PCHD November Surveillance Report

Providers are our eyes and ears in the community.  Please report immediately unusual numbers of patients presenting with similar symptoms, unusual symptoms, or unexplained infectious diseases in healthy individuals.  Do not wait until laboratory results become available.

You are welcome to call or fax in reports to:

Phone (520) 724-7797

Fax (520) 838-7538

For urgent reporting after hours or on holidays, please call (520) 743-7987.

Please complete a Communicable Disease Report available at http://webcms.pima.gov/health/resources_for_professionals/communicable_disease_reporting

You may also reach the Arizona Department of Health Services (ADHS), Disease Surveillance Hotline at 1-800-314-9243.

This report includes:

• Influenza and RSV 2017-2018 Season
• Increased Risk of Infectious Disease in Patients from Hurricane Affected Areas
• Mumps
• Clinical Timeline of Rocky Mountain Spotted Fever (RMSF) Signs and Symptoms
• Revised Communicable Disease Rules Posted

Influenza Virus and RSV

An unknown county reported the first locally acquired influenza case of the 2017-2018 season to the Arizona State Laboratory on October 16, 2017.  Providers are encouraged to vaccinate all eligible patients for influenza.

 Arizona is receiving more reports of influenza than were reported at the same time last year.

• For week 44 (October 29 to Nov. 4th) Pima County reported 24 cases of influenza
• The majority are type A/H3
• RSV
• Pima County no cases of RSV for week 44

The cases included in this report represent a small proportion of the true number of cases of influenza. Many people do not visit the doctor when ill and doctors should not be expected to run tests on all patients exhibiting influenza-like symptoms.

Increased Risk of Infectious Disease in Patients from Hurricane Affected Areas

Physicians are encouraged to obtain a travel history from patients to determine if they are at increased risk for certain diseases. Leptospirosis, vibriosis, hepatitis A, dengue, and typhoid fever.

Also infections associated with water damage such as invasive fungi, non-tuberculosis Mycobacterium, Legionella, and gram negative bacteria (Pseudomonas) may also occur especially in the elderly or immunocompromised.

For Puerto Rico and the U.S. Virgin Islands the risk of these diseases may be extended through March of 2018 due to the delay restoration of power and safe water facilities.

Mumps

Mumps is a difficult diagnosis because other viruses and oral conditions can also cause parotitis. Clogged or infected salivary glands or infected teeth can cause swelling that mimics mumps. Other viruses can also mimic mumps. The CDC conducted an investigation from 2009-2011 of suspected cases of sporadic mumps (suspected cases not linked to an outbreak). Buccal swabs in 38% of the patients tested positive for Epstein Barr (23%), Human Herpes Virus 6B (10%), Human parainfluenza virus 2 (3%) and Human parainfluenza virus 1( 1%).

In unvaccinated individuals mumps may have  prodromal symptoms of myalgia, anorexia, malaise, headache and low grade fever but these symptoms may be absent in vaccinated or partially vaccinated patients. Symptoms are swelling and tenderness in one or more salivary glands, usually the parotid, sublingual or submaxillary glands that lasts more than 2 days and may last at least a week to 10 days in unvaccinated people.

The best test for mumps is a buccal swab in viral media taken within 3 days of parotitis onset. Massage the salivary gland area for 30 seconds before collecting the swab. The state laboratory can test the swab. Contact the Pima County Health Department for sample submission. Most reference labs only run serology tests.

Mumps IgM in an unvaccinated person peaks at 1 week after onset and will remain elevated for several weeks. Mumps IgM in vaccinated individuals may be absent, delayed, or transient.

Mumps IgG is only useful in a vaccinated individual if there is a 4 fold rise between the acute and convalescent blood draws. Vaccinated individuals will often have a positive IgG at the initial blood draw.

 

Click below for a clear copy of the guidelines.

Clinical Time Line of RMSF

Revised Communicable Disease Rules Posted

 A “clean copy” of the revised communicable disease rules recently approved by the Governor’s Regulatory Review Council are now posted to the ADHS website. 

The official paper copy will be available for $9.00 at the Office of the Secretary of State, Administrative Rules Division, 1700 W Washington St. Fl 7, Phoenix, Arizona 85007-2808 once they post it on their website.

If you would like to subscribe to CDC Health Alert Network update, please visit: http://emergency.cdc.gov/han/updates.asp

If you are interested in receiving this report, please go to: https://webcms.pima.gov/cms/One.aspx?portalId=169&pageId=6232