Infectious Diseases and the
Impact on Our Schools
Mary G. McIntyre, MD, MPH
State Epidemiologist
Assistant State Health Officer for
Disease Control and Prevention
OBJECTIVES
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Define “the Public Health System”?
“What we do?”
Review of Disease Control and Prevention’s Structure
What is your role?
Examples
Questions
Mission Statement
for
Bureau of Communicable Disease
The mission of the Bureau of Communicable
Disease (BCD) is to prevent and control
designated communicable diseases and illness
in Alabama.
Bureau of Communicable Diseases
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Epidemiology
HIV/AIDS
Immunization
Sexually-transmitted Diseases
Tuberculosis
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Epidemiology Mission
Statement
To protect the residents of Alabama through
constant monitoring of the incidence and
prevalence of communicable, zoonotic, and
environmentally-related human disease.
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Epidemiology Division
Branches
• Analysis and Reporting
• Infection Control
– Healthcare-associated Infections*
– Infected Healthcare Workers Program*
• Surveillance
• Toxicology
• Zoonotic
*Call 1-800-338-8374 and
ask for Infection Control
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Mission Statement
for
Bureau of Clinical Laboratories
The mission of the BCL is to give laboratory
support for public health programs and make
policy decisions that protect and promote the
health of the citizens of Alabama.
BCL Locations and Branches
Montgomery
Mobile
• Clinical Chemistry
• Clinical
• Metabolic
• Environmental
• Microbiology
• Respiratory
• Sanitary
Bacteriology/Media
• Serology
www.adph.org/bcl
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HIPAA
ADPH is a public health authority as defined by
the Health Insurance Portability and Accountability
Act (HIPAA) to collect or receive protected health
information (PHI) for the purpose of surveillance,
investigations, and interventions of notifiable
diseases, without authorization of the patient.
http://www.cdc.gov/mmwr/preview/mmw
rhtml/m2e411a1.htm
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Outbreaks
• An outbreak is defined as illness in 2 or
more people, from separate households,
with a common exposure.
• “An outbreak” can occur in any of the BCD
divisions (STD, HIV, TB, STD, IMM or
EPI)
• Most often occurs in EPI due to the number
of potential diseases falling under this area
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Notifiable Diseases/Conditions
• Purpose of Notifiable Diseases
• ADPH administrative code authorizes and
requires reporting,
http://www.alabamaadministrativecode.state.al.us/docs/hlth/index.html
• ADPH is exempt from HIPAA Privacy Rules,
http://www.cdc.gov/mmwr/pdf/other/m2e411.pdf
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Surveillance Pyramid
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Immunization
The goal of the Immunization Division is to stop the
spread of diseases that are vaccine preventable by
providing vaccine to the citizens of Alabama,
educating the medical personnel and the public on the
importance of vaccinations, and ensuring that
children who are in day care, Head Start, and school
are adequately immunized against diseases that are
harmful and sometimes deadly.
Tuberculosis
The ultimate goal for the Division of Tuberculosis
(TB) Control is the elimination of tuberculosis in
Alabama. Until that goal is reached, the Division
strives to reduce the annual burden of disease, limit
transmission and prevent future cases through the
provision of diagnostic, treatment, and case
management activities. The Division of TB Control
provides these services to all persons in Alabama,
regardless of the ability to pay. This commitment to
the citizens of Alabama has contributed to historic
declines in TB morbidity and mortality.
STD
The Division of STD Prevention and Control is
charged with identifying populations at increased
risk for infection in order to reduce their chances
of developing a sexually transmitted disease
(STD), transmitting it to others, and/or developing
related complications. Statewide disease
intervention staff provide screening, diagnostic,
education, treatment, partner notification, and
referral services in every county of Alabama.
HIV
• The mission of the Division of HIV/AIDS Prevention
and Control, in collaboration with community
partners, is to reduce the incidence of HIV infections,
to increase life expectancy for those infected, and to
improve the quality of life for persons living with or
affected by HIV. The charge of the Division is to:
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monitor the epidemic
improve public understanding of HIV
prevent or reduce behaviors that transmit HIV
increase individual knowledge of HIV serostatus
strengthen systems for referral to appropriate prevention and
treatment services
Who Must Report
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Physicians
Dentists
Nurses
Medical Examiners
Hospital Administrators
Nursing Home Administrators
Laboratory Directors
Who Must Report
• School Principals
• Day Care Center Directors
– We expect and want multiple reports
EXAMPLE 1
FOODBORNE ILLNESSES
What is Foodborne Illness?
Foodborne Illness
• AKA – foodborne disease
• What is it?
– illness resulting from the consumption of food
– commonly known as food poisoning,
– can be caused by consuming a food contaminated
with a chemical or natural toxin, or pathogens
(bacteria, viruses, parasites)
– contamination can occur before, during, and after
food preparation
Stomach Pain
Diarrhea
Vomiting
Not the flu!?
