Texas & Ohio Quietly Reach End Of Ebola Contact Monitoring

Credit CDC PHIL

 

 

# 9295

 

This week marks the end of Ebola contact monitoring in the states of Ohio and Texas, as 21 days have now passed since the last known exposure to an infected patient.   The vigil in Ohio ended mid-week, while the one in Texas will end later today.

Since the majority of those being monitored were extremely `low risk’ contacts, the risks to the community were always considered small. This should, however, offer some reassurance to those who were worried that Ebola might quickly spread in the United States.

New York state continues to monitor contacts of Dr. Spencer, but thus far the new is very encouraging, as there are no indications that he transmitted the virus to anyone else.

 

Despite the media hysteria and the internet conspiracy predictions of doom, the evidence continues to mount that Ebola infected individuals – at least early in the symptomatic phase of their illness – are less infectious than many people originally feared.

 

While this phase of America’s Ebola experience draws to a close, the evidence suggests we’ll see more imported cases of Ebola (or MERS, Avian Flu, etc.) in the future, which will prompt similar public health responses.  Many of the lessons learned in Ohio and Texas will no doubt help other states when it becomes their turn to deal with a local case.

 

Two press releases follow:

 

FOR IMMEDIATE RELEASE November 5, 2014
Contact: Ohio Department of Health Public Affairs, (614) 644-8562

FINAL OHIO DAILY EBOLA CONTACT REPORT

11-05-14
COLUMBUS – The Ohio Department of Health reported this morning in its Daily Ebola Contact Report that there are currently:

• 0 confirmed cases of Ebola in Ohio;
• 0 people under quarantine;
• 0 contacts statewide;
  

Tuesday was the last day of monitoring all contacts as their 21 days exposure has ended. ODH officials and Centers for Disease Control and Prevention (CDC) Ohio team members worked together to identify anyone who may have had contact of some type with the Dallas nurse who was in Northeast Ohio, Oct. 10-13. No individuals have shown any symptoms.

The ODH call center will also go back to operating only between business hours of 8am-5pm. During the Ebola response effort, the call center saw 2404 calls. Ohioans can still call the number if they have any questions about Ebola. The number to call is 1-866-800-1404.

(Continue . . .)

 

Texas Reaches Ebola Monitoring Endpoint

News Release
Nov. 6, 2014

The last person being monitored in connection with the state’s three diagnosed Ebola patients will be cleared from twice-daily monitoring by the end of the day Friday after reaching the 21-day mark, the longest incubation period for the disease.

No additional cases of the disease have been diagnosed in Texas.

A total of 177 people – a mix of health care workers, household contacts and community members – have been monitored over time because they had contact with at least one of the three Texas Ebola patients, specimens or medical waste. The last person being monitored Friday is a hospital worker who handled medical waste Oct. 17.

“We’re happy to reach this milestone, but our guard stays up,” said Dr. David Lakey, commissioner of the Texas Department of State Health Services. “We reached this point through teamwork and meticulous monitoring, and we’ll continue to be vigilant to protect Texas from Ebola.”

Texas also recently cleared the people who were being monitored in Texas because they were passengers on one of the Dallas-Cleveland flights that carried a Dallas health care worker before she was diagnosed with Ebola.

State and local health officials worked with the Centers for Disease Control and Prevention to closely monitor people since the first patient was diagnosed Sept. 30.

Health officials continue to monitor all travelers who return to Texas from countries with widespread Ebola outbreaks. The CDC has identified about 50 people who have returned to Texas from those areas. One of those travelers, a Central Texas nurse who cared for Ebola patients in Sierra Leone, is considered to be at “some risk” of exposure to Ebola and has agreed to stay home until she reaches the 21-day mark. The rest are considered to be “low risk” contacts and are being monitored for symptoms.

Texas Health Presbyterian Hospital’s Open Letter To The Community

 

 

# 9214

 

While we tend to think of Ebola in terms of the tragic number infected, and the number of deaths, the damage done by this epidemic also includes impacts on society, the economy, and even personal and corporate reputations. 

 

One small example – Yesterday ABC News reported that the Ebola Scare Turns Dallas Hospital Into a 'Ghost Town', a response to the initial misdiagnosis of America’s index imported Ebola case, and the subsequent infection of at least two hospital employees.

 

While there is no Ebola risk to the public by visiting this facility, for the time being, they – and that includes thousands of dedicated employees, and the community who depend upon the medical care offered there - are suffering the consequences. 

 

How long it will take to repair the public relations damage is hard to say – and probably depends on whether more employees turn up sick – but this morning the hospital took out a full page ad in the Dallas Morning News to apologize.

(Excerpt – read the entire letter here).

Two Overnight Statements From Texas Health Presbyterian Hospital

 

 

# 9202

 

The Dallas Hospital where America’s index case of Ebola died, and where at least two nurses were infected, has issued a pair of statements overnight.  

 

The first is an offer to employees who have had a potential exposure to the Ebola virus that they can self quarantine at the hospital. The second refutes a number of the claims lodged yesterday by local nurses regarding the infection control protocol used in the treatment of their index case (see Nurses Claim Lack Of Safety Protocols For Dealing With Ebola).

 

Ebola Update, Oct. 15, 9:44 p.m. CDT
10/15/2014

Ebola Virus

Statement from Texas Health Presbyterian Hospital Dallas

With a second one of our health care workers now infected with the Ebola virus despite following recommended protection procedures, Texas Health Dallas is offering a room to any of our impacted employees who would like to stay here to avoid even the remote possibility of any potential exposure to family, friends and the broader public.

We are doing this for our employees’ peace of mind and comfort.

This is not a medical recommendation. We will make available to our employees who treated Mr. Duncan a room in a separate part of the hospital throughout their monitoring period.

We want to remind potentially affected employees that they are not contagious unless and until they demonstrate any symptoms, yet we understand this is a frightening situation for them and their families. We will be coordinating this effort with the county monitors who are already regularly checking on their temperatures for any sign of infection.

The hospital will contact directly those being monitored to make arrangements. We also ask our potentially affected employees to be the good citizens that we know they are by avoiding using public transportation or engaging in any activities that could potentially put others at risk.

 

With regard to the charges made yesterday by the coalition of nurses, and the denials today by the hospital, I can only hope that a full and open hearing of the facts will be held, so that we can find out what actually happened.

