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Home , Gonorrhea, Syphilis

THE communicable disease Communiqué

M C H E N R Y C O U N T Y DEPARTMENT O F H E A L T H

COMMUNICABLE DISEASE EMERGENCY WINTER 2016 WWW.MCDH .INFO NOTIFICATION INFORMATION Urgent issues shall be reported immediately (within 3 hours) to the McHenry County De- SEXUALLY TRANSMITTED DISEASES partment of Health and include the following: * Anthrax (suspected or confirmed) According to the Centers for Disease Control and Prevention (CDC), there are almost 20 million * Botulism (foodborne) new sexually transmitted diseases (STDs) in the United States each year. * Table of Contents Youth aged 15-24 bear a particularly high burden of new . * Q- While youth make up only 25% of the sexually experienced population, * STDs……..………………..1 * Tuleremia they account for half of all new infections. Most STDs are easily treated,

* Any suspected Bioterrorist threat but many go undiagnosed since infected individuals often experience no STD Cases in McHenry symptoms. Untreated STDs can result in serious consequences, especially County…………………… 1 REGULAR OFFICE HOURS for women. , for example, can lead to , ectopic preg- (Monday – Friday 8am – 4:30pm) nancy, Pelvic Inflammatory Disease (PID), and chronic . (815) 334-4500 C……………….. 2

Please ask for one of the following: Taking a thorough sexual history is vital in determining who should be Communicable Disease Staff: …………………... 3 screened for STDs. All sexually active patients 25 and under should be Susan Karras, RN, BSN, MBA Communicable Disease Coordinator screened annually. Minors aged 12 or over can legally consent to STD MCDH STD Clinic………..3 Faith Schoen, RN, BSN testing and treatment without parental consent. This is to remove barriers

CD Investigator to STD medical care. Sexually active patients 26 and older with symp- Expedited Partner Therapy. 4 Kathy Ubanus-Bernero, RN toms, a new partner, or multiple partners should be tested annually as CD Investigator well. Patients at risk for STDs should be tested for chlamydia, , Holli Wilke, RN, BSN STD Treatment Guidelines..5 syphilis, and Human Immunodeficiency (HIV). Patients at high risk STD Public Health Nurse Danielle Burck, RN, BSN for HIV and Syphilis should be tested every 6 months. High risk individu- for Adults…….…5 Public Health Nurse als include men who have sex with other men (MSM), female partners of

Siobain Daughenbaugh ,RN MSM, patients with a high number of sex partners, patients with an HIV TB Nurse Reporting Requirements….6 positive sex partner, and injection drug users (IDU). Karen Stephenson, RN, MS TB Nurse Christina Hayes, BS CD Investigator/Health Educator

AFTER OFFICE HOURS (Monday – Friday 4:30pm – 8am; STD Cases McHenry County 2010-2014 Saturday, Sunday and Holidays) (815) 344-7421 700 Ask to speak to the Communicable Disease “On-Call” Person. 600

590 Mission 500 555

The Communiqué is a newsletter 484 intended to prevent morbidity and 400 452 mortality of infectious diseases by 394 providing data and recommendations 300 to clinicians, laboratories, control personnel and others who 200 diagnose, treat or report infectious diseases in McHenry County. 100 29 3 33 4 39 1 32 5 40 4 We welcome comments and sugges- 0 tions. Please call if you wish to be 2010 2011 2012 2013 2014 added to our e-mail list. Contact Susan Karras at 815-334-4850 or email [email protected] Chlamydia Gonorhea Early Syphilis

COMMUNIQUÉ WINTER 2016

HEPATITIS C

Hepatitis C (HCV) used to be considered an STD, however, it is not commonly spread through sexual activity. HCV is a virus that causes liver damage, scarring, failure, and cancer. It is spread primarily through contact with infected blood. Ac- cording to the CDC, there are about 3 million people living with HCV in the United States, many of whom are unaware of their infection. It is recommended that all (people born between 1945-1965) be screened for HCV using an test. Those testing positive for must have a confirmatory HCV RNA test to determine if they are actively infected with the virus. People who test positive for HCV, should be vaccinated for Hepatitis A and B to protect their liver from further damage.

