July 17, 2019 Shawnee County Health Department Volume 4, Issue 7

EPI-SURVeillance

Love at first bite!

INSIDE THIS ISSUE

Vector-borne Diseases …………. 1 June Disease Summary ………… 3

Shawnee County Health Department Over the last ten years, the Shawnee County Health Department received over 460 vector- borne disease reports for Shawnee County residents. Of those, 144 vector-borne disease re- WIC and Administrative Offices ports met the definition of confirmed or probable cases by standardized case definitions. Vec- 2600 SW East Circle Drive tor-borne diseases are infections transmitted to humans by blood-feeding arthropods, such as Topeka, Kansas 66606 785.251.5600 mosquitoes, ticks and fleas. With warmer weather and longer days increasing outdoor activities and exposure to ticks and mosquitoes, Shawnee County providers should consider vector-borne Immunization/ diseases in the differential diagnosis for summertime flu-like symptoms, especially this time of Communicable Disease Clinic year. 2115 SW 10th Street TIME FOR TICKS Topeka, Kansas 66604 785.251.5700 Of all the confirmed cases of vector-borne diseases in Shawnee County over the last ten years, 85% were tick-borne diseases. The most common tick-borne diseases we see in Shawnee Coun- Environmental Health ty on a yearly basis are Rocky Mountain Spotted Fever (RMSF), Ehrlichiosis and Tularemia. Alt- 1515 NW Saline, Suite 221 hough less common, we also have had confirmed cases of Lyme Disease and Anaplasmosis. Topeka, Kansas 66618 Most tick-borne diseases in Shawnee County are usually reported between May to September with the tick season peaking in July each year. Tick-borne diseases can be mistaken for other pathogens due to their nonspecific presentation of fever, headache, fatigue, muscle pain and NEED TO REPORT A rash. Symptoms develop 3 to 14 days (varies with disease) after tick bite and can be life- COMMUNICABLE DISEASE? threatening, such as RMSF, if treatment is delayed. MOSQUITOES IN SHAWNEE COUNTY, KS Call the Kansas Department of West Nile Virus (WNV) and Malaria are the most common confirmed mosquito-borne diseases in Shawnee County. While Malaria cases reported in Shawnee County are usually acquired Health and Environment abroad, malaria-carrying mosquitoes (Anopheles) are commonly found here. Unlike Malaria, Epidemiology Hotline 24/7 cases of WNV are usually acquired locally. WNV infections typically occur late summer to early fall with symptoms similar to those seen in tick-borne illnesses. Symptoms develop 2 to 14 days 877.427.7317 after a bite with an infected mosquito. It is estimated 70-80% of people infected with WNV will Call the Health Department 24/7 be asymptomatic and 1% will develop the severe form of WNV neuroinvasive disease causing meningitis, encephalitis, and acute flaccid paralysis. In Shawnee County, there have been 10 785.806.6297 confirmed cases of WNV, 5 non-neuroinvasive and 5 neuroinvasive cases since 2009.

POPULATIONS AT RISK Disease Reporting Information: Although all age groups and genders are susceptible to WNV infections, the incidence of severe disease is highest among older adults, while tick-born infections can occur among all ages. In List of Reportable Diseases Shawnee County, RMSF cases have been confirmed in all age groups. In the United States, Disease Reporting Information RMSF case mortality is highest in males, people older than 50, children younger than 10 and Kansas Reportable Disease Form people who do not recall being bitten by a tick. People who are immuno-compromised are also at risk for severe disease if exposed to infected ticks or mosquitoes. Additionally, co-infections Disease Investigation Guidelines may also increase severity of disease outcomes. Image Source: CDC, Mosquito-Borne Diseases Image Source: CDC Facebook, May 29, 2019

Table 1: Most Common Vector-borne Disease in Shawnee County, KS Rocky Mountain Spotted Fever Ehrlichiosis Tularemia West Nile Virus Disease (Rickettsia rickettsii) (Ehrlichia chaffeensis or (Franciella tularensis) (Flavivirus) (Pathogen) E. ewingii) American Dog Tick Lone Star Tick American Dog, Lone Star, Culex species Main Vector (Dermacentar variabilis) (Amblyomma americanum) Rocky Mountain Wood Tick Mosquitoes Incubation Period 3-12 Days 5-14 Days 3-5 Days (range 1-21 Days) 3-15 Days * Ehrlichia IgG detection via * R. rickettsii IgG detection via IFA in paired serum samples * Isolation of F. tularensis  Isolation of viral agent IFA in paired serum samples from specimen or anti- or DNA from tissue, * Detection of Ehrlichia DNA body titer blood or CSF Laboratory * Detection of R. rickettsii DNA in via PCR on whole blood Testing skin biopsy by PCR assay * Detection of F. tularensis  CSF or blood testing * IHC staining from tissue via DFA or PCR for WNV specific IgM * IHC staining from tissue biopsy biopsy Doxycycline or Supportive Treatment Doxycycline Doxycycline Streptomycin Clinical Management Source: CDC Tickborne Diseases of the United States, A Reference Manual for Healthcare Providers, Fifth Edition, 2018

