iw 03.08 Infection Prevention - IN.gov · > “Medical Myths Debunked” by Jean Lawrence. Log on ... some cases, these illnesses can lead to serious disability or death. Amazing

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The old, the new and what’s true The outbreaks of SARS in Toronto in 2003, monkeypox in the Midwest in 2003 and measles

in Indiana in 2005 remind us that oceans no longer isolate us from the rest of the world.

Through public awareness, healthy habits, research and effective health care,

the prevention and control of infectious disease is possible.

As published in the March 2008 issue of Indianapolis Woman magazine

EFFECTIVE INFECTION PREVENTION

Fight infectious disease withgood habits and knowledge

As a physician, treatment of infections is a mainstay of medicalpractice. However, physicians are not the only ones who play acritical role in infection prevention: Everyone has a role.

Women are usually the first teachers and promoters of infectionprevention in the family. From teaching children how and when to washtheir hands to properly preparing food to disinfecting the home, womenmodel behaviors children and others can follow. In addition, womengenerally care for those who are ill in the home, and knowing how to carefor illnesses and seek health care advice is extremely important.

The world of infectious diseases is changing. Disease organismschange to cause new infections. Other infections we thought wereconquered have returned. Antibiotics are no longer “magic bullets” dueto improper and overuse.

But, we still have effective weapons against infectious diseases. Thetried-and-true practices we learned from our mothers, such as handwashing, staying home when you are ill and covering your mouth whenyou cough or sneeze, are as important as ever. Immunizations remain atop weapon in fighting infectious disease. Accurate, scientifically soundhealth information also is critical.

Not all health-related information is created equal, and knowingaccurate health information can make a big difference. And, nature hasarmed us with our body’s own defensive force: a powerful immunesystem. Keeping your immune system healthy is our first line of defenseagainst infections.

By practicing and modeling infection-fighting habits, getting theright information and keeping ourselves healthy, everyone can preventand control the spread of infection.

Judy Monroe, M.D.State Health Commissioner

Preventing InfectionHow much do you really know?

We live in the information age. We have moreinformation on every topic — from sports teams and celebrities to climate change and health. Butwhat do you know about infection prevention? Takeour true/false quiz and find out. The answers can be found on page 58.

11.. True or False: Feed a cold, starve a fever.22.. True or False: Individuals with the flu are only

contagious when they are coughing and sneezing.33.. True or False: You can get influenza, or flu, from

getting flu vaccine.44.. True or False: Stomach flu is a type of influenza.55.. True or False: Lice fly or jump from person to

person.66.. True or False: You can catch a cold by going out-

side in cold temperatures without a hat.77.. True or False: Adults don’t need immunizations

unless they are traveling outside the country.88.. True or False: Any infection can be treated with

the right antibiotic.99.. True or False: Mosquitoes only transmit disease

in tropical countries.1100.. True or False: Washing your hands regularly is

the number one way to prevent infection.More information and health facts can be found

throughout this special focus piece on infection prevention.

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>> “The 7 Kid’s Health Myths Every Mother Should Ignore” byCNN Health. Log on www.cnn.com/2006/HEALTH/parenting/12/07/par.sick.myths/index.html.

>> “Questions and Answers: Seasonal Flu Shot,” Centers forDisease Control and Prevention. Log on www.cdc.gov/flu/about/qa/flushot.htm.

>> “Medical Myths Debunked” by Jean Lawrence. Log onwww.medicinenet.com/script/main/art.asp?articlekey=46642

>> “Clean Hands Save Lives,” Centers for Disease Controland Prevention. Log on www.cdc.gov/cleanhands/.

>> “Health Myths. Get the Facts,” Centers for Disease Controland Prevention. Log on www.cdc.gov/women/owh/myths/.


Infectious diseases are all around us. From our attempts to ward off the fluwith yearly shots to our awareness of the food we eat to the number of timesa day we wash our hands, infectious diseases impact our lives.Caused by bacteria, viruses, fungi and parasites, references to ancient

scourges, such as leprosy and smallpox, can be found in sacred texts, myths andart. Evidence of infectious diseases has been found in mummified remains.

Infectious diseases have shaped the course of history. They include plagueepidemics that swept medieval Europe; smallpox outbreaks that wiped outnative communities following the discovery of the New World; and the influenzapandemic of 1918-19 that greatly affected World War I battles.

The 20th century saw great advancements to reduce the impact of infectiousdiseases such as mass vaccination, sanitation improvements, and the discoveryand development of antibiotics. The rates of death and illnesses due to infectiousdiseases declined sharply.

However, in the last two decades of the 20th century, that trend haschanged. New diseases, such as AIDS, and the re-emergence of “old” diseases,such as tuberculosis, have appeared and continue to spread. The developmentof antibiotic resistance poses a significant challenge for treatment of bacterialinfections that for many years had been easily treated.

Other challenges with infectious diseases also exist. Although smallpox waseradicated and plague infections in humans are extremely rare, the threat ofwidespread transmission exists with bioterrorism.

The outbreaks of SARS in Toronto in 2003, monkeypox in the Midwest in2003 and measles in Indiana in 2005 remind us that oceans no longer isolateus from the rest of the world.

Through air transportation, you are 24 hours away from any infectiousdisease on earth. Multi-state outbreaks relating to food contamination and thelikelihood of an influenza pandemic also remind us that infectious diseases areever present.

Infectious diseases and the possibilities of devastating effects are frightening.However, we do have several potent weapons against them, which aredescribed in the next several pages. We cannot live in fear, and we cannot livein denial.

Armed with a healthy respect for infectious diseases and the measures toprevent them, however, we can lessen their impact.

Shaping HistoryInfectious disease impacts world events

by Pam Pontones, MA, Director of Surveillance andInvestigation, Indiana State Department of Health

Historical DiseaseRemains a ThreatMore than 10 million people in the U.S. have latent tuberculosis

by Tina Feaster, Tuberculosis Epidemiologist, Indiana State Department of Health

More than 100 years ago,tuberculosis was theleading cause of death in

all age groups in the United States. Itwas estimated the tuberculosisbacillus infected 80 percent to 90 percent of thepopulation at that time.

Although many people may not be aware of it, the threatof TB remains alive. Nearly one-third of the world’spopulation is infected with TB, according to the Centers forDisease Control and Prevention. In an increasingly globalsociety, the chance of being infected by TB is still possible.

TB is transmitted through droplets released whenpeople cough, speak or sing. These germs can float in the airfor several hours, depending on the environment. TBbacteria then enter the lungs, but in most people withhealthy immune systems, the bacteria simply remaindormant. This is called latent tuberculosis infection.

People with the latent infection don’t feel sick and arenot infectious. Dr. Richard Kohler, medical advisor for theIndiana State Department of Health’s TB program, says TBbacteria can remain dormant but alive in our bodies foryears, only to awaken and cause disease when we becomevulnerable.

If not treated, active TB can be deadly. In 2005,1.6 million people worldwide died from TB.

The greatest risk for LTBI to become active occurswithin the first two years after infection. The greatestrisk for LTBI to progress is to also be infected with HIVor when other conditions that weaken the immune systemare present. Other high-risk factors include becominginfected with LTBI in infancy or early childhood, diabetes,abnormal chest X-rays and treatment with medicines tosuppress our immune systems, like steroids.