Hepatitis C Facts  Baby boomers are 5 times more likely to have HCV  Treatments are available to cure HCV  About 75 % of those infected are unaware of their infection  8 out of 10 people with HCV will have it for life unless they are treated  HCV is a leading cause of liver cancer  Most people with HCV do not have any symptoms  Only half of those testing antibody positive receive a confirmatory RNA test

People Who Should Be Screened for HCV  Those born 1945-1965  History of injection drug use  Received or organ transplant before 1992  Received blood products with clotting factor before 1987  Have HIV  Healthcare workers with needle stick injury  Born to mother with HCV  Have been on long term dialysis

All healthcare providers have a role to play in the fight against Hepatitis C. To learn more please visit the following web link.

http://www.cdc.gov/hepatitis/HCV/index.htm COMMUNIQUÉ WINTER 2016

McHENRY COUNTY COMMUNICABLE DISEASES

# OF CASES SYPHILIS YTD* YTD DISEASE 2015 2014 Bacterial 2 1 While syphilis rates are low in McHenry County, certain groups 0 0 are at higher risk of infection and should be screened annually. Chlamydia 462 397 Those at high risk include men who have sex with other men Creutzfeldt- 1 0 (MSM), transgendered individuals , people who have a very high Jakob Disease number of sex partners, such as sex workers, and female partners Crypto- 4 2 of MSM.. Syphilis is easily treated in it’s early stages, but symp- sporidiosis toms are often missed and consequences of untreated infections E.Coli 10 9 are severe. Syphilis during is particularly dangerous Gonorrhea 39 24 and can lead to disability and/or death in infants of infected moth- Group A 2 7 ers. All pregnant women must be screened for syphilis and treated if necessary. For these reasons each case of syphilis is thoroughly Haemophilius 8 3 investigated by an MCDH Communicable Disease Investigator to Influenza determine stage of infection, appropriate treatment, and partners at Hepatitis A 1 0 risk to be tested and treated. MCDH can assist healthcare provid- 16 10 ers with patient management should you suspect or diagnose a Hepatitis C 101 63 case. HIV 3 1 3 3 Legionellosis 3 5 34 36 1 1 MRSA 3 1 MCDH STD CLINIC (≤61 days old) Non- 2 0 MCDH receives supplies and laboratory services from the Illinois Depart- Vibriosis ment of Public Health (IDPH). We follow IDPH recommended testing Pertussis 72 57 guidelines to determine who we can serve in our clinic. Treatment is pro- Rabies (potential vided to those who test positive for chlamydia, gonorrhea, or syphilis and 31 17 exposure) their sex partners. Anyone who has health insurance is encouraged to see Rocky Mountain their healthcare provider for testing. 4 1 Tests Performed: Salmonella 67 44  Chlamydia, Gonorrhea, HIV, and Syphilis Step 2 1 (≤ 4 years) Clients Served:  Sexually active individuals between 12 and 25 years of age Syphilis 7 8 Toxic Shock  Sexually active women 26 and older with symptoms or risk factors 0 0 ● Symptoms consistent with STDs Syndrome ● Sex partner who tested positive for an STD 3 5 ● More than one sex partner Varicella 12 27 ● New sex partner (Chicken Pox)  Sexually active men 26 and older with symptoms West Nile Virus 2 1  Treatment for sex partners who test positive– you can refer your pa- tient’s sex partners to our clinic for treatment *YTD Data as of Nov. 30, 2015 COMMUNIQUÉ WINTER 2016

EXPEDITED PARTNER THERAPY

It is common for young women to become re-infected with chlamydia. This most likely happens due to failure to treat sex partners. Genital chlamydial infections can lead to pelvic inflammatory disease (PID), chronic pelvic pain, , and infertility in women. In order to prevent repeat infections and complications in individuals, and to stop the spread of chlamydia in the community, sexual partners of infected individuals must be treated with the appropriate therapy in a timely manner. Histori- cally, partner management was initiated by local health departments. Due to a lack of resources and the overwhelming number of cases, health departments are unable to contact every case of chlamydia to discuss partner management. Therefore, the current standard of care for partner management is patient referral. The efficacy of this strategy depends on the patient’s decision to notify their sexual contacts, and the contact’s decision to seek out treatment. Contacts without symptoms may not seek treatment be- cause they may believe they are not infected, or they may be uninsured, lack a primary care provider, or lack access to medical care. These limitations demonstrate the need for additional strategies such as Ex- pedited Partner Therapy (EPT).

