Rabies Article

By David W. Blodgett, MD, MPH

SWUPHD Director & Health Officer

 

I sometimes have the opportunity to speak to local middle school-aged students about how various diseases spread.  Knowing this can make all the difference in keeping disease from spreading and avoiding infection in the first place. One of the points I always make is this: if you encounter a wild animal that seems easy to catch, but would normally not be, stay away! This generally means there is something wrong, so consider it a warning sign to keep your distance.

Rabies, tularemia, and plague are among diseases that can infect animals and then be transmitted to humans. This year there have been more reports than usual of rabid animals throughout Utah, including several cases here in our part of the state.  I thought it might be helpful to share some information about rabies and its risks.

Rabies is a deadly virus spread to people from the saliva of infected animals, usually through a bite. In developing countries, stray dogs are most likely to spread rabies to people. While any mammal could transmit the disease,  the animals most likely to do so in the United States include bats, coyotes, foxes, raccoons, and skunks. Cases in domestic dogs and cats are fewer in number due to vaccination programs, but can still occur. Most of the rabies identified in southwest Utah occurs in bats or animals that have been bitten by bats.

Human rabies cases in the United States are rare, with only one to three cases reported annually. Thirty-four cases of human rabies have been diagnosed in the United States since 2003, although ten of those cases were found to have been infected outside of the country.

Rabies infection usually results in flu-like symptoms along with confusion, anxiety, and agitation; followed by insomnia, abnormal behavior, and hallucinations. Unfortunately, once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For this reason, anyone who is determined to have possibly been infected should receive rabies vaccine for protection. When given soon enough, the vaccine is very effective.

Seek immediate medical care if you’re bitten by any animal, or exposed to an animal suspected of having rabies. Based on your injuries and the situation in which the exposure occurred, you and your doctor can decide whether you should receive treatment to prevent rabies. It may be helpful to consult with the health department as well. In our area, only emergency rooms administer rabies vaccines and medication,

To be on the safe side, seek medical attention, even if you’re unsure you were bitten. If you awaken to find a bat in your room, assume you’ve been bitten, which may have occurred without waking you. If you find a bat near a person who can’t report a bite, such as a small child or a person with a disability, also assume that person has been bitten.

There’s no way to know whether a bite from a rabid animal has actually transmitted the virus to you. For this reason, treatment to prevent infection is recommended if the doctor thinks there’s even a chance you have been exposed.

Rabies vaccines are given as injections which include:

  • A fast-acting rabies immune globulin to prevent the virus from infecting you. Part of this injection is given near bite area, if known, and as soon as possible after being exposed.
  • A series of four rabies vaccines to help your body learn to identify and fight the virus. These shots are given in the arm over a 14 day period.

In many cases it’s possible to determine whether the animal that bit you has rabies before starting the vaccine series. If the suspect animal turns out to be rabies-free, you won’t need the shots, which can be very expensive. Procedures depend on the scenario:

  • After a bite from a cat, dog, or ferret, the animal can be observed for ten days for signs and symptoms of rabies. If the animal that bit you remains healthy during the observation period, then you won’t need rabies shots. Other pets and farm animals are considered on a case-by-case basis. Talk to your doctor or the health department to determine whether you should receive rabies shots.
  • A bite from a wild animal that can be found and captured, such as a bat that entered your home, can be killed and tested for rabies. Negative test results mean you won’t need the shots.
  • If the animal that bit you can’t be found, discuss the situation with your doctor and the health department. In certain cases, it may be safest to assume that the animal had rabies and proceed with the rabies shots. In other cases, it may be unlikely that the animal in question had rabies and that rabies shots aren’t necessary.

If an animal bites you, get medical attention for the wound as soon as you can. Make sure to tell the doctor about the circumstances of your injury. The doctor will ask:

  • What animal bit you?
  • Was it a wild animal or a pet?
  • If it was a pet, do you know to whom the animal belongs? Was it vaccinated?
  • Can you describe the animal’s behavior before it bit you? Was the animal provoked?
  • Were you able to capture or kill the animal after it bit you?

In the meantime, wash your wound gently and thoroughly with soap and generous amounts of water, which may help prevent infection from the virus.

