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Official Nh Dhhs Health Alert
THIS IS AN OFFICIAL NH DHHS HEALTH ALERT Distributed by the NH Health Alert Network [email protected] May 18, 2018, 1300 EDT (1:00 PM EDT) NH-HAN 20180518 Tickborne Diseases in New Hampshire Key Points and Recommendations: 1. Blacklegged ticks transmit at least five different infections in New Hampshire (NH): Lyme disease, Anaplasma, Babesia, Powassan virus, and Borrelia miyamotoi. 2. NH has one of the highest rates of Lyme disease in the nation, and 50-60% of blacklegged ticks sampled from across NH have been found to be infected with Borrelia burgdorferi, the bacterium that causes Lyme disease. 3. NH has experienced a significant increase in human cases of anaplasmosis, with cases more than doubling from 2016 to 2017. The reason for the increase is unknown at this time. 4. The number of new cases of babesiosis also increased in 2017; because Babesia can be transmitted through blood transfusions in addition to tick bites, providers should ask patients with suspected babesiosis whether they have donated blood or received a blood transfusion. 5. Powassan is a newer tickborne disease which has been identified in three NH residents during past seasons in 2013, 2016 and 2017. While uncommon, Powassan can cause a debilitating neurological illness, so providers should maintain an index of suspicion for patients presenting with an unexplained meningoencephalitis. 6. Borrelia miyamotoi infection usually presents with a nonspecific febrile illness similar to other tickborne diseases like anaplasmosis, and has recently been identified in one NH resident. Tests for Lyme disease do not reliably detect Borrelia miyamotoi, so providers should consider specific testing for Borrelia miyamotoi (see Attachment 1) and other pathogens if testing for Lyme disease is negative but a tickborne disease is still suspected. -
Food Handler Exclusion Guidelines
Food Handler Exclusion Guidelines A guide for determining suitable exclusion periods for ill food handlers November 2017 Food handler exclusion guidelines Published by the State of Queensland (Queensland Health), November 2017 This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Queensland Health) 2017 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: Food Safety Standards and Regulation, Department of Health, GPO Box 48, Brisbane QLD 4001, email [email protected], phone 07 3328 9310. An electronic version of this document is available at www.health.qld.gov.au. Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information. Food Handler Exclusion Guidelines - ii - Contents 1. Introduction ............................................................................................... -
PEDIARIX Is a Vaccine
HIGHLIGHTS OF PRESCRIBING INFORMATION • If Guillain-Barré syndrome occurs within 6 weeks of receipt of a prior These highlights do not include all the information needed to use vaccine containing tetanus toxoid, the decision to give PEDIARIX should PEDIARIX safely and effectively. See full prescribing information for be based on potential benefits and risks. (5.2) PEDIARIX. • The tip caps of the prefilled syringes contain natural rubber latex which may cause allergic reactions. (5.3) PEDIARIX [Diphtheria and Tetanus Toxoids and Acellular Pertussis • Syncope (fainting) can occur in association with administration of Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus injectable vaccines, including PEDIARIX. Procedures should be in place Vaccine], Suspension for Intramuscular Injection to avoid falling injury and to restore cerebral perfusion following Initial U.S. Approval: 2002 syncope. (5.4) • If temperature ≥105°F, collapse or shock-like state, or persistent, ----------------------------- INDICATIONS AND USAGE ---------------------------- PEDIARIX is a vaccine indicated for active immunization against diphtheria, inconsolable crying lasting ≥3 hours have occurred within 48 hours after tetanus, pertussis, infection caused by all known subtypes of hepatitis B virus, receipt of a pertussis-containing vaccine, or if seizures have occurred and poliomyelitis. PEDIARIX is approved for use as a 3-dose series in infants within 3 days after receipt of a pertussis-containing vaccine, the decision born of hepatitis B surface antigen (HBsAg)-negative mothers. PEDIARIX to give PEDIARIX should be based on potential benefits and risks. (5.5) may be given as early as 6 weeks of age through 6 years of age (prior to the • For children at higher risk for seizures, an antipyretic may be 7th birthday). -
Iron Is an Essential Nutrient 4 Bacteria and Humans
