise precautionary steps regarding a suspected Norovirus outbreak

An outbreak of diarrhea and vomiting, suspected to be caused by Norovirus, was reported to the Benton County Health Department on Friday, April 21, 2006. As of Monday morning, 13 cases were identified. Cases identified so far are connected with North Albany Community Church. Samples were sent to the Oregon Public Health Laboratory on Monday, April 24, 2006, and results are expected by Thursday.

All people directly linked to the outbreak have been identified and contacted. Preventive measures, including cancellation of services and cleaning the facilities, were implemented over the weekend. The Benton County Health Department Communicable Disease and Environmental Health staff is working with the Oregon Department of Human Services, and Linn County Health Department to address the health issue. The church has been proactive and cooperative throughout the process.

“Norovirus is the infamous ‘cruise ship virus,’ which has caused a number of high-profile diarrhea outbreaks,” said Charlie Fautin, Public Health Division deputy administrator. “It is a common virus and outbreaks occur when someone who is infected handles food for others.”

Hand sanitizers may not be effective against Norovirus. The Health Department advises anyone with nausea or diarrhea to be vigilant:

  • Wash hands frequently with soap and water for at least 20 seconds and especially after using the bathroom and changing a diaper, after coughing and sneezing, and before preparing and eating food
  • Use a bleach solution (14 oz. of bleach to one gallon of water) to clean contaminated surfaces, such as doorknobs, shared tables or countertops
  • Cover your nose and mouth when you cough or sneeze because the Norovirus can also be transmitted by airborne matter
  • Cook foods well and wash fruits and vegetables before eating them since transmission can also occur through eating contaminated foods

An active role must be taken to prevent the spread of Norovirus. The illness is usually very brief and lasts no more than a day or two. Most persons recover without treatment.

Symptoms include sudden onset of high rates of vomiting, diarrhea, nausea, and stomach cramps. Other symptoms include headache, low-grade fevers, chills, muscle aches, and a general sense of tiredness. With diarrhea and vomiting, it is important to stay hydrated with lots of water.

There is no vaccine available to prevent infection.

For More Information:

Mumps Health Update April 15, 2006

This is an official CDC Health Update distributed via the Health Alert Network on April 15, 2006, 12:39 EDT (12:39 PM EDT).

Corrected: Multi-state Mumps Outbreak

This message is being sent to correct the flight arrival city in Arkansas indicated for this outbreak. The arrival city was Bentonville, AR not Lafayette.

Original information from the CDC Advisory #00243, transmitted April 14, 2006:

The state of Iowa has been experiencing a large outbreak of mumps that began in December 2005 (1). As of April 12, 2006, 605 suspect, probable and confirmed cases have been reported to the Iowa Department of Public Health (IDPH) (IDPH, unpublished data). The majority of cases are occurring among persons 18-25 years of age, many of whom are vaccinated. Additional cases of mumps, possibly linked to the Iowa outbreak, are also under investigation in eight neighboring states, including Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin (CDC unpublished data, April 14, 2006)

In addition, the Iowa Department of Public Health has identified two persons diagnosed with mumps who were potentially infectious during travel on nine different commercial flights involving two airlines between March 26, 2006 and April 2, 2006. The origin and arrival cities for these flights include Cedar Rapids and Waterloo, IA; Dallas, TX; Detroit, MI; Lafayette, AR; Minneapolis, MN; St. Louis, MO; Tucson, AZ; and Washington, D.C. (2).

The source of the current US outbreak is unknown. However the mumps strain has been identified as genotype G, the same genotype circulating in the United Kingdom (UK). The outbreak in the UK has been ongoing from 2004 to 2006 and has involved > 70,000 cases. Most UK cases have occurred among unvaccinated young adults (3). The G genotype is not an unusual or rare genotype and, like the rest of known genotypes of mumps, it has been circulating globally for decades or longer.

Mumps Clinical Manifestations and Transmission

Mumps is an acute viral infection characterized by a non-specific prodrome including myalgia, anorexia, malaise, headache and fever, followed by acute onset of unilateral or bilateral tender swelling of parotid or other salivary glands (4). In unvaccinated populations, an estimated 30-70% of mumps infections are associated with typical acute parotitis (4, 5). However, as many as 20% of infections are asymptomatic and nearly 50% are associated with non-specific or primarily respiratory symptoms, with or without parotitis (4).

Complications of mumps infection can include:

  • deafness
  • orchitis
  • oophoritis or mastitis (inflammation of the testicles, ovaries, or breasts respectively)
  • pancreatitis
  • meningitis/encephalitis
  • spontaneous abortion

With the exception of deafness, these complications are more common among adults than children (4).

Transmission of mumps virus occurs by direct contact with respiratory droplets, saliva or contact with contaminated fomites. The incubation period is generally 16-18 days (range 12-25 days) from exposure to onset of symptoms (4, 6). Mumps virus has been isolated from saliva from between two and seven days before symptom onset until nine days after onset of symptoms (4, 6).