Fortunately, LTBI can be detected through skin andblood testing, and active disease can be prevented.Treatment typically includes a nine-month course of theantibiotic Isoniazid. Active infection requires additionalantibiotics, and the treatment must be carefully followed.See your health care provider if you think you may havebeen exposed to TB.

The spread of LTBI can be stopped. Become anactive participant in your own health care, and takeantibiotics appropriately. Treating LTBI prevents activeTB disease from occurring.


Despite the amazing healing power ofantibiotics, they’re not magic bulletsfor all illnesses. Antibiotics are only

effective against bacterial infections, such asstrep throat, ear infections and sinus infections.They do not cure viral infections, such as thecommon cold, most sore throats and influenza.

Improper use of antibiotics can lead toresistance in bacteria, making antibioticsineffective.

Penicillin was the first “miracle” drug todrastically change the treatment of bacterialdiseases. Antibiotics became widely used in1940s and have greatly reduced illness anddeath caused by bacterial infections.

Today, there are many forms of antibiotics,each designed to work against a specific typeof bacteria. However, this same widespreadantibiotic use also has created a major publichealth threat of antibiotic resistance.

Over the past decade, the number ofbacteria resistant to antibiotics has increased.Each time a person takes antibiotics, sensitivebacteria are killed, but resistant germs maybecome stronger and less responsive toantibiotics and can spread quickly to others.

Antibiotic resistance occurs when bacteriachange in a way that reduces or eliminatesthe effectiveness of antibiotics. Theseresistant bacteria survive and multiply, creatingnew strains of bacteria that are more difficultto cure and more expensive to treat. Insome cases, these illnesses can lead to seriousdisability or death.

Amazing AntibioticsExperts debate whether the wonder drug is overused

by Jean Svendsen RN, BS, Chief Nurse Consultant, Indiana State Department of Health

Repeated and improper uses of antibioticsare the primary causes for the increase inantibiotic resistant bacteria.

To prevent resistance, follow these simpleguidelines:

>> Do not demand an antibiotic whenyour health care provider has determinedone is not needed — such as for a viralinfection.

>> Do not share or take another’s antibiotic.That antibiotic may not be appropriate foryour infection.

>> Take antibiotics exactly as your healthcare provider has prescribed.

>> Finish taking all of your medication.You may begin to feel better before theantibiotics kill all the bacteria.

>> Viral infections may lead to bacterialinfections. If an illness becomes worse ordoes not improve over time, contact yourhealth care provider. Even healthy peoplewho have never taken antibiotics can becomeinfected with antibiotic resistant bacteriafrom others. Avoiding close contact withothers who are ill and properly washingyour hands can reduce the risk for viral andbacterial infections.

Further information about the properuse of antibiotics is provided by the CDC’sGet Smart: Know When Antibiotics Workcampaign at www.cdc.gov/drugresistance/community/ or the Indiana Coalition forAntibiotic Resistance Education Strategies(ICARES) program at www.icares.org.

Health CheckMake sure medical centers aren’tputting you at risk for infection

by Sara Sczesny, MT (ASCP), graduatestudent intern,Indiana StateDepartment of Health

The places you visit for trusted healthcare — including the doctor’s officeor the hospital — also may be the

places where you can get sick.One of the most common risks associated

with receiving health care services is aninfection. These health care-associatedinfections can occur in any health care setting.It is estimated 2 million HAIs occur eachyear in the United States — affecting aboutone out of every 150 people, according toAdvanced Practice in Acute Critical Care.

HAIs are most commonly caused bybacteria, and the most common HAIs arelower respiratory and urinary tract infections.Skin and blood infections also may occur.

Young children and the elderly are atgreater risk since they have weaker immunesystems. However, all patients are at risk.Antibiotic resistance has become a greater


problem with some hospital-acquiredinfections, making them more difficult to treat.

Getting proper care means consumersmust be aware of their options; able toeffectively communicate their symptoms,concerns and health care needs; ask goodquestions; and just as importantly, ensureproper health care etiquette is practicedwhere they are treated.

Something as simple as a proper hand-washing technique has a direct effect onyour ability to get healthy — and stayhealthy — while being treated by yourhealth care provider. To reduce your risk ofgetting a health care associated infection orHAI, it is OK to ask your health careproviders about their hand hygiene policiesand whether they washed their hands beforebeginning your procedure.

The best way for health care providers toprevent HAIs is to use proper hand hygiene,which includes the use of alcohol-basedhand sanitizers and proper hand washing.

Health care providers should use alcohol-based hand sanitizer when hands are notvisibly soiled, and they should wash handswhen hands are soiled and before and aftereach use of gloves. Properly washing handsincludes wetting the hands, applying soapand rubbing hands vigorously for 15 seconds,rinsing and then drying hands thoroughly.

Schools and facilities closed for dis-infection. Sporting events cancelled.Worried school officials and concerned

parents. What is MRSA all about? Here aresome facts to help you understand thesebacteria.

WWhhaatt iiss MMRRSSAA??Staphylococcus aureus is a common

bacterium found on the skin in the armpit,groin, and nose of about 30 percent of people.Normally, these bacteria do not cause illness.If these bacteria enter the body through a skinbreak, they can cause localized skin infectionslike pimples and boils. These infections aregenerally minor and easily treated with antibi-otics. Rarely, staph bacteria can cause serious,even fatal, infections, if the bacteria enter thebloodstream or infect a major body organ.

Methicillin-resistant Staph aureus (MRSA)is a type of Staph aureus bacteria that haddeveloped resistance to the antibioticmethicillin and usually several otherantibiotics. This resistance makes MRSAinfections more difficult to treat.

A small percentage of the population alsocarries MRSA on the skin or in the nose. MostMRSA infections are localized skin infectionsthat are treatable with appropriate antibiotics.Rarely MRSA bacteria may cause serious orfatal infections if the bacteria enter thebloodstream or infect a major body organ.

MRSA is not a new infection, nor is itspecific to Indiana. However, the occurrence ofhealth care- and community-acquired strainsof resistant bacteria is an increasing problem,particularly among hospitalized patients withMRSA skin and soft tissue infections thatrequires effective and timely treatment.

HHooww iiss MMRRSSAA sspprreeaadd??>> Direct skin contact with an infected

person — wound pus or drainage is veryinfectious.

>> Contact with contaminated objects orsurfaces like towels, razors, soap, bedding,wound bandages and athletic equipment.

>> Picking at wounds or skin lesions withfingers.

>> Poor hand hygiene.

HHooww iiss MMRRSSAA ttrreeaatteedd??Generally, MRSA infections are treatable

with the appropriate antibiotics. Your healthcare provider will decide which antibiotic isappropriate for you. Through clinical studies,more effective treatments for antibioticresistant diseases continue to be discovered.

HHooww iiss MMRRSSAA pprreevveenntteedd??Prevention is important and easy. Proper

prevention at all times can help decrease theincidence of MRSA infections.

