Fourth 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! 
Clinicians urged to report cases of lung injury associated with e-cigarettes or vaping

Since August, the Centers for Disease Control and Prevention (CDC) has received reports of 2,172 cases of lung injury, including 42 confirmed deaths, associated with "vaping" (use of e-cigarette devices to aerosolize substances for inhalation) or "dabbing" (vaping marijuana oil, extracts or concentrates). The median age of deceased patients was 52 years and ranged from 17 to 75 years old. Two of these deaths were reported in Kansas and the number of injury cases in Kansas is between 10 and 49.

Last week the CDC announced that they detected vitamin E acetate in all the samples of lung fluid submitted for testing. Vitamin E acetate is used as an additive in the production of e-cigarette, or vaping, products. This is the first time that the CDC detected a potential chemical of concern in biologic samples from patients with these lung injuries.

As the investigation continues, the CDC  encourages  clinicians to report cases of significant respiratory illness of unclear etiology and a history of vaping to their state and/or local health department.  If an e-cigarette product is suspected as a possible etiology of a patient's illness,  obtain a detailed history including: 
  • Types of substances used (e.g., tetrahydrocannabinol [THC], cannabis [oil, dabs], nicotine, modified products or the addition of substances not intended by the manufacturer); product source, specific product brand and name; duration and frequency of use, time of last use; product delivery system, and method of use (aerosolization, dabbing, or dripping).
Clinicians should determine if any retained product, including devices and liquids, are available for testing. Testing can be coordinated with the local/state health department.  Report cases or suspect cases of unexplained vaping-associated pulmonary illness to JCDHE at 913-826-1303 or the  Kansas Department of Health and Environment  at 877-427-7317 or  contact .

When treating patients with respiratory symptoms who report a history of vaping, consider
consultation with a pulmonologist and conduct a thorough infectious disease evaluation. Also
consider running a heavy metal panel as many vaping products contain high levels of nickel and lead.

The U.S. Food and Drug Administration encourages the public to submit detailed reports of any unexpected tobacco- or e-cigarette-related health or product issues via the online Safety Reporting Portal.
Vape-Free Schools toolkit available 

The Kansas Vape-Free Schools Toolkit is a free guide to help schools and school districts become tobacco-free and e-cigarette-free.  The toolkit contains information and resources to help schools effectively implement, clearly communicate, regularly enforce and support a truly tobacco-free and e-cigarette-free campus. 

This resource is brought to you by Resist, a youth-led, state-wide tobacco prevention program, the Kansas Department of Health and Environment and the Tobacco Free Kansas Coalition. Resist's initiative is to help all Kansas schools implement 100 percent comprehensive tobacco-free and vape-free policies. This type of policy is critical to creating tobacco-free and vape-free learning environments for students. Download more materials here.
Kansas reports dramatic increase in congenital syphilis

Congenital Syphilis
Last month the Centers for Disease Control and Prevention released their annual STD Surveillance report. In 2018 the number of babies born with syphilis reached its highest level in more than 20 years. This report also shows that Kansas ranks 15th in the nation for Congenital Syphilis cases when adjusted
for population, despite ranking much lower in syphilis infections among adults

Dr. Lee Norman, secretary of the Kansas Department of Health and Environment (KDHE), said in an Oct. 8 news release, "Untreated syphilis in pregnant women results in infant death in up to 40 percent of cases, so all pregnant women should be tested for syphilis at the first prenatal visit, and we recommend that the syphilis screening test should be repeated at the beginning of the third trimester (28 to 32 weeks gestation) and again at delivery." 

This is good advice as Johnson County, Kansas has seen an increase in the number of syphilis cases in women of child-bearing age in the last 5 years. In 2015, Johnson County had 2 cases of syphilis in women age 15-44 years. So far in 2019 that number is up to 16 cases.