These are symptoms of a
FOODBORNE ILLNESS
Did you know?
According to the Center
for Disease Control:
76 million become
ill due to food / year
325,000 hospitalized
5000 die / year
How Many Are There?
• There are more than 250 known foodborne
illnesses.
What Foods Are Most Likely to be
Contaminated?
• raw meat and poultry
• raw eggs (even in uncooked brownie, cake, or
cookie dough)
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unpasteurized milk
raw shellfish
unwashed raw fruits and vegetables
unpasteurized fruit juice
How Do You Know If You Have
Foodborne Illness?
• Onset of symptoms can occur in hours to
days of food consumption
– known as the incubation period
• Symptoms vary
– mild to severe (requiring hospitalization)
• Common symptoms include:
– diarrhea, abdominal cramps, and nausea
Am I at Risk?
• YES
– 76 million cases of foodborne illness occur
each year in the U.S.
– pregnant women, infants, the elderly, and
those weakened immune systems are at greater
risk for foodborne illness
What Can I Do?
• Follow these simple guidelines:
– CLEAN
– COOK
– CHILL
– LEFTOVERS
Food Poisoning and
Foodborne Illness
Can be caused by eating food contaminated with:
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BACTERIA
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VIRUS
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TOXINS
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CHEMICALS
What Are the Most Common
Causes of Foodborne Illness?
• Those caused by the bacteria:
– Campylobacter
– Salmonella
– E. coli O157:H7
• Those caused by a group of viruses:
– Norwalk and Norwalk-like viruses
Campylobacter
Found in the intestinal tract of birds,
sheep, cattle and on the surface of
raw poultry.
Salmonella
Found in the intestines of birds,
reptiles, & mammals.
E-coli 0157:h7
 Lives in cattle & other similar animals.
 Found in raw meat, non-pasteurized
milk, apple cider, sprouts.
Influenz
Norovirus
The cause of HALF of all foodborne
illness.
Spread by
hand contact with food
food placed on a surface that is contaminated
by the virus
or when virus is airborne.
Cold foods such as
sandwiches & salads are
often associated with
Norovirus.
Norovirus
Starts suddenly.
Causes diarrhea, vomiting,
abdominal cramps, headache,
low-grade fever, chills &
muscle aches.
Often called the flu.
Symptoms begin 12 to 48
hours after ingestion of the
virus.
Recovery in 2-3 days but may
remain ill for up to 2 weeks.
HEPATITIS A VIRUS
Another
Foodborne Illness Virus
Possible sources include by shellfish, salads,
deli meats fruits, milk and milk products
Symptoms include sudden onset of fever,
general discomfort, fatigue, headache, nausea,
loss of appetite, vomiting, abdominal pain &
jaundice after several days.
Lasts 1 to 2 weeks (severe cases up to several
months).
Biological Toxins
Biological Toxins are
produced by some
pathogens found in food
contamination.
They could also come
from a plant or animal.
Bacterial Toxins
Some bacteria produce
poisons or toxins that cause:
FOODBORNE ILLNESS
(sometimes intentional)
Staphylococcus aureus
Commonly associated with
food service.
Staphylococcus Aureus
produces a toxin that causes
serious vomiting and
stomach cramps.
Clostridium Botulinum
Toxin producing bacteria
Causes botulism
Symptoms are nerve related and can
cause muscle paralysis
Symptoms typically occur
8 to 36 hours after
or as late as 10 days
Lasts several days to 1year
CHEMICAL POISONING
Careless or
improper storage of chemicals
Improper use of chemicals
Improper labeling
Sometimes intentional
addition of poison
CHEMICAL POISONING
Always store cleaners and
chemicals below your food or
food surfaces.
Choose pesticides that are
approved for use in the kitchen.
What Can I Do?
• Follow these simple guidelines:
– CLEAN
– COOK
– CHILL
• LEFTOVERS
CHILL OUT………
Refrigerate leftovers promptly:
Bacteria grows quickly at
room temperature, so
refrigerate leftover foods
within 2 hours.
Food will cool more quickly if divided into
several shallow containers for
refrigeration.
WASH YOUR HANDS
OFTEN
Especially:
When preparing food.
After using the bathroom.
Avoid direct contact with public restroom
doorknobs. (use paper towel to open door)
WHEN WASHING
YOUR HANDS
Use warm, soapy
running water.
Rub your hands
thoroughly, scrubbing
between fingers, and
nails for:
10–15 SECONDS.
Fruits & Vegetables
Do’s &
Don’ts
Do wash your hands with
soap and water before
preparing food.
Do rinse fresh fruits &
vegetables with cold water.
