Epidemiology

Epidemiology is the study of the distribution and determinants of disease in a population. Public health epidemiologists monitor the health and illness of a population, investigate the factors that affect the community’s health, and recommend interventions to reduce the risk of disease. Epidemiology is practiced in health departments daily and involves principles of surveillance, investigation, laboratory testing, data management and communication. Call 804-205-3752 for more information.

washinghandsEpidemiological surveillance is the collection, analysis, and dissemination of health data for the planning, implementation, and evaluation of health programs. The Epidemiology Department at Richmond City Health District collects information in conjunction with the Virginia Department of Health’s Division of Surveillance and Investigation (DSI) in order to determine disease impact, assess trends in disease occurrence, characterize affected populations, prioritize control efforts, and evaluates prevention strategies in Richmond City.


Zika Virus Disease Information

zika-virus

Zika Fact Sheet

Contact Information

Communicable Disease Fax Line
804-371-2252

After Hours Emergency Number
866-531-3068

District Epidemiologist
Okey Utah, MBBS, MPH
804-205-3752
okey.utah@vdh.virginia.gov

TB Nurse
804-482-5498

STI/HIV Counselor
804-482-8007

District Deputy Epidemiologist Rabies Nurse
804-482-5488

Blue Bell Creameries Recall

A multi-state outbreak of Listeria infection linked to Blue Bell Creameries products continues to be investigated. To date, there have been 10 cases identified. No cases have been identified in Virginia. The most up-to-date information can be found on the CDC Multistate Outbreak of Listeriosis Linked to Blue Bell Creameries Products webpage.

Current Situation

Several strains of Listeria monocytogenes are involved in this outbreak. Information indicates that various Blue Bell brand products produced in facilities in Texas and Oklahoma are the source of this outbreak.

As of April 21, 2015, a total of ten people with listeriosis related to this outbreak have been confirmed from 4 states: Arizona (1), Kansas (5), Oklahoma (1), and Texas (3). Three deaths were reported from Kansas. No cases have been identified in Virginia.

Listeria

What is Listeriosis?
Listeriosis is a disease caused by eating food contaminated with the Listeria monocytogenes bacteria (germ). The bacteria are found in soil, food for horses and cattle, water, mud and silage. It is spread by ingesting raw or contaminated milk, soft cheeses, unwashed raw vegetables, undercooked poultry, and ready-to-eat meats (like cold-cuts). It can also be spread from a pregnant woman to her baby in the womb or during birth.

Who is most at risk and what are possible symptoms?

  • People with weakened immune systems and people over 65 years old: Symptoms can include fever, muscle aches, headache, stiff neck, confusion, loss of balance, and convulsions.
  •  Pregnant women: Pregnant women typically experience only a mild, flu-like illness. However, infection during pregnancy can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn.
  • Other people: Most healthy people can consume contaminated foods without getting ill. Occasionally, healthy people aged less than 65 years old may develop invasive (meaning the bacteria spread to the bloodstream or other sites) listeriosis. In addition, people exposed to a very large dose of Listeria bacteria can develop a non-invasive illness, and may develop diarrhea and fever.

Which Blue Bell products are being recalled:
As of April 20th, Blue Bell has voluntarily recalled all of its products made at all of its facilities in order to ensure Listeria contamination can be eliminated. Products include all Blue Bell brand ice cream, frozen yogurt, sherbet, and frozen snacks.
If recalled product(s) are or were in your home:

  • Return any recalled products to the place of purchase for a full refund or throw them away.
  •  If throwing away recalled products, dispose of recalled products in a closed plastic bag placed in a sealed trash can. This will prevent people and animals from eating them.
  •  For more information, consumers with questions may call 1-866-608-3940 Monday – Friday 8 a.m. – 8 p.m., Saturday 10 a.m. – 2 p.m. CST or go to www.bluebell.com.

What to do if you have eaten food contaminated with Listeria:
It can take between a few days to one month for someone infected with Listeria to show symptoms. It may take up to 70 days for pregnant women.  A person who ate a product recalled because of possible Listeria contamination and develops symptoms of listeriosis after eating the recalled product should consult their health care provider.
If you have eaten a recalled product and do not have any symptoms, most experts believe that tests or treatment are not needed.
Institutions and retailers:

  • Inspect freezers and inventory for Blue Bell products.
  • Do not serve or sell any Blue Bell products for the duration of the recall .

