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COMMUNICABLE DISEASE EMERGENCY NOTIFICATION

INFORMATION

Urgent Public Health issues shall be reported immediately (within 3 hours) to the McHenry County De-partment of Health and include the following:

* Anthrax (suspected or confirmed) * Botulism (foodborne) * Plague * Q-fever * Smallpox * Tuleremia * Any suspected Bioterrorist threat

REGULAR OFFICE HOURS (Monday – Friday 8am – 4:30pm)

(815) 334-4500 Please call one of the following:

Marylou Ludicky, RN, MPH Communicable Disease Coordinator

Melissa Manke, RN Investigator

Susan Karras, RN Investigator

Barbara Birmingham, RN Investigator

Blanca Trinidad, RN TB Nurse

Karen Stephenson, RN TB Nurse

Christina Hayes, BS CD Health Educator

Amanda Reich, CD Intern

AFTER OFFICE HOURS

(Monday – Friday 4:30pm – 8am; Saturday, Sunday and Holidays)

(815) 344-7421 Ask to speak to the Communicable

Disease “On-Call” Person.

Mission

The Communiqué is a newsletter

intended to prevent morbidity and

mortality of infectious diseases by

providing data and recommendations

to clinicians, laboratories, infection

control personnel and others who

diagnose, treat or report infectious

diseases in McHenry County.

We welcome comments and sugges-

tions. Please call if you wish to be

added to our mailing list. Contact

Mary Lou Ludicky at 815-334-4500

or email mlludick@co.mchenry.il.us

J U N E 2 0 1 2 W W W . M C D H . I N F O

M C H E N R Y

C O U N T Y

D E P A R T M E N T

O F H E A L T H

THE communicable disease Communiqué

Vector-borne diseases are bacterial and viral

diseases transmitted by mosquitoes, ticks,

and fleas. Vector-borne diseases are among

the most complex of all of the communicable

diseases; it is nearly impossibly to predict the habits of the mosquitoes, ticks,

and fleas carrying the diseases, as well as the other animals they may infect,

including humans.

The most common vector-borne disease in the United States is Lyme Disease,

which is caused by the black-legged deer tick. Other vector-borne diseases

include Malaria, Plague, Dengue Fever, Anaplasmosis, Erlichilous, and West

Nile Virus.

With temperatures heating up early this year, increased insect populations are

anticipated. Increased insect activity, translates to an increased presence of

both Ixodes scapularis, the tick that causes Lyme Disease, as well as the Culex

Pipiens mosquito, which causes West Nile Virus. McHenry County has al-

ready had its first Lyme disease cases of the season. Neighboring Cook and

DeKalb counties have had birds test positive for West Nile Virus, while Cook

and nearby DuPage counties have had positive batches of mosquitoes. The

Illinois Department of Public Health recently issued an official statement re-

minding providers that there is higher than normal West Nile activity in the

state, especially for so early in the season.

With both illnesses, underreporting is common. Increased awareness of pre-

vention strategies, symptoms, and case reporting guidelines is crucial for an

accurate portrait of vector-borne disease in McHenry County.

Monitoring these disease-causing vectors

has begun; McHenry County Department

of Health sets up mosquito traps

(pictured left) around the county. Speci-

mens are then collected and tested regu-

larly for West Nile Virus, St. Louis En-

cephalitis, and Eastern Equine Encephali-

tis. Frequent testing mosquitoes allows

for early detection of the presence of and

more effective prevention of arboviruses,

especially West Nile Virus, in the county.

MCDH is also collecting deer ticks to test

for Lyme Disease, more information is

available on page 2.

Table of Contents

Lyme disease general

information….. 2

Identification of

Erythema Migrans…..3

Tick-borne disease

algorithm….. 4

Lyme Disease Case

Report Form….. 5

West Nile Virus

Information…. 6

Preventing Tick–borne

& Mosquito– borne

Disease….. 6

Reportable Diseases

Year-to-Date….. 6

VECTOR-BORNE

DISEASES

Black-legged deer tick

Lyme disease

Lone-star tick

STARI and Erlichiosis

Dog Tick

Rocky Mountain Spotted Fever

House Mosquito

West Nile Virus

The Culex Pipiens, or house

mosquito is identified by its

striped abdomen and elon-

gated proboscis (mouthpart).