Abstract The bhuTUV and bhuO genes play vital roles in the ability of Brucella abortus to use heme as an iron source and are regulated in an iron-responsive manner by RirA and Irr by Jenifer F. Ojeda April, 2012 Dissertation Advisor: RM Roop II Department of Microbiology and Immunology Brucella abortus is a Gram negative intracellular pathogen that causes the zoonotic disease brucellosis. Antibiotic treatment for brucellosis in humans is prolonged and sometimes followed by relapses. Currently, the United States employs prevention of the illness in humans through cattle vaccinations, eliminating the bacterium in its natural host. Unfortunately, these vaccine strains cause the disease in humans, and Brucella research ultimately aims to identify new vaccine targets as well as alternative treatment options. Brucella abortus resides in the phagosomal compartment of the host macrophage where essential nutrients such as iron are limited. Most bacteria need iron, and within the macrophage, heme is a likely source of iron due to the breakdown of red blood cells by the host macrophage. Heme transporters in Gram negative bacteria are highly conserved, and include components for outer membrane, periplasmic, and cytoplasmic membrane transport. BhuA has been previously characterized as the outer membrane heme transporter of Brucella abortus and here we report that BhuT, BhuU, and BhuV (BhuTUV) are the periplasmic and cytoplasmic heme transport components and that they are required in order for Brucella abortus to transport heme as an iron source. Utilization of heme as an iron source requires the breakdown of heme into ferrous iron, carbon monoxide, and biliverdin by a heme oxygenase. -
Summary Guide to Tetanus Prophylaxis in Routine Wound Management
Summary Guide to Tetanus Prophylaxis in Routine Wound Management ASSESS WOUND A clean, minor wound All other wounds (contaminated with dirt, feces, saliva, soil; puncture wounds; avulsions; wounds resulting from flying or crushing objects, animal bites, burns, frostbite) Has patient completed a primary Has patient completed a primary tetanus diphtheria series?1, 7 tetanus diphtheria series?1, 7 No/Unknown Yes No/Unknown Yes Administer vaccine today.2,3,4 Was the most recent Administer vaccine and Was the most Instruct patient to complete dose within the past tetanus immune gobulin recent dose within series per age-appropriate 10 years? (TIG) now.2,4,5,6,7 the past 5 years?7 vaccine schedule. No Yes No Yes Vaccine not needed today. Vaccine not needed today. Administer vaccine today.2,4 2,4 Patient should receive next Administer vaccine today. Patient should receive next Patient should receive next dose Patient should receive next dose dose at 10-year interval after dose at 10-year interval after per age-appropriate schedule. per age-appropriate schedule. last dose. last dose. 1 A primary series consists of a minimum of 3 doses of tetanus- and diphtheria- 4 Tdap* is preferred for persons 11 through 64 years of age if using Adacel* or 10 years of containing vaccine (DTaP/DTP/Tdap/DT/Td). age and older if using Boostrix* who have never received Tdap. Td is preferred to tetanus 2 Age-appropriate vaccine: toxoid (TT) for persons 7 through 9 years, 65 years and older, or who have received a • DTaP for infants and children 6 weeks up to 7 years of age (or DT pediatric if Tdap previously. -
Phenotypic and Genomic Analyses of Burkholderia Stabilis Clinical Contamination, Switzerland Helena M.B
RESEARCH Phenotypic and Genomic Analyses of Burkholderia stabilis Clinical Contamination, Switzerland Helena M.B. Seth-Smith, Carlo Casanova, Rami Sommerstein, Dominik M. Meinel,1 Mohamed M.H. Abdelbary,2 Dominique S. Blanc, Sara Droz, Urs Führer, Reto Lienhard, Claudia Lang, Olivier Dubuis, Matthias Schlegel, Andreas Widmer, Peter M. Keller,3 Jonas Marschall, Adrian Egli A recent hospital outbreak related to premoistened gloves pathogens that generally fall within the B. cepacia com- used to wash patients exposed the difficulties of defining plex (Bcc) (1). Burkholderia bacteria have large, flexible, Burkholderia species in clinical settings. The outbreak strain multi-replicon genomes, a large metabolic repertoire, vari- displayed key B. stabilis phenotypes, including the inabil- ous virulence factors, and inherent resistance to many anti- ity to grow at 42°C; we used whole-genome sequencing to microbial drugs (2,3). confirm the pathogen was B. stabilis. The outbreak strain An outbreak of B. stabilis was identified among hos- genome comprises 3 chromosomes and a plasmid, shar- ing an average nucleotide identity of 98.4% with B. stabilis pitalized patients across several cantons in Switzerland ATCC27515 BAA-67, but with 13% novel coding sequenc- during 2015–2016 (4). The bacterium caused bloodstream es. The genome lacks identifiable virulence factors and has infections, noninvasive infections, and wound contamina- no apparent increase in encoded antimicrobial drug resis- tions. The source of the infection was traced to contaminat- tance, few insertion sequences, and few pseudogenes, ed commercially available, premoistened washing gloves suggesting this outbreak was an opportunistic infection by used for bedridden patients. After hospitals discontinued an environmental strain not adapted to human pathogenic- use of these gloves, the outbreak resolved. -