Resources for Health Care Prof

Communicable Disease Quarterly Report

Online Resource for Healthy Swimming


Online Resources

Office of Epidemiology
Home page for VDH’s Office of Epidemiology.  It will connect you with the Divisions of Surveillance and Investigation, Disease Prevention, Environmental Epidemiology, Immunization and Radiological Health.

Disease Regulation Information
Contains the complete regulations for disease reporting and control for Virginia.  You will also find the reportable disease list, conditions reportable by laboratories, outbreak reporting requirements and the reporting form (Epi-1).

Disease Fact Sheets
Contains all of VDH’s disease fact sheets. From head lice to whooping cough to West Nile Virus, this is the first stop for quick, reliable disease information. Fact sheets are also available here in Spanish.

Communicable Disease Chart for Schools
Direct link to the PDF.  Make sure to review the footnotes at the bottom of this document.  Last revised November 1st, 2011.  More information can be found in the VDOE School Health Guidelines(located at the bottom of the page).

Nursing Facility Regulations
Contains a line list of guidelines from VDH ’s Office of Licensure and Certification.  The Rules and Regulations for the Licensure of Nursing Facilities in Virginia can be found here.

VDSS Assisted Living Facility Regulations
Contains information on regulations, Code of Virginia, application process, guidelines, forms, training and more.

Successful Strategies for Infection Prevention & ControlThis toolkit contains infection prevention presentations, resources, and tools that have been adapted for the assisted living facility (ALF) and nursing home (NH) setting whenever possible. Much of the tools like infection prevention guidance, fact sheets and surveillance logs, however, are generally applicable to other settings.

EPA Registered Disinfectants
Contains listings of EPA registered antimicrobial products that are effective against HIV, Hepatitis B and C, Norovirus, MRSA and more.

FDA Bad Bug Book
Provides basic facts regarding foodborne pathogens and natural toxins

CDC Health Alert Network
Provides recent and archived health alerts, advisories, updates and informational messages regarding vital health information.

Lyme Disease

Lyme disease is a tick-borne illness caused by the bacteria Borrelia burgdorferi. Lyme disease is endemic, or commonly found, in Richmond, Virginia.  The blacklegged tick (Ixodes scapularis), formerly known as the deer tick, is the only carrier of Lyme disease in the Eastern U.S. Lyme disease transmission to humans usually occurs during the late spring and early summer. Transmission of Lyme disease does not occur until the tick has been attached to a human or animal host for at least 36 hours. There are several ways to prevent tick bites and Lyme disease.

If left untreated, Lyme disease may progress to affect the joints, nervous system, or heart several weeks to months after the tick bite. In a small percentage of infected people, late symptoms may occur months to years later and cause long-term nervous system problems or arthritis.

Graphic: Reported Cases of Lyme Disease- US, 2013: http://www.cdc.gov/lyme/stats/maps/map2013.html(CDC)

Frequently Asked Questions about Lyme Disease (CDC)

Brochure on Lyme Disease


Ebola Outbreak in West Africa

ebola ***Outbreak Update – June 3, 2015
According to http://apps.who.int/ebola/en/current-situation/ebola-situation-report-3-june-2015:

  • Since the week ending 10 May, when a 10-month low of 9 cases of Ebola virus disease (EVD) were reported from 2 prefectures of Guinea and 1 district of Sierra Leone, both the intensity and geographical area of EVD transmission have increased. In the week ending 31 May, a total of 25 confirmed cases were reported from 4 prefectures of Guinea and 3 districts of Sierra Leone. Several cases in both Guinea and Sierra Leone arose from unknown sources of infection in areas that have not reported confirmed cases for several weeks, indicating that chains of transmission continue to go undetected. Rigorous contact tracing, active case finding, and infection prevention and control must be maintained at current intensive levels in order to uncover and break every chain of transmission. However, the onset of the rainy season will make field operations more difficult from now onwards.
  • A total of 13 cases were reported from 4 western prefectures of Guinea in the week to 31 May. Most cases (7) were reported from the prefecture of Forecariah, which borders Sierra Leone. Multiple chains of transmission gave rise to cases in 4 of Forecariah’s 10 sub-prefectures, although all cases were either registered contacts of a previous case or had an established epidemiological link to one. The remaining cases were reported from the north-western prefecture of Boke (1 case), which borders Guinea-Bissau; the west-coast prefecture of Dubreka (4 cases), which borders the capital, Conakry; and the western inland prefecture of Fria (1 case).
  • Community engagement has proved challenging in all 4 affected prefectures of Guinea, with several reported incidents of violence directed at field staff during the past week. In addition, 4 of the 13 nationally reported cases were identified only after post-mortem testing of community deaths. Of those 4 community deaths, 2 were registered contacts, suggesting that even when contacts can be traced, regular monitoring to ensure they receive prompt testing and treatment as soon as symptoms arise remains a challenge.
  • As at 31 May, a total of 1880 contacts associated with reported confirmed cases were under follow-up in 6 Guinean prefectures: Boke, Conakry, Dubreka, Forecariah, Fria, and Kindia. A total of 461 contacts were under follow-up in 3 districts of Sierra Leone: Kambia, Port Loko, and Western Area Urban (the area that includes the capital, Freetown).