Tick Identifica-

tion and vector-

borne disease

associated with

each species.

2

Based on recent case reports, areas of probable exposure

include: Sterns Woods (Crystal Lake), Veteran's Acres

(Crystal Lake), The Hollows (Cary), and Exner Marsh

Nature Preserve (Lake in the Hills). For information on

the prevention of Lyme Disease, please consult page 6.

Cases of Lyme Disease are often underreported; in order

for MCDH to better identify potential high risk areas

within the county, ALL confirmed cases, including

those that did not require serology (Diagnosed EM > 5

cm), should be reported to the Communicable Disease

Program of MCDH at 815-334-4500. A case reporting

form can be found on page 5.

If a patient has a tick specimen, the Environmental

Health division of MCDH is offering tick-testing. For

more information, please call 815-334-4585.

Testing for Lyme Disease

For a case to be classified as Lyme Disease, order-

ing only Borrelia burgdorferi IgG/IgM ABS is not

sufficient to meet case definition set by the Centers

for Disease Control and Prevention and Illinois

Department of Public Health. There can be a false

positive serology from other diseases such as

mononucleosis, multiple sclerosis, rheumatoid fac-

tor, syphilis, and systemic lupus erythematosus.

Therefore, with a positive antibody serology result,

a Western Blot must be ordered to confirm the

diagnosis. The Western Blot will include both IgG

and IgM bands.

Lyme disease serology screening is two-

tiered. If an Enzyme Immunoassay (EIA) is

performed and is positive, labs will NOT

automatically run the Western Blot. In or-

der for the lab to confirm the case as Lyme

Disease, the EIA MUST be followed with the

Western Blot. If a Lyme EIA Screening is

ordered, the order should include Western

Blot contingent on a positive EIA result, so

that the same serosample can be used.

To interpret if the Western Blot is positive, the

Lyme IgG must have 5 of the following bands

present: 18, 21-24, 28, 30, 39, 41, 45, 58, 66 or 93

kDa and the Lyme IgM must have any 2 of the

following bands present: 21-24*, 39, or 41 kDa

within 30 days of symptom onset.

If the Western Blot is negative, please remember

to test for Erlichiosis, another disease with similar

symptoms as Lyme, and known to be present in

McHenry County.

LY M E D I S E A S E

Lyme Disease has three stages.

Early Localized Stage. At this stage a red, bulls-

eye-shaped rash, known as an

Erythema Migrans (EM) -may

occur. The EM occurs in ap-

proximately 70-80% of persons

and appears on average seven

dates following the tick bite,

but can occur after only 48

hours and up to 30 days post-

tick bite. EM lesions can be

found on any area of the body

and generally expand over several days. For more in-

formation on EM lesions consult page 3.A clinical

presentation of an EM larger than 5 centimeters as

diagnosed by a practitioner is considered a CON-

FIRMED case of Lyme Disease and should be re-

ported to MCDH. Other symptoms of this stage can

also include fatigue, chills, fever, headache, muscle and

joint aches, and swollen lymph nodes.

Early Disseminated Stage. If left untreated Lyme

Disease will enter into this stage with clinical symp-

toms such as Facial or Bell’s palsy, severe headaches

and neck stiffness due to meningitis, joint pain and in-

flammation, shooting pains, and heart palpitations or

dizziness due to irregular heartbeat. Many of these

symptoms will abate with time, but if left untreated

Lyme Disease can continue to progress, leading to ad-

ditional health complications.

Late disseminated Stage. Approximately 60% of

patients who are left untreated may develop intermit-

tent arthritis, with severe joint pain and swelling. As

many as 5% of persons with untreated Lyme disease

can develop advanced neurological and cardiac symp-

toms and possible organ degeneration.