Healthcare providers should talk with patients about their sexual history and provide STI counseling to those at risk. Syphilis testing should be performed for sexually active patients as part of an annual STI/Sexual Health panel, and more frequent STI screening should be considered if a patient reports multiple sex partners, substance use, or other risk factors.

When patients test positive for reportable STIs, treat them as soon as possible with medications recommended by the CDC, and test and treat the infected patient's sex partner(s) as well to avoid reinfection.  And, as with all reportable diseases, cases of chlamydia, gonorrhea, syphilis, and HIV should be reported to KDHE's STI/HIV Section at 785-296-6174. The Kansas STI Case Report Form can be found here.   
Kansas health officials recommend 5 day exclusion for flu 

Mom and sick child flu
The Kansas Department of Health and Environment is recommending that the state reduce its influenza isolation requirement to five days instead of seven for the current flu season.
State Epidemiologist Farah Ahmed said in an Oct. 23 memo that after examining scientific literature and evaluating data from last year's influenza season, the seven day recommendation was inconsistent with the scientific knowledge about the length of infectiousness for most adults and children. 

Therefore, JCDHE recommends that anyone with influenza-like illness who has received a positive laboratory test for influenza or is being treated with antiviral medication for influenza, remain in home isolation for five days following onset of illness. If fever persists for more than 5 days, continue exclusion until 24 hours fever-free.

For each person hospitalized with a case of influenza, droplet precautions shall be followed for five days following onset of illness. If fever persists for more than 5 days, continue droplet precautions until 24 hours fever-free.
Protect your adult patients from influenza this season

Doctor giving woman flu shot
During most influenza seasons, adults 65 years and older bear the greatest burden of severe influenza disease. In fact, it is estimated that between 70-85 percent of influenza-related deaths and 50-70 percent of influenza related hospitalizations occur among people in this age group.

Health care professionals caring for older adults have an important role in ensuring their patients know they are at high risk of influenza complications and receive an influenza vaccine every year. Talk to your patients about influenza and what influenza vaccines are available for them this season.

There are several influenza vaccines available for people 65 years and older, including:
  • The "high dose" influenza vaccine (Fluzone High DoseĀ®) contains 4 times the amount of antigen as regular influenza. It is associated with a stronger immune response following vaccination.
  • The adjuvant vaccine (FluadĀ®) is a standard dose influenza vaccine with an added adjuvant. An adjuvant is an ingredient added to a vaccine to help create a stronger immune response to vaccination.
Learn more about influenza in people over age 65.
CDC toolkit prepares your practice to "Fight Flu"

Get a flu shot
Whether you're a primary care physician, nurse, pharmacist, or other health care professional (HCP), you play a significant role in helping protect Johnson County citizens against influenza. Your strong influenza vaccine recommendation is one of the most important factors in patients accepting the vaccine. 

The Centers for Disease Control and Prevention (CDC) has put together a Fight Flu Toolkit to  prepare your practice to fight flu. Use these materials throughout flu season and during National Influenza Vaccination Week, Dec. 1-7. The materials will:
  • Equip you to make strong influenza vaccine recommendations
  • Facilitate productive conversations with your patients
  • Improve your influenza vaccination rates

JCDHE's immunization clinics offer seasonal flu shots at these locations and times: 

Olathe Clinic (11875 S. Sunset Drive) - Monday and Tuesday, 8 a.m. to 4 p.m.; Wednesday, 8 a.m. to 6 p.m.; Thursday, 8 a.m. to 4 p.m.; and Friday, 8 a.m. to 2 p.m.

Mission Clinic (6000 Lamar Ave.) - Tuesday and Thursday, 8 a.m. to 4 p.m.
PCR and culture is gold standard for pertussis testing

An increase in pertussis (whooping cough) cases in Johnson and Wyandotte counties in Kansas this fall has disease investigators at both health departments concerned. The disease is very contagious and can be especially severe in babies, infants and those who are immunocompromised.
Any person presenting with a cough lasting more than 7 days, a paroxysmal cough, or post-tussive vomiting should be considered for pertussis testing, regardless of immunization status. In addition, any person who has a cough of any duration and has recently been exposed to pertussis should be tested.

