Dear Central Ohio Area Physicians,
The Columbus syphilis outbreak continues to worsen and Columbus Public Health requests the help of central Ohio area physicians to test and treat whenever possible.
Infectious early syphilis (ES) cases have increased by 50% comparing January- June of 2014 to January -June of 2015. There have been more than 200 cases reported in the 1st half of 2015. It is anticipated that by the end of 2015 data will reflect a rate increase of more than 83% since 2013.
While most cases are being diagnosed in men who have sex with men, a staggering increase among females has resulted in treatment of several pregnant woman and 8 cases of congenital syphilis during 2014 and 3 cases already in 2015. Congenital syphilis is often severe, disabling, and life-threatening.
Please take a few minutes to review this alert and the recommend screening guidelines.
In light of the recent detection of Highly Pathogenic Influenza A (HPAI) in wild birds and poultry flocks in 20 US states (not Ohio) as well as the detection of swine variant influenza A in Ohio and other states, the Ohio Department of Health (ODH) will be enhancing statewide influenza surveillance activities. As part of this effort, ODH is requesting that Ohio health care providers consider sending any influenza A positive specimens to the ODH Laboratory for confirmatory testing and subtyping between July 15 and September 30, 2015. Details are in the Health Advisory below.
This is an update to the Ebola Hemorrhagic Fever Outbreak that occurred in October 2014.
Public Health Advisory - Columbus Public Health and Franklin County Public Health (June 26, 2015)
The United States is currently experiencing a multi-state outbreak of measles linked to an amusement park in California. Cases linked to the outbreak have been found in more than a dozen states. At this time, no Ohioans have been linked to the California outbreak and there have been no cases of measles in Ohio since the summer of 2014.
Vaccine is the best intervention to prevent measles. One dose of MMR is 93% effective and two doses are 97% effective at preventing measles.
The Ohio Department of Health will accept specimens from suspected measles cases who meet testing criteria.
If you have a case that may be suspected as Ebola please call IDRS at (614) 525-8888 immediately to report it. Risk factors include a fever of 101.5, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND travel to a country or exposure to someone who traveled to a country with Ebola.
West Africa Outbreak - The Centers for Disease Control and Prevention (CDC) is working with the World Health Organization (WHO), the ministries of health of Guinea, Liberia, and Sierra Leone, and other international organizations in response to an outbreak of Ebola Virus Disease (EVD) in West Africa, which was first reported in late March 2014. This is the largest outbreak of EVD ever documented and the first recorded in West Africa.
U.S. Diagnosed Case – On September 30, 2014, CDC confirmed the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from West Africa. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately five days after arriving in the United States.
The person sought medical care at Texas Health Presbyterian Hospital of Dallas after developing symptoms consistent with Ebola. Based on the person’s travel history and symptoms, CDC recommended testing for Ebola. CDC and the Texas Health Department reported the laboratory test results to the medical center to inform the patient. Local public health officials have begun identifying close contacts of the person for further daily monitoring for 21 days after exposure.
The ill person did not exhibit symptoms of Ebola during the flights from West Africa and CDC does not recommend that people on the same commercial airline flights undergo monitoring, as Ebola is only contagious if the person is experiencing active symptoms. The person reported developing symptoms several days after the return flight.
Even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.
HHS Press Release - (December 2, 2014)
Web Based PPE Training
Ambulatory Care Evaluation of Patients with Possible Ebola Virus Disease
Emergency Department Evaluation & Management of Patients with Possible Ebola Virus Disease
Resources for Parents, Schools & Pediatric Healthcare Professionals
CDC Key Messages - (October 2, 2014)
Public Health Advisory - Columbus Public Health and Franklin County Public Health (October 1, 2014)
Ebola ODH Infograph for Travelers & Schools (August 20, 2014)
Public Health Advisory - Columbus Public Health and Franklin County Public Health (August 8, 2014)
CDC Health Advisory - Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease (August 1, 2014)
Test results from the Centers for Disease Control and Prevention (CDC) has confirmed the Enterovirus D68 (EV-D68) in suspected cases in Ohio. This virus has been causing pediatric respiratory illnesses and hospitalizations in several other states, and Central Ohio has recently seen an increase in respiratory illnesses and hospitalizations among children.