The CDC defines a county in which

Lyme disease is endemic as “one in

which at least two confirmed cases

have been acquired in the county or in

which established populations of a

known tick vector are infected with B.

burgdorferi”; under these criterion

McHenry County can be identified as

an endemic area.

For additional information on tick-borne disease case definitions and

a testing algorithm for Lyme Disease, please consult page 4. 2

3

3

6

McHENRY COUNTY

COMMUNICABLE DISEASES

# OF CASES

DISEASE

YTD 2012

YTD 2011

Bacterial

Meningitis 1 1

Brucellosis 1 0

Chlamydia 169 188

Creutzfeldt-Jakob

Disease 1 0

Cryptosporidiosis 4 0

E.Coli 2 3

Ehrlichiosis 1 0

Giardia 2 5

Gonorrhea 21 8

Group A

Streptococcus 2 3

H1N1

Hospitalizations 0 2

Haemophilius

Influenza 5 3

Hepatitis A 1 0

Hepatitis B 12 9

Hepatitis C 31 27

HIV 0 4

Histoplasmosis 0 1

Legionellosis 0 2

Lyme Disease 9 3

Malaria 0 1

MRSA,

infants < 61 days 0 1

Non-Cholera

Vibriosis 1 0

Pertussis 209 1

Rabies (potential

exposure) 9 3

Salmonella 15 11

Syphilis 1 7

Step Pneumonia

(≤ 4 years) 0 2

Toxic Shock

Syndrome 0 1

Tuberculosis 1 2

Varicella

(Chicken Pox) 19 30

West Nile Virus 0 0

West Nile Virus is a flavivirus of the arthro-

pod-borne virus family, and is included in the

Abroviruses for reporting. Although several

species can carry West Nile Virus (WNV), in

McHenry County, WNV is primarily trans-

mitted by the species Culex pipiens, or the

house mosquito. The house mosquito prefers

stagnant water for breeding, such as catch-

basins, old tires, poorly draining ditches,

clogged gutters, and bird baths. The virus

must be present in the mosquito’s salivary

glands for transmission to occur. An infected

Culex mosquito transmits the virus during a

blood meal and so only female house mosqui-

toes can transmit WNV; the virus can then be

transmitted from the host to another mos-

quito as it gathers its meal.

Mosquitoes

Avoid outdoor activities when mosquitoes are most active (dawn and dusk). Eliminate areas where water can collect and create ie. old tires, bird baths, garbage cans, wheelbarrows, clogged gutters, etc Make sure door and window screens are tight fitting and in good condition.

Ticks Avoid wooded and brushy areas with high grass and leaf litter. Tuck your pants into your socks or boots, and tuck your shirt into your pants to keep ticks on clothing. Put clothing in the dryer on high heat for 60 min. to kill any remaining ticks. Take a shower as soon as you can after coming indoors Use a handheld mirror to check your body for ticks. Ticks can hide behind the knees and in the armpits, hair, and groin.

Both Use insect repellent

that contains 20-30% DEET.

Apply permethrin to clothing and outdoor gear prior to wearing; do NOT apply to skin

directly Wear a hat and long pants, long sleeves,

and socks.

Preventing Tick and Mosquito Related Illnesses

Most individuals infected with WNV will not

develop any symptoms or clinical illness.

Only about 20% of infected individuals do

develop symptoms, with most people only

developing the milder flu-like illness, West

Nile Fever. West Nile Fever symptoms in-

clude fever, headache, body aches, skin

rashes, and swollen lymph nodes. Less than

one percent of infected individuals express

severe symptoms, including encephalitis,

ataxia, myelitis, optic neuritis, polyradiculitis,

and seizures. Individuals over 50 or otherwise

immunocompromised are at higher risk for

developing severe symptoms.

West Nile Virus can be diagnosed us-

ing a blood sample or a sample of cere-

brospinal fluid, for more information

on diagnosing West Nile Virus, visit

the CDC’s WNV website. Laboratory

testing for WNV is available through

the Illinois Department of Public

health through October 31st, or until

two weeks following the first killing

frost. There is no specific treatment

available for West Nile Virus.

West Nile Virus

YTD: Through May 31, 2012