Practice frequent and appropriate handhygiene. Alcohol-based hand sanitizersshould be readily available in addition tofunctional hand-washing facilities. Parents,school officials and coaches should practiceand encourage frequent hand hygiene.

Keep open areas on the skin covered with awaterproof or impermeable bandage. Do nottouch another person’s bandages or open skinareas. Do not share personal hygiene itemslike soap, towels, deodorant and clothing.

Practice prompt effective wound care. Washall wounds thoroughly with soap and water;apply an antiseptic and a waterproof bandage.Deep wounds, like cuts, puncture woundsand human or animal bites, require promptmedical attention. You may receive a tetanusshot if the wound was dirty or if more than fiveyears have passed since your last tetanus shot.

See your health care provider immediately ifyou notice wounds or skin breaks that are red,swollen, painful or draining. Students,including athletes, who notice thesewounds at school, should immediately reportthem to the school nurse or athletic coach.

Understanding MRSAWith the infection becoming a new household word, families’ fears of the bacteria are heightened

by Jean Svendsen, RN, Chief Nurse Consultant, Indiana State Department of Health


There’s nothing like being on an airplaneor in an elevator with someone who issneezing, coughing, feverish and just

plain sick.You are an innocent bystander now suscept-

ible to respiratory illnesses like colds and flu thatcan be spread person to person through dropletsreleased when others cough or sneeze. Thesedroplets move through the air, and then weinhale them through our mouths or noses,especially when we are in confined spaces.Germs also can be spread when you touchcontaminated surfaces like elevator buttons,desktops or the handy pens at the grocery store.

When you touch your own eyes, mouthor nose before washing hands, these dropletscan infect you with myriad illnesses. Someviruses and bacteria even can live two hoursor longer on surfaces like cafeteria tables,doorknobs, telephone and desks.

To avoid illnesses like colds and flu, followthese simple tips:

Avoid close contact. Stay away from peoplewho are sick. If you’re sick, keep your distancefrom others to protect them from getting sick.

Stay home when you are sick, especially ifyou have a fever. In some cases, it’s againstIndiana law to go to work with a fever or othersymptoms. Many schools and child careproviders have policies restricting those who

Nothing to Sneeze AtLearn the rules of etiquette for the sick

by Shawn Richards, BS, Respiratory Disease Epidemiologist,

Indiana State Department of Health

are ill from attending.Cover your mouth and nose. Use the bend

of your elbow or upper sleeve to cover yourmouth and nose when sneezing or coughing.You trap more germs by completely coveringyour nose and mouth to absorb the dropletsthat naturally flow downward after your sneezeor cough. If you use tissues, throw them awayimmediately. Do not use cloth handkerchiefs.

Clean your hands.Washing your handsoften will help protect you from germs. Usesoap and running water, but if it is not available,an alcohol-based hand sanitizer can be effectiveagainst some germs. Wash your hands longenough to sing “Happy Birthday” twice.

Avoid touching your eyes, nose or mouth.Germs often are spread when a person touchessomething contaminated, then touches his orher eyes, nose or mouth where germs can enterthe body. Wash your hands before touchingyour eyes, nose or mouth.

For resources you can download, go to theCenters for Disease Control Web site atwww.cdc.gov and conduct a search for:

Cover Your Cough (English and Spanishversions); Be a Germ Stopper: HealthyHabits Keep You Well; Flu PreventionToolkit; Real People, Real Solutions; andStopping the Spread of Germs at Home,Work and School.

In a hurry-up world, taking time to washyour hands often and properly remains thesingle most effective means of ridding

yourself of the germs that can cause you topick up an infection.

The common cold, influenza, ear infections,strep throat and other diseases all can bespread because of unwashed or improperlywashed hands. So, clean up your act, andconsciously take time to effectively cleangerms from your hands for better health.

Your hands pick up bacteria, viruses andother germs when you touch surfaces, andthese germs can stay on your hands. Whenyou put your hands in your mouth by eating,putting a finger or pencil/pen/eraser in yourmouth or touching

Don’t GetCaught DirtyHanded Make sure you’re using proper

hand-washing techniques

by Shawn Richards, BS, Respiratory Epidemiologist, Indiana State Department of Health


Ahealthy home means an informedfamily will make sure each member’swell-being is a priority.

Each person can play an importantrole in keeping the family healthy. Forexample, when someone becomes ill withan infection, a sibling or parent can remindthe others to wash their hands frequentlyand follow other guidelines to keep infectionfrom spreading.

Keeping a clean homealso creates a

healthier home.

viruses such as influenza). Follow the labeldirections on the disinfectant.

CCuuttss aanndd mmiinnoorr iinnjjuurriieessKeep infections at bay by properly treating

wounds and scrapes. A few healthy habitscan help them heal faster without becominginfected.

Any break in your skin provides a routefor germs to enter your body and cause aninfection. Before and after cleaning a woundor changing a bandage, wash your hands.

For surface wounds, like scrapes, abrasionsand minor cuts, thoroughly wash the injuredarea with cool water to remove dirt anddebris. You can hold the wound under runningwater. Use soap and a soft washcloth to cleanthe skin around the wound. Then apply asterile bandage.

Deeper wounds such as deep cuts, puncturewounds, and human or animal bites requireprompt medical attention.

You may receive a tetanus shot if thewound was dirty or if more than five yearshave passed since your last tetanus shot. Ifyou see signs of infection — such as rednessaround the wound, red streaks extendingfrom the wound, swelling or yellowishdrainage — see your health care providerright away.

Since germs can be transmitted on personalitems, it’s important to refrain from sharingitems such as toothbrushes, razors, deodorant,drinking or eating utensils, towels andwashcloths.

Keeping a clean home also creates ahealthier home. You can eliminate germsby disinfecting frequently touched hardsurfaces within your home such as lightswitches, doorknobs, phones, sinks, toiletsand kitchen counters. Use a product that isdesigned to kill a broad spectrum of harmfulbacteria, such as staph and salmonella, and

your teeth; your eyes by wiping them orleaning on your hand; your nose by wipingor scratching; and even your ears, these germscan enter your body and make you sick.

Many diarrheal illnesses can be spread fromperson to person by individuals who don’twash their hands after using the toilet ordiapering children.

Wash your hands correctly, and send thosegerms down the drain!

Hand washing is so important to diseaseprevention that the Indiana State Departmentof Health has developed a Web site exclusivelyfor hand-washing information.

For information for kids, includinggames, songs and science experiments,information and guidance for adults, andscientific studies and educational materialsfor health care workers, log on www.in.gov/isdh/programs/hand_washing/images/handwashing_campaign/handwashing.

To properly washyour hands:

>> Wet hands with runningwater.

>> Lather hands with soap.>> Wash the palms, back of

hands, between fingers andunder fingernails for at least 20seconds (about the time it takesto sing “Happy Birthday” twice).

>> Rinse hands with runningwater.

>> Pat hands dry, beginning atthe wrist and moving downward.

>> Cover the faucet handle(s)with a paper towel to turn off thewater.

>> If possible, use the samepaper towel to open the bathroom door and dispose oftowel immediately.