Enteroviruses are very common viruses, with over 100 different types. EV-D68 infections are thought to be less common, usually causing mild to severe respiratory illness.
More Information on Enterovirus visit the CDC website.
Columbus Public Health is currently investigating a syphilis outbreak in the Columbus community. For more information, see Columbus Public Health's Advisory. For questions or comments, contact Columbus Public Health's main number at 614-645-6444 or call their Sexual Health Clinic at 645-7772.
The Ohio Department of Health and a number of local health departments in Ohio continues to investigate a measles outbreak. To date, there are no cases in Franklin County or any of our neighboring counties.
Measles is a Class A Disease and should be reported immediately.
For complete information on the status of the outbreak visit the Ohio Department of Health web site.
Measles Guidance for Healthcare Workers - June 18, 2014
Guidance for Schools - May 1, 2014
Measles Guidance for Healthcare Workers – April 30, 2014
Ohio Department of Health Alert to Ohio Hospitals – April 23, 2014
Measles Fact Sheet
Provider Quick Facts
Image of Measles Rash
**The community mumps outbreak has been resolved with less than one case per week sustained over seven consecutive weeks (Aug. 3-Sept. 20, 2014). During this time, only three cases of mumps with onset of illness were reported. The most recent central Ohio mumps case was reported on September 2.**
Columbus Public Health, Franklin County Public Health, Delaware General Health, and Madison County-London City Health Department continue to work with the Ohio Department of Health to investigate mumps cases in our community, stemming from an outbreak at The Ohio State University (OSU) that started in early 2014. To see the daily case count information, click here.
The boundaries of the community outbreak currently include Franklin, Delaware and Madison counties. Although there have been cases in residents of counties outside of Franklin, Delaware and Madison counties, these cases are linked to the community outbreak. Most of the linked cases work or attend school within Franklin, Delaware and Madison counties.
Mumps vaccine, the best way to prevent mumps, is included in the combination measles-mumps-rubella (MMR) & measles-mumps-rubella-varicella (MMRV) vaccines. Two doses of mumps vaccine are 88 percent effective at preventing disease; one dose is 78 percent effective. Children should receive the first dose of mumps-containing vaccine at 12-15 months & the second dose at 4-6 years. Adults born during or after 1957 likely have received one dose and may receive a second MMR for enhanced protection. Adults at higher risk, such as university students, healthcare personnel, international travelers and persons with potential mumps outbreak exposure should have two doses of mumps vaccine.
Contact: Elizabeth Koch, MD MPH&TM, Columbus Public Health, (614) 645-6578, EMKoch@columbus.gov or
Carol Stasko, RN, MS, APHN-BC, Franklin County Public Health, (614) 525-4717, firstname.lastname@example.org.
Collection and Submission of Suspected Mumps Guidance – April 10, 2014
Healthcare Worker Mumps Guidance – April 10, 2014
On December 7, 2013, the World Health Organization (WHO) reported the first local (autochthonous) transmission of chikungunya virus in the Americas. As of December 12th, 10 cases of chikungunya have been confirmed in patients who reside on the French side of St. Martin in the Caribbean. Laboratory testing is pending on additional suspected cases. Onset of illness for confirmed cases was between October 15 and December 4. At this time, there are no reports of other suspected chikungunya cases outside St. Martin. However, further spread to other countries in the region is possible.
Chikungunya virus infection should be considered in patients with acute onset of fever and polyarthralgia, especially those who have recently traveled to the Caribbean. Healthcare providers are encouraged to report suspected chikungunya cases to their state or local health department to facilitate diagnosis and to mitigate the risk of local transmission.
