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. Montana MonianaSlaloLibrary ll|||l!lll|l|IHIi 3 0864 1004 3455 7 Morbidity srm DocuMP.VTs collection Report MAY2C1991 ^r* 5 ,,.. ^ MONTANA STATE LIBRARY 1515 E. 6th AVE. HELENA, MONTANA 59620 •Xq^ VOL. 15:1 • •• / JAM(jA^Yv-^1991 Montana State Department of Health and Environmental Sciences ************************** ************************** * HIV/AIDS INFORMATION * * INDEX t * * * * ************************** ************************** AIDS Funding AIDS FUNDING l The Montana Department of Health and Environmental Sciences held an informa- SYPHILIS CASE DEFINITION 2 tional public hearing to solicit input on the Title II Comprehensive Plan for RESIDENT & NON-RESIDENT AIDS. 3 Montana, which describes the proposed use and distribution of assistance received MONTANA MORBIDITY 4 under Title II of the Ryan White Compre- hensive AIDS Resources Emergency Act of EPIDEMIOLOGY WORKSHOP 5 1990. The grant is to improve the quality, availability and organization of health care and support services for individuals and families with HIV infection, subsequent to the diagnosis of HIV infection. The hearing was held on February 20, 1991 in Helena. 2) Provide home-and community-based ser- A written copy of the proposed plan is vices for individuals with HIV disease. available and written comments are still (Similar to the current award granted invited by writing to Bruce Desonia, through 9/30/91, with the inclusion of AIDS/STD Program Manager, MDHES, Cogswell appropriate mental health, develop- Building, Helena, Mt. 59620. The mental and rehabilitative services as Department expects announcement of the an additional service available). award by April 1, 1991. 3) Provide assistance to assure the con- tinuity of health insurance coverage The services available under the grant are for individuals with HIV disease (we must demonstrate the funds are targeted 1) Establish and operate HIV care consor- to individuals who would not otherwise tia (of one or more public, one or more be able to afford'health insurance). nonprofit private, health care and sup- 4) Provide treatments, that have been port service providers and community- determined to prolong life or prevent based organizations) within areas most serious deterioration of health, to affected by HIV disease that shall be individuals with HIV disease, (similar designed to provide a comprehensive to our current AIDS Drug Reimbursement continuum of care to individuals and Program) families with HIV disease. Syphilig Case Definition Latent Syphilis Syphilis is a complex, sexually transmitted Clinical description: A stage of infection disease with a highly variable clinical due to Treponema pallidum in which organ- course, classification by a clinician with isms persist in the body of the infected expertise in syphilis may take precedence person without causing symptoms or signs. over the following case definitions Latent syphilis is subdivided into early, developed for surveillance purposes. late, and unknown syphilis categories based upon the length of elapsed time from init- Primary Syphilis ial infection. Clinical description: The characteristic Case classification: lesion of primary syphilis is the chancre, but atypical primary lesions may occur. Presumptive; no clinical signs or symptoms of syphilis and the presence Laboratory criteria for diagnosis: Demon- of one of the following: stration of Treponema pallidum in clinical specimens by darkfield, fluorescent anti- No past diagnosis of syphilis and body, or equivalent microscopic methods. a reactive nontreponemal test, and a reactive treponemal (fluorescent Case classification: treponemal antibody-absorbed [FTA- ABS], microhemagglutination assay Probable: a clinically compatible case for antibody to Treponema pallidum with one or more ulcers (chancres) con- [MHA-TP]) test, sistent with primary syphilis and a reactive serologic test. A past history of syphilis therapy and a current nontreponemal test Confirmed: a clinically compatible titer demonstrating fourfold or case that is laboratory confirmed. greater increase from the last nontreponemal test titer. Secondary Syphilis (STD case definitions taken from CDC's Clinical description: A stage of infection Morbidity and Mortality Weekly Report, Vol. due to Treponema pallidum, characterized by 39, no. RR-13, October 19, 1990.) localized or diffuse mucocutaneous lesions and generalized lymphadenopathy. Constitu- tional symptoms are common, and clinical manifestations are protean. The primary chancre may still be present. ************************** Laboratory criteria for diagnosis: Demon- stration of T. pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods. Vaccine Orders Case classification: We would like to remind the clinics it's Probable: a clinically compatible case time to place your vaccine orders again for with a reactive nontreponemal (VDRL, the next six months. The earlier we RPR) test titer of >4. receive your order, on the correct order form, the earlier we can fill your order. Confirmed: a clinically compatible If your have any questions in regards to case that is laboratory confirmed. your order, please call 444-5580. 