Ebola Update, Oct. 16, 4:00 a.m. CDT
10/16/2014

Correcting the Record: Facts about Protocols and Equipment at Texas Health Presbyterian Hospital Dallas

National Nurses United recently made allegations regarding the protocols and equipment in place during Thomas Eric Duncan’s treatment at Texas Health Presbyterian Hospital Dallas.

The assertions do not reflect actual facts learned from the medical record and interactions with clinical caregivers. Our hospital followed the Centers for Disease Control (CDC) guidelines and sought additional guidance and clarity.

The following are facts about procedures and protocols in place during Mr. Duncan’s treatment:

• When Mr. Duncan returned to the Emergency Department (ED), he arrived via EMS. He was moved directly to a private room and placed in isolation. THD staff wore the appropriate personal protective equipment (PPE) as recommended by the CDC at the time.
• Regarding the ED tube delivery system utilized during Mr. Duncan’s initial visit, all specimens were placed into closed specimens bags and placed inside a plastic carrier that travel through a pneumatic system. At no time did Mr. Duncan’s specimens leak or spill — either from their bag or their carrier — into the tube system.
• During Mr. Duncan’s second visit, the tube system was not used at all. His specimens were triple-bagged, placed in a container, and placed into a closed transport container and hand-carried to the lab utilizing the buddy system. Additionally, while Mr. Duncan was in the MICU, all lab specimens were hand-carried and sealed per protocol. Routine labs were done in his room via wireless equipment.
• Nurses who interacted with Mr. Duncan wore PPE consistent with the CDC guidelines. Staff had shoe covers, face shields were required, and an N-95 mask was optional — again, consistent with the CDC guidelines at the time.
• When the CDC issued updates, as they did with leg covers, we followed their guidelines.
• When the CDC recommended that nurses wear isolation suits, the nurses raised questions and concerns about the fact that the skin on their neck was exposed. The CDC recommended that they pinch and tape the necks of the gown. Because our nurses continued to be concerned, particularly about removing the tape, we ordered hoods.
• Protective gear followed governing CDC guidelines at the time.
• The CDC classified risk/exposure levels. Nurses who were classified as “no known exposure” or “no risk” were allowed to treat other patients per the CDC guidance.
• Per the CDC guidelines, patients who may have been exposed were always housed or isolated per the CDC guidance.
• Regarding hazardous waste, the hospital went above and beyond the CDC recommendations. Waste was well-contained in accordance with standards, and it was located in safe and containable locations.
• Admittedly, when we received Tyvek suits, some were too large. We have since received smaller sizes, but it is possible that nurses used tape to cinch the suits for a better fit.

According to an employee satisfaction survey by Press Ganey, Texas Health Dallas is in the top one percent in the country when it comes to employee engagement and partnership. We support the tireless and selfless dedication of our nurses and physicians, and we hope these facts clarify inaccuracies recently reported in the media.

CDC: Newest Ebola Patient Flew On 13th – Passengers To Be Notified

Credit CDC

 

 

 

# 9199

 

Although the latest Ebola case, reported this morning in a Healthcare worker in Dallas, was likely asymptomatic two days ago when she flew a domestic airline (and therefore unlikely to have been infectious) the CDC is taking steps to contact fellow passengers on that flight, as we learn from the following media statement.

 

 

CDC and Frontier Airlines Announce Passenger Notification Underway

On the morning of Oct. 14, the second healthcare worker reported to the hospital with a low-grade fever and was isolated. The Centers for Disease Control and Prevention confirms that the second healthcare worker who tested positive last night for Ebola traveled by air Oct. 13, the day before she reported symptoms.

Because of the proximity in time between the evening flight and first report of illness the following morning, CDC is reaching out to passengers who flew on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth Oct. 13.

CDC is asking all 132 passengers on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth on October 13 (the flight route was Cleveland to Dallas Fort Worth and landed at 8:16 p.m. CT) to call 1 800-CDC INFO (1 800 232-4636). After 1 p.m. ET, public health professionals will begin interviewing passengers about the flight, answering their questions, and arranging follow up. Individuals who are determined to be at any potential risk will be actively monitored.

The healthcare worker exhibited no signs or symptoms of illness while on flight 1143, according to the crew. Frontier is working closely with CDC to identify and notify passengers who may have traveled on flight 1143 on Oct. 13.  Passengers who may have traveled on flight 1143 should contact CDC at 1 800-CDC INFO (1 800 232-4636).

Frontier Airlines Statement

“At approximately 1:00 a.m. MT on October 15, Frontier was notified by the CDC that a customer traveling on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth on Oct. 13 has since tested positive for the Ebola virus. The flight landed in Dallas/Fort Worth at 8:16 p.m. local and remained overnight at the airport having completed its flying for the day at which point the aircraft received a thorough cleaning per our normal procedures which is consistent with CDC guidelines prior to returning to service the next day. It was also cleaned again in Cleveland last night. Previously the customer had traveled from Dallas Fort Worth to Cleveland on Frontier flight 1142 on October 10.

Customer exhibited no symptoms or sign of illness while on flight 1143, according to the crew. Frontier responded immediately upon notification from the CDC by removing the aircraft from service and is working closely with CDC to identify and contact customers who may traveled on flight 1143.

Customers who may have traveled on either flight should contact CDC at 1 800 CDC-INFO.

The safety and security of our customers and employees is our primary concern. Frontier will continue to work closely with CDC and other governmental agencies to ensure proper protocols and procedures are being followed.”

CDC Press Conference & Media Statement On New Texas Ebola Case

 

# 9182

 

The CDC held a press conference this morning to address reports of a Health care worker who has been infected while providing hospital care to Eric Duncan in Dallas (see Dallas Ebola Press Conference & Hospital Statement).  The CDC has been pretty quick to get the transcripts and audio files up on these pressers – and so I expect to see those later today on the CDC’s  Media Website.

First stop, however, is the CDC’s statement released at the time of the press conference, after which I’ll return with a few notes from the conference itself.

Texas Reports Positive Test for Ebola in a Health Care Worker

CDC doing confirmation testing today

A healthcare worker at Texas Presbyterian Hospital who provided care for the index patient has tested positive for Ebola according to preliminary tests by the Texas Department of State Health Services’ laboratory. The patient was isolated after the initial report of a fever and remains so now. Confirmation testing at the Centers for Disease Control and Prevention’s laboratory is being done today.