Chikungunya virus is a mosquito-borne alphavirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes. Humans are the primary reservoir during epidemics. Outbreaks have been documented in Africa, Southern Europe, Southeast Asia, the Indian subcontinent, and islands in the Indian and Pacific Oceans. Prior to the cases on St. Martin, the only chikungunya cases identified in the Americas were in travelers returning from endemic areas.
A majority of people infected with chikungunya virus become symptomatic. The incubation period is typically 3–7 days (range, 2–12 days). The most common clinical findings are acute onset of fever and polyarthralgia. Joint pains are often severe and debilitating. Other symptoms may include headache, myalgia, arthritis, or rash. Persons at risk for more severe disease include neonates (aged <1 month) exposed intrapartum, older adults (e.g., > 65 years), and persons with underlying medical conditions (e.g., hypertension, diabetes, or cardiovascular disease).
Chikungunya virus infection should be considered in patients with acute onset of fever and polyarthralgia who recently returned from the Caribbean. Laboratory diagnosis is generally accomplished by testing serum to detect virus, viral nucleic acid, or virus-specific immunoglobulin M (IgM) and neutralizing antibodies. During the first week of illness, chikungunya virus infection can often be diagnosed by using viral culture or nucleic acid amplification on serum. Virus-specific IgM and neutralizing antibodies normally develop toward the end of the first week of illness. To definitively rule out the diagnosis, convalescent-phase samples should be obtained from patients whose acute-phase samples test negative.
Chikungunya virus diagnostic testing is performed at CDC, two state health departments (California and New York), and one commercial laboratory (Focus Diagnostics). Healthcare providers should contact their state or local health department to facilitate testing.
No specific antiviral treatment is available for chikungunya fever. Treatment is generally palliative and can include rest, fluids, and use of analgesics and antipyretics. Because of similar geographic distribution and symptoms, patients with suspected chikungunya virus infections also should be evaluated and managed for possible dengue virus infection. People infected with chikungunya or dengue virus should be protected from further mosquito exposure during the first few days of illness to prevent other mosquitoes from becoming infected and reduce the risk of local transmission.
No vaccine or preventive drug is available. The best way to prevent chikungunya virus infection is to avoid mosquito bites. Use air conditioning or screens when indoors. Use insect repellents and wear long sleeves and pants when outdoors. People at increased risk for severe disease should consider not traveling to areas with ongoing chikungunya outbreaks.
Recommendations for Health Care Providers and Public Health Practitioners
State health departments are encouraged to report laboratory-confirmed chikungunya virus infections to ArboNET, the national surveillance system for arthropod-borne viruses.
For more information
General information about chikungunya virus and diesase
Chikungunya information for clinicians
Protection against mosquitoes
Travel notices related to chikungunya virus
Information about chikungunya for travelers and travel health providers
Chikungunya preparedness and response guidelines (161 pages, 8 MB PDF file download)
Dengue clinical management guidelines
Tubersol is a prescription solution that is injected just under the skin to test for tuberculosis infection.
TUBERSOL®, a product of Sanofi Pasteur Limited, is in shortage nationwide. This is a prescription solution that is injected just under the skin by a healthcare provider to test for tuberculosis infection. This is impacting healthcare providers using the solution for their testing.
Healthcare - Recommends Approaches
The Centers for Disease Control and Prevention recommends approaches for healthcare providers to address the shortage.
Learn more about the current shortage.
Franklin County Public Health (FCPH) investigated a Legionellosis outbreak associated with the Wesley Ridge Retirement Community, located at 2225 Taylor Park in Reynoldsburg, in July and August 2013. The Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health (ODH) assisted with the investigation. There were a total of 39 confirmed cases. The age range was 63-99 years of age. There were six deaths.
FCPH, CDC and ODH worked together to complete case interviews and investigations as well as patient chart review. The data was compiled and reviewed to see if a common exposure source could be determined. Water tests have confirmed legionella was present in both the potable water system and a cooling tower. The Wesley Ridge Retirement Community followed all recommendations to limit additional exposure to their residents, employees and visitors. They hired a contractor to test their environmental systems and completed remediation.