Mumps Prevention:

The principal strategy to prevent mumps is to achieve and maintain high immunization levels. The Advisory Committee on Immunization Practices (ACIP) recommends that all preschool aged children 12 months of age and older receive one dose of measles-mumps-rubella vaccine (MMR) and all school-aged children receive two doses of MMR, and to ensure that all adults have evidence of immunity against mumps (5). As noted below, two doses of mumps vaccine are more effective than a single dose. Consequently, during outbreaks and for at-risk populations, ensuring high vaccination coverage with two doses is encouraged. For example, health care workers may be at increased risk of acquiring mumps and transmitting to patients and thus should receive two doses of MMR vaccine or provide proof of immunity. Since vaccination is the cornerstone of mumps prevention, public and private health entities concerned about spread of mumps in a population can review the vaccination status of populations of interest and work to address gaps in vaccination.

Mumps Vaccine Effectiveness:

Data from outbreak investigations have shown that the effectiveness of MMR against mumps is approximately 80% after one dose and limited data suggest effectiveness of approximately 90% after two doses. Available evidence suggests that mumps vaccination should provide immunity against the genotype G virus responsible for the current US outbreak. A study of a 2005 New York outbreak that began with imported disease from the UK (7), demonstrated vaccine effectiveness in the expected range for both one and two doses (New York, unpublished data). However, since the vaccine is not 100% effective, some cases can occur in vaccinated persons. When a highly-vaccinated population is exposed to disease, most cases of disease would be expected to be among vaccinated persons. Mumps vaccine has not been shown to be effective in post-exposure prophylaxis and an interval of 2-4 weeks after vaccination may be required for the vaccine’s full immunogenicity to be achieved. For these reasons, and because of the mumps’ incubation period of 12-25 days, during an outbreak, newly-vaccinated persons may develop mumps disease as long as a month after vaccination (4, 5).

Control of Mumps Outbreaks:

The main strategies for controlling a mumps outbreak are to define the at-risk population and transmission setting, identify and isolate suspected cases, and to rapidly identify and vaccinate susceptible persons or, if a contraindication to MMR vaccine exists, to exclude susceptible persons from the setting to prevent exposure and transmission. Specific strategies are listed below:

  • Offer MMR vaccine to persons without evidence of immunity. Evidence of immunity includes physician diagnosis or laboratory evidence of mumps infection, birth before 1957 or one dose of MMR vaccine. For pre-school aged children, the first MMR dose should be administered as close to age 12 months as possible. Although birth before 1957 is usually considered proof of immunity, during an outbreak, vaccination can be considered for this age group if the epidemiology of the outbreak suggests that they are at increased risk of disease. Since two doses of MMR vaccine is more effective than one dose for preventing mumps, a second dose of MMR vaccine is recommended for the following groups: health care workers, school-aged children, students at post-high school educational institutions and other age groups considered at high risk of exposure (5, 8).
  • Surveillance for mumps should be enhanced in all affected areas for persons with parotitis or other salivary gland inflammation. Enhanced surveillance should continue for 50 days (two times the maximum incubation period) after the date of illness onset in the last identified case. CSTE approved case definitions and case classifications for mumps are available (5).
  • Persons with suspected mumps should be tested and reported immediately to local public health officials. http://www.cdc.gov/vaccines/vpd-vac/mumps/outbreak/faqs-lab-test-infect.htm. Testing is essential as not all cases of parotitis are mumps, although mumps is the only known cause of epidemic parotitis.
  • Persons suspected of having mumps should be isolated for nine days after symptom onset (5, 6). In health care settings, the use of respiratory precautions is recommended (5).
  • Exclusion of persons without evidence of immunity to mumps from institutions such as schools and colleges affected by a mumps outbreak (and other, unaffected institutions judged by local public health authorities to be at risk for transmission of disease) should be considered. Once vaccinated, students can be readmitted to school. The period of exclusion for those that remain unvaccinated should be for at least 25 days after the onset of parotitis in the last person with mumps in the affected institution (5, 6).

Additional information on mumps and the prevention and control of mumps outbreaks, including vaccination, can be found at the following web site: http://www.cdc.gov/vaccines/vpd-vac/mumps/default.htm.

2005

Rubella Health Alert June 10, 2005

A suspected case of rubella (also known as German Measles) was reported to the Benton County Health Department on June 10th. The case was laboratory confirmed on June 14th.

The Health Department is working on this case in conjunction with Oregon Department of Human Services (DHS) and the Centers for Disease Control & Prevention (CDC) to help determine where the infection originated.

Benton County Health Department is taking measures to protect members of the local community from exposure. Public health nurses have already identified and contacted all persons who might have been exposed. Because rubella is contagious and because it can be fatal, we follow up every case aggressively.

For more information visit the Communicable Disease page.

2004

Pertussis Health Advisory June 14, 2004

Pertussis (Whooping Cough) Talking Points

Pertussis is a serious bacterial respiratory illness. A classic case often starts with a runny nose, scratchy throat, and cough. Pertussis is difficult to diagnose because its symptoms may resemble those of the common cold, but the cough of pertussis becomes more severe and persists for up to six weeks.

Pertussis bacteria are spread by coughing, sneezing, or on the hands of infected persons.

For more information visit the Communicable Disease page.

 
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Benton County Health Department  •  530 NW 27th St.  •  Corvallis, OR 97330  •  541.766.6835
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