The CDC has recommended EPT since 2006. On January 1, 2010, EPT became legal in Illinois. EPT allows physicians, physician assistants, and nurse practitioners to dispense treatment for Chlamydia and Gonor- rhea to their patient’s sexual contacts without completing a clinical evaluation on the partners. EPT is not intended as a first line treatment; however, it may be useful in situations when the sexual contact is una- ble or unlikely to seek care. It is the responsibility of the health care provider to determine whether EPT is appropriate in each case. Factors to consider are whether the sexual contact is unwilling to seek care, is uninsured, lacks a primary care provider, or faces significant barriers to accessing clinical services. When EPT is provided, the sexual contacts should still be encouraged to seek follow-up care as soon as possible. Written materials must be provided to the index patient about the prescribed and the infec- tion it is meant to treat.

It is important to note that oral are no longer recommended by the CDC to treat cases of Gonorrhea. This provides a challenge for EPT for Gonorrhea infections. MCDH investigates all cases of Gonorrhea and can provide treatment to sexual contacts of infected patients. Please inform all patients infected with Gonorrhea to refer their sex partners to the health department for testing and treatment. Please contact the Communicable Disease program with any questions or concerns at 815-334-4500. Full guidance and additional information can be accessed at the following web address.

www.cdc.gov/std/ept

http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=096-0613&GA=096

http://www.dph.illinois.gov/sites/default/files/publications//illinoiseptguidelines.pdf

COMMUNIQUÉ WINTER 2016

STD TREATMENT GUIDELINES

The CDC recently updated the STD treatment guidelines. Please familiarize yourself with the guidelines and utilize the free wallcharts and booklets that are available at the following link. They even have an STD treatment guide app for your smart phone or tablet! Feel free to call MCDH with any questions or concerns. http://www.cdc.gov/std/tg2015/default.htm

Recommended treatment for common reportable STDs

Chlamydia 1 gm given orally as single dose

Gonorrhea 250 mg IM AND 1 gm azithromycin given orally as single dose

Syphilis treatment depends on how long the individual has been infected. Please call MCDH to determine appropriate disease staging and treatment.

VACCINES FOR ADULTS PROGRAM

Vaccination is the best way to prevent illness, followed by good, frequent hand washing. MCDH now offers adult vaccines to those who qualify.

Cost $15 administration fee

Available vaccines ● Hepatitis A and B ● Tetanus, diptheria, pertussis (Tdap) ● Human Papilloma Virus (HPV) ● Meningitis ● (Zoster) ● Pneumococcal-13 and Pneumococcal-23 ● , mumps, rubella (MMR)

Eligibility ● Adults over 19 with NO insurance ● Adults over 19 who have insurance that does NOT cover the they need ● Adults with Medicare Part B can only get Shingles or Tdap vaccine through our clinic ● Adults with Medicare Part D or Medicaid are NOT eligible for vaccines through our clinic

Multiple Walk-In Clinics are available every month. CALL 815-334-4500 FOR AVAILABILITY Illinois department of public healtH Illinois reportable diseases Mandated reporters, such as health care providers, hospitals and laboratories must report any suspected or confirmed human cases of these diseases to the McHenry County Department of Health within the designated time frame. (*HIV/AIDS is reportable directly to IDPH) CLASS Ia immediately

ANTHRAX BOTULISM, FOODBORNE PLAGUE CLUSTERS OF CASES INDICATING PUBLIC HEALTH HAZZARD POLIOMYELITIS DIPHTHERIA SEVERE ACUTE RESPIRATORY SYNDROME (SARS) INFLUENZA A, VARIANT VIRUS SMALLPOX MIDDLE EAST RESPIRATORY SYNDROME (MERS) RELATED COMPLICATIONS CLASS Ib within 24 hours

BOTULISM; INTESTINAL BOTULISM, WOUND, OTHER Q-FEVER DUE TO COXIELLA BURNETTI (UNLESS SUSPECT BIOTER- BRUCELLOSIS RORIST EVENT) (VARICELLA) RABIES, HUMAN (POTENTIAL EXPOSURE) CHOLERA (TOXIGENIC 01 OR 0139) RABIES, HUMAN INFECTIONS RUBELLA INFLUENZAE, MENINGITIS, & OTHER STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA) 2 OR INVASIVE DISEASE MORE CASES IN A COMMUNITY SETTING HANTAVIRUS PULMONARY SYNDROME STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA) IN HEMOLYTIC UREMIC SYNDROME, POST-DIARRHEAL INFANTS UNDER 61 DAYS OF AGE HEPATITIS A STAPHYLOCOCCUS AUREUS, INTERMEDIATE OR HIGH LEVEL RE- INFLUENZA (LABORATORY CONFIRMED INCLUDING RAPID DIAGNOS- SISTANCE TO VANCOMYCIN TIC TESTING) INTENSIVE CARE UNIT ADMISSIONS STREPTOCOCCAL INFECTIONS, GROUP A, INVASIVE DISEASE MEASLES MUMPS MENINGITIDIS, MENINGITIS AND INVASIVE DISEASE