On Friday October 10, a healthcare worker at Texas Presbyterian Hospital who provided care for the index patient reported a low grade fever and was referred for testing. The health care worker had been self-monitoring for fever and symptoms.

The hospital and patient were notified of the preliminary positive result. In addition, CDC has interviewed the patient to identify any contacts or potential exposures in the community.

This is understandably disturbing news for the patient, the patient’s family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures including ongoing contact tracing, health monitoring among those known to have been in contact with the index patient and immediate isolations if symptoms develop.

Ebola is spread through direct contact with bodily fluids of a sick person or exposure to objects such as needles that have been contaminated. The illness has an average 8-10 day incubation period (although it could be from 2 to 21 days) so CDC recommends monitoring exposed people for symptoms a complete 21 days.  People are not contagious during the incubation period, meaning before symptoms such as fever develop.

CDC tests results will be shared when confirmatory tests are done, following appropriate patient notification.

 

 

The press conference, which included both Dr. Thomas Frieden of the CDC and Dr. David Lakey, Commissioner, Texas Department of State Health Services, covered a lot of territory, but at this time we don’t have a good idea what may have caused this nurse’s exposure to the virus.  

 

By all accounts, this HCW followed the CDC’s recommended infection control procedures.  But . . . as anyone who has ever donned PPEs will tell you, it is very easy to make a mistake – particularly when doffing contaminated equipment.

 

There are concerns over the possibility that other hospital employees who followed essentially the same protocols as this nurse may also have been exposed, and so enhanced twice-daily monitoring has been ordered for all HCWs who may have had contact with the hospital’s index case – even though they wore PPEs.

 

The CDC, along with local officials, are looking very hard to find how this breach may have occurred.

While we’ve heard all along that any hospital `should be able to safely isolate and treat an Ebola patient’, for that to happen, every healthcare worker has to get the protocol 100% right - 100% of the time. 

 

And in the real world, that doesn’t always happen. 

 

So the CDC is recommending limiting the number of HCWs who have patient contact, reviewing the removal of PPEs for possible risks, and avoiding unnecessary `high risk’ procedures on Ebola patients (i.e. excessive blood draws, Intubation, Kidney dialysis, etc.) whenever possible

 

Dr. Richard Besser – formerly interim director of the CDC – asked during the Q&A if consideration was being given to transferring Ebola cases to specialty centers like Emory & Nebraska. 

Dr. Frieden replied they were looking at all options, but stressed that all hospitals need to be prepared to handle a `walk-in’ Ebola case, even if specialty hospitals are employed.

 

The bottom line is that while additional cases may turn up in Dallas – either among HCWs who treated Mr. Duncan or his family – there is very little risk to general public. Aggressive contact tracing and monitoring of contacts should be able to contain this virus before it can spread much further.

 

While the media will no doubt thrash this story to within an inch of its life, the real story is stopping the Ebola virus in Africa. 

 

Because that’s where the humanitarian crisis is, and because if we can halt the epidemic there, we can eliminate repeated introductions of the virus to other countries . . . including our own.

 

If the epidemic isn’t controlled at the epicenter – and soon – we face the very real possibility of seeing this virus exported to other heavily populated parts of the world (think: India, Pakistan, South America) where it could easily spread faster than local public health agencies could react to contain it.

For now, I believe we are well able to handle sporadic introductions of this virus into North America, Europe, or any other developed nations.  Some secondary cases, and even small clusters of cases, are probably inevitable.

 

But we have the resources, knowledge, and infrastructure to  identify and stop them.

 

But if this virus gains significant traction in large population centers outside of West Africa, I become considerably less sanguine about our long term prospects.

Dallas Ebola Press Conference & Hospital Statement

 

# 9181

 

A clearly subdued Dallas County Judge (highest ranking county official in the state of Texas) Clay Jenkins, in a press conference this morning at Texas Health Presbyterian Hospital, provided additional details on the first nosocomial transmission of Ebola in the United States.

What we know (some details are being withheld to protect the family, and observe HIPAA regulations), is that a healthcare provider at Texas Presbyterian Hospital – who was involved in Eric Duncan’s care after he was admitted on the 28th -  was in isolation last night with a mild fever. 

 

This particular HCW was considered a `low risk’ contact of Mr. Duncan. This patient’s initial tests came back positive around midnight last night.

According to Dr. Varga, head of clinical care at Texas Presbyterian, this HCW was following all CDC recommended infection control procedures (Gloves, gown, facemask & eye shield), but a review is underway to understand what happened. 

Here is a statement from Dr. Dan Varga, released at the same time as the press conference was begun:

 

Statement from Dr. Dan Varga, Oct. 12, 7:30 a.m. CDT

10/12/2014

Ebola Virus 

Statement from Dr. Dan Varga, Chief Clinical Officer, Senior Executive Vice President

Late Saturday, a preliminary blood test on a care-giver at Texas Health Presbyterian Hospital Dallas showed positive for Ebola. The healthcare worker had been under the self-monitoring regimen prescribed by the CDC, based on involvement in caring for patient Thomas Eric Duncan during his inpatient care that started on September 28.

Individuals being monitored are required to take their temperature twice daily. As a result of that procedure, the care-giver notified the hospital of imminent arrival and was immediately admitted to the hospital in isolation. The entire process, from the patient’s self-monitoring to the admission into isolation, took less than 90 minutes. The patient’s condition is stable. A close contact has also been proactively placed in isolation. The care-giver and the family have requested total privacy, so we can’t discuss any further details of the situation.

We have known that further cases of Ebola are a possibility among those who were in contact with Mr. Duncan before he passed away last week. The system of monitoring, quarantine and isolation was established to protect those who cared for Mr. Duncan as well as the community at large by identifying any potential ebola cases as early as possible and getting those individuals into treatment immediately.

Finally, we have put the ED on “diversion” until further notice because of limitations in staffed capacity — meaning ambulances are not currently bringing patients to our emergency department. While we are on diversion we are also using this time to further expand the margin of safety by triple-checking our full compliance with updated CDC guidelines. We are also continuing to monitor all staff who had some relation to Mr. Duncan’s care even if they are not assumed to be at significant risk of infection.

