Infectious Diseases and the Impact on Our Schools

Mary G. McIntyre, MD, MPH

State Epidemiologist

Assistant State Health Officer for

Disease Control and Prevention

OBJECTIVES

Define “the Public Health System”? “What we do?” Review of Disease Control and Prevention’s Structure What is your role? Examples Questions

Mission Statement for

Bureau of Communicable Disease

The mission of the Bureau of Communicable Disease (BCD) is to prevent and control designated communicable diseases and illness in Alabama. 

Bureau of Communicable Diseases• Epidemiology

• HIV/AIDS

• Immunization

• Sexually-transmitted Diseases

• Tuberculosis

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Epidemiology Mission Statement

To protect the residents of Alabama through

constant monitoring of the incidence and

prevalence of communicable, zoonotic, and

environmentally-related human disease.

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Epidemiology Division Branches

• Analysis and Reporting

• Infection Control– Healthcare-associated Infections*– Infected Healthcare Workers Program*

• Surveillance

• Toxicology

• Zoonotic

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*Call 1-800-338-8374 and ask for Infection Control

Mission Statement for

Bureau of Clinical Laboratories

The mission of the BCL is to give laboratory support for public health programs and make policy decisions that protect and promote the health of the citizens of Alabama.

BCL Locations and Branches

Montgomery• Clinical Chemistry• Metabolic• Microbiology• Respiratory• Sanitary

Bacteriology/Media• Serology

Mobile• Clinical• Environmental

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www.adph.org/bcl

HIPAA

ADPH is a public health authority as defined bythe Health Insurance Portability and Accountability Act (HIPAA) to collect or receive protected healthinformation (PHI) for the purpose of surveillance, investigations, and interventions of notifiable diseases, without authorization of the patient.

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http://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm

Outbreaks

• An outbreak is defined as illness in 2 or more people, from separate households, with a common exposure.

• “An outbreak” can occur in any of the BCD divisions (STD, HIV, TB, STD, IMM or EPI)

• Most often occurs in EPI due to the number of potential diseases falling under this area

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Notifiable Diseases/Conditions

• Purpose of Notifiable Diseases• ADPH administrative code authorizes and

requires reporting, http://www.alabamaadministrativecode.state.al.us/docs/hlth/index.html

• ADPH is exempt from HIPAA Privacy Rules, http://www.cdc.gov/mmwr/pdf/other/m2e411.pdf

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Surveillance Pyramid

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Immunization The goal of the Immunization Division is to stop the

spread of diseases that are vaccine preventable by providing vaccine to the citizens of Alabama, educating the medical personnel and the public on the importance of vaccinations, and ensuring that children who are in day care, Head Start, and school are adequately immunized against diseases that are harmful and sometimes deadly.

Tuberculosis

The ultimate goal for the Division of Tuberculosis (TB) Control is the elimination of tuberculosis in Alabama. Until that goal is reached, the Division strives to reduce the annual burden of disease, limit transmission and prevent future cases through the provision of diagnostic, treatment, and case management activities. The Division of TB Control provides these services to all persons in Alabama, regardless of the ability to pay. This commitment to the citizens of Alabama has contributed to historic declines in TB morbidity and mortality.

STD

The Division of STD Prevention and Control is charged with identifying populations at increased risk for infection in order to reduce their chances of developing a sexually transmitted disease (STD), transmitting it to others, and/or developing related complications. Statewide disease intervention staff provide screening, diagnostic, education, treatment, partner notification, and referral services in every county of Alabama.

HIV

• The mission of the Division of HIV/AIDS Prevention and Control, in collaboration with community partners, is to reduce the incidence of HIV infections, to increase life expectancy for those infected, and to improve the quality of life for persons living with or affected by HIV. The charge of the Division is to:– monitor the epidemic

– improve public understanding of HIV

– prevent or reduce behaviors that transmit HIV

– increase individual knowledge of HIV serostatus

– strengthen systems for referral to appropriate prevention and treatment services

Who Must Report

• Physicians

• Dentists

• Nurses

• Medical Examiners

• Hospital Administrators

• Nursing Home Administrators

• Laboratory Directors

Who Must Report

• School Principals

• Day Care Center Directors– We expect and want multiple reports

EXAMPLE 1FOODBORNE ILLNESSES

What is Foodborne Illness?

