Communicable
Disease Update
Avian Influenza in Wisconsin
Several domestic poultry flocks in Wisconsin have experienced
outbreaks of H5N2 influenza. Several other Midwestern states
APRIL, 2015
Acute & Communicable Disease Summary
for January - March 2015
Dane County
to humans, but there is concern the virus could mutate and
Below is a preliminary listing of the acute and
communicable diseases reported to Public Health
Madison & Dane County (PHMDC) during January
- March 2015 and January - March 2014 for
comparison. Data are based on ACD reports received
by PHMDC. These numbers are not a complete picture
of communicable diseases in Dane County; some
infections may not have been reported yet and some
are never reported.
more easily infect humans. The Wisconsin Department of Health
Reportable Communicable Diseases in Dane County
have also experienced outbreaks.
There has been no known transmission of this influenza virus
Services has issued guidelines for post-exposure prophylaxis
Disease
Number of Cases
1st Q 2015
1st Q 2014
0
2
for asymptomatic individuals exposed to infected birds
Anaplasmosis
Babesiosis
0
and guidelines for testing of exposed individuals who have
Blastomycosis
1
1
influenza-like illness or conjunctivitis. These guidelines can be
Campylobacter
22
26
Chikungunya
found at the end of this newsletter and on PHMDC’s website.
Chlamydia
Lyme Disease
Survey
Ebola
0
0
482
501
Coccidioidomycosis
0
0
Cryptosporidium
7
12
Dengue
0
0
Shiga toxin-producing E. coli
4
4
Ehrlichiosis
1
1
Giardia
17
16
Gonorrhea
121
86
Haemophilus influenzae invasive disease
2
1
Hepatitis A
0
1
Hepatitis B
18
14
Hepatitis C
75
51
Hepatitis E
1
0
Histoplasmosis
2
0
210
146
Legionella
0
0
Listeriosis
1
0
Lyme Disease
4
8
Malaria
1
2
Meningococcal disease
0
0
Mumps
0
1
Pelvic inflammatory disease
3
1
Pertussis (confirmed & probable)
24
14
Influenza-associated hospitalization
Inside this issue . . .
0
Q Fever
1
2
Salmonella
13
23
Shigella
1
6
Streptococcus, Group A invasive disease
4
5
Streptococcus, Group B invasive disease
4
6
Streptococcus pneumoniae invasive disease
8
10
Syphilis (1o, 2o)
5
4
Toxic shock syndrome
1
0
Toxoplasmosis
1
1
Tuberculosis
1
2
Varicella
13
8
Vibrio, non-cholera
0
1
It’s Time to Prevent Lyme Disease
Post-Exposure Prophylaxis Recommendations for People Bitten by Blacklegged Ticks
The arrival of spring brings increased tick activity in
Wisconsin and an increased risk of acquiring Lyme
disease.
Lyme disease is the most frequently reported tickborne disease in Wisconsin. Lyme disease is caused
by the bacterium Borrelia burgdorferi, which is spread
through the bite of an infected blacklegged tick (also
known as deer ticks). Blacklegged ticks in many parts
of Wisconsin, including Dane County, have been
found to be infected with B. burgdorferi. According to
the Wisconsin Department of Health Services (WDHS),
the average nymphal infectivity rate in Wisconsin is
22%.
If a patient calls about a tick bite, it is important that
the tick is removed promptly and properly, if still
attached. The CDC has good instructions for tick
removal. See www.cdc.gov/lyme/removal. If the tick
is removed within 24 hours of attachment, the risk for
Lyme disease is very low.
The Infectious Diseases Society of America (IDSA)
issued Lyme disease treatment guidelines in 2006.
They include the recommendation for post-exposure
prophylaxis (PEP) for people bitten by blacklegged
ticks if the following criteria are met:
yy The tick was attached for at least 36 hours (WDHS
recommends 24 hours), and;
yy It has been less than 72 hours after tick removal,
and;
yy The tick infectivity rate is at least 20% (all of
Wisconsin is considered to meet this criterion per
the WDHS), and;
yy Treatment with doxycycline is not
contraindicated.
The recommended antibiotic course for PEP is
a single dose of doxycycline for adults (200 mg)
and children >8 years old (4 mg/kg up to 200 mg).
Individuals who have had Lyme disease in the past
can become infected again so previous infection is
not a contraindication for PEP.
Helpful Websites:
yy CDC: www.cdc.gov/lyme
yy Wisconsin Department of Health Services: www.dhs.wisconsin.gov/tickborne/lyme/index.htm
yy University of Wisconsin Dept. of Entomology: http://labs.russell.wisc.edu/wisconsin-ticks/lyme-disease
yy IDSA treatment guidelines: http://cid.oxfordjournals.org/content/43/9/1089.full
Acute & Communicable Disease
Reports for 2014
2015 Community Health Needs
Assessment Survey
For Wisconsin case definitions, see individual diseases
at: www.dhs.wisconsin.gov/disease/index.htm.
