Mumps in Iowa-
If you suspect a case of Mumps in Garrett County, call the health department [(301) 334-7770] so we can help you get a definitive (and free) serologic diagnosis and do an epidemiologic study. The most recent details were reported May 18 in the MMWR. Click Here to access MMWR.
Public health officials have been unable to determine the source of the current outbreak. However, the strain has been identified as genotype G, the same genotype circulating in the United Kingdom (UK). The outbreak in the UK has been ongoing since 2004 and has reached more than 70,000 cases.
From December 2005 through April 12, 2006, 605 cases have been reported to the Iowa Department of Public Health. There have been over 20 hospitalizations but no deaths. Meningitis, oophoritis, mastitis, loss of hearing, spontaneous abortion and orchitis are among its serious complications. The majority of cases are occurring among people 18-25 years of age, many of whom have been vaccinated. The principal strategy to prevent mumps is to achieve and maintain high immunization levels. The Advisory Committee on Immunization Practices (ACIP) recommends all preschool aged children 12 months of age and older receive one dose of measles-mumps-rubella vaccine (MMR) and all school-aged children receive two doses of MMR. Additionally, during outbreaks and for at-risk populations, the CDC recommends high vaccination coverage with two doses.
Communicable Diseases Incidence-
C. difficile infections in a newborn and in adults are reported by several physicians. Click Here for the CDC review.
Immunization Requirements for the 2006-2007 School Year -
At School Entry the major change is that MMR immunizations that were given up to 4 days before a child's first birthday are now acceptable as a first dose. All Pre-schoolers and Kindergarten children up to age 5 are now required to have Pneumococcal Conjugate Vaccine PCV7 (Prevnar); the number of doses depends on the age of the child. Similarly, a child at age 5 (60 months) or at kindergarten entry is now required to have a second MMR in any child care or educational setting. Children in Grades 6-9 will now (next school year) be required to have a Hepatitis B series of 3 and a Varicella immunization or documented history of the disease (parental statement of month/year & symptoms to the public or school health nurse meets this requirement, or a serology can be drawn). This is another year of incremental increases in requirements for older children that had been previously established. All school-entry immunizations are being entered into Immunet (www.mdimmunet.org/), the state immunization registry, except when a parent opts out. This will be a handy reference for registered physicians in the future.
Pandemic Influenza -
Try to emphasize to your patients the difference between Avian
Flu and Pandemic Flu ; Avian Flu will certainly be coming to the Western Hemisphere , but there is no evidence at this time that it is having the genetic changes which would allow it to pass from human-to-human while retaining high pathogenicity for humans and thus cause an Influenza Pandemic. Surveillance for antigenic shifts by all influenza strains continue, as does testing of susceptibility of these new strains to anti-virals. Vaccines for protection from an H5N1 virus are being developed. Large grants have been awarded to develop viral culture methods for vaccine production that do not utilize chicken eggs, to speed up the process.
A special checklist has been developed by the CDC for doctors' offices to help them plan and prepare their practice and office in advance for a pandemic. Click Here for checklist.
The latest version of the Federal Pandemic Influenza Plan was released May 3, and adds additional areas of consideration. The basics of prevention continue to be infection control: voluntary home isolation, respiratory hygiene, hand washing and social distancing. Face masks for the general public are not of proven benefit, but can be used voluntarily. Although the current influenza virus is thought to spread by droplets, (surgical mask adequate) healthcare workers directly caring for patients may start with airborne precautions, (N95 mask, etc.) until the level of contagiousness of a pandemic virus is established by studies. Click Here to access plan.
Lead Screening by School Entry -
All children must present evidence that they have had at least one blood test for entry to school, as the entire county is considered to be a high-risk area for lead poisoning. Health regulations recommend blood tests for lead for children at 12 and 24 months of age, but this is not enforceable for mandatory compliance. Testing earlier than 12 months may be at the recommendation of the physician; indeed, damage could already have occurred at an earlier age. Dr. Maureen Edwards of the state health department will be presenting a continuing education session here Friday, June 23, on the occurrence, prevention and treatment of lead poisoning in our state.
Medicare Part D-
A standard PDF form has been released for physicians to request approval for exceptions to a particular drug plan's formulary: Model Part D Exception and Prior Authorization Request Form. The physician still has to find where to send the form (different for each drug plan), and completion of the form does not guarantee that the request will be granted. Click Here for form.