EMERGING VECTOR-BORNE DISEASES AND THE PUBLIC HEALTH IMPACT According to the Centers for Disease Control and Prevention (CDC), vector-borne diseases are a major cause of death and illness worldwide. In a recent CDC Morbidity and Mortality Weekly Report, cases of vector-borne diseases have tripled in the United States from 2004 to 2016. Addition- ally, 9 vector-borne pathogens were reported for the first time from the United States and U.S. territories. Kansas contributed to the list of newly discovered vector-borne pathogens in 2014 with Bourbon virus; the pathogen was isolated in a male resident, >50 years of age, of Bourbon Coun- ty, Kansas. The newest tick to make its appearance in the United States is the Asian longhorned tick. These ticks, native to East Asia, were first reported in the US in 2017 carry pathogens that can be potentially harmful to humans and animals. Research on Asian longhorned ticks is currently ongoing. Vector-borne diseases are a growing public health concern in the United States; controlling vectors and health education will be crucial in the prevention of vector-borne diseases. MOSQUITO SURVEILLANCE IN SHAWNEE COUNTY, KS The Shawnee County Health Department partnered with the Kansas Department of Health and Environment (KDHE) and the Kansas Biological Sur- vey to conduct mosquito surveillance in Shawnee County. Mosquitoes are identified and tested for the West Nile Virus each week. Data collected informs mosquito control activities in Shawnee County. For more information on mosquito surveillance in Shawnee County and the West Nile Vi- rus Risk Levels for our region, visit the Health Department website here and the KDHE WNV website here. WHAT PROVIDERS CAN DO  Remind patients to wear bug spray and treat clothing and gear with insect repellents containing DEET  Check for ticks, especially under the arm, in and around ears, inside belly button, behind knees, around the waist, on the hairline and scalp  Treat dogs and cats for ticks as recommended by a veterinarian  Ask about recent travel or outdoor activity history if patient presents with summertime flu like symptoms

2 JUNE COMMUNICABLE DISEASE SUMMARY

Last month, there were 68 new reports of notifiable diseases and conditions in Shawnee County. Forty-two reports have been classified as Confirmed or Probable Cases of Reportable Diseases by the Shawnee County Health Department and/or the Kansas Department of Health and Environment based on standardized case definitions. The chart below shows the number of disease reports which met the criteria of Confirmed or Probable. These are preliminary numbers and might change as case status changes with new information or further investigation. Below is a summary of select reports investi- gated in the month of June 2019.

SUMMARY OF NEWLY CONFIRMED CASES OF REPORTABLE DISEASES Respiratory: Last month, there were twelve respiratory reports; three Car- SHAWNEE COUNTY, JUNE bapenem-resistant Acinetobacter baumannii (CRAB), four Carbapenem-

Case Report Counts* resistant Pseudomonas aeuginosa (CRPA) 2016-2018 one Carbapenem-resistant Enterobacteri- 2019 2018 Diseases 3-Year June aceae (CRE), one Haemophilus influenzae June June Average invasive disease, two Tuberculosis Latent Infection (LTBI), two Histoplasmosis and Bloodborne one Legionellosis report. Please see table Hepatitis B, Chronic 2 2 1 to the left for confirmed cases of respiratory reports. Hepatitis C, Chronic 15 15 17.3 Vector-borne: There were seven vector- Foodborne and Waterborne borne reports last month; one Lyme Dis- Campylobacteriosis 4 7 7.7 ease (Borrelia burgdorferi), five Spotted Fever Rickettsiosis (RMSP), and one Tula- Shiga toxin-producing Escherichia coli (STEC) 2 10 3.3 remia disease reports. None of the vector- borne reports were confirmed cases. Vibriosis (non-cholera Virbrio species) 1 0 0 Respiratory Food or Waterborne: There were sev- Carbapenem-resistant Acinetobacter baumannii en food/water-borne illness reports last 3 0 0 (CRAB) month; four Campylobacteriosis, two Shi- Haemophilus influenzae, invasive disease ga toxin-producing Escherichia coli 1 0 0.3 (Including Hib) (STEC), and one Vibriosis (non-cholera Vibrio species) disease report. All food/ Histoplasmosis 2 0 0 water-borne illness reports were con- Legionellosis 1 1 0.3 firmed cases.

Tuberculosis Latent Infection (LTBI) 2 8 4.3 Bloodborne: There were eighteen Vaccine Preventable Bloodborne reports last month. All fifteen Hepatitis C reports and two Hepatitis B Varicella (Chickenpox) 3 1 0.3 reports received were confirmed cases. Sexually Transmitted Infections Chlamydia 90 103 87 Other: The Health Department received five pediatric elevated blood lead level Gonorrhea 61 68 49.3 reports last month. The elevated blood Syphilis 0 0 1 lead level reports were all confirmed cases. Two bats, one cat and one squirrel Other were submitted for Rabies testing. One bat Blood lead poisoning (All ages) 5 5 3 specimen was positive for the Rabies vi- Rabies, Animal 1 0 0 rus, while the other three specimens were negative for the rabies virus. This is our Grand Total 193 220 174.8 first positive Rabies animal case this year. There were eleven vaccine preventable * Case report counts are provisional numbers. Case statuses might change reports received last month; nine Varicel- with new information or further investigation. la, one Measles (rubeola), and one Hepati- tis A disease reports. Of the eleven reports, only three Varicella reports were confirmed cases. Healthy People — Healthy Environment — Healthy Shawnee County 3