Providers are encouraged to collect a nasopharyngeal (NP) swab for PCR and culture testing. A culture is considered the gold standard for testing and a PCR test can provide rapid and sensitive results. It is important to note that a negative PCR does not rule out pertussis infection and the provider should also consider clinical presentation. Serology testing can also be useful but should be collected in addition to, not in substitution of, a PCR and culture.
Pertussis is reportable to public health within 24 hours. Call JCDHE at 913-826-1303 or KDHE at 877-427-7317.
Meet the Disease Investigation Team: Braden Bardach 

Braden Bardach DHE
Braden Bardach joined the Johnson County Department of Health and Environment in July 2019 while completing his master's degree in public health in epidemiology at the University of Texas Health Science Center. Prior to making the spontaneous move to Kansas (he found an apartment, packed and moved within six days), he worked as an epidemiology intern for Collin County in north Texas.
Braden works as a disease investigator for the disease containment team. He performs surveillance on communicable diseases with the hopes of preventing the spread of them so that Johnson County can remain healthy and prosperous.
In his free time, Braden enjoys playing and watching sports. He especially enjoys watching his Texas Tech Red Raiders own the Big XII, and yes, he was there when Mahomes was their quarterback. You can reach him by phone at 913-826-1252 or by email at .
Human rabies vaccine shortage continues

Vaccine in arm
Last month the Kansas Department of Health and Environment (KDHE) sent an alert to health care providers about the ongoing human rabies vaccine and immune globulin product shortage. Providers are advised to continue to administer rabies post-exposure prophylaxis (PEP) when indicated.  

What Clinicians Should Do
If PEP is indicated and rabies vaccine is not readily available, order RabAvert directly from GlaxoSmithKline by calling 866-475-8222, option 3 or divert stock from another hospital within the same healthcare system, if possible. 

If the patient started PrEP or PEP with IMOVAX and IMOVAX is not available, complete the series with RabAvert.  Providers should consult with JCDHE at 913-826-1303 or KDHE at 877-427-7317 to ensure appropriate use of PEP. 

Standard rabies exposure prevention messaging should also be reinforced.
  • Pets and livestock should be vaccinated against rabies as recommended.
  • When possible, after an exposure, efforts should be made to safely capture the animal involved in the exposure and it should be held for observation (if a cat, dog, or ferret) or tested for rabies.
Upcoming holiday closures

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

Thursday, Nov. 28-Friday, Nov. 29, 2019 (Thanksgiving)


Wednesday, Dec. 25, 2019 (Christmas)


Wednesday, Jan. 1, 2020 (New Year's Day)


Monday, Jan. 20, 2020 (Martin Luther King, Jr. Day)


Clinic Holiday Hours

The Olathe clinic will close at  2 p.m. on Nov. 27 and Dec. 24. The Mission clinic will be closed Dec. 24-30. Both clinics will close at 3 p.m. on Dec. 31. 

Yellow Fever and shingles vaccines temporarily unavailable at clinics 

The Johnson County Department of Health and Environment is temporarily out of  Yellow Fever and shingles vaccines.

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.  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

Those seeking a SHINGRIX vaccine, an FDA-approved vaccine for the prevention of shingles (herpes zoster) in adults 50 years and older, can search this  vaccine locator. Call  ahead to ensure availability as some healthcare providers or local pharmacies are sometimes out of stock.
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

Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury 

Outbreak of Salmonella Infections Linked to Ground Beef (2 cases in Kansas)

Preventing Adverse Childhood Experiences (ACEs) to improve U.S. health

Rural Americans are dying more frequently from preventable causes than their urban counterparts

More People in the United States Dying from Antibiotic-Resistant Infections than Previously Estimated
Johnson County Department of Health and Environment |
REPORT A DISEASE:  (913) 826-1303; Fax: (913) 826-1300
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