| Epidemiological Bulletin: Winter 2002 (Part 1 of 2)
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New Health Department Evening STD Clinic
The San Mateo County Health Services Agency will begin a new walk-in evening STD (Sexually Transmitted Disease) clinic, starting on January 24 th . Testing and Treatment will be available. Clinics will take place every Thursday evening from 5:30 -7:30 pm on the first floor of the San Mateo County Medical Center at 222 West 39th Street in San Mateo. Clients should come through the main entrance of the hospital and follow signs to the Edison Clinic. Please contact the Public Health Mobile Clinic.
New Faces at the San Mateo County Disease Control and Prevention Unit
Leonel Angeles has joined the DCPU as Community Worker II, and will be working primarily on Directly Observed Therapy for tuberculosis patients. He will be working out of the North County Health Center. Leonel worked previously for Catholic Charities and Project Open Hand with HIV-positive individuals. We are excited to have someone with his background and experience joining the team.
Tamika Julien is a new Communicable Disease Investigator for HIV/AIDS and TB. Tamika obtained her MPH degree in Epidemiology from the University of Oklahoma Health Science Center. She worked previously for the State of California conducting Hepatitis A research. She will be a valued addition to the TB program and will also help coordinate HIV/AIDS surveillance for the county.
Jeanne Rhee is the new Lead Epidemiologist. She has an MPH in Epidemiology from Columbia University and recently received a PhD, also in Epidemiology, from Stanford University. She has worked previously at the Stanford Center for Tuberculosis Research. Her interests are infectious diseases, epidemiologic methods, and community-based research. She will be working to shape and improve public health research within the department.
NOTE: Epidemiologist Gloria Tzuang will be on maternity leave through August 2002.
Acute Hepatitis C Case Associated with Pedicures
Beth Schulz, PHN, MPH, Communicable Disease Control Officer
The San Mateo County Health Department is investigating a case of acute hepatitis C associated with professional pedicures in a local nail salon. The case reported that her foot calluses were routinely shaved with a razor type device and that tissue around her nail beds was cut with nail nippers, sometimes causing bleeding during monthly pedicure treatments. The case reported no other known risk factors for Hepatitis C transmission.
Nail salons are licensed and regulated by the State of California Department of Consumer Affairs, Bureau of Barbering and Cosmetology. Unfortunately, there is currently no inspector assigned to perform routine inspections of nail salons in a region of the Bay Area including San Mateo County except when triggered by a complaint. The Bureau of Barbering and Cosmetology and the county health department and district attorney's office did a joint inspection of the implicated nail salon. Several "Credo" blades (tools fitted with razor blades used to shave calluses) were confiscated during the inspection, as it is illegal for the devices to even be present in a nail salon. In addition, no disinfectant was found on the premises, instruments were not being disinfected, implements such as emery and buffing boards and burrs meant for one-time use were being reused and the whirlpool footbath was not being cleaned and disinfected.
Anecdotal reports from patrons of pedicure salons indicate that the illegal practice of trimming tissue using a variety of cutting instruments is not uncommon and that bleeding can result. San Mateo County is attempting to develop strategies to alert consumers and nail salon proprietors about these illegal practices and the importance of infection control in this largely unregulated industry. Further information about the regulation of nail salons can be found at the State Bureau of Barbering and Cosmetology website at http://www.dca.ca.gov/barber.
Immunization Update - Tetanus, Diphtheria and Acellular Pertussis
Adapted from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5051a3.htm
Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) remain in short supply, and the shortage will continue into mid-2002. Shortages are greatest in the public sector. Despite high vaccination rates, pertussis continues to cause serious illness and death, particularly among infants aged <6 months who are too young to have completed the 3-dose primary series of DTaP. Vaccinating infants on time with the 3-dose primary series of DTaP to protect them from serious disease remains a priority during this vaccine shortage.
The shortage began in 2000 when manufacturers Wyeth Lederle and Baxter Hyland Immuno Vaccines stopped production of DTaP. Aventis Pasteur and GlaxoSmithKline, producers of Tripedia ® and Infanrix " , respectively, are the only two remaining U.S. suppliers.
During the shortage of DTaP, the Advisory Committee on Immunization Practices recommends that providers who do not have enough DTaP to vaccinate all children with 5 doses give priority to vaccinating infants with the first 3 doses.
- To ensure an adequate supply of DTaP to vaccinate infants, providers should first defer vaccination of children aged 15-18 months with the fourth DTaP dose
- If deferring the fourth dose does not leave enough DTaP to vaccinate infants, then the fifth DTaP dose (given to children aged 4-6 years) also should be deferred.* In these cases, a written note allowing children to attend school should be provided.
When the DTaP shortage ends, providers should recall and administer DTaP to all children who missed a dose. Vaccination of children aged 4-6 years is needed to ensure immunity to pertussis, diphtheria, and tetanus during the elementary school years.
*Children traveling to countries where the risk for diphtheria is high should be vaccinated as per the Recommended Childhood Immunization Schedule. See the MMWR article for complete details.