All of these steps are being taken so the public and our own employees can have complete confidence in the safety and integrity of our facilities and the care we provide.

 

 

Meanwhile, the city of Dallas has sealed off this new patient’s apartment, decontaminated the common areas in the apartment complex, sealed and decontaminated the patient’s car, and has canvassed the neighborhood – knocking on doors – checking on everyone and providing information to nearby residents.

 

A close contact of this patient is also in isolation as precaution – but is not currently symptomatic.  There is also reportedly a pet in the apartment, and efforts will be made later today to check on, and provide for, this animal.

 

We will probably  be hearing later today from the CDC, the State of Texas, and Dallas County Department of Health.

 

While obviously a setback, this was not unexpected.  

 

Despite all of the reassurances over the level of precautions being taken, there is no way to reduce the risk of treating an Ebola patient to zero.  As Zach Thomas, head of Dallas County Health Department – in a TV interview (WFAA) right after the press conference – warned `Don’t be shocked if we see another case’.

Stay tuned.

Texas: Statement On Home Quarantine Of Ebola Patient’s Family

# 9138

 

Without providing details as to why they felt compelled to issue a written order, the State of Texas last night delivered orders to the family of America’s first imported Ebola case to remain home, and not accept unapproved visitors, while being monitored for possible symptoms until October 19th. 

First the statement, then I’ll be back with a bit more on the issues of isolation vs. quarantine.

 

 

Texas Department of State Health Services
NEWS RELEASE 
Oct. 2, 2014

Texas Orders Family of Ebola Patient to Stay Home

Out of an abundance of caution, Texas and Dallas County health officials have ordered four close family members of the Dallas Ebola patient to stay home and not have any visitors to prevent the potential spread of disease.

 
“We have tried and true protocols to protect the public and stop the spread of this disease,” said Dr. David Lakey, Texas health commissioner. “This order gives us the ability to monitor the situation in the most meticulous way.”

The local health department had previously instructed the family to stay home, but a strict public health control order is needed to ensure compliance. Ebola is not contagious until symptoms appear. The family members do not have symptoms at this time.

The orders were hand delivered to the family members Wednesday evening by local health officials. The orders legally require the family to stay at home and not have any visitors without approval from the local or state health department until at least Oct. 19. The order is in place until the incubation period has passed and the family is no longer at risk of having the disease.

The order requires the family to be available to provide blood samples and agree to any testing required by public health officials and to immediately report any symptoms to Dallas County Health and Human Services. Symptoms include fever above 100.5 degrees, headache, nausea, diarrhea or abdominal pain. 

Texas law allows the state health department and the local health authority to issue control measures to a person who is ill with, has been exposed to, or is the carrier of a communicable disease. (Health and Safety Code §81.083). Control measures by law can include isolation, quarantine and preventive therapy. If a person does not follow these orders, they can be enforced by the courts, and the person can face criminal charges.

 

 

Contrary to Hollywood’s draconian portrayal, quarantine usually consists of  having an exposed person stay home, and report to a healthcare worker by phone each day, during a disease’s incubation period. 

 

While usually voluntary, if there are reasons to suspect non-compliance and the threat to the public is considered great enough, then state and local health departments have legal recourse to enforce home (or other) confinement.

 

Just so we are all on the same page, here is how the CDC differentiates between Quarantine and Isolation:

The CDC applies the term "quarantine" to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.

The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies—quarantine and isolation—to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people's exposure to it.

The difference between quarantine and isolation can be summed up like this:

• Isolation applies to persons who are known to be ill with a contagious disease.
• Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

 

Two months ago, in A Revision In the List Of Quarantinable Communicable Diseases, we looked at a recent executive order that expanded slightly the types of diseases that could be quarantined.  

 

Ebola, and other hemorrhagic viruses, were already part of that short list.

 

Twenty months ago, in EID Journal: A Brief History Of Quarantine, we looked at the long and successful use of quarantine in the United States, and around the world, to contain highly infectious diseases. The ultimate containment of SARS in 2003 was due, in large part, to the use of home quarantines around the globe.

 

While never likely to be popular - particularly among those caught up in one – quarantines are an important public health tool, and can often spell the difference between containing a disease, and seeing it spread further.

Dallas,Tx Patient Tests Positive For Ebola

 

 

# 9130

 

In what is shaping up to be the worst-kept news embargo of all time, this afternoon the CDC has announced that the first undiagnosed Ebola case has arrived in the United States, and has tested positive after being isolated in a Dallas, Texas hospital since yesterday.

 

Now, before anyone is tempted to head down to the bunker, this was an expected development and one for which hospitals and public health departments across the country have been preparing for some time. 

 

While it is conceivable that an Ebola infected visitor could pass on the virus to close contacts here in the United States, the risks of seeing a significant outbreak here are considered low.  We have a public health infrastructure in place that can do contact tracing and health monitoring for the incubation period of up to 21 days.

At this time there are no other suspected cases in Texas.

The CDC’s timeline has the patient leaving Liberia on September 19th, and arriving on the 20th. At that time, the patient was not symptomatic.  Several days later the patient became unwell (24th), and apparently went to a hospital or clinic on the 26th, but was not diagnosed with the disease (early symptoms are often non-specific), and sent home.  

 

Two days later the patient returned to the hospital with more severe symptoms and was placed into isolation.  Very few details regarding the patient, his possible exposures in Liberia, and his condition have been released.

 

The news conference – which should be archived on the CDC Media site in the next couple of days - included statements and answers from:

 

Thomas Frieden, M.D., M.P.H,

Director, Centers for Disease Control and Prevention

David Lakey, M.D.,

Commissioner, Texas Department of State Health Services

Edward Goodman, M.D., FACP, FIDSA, FSHEA

Hospital Epidemiologist, Texas Health Presbyterian Hospital Dallas

Zachary Thompson, M.A.

Director, Dallas County Health and Human Services

 

As Dr. Thomas Frieden stated in this news conference, as long as the Ebola epidemic continues to rage in West Africa, we have to be prepared for the possibility of  additional cases like this showing up in the United States.

The Texas Department of Health has released the following statement:

 

Texas Confirms Ebola Case

News Release

September 30, 2014

A Texas hospital patient has tested positive for Ebola, making the patient the first case diagnosed in the United States. The test was conducted at the state public health laboratory in Austin. The Centers for Disease Control and Prevention confirmed the positive result.