If the animal that bit you can be contained or captured without further injury to yourself or others, do so. Tell your doctor that you have captured the animal that bit you. Your doctor may then contact the local health department to determine what to do next. Do not kill the animal with a blow or a shot to the head, as this may make it difficult to perform laboratory tests on the brain to determine whether the animal has rabies. If the animal is dead, put it on ice or in a refrigerator to preserve it for testing. Heat and freezing can make the test unreadable.

Animal owners can do their part by having their pets vaccinated against rabies according to the recommended schedule. This will protect the animals from contracting rabies, which in turn protects the people around them.

A final reminder: if a wild animal lets you get close to it, back off and don’t touch it!

 

E. coli Bacteria Risks

Update: Health Advisory:

By Order of the Health Officer:

Drinking, swimming, or other contact with the water at Nisson Park in Washington City, Utah is not  recommended, while the water is being tested for possible E. coli contamination.

As more information becomes available, it will be posted this website.

 

Recent news about E. coli outbreaks serves as a reminder to take precautions against this bacteria that can cause illness in humans, especially during the summer months. Although the most notable current E.coli outbreak has been linked to romaine lettuce, this bacteria can be found in a variety of sources.

E. coli are common bacteria which can be spread to people when tiny pieces of feces enter the mouth through unwashed hands; contaminated soil, water, and food. Sources of infection include under-cooked meat, unpasteurized dairy products, infected animals, and manure. Most types of E. coli are harmless, but some strains are harmful to humans.

Health officials continue to encourage following the practices listed below to help prevent infection from E. coli and other diseases:

  • Keep sick animals separated from people and consider consulting a veterinarian
  • Wash your hands with warm, soapy water
    • After contact with animals or exposure to animal feces
    • Before and after preparing or eating food
    • After using the bathroom and changing diapers
    • Before touching anything that enters an infant’s mouth
  • Wash produce thoroughly
  • Keep raw food separate from cooked food
  • Carefully clean all surfaces and objects that have touched raw meat
  • Cook meats thoroughly. Ground beef should be cooked to an internal temperature of 160 degrees (use a meat thermometer)

For more information about E. coli and preventing infection, visit: cdc.gov/ecoli/general

 

Here is more detailed information about E. coli:

What is E. coli and how is it spread?

  • Escherichia coli (E. coli) are bacteria commonly found in the environment, foods, and the feces of people and animals.
  • E. coli can be spread through unwashed hands, contaminated food (like_53234379_escherichia-coli.gif undercooked ground beef or unpasteurized food), water, animal exposure, and soil (where it can remain for several months).
  • People can become infected when they swallow tiny particles of infected human or animal feces which contain E. coli

What happens if people are infected?

  • Most types of E. coli are harmless, but some strains can make people sick.
  • The type involved in this outbreak is called E. coli O157:H7.
  • Symptoms usually begin 3-4 days after exposure to the bacteria and include severe stomach cramps, diarrhea (often bloody), and vomiting.
  • Most people recover within a week without treatment. Some people with E. coli O157:H7 develop a life-threatening complication called Hemolytic Uremic Syndrome (HUS), which can cause kidney failure.
  • HUS is more common in children younger than 5 years of age and older adults, although people any age can be affected.

When should people seek medical care?

  • Contact your healthcare provider if you have diarrhea that lasts for more than three days or is accompanied by fever, blood in the stool, or severe vomiting.
  • Seek emergency medical care if you experience any of these HUS symptoms following a diarrheal illness: urinating less often; fatigue; pale skin; or small, unexplained bruises or bleeding from the nose and mouth.

How can E. coli infection be prevented?

