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Health Alerts

The Snohomish Health District Health Officer Dr. Gary Goldbaum sends alerts via email to local health care providers. Alerts cover current local, regional or national health threats and important updates on medical care and protocols. Alerts are written as needed to cover urgent or emergent health issues.

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Middle East Respiratory Syndrome, Pertussis, Measles & Sexually transmitted diseases treatment guidelines

Today’s topics:

  • Middle East Respiratory Syndrome
  • Pertussis
  • Measles
  • Sexually transmitted diseases treatment guidelines

 
Middle East Respiratory Syndrome

Action requested: Screen patients with respiratory symptoms for travel to the Middle East or South Korea.

Background & Recommendations

Since May 20, 2015, the Republic of Korea has experienced the largest outbreak of MERS-CoV infections outside of the Arabian Peninsula, with 153 lab-confirmed cases and 19 deaths as of June 16, 2015.  The Centers for Disease Control & Prevention (CDC) has revised its MERS-CoV guidelines in light of the situation in Korea (see http://www.cdc.gov/coronavirus/mers/interim-guidance.html).

Clinicians should consider MERS-CoV infection in ill persons who have a history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset or travel to the Republic of Korea with history of being in a health care facility within 14 days before onset of symptoms. Be sure to take a travel history at the first opportunity (when scheduling or when the patient presents at the clinic site), and rapidly isolate the patient and evaluate for MERS-CoV.  Use standard, contact, and airborne precautions when MERS-CoV is suspected. Collect specimens per CDC guidelines.

If you suspect MERS-CoV, notify the Communicable Disease Program immediately at 425-339-5278.

Public Health—Seattle & King County provides concise triage and assessment advice at http://www.kingcounty.gov/healthservices/health/communicable/~/media/health/publichealth/documents/communicable/advisories/2015/advisory150611.ashx

For CDC’s detailed guidance about MERS-CoV, see http://www.cdc.gov/coronavirus/mers/index.html.

No vaccine or specific treatment for MERS-CoV infection is available; care is supportive. The World Health Organizations has posted guidance for clinical management of MERS-CoV patients at http://www.who.int/csr/disease/coronavirus_infections/InterimGuidance_ClinicalManagement_NovelCoronavirus_11Feb13u.pdf?ua=1.

Pertussis

Action requested
: If pertussis is suspected in a student, test, treat, and exclude the student from school.

Background & Recommendations

As of June 12, 103 cases of pertussis had been reported to the Health District in 2015.  As I have noted in earlier alerts, this is a dramatic increase over the past two years.  However, we are aware of problems in clinical management, such as situations where the provider tests for pertussis, but awaits results before treating and excluding the patient from school.  In a recent case, a student presented with paroxysmal cough and a letter from the school documenting potential exposure, but the provider diagnosed allergy and tested for pertussis only after the parents insisted—results were positive for pertussis.  If pertussis is suspected in a student where exposure risk is high, clinicians should consider testing, but should definitely treat and exclude the student from school.  If you suspect pertussis, notify the Communicable Disease Program at 425-339-5278.

For more detailed information about diagnosis and management of pertussis, see http://www.cdc.gov/pertussis/clinical/index.html.


Measles

Action requested
:  Be alert for possible measles in persons who visited certain Seattle locations on May 30.

Background & Recommendations

A person traveling through Seattle on May 30 developed a rash on June 3; measles was confirmed on June 9.  Anyone who was exposed and is not immune to measles would likely develop symptoms between June 9 and June 20.  For details about locations at which exposure may have occurred, see http://www.kingcounty.gov/depts/health/news/2015/June/10-measles-exposure.aspx.  If you suspect measles, notify the Communicable Disease Program immediately at 425-339-5278.

For more information about measles diagnosis and management, see http://www.cdc.gov/measles/hcp/index.html.

Sexually transmitted diseases treatment guidelines

Action requested
: Follow the updated Sexually Transmitted Diseases Treatment Guidelines, 2015.

Background & Recommendations

The Centers for Disease Control & Prevention (CDC) has just released Sexually Transmitted Diseases Treatment Guidelines, 2015 (available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm?s_cid=rr6403a1_e).  Revisions to prior guidelines include 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection.  Refer to these guidelines for the most current evidence-based diagnostic strategies and treatments for sexually transmitted diseases.

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Communicable Disease

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425.339.5278

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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.