The Butler County Health Department receives Health Alerts as they are issued by the Missouri Department of Health and Senior Services, the Centers for Disease Control along with other state and federal agencies.

These Health Alerts concern the public’s health and well being in cases of Biological Threats, Suspicious Letters and Packages. Sampling and submission of samples for analytical testing.

Operating procedures in the case of such an event in our community.

The Butler County Health Department works closely with our local Medical Facilities, the Fire Departments, Law Enforcement and Emergency Management Agencies.

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Health Guidance

July 12, 2018

FROM:           RANDALL W. WILLIAMS, MD, FACOG DIRECTOR

 SUBJECT:    Tick-Borne Disease Health Guidance

Summary

The Missouri Department of Health and Senior Services (DHSS) alerts healthcare providers that reports of tick-borne illnesses in 2018 are higher than the five-year median for the period 2013 through 2017. Many cases are still under investigation and case numbers are subject to change. Each year, Missouri experiences a substantial disease burden due to a variety of tick-borne illnesses including tularemia, ehrlichiosis, Rocky Mountain spotted fever (RMSF), and other spotted fevers. Other tick-borne illnesses have also been reported in Missouri, including Lyme disease and disease cause by Heartland and Bourbon viruses, but the number of cases identified for these diseases remains low.

Tick-borne Rickettsial Disease (TBRD)

Ehrlichiosis and RMSF are transmitted primarily through the bites of the lone star and American dog ticks, respectively. Tick-borne disease agents from the Rickettsiales order most frequently reported in Missouri are Ehrlichia chaffeensis (ehrlichiosis); E. ewingii (ehrlichiosis); and Rickettsia rickettsii and other Rickettsia species (RMSF and other spotted or eschar-associated illnesses).

In 2017, Missouri reported over 900 cases of TBRDs. As of July 9, 2018, reports of TBRDs are elevated compared to the five-year median for the period 2013 through 2017.

TBRDs can cause acute illness similar in initial presentation to many viral and bacterial febrile infections. Peak transmission of these tick-borne agents can continue into early August. Active transmission in Missouri typically is observed from late March through early October. TBRDs can cause severe illness and death in otherwise healthy adults and children. Diagnosis and treatment of these illnesses must be made on the basis of clinical signs and symptoms, and can later be confirmed using molecular and serological laboratory tests.

The standard for confirming a diagnosis of rickettsial infection is to perform an immunoglobulin G (IgG) indirect immunofluorescence antibody assay (IFA) on paired acute and convalescent phase specimens taken 2 to 4 weeks apart. During the first week of illness, when most patients seek medical care, antibodies are unlikely to be elevated. As the illness progresses past 7 days, however, the sensitivity of the IFA IgG assay increases in tandem with pathogen-specific antibody production. Because of its longevity and problems with cross-reaction, use of immunoglobulin M (IgM) antibody assays for TBRDs should not be used as a stand-alone method for diagnosis of these conditions.

 

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