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The Waco‐McLennan County Public Health District (WMCPHD) received 45 reports of com‐
municable disease from September 1st through November 30th of 2013. Reported diseases
for this time period are listed in Table 1. Fifty one reports of communicable disease were
reported in previous quarter (June‐August 2013). Ten animal rabies cases were identified
from McLennan County this quarter by the Department of State Health Services ‐ Zoonosis
Control Department. The majority of reports consisted of gastrointestinal illnesses with 3
parasitic and 28 bacterial as causative agents. There were 5 vaccine preventable diseases
that were reported during this quarter, all of which were Varicella (Chicken Pox).
Waco-McLennan County Public Health District
225 West Waco Drive, Waco, Texas 76707 P: 254-750-5450
Quarterly Report: Epidemiology & Public Health Preparedness
September-October-November 2013
Waco-McLennan County Public Health District
Table 1: Diseases Sep‐Nov 2013 Rates Jun‐Aug 2013 Rates Mar‐May 2013 Rates
Aseptic Meningitis 1 0.4
Campylobacter 5 2.1 14 6.0 2 0.9
Chagas (Chronic) 1 0.4
Cryptosporidiosis 3 1.3 2 0.9 1 0.4
Hepatitis A (Acute) 2 0.9 2 0.9
Hepatitis B (Acute) 2 0.9
Legionellosis* 1 0.4
Lyme 1 0.4 1 0.4
Pertussis 3 1.3 2 0.9 2 0.9
Salmonellosis 15 6.4 18 7.7 5 2.1
Shiga Toxin Producing Ecoli 1 0.4 1 0.4 1 0.4
Shigellosis 7 3.0 3 1.3 1 0.4
Streptococcus A 1 0.4
Streptococcus B 1 0.4
Tuberculosis 4 1.7 1 0.4
Varicella 5 2.1 5 2.1 12 5.1
Vibrio Parahemolyticus 1 0.4
TOTAL 45 19.2 51 21.7 31 13.2
Rates per 100,000 McLennan County population. (McLennan County 2010 Census population =234,906)
* Legionellosis case was ruled out as "not a case".
2012‐2013 Flu Vaccine
There are several flu vaccine options
for the 2013‐2014 flu season. Traditional
flu vaccines made to protect against
three different flu viruses (called
“trivalent” vaccines) are available. In ad‐
dition, this season, flu vaccines made to
protect against four different flu viruses
(called “quadrivalent” vaccines) also are
available. The trivalent flu vaccine pro‐
tects against two influenza A viruses and
an influenza B virus.
The following trivalent flu vaccines are
available:
Standard dose trivalent shots that
are manufactured using virus grown in
eggs. These are approved for people ages
6 months and older. There are different
brands of this type of vaccine, and each is
approved for different ages. However,
there is a brand that is approved for chil‐
dren as young as 6 months old and up.
A standard dose trivalent shot con‐
taining virus grown in cell culture, which
is approved for people 18 and older.
20122012--2013 F2013 FLULU S SEASONEASON Page 2
McLennan County Weekly Flu Activity, 2013
0
10
20
30
40
50
60
8/3
8/10
8/17
8/24
8/31 9/
79/14
9/21
9/28
10/5
10/12
10/19
10/26
11/2
11/9
11/16
11/23
11/30
12/7
Week Ending
Co
un
t
ILI Rapid flu A Rapid flu B Rapid flu ND*
Flu Activity
Statewide influenza‐like illness
(ILI) activity continues to increase and
is above baseline levels. Influenza ac‐
tivity is increasing steadily. All Texas
Regions have reported laboratory con‐
firmed influenza, and the percentage
of specimens positive for influenza is
now over 10%. This is one threshold
used by CDC to indicate the start of the
flu season.
WMCPHD performs year around
flu surveillance. Weekly flu activity in
McLennan County is shown in the pic‐
ture below.
A standard dose trivalent shot that is
egg‐free, is approved for people 18
through 49 years of age.