Keep Your House HealthyA few steps go a long way in preventing the spread of illness

by Jean Svendsen, RN, BS, Chief Nurse Consultant, Indiana State Department of Health


QQ:: WWhhaatt iiss tthhee fflluu?? A: The flu is an infection of the nose,

throat and lungs that is caused by influenzaviruses. Influenza spreads from person toperson through droplets released whensomeone sneezes or coughs and someone elsebreathes in these droplets.

QQ:: WWhhaatt aarree tthhee ssyymmppttoommss oofftthhee fflluu??

A: Most people with the flu feel tired andhave a fever, headache, dry cough, sorethroat, runny or stuffy nose and sore mus-cles. Some people, especially children, alsomay have stomach problems and diarrhea.The cough can last two or more weeks. Mostpeople with the flu feel sick for about a week.However, some people — especially youngchildren, pregnant women, older peopleand people with chronic health problems —can get very sick, and some can die.

QQ:: HHooww lloonngg ccaann aa ssiicckk ppeerrssoonnsspprreeaadd tthhee fflluu ttoo ootthheerrss??

A: Most healthy adults may be able tospread the flu from one day before gettingsick to up to five days after getting sick. Thiscan be longer in children and in people whodon’t fight disease as well, such as those withweakened immune systems.

QQ:: HHooww ccaann II pprrootteecctt mmyysseellff aannddmmyy cchhiilldd ffrroomm tthhee fflluu??

A: A flu vaccine is the best way to protectagainst the flu. The CDC recommends allchildren from the ages 6 months to 5 yearsget a flu vaccine every fall or winter.Children getting a vaccine for the first timeneed two doses.

Flu shots can be given to children 6months and older.

Nasal-spray vaccine can be given tohealthy children 2 years and older.

Children under 5 years old who have hadwheezing in the past year or a child with

All About InfluenzaArm yourself and your family against infection

by Shawn Richards, BS, Respiratory Disease Epidemiologist, Indiana State Department of Health

chronic health problems should get the flu shot.You can protect your child by getting a flu

vaccine for yourself too. Also encourage yourchild’s close contacts to get the flu vaccine. Thisis very important if your child is youngerthan 5 years old or has a chronic health problemlike asthma (a breathing disease) or diabetes.

QQ:: WWhhaatt ccaann II ddoo iiff II oorr mmyy cchhiillddggeettss ssiicckk??

A: Consult your doctor and make sureyour child gets plenty of rest and drinks a lotof fluids. If your child is older than 2 years,you can buy medicine without a prescriptionthat might make your child feel better. Becareful with these medicines and follow theinstructions on the package. Never giveaspirin or medicine that has aspirin in it tochildren or teenagers who may have the flu.

QQ:: SShhoouulldd mmyy cchhiilldd ggoo ttoo sscchhoooolloorr II ggoo ttoo wwoorrkk iiff ssiicckk??

A: No. People should stay home to restand to avoid giving the flu to others.

QQ:: WWhheenn ccaann mmyy cchhiilldd ggoo bbaacckkttoo sscchhooooll oorr II ggoo ttoo wwoorrkk aafftteerrhhaavviinngg tthhee fflluu??

A: Stay home until your temperature hasbeen normal for 24 hours. Remind childrento cover their mouths when coughing orsneezing to protect others. You may want tosend some tissue and wipes or gels with alcoholin them to school or take them to work, ifpolicy permits. Wash your hands well.

Call your health care provider if thefollowing signs or symptoms develop:

>> High fever or fever that lasts a long time>> Trouble breathing or rapid, shallow

breathing >> Skin that looks blue>> Not drinking or eating enough>> Confusion, difficulty waking up or

seizures (uncontrolled shaking)>> Symptoms improve but then worsen

Smoking andInfluenza

If you are thinking aboutquitting smoking, today is thetime to take the appropriatesteps to do so.

>> Some research studiesshow an increase in influenzainfections among smokers compared to nonsmokers.

>> There is a higher mortalityrate for smokers than nonsmokers from influenza.

Additional respiratory healthconsequences:

>> Smoking is related to chronic coughing and wheezingamong adults and children, and chronic bronchitis and emphysema among adults.

>> Smokers are more likely thannonsmokers to have upper andlower respiratory tract infections,perhaps because smoking suppresses immune function.

>> Within 20 minutes after yousmoke that last cigarette, yourbody begins a series of positivechanges that continue for years.


called the Vaccine Adverse Event ReportingSystem, or VAERS.

From 1991 to 2001, more than 1.9 billionvaccines were distributed in the United States.VAERS reported the total adverse eventsfollowing immunization were significantlyless than 1 percent of the total vaccinesdistributed during this 10-year period. Themost common adverse reaction reportedfollowing a vaccination was fever, accordingto Morbidity and Mortality Weekly Report.

Though factual data exists on the devas-tating impact of vaccine-preventable diseases,many people are influenced by often misleadinginformation that produces unnecessaryfear of immunizations. As a result, theyavoid getting the recommended vaccinations.

Recent history shows the impact ofdecreased vaccinations. A 2005 measlesoutbreak in Indiana raised awareness formany about the need to be protectedthrough immunization. Within four weeks,34 cases were identified, and three of theseindividuals were hospitalized. One requiredmechanical ventilation. The outbreak wastraced to an unvaccinated individual whowas exposed to measles while traveling overseas.

The goal of public health is eliminatingdisease. One of the best weapons to preventdisease is vaccination.

In 1980, the World Health Organizationdeclared smallpox — an often fatal anddisfiguring disease — had been eradicated

from the globe.This historic achievement was accomplished

through aggressive, worldwide vaccinationcampaigns. Just one or two generations before,images of disabled children and a United Statespresident affected by smallpox were common.

Through immunization, polio has beeneliminated from all but a few countries, makingleg braces and iron lungs distant memories.

In 2002, more than 500,000 deaths dueto measles were reported worldwide,according to WHO. That same year, due toroutine childhood vaccination, only 41 casesof measles were reported in the United States.Two of those cases occurred in Indiana, andthere were no deaths.

Despite these successes, concern over thesafety of vaccines has been a topic of debateduring recent years. In the United States,more than 10 million vaccinations per yearare given to children under age 1. Though thereare risks associated with the administrationof any medication, adverse events fromimmunizations are rare, and severe reactionsare even less common.

The mechanism responsible for monitoringinjury or illness following vaccination is

Preventing DiseasesImmunizations provide a first line of defensefor your family

by Karee Buffin, MS, Vaccine Preventable Disease Epidemiologist,and David L. Ellsworth, M.Ed., Public Health Investigator, IndianaState Department of Health

Quiz Answers (from page 52)

11.. FFaallssee.. You very much need liquidsand nutrients in order to get well,regardless of whether you have a cold,fever, or other symptoms.

22.. FFaallssee.. Influenza is spread throughthe mucous droplets released duringcoughing and sneezing. However, peopleare actually infectious 24 to 48 hoursbefore they show active symptoms.

33.. FFaallssee.. You cannot catch the flufrom receiving flu vaccine. Injectable fluvaccine contains killed virus, and nasalmist vaccines contained very weakenedvirus. Neither can cause influenza.