Foodborne Illness

• AKA – foodborne disease

• What is it?

– illness resulting from the consumption of food

– commonly known as food poisoning,

– can be caused by consuming a food contaminated with a chemical or natural toxin, or pathogens (bacteria, viruses, parasites)

– contamination can occur before, during, and after food preparation

These are symptoms of a FOODBORNE ILLNESS

Stomach PainDiarrheaVomiting

Not the flu!?

Did you know? According to the

Center for Disease Control:

76 million become ill due to food / year

325,000 hospitalized 5000 die / year

How Many Are There?

• There are more than 250 known foodborne illnesses.

What Foods Are Most Likely to be Contaminated?

• raw meat and poultry• raw eggs (even in uncooked brownie, cake, or

cookie dough)

• unpasteurized milk

• raw shellfish

• unwashed raw fruits and vegetables

• unpasteurized fruit juice

How Do You Know If You Have Foodborne Illness?

• Onset of symptoms can occur in hours to days of food consumption– known as the incubation period

• Symptoms vary– mild to severe (requiring hospitalization)

• Common symptoms include:– diarrhea, abdominal cramps, and nausea

Am I at Risk?

• YES– 76 million cases of foodborne illness occur

each year in the U.S. – pregnant women, infants, the elderly, and

those weakened immune systems are at greater risk for foodborne illness

What Can I Do?

• Follow these simple guidelines:

– CLEAN

– COOK

– CHILL

– LEFTOVERS

Food Poisoning and Foodborne Illness

BACTERIA

VIRUS

TOXINS

CHEMICALS

 

Can be caused by eating food contaminated with:

What Are the Most Common Causes of Foodborne Illness?

• Those caused by the bacteria:– Campylobacter– Salmonella– E. coli O157:H7

• Those caused by a group of viruses:– Norwalk and Norwalk-like viruses

Campylobacter

Found in the intestinal tract of birds, sheep, cattle and on the surface of

raw poultry.

Salmonella

Found in the intestines of birds, reptiles, & mammals.

E-coli 0157:h7

Lives in cattle & other similar animals. Found in raw meat, non-pasteurized

milk, apple cider, sprouts.

Influenz

Norovirus

The cause of HALF of all foodborne illness. Spread by

hand contact with foodfood placed on a surface that is contaminated by the virusor when virus is airborne.

Cold foods such as sandwiches & salads are

often associated with Norovirus.

NorovirusStarts suddenly.

Causes diarrhea, vomiting, abdominal cramps, headache, low-grade fever, chills & muscle aches.

Often called the flu.

Symptoms begin 12 to 48 hours after ingestion of the virus.

Recovery in 2-3 days but may remain ill for up to 2 weeks.

HEPATITIS A VIRUS

Another Foodborne Illness Virus

Possible sources include by shellfish, salads, deli meats fruits, milk and milk products

Symptoms include sudden onset of fever, general discomfort, fatigue, headache, nausea, loss of appetite, vomiting, abdominal pain & jaundice after several days.

Lasts 1 to 2 weeks (severe cases up to several months).

Biological Toxins

Biological Toxins are produced by some pathogens found in food contamination.

They could also come from a plant or animal.

Bacterial Toxins

Some bacteria produce

poisons or toxins that cause:

FOODBORNE ILLNESS (sometimes intentional)

FOODBORNE ILLNESS (sometimes intentional)

Staphylococcus aureus

Commonly associated with food service.

Commonly associated with food service.

produces a toxin that causes

serious vomiting and

stomach cramps.

produces a toxin that causes

serious vomiting and

stomach cramps.

