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The Epi-Log Newsletter
Volume 43, No. 1 - January 2003
Smallpox Vaccine (Vaccinia) Adverse Event Recognition and Management
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Military bases and U.S. Coast Guard facilities in our region are beginning to vaccinate small numbers of personnel for smallpox. It is possible, though unlikely, that persons with adverse events related to smallpox vaccination, including secondary vaccinia virus infection, will present to health care providers in the community for evaluation and care. Civilian Smallpox Health Care and Public Health Teams are scheduled to begin receiving immunizations in February, and the current National Smallpox Vaccination Plan (NSVP) calls for a progressive increase in the number of persons vaccinated in the community this year. Therefore, health care providers should become familiar with the recognition, evaluation, and management of adverse events related to smallpox vaccination, including those occurring in close contacts of vaccinees due to secondary spread (see training resources, below). Health care providers should also know how to contact infectious disease, dermatology, and immunology specialists for assistance in evaluating persons with possible smallpox vaccine adverse events. Please also contact Public Health's Communicable Disease Control, Epidemiology, and Immunization Section at (206) 296-4774 when evaluating vaccinees, or contacts of vaccinees suspected to have complications of smallpox vaccination.
Update on TB outbreak among homeless
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An increase of tuberculosis among homeless persons in King County was described in the November 2002 Epi-Log. Twenty-nine cases of tuberculosis were diagnosed in 2002, a doubling of the usual 12 to 15 cases per year diagnosed in King County. All culture-positive cases in the homeless (tested to date) are fully sensitive to standard TB medications. Twelve of these cases have the same DNA fingerprint, demonstrating a discrete outbreak that appears to account for the increase in cases among the homeless. A high proportion of the outbreak cases are Native American and/or HIV-infected.
Public Health-Seattle & King County's TB control program is being assisted by the Washington State Department of Health TB control program and the CDC to investigate and manage this outbreak. CDC staff have been instrumental in helping to evaluate potential sites of transmission and the magnitude of TB exposure at these sites.
Please maintain a high level of vigilance for signs and symptoms of tuberculosis among patients, especially the homeless, and call the TB program at (206) 744-4579 to report suspected new active cases. The TB Clinic's website contains useful information on TB infection and disease, reports describing local TB epidemiology, and links to other authoritative TB resources: www.metrokc.gov/health/sts_svs/tuberculosis.htm
Increase in Salmonella enteritidis in Washington State
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Since mid-December, more than two dozen Salmonella Enteritidis cases have been reported in Washington State. Many of the isolates are indistinguishable by Pulsed Field Gel Electrophoresis (PFGE) indicating they may be related to a common source. The majority of cases are in residents of King and Snohomish Counties and most of the cases ate eggs during their incubation period. Symptoms of salmonella infection include sudden onset of diarrhea, abdominal cramps, usually fever, and sometimes vomiting. To help with this ongoing investigation, please obtain stool specimens for bacterial testing from persons with symptoms compatible with salmonellosis, and report any suspected or confirmed cases to public health as soon as possible. Persons at high risk for serious complications of salmonella infection include the very young, the elderly, and persons with compromised immune systems. Such persons should be particularly careful not to consume foods containing raw eggs (such as Caesar salad dressing, raw cookie dough) and should consume only egg dishes which are completely cooked.
Information on salmonellosis is available online at: www.metrokc.gov/health/prevcont/salmon.htm
Sporadic Influenza A is being reported in Washington State
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Influenza is present, activity remains relatively quiet to-date. Both influenza A H1 strains and H3N2 strains have been reported by the Public Health laboratory. Both strains are represented in this year's flu vaccine. Since the peak of the influenza season is still to come, there is still time to vaccinate high-risk individuals and their household members, health care workers, and others who wish to avoid influenza this season.
Guillain-Barré Syndrome investigation
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Public Health is investigating four recent cases of Guillain-Barré Syndrome. Two of the cases experienced a respiratory illness shortly before onset of Guillain-Barre Syndrome; no other common risk factor has been present. We are soliciting reports of Guillian-Barré Syndrome from health care providers in King County at this time to determine if there are additional cases occurring. Please call Laurie Stewart at (206) 296-2735 to report any recent cases of Guillain-Barré Syndrome. It would be helpful if you could provide information on recent illnesses, vaccinations, or travel among the cases.
Register for CDC's Epidemiology & Vaccine-Preventable Diseases Course 2003
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Registration information for the course: Epidemiology and Prevention of Vaccine-Preventable Diseases, is now available at: www.metrokc.gov/health/immunization/providers.htm
This training is scheduled for February 13, 20, 27, and March 6, 2003 and is being co-sponsored by the Region X Public Health Service. It will be held at the Blanchard Plaza Building, at 6th and Blanchard in downtown Seattle. Each interactive broadcast will run from 9:00 AM to 12:30 PM. If you have additional questions about this course, please contact Tiffany Acayan at (206) 205-5812 or tiffany.acayan@metrokc.gov.
Communicable Disease and Epidemiology contact information
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> Disease reporting
| AIDS |
(206) 296-4645 |
| Sexually Transmitted Diseases |
(206) 744-3954 |
| Tuberculosis |
(206) 744-4579 |
| Other Communicable Diseases |
(206) 296-4774 |
| Automated 24-hour reporting line for conditions not immediately notifiable |
(206) 296-4782 |
> Hotlines
| Communicable Disease Hotline |
(206) 296-4949 |
| HIV/STD Hotline |
(206) 205-7837 |
> For health providers:
- Health Provider homepage
Resources to fact sheets, updated news, vaccine information, health educational materials and external links.
www.metrokc.gov/health/providers
Reported Cases of Selected Diseases in Seattle and King County
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Cases reported
in December
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Cases reported through December
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2002
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2001
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2002
|
2001
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| AIDS |
23
|
37
|
277
|
327
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| Campylobacteriosis |
16
|
27
|
300
|
325
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| Cryptosporidiosis |
6
|
3
|
34
|
29
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| Chlamydial infections |
429
|
349
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4465
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4297
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Enterohemorrhagic
E. coli (non-O157) |
0
|
1
|
0
|
4
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| E. coli O157:H7 |
5
|
1
|
32
|
32
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| Giardiasis |
5
|
11
|
171
|
150
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| Gonorrhea |
127
|
111
|
1461
|
1555
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| Hæmophilus influenzæ (cases <6 years of age) |
0
|
1
|
0
|
0
|
| Hepatitis A |
3
|
3
|
31
|
28
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| Hepatitis B (acute) |
1
|
5
|
31
|
36
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| Hepatitis B (chronic) |
63
|
46
|
585
|
629
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| Hepatitis C (acute) |
0
|
0
|
12
|
9
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| Hepatitis C (chronic, confirmed/probable) |
119
|
114
|
1458
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1431
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| Hepatitis C (chronic, possible) |
35
|
22
|
470
|
528
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| Herpes, genital (primary) |
39
|
335
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650
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672
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| Measles |
0
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0
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0
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12
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| Meningococcal Disease |
4
|
21
|
2
|
13
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