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COMMUNICABLE
DISEASE NEWSLETTER
Hand, Foot, & Mouth Disease
Our Mission: Our commitment is to protect and promote the public’s health and well-being.
Saginaw County Department of Public Health
Volume 6 Issue 7
FALL 2004
HAND, FOOT, & MOUTH DISEASE
INFLUENZA 2004/2005
Statistically 36,000 people die each year from this
vaccine preventable disease in the United States.
Influenza is caused by a virus that spreads from
infected persons to the nose or throat of others.
Anyone can get influenza and most people are ill only
a few days but some get much sicker and die.
Persons over 65 years account for 90% of these
deaths but children under 2 years account for most
hospitalizations. This year the ACIP (A dvisory
Committee for Immunization Practice) has added
new recommendations as to who should receive the
vaccine which include routine vaccination of all
children 6-23 months of age & women who are
pregnant. As in past years people with high risk
conditions should also receive vaccine, those with
pulmonary, cardiovascular, metabolic, renal
dysfunction, hemoglobinopathy, immunosuppression
(including HIV) diseases and anyone over 50 years of
age. Conditions that increase the risk of influenza
complications are residents of long term care
facilities, persons 6 months to 18 years of age
receiving aspirin therapy, and pregnancy. Any
healthy persons living with or giving care to someone
with these high risk conditions should also receive
influenza vaccine to reduce the high risk person’s
chances of exposure.
Flu vaccine is available by injection (inactivated flu
vaccine) for ages 6 months through adult life.
Intranasal flu mist (live, attenuated) is available for
people 5 years through 49 years of age who do not
fall under any of the high risk conditions listed above.
The composition of 2004/2005 influenza vaccine
include A/Fujian/411/2002 (H3N2), A/New
Caledonia/20/99 (H1N1) & B/Shanghai/361/2002.
These strains are the same for injectable vaccine &
intranasal flu mist.
Influenza vaccine is recommended to be given from
mid October through December and may continue to
be administered throughout the flu season.
References: www.cdc.gov/nip; [email protected]
Hand, foot and mouth disease (HFMD) is caused by
a group of viruses called enteroviruses. The most
common is coxsackievirus A16. HFMD is a common
illness of infants and children under 10 years old. It
is moderately contagious. It is spread person to
person by direct contact with nose and throat
discharges, saliva, fluid from blisters, or the stool of
infected persons. A person is most contagious
during the first week of the illness. HFMD is not
transmitted to or from pets or other animals.
Symptoms
HFMD is characterized by fever, sores in the mouth,
and a rash with blisters. The lesions may persist
from 7-10 days and are commonly on the palms, and
fingers of the hands and soles of feet. Occasionally,
maculopapular lesions appear on the buttocks. The
disease is usually mild and patients recover without
medical treatment. In rare instances, the patient with
coxsackievirus A16 infection may also develop viral
meningitis, in which the person has fever, headache,
stiff neck, or back pain, and may need to be
hospitalized.
Treatment
There is no specific treatment necessary.
Symptomatic treatment is given to provide relief from
fever, aches, or pain from the mouth ulcers.
Prevention
There is no specific intervention for HFMD, however
risks can be lowered through good hygiene practices.
Prevention measures include frequent hand washing,
cleaning contaminated surfaces and items using
dilute solution of chlorine-containing bleach, and
washing soiled articles of clothing. Since the virus
can be shed in the stool for several weeks after the
onset of infection, continued personal hygiene is very
important.
References: Control of Communicable Diseases
th
Manual. 17 edition. 2000. James Chin, MD, MPH,
Editor. pp. 129-131.
http:// www.cdc.gov
INFECTIOUS MONONUCLEOSIS
Infectious mononucleosis, a disease that is sometimes
referred to as “mono” or “the kissing disease” is an acute
viral syndrome that is commonly caused by the EpsteinBarr virus (EBV). EBV is a member of the herpes virus
family and is one of the most common human viruses.
The virus is found worldwide, and most people become
infected with EBV at some time in their lives. In the
United States, as many as 95% of adults between 35
and 40 years of age have been infected. Therefore, most
individuals who are exposed to infectious mononucleosis
have previously been infected with EBV and are not at
risk for developing this disease. The Epstein-Barr virus
is most often spread by infected saliva; there have been
rare cases of the virus spreading through blood
products. The incubation period, or time from infection to
appearance of symptoms, ranges from 4-6 weeks.