Staphylococcus AureusStaphylococcus Aureus

Clostridium Botulinum

Toxin producing bacteria

Causes botulism

Symptoms are nerve related and can cause muscle paralysis

Symptoms typically occur 8 to 36 hours after

or as late as 10 days

Lasts several days to 1year

CHEMICAL POISONING

Careless or improper storage of chemicals

Improper use of chemicals

Improper labeling Sometimes intentional

addition of poison

CHEMICAL POISONING

Always store cleaners and chemicals below your food or food surfaces.

Choose pesticides that are approved for use in the kitchen.

                        

       

                        

       

What Can I Do?

• Follow these simple guidelines:

– CLEAN

– COOK

– CHILL

• LEFTOVERS

CHILL OUT………

Bacteria grows quickly at room temperature, so refrigerate leftover foods within 2 hours. 

Bacteria grows quickly at room temperature, so refrigerate leftover foods within 2 hours. 

Food will cool more quickly if divided into several shallow containers for refrigeration.

Refrigerate leftovers promptly: 

WASH YOUR HANDS OFTEN

Especially:

When preparing food.

After using the bathroom.

Avoid direct contact with public restroom doorknobs. (use paper towel to open door)

WHEN WASHING YOUR HANDS

Use warm, soapy running water.Rub your hands thoroughly, scrubbing between fingers, and nails for:

10–15 SECONDS.

Do wash your hands with soap and water before preparing food. 

Do rinse fresh fruits & vegetables with cold water.

Do refrigerate at a temperature of 40o F or less.

Do throw away items that have come into contact with raw meat or chemicals.

Do not prepare food for others if you yourself have diarrhea.

Do not use bleach or soap on fruits & vegetables.

Do NOT eat fresh cut items left un-refrigerated for > 2 hours.

Do not eat bruised or damaged fruits & vegetables.

Fruits & Vegetables Do’s & Don’ts

Safe Preparation of Raw Meats

A few simple precautions can reduce the risk of foodborne diseases: 

COOK

SEPARATE

CHILL

REPORT

SEPARATE:

Put cooked meat on a clean platter rather than back on one that held the raw meat. 

Don't cross- contaminate one food with another. 

Avoid cross-contaminating foods by washing hands, utensils, and cutting boards after they have been in contact with raw meat or poultry. 

If in doubt asto the safetyof your food,

THROW IT OUT!!

I’m Telling….

REPORT:Foodborne illnesses to your LOCAL HEALTH DEPARTMENT. 

Your local health department works hard to track down the causes of the foodborne illness.

Your local health department works hard to track down the causes of the foodborne illness.

Prevent Food Poisoning

The Bottom Line• Keep Hot Food Hot

• Cold Food Cold

• Keep Everything Clean

• Especially: Wash Your Hands • Don’t go to work sick.

                                                                                                                                                                                                                                                                                                                                                    

Assemble a TeamEveryone Has a Role in

the Safety of Food

National Coalition for Food Safe Schools

Action Guide and Tool Kit

www.foodsafeschools.org

www.neha.org

www.foodsafeschools.org

www.neha.org

This Children's Environmental Health presentation was made possible

through a grant from

The Dow Chemical Company Foundation

Credits

• Charles Lichon, R.S., M.P.H., Creator of Children’s EH Program, Midland County Health Department (CHD) Michigan

• Nancy Atwood, M.S., Midland CHD (MI) Sanitarian

• Christine Rogers, Meth Response Coordinator, Kalamazoo CHD, MI

• Gayle Blues, Midland CHD, layout and design

• Robert Wolfe, R.S., Midland CHD (MI) Sanitarian

• John Demerjian and Linda Van Orden, Wayne CHD, MI, Body Art

• National Environmental Health Association (NEHA.org) for website storage and oversight.NOTE: Permission to use this and all Children’s EH Power Point presentations is granted thru NEHA, however, all grant and credit notices & informational slides must be used during each presentation.