Vaccines 101 the Very Last Day That I Was a Pediatric Resident. Um, Many
Vaccines 101 The very last day that I was a pediatric resident. Um, many years ago, a toddler walked into the emergency room and uh, and progressively got sicker and sicker. That's Dr. Katherine Edwards, a world expert in pediatric infectious disease in vaccinology. She's also a professor of pediatrics at Vanderbilt university and she's been working on vaccines for 40 years. I did a spinal tap on her and realized that she had Haemophilus influenza, typ e B meningitis, Haemophilus influenza, type B or HIB is it bacteria normally found in our nose and throat that can lead to very serious life threatening infections and no matter what I did in that day and into the night in terms of prompt antibiotics and she'd just been sick a few hours and, and fluids and all the, you know, ventilators and all the best things that modern medicine, she died, the vaccine for hip was not available until the 1990s. And until it did become available, hip disease affected approximately 25,000 children each year with things like meningitis, pneumonia, and bloodstream infections. And at that time in the hospital that I was practicing at any one time, there were generally five or six patients that had Haemophilus meningitis or invasive disease or some complication of this particular infection. And we knew that from the basic science that if you had antibody to the capsule or to the coat of the organism, that you were protected from disease. But we really didn't know how to make little kids make antibody. -
Diphtheria, Tetanus, Pertussis, Polio, Hib and Hepatitis B Vaccine for Babies and Children
Diphtheria, Tetanus, Pertussis, Polio, Hib and Hepatitis B vaccine for babies and children This leaflet tells you about the DTaP/IPV/Hib/ HepB vaccine, also known as “6 in 1” as it protects against six diseases, diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b and hepatitis B (HepB) disease. What does the vaccine protect against? Diphtheria Diphtheria is a serious disease that usually begins with a sore throat and can quickly cause breathing problems. It can damage the heart and nervous system and, in severe cases, can kill. Before diphtheria vaccine was introduced in the UK, there were up to 70,000 cases of diphtheria and around 5,000 deaths a year. Diphtheria can be spread from person to person through close contact. Tetanus Tetanus is a disease affecting the nervous system which can cause muscle spasms and breathing problems and can kill. It is caused when germs found in soil and manure get into the body through wounds or burns. Tetanus cannot be passed from person to person. 2 Published June 2018 Pertussis (whooping cough) Whooping cough is a disease that can cause long bouts of coughing and choking, making it hard to breathe. It can last for up to 10 weeks and babies under one year of age are most at risk. The disease is very serious and can kill. Before the pertussis vaccine was introduced, the average number of cases reported each year in the UK was 120,000 and 92 children died in the year before the vaccine was introduced. Whooping cough is usually spread by coughs and sneezes. -
Vaccine Hesitancy
Vaccine Hesitancy Dr Brenda Corcoran National Immunisation Office Presentation Outline An understanding of the following principles: • Overview of immunity • Different types of vaccines and vaccine contents • Vaccine failures • Time intervals between vaccine doses • Vaccine overload • Adverse reactions • Herd immunity Immunity Immunity • The ability of the human body to protect itself from infectious disease The immune system • Cells with a protective function in the – bone marrow – thymus – lymphatic system of ducts and nodes – spleen –blood Types of immunity Source: http://en.wikipedia.org/wiki/Immunological_memory Natural (innate) immunity Non-specific mechanisms – Physical barriers • skin and mucous membranes – Chemical barriers • gastric and digestive enzymes – Cellular and protein secretions • phagocytes, macrophages, complement system ** No “memory” of protection exists afterwards ** Passive immunity – adaptive mechanisms Natural • maternal transfer of antibodies to infant via placenta Artificial • administration of pre- formed substance to provide immediate but short-term protection (antitoxin, antibodies) Protection is temporary and wanes with time (usually few months) Active immunity – adaptive mechanisms Natural • following contact with organism Artificial • administration of agent to stimulate immune response (immunisation) Acquired through contact with an micro-organism Protection produced by individual’s own immune system Protection often life-long but may need boosting How vaccines work • Induce active immunity – Immunity and immunologic memory similar to natural infection but without risk of disease • Immunological memory allows – Rapid recognition and response to pathogen – Prevent or modify effect of disease Live attenuated vaccines Weakened viruses /bacteria – Achieved by growing numerous generations in laboratory – Produces long lasting immune response after one or two doses – Stimulates immune system to react as it does to natural infection – Can cause mild form of the disease (e.g. -