The Healthy Dane Collaborative (HDC) would like
Sexually Transmitted Infections
Dane County
2014
2013
Chlamydia
Gonorrhea
Syphilis (1° & 2°)
HIV/AIDS
1888
394
13
25
2,046
280
14
30
13
0
1
0
0
119
4
0
57
0
3
30
1
0
53
8
0
3
66
222
0
0
0
0
321
0
0
10
1
85
4
0
1
40
3
162
1
2
106
18
70
0
2
1
0
8
1
0
28
6
0
0
16
2
3
0
0
110
0
1
73
4
1
35
1
3
61
7
0
2
60
184
0
0
2
0
319
1
2
10
0
122
2
0
4
0
3
115
0
0
84
6
66
0
0
1
2
6
0
0
30
2
4
2
Other Communicable Diseases
Anaplasmosis
Babesiosis
Blastomycosis
Botulism
Brucellosis
Campylobacteriosis
Chikungunya
Coccidioidomycosis
Cryptosporidiosis
Cyclosporiasis
Dengue
E. coli, shiga toxin-producing
Ehrlichiosis
Ehrlichiosis/anaplasmosis undetermined
Giardia
Haemophilus influenzae invasive disease
Hemolytic uremic syndrome
Hepatitis A
Hepatitis B*
Hepatitis C*
Hepatitis D
Hepatitis E
Histoplasmosis
Influenza A, novel subtype
Influenza-associated hospitalization
Jamestown Canyon virus
LaCrosse encephalitis
Legionellosis
Listeriosis
Lyme Disease
Malaria
Meningitis, bacterial
Meningococcal disease
Mumps
Pelvic inflammatory disease
Pertussis
Q fever
Rocky Mountain Spotted Fever
Salmonella
Shigella
Streptococcal disease, invasive
Tetanus
Toxic shock syndrome
Toxoplasmosis
Transmissible spongiform encephalopathy
Tuberculosis
Typhoid fever
Typhus fever
Varicella
Vibriosis, non-cholera
West Nile virus infection
Yersiniosis
*Includes newly reported carriers
to invite you to participate in the 2015 Community
Health Needs Assessment survey.
HDC is comprised of Public Health Madison & Dane
County, St. Mary’s Hospital, Meriter Hospital, UW
Hospital and Stoughton Hospital. Every three years
the HDC conducts a county-wide Community Health
Needs Assessment. Data from the assessment will
help guide programs and funding to improve health
in the areas identified by you, the voices of Dane
County.
Your opinion matters! Here is the link to the 2015
Community Health Needs Assessment, in Spanish and
English: www.healthydane2015.com.
Please share with your partners and networks. The
survey closes on May 30.
Thank you for taking a few minutes to complete this
questionnaire!
Local Ebola Response Update
Ebola cases continue to occur in Liberia, Sierra Leone and
Guinea. Therefore, Ebola remains a focus of Public Health
Madison & Dane County’s (PHMDC) work. Since October
2014, PHMDC has been monitoring two to five travelers
at any given time for a total of 32 individuals and 37
monitoring periods (some individuals have made more than
one trip). Almost all travelers have been classified as “Low
Risk”, meaning that they were in one of the Ebola-affected
West Africa countries, but were very unlikely to have been
exposed to Ebola. Low Risk travelers take their temperatures
twice daily and PHMDC staff check in with them via phone
once each day for 21 days. A small number of travelers
arriving in Dane County have been classified as “Some
Risk”. That means they were in proximity to the Ebola virus or people with it, but took precautions adequate to
prevent exposure. PHMDC staff phone Some Risk travelers twice daily for temperature and symptom reports,
with one of these calls being made with a video-phone software application such as FaceTime. PHMDC is
working with a local tech start-up to develop an app to monitor healthcare workers in the event of a confirmed
local case, as individuals participating in the individual’s care would require monitoring for at least 21 days.
In addition to monitoring, work with travelers has included discussions with the Wisconsin Division of Public
Health (WI DPH) and relevant health care providers about whether travelers need to seek medical care during
their monitoring periods. Most health care visits have been deferred until after the 21 days of monitoring. In
the unusual circumstances when medical care was needed more urgently, PHMDC, WI DPH, the health care
organization and Madison Fire Department worked intensively together to assure safe transport and care,
without alarming other patients or the community.