The patient is an adult with a recent history of travel to West Africa. The patient developed symptoms days after returning to Texas from West Africa and was admitted into isolation on Sunday at Texas Health Presbyterian Hospital in Dallas.

The Texas Department of State Health Services is working with the CDC, the local health department and the hospital to investigate the case and work to prevent transmission of the disease. The hospital has implemented infection control measures to help ensure the safety of patients and staff.

Ebola is a severe, often fatal disease. Early symptoms of Ebola include sudden fever, fatigue and headache. Symptoms may appear anywhere from 2 to 21 days after exposure.

Ebola is spread through direct contact with blood, secretions or other bodily fluids or exposure to contaminated objects, such as needles. Ebola is not contagious until symptoms appear.

The CDC recommends that individuals protect themselves by avoiding contact with the blood and body fluids of people who are ill with Ebola. DSHS also encourages health care providers to ask patients about recent travel and consider Ebola in patients with fever and a history of travel to Sierra Leone, Guinea, Liberia, and some parts of Nigeria within 21 days of the onset of symptoms.

Texas: Two Recent Hantavirus Cases

Credit CDC

 

 

# 8816

 

Two weeks ago, in Hantaviruses: Of Mice And Men, we looked at a recent Hantavirus fatality in Saskatchewan, and reviewed some of the history of the these rare – but often fatal – rodent borne diseases.  You may recall that in the fall of 2012, we followed an outbreak at Yosemite National Park (see MMWR: Yosemite Hantavirus) which resulted in 10 infections, and 3 deaths.

 

Hantavirus infections (aka HPS or Hantavirus Pulmonary Syndrome) in the United States are most common west of the Mississippi.

Credit CDC

 

While admittedly rare, each year the US sees between 20 and 50 cases, of which more than 1/3rd usually prove fatal.

Credit CDC

 

 

Yesterday, in response to two recent Hantavirus cases in Texas, the Texas Department of State Health Services released the following statement:

 

New Hantavirus Cases Trigger Precaution Reminder

News Release

July 8, 2014

Two recent cases of hantavirus pulmonary syndrome were confirmed in residents of the Texas Panhandle and South Plains, bringing the year’s total to three.

Texas had one case in 2013. No cases were reported from 2009 to 2012.

The disease is severe and sometimes fatal, prompting the Texas Department of State Health Services to remind people to protect themselves from the virus that causes HPS. A case confirmed earlier this year was a resident of the Panhandle.

Hantavirus is carried by certain species of rats and mice that shed the virus in their urine, droppings and saliva. The virus can be transmitted to people when nesting materials or dust contaminated by infected rat or mouse urine, droppings and saliva are stirred up, allowing the virus to be breathed in by humans. The illness is rare, but HPS cases are frequently associated with spring cleaning.

DSHS recommends general safety precautions that apply to Hantavirus as well as other infectious diseases:

• Seal openings that may allow rats and mice to enter homes and workplaces.
• Remove brush, woodpiles, trash and other items that may attract rats and mice.
• Tightly close garbage cans, pet food containers and other food sources.
• Before cleaning up nests or droppings found inside, open windows and doors to ventilate the area for at least 30 minutes.
• If any dust will be stirred up, goggles and a HEPA or N-95 mask are recommended.
• Wear protective gloves to handle dead mice and rats or to clean up nesting areas, urine or droppings.
• Do not stir up dust by sweeping or vacuuming. Dampen areas before cleanup with either a 1-to-10 bleach-water mixture or another effective disinfectant, in order to eliminate dust and begin inactivating the virus. After 30 minutes, apply the viricide again and immediately begin the cleaning process.
• Use the same viricide and apply to dead rodents, nests, urine and droppings before cleaning, with the same 30 minute interval and reapplication process.

Early symptoms of hantavirus infection include fatigue, fever and muscle aches. These symptoms may be accompanied by headaches, dizziness, chills, nausea, vomiting, diarrhea and abdominal pain. Later symptoms include coughing and shortness of breath. If hantavirus is suspected, people should contact their health care provider immediately and inform the practitioner of exposure to rodents, their waste, or their nesting material.

A total of 41 HPS cases have been confirmed in Texas since 1993, the first year it was reported. 14 of those cases resulted in death.

 

 

For more information on how you can prevent rodent infestations, the following information is available on the CDC Rodents site. And for more information, the CDC offers a 16 page PDF  on Hantavirus, which is available on their Hantavirus Main page.

Texas DSHS Letter To Doctors On Influenza Outbreak

Credit Texas Influenza Weekly Surveillance

 

# 8097

 

While some in the media this week are hyping the recent influenza deaths in Texas (see Texas DSHS Statement On Recent Spike In Flu Activity) as the `Return of Swine Flu’, the reality is, the virus never left.

 

It has been with us since it first emerged in 2009, but has taken a backseat to the other seasonal strain - H3N2 - in North America over the past couple of years.

 

While H1N1 is no longer a pandemic virus, it can still pack a punch . . . particularly for those under the age of 65, and those with pre-existing medical conditions.  And since it hasn’t been the dominant strain in North America the past couple of years, many people have reduced immunity to it (particularly if they skipped the flu shot).

 

This week we’ve seen reports of multiple deaths in Texas, and around the nation, now attributed to the H1N1 virus.  Many others have been hospitalized with severe illness.

 

Yesterday, the Texas DSHS sent out a notice to doctors and hospitals advising them on how to test for, and treat, severe cases of flu.

 

TEXAS DEPARTMENT OF STATE HEALTH SERVICES
DAVID L. LAKEY, M.D.  COMMISSIONER
www.dshs.state.tx.us

**INFLUENZA HEALTH ALERT**

December 20, 2013

Dear Colleague: 

Statewide influenza-like illness (ILI) activity continues to increase and is above baseline levels. ILI intensity is high in Texas, and influenza is now widespread. All Texas regions have reported laboratory confirmed influenza. Over 90% of positive influenza tests reported from Texas laboratories have been typed as influenza A. Of those influenza A viruses that have been subtyped, 90% have been the 2009 pandemic H1N1 subtype. This subtype of influenza is included in this season's influenza vaccine. 

No novel influenza cases have been reported in Texas. 

No antiviral resistant influenza strains have been reported in Texas. 