2. MONTANA DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES MONTANA RESIDENT AND NON-RESIDENT AIDS CASES^ Acquired Immunodeficiency Syndrome (AIDS) Definitive and Presumptive AIDS Cases Surveillance Report - As of January 31, 1991 Adult/Adolescent/Pediatric Disease Category Cases %) Deaths %) ( ( POP '-34 43) 26 76) ( { Other Disease w/o PCP 44 55) 25 57) ( ( KS Alone 2 3) 0) ( ( No Diseases Listed 01 _Q_J Oi ( Total 80 100) 51 64) ( ( 2. Age Cases 11 ( Under JANUARY 1991 ***************************** t EPIDEMIOLOGY WORKSHOP * * * ************************** Hutchinson Cancer Research Center in A two-part chronic disease epidemiology Seattle. His primary research activity has workshop will be held March 13-15, and May focused on cancer epidemiology. He is 15-17, 1991 at the Coach House East in presently involved in studies of adverse Helena. The workshop is co-sponsored by reproductive outcomes and cardiovascular the Montana Department of Health and disease. Environmental Sciences, the Montana Medical Association, the University of Washington Applications have been submitted for con- School of Public Health and Community tinuing education credit for nurses and Medicine and the Montana Area Health dietitians. MMA has approved 26 hours of Education Center. Registration for the CMEU's for full attendance at the 4-day two-part course is $25. workshop. For more information about the epidemiology workshop, contact Bob Moon at Targeted to state and local health program 444-4488 or Marsha McFarland at 444-2555. managers, the workshop is designed to provide the skills and knowledge needed to plan, implement and integrate programs to reduce chronic disease in Montana. The 4- **************************** day workshop will be most effective for those whose job responsibilities include making program and policy decisions based on surveillance data or allocating resources for chronic disease programs. SalmonelloaJB Surveillance Faculty members include Steven Helgerson, This is to alert you to a potential problem MD, MPH; Mark W. Oberle, MD, MPH; Stephen and ask you to increase surveillance for Schwartz, PhD, MPH; and Todd Damrow, PhD, Salmonellosis for several months. We would MPH. Todd Damrow, PhD, MPH, is the newly- also encourage you to obtain testing on assigned Montana state epidemiologist. Dr. diarrhea stools in patients who present Damrow was formerly a microbiologist and with at least 2 days of diarrhea and other epidemiologist with the Washington Depart- symptoms consistent with a bacterial ment of Health. infection, such as fever. We encourage laboratories to refer Salmonella isolates Dr. Helgerson is senior epidemiologist for to the Montana Department of Health and the Indian Health Service and area epi- Environmental Sciences Public Health demiologist for the Portland and Billings Laboratory for further analysis. Indian Health Service Headquarters. He has 17 years of field experience in epidemio- After discussions with the Centers for logy and has contributed many research Disease Control, we would also like to take articles to the science of epidemiology. this opportunity to remind you raw shell eggs are now considered a hazardous food. Dr. Oberle is Assistant Dean for Public This means they must be refrigerated during Health Practice, School of Public Health storage and thoroughly cooked before eating and Community Medicine, University of to minimize the risk of transmission of Washington. He previously was acting pathogens, primarily Salmonella The . director for Science, Center for Health northeastern United State has been having Promotion and Education at the Centers for a Salmonellosis outbreak for approximately Disease Control He has both international 5 years and the source has been traced to and domestic experience in epidemiology. shell eggs from infected flocks. Persona whose health is compromised by various Stephen M. Schwartz, PhD, MPH, is Assistant conditions are at greater risk of Professor of Epidemiology at the University developing Salmonellosis and subsequent of Washington. Dr. Schwartz also serves as severe sequelae such as sepsis. affiliate investigator at the Fred AIDS cases per 100.000 population - United States, January-December 1990 ) 5, MonlanaStaleL : i , '|'{'l'|'||l'||'l"""' ' llllll'I'l' lwXOn.L2L9!lA ^ f5 No.Z- 3 0864 1004 3454 Morbidity ^^^ ReOOrt CCCt/MFNTS COLLPCLON '^^^[^j^VSTATE LIBRARY VOL. 15:2 "^LENA. MONMNA^Igg^o February, 1991 Montana State Department of Healt±L and Environmental Sciences New Staff and Position Changes INDEX at MDHES AIDS/STD Program AIDS/STD STAFF CHANGES 1 Kathy Anderson has recently been promoted HOTLINE UPDATE 1 from Public Health Educator to the Program CASE DEFINITIONS 2 Officer. CONGRATULATIONS KATHY Kathy can RESIDENT & NONRESIDENT AIDS 3 1 still be reached at 444-3556. MONTANA MORBIDITY 4 LEGIONELLOSIS & HOT TUBS? 5 We also have a new administrative aide. NEW STATE EPIDEMIOLOGIST 5 Jeannie Thrush comes to our department from