Second Quarter 2019
The EPI Update is a quarterly e-newsletter provided by the disease containment staff of the Johnson County Department of Health and Environment (JCDHE). This newsletter will arm health care providers and public health professionals with information about disease trends and public health services in Johnson County, Kansas. If you have a story idea for a future issue, send an email to Share this newsletter with your colleagues! 
Johnson County flu season lingers into spring

Girl with flu
Flu season in Johnson County lingered into early April before the number of cases slowed down. Influenza A was responsible for 88 percent of the 5,426 cases of influenza that were voluntarily reported to JCDHE as of May 10. This is a decrease in influenza cases (22 percent) from this same time last year when 6,940 cases were voluntarily reported. There were 7 deaths in Johnson County directly linked to influenza as of May 13.  

Thank you to all the providers who voluntarily sent in their flu reports to JCDHE this season. You can help JCDHE get a more accurate picture of flu activity in Johnson County by submitting a Weekly Influenza Surveillance Reporting  Form . Complete the form each week and fax to 913-826-1300.
STD Awareness Month
STDs surge across the United States: JCDHE says, Talk.Test.Treat.

Three common STDs have increased sharply across the United States for the fourth year in a row. To help reverse this trend, the Johnson County Department of Health and Environment (JCDHE) is calling on individuals and healthcare providers to take these three actions to protect themselves, their partners, and their patients from STDs: Talk.Test.Treat.

In 2018 alone, Johnson County, KS had 2,134 cases of chlamydia, 571 cases of gonorrhea, 27 cases of primary and secondary syphilis, 45 cases of early latent syphilis, and 72 cases of early syphilis. More than two million cases of the three STDs combined were reported nationwide. Congenital syphilis - syphilis passed from a mother to her baby during pregnancy or delivery - has also dramatically increased. The Kansas Department of Health and Environment (KDHE) received reports of 8 cases in 2018 and only one case in the seven years prior.

"Across the nation, these data mean our work is more important than ever - and we can all get involved," says Gail Bolan, MD, Director of CDC's Division of STD Prevention.  "CDC and other federal organizations, community leaders, health departments, community-based organizations, health care providers, and individuals can all take action at work, in our schools and communities, and at home to make a difference."

Untreated STDs Can Have Serious Effects
Chlamydia, gonorrhea, and syphilis are curable with the right medicines, yet most cases go undiagnosed and untreated - which can lead to severe health problems that include infertility (inability to become pregnant), ectopic pregnancy (pregnancy outside the womb), stillbirth in infants, and increased HIV risk.

Anyone who has sex can get an STD, but some groups in Johnson County are more affected than others such as young people aged 15-24. In 2018, this group made up 63% of all chlamydia and gonorrhea cases in Kansas. Prior studies suggest a range of factors may be at play - from socioeconomic challenges, like poverty, to issues of stigma and discrimination.

"STD rates in Johnson County continue to climb each year," says Lougene Marsh, JCDHE director. "We offer confidential, affordable testing and treatment at our walk-in clinics in Olathe and Mission. No appointment is necessary and we're open until 6:30 p.m. on Wednesdays making it convenient for clients to visit us after school or work."

The good news?  All STDs can be prevented and treated, and most can be cured. Here's how individuals and healthcare providers can add the  Talk.Test.Treat. strategy into their health routine:

Individuals can
  • Talk openly with partner(s) and healthcare providers about sex and STDs.
  • Get tested. Because many STDs have no symptoms, getting tested is the only way to know for sure if you have an infection.
  • If you test positive for an STD, work with your doctor to get the correct treatment for you and your partner. Some STDs can be cured with the right medication. Those that aren't curable can be treated.
Healthcare providers can
Visit the  official website for more information on how you can talk, test, and treat.
Measles cases in the U.S. are highest in 25 years

Multiple outbreaks of measles around the country have totaled 839 cases in 23 states as of May 10. This is the greatest number of reported cases in the U.S. since 1994 and since measles was declared eliminated in 2000.  The majority of measles cases are in New York City and New York state, which are primarily among  unvaccinated people in Orthodox Jewish communities and associated with travelers who brought measles back from Israel. There are no reported cases of measles in Johnson County as of May 15.   