Measles Outbreak Alert
The San Francisco Department of Public Health reports that since September 20th 2001, six San Francisco residents have been diagnosed with measles, two of whom required hospitalization. These cases are Latino immigrants who worked mostly in restaurants in San Francisco and San Mateo counties while infectious. Although it is too late to prevent secondary infections and none have subsequently been identified, this is a good opportunity to remind providers to consider measles in the differential diagnosis for persons presenting with febrile rash illness.
Two doses of MMR vaccine, at least one month apart, should be provided to any person who has no history of measles and an uncertain vaccination status. In addition, all health care workers born after 1956 should be immunized with two doses of MMR, one month apart, unless they have proof of prior disease or laboratory evidence of immunity.
CDC Responds: Public Health Training Network
The DHS Office of AIDS will conduct a survey among health care providers of HIV-related services in collaboration with Alameda, Kern, Sacramento, San Bernardino, and San Francisco counties. The survey will take The Centers for Disease Control and Prevention (CDC) has been sponsoring a weekly series of live broadcasts regarding emerging public health threats for American frontline clinical and public health practitioners. These programs can be viewed live on the broadcast date via multiple formats including satellite broadcast at the San Mateo County Health Department. Programs can also be viewed after the original broadcast date at http://webcasts.sph.unc.edu. Videotapes of each program can also be ordered free of charge by calling 1-877-252-1200 from 9 AM-5 PM Eastern Time. Videotapes may also be borrowed from the San Mateo County Disease Control and Prevention Unit. Call (650) 573-2346 for information. Further informa-tion about these broadcasts is available from the Public Health Practice Program Office at http://www.phppo.cdc.gov/phtn.
Recent topics of the live broadcasts have included:
- 10-18-2001 Anthrax: What Every Clinician Should Know (Part I)
- 11-01-2001 Anthrax: What Every Clinician Should Know (Part II)
- 11-09-2001 CDC Responds: Coping with Bioterrorism - The Role of the Laboratorian
- 11-16-2001 CDC Responds: Bioterrorism and the Healthcare Epidemiology/Infection Control Team
- 11-29-2001 Clinical Diagnosis and Management of Anthrax - Lessons Learned
- 12-06-2001 Risk Communication and Bioterrorism
- 12-13-2001 Smallpox: What Every Clinician Should Know
- 12-21-2001 Update on Options for Preventive Treatment for Persons at Risk for Inhalation Anthrax
An interesting article in the November/December 2001 issue of Emerging Infectious Diseases, "Developing New Smallpox Vaccines," is available online at http://www.cdc.gov/ncidod/eid/vol7no6/rosenthal.htm.
HIV Non-Name Code Reporting Up-date
Revised HIV reporting regulations were submitted to the Department of Health Services (DHS) Office. Please report all suspected cases IMMEDIATELY to the San Mateo County Disease Control & Prevention Unit at (650) 573-2346.
place between January and March of 2002. The primary goals of the survey are to 1) assess providers' knowledge about the proposed non-name-based HIV reporting regulations and their attitudes toward mandatory HIV reporting, 2) identify potential operational and technical challenges providers may encounter, and in particular, 3) identify any needs for training and technical assistance in implementing the proposed HIV reporting regulations. The results of this survey will provide the state and local health departments with valuable information regarding providers' ability to work with the proposed reporting system and needs for training and technical assistance.
In 1999, the DHS Office of AIDS has already completed a survey of California laboratories licensed to conduct HIV antibody tests. The purposes of the survey were to determine 1) the number of HIV-related tests performed (antibody and viral load tests) by the laboratories, 2) HIV seropositivity rates, and 3) the availabil-ity of data elements for notification to local health officers. Researchers at the DHS Office of AIDS are finalizing their data analysis, and a statewide report of the results will be released in the near future.
The DHS Office of AIDS has provided funding to local health departments to assist the development of an infrastructure and the implementation of HIV non-name reporting. The HIV/AIDS Registry dedicated a centralized computer, database, and Soundex system to meet the needs of HIV non-name reporting. A program is being developed that will match and unduplicate identical HIV/AIDS cases.
The HIV/AIDS Surveillance Conference will be held February 27 - March 1, 2002 in Sacramento.
There will be two plenary sessions highlighting HIV Non-Name Reporting. One breakout session will present the twenty most frequently asked questions about HIV Non-Name Reporting and will offer the opportunity for further questions. This session will be held twice, once in the morning and once in the afternoon. All sessions on Friday, March 1st will highlight successes and barriers encountered by the San Diego HIV Reporting Pilot Project.
For more information about the conference, call the Office of AIDS at (916) 445-0553.
21ST CENTURY NATIONAL CONFERENCE
The California HIV/STD Training Center Presents STDS IN THE 21ST CENTURY NATIONAL CONFERENCE FRIDAY, MAY 17, 2002 WESTIN HOTEL SAN FRANCISCO AIRPORT
This conference is designed specifically for clinicians who already have a working knowledge of STDs and will cover the latest advances and the most up-to-date information on STDs. For further information, contact RDL enterprises at (916) 443-0218 or.
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