the Department of Revenue, Property Assessment Division. She is a Montana native who moved to Helena 4 1/2 years ago if-k-k-k-k-k-k-k-k-k-k-tt-k-k-k-k-k-k-k-klt from her hometown of Missoula. She is a *******H*IV*/A*ID*S *IN*FO*RM*AT*IO*N****** newlywed who loves to play the piano and ride horses. Welcome to the program! Hotline Update! Another change is that we have recently changed our phone system. Please do not The Montana Department of Health and use the 444-4740 number any longer. You Environmental Sciences AIDS Hotline has may reach our program through 444-3565 (STD been updated! The AIDS Hotline is recorded Program at 444-3949) or through the staff's messages on a variety of HIV-related extensions, which are as follows: issues. The changes to the hotline are not only new information but new categories as Judy Gedrose 444-4748, Bureau Chief well. We have combined "How to Protect Bruce Desonia 444-2457, Program Manager Yourself" and "How to Use a Condom Kathy Anderson 444-3566, Program Officer II Correctly," in order to make space for a Jim Murphy 444-4744, Health Officer I section on Infection Control to prevent HIV (Surveillance and ADRP) and HBV exposure. This section will also Amy E. Harris 444-2675, Public Health be updated as soon as the CDC proposes it's Educator (CEOs, CTS, etc) new recommendations on preventing patient Karen Winden 444-2454, Administrative exposure from Health Care Workers with HIV. Assistant (Contract info. The MDHES AIDS Hotline's number is 1-800- Jeannie Thrush 444-3565, Administrative 233-MONT (6668). Other local Hotline Aide (brochures, videos etc) numbers are: Out In Montana 1-800-336-4297 and for eastern Montana Yellowstone AIDS Valinda Holmes 444-3949, Administrative Project, 1-800-675-2437. The National AIDS Clerk Hotline is 1-800-342-2437. Paul Lamphier 444-1604, Field Health Officer \ i".-.^'- fe» ^rt -N :' » Case Definitiong (STD case definitions taken from CDC's Case classification: Morbidity and Mortality Weekly Report vol. , 29, no. RR-13, October 19, 1990) Probable: A clinically compatible case (in which primary and secondary syph- CHLAMYDIA TRACHOMATIS INFECTION ilis has been ruled out by serology and darkfield microscopy, when available) Clinical description: Infection with Chla- with either a diagnosis of genital mydia trachomatis may result in urethritis, herpes based on clinical presentation epididymitis, ceryicitis, acute salpin- (without laboratory confirmation) or a gitis, or other syndromes when sexually history of one or more previous epi- transmitted. Perinatal infections may sodes of similar lesions. result in inclusion conjunctivitis and pneumonia among newborns. Other syndromes Confirmed: A clinically compatible that can be caused by C. trachomatis case that is laboratory confirmed. include lymphogranuloma venereum (see Lymphogranuloma Venereum Infection) and Comment: Herpes should be reported only trachoma. once per patient. The first diagnosis for a patient with no previous diagnosis should Laboratory criteria for diagnosis: be reported. Isolation of C. trachomatis by culture, or GONORRHEA Demonstration of C. trachomatis in a Clinical description: A sexually trans- clinical specimen by antigen detection mitted infection commonly manifested by methods. urethritis, ceryicitis or salpingitis. Infection may be asymptomatic. Case classification: Laboratory criteria for diagnosis: Confirmed: A case that is laboratory confirmed. Isolation of Neisseria gonorrhoeae from a clinical specimen or GENITAL HERPES (HERPES SIMPLEX VIRUS) Observation of gram-negative intracellular diplococci in a urethral smear Clinical description: An illness charac- obtained from a man. terized by visible, painful genital or anogenital lesions. Case classification: Laboratory criteria for diagnosis: Probable: Demonstration of gram- negative intracellular diplococci in an Isolation of herpes simplex virus from endocervical smear obtained from a cervix, urethra or anogenital lesions, woman, or a written (morbidity) report or of gonorrhea submitted by a physician. Demonstration of virus by antigen Confirmed: A clinically compatible detection technique in clinical case that is laboratory confirmed. specimens from cervix, urethra, or anogenital lesion, or Demonstration of multinucleated giant cells on a Tzanck smear of scrapings from an anogenital lesion. MONTANA DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES NONTANA J RESIDENT AND NON-RESIDENT AIDS CASES' Acquired Immunodeficiency Syndrome (AIDS) Definitive and Presumptive AIDS Cases Surveillance Report - As of February 28, 1991 f t Ul FEBRUARY 1991 6 Boaverhead BigHorn Blaine Broadwater Carbon CaMer Cascade Chouteau Cusler Daniels Oavwson DeerLodoe Fallon Ferous Flc'nead Gallatin GarJield Glacier GoldenValtey Granite Hill Jetlerson JudithBasin Lewis&Clark Liberty Lincoln McCone Madison Meagher Mineral Missoula Musselshell Park Petroleum Philliigs_ Pondera PowderRiver Powell Prairie Ravall Richland Roosevelt Rosebud Sanders Sheridan SilverBow Stillwater SweetGrass Teton Toole Treasure Valley Wheatland Wibaux Yellowstone