Encourage patients to get vaccinated for influenza. 

Clinicians should consider antivirals even if the Rapid Influenza Diagnostic Test is negative. 

Background: Influenza viruses can be spread by large respiratory droplets generated when an infected person coughs or sneezes in close proximity to an uninfected person. Symptoms can include fever, dry cough, sore throat, headache, body aches, fatigue, and nasal congestion. Among children, otitis media, nausea, vomiting, and diarrhea are common.

Most people generally recover from illness in 1-2 weeks, but some people develop complications and may die from influenza. The highest rates of influenza infection occur among children; however, the risks for serious health problems, hospitalizations, and deaths from influenza are higher among people 65 years of age or older, very young children, and people of any age who have medical  conditions that place them at increased risk for complications from influenza (see Treatment). 

Vaccination: Everyone who is at least 6 months of age should get a flu vaccine this season. It is not too late for vaccination. There are several flu vaccine options available for the 2013-2014 flu season. All these vaccines contain the currently circulating H1N1 strain. DSHS does not recommend one flu vaccine over another, although there are special indications for some (such as a high-dose inactivated trivalent vaccine approved for persons age 65 years and older). 

The 2013-2014 trivalent influenza vaccine is made from the following three

  An A/California/7/2009 (H1N1)pdm09-like virus 
  An A(H3N2) virus antigenically like the cell-propagated prototype virus A
  A B/Massachusetts/2/2012-like virus

Rapid Lab Tests: Rapid Influenza Diagnostic Tests (RIDTs) can be useful to identify influenza virus infection, but false negative test results are common during influenza season. Clinicians should be aware that a negative RIDT result does NOT exclude a diagnosis of influenza in a patient with suspected influenza. When there is clinical suspicion of influenza and antiviral treatment is indicated, antiviral treatment should be started as soon as possible, even if the result of the RIDT is negative, without waiting for results of additional influenza testing. 

Treatment: Oseltamivir and zanamivir are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses. Early antiviral treatment can shorten the duration of fever and illness symptoms, may reduce the risk of complications and death, and may shorten the duration of hospitalization. Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset. Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza. 

Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who:

  Is hospitalized.
  Has severe, complicated, or progressive illness. 
  Is at higher risk for influenza complications. 

Persons at higher risk for influenza complications recommended for antiviral treatment include: 

  Children aged younger than 2 years.
  Adults aged 65 years and older. 
  Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, or hematological disease (including sickle cell disease); metabolic disorders (including diabetes mellitus); or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury).   Persons with immunosuppression, including that caused by medications or by HIV infection. 
  Women who are pregnant or postpartum (within 2 weeks after delivery).
  Persons aged younger than 19 years who are receiving long-term aspirin therapy.
  American Indians/Alaska Natives.
  Persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40).
  Residents of nursing homes and other chronic-care facilities. 

Clinical judgment, on the basis of the patient's disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high-risk outpatients. 

Additional details regarding antiviral treatment can be found at
http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. 

Disease Reporting Requirements/Statute: Several Texas laws (Health & Safety Code. Chapters 81, 84, and 87) require specific information regarding notifiable conditions to be provided to DSHS. Health care providers, hospitals, laboratories, schools, childcare facilities and others are required to report patients who are suspected of having a notifiable condition (Chapter 97, Title 25, Texas Administrative Code).  In Texas, influenza-associated pediatric mortality is required to be reported within one work day. Clusters or outbreaks of any disease, including influenza, should be reported immediately. Reports of influenza-associated pediatric mortality and influenza or influenza-like illness outbreak should be made to your local health department or to 1-800-705-8868.

David Lakey, M.D.
Commissioner
Texas Department of State Health Services

 

 

Some of the initial confusion with the outbreak in Texas came from reports of `negative flu tests’ among some of the patients.   As we’ve discussed often in the past, Rapid Influenza Detection Tests are quick and easy – but they aren’t always accurate (see No Doesn’t Always Mean No).

Hence the reminder by the DSHS (and the CDC, btw) that `a negative RIDT result does NOT exclude a diagnosis of influenza’.

 

For more on the limitations of RIDT tests, you may wish to revisit last year’s side-by-side comparison of 11 commercially available test kits in MMWR: Evaluating RIDTs.

 

With H1N1 prowling the nation, aided and abetted by H3N2 and Influenza B, it is particularly important to maintain good flu hygiene right now.   The CDC recommends:

• Wash your hands often with soap and water or an alcohol-based hand rub.
• Avoid touching your eyes, nose, or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.

And if you haven’t already gotten your flu shot, it is certainly not too late to do that as well.

Texas DSHS Statement On Recent Spike In Flu Activity

CDC FluView Report  Week 50

# 8096

 

Texas, along with several other southern states,are seeing a sharp increase in influenza activity over the past couple of weeks, as illustrated by the map at the top of this post from today’s CDC FluView

 

Today’s summary from the Texas Weekly Influenza Surveillance report states:

 

Statewide influenza-like illness (ILI) activity continues to increase and is above baseline levels. Influenza activity is increasing steadily. All Texas Regions have reported laboratory confirmed influenza, and the percentage of specimens positive for influenza is over 10%. ILI intensity is high, and influenza is widespread in Texas.

.

As the following graphic shows, not only are the vast majority of flu cases Influenza A, the 2009 (H1N1) virus – which has a history of hitting younger patients particularly hard - is the dominant strain being reported in Texas.

 

 

 

Partially as a response to this week’s high profile accounts of severe influenza cases (including fatalities) in and around Montgomery County, Texas (see and the Montgomery County Flu Updates – Dec 19th), and in part due to the statewide increase in influenza, the Texas DSHS  released the following statement this afternoon.  

 

 

Texas Encourages Vigilance in Flu Treatment, Precautions

News Release

Dec. 20, 2013

Though recent increases in flu activity are not unusual, Texas issued flu testing and treatment guidance today to doctors and is continuing to encourage everyone to get vaccinated now to protect themselves.

The level of flu-like illness is classified as “high” in Texas, and medical providers are seeing an increase in flu in multiple parts of the state. Unusually severe cases of flu-like illness are routinely investigated during the flu season by local health departments in coordination with the Texas Department of State Health Services. H1N1 is the most common circulating flu strain so far this season. This year’s flu vaccine includes protection against the most common flu strains, including H1N1.