Measles is highly contagious and spreads through the air when an infected person coughs or sneezes.  Healthcare professionals should be vigilant about measles:
  • Ensure all patients are up to date on MMR vaccine -- especially students at post-high school education institutions, healthcare personnel and international travelers. The killed measles virus vaccine was available from 1963-1968 to less than 5% of adults.The ACIP recommendation is to re-vaccinate anyone who received the killed measles virus vaccine. 
  • Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, runny nose, and conjunctivitis) who have recently traveledPatients exposed to measles while traveling for Passover could begin to develop symptoms through mid-May.
  • Ask patients about recent travel internationally or to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.
  • Promptly isolate patients with suspected measles to avoid disease spread and immediately report the suspect measles case to the health department.
  • Contact the Kansas Department of Health and Environment (KDHE) at 1-877-427-7317 about submitting specimens for testing from patients with suspected measles.
Measles is so contagious that if one person has it, up to 9 of 10 people around them will also become infected if they are not protected. The virus can cause serious health complications, such as pneumonia or encephalitis, and even death.

CDC continues to encourage parents to get their children vaccinated on schedule with the MMR vaccine. People 6 months and older should be protected with the vaccine before leaving on international trips. 

CDC has developed a digital toolkit with products for providers and patients about vaccines and measles.  If you suspect a patient may have measles, immediately call 913-826-1303 during regular business hours or 1-877-427-7317 after business hours or on weekends. 
Advancements lead to quicker detection of drug-resistant TB

Advancements in lab diagnostics and genotyping to quickly detect drug-resistant Tuberculosis (TB) were revealed last month at the National TB Conference in Atlanta. 

Using Molecular Detection of Drug Resistance (MDDR) for Mycobacterium tuberculosis (MTB), labs can now provide rapid detection of drug-resistant TB in as few as two hours compared to traditional growth based methods which required 3 to 4 weeks to produce results . This advancement helps guide the treatment of patients with drug-susceptible TB who are intolerant of treatment with first-line anti-tuberculosis drugs. 

TB genotyping helps identify persons with TB disease involved in the same chain of recent transmission. In the same way, TB genotyping helps distinguish between persons whose TB disease is the result of TB infection that was acquired in the past, as compared to recently or newly acquired infection with development of TB disease. 
The 2018 Kansas statewide active TB case rate is 0.96 per 100,000. In Johnson County the case rate is 0.51 per 100,000. 

The CDC plans to release new guidelines for preventing the transmission of MBT in health care settings this month.
Nurses essential in easing parental concerns about vaccination 

Nurse talking to mother and daughter
Parents consider health care professionals one of the most trusted sources in answering questions and addressing concerns about their child's health. A recent survey on parents' attitudes, knowledge, and behaviors regarding vaccines for young children - including vaccine safety and trust - found that 82% of parents cited their child's health care professional as one of their top 3 trusted sources of vaccine information. With so many parents relying on the advice of health care professionals about vaccines, a nurse's recommendation plays a key role in guiding parents' vaccination decisions.

"A nurse's expertise, knowledge, and advice are vital in creating a safe and trusted environment for discussing childhood immunizations," said Dr. Nancy Messonnier, CDC's Director of the National Center for Immunization and Respiratory Diseases. "How you communicate with parents during routine pediatric visits is critical for fostering parental confidence in the decision to vaccinate their children."

The survey also found that 71 percent of parents were confident or very confident in the safety of routine childhood immunizations, although parents' most common question is what side effects they should look for after vaccination. Twenty-five percent are concerned that children get too many vaccines in one doctor's visit and 16 percent of survey participants are concerned that vaccines may cause autism.

"Reinforcing vaccine safety messages can go a long way towards assuring parents that they are doing the best thing for their children," says Patsy Stinchfield, a Pediatric Nurse Practitioner who represents the National Association of Pediatric Nurse Practitioners. "One of the best ways you can establish trust with parents is by asking open-ended questions to help identify and address concerns they may have about vaccines. Also, restate their questions and acknowledge concerns with empathy."

Make sure to address questions or concerns by tailoring responses to the level of detail the parent is looking for. Some parents may be prepared for a fairly high level of detail about vaccines, how they work and the diseases they prevent, while others may be overwhelmed by too much science and may respond better to a personal example of a patient you've seen with a vaccine-preventable disease. A strong recommendation from you as a nurse can also make parents feel comfortable with their decision to vaccinate.

For all parents, it's important to address the risks of the diseases that vaccines prevent. It's also imperative to acknowledge the risks associated with vaccines. Parents are seeking balanced information. Never state that vaccines are risk-free and always discuss the known side effects caused by vaccines.

If a parent chooses not to vaccinate, keep the lines of communication open and revisit their decision at a future visit. Make sure parents are aware of the risks and responsibilities they need to take on, such as informing schools and child care facilities that their child is not immunized, and being careful to stay aware of any disease outbreaks that occur in their communities. If you build a trusting relationship over time with parents, they may reconsider their vaccination decision.