  • Always wash your hands with warm, soapy water
    • Before and after preparing or eating food.
    • After using the bathroom and changing diapers.
    • After contact with animals or their environments where there is exposure to animal feces.
    • Before preparing or touching anything that enters an infant’s mouth.
    • Use hand-sanitizer if soap and water is not available.
  • Don’t allow raw food to touch cooked food. Don’t use the same cutting board or plate. Carefully clean countertops, dishes, and utensils which have touched raw meat with hot, soapy water.
  • Cook meats thoroughly. Ground beef should be cooked to an internal temperature of 165 degrees. Pork should be cooked to an internal temperature of 145 degrees. Use a meat thermometer.
  • Avoid raw (unpasteurized) milk and unpasteurized dairy products/juices.
  • Don’t swallow water when swimming

 

Hepatitis A

UPDATE: Customers who used the restroom or ate at at the following Spanish Fork restaurants during the times listed may have been exposed to hepatitis A:

  • Sonic Drive-In (971 North Main Street, Spanish Fork) from December 23-24
  • Olive Garden  (1092 North Canyon Creek Parkway, Spanish Fork) from December 21-30
  • Tabitha’s Way Local Food Pantry (South County, Spanish Fork), from December 28-January 3 (only applies to food that is not canned)

If you think you were exposed, visit https://health.utah.gov/investigation/ to determine your risk, or call 801-851-HEPA (4372).

Related news story link

 

HEPATITIS A

Hepatitis A is a contagious liver disease. It is usually transmitted  when a person unknowingly ingests the virus from objects, food, or water that have been contaminated by fecal particles from an infected person.

Symptoms include fatigue, low appetite, stomach pain, nausea, vomiting, and jaundice (yellowing of the skin and eyes), which usually resolve within 2 months. Hepatitis A is not a chronic infection and most people fully recover.

Higher risk factors include travel to countries where hepatitis A is common, poor hygiene, homelessness, use of illicit drugs, and incarceration. The best way to prevent hepatitis A infection is vaccination, which is highly effective and especially important for people in these categories. Vaccination is also recommended for those who work among these populations, since having direct contact with someone who is infected puts you at risk.

You can confirm your vaccination status by asking your health care provider to  review your personal immunization record.  If you have not been vaccinated, visit your local health department (620 S. 400 E. for the St. George area). Your insurance plan may cover the cost (see below). You can also get vaccinated against hepatitis A through your health care provider or pharmacy.

In addition to getting immunized, you can help prevent hepatitis A infection by thorough hand washing with soap and warm water, especially after visiting a  restroom. A chlorine bleach solution is an effective disinfectant and should be used frequently to sanitize frequently touched surfaces such as:

  • Toilet handles
  • Faucets
  • Sinks
  • Counters and tables
  • Doorknobs
  • Light switches
  • Remote controls
  • Phones

Find more hepatitis A information at this Centers for Disease Control (CDC ) LINK

Insurance plans accepted by SWUPHD for hepatitis A vaccine:

Aetna
Deseret Mutual (DMBA)
PEHP
Select Health
Tall Tree
Healthy Premier
United
HSA Health Insurance
Medicaid
Chip

 

 

 

Flu Shoot-Outs Are Here!

Getting immunized is one of the best ways to protect yourself against influenza. The Southwest Utah Public Health Department has scheduled our annual Flu Shoot-Out in several locations in preparation for this year’s flu season. It’s inexpensive (or NO CHARGE with some insurances, see below)* and convenient, no appointment needed!

Salmonella Outbreak

Linked to cucumbers, 30 cases in Utah…

cucumbers.jpg

 

A salmonella outbreak linked to cucumbers imported from Mexico to the U.S. has sickened at least 285 people in 27 states. 30 cases are confirmed in Utah among 7 local health districts, resulting in seven hospitalizations.

Anyone who purchased cucumbers recently (between August 1st and September 3rd) is advised to throw them away (see this link for specific stores involved).

State agricultural and health departments are working with local and national agencies to investigate and end the spread of the outbreak.

Salmonella is a bacterial disease which causes fever, abdominal cramps, and diarrhea. Symptoms start between 12 and 72 hours after ingesting contaminated food or drinks and last from 4-7 days. Most people recover at home without treatment, but hospitalization may be required for dehydration and other complications. Children under 5, the elderly, and those with weakened immune systems may experience more severe illness.

Ways to prevent salmonella infection include:

  • Wash surface area of produce to be eaten raw
  • Keep these foods separate from raw meat
  • Wash hands, work surfaces, and utensils with soap and water immediately after handling raw meat
  • Run non-porous cutting boards through the dishwasher

LINK: CDC information on the salmonella outbreak