PCHD releases latest Epidemiology Enhanced 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.

This report includes:

• Guillain-Barré Syndrome and Zika Virus Infection
• Miami-Dade County Zika Cautionary Area lifted
• Legionnaires in Newborns after Water Births
• World Hepatitis Day Event on July 28
• Cryptosporidiosis

Guillain-Barré Syndrome (GBS) and Zika Virus Infection      

Current CDC research suggests that GBS is strongly associated with Zika; however, only a small proportion of people with recent Zika virus infection get GBS. CDC is continuing to investigate the link between GBS and Zika to learn more. If you have a patient diagnosed with Guillain-Barré Syndrome and has a history of travel to a country with local Zika virus transmission, order a Zika PCR and IgM test in addition to the usual tests ordered such as West Nile Virus.

As a reminder, the CDC-recommended diagnostic evaluation for Zika virus infection consists of RNA nucleic acid testing (NAT) conducted on urine samples collected less than 14 days after symptom onset. Urine should always be collected with a patient-matched serum specimen. A positive RNA NAT result on any sample confirms Zika virus infection and no additional testing is indicated. A negative RNA NAT result does not exclude Zika virus infection and serum should be analyzed by IgM antibody (serological) testing.

Miami-Dade County Zika Cautionary Area lifted

Miami-Dade County was previously designated as a Zika cautionary (yellow) area, but that designation was removed on June 2, 2017. This means that there are no longer any travel recommendations related to Zika virus for Miami-Dade County, Florida. Although the level of risk of Zika virus transmission after a yellow area is removed is not known, it is likely to be low. However, sporadic cases may still occur. For this reason, CDC recommends that people living in or traveling to Miami-Dade County continue to protect themselves from mosquito-borne illnesses, including Zika virus.

Legionnaires in Newborns after Water Births

Two cases of Legionnaires disease in newborns occurred in Maricopa County in 2016 after water births. Both cases were delivered by midwives at home with tap water from the faucet. One of the infants was delivered into a jetted tub instead of a birthing tub and the water was allowed to sit for a week before the birth. Tap water is not sterile and Legionella’s optimum temperature for growth is 77 ˚ to 108˚ F. ADHS has adapted water-birthing guidelines. The website is provided below.

http://www.azdhs.gov/licensing/special/midwives/index.php?utm_medium=email&utm_source=govdelivery#training

World Hepatitis Day Event on July 28

World Hepatitis Day brings awareness of the global burden of viral hepatitis to the public and influence change. Viral hepatitis is a global epidemic that affects millions of people and is one of the leading causes of death globally, accounting for 1.34 million deaths per year (as many as HIV/AIDs, TB, or malaria). The American Liver Foundation (ALF) will be hosting an event in Phoenix (location TBD) to engage the public on this issue by providing free hepatitis C testing and education.

Cryptosporidiosis

A total of 549 cases of confirmed and probable cryptosporidiosis were reported in Arizona in 2016. An outbreak in 2016 was associated with multiple recreational water parks. Cryptosporidiosis is resistant to normal swimming pool treatment levels. People with cryptosporidiosis should not swim in a pool, sit in a spa, wading pool or attend a fountain style water park.

Influenza Virus and RSV

• Influenza activity is decreasing in Arizona, which reported local Activity for week 25 (June 18 to June 24). Findings:
• Currently type B is the predominant influenza typed at the State Health Department
• Two influenza-associated pediatric deaths have been reported for the 2016-2017 season one in a Pima County resident and one in a Maricopa County Resident. Both cases were PCR-positive for influenza A (H3).
• Pima County has reported 773 cases of RSV this season with most cases occurring in children 4 years of age and less.
• Statewide there has been a 25% increase in RSV cases compared to the 2015-2016 season.

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.

Contacting and Reporting to the Pima County Health Department

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.

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.

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

By:  Pima County Health Department