44.. FFaallssee.. “Stomach flu” is notinfluenza, which is a respiratory illnesscharacterized by fever, sore throat, cough,and muscle aches. “Stomach flu” isactually viral gastroenteritis, characterizedby nausea, diarrhea and vomiting.

55.. FFaallssee.. Lice are neither able to flynor jump, but they can crawl. They arespread by head-to-head contact andsometimes by shared combs and hats.

66.. FFaallssee.. Viruses cause colds, notcold air. This myth likely started becauseviruses are more active during winter— making it more likely for a person tobe exposed to cold air and wind.

77.. FFaallssee.. Far too many adultsbecome ill, are disabled, and die eachyear from diseases that could easilyhave been prevented by vaccines, suchas influenza. Immunized adults are alsoless likely to pass illnesses to children.

88.. FFaallssee.. Only bacterial infectionscan be treated with antibiotics. Viralinfections cannot be treated withantibiotics. Use of antibiotics to treatviral infections can encourage antibioticresistance.

99.. FFaallssee.. In Indiana, mosquitoescan transmit several types of viralencephalitis. It is important to protectyourself from mosquito bites whenmosquitos are active.

1100.. TTrruuee.. Keeping hands clean isone of the most important steps we cantake to avoid getting sick and spreadinggerms to others.

“When children in this country were dyingfrom diseases such as measles and whoopingcough, it was easy for parents to see thebenefits of vaccination. We have done sucha good job reducing the burden of vaccine-preventable diseases that — to some people — the riskdoesn’t seem real any longer. The potential risk of sideeffects from immunization may seem larger than the realrisk of disease.” — Joan M. Duwve, MD, MPH, Medical Director for

Immunization and Injury at the Indiana State Department of Health


Salmonella in peanut butter. E. coli inspinach. Botulism in chili sauce. Theseoutbreaks remind us foods not only

nourish us but also can make us sick. TheCenters for Disease Control and Preventionestimates 76 million cases of foodborneillness — representing one out of every fourpeople — occur in the United States eachyear, with more than 1,200 cases identifiedeach year in Indiana.

Many organisms can cause foodborneillnesses, some of which are merely a nuisance,and others, like botulism, which can be deadly.Contrary to popular belief, foodborne illnessalmost never is caused by the last meal eaten.Instead, it’s usually the meal you had two toseven days ago, often making it difficult todetermine which food was the culprit.

Recent news coverage of foodborneoutbreaks might suggest more outbreaks areoccurring. However, much of the reason forthe increase of identified outbreaks is bettertechnology, communication and investigationpractices.

Though outbreaks involving commoncommercial food items are the most alarming,many outbreaks also are associated withrestaurants, caterers, schools and even home-prepared foods.

If you suspect you may have a foodborneillness, contact your health care provider andrequest stool testing to determine the cause.Symptoms of foodborne illness, such asdiarrhea and vomiting, are common to many

Sickening FoodUnwanted organisms at the dinner tableoften cause outbreaksby Lynae Granzow, MPH, Enteric Epidemiologist,Indiana State Department of Health

diseases. Also, contact your local healthdepartment to report a foodborne complaintor outbreak. Your information may make thedifference in identifying a foodborne outbreak.

Though the United States has one of thesafest food supplies in the world, responsibilityalso lies with the consumer. Follow thesefood safety tips to prevent foodborne illness:

>> Wash your hands thoroughly beforeand after preparing food. Do not preparefood for others if you are ill with diarrhea orvomiting. Many foodborne illnesses can easilybe passed to others.

>> Thaw frozen foods in the refrigeratorinstead of at room temperature.

>> Separate uncooked foods from ready-to-eat foods and cooked foods to avoid cross-contamination. Use separate equipment andutensils for handling raw and cooked foods.

>> Clean all produce before eating raw orcooking.

>> Cook to USDA-recommended safeminimum internal temperatures and checkwith a food thermometer.

>> Refrigerate food promptly in smallcontainers to speed cooling.

>> Heed food recalls. Check your pantry,cabinets and emergency kits for recalleditems and discard them appropriately.Inform others.

>> Check expiration dates of food items.Discard those that have expired.

>> Avoid unpasteurized dairy or juiceproducts.

Stomach WoesTiny culprits can cause big problems with your digestivesystem

Norovirus and its notorious cousinsare stomach viruses causing up to23 million cases of infectious

diarrhea and vomiting in the United States.Most people refer to these illnesses as

“stomach flu,” which is a misnomer.Influenza or “the flu” is a respiratoryillness characterized by coughing, sorethroat and fever and is caused by differentviruses. By contrast, stomach viruses orviral gastroenteritis cause vomiting anddiarrhea.

Although you may feel horrible, viralgastroenteritis rarely causes complications.Symptoms, mainly nausea, vomiting anddiarrhea, begin 12 to 72 hours after exposureand last 24 to 48 hours. While there is nocure for viral gastroenteritis, adequatehydration is important, especially for thevery young and the elderly.

People may be able to transmit stomachviruses up to two weeks after symptomsstop. It’s important to take measures tocontrol the spread of the illness.

Stomach viruses can be transmittedthrough contaminated food, contaminatedsurfaces and person-to-person contactwith someone who is ill. So before youblame the food, consider the peoplearound you with similar symptoms. Theseviruses are very hardy and contagious —commonly passed throughout entiregroups of people, like households, childcare centers, schools and cruise ships. Hereare some tips to avoid passing aroundthese viruses:

>> Wash your hands. It’s been said manytimes, but it bears repeating. Clean yourhands often with soap and warm water,especially after using the restroom, diaperinga child, assisting someone who is ill andcleaning soiled areas.

>> Do not share food or beverages.>> Do not go to work or send children

to school or daycare while ill.>> Clean hard, nonporous surfaces that

are contaminated with a bleach solutionmade with one cup of bleach and onegallon of water. — L.G.


Salmonella ScareMegan Zaborowsky takes action toreduce future threatby Deb Wezensky

As a mother to 3-year-old Mia, MeganZaborowsky knows how to nurtureand care for young children. Her

ability to love and care for her daughter alsomakes her a natural for her calling as a teacherfor Greenwood Community Schools.

Because of all her experience with children,Zaborowsky knows how to read the behaviorof children so she can provide a setting inwhich they can be safe to grow and learn.

At times, however, it’s challenging todiscern what may be wrong with a child. Thislesson hit home when her daughter came downwith an unknown illness and had to behospitalized for two days. Mia ran a highfever, followed by severe diarrhea and stomachcramping. Nothing seemed to help.

When the child’s symptoms worsened,Zaborowsky took her daughter to the doctorat the St. Francis South campus. A stool culturewas taken, and the doctor immediately hadMia admitted to the hospital. It was therethat the diagnosis of salmonella was made.

With the help of the Indiana StateDepartment of Health, Zaborowsky was able todetermine the origin of infection. The businesslinked to the salmonella acknowledgedresponsibility and took the appropriate actionto ensure this would not affect other customersin the future.

After two and half weeks, Mia was back toher usual active self.

Zaborowsky always has taken precautionsto provide a clean and healthy environment forher family. However, after the experience ofseeing her young child suffer from salmonella,she admits being more careful about hershopping habits. She is much more thoroughin checking the dates and appearance of fooditems she purchases, as well as the overallcleanliness of where she shops.