EXAMPLE 2TUBERCULOSIS

Basic TB Facts• Tuberculosis (TB) is caused by a bacterium

called Mycobacterium tuberculosis.– the bacteria usually attack the lungs, but TB

bacteria can attack any part of the body such as the kidney, spine, and brain

– if not treated properly, TB disease can be fatal– in the past, TB was the leading cause of death in

the United States– today, TB is still a leading cause of death across

the globe

How TB Spreads• TB is spread through the air from one person

to another– the TB bacteria are expelled when a person with

TB disease of the lungs or throat coughs, sneezes, speaks, or sings

– people sitting or working nearby may breathe in these bacteria and become infected

• Do you know the guy in the next slide?

How TB is Controlled

• Public health interventions are designed to interrupt TB transmission

• How do we accomplish that task?– identify and treat-to-cure those with active TB

disease, and– identify, evaluate, and preventively treat

contacts through disciplined use of public health tools and methodologies

Concentric Circle Approach

(an important methodology in contact follow up)

Household

Leisure Work /

School

INDEX

PATIENT

Close Contacts

Other-than-Close Contacts

TB is NOT spread by:

• Shaking someone’s hand

• Sharing food or drink

• Touching bed linens or toilet seats

• Sharing toothbrushes

• Kissing

TB Infection

• TB bacteria can live in the body without making you sick - this state is called TB infection

• Most people who breathe in TB bacteria and become infected are able to fight and contain the bacteria to stop them from multiplying

• People with TB infection do not feel sick and do not have any symptoms

• People with TB infection are not infectious and cannot spread TB bacteria to others.

TB Disease

• Also called “active TB disease” because the body’s immune system can't stop the bacteria from “actively replicating” or multiplying

• People with TB disease are sick and will likely have symptoms – persons with pulmonary or airway disease may

be capable of spreading the bacteria to other people they spend time with every day

Symptoms of TB Disease

• Bad cough that lasts 3 weeks or longer

• Chest pain

• Coughing up blood or sputum

• Weakness or fatigue

• Weight loss / Loss of appetite

• Fever / Chills

• Night sweats

Infection vs. Disease

• Positive TB Skin Test

• Normal Chest X-Ray

• No symptoms• Cannot transmit to

others• May be treated

preventively

• Positive TB Skin Test• Abnormal Chest X-Ray• Has symptoms• May transmit to others• May be treated and

cured

Testing for TB Infection

• There are two kinds of tests that are used to detect TB bacteria in the body: the tuberculin skin test (TST) and TB blood tests. These tests can be accessed through your health care provider or, in certain cases, through TB staff in your public health area.

• If you have a positive reaction to either of the tests, a chest X-ray is indicated to see if you have TB disease.

Treatment for TB Infection

• If your chest X-ray is clear and TB disease is ruled out, we may want to treat you to keep you from developing TB disease

• Treatment of TB infection is often called “preventive therapy” because it reduces the risk that TB infection will progress to active TB disease in the future

How TB Control is Organized in Alabama

• Each Public Health Area has a TB team: this team may include a Manager, a Nurse, a Disease Intervention Specialist, and an Administrative Support Assistant

• This team is responsible for executing the TB Protocol and the provision of TB control services in their respective area

• One important take away point is that your local TB expert is just a phone call away!

Take away points…

• TB is an infectious disease that touches the lives of hundreds of Alabamians each year.

• TB cases and their contacts receive expert care at no cost from dedicated public health physicians, nurses and staff.

• TB control efforts have been successful, but continued vigilance and response capacity is required to protect the public health.

Take away points…

• TB screening for school employees should be reserved for new hires with risk factors for tuberculosis

• Contact your local TB expert if anyone (i.e., student, faculty, or other staff) exhibit symptoms of active TB disease.

DISCUSSION AND QUESTIONS