| Epidemiological Bulletin (Part 1 of 4)
This file is also available as a PDF
Introduction
We are all shocked, horrified, and deeply saddened by the September 11th attack on our nation. Our thoughts and prayers are with everyone who was victimized by this tragic event. As you know, it is normal to have emotional and physical responses to traumatic events such as this. You may be seeing these traumatic reactions in your patients and are no doubt having some of these reactions yourselves. Also, it is important to keep in mind that we all are on different timetables in dealing with this, so don't expect others - patients, family members, community leaders - to handle things or be feeling the same way you do or vice versa.
You may want to download some printed information to give to your patients. There are some useful documents developed by the San Mateo County Mental Health Division and the American Red Cross posted on the County website at: www.co.sanmateo.ca.us/new.htm If you lack referrals or resources for patients who need mental health or counseling services due to the recent events, San Mateo County Mental Health Services has a number that anyone can call. The San Mateo County Mental Health Access Team can be reached at 1-800-686-0101.
DCPU Welcomes New Communicable Disease Investigator
The San Mateo County DCPU would like to welcome Tanya Perez to the Unit. Tanya, who is a 2001 graduate in Human Biology from Stanford University, has joined the staff as a communicable disease investigator (CDI).
Tanya started in July and will be splitting her time between HIV/AIDS surveillance duties and bi-lingual communicable disease investigation and follow-up. She will also be playing a key role in the upcoming implementation of HIV infection reporting in the County. We look forward to having our providers and clients meet the newest member of our staff.
Reminder on Rabies Post-exposure Prophylaxis for Providers
Beth Schulz, PHN, MPH (CD Control Officer) & Francis Wiser, MSPH (Epidemiologist)
Recently, a Woodside resident noticed his cat toying with a downed bat, which was subsequently brought to the San Mateo County Public Health Laboratory and found to be positive for rabies virus by Flourescent Rabies Antibody test. Fortunately, the cat was up to date with its feline rabies vaccinations and remains healthy under veterinary surveillance as of the date of publication.
Rabies is a uniformly fatal disease transmitted by a virus in wild and domestic animals. It was once commonly present in dogs in the U.S., but as a result of laws mandating canine vaccinations, now mainly occurs in wild animals. The infection is particularly common in wild predators such as bats, skunks, and raccoons. In fact, due to regional incidence in wildlife, all counties in California are classified as rabies endemic areas. Domestic animals - such as cats, dogs, and horses - that have not been immunized against rabies are at risk should they encounter a rabid wild animal. Cats have been the most commonly diagnosed rabid domestic animal in California and the U.S. for the past several years.
San Mateo County has had separate incidents involving rabies in a cat and a horse in the past several years. These situations resulted in many human contacts to these animals having to undergo rabies prophylaxis and vaccination. Therefore, it is of paramount importance that pets be routinely vaccinated against rabies. It is also important not to attempt to feed or handle wild animals (including feral cats) as well as domestic animals that are behaving in an unusual manner, whether aggressive or withdrawn. Children should also be taught to avoid contact with wild animals.
It is extremely important for health care professionals to elicit a careful history and have a high index of suspicion for potential rabies exposure in the patient reporting an animal bite. Health professionals are both ethically and legally mandated to inform patients of a potential rabies exposure related to an animal bite and to report that bite to the local health authorities. Bites occurring within San Mateo County should be reported to the Peninsula Humane Society at (650) 340-8200.
To assist clinicians, the rabies post-exposure prophylaxis algorithm originally included in a 2000 Epibulletin is reprinted on p.2. (This algorithm is also posted in PDF format on the the DCPU web site) As many animal bites and potential rabies exposures are complex and situational, consultation is available from the Disease Control and Prevention Unit by calling (650) 573-2346.
One important aspect of that algorithm that the DCPU would like to bring to the attention of providers involves the risk distinctions between domestic and wild animals. Bites from domestic animals are evaluated for rabies risk potential with an eye towards whether the bite was provoked, how the animal was acting and whether the animal is available for quarantine. In contrast, bites from most wild species (foxes, raccoon, skunks and bats in particular) require an assumption of rabies infection in the animal unless the animal is available for testing to prove otherwise. Application of prophylaxis and vaccination is highly recommended in such situations.
Bites from small rodents-such as squirrels, rats, hamsters-almost never call for rabies prophylaxis. Such animals are usually killed by bites received from rabid carnivores and therefore do not become carriers. Larger rodents (beavers, muskrats, marmots, and woodchucks) are capable of surviving such attacks and may live to develop rabies. Unprovoked attacks from these larger rodents suggest rabies infection.
Changes in Pesticide-Poisoning Reporting Requirements
Beth Schulz, RN, MPH (CD Control Officer)
Health and Safety Code Section 105200 requires that physicians report patients with pesticide-related illnesses or injuries to the local health officer by telephone directly within 24 hours. The reporting requirement includes all types of pesticide cases and covers skin and eye injuries, systemic poisonings, homicides, suicides, home cases and occupational cases. A case suspected or seen as a pesticide poisoning may not be categorized as "first aid". All cases must be reported.
