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Communicable Diseases for IMT-managed Incidents LCDR Antonio Neri MD, MPH Centers for Disease Control and Prevention January 26 th, 2010 Views are those.

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Presentation on theme: "Communicable Diseases for IMT-managed Incidents LCDR Antonio Neri MD, MPH Centers for Disease Control and Prevention January 26 th, 2010 Views are those."— Presentation transcript:

1 Communicable Diseases for IMT-managed Incidents LCDR Antonio Neri MD, MPH Centers for Disease Control and Prevention January 26 th, 2010 Views are those of the presenter and do not necessarily represent official policies and procedures of CDC/ATSDR or the US DHHS

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4 Post-disaster Situations Katrina – via Dr. Eric Stern Source: http://images.mirror.co.uk/upl/m4/jan2010/8/0/leogane-haiti-pic-dm-ian-vogler-745564000.jpghttp://images.mirror.co.uk/upl/m4/jan2010/8/0/leogane-haiti-pic-dm-ian-vogler-745564000.jpg Haiti

5 Roadmap Review of common diseases and their prevention Resources Questions

6 Common Diseases During Incidents Skin infections –Methicillin-Resistant Staphylococcus Aureus (MRSA) –“Rashes” Respiratory disease –Influenza –Colds Gastrointestinal Illness –Norovirus –“food poisoning”

7 Warning! The next series of slides contain pictures of rashes, not the most appealing topic. Source: http://www.deletetheweb.com/unstuck/tank-sign.jpghttp://www.deletetheweb.com/unstuck/tank-sign.jpg Kosovo bridge sign

8 Skin Infections Source: http://children.webmd.com/slideshow-common-childhood-skin-problemshttp://children.webmd.com/slideshow-common-childhood-skin-problems “heat rash” Poison Ivy Source: http://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/picpage.asphttp://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/picpage.asp MRSA

9 Skin Infections – Heat Rash Cause - Occluded sweat ducts Tx – gentle cleaning, keep dry, antihistamine

10 Skin Rashes – Poison Ivy Tx – Dishsoap to break up oils on skin and clothes, clean dressing, ± MD visit

11 Methicillin-Resistant Staphylococcus Aureus (MRSA) Source: http://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/picpage.asphttp://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/picpage.asp

12 MRSA Locations – Existing cuts, hair follicles Transmission – Skin-to-skin or shared items –Towels, razors, soap, weights, etc… Tx – MD visit, use clean bandage, avoid contact with pus

13 Skin Rash – Prevention Heat Rash – Hygiene, mild soap Poison Ivy – Identify area, safety briefing MRSA –Handwashing, > 60% ETOH hand sanitizer –Individual soap / razors, wipe down surfaces –Cleaner / bleach (1 tablespoon / gallon) Eye, nose, throat irritation if overused –Isolate infected, medical care

14 Respiratory Diseases Source: http://media.photobucket.com/image/sneeze/chuan3205/sneeze_682_473022a.jpghttp://media.photobucket.com/image/sneeze/chuan3205/sneeze_682_473022a.jpg │---------- 12 feet? ----------- │

15 Influenza VirusVirus Types A,B,CTypes A,B,C

16 Influenza A H1N1 Central America origin? (Usually SE Asia)Central America origin? (Usually SE Asia) Predominant influenza strain worldwidePredominant influenza strain worldwide TransmissionTransmission Person-to-Person, mainly from coughing and sneezingPerson-to-Person, mainly from coughing and sneezing Also from contaminated surfaces and inanimate objectsAlso from contaminated surfaces and inanimate objects –NOT transmitted from: Eating porkEating pork Drinking waterDrinking water Recreational waterRecreational water

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19 Current US Influenza Activity During week 52 (December 27, 2009 – January 2, 2010), influenza activity decreased slightly in the U.S.(as of January 2, 2010) Case rates highest in persons 5-14 years old

20 Influenza – Treatment Symptomatic (fluids, rest, fever control) Oseltamivir (Tamiflu) Zanamivir (Relenza) –Symptoms for ≤ 2 days –Early Tx – Pregnancy & pre-existing diseases Stay home for at least 24 hours after your fever is gone –If you have to go out and you are ill, consider wearing a mask to prevent spreading germs to others

