Infectious Tidbits The Quarterly Infectious Disease Newsletter form Tri-County Health Department (TCHD) Winter 2019

Hepatitis A Outbreak Update Outbreak Overview 2019-2020 Influenza Season RSV (Respiratory Syncytial Virus) World AIDS Day Hand Foot and Mouth Disease (HFMD)

Hepatitis A Outbreak Update

What you need to know: Since October 2018, Colorado has been experiencing an outbreak of hepatitis A virus (HAV) affecting people experiencing homelessness, people with substance use issues, men who have sex with men, and people currently or recently incarcerated. The nationwide outbreak was first identified in 2016, and as of 12/3/19, 30 states have reported 28,609 cases, 17,316 hospitalizations and 288 deaths. In Colorado as of 12/3/19, there have been 264 reported cases, 194 hospitalizations and 2 deaths in 14 different counties. Check HERE for updates in Colorado. Case counts have continued to rise, the City and County of Denver has seen the largest increase in the number of cases over the past couple of months. As of 12/2/19, there have been 22 confirmed hepatitis A cases associated with the outbreak in TCHD’s jurisdiction – 5 in Douglas County, 5 in Adams County and 12 in Arapahoe County. TCHD is partnering with neighboring local public health agencies (LPHAs) to collaborate on outreach efforts addressing barriers for reaching our high risk population. This includes performing case investigations, locating cases, identifying case contacts, and providing post exposure prophylaxis when necessary. TCHD is collaborating with community partners, who serve our high risk population, providing targeted messaging on prevention of HAV and encouraging vaccinations. TCHD is also supporting outreach and vaccination for high-risk individuals at resource centers, jails and encampments as well as coordinating prevention efforts in area hospital emergency departments.

Outbreaks Investigated in TCHD Jurisdiction* *Data excludes multi-jurisdictional outbreaks (e.g. hepatitis A) as well as non-reportable disease (e.g. hand foot and mouth disease) outbreaks.

TCHD has had a total of 77 outbreaks from January 1 st to December 2 nd , 2019, which is similar to previous years. The majority of outbreaks are from gastroenteritis/norovirus or influenza.

Outbreaks from the ‘other’ category include: Campylobacter from drinking raw milk Salmonella from a halfway house E. Coli at a restaurant Vibrio from an Asian buffet Legionella at a residential care facility Norovirus /viral gastroenteritis have caused the majority of the outbreaks in TCHD’s jurisdiction affecting primarily persons in residential care facilities, child care facilities, and schools. Prevention measures for norovirus infections include: Hand washing after using the restroom, after diaper changing, and before handling food Staying home when you’ve been ill with diarrhea and/or vomiting until 24 hours after symptoms have stopped Cleaning diarrhea and/or vomit with an effective disinfectant Using a separate restroom whenever possible from persons who are ill

2019-2020 Influenza Season

Influenza (flu) activity is currently increasing in the U.S. Though flu surveillance in Colorado starts the end of September and continues through the middle of May, seasonal flu viruses can be detected year-round. The Colorado Department of Public Health and Environment (CDPHE) and CDC conduct flu surveillance, both at the state and national level, respectively. Colorado’s weekly flu surveillance report can be accessed HERE . CDC’s flu surveillance report (FluView) can be accessed HERE .  Most people who contract flu will recover within a few days, up to 2 weeks. However, some individuals can develop serious complications, which can be fatal. The best way to prevent the flu and flu complications is to receive a vaccine each season. Many available flu vaccines protect against 4 different flu viruses. The CDC recommends all people 6 months of age and older receive a flu vaccine! The National Influenza Vaccination Week (NIVW) is a national awareness week focused on highlighting the importance of influenza vaccination. NIVW 2019 is observed December 1-7, 2019. Communication and additional resources can be found HERE . Flu prevention information from the National Influenza Vaccination Disparities Partnership (NIVDP) for underserved populations is available through the CDC.

Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. In fact, RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States. It is also a significant cause of respiratory illness in older adults causing pneumonia, congestive heart failure, and more severe illness in people with asthma and chronic obstructive pulmonary disease (COPD). Did you know all outbreaks are a reportable condition, and outbreaks of RSV in Long Term Care Facilities (LTCF) must be reported to TCHD? The state health department has created a guidance document and a report form for outbreaks of RSV in LTCF in Colorado. TCHD is here to work with you on control measures and answer any questions you might have. For more information, visit CDC’s website .

World AIDS Day 2019

December 1 is World AIDS Day . Since its inception in 1988, this day of observance unites people from across the world in the global fight against HIV and AIDS. World AIDS Day aims to support people living with HIV, commemorate those who have died from AIDS-related illness, raise awareness, and inspire solidarity. World AIDS Day is recognized as the first global health day. For more information, visit: https://www.worldaidsday.org/ TCHD offers HIV testing and counseling services, including Linkage to Care coordination services for those diagnosed with HIV or AIDS. We have HIV prevention program clinics that offer HIV and Hepatitis C testing for those who qualify based on risk factors.

Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease (HFMD) is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in older children and adults. It usually starts with a fever, reduced appetite, sore throat, and a feeling of being unwell (malaise). There is no treatment and no vaccine.  HFMD is spread through: The air when an infected person coughs or sneezes Contact with feces, such as changing diapers of an infected person, then touching your eyes, nose, or mouth before washing your hands Contact with contaminated objects and surfaces, like touching a doorknob that has HFMD virus on it, then touching your eyes, mouth, or nose before washing your hands TCHD’s jurisdiction has had 21 reported outbreaks from January 1 st to November 25 th in child care facilities, elementary schools and high schools. To prevent the spread: Lots of hand washing with warm water and soap, especially after using the bathroom, changing diapers, before eating and touching food. Also after touching any body fluids. Disinfect soiled surfaces using a solution of bleach. Be sure to read the manufacturer’s label. Avoid close contact (kissing, hugging, sharing utensils, etc.) with infected persons may help to reduce the risk of infection. Cover your mouth and nose when coughing/sneezing with their arm and not their hand Exclude children from child care or school settings if the child’s blisters are weeping or has mouth sores and is drooling uncontrollably.

Thank you to our community partners, including providers and  laboratories, for support in the timely reporting of reportable conditions  which is critical to our prompt and effective response to outbreaks  to protect the communities we serve!

Eleven offices along the Colorado  front range serving the residents of Adams, Arapahoe and Douglas Counties Administration Office:  6162 S. Willow Drive, Suite 100     Greenwood Village, CO 80111 Phone: 303-220-9200 Fax: 303-220-9208 Website:  www.tchd.org Contact Information: Report infectious diseases or  outbreaks to TCHD immediately  to help prevent  further spread of illness!   Call Communicable Disease at  (303) 220-9200  After hours: (720) 200-1486 Colorado Reportable  Diseases Link