References:
http://www.cdc.gov/ncidod/diseases/ebv.htm August,
2004
th
Control of Communicable Diseases Manual.17 edition.
2000. James Chin, MD, MPH, Editor. pp. 350-352.
COMMUNICAB LE DISEASE
REPORTED FOR SAGINAW COUNTY
Symptoms
4/1/2004 – 6/1/2004
Symptoms of infectious mononucleosis include fever,
sore throat, fatigue, and swollen lymph glands.
Sometimes an enlarged spleen or liver involvement may
develop. Heart problems or involvement of the central
nervous system occurs rarely, and infectious
mononucleosis is almost never fatal. There are no
known connections between EBV infection and problems
during pregnancy e.g. birth defects or miscarriages. The
symptoms of infectious mononucleosis usually resolve in
1-2 months. EBV remains dormant in the infected
person’s body and can be reactivated and occur without
symptoms of illness. This person can then spread the
EBV to others for a period of several weeks. In fact,
many healthy people can carry and spread the virus
intermittently for life. Children who come in contact with
the virus usually have no symptoms or have very mild,
brief illnesses. Adolescents and young adults typically
have more severe symptoms.
Diagnosis
The clinical diagnosis of infectious mononucleosis is
based on symptoms and confirmed with a laboratory
blood test. Positive findings show an elevated white
blood cell count, an increased percentage of certain
atypical white blood cells, and a positive reaction to a
“mono spot” test.
Treatment
Supportive measures such as fever reducing medication
and extra rest are commonly recommended for the
person diagnosed with infectious mononucleosis to
reduce or alleviate symptoms. Contact sports should be
avoided during the time the spleen is felt to be enlarged.
It is recommended that the client should be excluded
from the school or work setting during the period of time
he/she feels ill and is unable to tolerate much general
activity. In most cases this is about 1-2 weeks.
Recommendations include increased hand washing,
avoidance of activities that can transfer saliva e.g.
sharing drinking glasses, eating utensils, toothbrushes,
or mouth-to-mouth kissing.
Disease
CAMPYLOBACTER
CHICKEN POX
ENCEPHALITIS
FLU-LIKE DISEASE
GIARDIASIS
HEAD LICE
CHRONIC HEPATITIS C
ASEPTIC MENINGITIS
BACTERIAL MENINGITIS
SALMONELLOSIS
CHLAMYDIA
GONORRHEA
No.
Reported
5
6
1
7981
1
210
8
10
3
3
203
99
TRICHOMONIASIS
Trichomoniasis or “Trich” as it is often referred to, is a
common sexually transmitted disease (STD) that affects
both women and men, although symptoms are more
common in women. An estimated 7.4 million new cases
occur each year making Trichomoniasis the most
common curable STD in young, sexually active women.
Trichomoniasis is caused by the single-celled protozoan
parasite, Trichomonas vaginalis. The urethra is most
common site of infection in men and the vagina is the
most common site of infection in women. The parasite is
transmitted through sexual intercourse. Women may
acquire the disease from infected men or women, but
men usually contract it only from infected women. Most
men with trichomoniasis do not have signs or symptoms.
Women may have symptoms of infection, which include
a frothy, yellow-green vaginal discharge with a strong
odor. The infection may also cause discomfort during
intercourse or urination. Symptoms may also include
irritation and itching of the female genital area.
Symptoms usually appear in women within 5 to 28 days
of exposure.
For both men and women a physical examination and
laboratory testing must be performed by a health care
provider to diagnose trichomoniasis. If trichomoniasis
goes undiagnosed complications can occur such as an
increased susceptibility to HIV infection, and for
pregnant women trichomoniasis may cause babies to be
born prematurely or with low birth weight.
Treatment of trichomoniasis is usually done with a
prescription drug called metronidazole, given by mouth
in a single dose. It is important to note that an infected
man whose symptoms have stopped or who has had no
symptoms at all can continue to infect or re-infect a
female partner until he has been treated. Therefore,
both partners should be treated at the same time to
eliminate the parasite. Persons being treated for
trichomoniasis should avoid sex until they and their sex
partners complete treatment and have no symptoms.