For additional information on this Legionellosis outbreak, contact FCPH at (614) 525-3097 or IDRS at (614) 525-8888.
As Ohio’s 2013 agricultural fair season kicks off, the Ohio Departments of Health (ODH) and Agriculture (ODA) are reminding Ohioans to practice good hygiene when visiting livestock exhibits as the H3N2 variant virus (H3N2v) makes another comeback this year. This virus is also known as the flu virus from swine exposure.
Last year, 309 cases in 12 states (including Ohio) were part of an outbreak caused by H3N2v. Most of these infections were associated with prolonged exposure to pigs at agricultural fairs.
Influenza viruses such as H3N2 and its variants are not unusual in swine and can be directly transmitted from swine to people and from people to swine in the same way that all viruses can be transmitted between people. When humans are in close proximity to live infected swine, such as in barns and livestock exhibits at fairs, movement of these viruses can occur back and forth between humans and animals. Influenza viruses cannot be transmitted by eating pork or pork products.
Individuals should always wash hands with soap and water before and after petting or touching any animal. Never eat, drink, or put anything in your mouth in animal areas. Older adults, pregnant women, young children, and people with weakened immune systems should be extra careful around animals.
Those who have direct, routine contact with swine, such as working in swine barns or showing swine at fairs, and have experienced cough or influenza-like illness should contact their health care provider or local health department. Symptoms include cough, sore throat, fever, body aches, and possibly other symptoms, such as nausea, vomiting or diarrhea.
CDC Health Alert Network (HAN) Advisory
Feb 14 - New CRE Warrant Additional Action by Healthcare Providers
CDC Morbidity and Mortality Weekly Report (MMWR)
Mar 05 - Vital Signs: Carbapenem-Resistant Enterobacteriaceae
Feb 15 - Notes from the Field: Hospital Outbreak of Carbapenem-Resistant Klebsiella pneumoniae Producting New Delhi Metallo-Beta-Lactamase
Mar 05 - CDC Vital Signs Press Release Graphic: Making Health Care Safer
CDC is coordinating a multi-state investigation of fungal meningitis among patients who received epidural steroid injections (medication injected into the spine). Several of these patients have had strokes related to the meningitis. Cases have all linked to back injections with steroids distributed by the New England Compounding Center (NECC). The investigation also includes fungal infections associated with injections in a peripheral joint space, such as a knee, shoulder or ankle. Fungal meningitis is not contagious. For additional information on the investigation visit the CDC web site.
A total of four clinics in Ohio were identified to have received one of the recalled lots from the NECC associated with illness. One is from here in Franklin County – the Ortho-Spine Rehab Center in Dublin. That clinic, along with Franklin County Public Health, has contacted the patients who received the recalled epidural and advised them what symptoms to closely watch for.
On October 3, 2012, NECC ceased all production and initiated recall of all methylprednisolone acetate (a steroid medication) and other drug products prepared for injections in and around the spinal cord (known as intrathecal administration). On October 6, NECC announced a recall of all its products. A complete list of all products subject to this recall can be accessed here. Franklin County Public Health, Columbus Public Health and the Ohio Department of Health (ODH) alerted health care providers to inform them of symptoms that could be cause by the tainted drug as well as updated lists of recalled products.
All health care providers have been asked to follow-up with patients who received any injectable products from NECC since May 2012. The products on the expanded list have not been linked to any illnesses, FDA is providing the information out of an abundance of caution. The Centers for Disease Control and Prevention (CDC) has provided states with a list from the Food and Drug Administration (FDA) of all facilities that purchased NECC products during that time frame. ODH is making the list of the 64 Ohio facilities available online to aid in the outreach to patients. The list includes any provider who bought a NECC product since May 21, 2012, even topical products, which FDA has indicated are low- or no-risk products.
For details on cases in Ohio visit the Ohio Department of Health web site.
Fungal Meningitis related to this recall is considered a Class A Disease and must be reported within 24 hours.