The systems that PHMDC, Dane County’s health care systems, emergency responders, and WI DPH worked
hard to develop have performed exceedingly well and PHMDC appreciates everyone’s cooperation during this
ongoing public health emergency.
PUBLIC HEALTH CONTACT INFORMATION
Report Communicable Diseases in Madison and Dane County:
Call the Communicable Disease Intake Nurse............................................................................................................... (608) 266-4821
Fax:
Communicable Disease Intake Nurse..................................................................................................... (608) 266-4858
Mail:
PUBLIC HEALTH MADISON & DANE COUNTY
ATTN: COMMUNICABLE DISEASE
2300 S PARK ST STE 2010
MADISON WI 53713
Communicable Disease Epidemiologist:
Amanda Kita-Yarbro ([email protected])................................................................................................... (608) 243-0336
Public Health Madison & Dane County:
General........................................................................................................................................................................................ (608) 266-4821
Fax................................................................................................................................................................................................. (608) 266-4858
After Hours Contact Number for Public Health Madison & Dane County:
Dane County Non-Emergency Dispatch......................................................................................................................... (608) 267-3913
DIVISION OF PUBLIC HEALTH
Scott Walker
Governor
Kitty Rhoades
Secretary
1 WEST WILSON STREET
P O BOX 2659
MADISON WI 53701-2659
State of Wisconsin
Department of Health Services
608-266-1251
FAX: 608-267-2832
dhs.wisconsin.gov
TO:
Wisconsin Health Care Providers
FROM: Jeffrey P. Davis, MD, Chief Medical Officer and State Epidemiologist for Communicable
Diseases
RE:
Guidance to clinicians presented with a person following exposure to avian influenza
DATE: April 21, 2015
Three outbreaks of H5N2 influenza among domestic poultry have recently occurred in Wisconsin. This
follows the occurrence of outbreaks among birds in Minnesota, South Dakota, Missouri, Iowa, and
several other states caused by this H5N2 strain of influenza A virus.
1) To date, the H5N2 influenza virus causing the current outbreaks in U.S. poultry has not been
demonstrated to be pathogenic in humans. However there is concern about the virus’ potential to
mutate and increase its host range.
2) Persons at risk include only those who had direct unprotected contact (i.e., no use of personal
protective equipment) with the infected flock or who have been on the farm premises within the
past 10 days.
3) If a person at risk is not ill and has simply been exposed to infected birds, we recommend
oseltamivir (Tamiflu) prophylaxis using a treatment dosage.
a. Adult dose: 75 mg orally BID for 10 days
b. Pediatric dosing for children > 12 months:
- Weight <15kg (<33 pounds) - oseltamivir 30 mg orally twice daily for 7-10 days
- Weight 16-23kg (34-51 pounds) - oseltamivir 45 mg orally twice daily for 7-10 days
- Weight 24-40kg (52-88 pounds) - oseltamivir 60 mg orally twice daily for 7-10 days
- Weight >40kg (>88 pounds) - oseltamivir 75 mg orally twice daily for 7-10 days
c. Dosing adjustments for persons with known renal impairment can be found at
www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm in Table 5.
4) If an exposed person has an influenza-like illness or conjunctivitis, he or she should be seen for
evaluation and testing. Please mask the patient upon clinic entry and take directly into an exam
room. Airborne and contact precautions are advised (gloves, gown, eye protection such as
goggles or face shield, and N-95 or PAPR) for all patient care activities.
a. Collect a nasopharyngeal (NP) and oropharyngeal (OP) swab, place both into the same
viral transport media, and submit the specimen to the Wisconsin State Laboratory of
Hygiene (WSLH) for influenza testing and strain identification.
- MORE-
Wisconsin.gov
Page 2
Please use the Enhanced Surveillance Form when submitting specimens to WSLH. The
form is available by calling the WSLH Customer Service department at 608-262-6386 or
online at www.slh.wisc.edu/wcln-surveillance/surveillance/virology-surveillance/
Contact the Division of Public Health to obtain approval for testing (608-267-9003
during office hours, 608-258-0099 after hours).
b. We recommend that oseltamivir be prescribed for exposed persons who are symptomatic
with influenza-like illness. Dosages are the same as for prophylaxis (see point 3 above),
but treatment duration is typically 5 days. Longer treatment courses for patients who
remain severely ill after 5 days of treatment can be considered.
c. Consider oseltamivir prophylaxis for other household members if the index patient tests
positive for influenza.
5) Notify the Wisconsin Division of Public Health promptly if you have seen a patient with
influenza-like illness who had exposure to infected birds. Be prepared to provide demographic
details and exposure information for the patient. Please call our Bureau of Communicable
Diseases at 608-267-9003.