A high‐dose trivalent shot, approved
for people 65 and older.
A standard dose intradermal triva‐
lent shot, which is injected into the skin
instead of the muscle and uses a much
smaller needle than the regular flu shot,
is approved for people 18 through 64
years of age.
The quadrivalent flu vaccine protects
against two influenza A viruses and two
influenza B viruses. The following
quadrivalent flu vaccines are available:
A standard dose quadrivalent shot
A standard dose quadrivalent flu
vaccine, given as a nasal spray, is ap‐
proved for healthy people 2 through 49
years of age
For more information visit:
http://www.cdc.gov/flu/about/season/
flu‐season‐2013‐2014.htm
Visit http://flushot.healthmap.org/ to
find vaccine in your area.
Influenza-like illness activity (ILI): ILI is defined as fever over 100F and cough and/or sore throat in the absence of another diagnosis.
This report , disease reporting and flu reporting forms are also available on http://www.waco-texas.com/cms-healthdepartment
When winter temperatures drop
significantly below normal, stay‐
ing warm and safe can become a
challenge. Extremely cold tem‐
peratures often accompany a
winter storm, so you may have
to cope with power failures and
icy roads. Although staying in‐
doors as much as possible can
help reduce the risk of car
crashes and falls on the ice, you
may also face indoor hazards.
Many homes will be too cold—
either due to a power failure or
because the heating system isn’t
adequate for the weather.
wood stove, or kerosene
heater, install a smoke detec‐
tor and a battery‐operated
carbon monoxide detector
near the area to be heated.
Test them monthly, and re‐
place batteries twice yearly.
Your ability to feel a
change in temperature de‐
creases with age, and older
people are more susceptible
to health problems caused by
cold. If you are over 65 years
old, place an easy‐to‐read
thermometer in an indoor
Although periods of extreme
cold cannot always be pre‐
dicted far in advance, weather
forecasts can sometimes pro‐
vide you with several days’
notice. Listen to weather
forecasts regularly, and check
your emergency supplies
whenever a period of extreme
cold is predicted.
If you plan to use a fireplace
or wood stove for emergency
heating, have your chimney or
flue inspected each year. Also,
if you’ll be using a fireplace,
location where you will see
it frequently, and check the
temperature of your home
often during the winter
months.
Insulate any water lines
that run along exterior walls
so your water supply will be
less likely to freeze. To the
extent possible, weatherproof your home by adding
weatherstripping, insulation, insulated doors and
storm windows, or thermal‐pane windows.
If you have pets, bring them indoors. If you cannot
bring them inside, provide adequate shelter to keep
them warm.
person) in case your water pipes freeze and rupture. • Medicines that any family member may need. If your area is prone to long periods of cold tempera-tures, or if your home is iso-lated, stock additional amounts of food, water, and medicine.
Keep several days’ supply of these items: • Food that needs no cook-ing or refrigeration, such as bread, crackers, cereal, canned foods, and dried fruits. Remember baby food and formula if you have young children. • Water stored in clean con- tainers, or purchased bottled water (5 gallons per
Plan Ahead Cold Weather SafetyCold Weather Safety
Prepare Your Home for Winter
Page 3
Prepare for extremely cold weather every winter—it’s always a possibility.
When people must use space
heaters and fireplaces to stay
warm, the risk of household fires
increases, as well as the risk of
carbon monoxide poisoning. Ex‐
posure to cold temperatures,
whether indoors or outside, can
cause other serious or life‐
threatening health problems.
Infants and the elderly are par‐
ticularly at risk, but anyone can
be affected. To keep yourself and
your family safe, you should
know how to prevent cold‐
related health problems and
what to do if a cold‐weather
health emergency arises.
Emergency Supplies List:
• an alternate way to heat your home during a power failure: - dry firewood for a fireplace or wood stove, or - kerosene for a kerosene heater • furnace fuel (coal, propane, or oil) • electric space heater with automatic shut-off switch and non-glowing elements • blankets • matches • multipurpose, dry-chemical fire extinguisher • first aid kit and instruction manual • flashlight or battery-powered lantern • battery-powered radio • battery-powered clock or watch • extra batteries • non-electric can opener • snow shovel • rock salt • special needs items (diapers, hearing aid batteries, medications, etc.)