To help communicate about vaccine-preventable diseases, vaccines, and vaccine safety, the Centers for Disease Control and Prevention (CDC), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP) have partnered to develop Provider Resources for Vaccine Conversations with Parents. These materials include vaccine safety information, fact sheets on vaccines and vaccine-preventable diseases, and strategies for successful vaccine conversations with parents. They are free and  available online.
Summer Holiday Closures 

The Johnson County Department of Health and Environment's offices and clinics will be closed on the following holidays:

  • Monday, May 27, 2019 (Memorial Day)
  • Thursday, July 4, 2019 (Independence Day)
  • Monday, September 2, 2019 (Labor Day)
Annual symposium prepares public health leaders and others

More than 130 leaders in public health, emergency response, preparedness and health care from around the region gathered at the Johnson County Arts and Heritage Center in Overland Park on May 1 for the third Kansas Infectious Disease Symposium. 
Experts in infectious diseases, tuberculosis, sexually transmitted infections and influenza provided data and shared tips on how to plan for and manage outbreaks and disease investigations. Other presenters provided a perspective on opioid prevention and rabies control measures. Dr. Diane Peterson, Johnson County's chief medical examiner, was the lunchtime presenter and explained the role of forensic pathology in emerging infectious diseases. The Kansas Department of Health and Environment gave attendees demos on how to use the Essence surveillance system.
"Getting all of these local, state and federal partners in one room to share information and learn from one another will enhance our ability to prepare for and respond during a public health emergency," said Lougene Marsh, director of the Johnson County Department of Health and Environment (JCDHE). "Whether it's a foodborne illness investigation, a measles outbreak or bioterrorism, the people in this room are the ones that will help  us protect the community's health."
The annual event was presented by JCDHE and KDHE.
Yellow Fever vaccine temporarily unavailable at clinics 

The Johnson County Department of Health and Environment's walk-in immunization clinics are temporarily out of the  Yellow Fever vaccine.

Because of a total depletion of their supply of YF-Vax, the manufacturer (Sanofi Pasteur) has made an alternative yellow fever vaccine, Stamaril, available at select locations until YF-Vax supply returns, which is expected by mid-2019.

Yellow fever virus is found in tropical and subtropical areas in South America and Africa. More information about the vaccine shortage and how to prevent it can be found here
Meet the Disease Investigation Team: Chase Schlesselman 

Chase Schlesselman, MPH, joined the Johnson County Department of Health and Environment's disease investigation team in December 2018 after completing his Masters in Public Health with an emphasis in Health Promotion and Policy and his Graduate Certificate in Epidemiology from the University of Missouri in May 2018. Chase investigates  cases of reportable disease in Johnson County residents. He works to determine where the person contracted the disease thereby preventing further spread of the disease. 

Prior to joining JCDHE, Chase conducted wellness assessments for health insurance companies and was also an academic advisor for the Mizzou MPH program. He's also spent time working in food security, diabetes, exercise and obesity in adolescents, and vector control for communicable disease.

In his free time, Chase likes to exercise, go to Kansas City Royals games, try (and fail) to teach his cats to do tricks, play video games and try new foods. You can reach him at 913-826-1252 or .
Johnson County Disease and Surveillance Reports
The Johnson County Department of Health and Environment produces a monthly disease report listing cases (confirmed, suspect, probable and not a case) that are investigated by our staff. Starting in the fall through late spring, we post weekly influenza surveillance reports. We also compile end of the year reports about diseases and influenza on this page
Get notified about disease outbreaks in Johnson County 

The Johnson County Department of Health and Environment uses NotifyJoCo to alert local healthcare providers about disease outbreaks in Johnson County, Kan. and other related information. This service is in addition to the Kansas Health Alert Network (KS-HAN) messages you may already be receiving from the Kansas Department of Health and Environment.  

Healthcare providers can sign up to receive these alerts by clicking here. Create an account (if you don't have one). Choose My Subscriptions --> Johnson County Subscriptions --> Dept of Health & Environment.  Next, choose "Department of Health Community Partner" as the type of contact. There is no need to select a building or duty assignment.  Your contact information will only be used to send out alerts from JCDHE via NotifyJoCo. 

If you have questions about the sign up process, call 913-826-5555.  
News from the CDC

Training module offered for Rocky Mountain spotted fever

Healthy and Safe Swimming Week is May 20-26, 2019 (Toolkit/fact sheets for providers available)

Outbreak of Salmonella Infections Linked to Pre-Cut Melons

Clean Hands Count campaign offers materials for patients and providers in English and Spanish
Johnson County Department of Health and Environment |
REPORT A DISEASE:  (913) 826-1303; Fax: (913) 826-1300
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