21 Influenza – Prevention Measures Cover your cough Hand washing Hand sanitizer –availability in group settings ↓ resp illness Avoid touching your eyes/nose/mouth Bed spacing ≥ 3ft –Head-to-Toe orientation

22 Influenza – Prevention Measures Vaccinations –Consider seasonal influenza vaccination –H1N1 vaccine now available everywhere Self-isolation of ill persons for observation Cleaning surfaces (heat, bleach, alcohols) –Infectious up to 8 hrs after contact with surface

23 Gastrointestinal Illness Staphylococcus aureus Norovirus Bacillus cereus Clostridium E. coli Salmonella Shigella Giardia Source: http://www.voiceinthedesert.org.uk/weblog/archives/images/norovirus.gifhttp://www.voiceinthedesert.org.uk/weblog/archives/images/norovirus.gif

24 Staphylococcus aureus – GI illness Pre-formed toxin –Bacteria grow on UN-refrigerated food and produce toxin –Irritate upper GI tract → vomiting Cause – Poor food handling practices Tx – Symptomatic, ± MD

25 Norovirus – GI Illness In US population (1999 estimates) –Estimated 76 million total cases / year –Estimated 23 million cases of norovirus ~ 38% of cases caused by norovirus

26 Norovirus – Transmission Infectious dose ≤ 100 particles Viable on surfaces for extended periods Rapid onset diarrhea / vomiting –Lasts ~ 24 Hrs. Excretion in stool 12 – 72 hours (2 Wks?) Norovirus scanning Electron Micrograph (CDC Public Health Image Library)

27 Norovirus – Transmission Foodborne –Sick handler –Poor food handling practices Person-to-person –Small infectious dose + long viability Occurs in –Schools, cruise ship, refugee camps, hospitals, etc…

28 Preventing Foodborne Illness Make sure foods are within their appropriate handling temps for a given time – 140 °F Certified Kitchen Manager course –http://www.dshs.state.tx.us/foodestablishment s/cfm.shtmhttp://www.dshs.state.tx.us/foodestablishment s/cfm.shtm “Design out” poor food handling processes –Sneeze guards, servers vs. self-serve

29 Discussion – Hand Washing Key features of a successful program –Accessible facilities –Leadership by demonstration –Personal interactions Courtesy CAPT George Vaughan, CDC, Vessel Sanitation Program

30 Discussion – Control of NV Ill people were less likely to believe in the efficacy of hand washing / hand sanitizer, know that hand sanitizer was available before an outbreak occurred, or practice hand washing Mark hand wash / sanitizer stations clearly –Notify the population about their presence and efficacy through multiple sources

31 Discussion – Hand Sanitizer Varying alcohol concentrations Contradictory research findings CDC advocates sanitizer as an adjunct Courtesy CAPT George Vaughan, CDC, Vessel Sanitation Program

32 Roadmap Review of common diseases and their prevention Resources Questions

33 Resources for IMTs - NPS InsideNPS; click swine flu (H1N1) under Hot Topics on right-hand side http://inside.nps.gov/waso/waso.cfm?lv =2&prg=122 http://inside.nps.gov/waso/waso.cfm?lv =2&prg=122 External website http://www.nps.gov/public_health/di/flu. htm http://www.nps.gov/public_health/di/flu. htm

34 Resources for IMTs - NPS ARC guidelines for shelters http://www.region4a- mrc.org/documents/2009march/AMERICAN%20RE D%20CROSS%20GUIDE%20FOR%20SHELTER %20MANAGERS.htmhttp://www.region4a- mrc.org/documents/2009march/AMERICAN%20RE D%20CROSS%20GUIDE%20FOR%20SHELTER %20MANAGERS.htm CDC Shelter assessment survey http://www.bt.cdc.gov/shelterassessment/ http://www.bt.cdc.gov/shelterassessment/ SPHERE guidance for minimum standards of water / sanitation http://www.sphereproject.org/http://www.sphereproject.org/ US Army recommendations for preventing acute infectious disease for close-quarter living http://usachppm.apgea.army.mil/documents/TG/TG 314.pdf http://usachppm.apgea.army.mil/documents/TG/TG 314.pdf

35 Questions? LCDR Antonio Neri MD, MPH US Centers for Disease Control and Prevention Work: 770-488-3378 Email: aneri@cdc.govaneri@cdc.gov CDC EOC 800-232-4636 770-488-7100 eocreport@cdc.gov


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