Heat your home safely. Keep space heat‐
ers away from things that can catch fire,
such as drapes, furniture or bedding, and
do not place them on furniture. Never
leave children unattended around space
heaters and avoid running cords where
they may be tripping hazards.
Do not use charcoal or gas grills or genera‐
tors indoors. Fumes can be deadly.
Conserve heat by closing doors to rooms
that are not being used. Roll towels and
place under doors. Cover windows with
drapes or blankets.
Protect your pipes. Leave a slow drip and
open cabinets with pipes.
Recognizing Hypothermia Adults: • shivering, exhaustion • confusion, fumbling
hands memory loss, slurred
speech drowsiness Infants: • bright red, cold skin very low energy If a person’s tempera-ture gets below 95° seek medical attention imme-diately.
Source: “Extreme Cold: A Prevention Guide to Promote Your Health and Safety” http://www.bt.cdc.gov/disasters/winter/pdf/extreme-cold-guide.pdf
DDDISEASEISEASEISEASE R R REPORTINGEPORTINGEPORTING
The Waco-McLennan County Public Health District has a 24-hour a day/ 7 days a week number that can be utilized to report any cases of disease.
The 24/7 disease reporting number is (254) 750-5411
On a daily basis the epidemiology department reviews, investigates, and reports all cases of communicable disease recognized
as Notifiable Diseases in Texas. This allows for monitoring of disease trends and detection of outbreaks. Reporting may also
be done directly to Epidemiology at (254) 750‐5493 or fax reports to (254) 750‐5405.
Visit us at http://www.waco‐texas.com/cms‐healthdepartment/
E59-11364 (Rev. 01/13) DSHS, Visit www.mclennanpublichealth.org to download disease reporting forms. This document was modified to be used in McLennan County on 2/2013.
Report confirmed and suspected cases. Unless noted by *, report to Waco-McLennan County Public Health District using number above or Epidemiology
Department at 254-750-5493 or FAX 254-750-5405.
A – I When to Report L – Y When to Report
*Acquired immune deficiency syndrome (AIDS)1, 2 Within 1 week *Lead, child blood, any level & adult blood, any level6 Call/Fax Immediately
Amebiasis3 Within 1 week Legionellosis3 Within 1 week
Amebic meningitis and encephalitis3 Within 1 week Leishmaniasis3 Within 1 week
Anaplasmosis3 Within 1 week Listeriosis3, 4 Within 1 week
Anthrax3, 4 Call Immediately Lyme disease3 Within 1 week
Arbovirus infection3, 5 Within 1 week Malaria3 Within 1 week
*Asbestosis6 Within 1 week Measles (rubeola)3 Call Immediately
Babesiosis3 Within 1 week Meningococcal infections, invasive3, 4 Call Immediately
Botulism (adult and infant)3, 4 Call Immediately Mumps3 Within 1 week
Brucellosis3, 4 Within 1 work day Pertussis3 Within 1 work day
Campylobacteriosis3 Within 1 week *Pesticide poisoning, acute occupational6 Within 1 week
*Cancer7 See rules7 Plague (Yersinia pestis)3, 4 Call Immediately
Chagas’ disease3 Within 1 week Poliomyelitis, acute paralytic3 Call Immediately
*Chancroid1 Within 1 week Poliovirus infection, non-paralytic3 Within 1 work day
Chickenpox (varicella)8 Within 1 week Q fever3 Within 1 work day
*Chlamydia trachomatis infection1 Within 1 week Rabies, human3 Call Immediately
*Contaminated sharps injury9 Within 1 month Relapsing fever3 Within 1 week
*Controlled substance overdose10 Call Immediately Rubella (including congenital)3 Within 1 work day
Creutzfeldt-Jakob disease (CJD)3 Within 1 week Salmonellosis, including typhoid fever3 Within 1 week
Cryptosporidiosis3 Within 1 week Severe Acute Respiratory Syndrome (SARS)3 Call Immediately
Cyclosporiasis3 Within 1 week Shigellosis3 Within 1 week
Cysticercosis3 Within 1 week *Silicosis6 Within 1 week
*Cytogenetic results (fetus and infant only)11 See rules11 Smallpox3 Call Immediately
Dengue3 Within 1 week *Spinal cord injury12 Within 10 work days
Diphtheria3 Call Immediately Spotted fever group rickettsioses3 Within 1 week
*Drowning/near drowning12 Within 10 work days Staph. aureus, vancomycin-resistant (VISA and VRSA)3, 4 Call Immediately