DSHS advises clinicians to consider antiviral treatment, even if an initial rapid-flu test comes back negative. A negative result does not exclude a diagnosis of flu in a patient with suspected illness. Antiviral treatment is recommended for anyone with confirmed or suspected flu who is hospitalized, has severe or progressive illness or is at a higher risk for complications.

“Given the timing and the season, flu is on the rise and causing severe illness in certain people. This is not unexpected, but it’s a good reminder for people to get vaccinated and stay home if they’re sick,” said Dr. David Lakey, DSHS commissioner. “Flu can be deadly. People who have not been vaccinated should do so now. It’s the best defense we have.”

Flu is a serious disease that kills an average of 23,600 Americans a year, according to estimates from the Centers for Disease Control and Prevention. People over 65, pregnant women, young children and people with chronic health conditions are most at risk for complications, so it’s especially important for them to be vaccinated.

Flu cases and flu-related deaths in adults are not required to be reported to DSHS. Healthcare providers are required to report pediatric flu deaths to their local health department within one business day. There are no confirmed pediatric flu deaths in Texas this season.

DSHS recommends everyone six months old and older get vaccinated. People should talk to their health care provider about the best type of flu vaccine for them. A nasal spray version is available for healthy people ages 2 to 49 who are not pregnant, and a high-dose vaccine is approved for people 65 and older.

Dr. Lakey also urged people to follow standard illness-prevention steps:

• Wash hands frequently with soap and water or alcohol-based hand sanitizer;
• Cover coughs and sneezes;
• Stay home if sick

-30-

 

While Texas, Louisiana, Alabama, and Georgia are reporting the most intense flu activity right now, even states still shown in green, flu activity is on the rise. Just today, news media in Florida reported on the death of a 27 year old woman from H1N1 in Pasco County.

 

With the holidays ahead, and lots of people mingling and traveling, flu is likely to increase substantially around the nation over the next couple of months.   It is not too late to get a flu shot, and of course, one should always practice good flu hygiene regardless of your vaccination status.

Update On Montgomery County, Tx Unidentified Flu-like Illness

 

 

# 8086

 

With the caveat that most of the time, reports of unidentified illnesses such as this one end up being something fairly routine, we’ve an extended audio interview/remarks (h/t Emily on FluTrackers) this morning from Dr. Mark Escott - Medical Director for the Montgomery County Hospital District - on the recent reports of four deaths from an as-yet unidentified flu-like illness in Texas (see Texas: MCHD On Deaths From Unidentified `Flu-like’ Illness).

 

This audio interview comes from reporter Scott Engle of the the Montgomery County Police Reporter, and is posted on his youtube channel.

 

 

Local TV station KHOU-TV also has a video report, and accompanying story, on their website, where they describe a widening search in local hospitals for potential additional cases.  For now, the cause of this illness remains unknown.

KHOU-TV – Click to Watch

 

Understandably, this story has caught the attention of the media in Texas, and across the nation.  `Medical Mysteries’ are always good for a headline.  But until doctors figure out what this illness is, we don’t even really know whether these eight patients are all suffering from the same infection.

 

We’ve discussed it before, but it is worth repeating that anytime there is an outbreak of an illness, the most serious cases are almost always identified first, since they are the ones that end up seeking treatment.

 

Invariably, that tends to skew our initial perceptions as to its severity.

 

For now, I see  little point in speculating as to the cause, as `flu-like’ symptoms covers a lot of territory. With the CDC and local public health agencies on the trail of this illness, I fully expect we’ll learn more in the next day or two. In the meantime, this is flu season, and `mystery illness’ or not, it would be prudent to observe the following flu hygiene steps from the CDC, no matter where you live.

 

• Wash your hands often with soap and water or an alcohol-based hand rub.
• Avoid touching your eyes, nose, or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.

 

Because mundane or not, seasonal flu claims thousands of lives every year in this country.

JAMA: The 2012 West Nile Encephalitis Epidemic in Dallas, Tx

 

 

# 7487

Although West Nile Virus (WNV) activity was high across much of the country in 2012, the hardest hit area was Dallas County, Texas, where at least 19 people died from the severe form of this mosquito borne infection called Neuroinvasive West Nile Disease.

 

Mild cases – called West Nile Fever – often go undiagnosed, with probably only 2%-3% being identified. You’ll find some of my coverage of last year’s outbreak in Texas in the following blogs:

 

CDC Telebriefing on West Nile Virus

Updating the Texas West Nile Outbreak

Dallas West Nile Update

 

Nationally, the CDC reported last May:

 

Final 2012 West Nile virus update:

In 2012, all 48 contiguous states, the District of Columbia, and Puerto Rico reported West Nile virus infections in people, birds, or mosquitoes. A total of 5,674 cases of West Nile virus disease in people, including 286 deaths, were reported to CDC. Of these, 2,873 (51%) were classified as neuroinvasive disease (such as meningitis or encephalitis) and 2,801 (49%) were classified as non-neuroinvasive disease. The numbers of neuroinvasive, non-neuroinvasive, and total West Nile virus disease cases reported in 2012 are the highest since 2003.

 

 

It is estimated that only about 20% of the people who are infected with WNV develop symptoms, and the vast majority of those only experience a mild flu-like illness. Accordingly, mild, asymptomatic, or non-neuroinvasive infections are likely vastly undercounted.

 

The more severe `neuroinvasive’ form of WNV can produce symptoms that include headache, stiff neck, confusion, coma, convulsions, and even paralysis.

 

According to the CDC’s WEST NILE SYMPTOMS Q&A page.

 

What are the symptoms of West Nile virus disease?

No symptoms in most people. Most people (70-80%) who become infected with West Nile virus do not develop any symptoms.

 

Febrile illness in some people. About 1 in 5 people who are infected will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea, or rash. Most people with this type of West Nile virus disease recover completely, but fatigue and weakness can last for weeks or months.

 

Severe symptoms in a few people. Less than 1% of people who are infected will develop a serious neurologic illness such as encephalitis or meningitis (inflammation of the brain or surrounding tissues). The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures, or paralysis.

 

Recovery from severe disease may take several weeks or months. Some of the neurologic effects may be permanent. About 10 percent of people who develop neurologic infection due to West Nile virus will die.

