Minnesota Department of Health (MDH) Bug Bytes
July 9, 2001
Vol. 2: No. 13
1. Farm Animals and Multiple Pathogens
2. More Summer Camp Illness
3. Suspect Human Rabies
4. Occupational Exposure to HBV, HCV, and HIV
5. Smallpox Vaccine Recommendations
6. Goodbyes
1. Farm Animals and Multiple Pathogens
We have been investigating an outbreak of gastrointestinal illnesses among children
attending a day camp, the focus of which is contact with various farm animals
including calves. Last summer, attendance at this camp resulted in 11 laboratory
confirmed cases of Cryptosporidium parvum, 1 case of Salmonella
Typhimurium, 1 case of Campylobacter jejuni, and 1 case of non-O157 enterohemorrhagic
E. coli. Despite heightened awareness of the risk and increased attention
to handwashing, an outbreak among campers once again occurred this summer. This
year we have documented 7 cases with Cryptosporidium parvum, 2 cases
with E. coli O157:H7, and 2 cases with both E. coli O157:H7 and
Cryptosporidium infection. The camp was temporarily closed to determine
what additional interventions should be put into place to reduce the risk to
campers.
2. More Summer Camp Illness
Every summer we investigate illness outbreaks associated with summer camps.
In addition to the one described above, we are investigating an outbreak of
respiratory disease (persistent productive cough, runny nose, some with low
grade fever). Two thirds of the campers have been ill. We suspect a viral etiology;
laboratory testing at MDH is ongoing.
We also have heard of an outbreak of gastrointestinal illness among boy scouts, including Minnesota scouts, attending a camp in Florida. The outbreak is being investigated by a Florida local health department with our assistance.
3. Suspect Human Rabies
On June 27, a 21 year-old female was hospitalized with suspect rabies. The patient
had received two of the three recommended doses of preexposure rabies vaccine
in January. She had traveled to Nepal and India from January to June. While
in India, during the first week of May, she was bitten on her foot by a stray
dog. She did not seek rabies postexposure prophylaxis. During the second week
of June, the patient developed paresthesia, pain, and swelling at the site of
the bite wound. The zone of paresthesia increased in an ascending fashion and
was followed by paresthesia in the other leg. This history and symptoms are
consistent with rabies; the other differential diagnosis considered was Guillain-Barre
Syndrome (GBS). The patient had diarrhea approximately two weeks before development
of initial symptoms of paresthesia. Campylobacter jejuni is a common
cause of traveler's diarrhea and a known cause of GBS.
Saliva and a nuchal biopsy obtained June 28 were sent to CDC for rabies testing by PCR and direct fluorescent antibody; test results were negative. CSF obtained July 2 was negative for rabies antibody and negative for rabies by PCR. The cause of the patient's illness remains unknown.
4. Occupational Exposure to HBV, HCV, and HIV
The U.S. Public Health Service has released revised guidelines for management
of occupational exposures to HBV, HCV, and HIV (at http://www.cdc.gov/mmwr//mmwr_rr.html
). Attention: Non-MDH link These guidelines are a very handy consolidation of previous blood
and body fluid exposure recommendations. There are no substantial changes
from previous recommendations. An oversimplified summary: care for exposure
site, evaluate the risk, evaluate the exposure source and the worker exposed,
give postexposure prophylaxis for HBV and HIV (none for HCV), perform
follow-up testing and provide counseling.
5. Smallpox Vaccine Recommendations
The ACIP has issued recommendations for vaccinia (smallpox) vaccine (at
http://www.cdc.gov/mmwr/preview/
mmwrhtml/rr5010a1.htm). Attention: Non-MDH link
Wait a minute - wasn't smallpox eradicated globally in 1977? Yes, but
there is a risk, albeit low, that terrorists have secured smallpox (variola)
virus and may deliberately use it as a bioterrorism weapon causing widespread
illness and death. These recommendations provide a basis to manage an
ensuing epidemic.
6. Goodbyes
We say goodbye to Dr. Tim Naimi who has left to pursue a Preventive Medicine
Residency at the CDC and Dr. Liz Wagstrom who has left to be the Director of
Veterinary Sciences at the National Pork Producers Council in Des Moines, IA.
Thanks for being part of the Minnesota epidemiology team and good luck!
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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