Ehrlichiosis3 Within 1 week Streptococcal disease (group A, B, S. pneumo), invasive3 Within 1 week
Escherichia coli infection, Shiga toxin-producing3, 4 Within 1 week *Syphilis – primary and secondary stages1, 13 Within 1 work day
*Gonorrhea1 Within 1 week *Syphilis – all other stages1, 13 Within 1 week
Haemophilus influenzae type b infections, invasive3 Within 1 week Taenia solium and undifferentiated Taenia infection3 Within 1 week
Hansen’s disease (leprosy)3 Within 1 week Tetanus3 Within 1 week
Hantavirus infection3 Within 1 week *Traumatic brain injury12 Within 10 work days
Hemolytic Uremic Syndrome (HUS)3 Within 1 week Trichinosis3 Within 1 week
Hepatitis A (acute)3 Within 1 work day Tuberculosis (includes all M. tuberculosis complex)4, 14 Within 1 work day
Hepatitis B, C, and E (acute) 3 Within 1 week Tularemia3, 4 Call Immediately
Hepatitis B identified prenatally or at delivery (acute & chronic) 3 Within 1 week Typhus3 Within 1 week
Hepatitis B, perinatal (HBsAg+ < 24 months old) 3 Within 1 work day Vibrio infection, including cholera3, 4 Within 1 work day
*Human immunodeficiency virus (HIV) infection1, 2 Within 1 week Viral hemorrhagic fever, including Ebola3 Call Immediately
Influenza-associated pediatric mortality3 Within 1 work day Yellow fever3 Call Immediately
Influenza, Novel3 Call Immediately Yersiniosis3 Within 1 week
In addition to specified reportable conditions, any outbreak, exotic disease, or unusual group expression of disease that may be of public health concern should be reported by the most expeditious means available
* Call 254-750-5478 for HIV/STD and 254-750-5496 for Tuberculosis related questions and reporting 1 Please refer to specific rules and regulations for HIV/STD reporting and who to report to at: http://www.dshs.state.tx.us/hivstd/healthcare/reporting.shtm. 2 Labs conducting confirmatory HIV testing are requested to send remaining specimen to a CDC-designated laboratory. Please call 512-533-3132 for details. 3 Reporting forms are available at http://www.dshs.state.tx.us/idcu/investigation/forms/. Investigation forms at http://www.dshs.state.tx.us/idcu/investigation/
Call as indicated for immediately reportable conditions. 4 Lab isolate must be sent to DSHS lab. Call 512-776-7598 for specimen submission information. 5 Reportable Arbovirus infections include neuroinvasive and non-neuroinvasive California serogroup including Cache Valley, Eastern Equine (EEE), Dengue, Powassan,
St. Louis Encephalitis (SLE), West Nile, and Western Equine (WEE). 6 Please refer to specific rules and regulations http://www.dshs.state.tx.us/lead/Reporting-Laws-Administrative-Code.aspx. 7 Please refer to specific rules and regulations for cancer reporting and who to report to at http://www.dshs.state.tx.us/tcr/reporting.shtm. 8 Varicella reporting form at http://www.dshs.state.tx.us/idcu/health/vaccine_preventable_diseases/forms/NewVaricellaForm.pdf. Call local health dept for copy with their fax number. 9 Not applicable to private facilities. Initial reporting forms for Contaminated Sharps at http://www.dshs.state.tx.us/idcu/health/infection_control/bloodborne_pathogens/reporting/. 10 Contact local poison center at 1-800-222-1222. For instructions, forms, and fax numbers see http://www.dshs.state.tx.us/epidemiology/epipoison.shtm#rcso. 11 Report cytogenetic results including routine karyotype and cytogenetic microarray testing (fetus and infant only). Please refer to specific rules and regulations for birth defects
reporting and who to report to at http://www.dshs.state.tx.us/birthdefects/BD_LawRules.shtm. 12 Please refer to specific rules and regulations for injury reporting and who to report to at http://www.dshs.state.tx.us/injury/rules.shtm. 13 Laboratories should report syphilis test results within 3 work days of the testing outcome. 14 MTB complex includes M. tuberculosis, M. bovis, M. africanum, M. canettii, M. microti, M. caprae, and M. pinnipedii. Please see rules at http://www.dshs.state.tx.us/idcu/disease/tb/reporting/.