Hepatitis B? HEPATITIS B Hepatitis B Is a Contagious Liver Disease That Results from Infection with the Hepatitis B Virus
What is Hepatitis B? HEPATITIS B Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. When first infected, a person can develop Are you at risk? an “acute” infection, which can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. Acute Hepatitis B refers to the first 6 months after someone is exposed to the Hepatitis B virus. Some people are able to fight the infection and clear the virus. For others, the infection remains and leads to a “chronic,” or lifelong, illness. Chronic Hepatitis B refers to the illness that occurs when the Hepatitis B virus remains in a person’s body. Over time, the infection can cause serious health problems. How is Hepatitis B spread? Hepatitis B is usually spread when blood, semen, or other body fluids from a person infected with the Hepatitis B virus enter the body of someone who is not infected. This can happen through having sex with an infected partner; sharing needles, syringes, or other injection drug equipment; or from direct contact with the blood or open sores of an infected person. Hepatitis B can also be passed from an infected mother to her baby at birth. Who should be tested for Hepatitis B? Approximately 1.2 million people in the United States and 350 million people worldwide have Hepatitis B. Testing for Hepatitis B is recommended for certain groups of people, including: Most are unaware of their infection. ■ People born in Asia, Africa, and other regions with moderate or high rates Is Hepatitis B common? of Hepatitis B (see map) Yes. -
Hepatitis A, B, and C: Learn the Differences
Hepatitis A, B, and C: Learn the Differences Hepatitis A Hepatitis B Hepatitis C caused by the hepatitis A virus (HAV) caused by the hepatitis B virus (HBV) caused by the hepatitis C virus (HCV) HAV is found in the feces (poop) of people with hepa- HBV is found in blood and certain body fluids. The virus is spread HCV is found in blood and certain body fluids. The titis A and is usually spread by close personal contact when blood or body fluid from an infected person enters the body virus is spread when blood or body fluid from an HCV- (including sex or living in the same household). It of a person who is not immune. HBV is spread through having infected person enters another person’s body. HCV can also be spread by eating food or drinking water unprotected sex with an infected person, sharing needles or is spread through sharing needles or “works” when contaminated with HAV. “works” when shooting drugs, exposure to needlesticks or sharps shooting drugs, through exposure to needlesticks on the job, or from an infected mother to her baby during birth. or sharps on the job, or sometimes from an infected How is it spread? Exposure to infected blood in ANY situation can be a risk for mother to her baby during birth. It is possible to trans- transmission. mit HCV during sex, but it is not common. • People who wish to be protected from HAV infection • All infants, children, and teens ages 0 through 18 years There is no vaccine to prevent HCV. -
The Challenge of Achieving Universal Access to Vaccines
Keynote Address: The Challenge of Achieving Universal Access to Vaccines WIPO & AMF Seth Berkley M.D, CEO 8 November 2017 www.gavi.org 1 Vaccine landscape WIPO 8 November 2017 The world before vaccines Examples of major disease outbreaks Polio Cholera New York pandemic 1916 Europe 6,000 deaths 1829-1851 >200,000 deaths Yellow fever Philadelphia Smallpox 1793 epidemic >5,000 India deaths 1974 15,000 deaths Flu pandemic 1918-1920 > 50-100 million deaths worldwide WIPO 8 November 2017 History of vaccine development Source: Delaney et.al. 2014 WIPO 8 November 2017 Cumulative number of vaccines developed licensed 50+ vaccines Lyme OspA, protein (1998) Tuberculosis (Bacille Calmette-Guérin) Pneumococcal conjugate, heptavalent* (2000) 1927 Typhus Varicella (1995) Meningococcal quadrivalent conjugates* (2005) Japanese encephalitis (Vera-cell) (2009) 1938 Cholera (recombinant Toxin B) # (1993) Cholera (WC only) (2009) Tetanus toxoid Cholera (WC-rBC) (1991) Human papillomavirus recombinant bivalent (2009) Influenza H. influenzaeconjugate* (1987) Quadrivalent influenza vaccines (2012) Typhoid Cholera Pertussis 1936 Meningococcal C and Y and 1886 1896 1926 H. influenza type B polysaccharide (1985) Haemophilusinfluenza type b (2012) Adenovirus (1980) Meningococcal B (2013) Smallpox Diphtheria Yellow Rabies, cell culture (1980) Influenza vaccine (baculovirus) (2013) 1798 toxoid Fever Typhoid conjugate vaccine (2013) Rabies Plague Meningococcal polysaccharides (1974) 1923 1935 Human papillomavirus, 9-valent (2014) 1885 Rubella, live (1969) 1897 vaccines