Preventing trichomoniasis can be accomplished most
effectively by abstaining from sexual contact, or by
maintaining a long-term mutually monogamous
relationship with a partner who has been tested and is
known to be uninfected. Latex male condoms, when
used consistently and correctly, can reduce the risk of
transmission of trichomoniasis.
Any genital symptom such as discharge or burning
during urination or an unusual sore or rash should be a
signal to stop having sex and to consult a health care
provider immediately. A person diagnosed with
trichomoniasis or any other STD should receive
treatment and should notify all recent sex partners so
that they can see a health care provider and be treated.
This reduces the risk that the sex partners will develop
complications from trichomoniasis and reduces the risk
that the person with trichomoniasis will become reinfected. Sex should be stopped until the person with
trichomoniasis and all of his or her recent partners
complete treatment for trichomoniasis and have no
symptoms.
Reference: www.cdc.gov/std
HOW DO I KNOW IF I HAVE GBS?
About three to five weeks before the expected delivery
date (35-37 weeks gestation), during a regular prenatal
visit, the doctor collects a sample by touching the outer
part of the vagina and just inside the anus with a sterile
Q-tip. If the test is positive for GBS, it will be
recommended that the pregnant woman receive
intravenous antibiotics during labor. Penicillin is usually
the treatment of choice. GBS is very sensitive to
antibiotics and is easily removed from the vagina.
Taking oral antibiotics has not been as effective, so that
is why medication is required by IV. A few intravenous
doses given up to four hours before birth almost always
prevents the baby from picking up the bacteria during
birth. It is important to remember that GBS is typically
NOT harmful to the pregnant woman or her baby before
labor begins.
HOW DOES GBS AFFECT NEWBORNS?
Most cases of GBS disease among newborns occur in
the first week of life and symptoms often begin a few
hours after birth. Sepsis, pneumonia, and meningitis are
the most common problems. If the infection is early and
the baby is full-term, most babies will completely recover
with IV antibiotic treatment. Of the babies who get sick,
about one in six can have serious complications and
some of those may die.
WHO IS AT HIGHER RISK FOR GBS DISEASE?
Pregnant women with the following conditions are at
higher risk of having a baby with GBS disease:
-GBS test that is positive late in pregnancy
-previous baby with GBS disease
-urinary tract infection due to GBS
-fever during labor
-rupture of membranes 18 hours or more before delivery
-premature labor and birth (birth of baby before 37
weeks)
If you are pregnant and have further questions,
please ask your OB provider at your next visit. This
is a very important screening test in preventing
newborn infection.
References:
Group B Strep Infection. March of Dimes Birth Defects
Foundation, 2002.
GROUP B STREP IN PREGNANCY
WHAT IS GROUP B STREP? (GBS)
Group B streptococcus (GBS) is one of many common
bacteria that live in the human body without causing
harm in healthy people. GBS can be found in the
intestine, rectum, and vagina in about 2 of every 10
pregnant women near the time of birth.
If a pregnant woman carries the GBS bacteria in her
vagina or rectum at the time of labor and delivery, there
is a risk of passing the bacteria to the baby during birth
with serious complications for the baby. GBS is NOT a
sexually transmitted disease, and it does not cause
discharge, itching, or other symptoms.
Group B Streptococcal Disease (GBS).
http://www.cdc.govncidod/dbmd/diseaseinfo/
Group B Strep in Pregnancy: Frequently Asked
Questions. American College of Nurse-Midwives. 2002.
Fight
the Flu
Saginaw County Department of Public Health
1600 N. Michigan Ave.
Saginaw, MI 48602
This newsletter is provided to all Saginaw County
healthcare providers, hospitals, schools, local
colleges, universities, urgent care facilities,
and local media.
If you know anyone who would
like a copy of this newsletter, or has a topic of
interest, contact the Communicable Disease
Program at 758-3887.
Articles for this newsletter are written and
researched by the following members of the
Personal and Preventive Health Services Division:
Deanna Frank, R.N., Susan Gottlieb, R.N., Jayne
Heringhausen, R.N., B.S.N., Tawnya Simon, R.N.,
B.S.N., M.S.A., and John Winden, R.N., B.S.N.
Please visit our website at
www.saginawpublichealth.org where our
communicable disease pamphlets are
available.