 

 

Which brings us to a research article (which you can read in its entirety) that appeared in JAMA yesterday on the Dallas epidemic, that finds correlations between an unusually mild winter, the early detection of WNV bearing mosquitoes, and the likelihood of seeing a major WNV outbreak.

 

 

The 2012 West Nile Encephalitis Epidemic in Dallas, Texas FREE

Wendy M. Chung, MD, SM¹; Christen M. Buseman, PhD, MPH¹; Sibeso N. Joyner, MPH¹; Sonya M. Hughes, MPH¹; Thomas B. Fomby, PhD⁴; James P. Luby, MD²; Robert W. Haley, MD³

Conclusions and Relevance Large West Nile virus epidemics in Dallas County begin early after unusually warm winters, revisit similar geographical distributions, and are strongly predicted by the mosquito vector index. Consideration of weather patterns and historical geographical hot spots and acting on the vector index may help prevent West Nile virus–associated illness.

 

The outbreak, which reached its peak in early August, was eventually brought under control after aerial spraying began in week 32 (see chart below).

 

Despite some initial public concerns over the use of aerial insecticides, surveillance of local emergency rooms did not detect any increase in ER visits for respiratory symptoms or rashes following airborne spraying.

 

In addition to the study you’ll find a short (4 minute) video by Dr. WM Chung, lead author of the study. 

 

 

 

Although it is too early in the summer to know what kind of WNV season 2013 will bring, the CDC’s DVBID reports the following activity:

 

Preliminary Maps & Data for 2013

As of July 9, 2013, 25 states and the District of Columbia have reported West Nile virus infections in people, birds, or mosquitoes. A total of 14 cases of West Nile virus disease in people, including two deaths, have been reported to CDC. Of these, five (36%) were classified as neuroinvasive disease (such as meningitis or encephalitis) and nine (64%) were classified as non-neuroinvasive disease.

 

 

Which is why health departments across the nation urge people to follow the `5 D’s’ of mosquito protection:

Texas: First West Nile Case Of 2013

Photo Credit CDC 

 

#7319

 

 

Last year Texas endured a record-setting outbreak of West Nile Virus – spread by mosquitoes - recording 1869 cases and 89 death (see DVBID: 2012 Record Number Of West Nile Fatalities). While the entire country saw record numbers of WNV in 2012, roughly 1/3rd of all cases were diagnosed in Texas.

 

Nationwide, the numbers came in at:

 

Total cases                5,674 cases

Neuroinvasive cases   2,873 (51%)   

Mild cases                  2,801 (49%)

Deaths                          286

 

Neuroinvasive cases (which present with meningitis, encephalitis, or flaccid Paralysis) are severe enough that they result in hospitalization and diagnosis, and so they are considered the best indicator of the scope of each year’s epidemic.

 

Most people only end up with a mild, often sub-clinical infection, and never know they were infected. 

 

For every mild case diagnosed, there may be another 50 cases that go unreported.  

 

Yesterday the Texas Department of State Health Services released two statements on West Nile threat; one announcing their first diagnosed case of the year, and another warning that people need to start taking mosquito precautions now that summer is upon us.

 

 

 

Texas Confirms First West Nile Case of the Season

News Release
May 24, 2013

The Texas Department of State Health Services today confirmed the state’s first case of West Nile illness of the season. DSHS is urging people to take precautions to reduce the risk of contracting West Nile virus, a mosquito-borne illness.

 

West Nile illness was confirmed in an adult male from Anderson County. The patient is recovering from the neuroinvasive form of the disease. Additional details about the patient are not being released to protect the patient’s identity.

 

“This is a serious illness that can take a long-lasting toll,” said Dr. David Lakey, DSHS Commissioner. “Last season was unprecedented, with record numbers of cases and deaths reported in Texas. People need to do all they can to protect themselves from mosquito bites.”

 

Last year, Texas reported 1,868 human cases of West Nile illness, including 89 deaths.

 

State health officials said there is no way to predict the severity of this year’s season. The intensity of West Nile virus activity in Texas fluctuates from year to year and depends on a variety of factors including the weather, the numbers of birds and mosquitoes that maintain and spread the virus and human behavior. The season can last up until the first hard freeze of the year.

(Continue . . .)

DSHS Urges Precautions to Reduce West Nile Exposure

News Release
May 24, 2013

As Memorial Day approaches and people are spending more time outdoors, the Texas Department of State Health Services urges people to take precautions to reduce the risk of contracting West Nile virus, a mosquito-borne illness.

 

Last year, Texas reported 1,868 human cases of West Nile illness, including 89 deaths. State health officials said there is no way to predict the severity of this year’s season. The intensity of West Nile virus activity in Texas fluctuates from year to year and depends on a variety of factors including the weather, the numbers of birds and mosquitoes that maintain and spread the virus and human behavior. The season can last up until the first hard freeze of the year.

To reduce exposure to West Nile virus:

• Use an approved insect repellent every time you go outside and follow the instructions on the label. Among the EPA-approved repellents are those that contain DEET, picaridin, IR3535 or oil of lemon eucalyptus.
• Regularly drain standing water, including water collecting in empty cans, tires, buckets, clogged rain gutters and saucers under potted plants. Mosquitoes that spread WNV breed in stagnant water.
• Wear long sleeves and pants at dawn and dusk when mosquitoes are most active.
• Use air conditioning or make sure there are screens on all doors and windows to keep mosquitoes from entering the home.

Symptoms of the milder form of illness, West Nile fever, can include headache, fever, muscle and joint aches, nausea and fatigue. People with West Nile fever typically recover on their own, although symptoms may last for several weeks. Symptoms of the more serious form, West Nile neuroinvasive disease, can include those of West Nile fever plus neck stiffness, stupor, disorientation, tremors, convulsions, muscle weakness and paralysis. Up to 80 percent of people infected with the virus will have no symptoms.

(Continue . . .)

 

Given its severity (and that of less common mosquito borne diseases in the U.S., like EEE, Dengue, SLEV), it makes sense to take steps to protect yourself and your family.

 

So today would be a good day to go around and look for likely breeding places in, and around your home. This should become a weekly habit – at least during mosquito season.

 

And to help you with warding off these pests, we’ve an interactive insect repellant search engine developed by the EPA that will that will allow you to input your needs and it will spit out the best repellants to use.

 

(click image to go to search engine)