T he very nature of travel createsopportunities for surprises andoften a change of plans that will be

an unwelcome part your excursions. Whiletraveling overseas can have its share of pitfalls,effective planning can keep you healthy soyou can enjoy more of your travel time.

Overseas travelers have a 50 percent chanceof suffering from a travel-related illness, mostlyfrom gastrointestinal infections contractedfrom poorly cooked food or untreated water.Many diseases common in other countriesare nonexistent or rare in the United States.

To increase your chances of stayinghealthy, there are precautions you can take thatmay not be a part of your routine health care.Several vaccines may be recommended — orrequired — four to six weeks prior to travel.

Typhoid fever, yellow fever and hepatitisA vaccine may be required or recommendedfor travel to some countries, even though theyare not required here in the United States.Malaria, a mosquito-borne illness, is commonin many parts of the world, especially Africa,South America and parts of Asia, and apreventive medication may be necessary.

Visiting an international travel clinic a fewmonths before your scheduled trip overseas is avital part of planning for your trip. Travelclinics provide health care services includingvaccines, medication and information onoverseas travel.

In addition to visiting a travel clinic,follow these tips when traveling overseas:

CCoonnssuummee ssaaffee ffoooodd aanndd wwaatteerr::>> Don’t buy food from street vendors.>> Don’t eat raw or undercooked meat or

Travel SafelyEnsure you bring back nothing more than great memories

by Mike Wilkinson, BS, Hepatitis C Epidemiologist,


shellfish.>> Avoid using ice in drinks.>> Don’t eat raw fruits and vegetables you

cannot peel yourself.>> Don’t drink or eat unpasteurized milk

and dairy products.>> Drink bottled water or canned beverages.

AAvvooiidd iinnsseecctt bbiitteess::>> Use mosquito repellent with 30 percent

DEET; follow instructions to use safely.>> Apply a permethrin-containing repellant

to clothes and bedding if staying outdoors. >> Wear socks, long pants, a long-sleeve

shirt and a hat during outdoor activities.>> Use a bed net and screens if sleeping

outside.

SSeeee yyoouurr hheeaalltthh ccaarree pprroovviiddeerr.. Make sure you are healthy enough to travel,

that your routine vaccines are current and youhave an adequate supply of prescriptionmedications.

CChheecckk iinnssuurraannccee ccoovveerraaggee.. Make sure your medical insurance will cover

you for overseas travel. Medicare will not coveryou outside of the United States. Consider asupplemental health insurance policy.

RReesseeaarrcchh WWeebb rreessoouurrcceess..Prepare for your trip by checking the

following resources:>> The Indiana State Department of Health,

www.in.gov/isdh/programs/immunization/international_travel/travel_clinics.htm.

>> U.S. Department of State, Bureau ofConsular Affairs, www.travel.state.gov.


Disease detectives,officially knownas epidemiolo-

gists, investigate a varietyof events that affect our health. How is thisimportant to you and your family?

Epidemiologists essentially are scientistswho help maintain your health by investigatinginfectious disease outbreaks, such as influenzaor foodborne illnesses. With their expertise,the goals are to effectively treat the diseaseand to reduce the number of people threatenedby the outbreak.

These disease detectives can work forstate health departments, federal governmentagencies and some local, city or countyhealth departments.

By Indiana law, health care providers,hospitals and laboratories are required to

report certain diseases or laboratory resultsto local health departments. Local publichealth officials investigate these disease casesto find out how people became sick,determine whether other people wereexposed and implement control measures.

As disease detectives investigate cases,these detail-oriented experts look for commonlinks among cases that may provide clues toan outbreak.

Local health officials, state health officialsand epidemiologists coordinate efforts andexpertise to solve the cases when outbreaksare reported. Sometimes the “feds” must becalled in. That is, federal health agenciesmay become involved if an outbreakinvolves multiple states, a commercial fooditem, international port or ship.

Epidemiologists gather clues from those

Your RoleBesides public health officials, the public also has a responsibility in

outbreak investigations:If you suspect you may be part of a disease outbreak, contact your local

health department. Your input may provide vital clues for health officials toidentify an outbreak and prevent additional people from becoming ill.

If health officials contact you regarding an outbreak investigation, yourcooperation in answering questions fully and being willing to have laboratorytesting done helps keep others safe from infectious disease. Althoughsubmitting “evidence,” such as a clinical sample, is sometimes unpleasant, itcan be the key to identifying the illness and making necessary treatmentsavailable to minimize the effects of the disease.

Having head lice is an annoying problemthat can cause severe itching and evenloss of sleep. Though obnoxious, the

good news is lice are not a serious health hazard.Lice are actually small parasitic insects

uniquely adapted to living on the scalp andneck hairs of human hosts. Head lice feed onthe blood of their host at least once a day andcannot survive for more than a day at roomtemperature without access to a person’s blood.

To clear up some common misconceptionsabout head lice, here are a few facts:

>> Lice do not spread between pets andpeople.

>> They are not known to transmit diseasefrom person to person.

>> People with poor personal hygienepractices are not more likely to have lice.

Hats, brushes and other items that come incontact with your head or hair can transmitlice; hence, the increased possibility of yourchild coming into contact with lice at school.Lice also can spread through close physicalcontact, especially head-to-head contact.

Head lice can affect people of all ages andsocioeconomic backgrounds. However,children are affected more often. Girls aremore commonly affected than boys, andCaucasian children are more frequentlyaffected than those of other ethnicities.About 6 million to 12 million children, ages3 to 12, are infested with head lice each year.

Treatment of an active lice infestation relieson the proper use of over-the-counter andprescription medications. Consult with yourhealth care provider or pharmacist to determinethe treatment you should use. Additionalactions to eradicate an infestation are:

>> Wash all bed linens, clothes and otheritems that the infested person has used. Usethe hottest washer and dryer settings.

>> Thoroughly vacuum rugs, upholsteredfurniture and mattresses in the household.

>> Do not share hairbrushes, combs, hatsor other personal items.

Head LiceThe itchy infestation spreads quickly without precautions

by Wayne Staggs, MS,Invasive DiseaseEpidemiologist, IndianaState Department of Health

Mysteriously Ill?Disease detectives identify presence of outbreaks

by Tom Duszynski, BS, REHS, Field Epidemiology Director, Indiana State Department of Health


Besides ruining picnics, mosquitoes andticks can transmit disease. In Indiana,two of the common diseases transmitted

by mosquitoes and ticks are the West Nilevirus infection and Lyme disease. However,other vector-borne diseases in Indiana can beas serious as West Nile or Lyme.

Humans get infected when ticks bitethem. Disease is transmitted when the ticktakes a blood meal to complete the nextstage of its life cycle. Ticks must generallyremain attached for four to 36 hours totransmit disease. Checking your clothingand skin for ticks after being outside isimportant for preventing disease. Fortunately,all of these diseases can be treated successfullywith antibiotics.