Texas Notifiable Conditions24/7 Number for Immediately Reportable– 254-750-5411
Above Information is CONFIDENTIAL. Please notify sender if received in error and return or destroy. EEPI-2 (HSR7 Rev. 8/08)
General Instructions This form may be used to report suspected cases and cases of notifiable conditions in Texas, listed with their reporting timeframes on the reverse side of this form or available at www.dshs.state.tx.us/idcu/investigation/forms/101A.pdf. In addition to specified reportable conditions, any outbreak, exotic disease, or unusual group expression of disease that may be of public health concern should be reported by the most expeditious means available. A health department epidemiologist may contact you to further investigate this Infectious Disease Report. Information needed to classify cases of infectious disease is outlined in the Epi Case Criteria Guide found at www.dshs.state.tx.us/idcu/investigation/forms/EpiCaseGuide.pdf.
Confirmed and suspected cases should be reported to your local or regional health department at the following address, phone or fax number:
Waco-McLennan County Public Health District 225 West Waco Drive, Waco, TX 76707
Phone: (254)750-5411 (24/7 reporting)
Fax: (254) 750-5405 As needed, cases may be reported to the Department of State Health Services at 1-800-252-8239, 512-458-7676, or after-hours at 512-458-7111
Disease or Condition Date: _________________ (Check type) Onset Specimen collection (Please fill in onset or closest known date) Absence Office visit
Physician Name Physician Address See Facility address below Physician Phone See Facility phone below ( ) -
Diagnostic Criteria (Diagnostic Lab Result and Specimen Source or Clinical Indicators)
Patient Name (Last) (First) (MI) Telephone ( ) -
Address (Street) City State Zip Code County
Date of Birth (mm/dd/yyyy) Age Sex Male
Female
Ethnicity Hispanic
Not Hispanic
Race White Black
Asian Other UnknownOccupation (if student also include school name and grade)
(if under 18) Guardian’s Name Occupation
Telephone (_____) ______ - ______
Was patient hospitalized? ___ Yes ____ No If yes, Name of Hospital: _____________________________________________________
Admission Date: ____/_____/_______ Discharge Date: _____/______/________ Discharge status: Recovering/Recovered Deceased Unknown
FOR HEPATITIS REPORTING: Liver Function Test Date: ALT: AST: Name of Reporting Facility Address
Name of Person Reporting Title Phone Number
( ) - extension
Date of Report (mm/dd/yyyy) E-mail
Notes, comments, or additional information such as other lab results/clinical info, pregnancy status, travel history, etc. PLEASE ATTACH LAB REPORT IF AVAILABLE.
Confirmed Probable Suspected Dropped Duplicate, with new information
Entered into Epi Tracker Entered into NEDSS (date): Case ID#
Initial Provider
Infectious Disease Report
This form expires on January 1, 2010.