CDC Health Alert Network (HAN) Alerts
Dec 3 - Update: Additional Contamination Identified in Medical Products from New England Compounding Center
Nov 20 - Update: Multistate Outbreak of Fungal Meningitis and Other Infections Associated with Contaminated Steroid Medication
Nov 1 - Contamination Identified in Additional Medical Products from New England Compounding Center
Nov 1 - Voluntary Recall of All Ameridose Medical Products
Oct 23 - Issuance of Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products
Oct 17 - Update: Multistate Outbreak of Fungal Meningitis and Joint Infections Associated with Contaminated Steroid Medications
Oct 8 - Multistate Outbreak of Meningitis and Stroke Associated with Potentially Contaminated Steroid Medication
Oct 4 - Meningitis and Stroke Associated with Potentially Contaminated Product
CPH & FCPH Update
Oct 7 - Ohio Emergency Medicine Care Providers Memo
Ohio Department of Health News Releases
Oct 16 - Ohio Department of Health News Release
Oct 11 - Ohio Department of Health News Release
Oct 8 - Ohio Department of Health News Release
Oct 6 - Ohio Department of Health News Release
Oct 5 - Ohio Department of Health News Release
CDC Recommendations for Clinicians
Because recommendations are evolving daily, please visit the CDC web site for the most current guidelines.
Oct 6 - Treatment Guidance for Fungal Meningitis
Oct 6 - Diagnostic Testing & Specimen Submission Guidance
Oct 6 - Case Definition
As of September 28, 307 cases of variant Influenza A ("H3N2v") associated with swine exposure have been confirmed by the Centers for Disease Control and Prevention (CDC). To see the breakdown of the 10 states with cases, visit the CDC web site.
As of the end of September there were 107 confirmed cases in Ohio. Those with confirmed cases are between the ages six months and 61 years. Most ill individuals have recovered on their own or were treated and released after a short stay in the hospital. One death in Madison County has been associated with H3N2v. Individuals most likely became ill with the flu virus after exposure to swine. Some limited human-to-human passage of the virus has been confirmed. To see the breakdown of the counties with cases visit the Ohio Department of Health web site.
Because of the number of cases in Ohio, as well as confirmed H3N2v activity in other states, Columbus Public Health and Franklin County Public Health are conducting enhanced surveillance for outbreaks and unusual cases of influenza-like illnesses (ILI). ILI is defined as fever ≥ 100° F and cough and/or sore throat in the absence of a known cause other than influenza.
Who is at Risk
People in close proximity to live infected swine, such as in barns and livestock exhibits at fairs. Children, pregnant women, elderly, and those with compromised immune systems should be especially careful around swine.
For all persons with ILI that report direct contact with swine, please complete the Novel Virus Infection Confidential Case Report Form. Call (614) 525-8888 to report and fax form to (614) 525-8890.
Lab and Specimen Testing
At this time, Ohio Department of Health Lab will accept specimens for testing in the following situations:
For patients in Franklin County and Columbus who fall under the above situations, please call the Franklin County and Columbus disease reporting line at (614) 525-8888 to report a suspected case and arrange for sample submission.
Ohio Department of Health News Releases
Aug 31 - Ohio Documents First H3N2v-Associated Death
Aug 24 - Ohio Documents 98 Human Cases of Influenza A H3N2v
Aug 14 - H3N2v Update: 54 Cases Confirmed
Aug 10 - County Fair Outreach Underway
Aug 08 - Additional H3N2v Cases Confirmed in Ohio
Aug 06 - Additional H3N2v Cases in Ohio Confirmed by CDC
Aug 03 - State Officials Continue Flu Surveillance and Prevention
Aug 02 - Health Officials Confirm Flu Virus Strain from Butler County Fair
Aug 01 - Health Officials Investigating Flu Illnesses from Butler County Fair
Aug 3 - CDC Increase in Influenza A H3N2v Virus Infections in Three U.S. States
Aug 3 - Healthcare Provider Advisory
Aug 3 - Influenza A Novel Virus Infection Confidential Case Report