CLASS ii within 7 days

AIDS* (HANSEN’S DISEASE) ARBOVIRAL INFECTIONS (INCLUDING, BUT NOT LIMITED TO CHIKUNGUNYA FEVER, CALIFORNIA , ST. LOUIS EN- CEPHALITIS, DENGUE FEVER, & WEST NILE VIRUS) LYME DISEASE MALARIA CLAMYDIA OPHTHALMIA NEONATORUM CREUTZFELDT-JAKOB DISEASE (CJD) (ORNITHOSIS) DUE TO CRYPTOSPORIDIOSIS ROCKY MOUNTAIN SPOTTED FEVER CYCLOSPORIASIS , HUMAN GRANULOCYTOTROPIC (HGA) STREPTOCOCCUS PNEUMONIAE, INVASIVE DISEASE IN EHRLICHIOSIS, HUMAN MONOCYTOTROPIC (HME) CHILDREN LESS THAN 5 YRS GONORRHEA SYPHILIS HEPATITIS B AND HEPATITIS D TETANUS HEPATITIS C, ACUTE INFECTION AND NON-ACUTE DUE TO STAPHYLOCOCCUS AUREUS INFECTION CONFIRMED INFECTION TICKBORNE DISEASE (ALL) HISTOPLASMOSIS TRICHINOSIS (TRICHINELLOSIS) HIV INFECTION* TUBERCULOSIS INFLUENZA, DEATH (IN PERSONS LESS THAN 18 YRS) VIBRIOSIS (OTHER THAN TOXIGENIC VIBRIO CHOLERA O1 OR O139) LEGIONELLOSIS

ALL REPORTS ARE CONFIDENTIAL AND HIPAA EXEMPT AND SHOULD INCLUDE —  THE DISEASE OR CONDITION BEING REPORTED  PHYSICIAN’S NAME, ADDRESS, AND TELEPHONE NUMBER  PATIENT’S NAME, DATE OF BIRTH, AGE, SEX, RACE/ETHNICITY, ADDRESS, AND TELEPHONE NUMBER

TO REPORT A CASE: CONTACT THE MCHENRY COUNTY DEPARTMENT OF HEALTH REPORT 24 HOURS A DAY MONDAY THROUGH FRIDAY 8AM – 4:30PM: (815) 334-4500 FAX: (815) 334-1884 AFTER HOURS: (815) 344-7421

McHenry County Department of Health 2014 REPORTING REQUIREMENTS

All diagnosed cases of chlamydia, gonorrhea, and syphilis must be reported to the local health depart- ment in which your office resides, regardless of where the patient lives. HIV is directly reportable to IDPH. HIV must be reported each time a healthcare provider diagnoses OR treats an HIV case, even if the case has been previously reported. All cases must be reported within 7 days of diagnosis.

Please familiarize yourself with the administrative codes which can be found at the flowing links. http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1550&ChapterID=35 http://www.ilga.gov/commission/jcar/admincode/077/077006900C02000R.html http://www.ilga.gov/commission/jcar/admincode/077/07700693sections.html

To make STD reporting as easy as possible, MCDH has a one page Case Report Form that is to be completed and faxed to 815-334-1884. A copy of the case report form can be found by clicking on the following link. https://www.co.mchenry.il.us/home/showdocument?id=24290

Receive the latest health alerts from the BECOME PART CDC, the Illinois Department of Public OF OUR BLAST Health and the McHenry County Depart- ment of Health on topics such as: EMAIL NETWORK ● West Nile Virus ● Bioterrorism ● Flu Updates ● Area Outbreaks

● Other emerging infectious diseases

To receive email correspondence contact Susan Karras, CD Coordinator by phone or email.

815-334-4850 [email protected]