In an attempt to improve physician reporting of pesticide-related illnesses, California Poison Control now offers to report cases to the local health authorities when physicians call for consultation. A flyer containing the Poison Control toll-free phone number is reproduced below for posting.
| Reporting Pesticide-Related Illnesses and Injuries
California law requires physicians to report any condition they suspect is related to pesticides.
The California Poison Control System (CPCS) and the Department of Pesticide Regulation (DPR) have teamed up to make the required reporting of pesticide-related conditions easier.
When physicians call CPCS on a pesticide case, CPCS will offer to report the case for them. CPCS will collect some information and fulfill the reporting requirement. No extra phone calls to make and no forms to fill out.
CPCS: 1 - 800 - 411 - 8080
For more information on the reporting program, contact Dr. Louise Mehler (DPR) at (916) 445-4190.
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Summary of Exotic Mosquito Aedes albopictus Introductions and Surveillance in California
Sasha Porshnikoff (Asst. Vector Ecologist)
Ms. Porshnikoff is a vector ecologist for the San Mateo County Mosquito Abatement District, a joint powers agency performing mosquito and other vector control duties for San Mateo County.
Aedes albopictus, the Asian tiger mosquito, has been imported into the continental United States, principally in used vehicle tires, for more than 15 years. In 1985, a breeding colony was discovered in discarded tires in Houston, Texas. To date, Ae. albopictus has been identified in 26 states, including an isolated discovery in Alameda County in 1987. Until a few weeks ago, Aedes albopictus had not been detected in California since that incident. Globally, Aedes albopictus mosquitoes are known vectors for yellow fever, dengue, LaCrosse encephalitis, dog heartworm, western equine encephalomyelitis, St. Louis encephalitis, and potentially many other viruses. Local introduction of this particular species is thus a matter of substantial public health concern.
06/14/01, quarantine officials notified the Greater Los Angeles Mosquito and Vector Control District (GLAMVCD) of a mosquito infestation in a maritime cargo shipment containing "lucky bamboo", a species of Dracaena. Several species of mosquitoes were identified from these shipments, including Ae. albopictus. Traps set out by GLAMVCD personnel on 06/20 at wholesale nursery suppliers throughout Southern California yielded more mosquitoes. California Mosquito and Vector Control Districts were notified of the introductions on 06/22. On 06/27, Coastal Region Districts met with the California Department of Health Services, Vector-borne Disease Section (CDHS-VBDS), the Centers for Disease Control (CDC), and the United States Department of Agriculture (USDA) to discuss control measures against further Ae. albopictus introductions. The CDC commented that tire inspections were discontinued approximately 4 years ago since 1)Ae. albopictus is already established throughout much of the United States; and 2) the Center lacks personnel to inspect shipments (only 4 staff members were available for tire inspections throughout the entire United States). CDHS, MVCAC, and GLAMVCD issued official press releases the same day.
The CDC issued an embargo on the importation of Dracaena shipments in water on 06/29, effective 07/17. Agencies surveyed wholesale nurseries to determine the destination of the shipments and degree of infestation. A total of 8 infestations have been confirmed to date: 2 in San Bernardino County, 2 in Orange County, 3 in Los Angeles County, and 1 in Santa Clara County. Unfortunately, these introduced populations of mosquitoes appear to be expanding their distribution; new infestations have been discovered every week since authorities were alerted to the initial infestation.
Shipments of Dracaena have been arriving in the United States for at least three years. The plants are shipped from China, Taiwan, Thailand, Indonesia, Malaysia, Costa Rica, and other countries by both maritime and air freight. Three major shipping ports receive shipments on the West Coast: Seattle, Los Angeles, and Oakland. Maritime shipments arriving at the Port of Oakland are transported to the USDA Plant Inspection office in South San Francisco for inspection. Each 40- foot shipping container can hold up to 600 individual Styrofoam boxes filled with 75-1000 Dracaena plants. The boxes are filled with 2-3 inches of water. Maritime shipments require two weeks to arrive in the United States. In contrast, air freight shipments take two days,and are shipped dry. However, Aedes albopictus can attach their eggs to bare stems, and are highly resistant to desiccation. These eggs may remain viable for a period of many years. In fact, the Sacramento and Los Angeles Districts found that store-bought "lucky bamboo", when removed from the planting substrate and placed in water, yielded live larvae. These preliminary experiments show that dry, air-shipped cargo of Dracaena may still be a source of Ae. albopictus introductions, even if maritime "wet" shipments of the plant are more carefully controlled. The various Mosquito Abatement Districts will continue surveillance efforts for this mosquito.
For More Information Contact:
San Mateo County Mosquito Abatement District
1351 Rollins Road
Burlingame, CA 94010
(650) 344-8592 Office
(650) 344-3843 Fax
www.smcmad.org
E-mail: vectecol@aol.com
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