Mosquitoes transmit several viruses inIndiana that can cause infections fromminor illnesses to potentially deadlyencephalitis. In recent years, West Nileinfection has been the most common.However, mosquitoes also transmit St. Louisencephalitis, Eastern equine encephalitisand LaCrosse encephalitis viruses. There areno effective treatments for these diseases orvaccines to prevent them.

LaCrosse encephalitis occurs mainly inchildren younger than 16. Severe West Nileand St. Louis encephalitis infections occurmainly in people older than 50. All deaths inIndiana due to West Nile infection haveoccurred in elderly patients.

Unwanted PestsTicks and mosquitoes can be more than a nuisance

by James Howell, DVM, MPH, DACVPM, Veterinary Epidemiologist,


Although human cases are rare in Indiana,Eastern equine encephalitis infection can bedeadly. Of all encephalitis infections, onlyrabies has a higher death rate.

To minimize the risk of you and yourfamily contracting these infectious diseases,it is important to make environmentalchanges and take personal steps to preventtick or mosquito bites. These include:

>> Removing debris from around yourhome where ticks or their rodent hosts can hide.

>> Keeping grass and weeds cut short andremoving brush to reduce tick habitats.

>> Eliminating mosquito-breeding areaslike old tires, cans, bottles, flush bird bathsand ornamental fountains. It is also importantto frequently empty and clean gutters.

>> Wearing long-sleeved shirts and longpants when outdoors during hours of highmosquito activity — usually dawn and duskhours — and when entering tick habitats,such as wooded areas. After activity, examineyour clothing and exposed skin for attachedticks. Remove any attached ticks immediately.(See box.)

>> Using repellants on clothing and bareskin. DEET and Picaridin are commonlyavailable in various strengths and are effectivelonger than others. The American Academyof Pediatricians recommends not usingDEET on infants under eight weeks of age.Follow the label directions of any repellent toensure proper application and use.

Safe Tick Removal11.. Using a clean pair of fine-tipped

tweezers, firmly grasp the tick asclose to your skin as possible.

22.. With a steady motion, pull thetick’s body away from your skin.Avoid crushing the tick’s body. Donot be alarmed if the tick’s mouth-parts remain in the skin — once themouthparts are separated from thetick’s body, the tick can no longertransmit disease. If you accidentallycrush the tick, clean your skin withsoap and water or alcohol.

33.. Wash your skin around the tickbite with soap and water and applyan antiseptic and clean bandage.

44.. Discard the tick in the trash.55.. Do not use petroleum jelly, a

hot match, nail polish or other products to remove a tick.

66.. If you notice signs of infection,like redness, swelling or drainagearound the tick bite, or if you develop symptoms of fever, chillsand/or a rash, see your health careprovider right away.

involved in the outbreak. Relevant information,such as symptoms of the illness, the day theillness began and possible exposures, includingother ill people and foods eaten, is recorded.Epidemiologists may recommend that thepeople who are ill have testing to identify thespecific disease causing the outbreak.

Now the work begins to “reconstruct” theoutbreak occurrence. Epidemiologists reviewdata, laboratory results, inspection informationand other data to learn how the infectiousdisease was introduced to the population.They then implement the appropriate controlmeasures to contain the disease. Thesemeasures are designed to be the leastrestrictive but the most effective.

Once the outbreak is over, the investigationis documented in an official report and sentto all agencies involved. This is an importantpiece of the puzzle since it serves as a publicrecord of the incident and a scientificrecord of the outbreak, which can be utilizedin the future for similar investigations,teaching and training of other public healthofficials and those interested in pursuingepidemiology.

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As an employee of Columbus RegionalHospital’s wellness program, ShaylaHoltkamp always considered health

a major focus in her daily life.However, she became acutely aware of

health on a more personal level when, in1997, she was diagnosed with breast cancer.Yet, Holtkamp’s experience with chemotherapyand radiation paled in comparison to whattranspired just six weeks after her treatmentswere completed.

Her healthy, athletic 14-year-old daughter,Jolie Crider contracted bacterial meningitis.

Holtkamp recalls her daughter crawlinginto bed with her after midnight. Afterwatching Jolie repeatedly vomit over threehours, Holtkamp took her to the doctor’soffice the next morning.

Her intuition prompted her to ask if Joliehad meningitis. The teen’s temperature was101 degrees — not excessively high — andher neck was checked for stiffness, a commonsymptom for meningitis. However, Jolie didnot show signs of a stiff or sore neck.

Since the flu was going around, Joliewas prescribed phenegrine, an anti-nauseamedication, to calm her stomach.

AA ttuurrnn ffoorr tthhee wwoorrsseeAfter returning home, Jolie fell asleep. Later

that night, she became nauseous again. Feelingworse with the onset of diarrhea and a hurtinghead, she was taken to the emergency room ofa nearby hospital where she immediately wastaken to an examination room. Her motherand father anxiously awaited a diagnosis.

Turned Upside DownShayla Holtkamp deals withthe loss of her daughter tomeningitis

by Deb Wezensky

In most cases, the sad and tragic results ofmeningitis can be prevented. While it is afairly rare disease, 10 percent to 12 percent

of the cases are fatal, according to theCenters for Disease Control and Prevention.

Nearly 3,000 cases are reported every yearin the United States. Among those who survivemeningococcal disease, about 20 percent sufferlong-term consequences, such as brain damage,kidney disease or hearing loss, the NationalMeningitis Association reports.

Meningitis is an infection that causesinflammation of the membranes covering thebrain and spinal cord. Most cases of meningitisare viral infections, but bacterial and fungalinfections also can lead to meningitis.

Infection is transmitted by direct contactwith infected people through coughing orsneezing in someone’s face, kissing or sharingutensils, drinking glasses or cigarettes. Dueto more crowded living conditions, teens andyoung adults may be at increased risk.

Meningococcal disease often is misdiag-nosed as something less serious because earlysymptoms are similar to the flu. These mayinclude sudden onset of fever, headache anda stiff neck, as well as nausea, vomiting, sen-sitivity to light, altered mental status andseizures. After the disease has taken hold, a rashmay appear. If you experience two or more ofthese symptoms or the severe sudden onset of asymptom, seek medical care immediately.

Viral meningitis is less severe than bacterialmeningitis and occurs more frequently in

MeningitisThis rare but deadly disease ignites fear in parents and the public

by Wayne Staggs, MS, Invasive Disease Epidemiologist, Indiana State Department of Health

late summer and early fall.Bacterial meningitis is extremely serious

and requires medical intervention. It can resultin death, brain damage or amputation.However, if identified promptly, it can betreated successfully with antibiotics.

Fortunately, meningitis can be prevented.Vaccines can prevent some forms of bacterialmeningitis. Some of these vaccines arerequired for school or child care entry.

Contact your health care provider or localhealth department to see if you or membersof your family should receive these vaccines.To check the immunization schedules, log onto the Centers for Disease Control andPrevention Web site at www.cdc.gov/vaccines/recs/schedules/default.htm.

OOtthheerr wwaayyss ttoo pprreevveennttmmeenniinnggiittiiss iinncclluuddee::

>> Wash your hands often,especially after:

• coughing or sneezing • before and after caring for a

sick person • after using the toilet or

changing diapers >> Teach children to clean their

hands often and properly, usingsoap and water or an alcohol-based hand sanitizer.