SOURCE: CDC WEBSITE

***Updated travel guidelines as of May 4, 2015 for Liberia: http://wwwnc.cdc.gov/travel/notices/alert/ebola-liberia

Current Situation
The countries of Guinea, Sierra Leone, and Liberia continue to experience an outbreak of Ebola. For the most up-to-date information, including case counts, visit the CDC Ebola Outbreak webpage.

Public health efforts to control disease transmission include:

  • Airport exit screening of travelers leaving countries experiencing widespread Ebola transmission. Travelers determined to have symptoms are detained for further evaluation.
  • Airport entrance screening of travelers from Ebola-affected countries entering the United States. Travelers are evaluated for symptoms and risk of Ebola exposure.
  • Post-arrival 21 day monitoring of all travelers from Ebola-affected countries entering the United States. Travelers from Guinea, Sierra Leone, Liberia, and Mali are monitored for 21 days by public health authorities.

What is Ebola?
Ebola hemorrhagic fever is one of several Viral Hemorrhagic Fevers. It a rare and deadly disease caused by one of the Ebola virus strains. People who become infected typically develop fever, headache, weakness, joint and muscle aches, diarrhea, vomiting, stomach pain, and loss of appetite. Some people may also begin to hemorrhage (bleed) inside and outside of the body. It is spread by direct contact (through broken skin or mucous membranes) with an infected person’s blood or body fluids, such as urine, saliva, feces, vomit, and semen. It is also spread through contact with objects (like needles) that have been contaminated with infected secretions. For more information, see the CDC Ebola fact sheet.

Risk in the U.S.
Transmission of the virus requires direct contact with an infected person’s blood or body fluids or contact with objects contaminated with infected secretions. Therefore, there is no significant risk for widespread transmission in the U.S.

Healthcare providers in the U.S.
CDC encourages all U.S. healthcare providers to

  • Take good travel histories of their patients to determine if they have traveled to Guinea, Sierra Leone, Liberia or Mali within the last 3 weeks.
  • Know the symptoms of Ebola—fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain and lack of appetite, and in some cases bleeding.
  • For symptomatic patients with recent travel to Guinea, Sierra Leone, Liberia or Mali or contact with a known case, isolate the patient properly, then follow infection control precautions to prevent spread.
  • Contact your local health department to discuss any suspected case and testing.

For complete Ebola Information for Healthcare Providers and Facilities, click here.

Information Resources
For more information about Ebola and what the Virginia Department of Health is doing, visit the VDH Ebola website or call 211.


Measles – Multi-state Outbreak Update

February 2015

measles-multi-state-outbreaksThe United States is currently experiencing a large, multi-state outbreak of measles linked to an amusement park in California. From January 1 to February 6, 2015, 121 people from 17 states in the U.S. have been reported with measles. Most of these cases are part of a large, ongoing outbreak linked to an amusement park in California. To date, there have been no reported cases of measles in Virginia this year.

The outbreak likely started from a traveler who became infected overseas with measles, then visited the amusement park while infectious. However, no source has been identified. For current details on the outbreak, visit the CDC Measles Multi-state Outbreak webpage.

Between 2009 and 2014, 13 cases of measleswere reported in Virginia. Six of these individuals were unvaccinated (three of whom were too young to receive vaccine), five were not fully vaccinated, and two were fully vaccinated. In Virginia, 88.6 percent of children have received the measles vaccine by their second birthday and 93.1 percent are fully vaccinated against measles when they begin school.

Measles is highly infectious, but it is also highly preventable through vaccination. The Virginia Department of Health urges persons who are not vaccinated or whose children have not been vaccinated, to receive vaccine as soon as possible. You may receive vaccine from your doctor or local health department. Virginia Code allows for exemption from required immunizations for religious and/or medical reasons; however, exemption rates remain low at 0.19 percent for medical and 0.84 percent for religious reasons.