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Jackie Dawson, PhD
Public Health Epidemiologist
Chelan, Douglas, Grant, Kittitas and Okanogan Counties
[email protected]
886-6428
Lyme Disease (Borrelia burgdorferi)

Ticks Infected with Borrelia burgdorferi (Lyme)

Tick-borne Relapsing Fever
(Borrelia hermsii)

 Rodent infested cabins
 Signs/symptoms: Fever, headache,
myalgia, chills, nausea, vomiting,
arthralgia
Tick-borne Diseases

Tick Paralysis

 Caused by a neurotoxin from an attached tick.
 Progressive paralysis that usually starts in the legs with muscle
weakness, loss of coordination, numbness, and difficulty standing or
walking. The symptoms progress upwards to the abdomen, back,
and chest.
 Similar to Guillain-Barre syndrome or botulism
 If the tick is not removed, paralysis of the chest muscles can lead to
respiratory failure and death within 24 to 48 hours after symptoms
begin.
 Prompt removal of the tick usually leads to a complete recovery.
 Ticks include Ixodes and Dermacentor species
Preventing Tick Bites

 Avoid wooded and bushy areas with high grass and leaf litter. Walk in the
center of trails.
 Use repellents that contain 20 to 30% DEET (N, N-diethyl-m-toluamide) on
exposed skin and clothing for protection that lasts up to several hours.
 Treat clothing and gear with products containing 0.5% permethrin.
 Bathe or shower as soon as possible after coming indoors (preferably
within 2 hours
 Conduct a full-body tick check. Parents should check their children for ticks
under the arms, in and around the ears, inside the belly button, behind the
knees, between the legs, around the waist, and especially in their hair.
 Examine gear and pets.
 Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.
http://www.cdc.gov/ticks/avoid/on_people.html

www.cdc.gov/ticks/removing_a_tick.html
Insect Repellents

http://cfpub.epa.gov/oppref/insect/search_results.cfm?Rangetime=&hidSelected=1&
ProductName=&Ingredient=null&Company=null&Registration=&Submit=Search
Whatcom E.coli Outbreak

 >1,300 first graders
 Milk Makers Fest April 21-23, 2015 held in dairy barn
 Shiga toxin-producing E.coli 0157:H7; fecal-oral transmission
 20 lab-confirmed cases, 4 cases of hemolytic uremic
syndrome=HUS=kidney failure, 9 hospitalized; 0 deaths
 1 to 8 days: stomach cramps, diarrhea (bloody), vomiting
 Adults excrete E. coli O157:H7 for up to 1 week but 1/3 of
children up to 3 weeks.
 Farm animal petting zoo?
 Pasteurized chocolate milk
 CDC assisting with investigation
Healthcare Worker Definition

 Health care workers include (but are not limited to) physicians,
nurses, nursing assistants, therapists, technicians, emergency
medical service personnel, dental personnel, pharmacists,
laboratory personnel, autopsy personnel, students and trainees,
contractual staff not employed by the health-care facility, and
persons (e.g., clerical, dietary, housekeeping, laundry, security,
maintenance, administrative, billing, and volunteers) not
directly involved in patient care but potentially exposed to
infectious agents that can be transmitted to and from health
care workers and patients.
www.cdc.gov/flu/healthcareworkers.htm
Healthcare Personnel Vaccination Recommendations

 MMR – For healthcare personnel (HCP) born in 1957 or later
without serologic evidence of immunity or prior vaccination,
give 2 doses of MMR, 4 weeks apart.
 Although birth before 1957 generally is considered acceptable
evidence of immunity, 2 doses of MMR vaccine should be
considered for unvaccinated HCP born before 1957 who do not
have laboratory evidence of disease or immunity to measles
and/or mumps.
 One dose of MMR vaccine should be considered for HCP with
no laboratory evidence of disease or immunity to rubella. For
these same HCP who do not have evidence of immunity, 2
doses of MMR vaccine are recommended during an outbreak
of measles or mumps and 1 dose during an outbreak of rubella.
www.immunize.org/catg.d/p2017.pdf

 Spokane: 10th case (unvaccinated, exposed to 9th case)
 183 measles cases in Ontario, Manitoba, and British Columbia
www.seattlechildrens.org/healthcare-professionals/education/outreach/
Healthcare Personnel Vaccination Recommendations

 Hepatitis B – If previously unvaccinated, give 3-dose series (dose #1 now, #2 in
1 month, #3 approximately 5 months after #2). For HCP who perform tasks that
may involve exposure to blood or body fluids, obtain anti-HBs serologic testing
1–2 months after dose #3.
 Influenza – Give 1 dose of influenza vaccine annually.
 Varicella (chickenpox) – For HCP who have no serologic proof of immunity,
prior vaccination, or diagnosis or verification of a history of varicella or herpes
zoster (shingles) by a healthcare provider, give 2 doses of varicella vaccine, 4
weeks apart.
 Meningococcal – Give 1 dose to microbiologists who are routinely exposed to
isolates of Neisseria meningitidis and boost every 5 years if risk continues.
 Tetanus, diphtheria, pertussis – Give 1 dose of Tdap as soon as feasible to all
HCP who have not received Tdap previously and to pregnant HCP with each
pregnancy (see below). Give Td boosters every 10 years thereafter.
 Hepatitis A, typhoid, and polio vaccines are not routinely recommended for
HCP who may have on-the-job exposure to fecal material.
www.immunize.org/catg.d/p2017.pdf

http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-254-PertussisUpdate.pdf
WA: Pertussis cases, 2015

79% cases in school aged children.
www.doh.wa.gov/Portals/1/Documents/Pubs/348-254-PertussisUpdate.pdf

www.doh.wa.gov/Portals/1/Documents/Pubs/348-254-PertussisUpdate.pdf
Tdap Efficacy

 If all pertussis vaccines received were acellular and
then the individual received Tdap:
 Vaccine efficacy =
 1st year -73% effective
 2nd year -54% effective
 3rd to 4th year -34% effective
www.seattlechildrens.org/healthcare-professionals/education/outreach/
Questions?


WA: reported measles cases

www.seattlechildrens.org/healthcare-professionals/education/outreach/
May 6, 2015
K20 Statewide Nursing Seminar: Stopping the Spread of Communicable Disease in Schools