>> Avoid sharing eating utensilsand drink containers.


This time, her temperature registeredat 97 degrees. Again, Holtkamp asked ifher daughter might have meningitis. Again,the child’s neck was examined, but shedid not appear to have classic symptoms formeningitis. To help with a diagnosis, thedoctor ordered blood work.

In the meantime, Jolie’s condition worsened.She appeared to sleep with her eyes open,recalls Holtkamp, who tried unsuccessfully toawaken her. By then, Holtkamp was convincedsomething was seriously wrong.

Her presumption was on target. Resultsfrom the blood work indicated Jolie’swhite blood cell count was 38,000, farabove the normal range of 4,500 to 10,000and indicative of a severe infection.

Jolie’s breathing became erratic, and awhirlwind of activity followed. She suffered aseizure. A CAT scan revealed she had swellingin the brain. Suddenly, Jolie’s breathingstopped, and she was hooked to a ventilator.

Jolie’s parents struggled to take in whatwas happening to their daughter.

Holtkamp remembers pleading with herdaughter, “Please don’t leave me, please don’tleave me.”

FFiigghhttiinngg ffoorr JJoolliiee’’ss lliiffeeAs Jolie’s condition drastically worsened,

she was Lifelined to Riley Hospital forChildren, where she was given antibiotics.

Because of the swelling in Jolie’s brain, aspinal tap could not be performed, whichwould allow doctors to diagnose meningitis.Her movements were deemed as reflexive.

At 4 a.m. — a little more than 24 hoursafter the onset of her illness — a test revealedJolie’s brain showed no activity. A second testconfirmed the teen, who played baseball justdays earlier, was kept alive solely by life support.

Holtkamp crawled into bed with herdaughter to assure her it was OK for her to goto be with God. And Jolie was gone, she says.

The following day, tests confirmed Joliehad died from bacterial meningitis.

Her parents, as a part of coming to termswith Jolie’s death, both frequently speak toIndiana University students who enrolled ina course on Death and Dying.

Holtkamp says she’s committed to live apurposeful life in honor of her daughter.

Your body’s main line of defenseagainst infectious diseases is yourimmune system. Made up of white

blood cells and other tissues, your immunesystem protects your body from organismsthat cause disease.

The immune system guards your bodyagainst invading organisms and attacksinfections. It also “remembers” the infectionsto which you are exposed through illness orvaccination to protect you from becoming illfrom these same organisms later in life.

Like any other body system, however, it isimportant to keep your immune systemhealthy so it functions properly. Thosewhose immune systems are weakened due toyouth or old age, certain diseases or geneticdisorders should be especially careful to keepthe immune system strong.

These six tips can help you keep yourimmune system armed and ready:

11.. EEaatt aa bbaallaanncceedd ddiieett.. Many fruitsand vegetables contain compounds thatstrengthen your immune system. Dark-

skinned fruits and vegeta-bles, like eggplant,

cranberries, grapesand blueberries,contain especiallypowerful antioxi-dants that boost the

Protecting your Immune SystemThe best offense against infection is good defense

by Pam Pontones, MA, Director of Surveillance and Investigation, Indiana State Department of Health

immune system.22.. GGeett pplleennttyy ooff rreesstt.. Like other

body systems that are overused or stressed,your immune system can become weakenedfrom lack of sleep, and your resistance toinfection becomes lowered. Aim for seven toeight hours of sleep per night.

33.. KKeeeepp hhyyddrraatteedd.. Mucous membranes,like your eyes, nose, mouth and throat, arenatural entry points for disease organisms.The natural mucous lining helps protectthese sensitive tissues from infection.Drinking plenty of fluids, especially duringwinter months of cold, dry weather, can helpkeep these tissues from drying out andbecoming more vulnerable to infection.

44.. EExxeerrcciissee rroouuttiinneellyy.. Besidesstrengthening your heart, toning yourmuscles and burning fat, exercise also boostsyour immune system.

55.. GGeett vvaacccciinnaatteedd.. Vaccinations exposeyour immune system to disease organismswithout exposure to the diseases themselves.This creates immune memory that allowsyour immune system to “remember” diseaseorganisms for several months to years.

66.. SSeeee yyoouurr hheeaalltthh ccaarree pprroovviiddeerrrreegguullaarrllyy.. He or she can determine whatother steps you can take to keep yourimmune system healthy and spot potentialproblems early.


As a savvy health care consumer, youvalue credible information fromreliable sources. How do you know

which sources are trustworthy? The followingtips and recommendations will help you findsources that will allow you to make soundhealth care decisions for you and your family.

> Credibility: Perhaps the mostimportant consideration when determining thequality of an article is who or what organizationwrote the information. Is the source consideredan authority in the topic? Although notfoolproof, look for Web site addresses ending in.org, .edu and .gov. These generally indicate a

not-for-profit status and potentially moreobjective, less biased information.

> Funding reliability: Does thearticle or Web site indicate who paid for thepublication? If someone benefits from youreading the publication, there is a higherlikelihood the information may be biased ––purposefully trying to influence you in a spe-cific way. Funding sources, such as not-for-profit funding and federal/state grants, typi-cally reduce the potential for bias.

> Age of timely information:Much has been learned about medicine andhealth in recent decades, so it is important to

use current information. However, beware of“latest study shows”-type articles. One studyis just that: one study. Trustworthy healthinformation rests firmly on a foundation ofmany studies –– not just one or two. Thelatest studies are interesting but most oftenshould not be the basis of personal healthchoices. It is also a good idea to get medicalinformation from more than one site.

Remember, health information found onthe Internet should not replace the informationgiven by your health care provider. Ask yourdoctor for reliable sites that can supplementyour care.

ResourcesThe Medical Library Association’s “Top Ten” Most Useful Consumer Health Web sites*:

Cancer.gov: http://www.cancer.gov/Centers for Disease Control and Prevention: http://www.cdc.gov/

Familydoctor.org: http://www.familydoctor.org/Healthfinder®: http://www.healthfinder.gov/

HIV InSite: http://hivinsite.icsf.edu/Kidshealth: http://www.kidshealth.org/

Mayo Clinic: http://mayoclinic.com/Medem: http://medem.com/

MEDLINEplus: http://medlineplus.gov/NOAH: New York Online Access to Health: http://noah-health.org/

* Deciphering Medspeak for Health Consumers, “Top Ten” Most Useful Websites, http://www.mlanet.org/resources/medspeak/topten.html

Reprints of Effective Infection Prevention — The old, the new and what’s true are available by calling 317.585.5858 or by mail:Weiss Communications, 6610 N. Shadeland Ave., Suite 100, Indianapolis, IN 46220.

Which News Should You Use?Assess credibility of health information by checking sources

by Wayne Staggs, MS, Invasive Disease Epidemiologist, Indiana State Department of Health, and Michael Wade, MPH, Syndromic Surveillance Epidemiologist, Indiana State Department of Health

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iw 03.08 Infection Prevention - IN.gov · > “Medical Myths Debunked” by Jean Lawrence. Log on ... some cases, these illnesses can lead to serious disability or death. Amazing