Do refrigerate at a
temperature of 40o F or less.
Do throw away items that
have come into contact with
raw meat or chemicals.
Do not prepare food for
others if you yourself have
diarrhea.
Do not use bleach or soap
on fruits & vegetables.
Do NOT eat fresh cut items
left un-refrigerated for > 2
hours.
Do not eat bruised or
damaged fruits & vegetables.
Safe Preparation
of Raw Meats
A few simple precautions can reduce
the risk of foodborne diseases:
COOK
SEPARATE
CHILL
REPORT
SEPARATE:
Don't crosscontaminate one
food with another.
Avoid cross-contaminating foods by washing
hands, utensils, and cutting boards after they have
been in contact with raw meat or poultry.
Put cooked meat on a clean platter rather than
back on one that held the raw meat.
If in doubt as
to the safety
of your food,
THROW IT OUT!!
I’m Telling….
REPORT:
Foodborne illnesses to your
LOCAL HEALTH DEPARTMENT.
Your local health department
works hard to track down the
causes of the foodborne illness.
Prevent Food Poisoning
The Bottom Line
• Keep Hot Food Hot
• Cold Food Cold
• Keep Everything Clean
• Especially: Wash Your Hands
• Don’t go to work sick.
Assemble a Team
Everyone Has a Role in
the Safety of Food
National Coalition for
Food Safe Schools
Action Guide and Tool Kit
www.foodsafeschools.org
www.neha.org
This Children's Environmental Health
presentation was made possible
through a grant from
The Dow Chemical Company
Foundation
Credits
• Charles Lichon, R.S., M.P.H., Creator of Children’s EH Program,
Midland County Health Department (CHD) Michigan
• Nancy Atwood, M.S., Midland CHD (MI) Sanitarian
• Christine Rogers, Meth Response Coordinator, Kalamazoo CHD,
MI
• Gayle Blues, Midland CHD, layout and design
• Robert Wolfe, R.S., Midland CHD (MI) Sanitarian
• John Demerjian and Linda Van Orden, Wayne CHD, MI, Body Art
• National Environmental Health Association (NEHA.org) for
website storage and oversight.
NOTE: Permission to use this and all Children’s EH Power Point
presentations is granted thru NEHA, however, all grant and credit notices &
informational slides must be used during each presentation.
EXAMPLE 2
TUBERCULOSIS
Basic TB Facts
• Tuberculosis (TB) is caused by a bacterium
called Mycobacterium tuberculosis.
– the bacteria usually attack the lungs, but TB
bacteria can attack any part of the body such as the
kidney, spine, and brain
– if not treated properly, TB disease can be fatal
– in the past, TB was the leading cause of death in
the United States
– today, TB is still a leading cause of death across
the globe
How TB Spreads
• TB is spread through the air from one person
to another
– the TB bacteria are expelled when a person with
TB disease of the lungs or throat coughs, sneezes,
speaks, or sings
– people sitting or working nearby may breathe in
these bacteria and become infected
• Do you know the guy in the next slide?
How TB is Controlled
• Public health interventions are designed to
interrupt TB transmission
• How do we accomplish that task?
– identify and treat-to-cure those with active TB
disease, and
– identify, evaluate, and preventively treat
contacts through disciplined use of public
health tools and methodologies
Concentric Circle Approach
(an important methodology in contact follow up)
Household
Other-than-Close Contacts
Close Contacts
Leisure
INDEX
PATIENT
Work /
School
TB is NOT spread by:
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Shaking someone’s hand
Sharing food or drink
Touching bed linens or toilet seats
Sharing toothbrushes
Kissing
TB Infection
• TB bacteria can live in the body without
making you sick - this state is called TB
infection
• Most people who breathe in TB bacteria and
become infected are able to fight and contain
the bacteria to stop them from multiplying
• People with TB infection do not feel sick and
do not have any symptoms
• People with TB infection are not infectious
and cannot spread TB bacteria to others.
TB Disease
• Also called “active TB disease” because the
body’s immune system can't stop the bacteria
from “actively replicating” or multiplying
• People with TB disease are sick and will likely
have symptoms
– persons with pulmonary or airway disease may
be capable of spreading the bacteria to other
people they spend time with every day
Symptoms of TB Disease
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Bad cough that lasts 3 weeks or longer
Chest pain
Coughing up blood or sputum
Weakness or fatigue
Weight loss / Loss of appetite
Fever / Chills
Night sweats
Infection vs. Disease
• Positive TB Skin
Test
• Normal Chest XRay
• No symptoms
• Cannot transmit to
others
• May be treated
preventively
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Positive TB Skin Test
Abnormal Chest X-Ray
Has symptoms
May transmit to others
May be treated and
cured
Testing for TB Infection
• There are two kinds of tests that are used to
detect TB bacteria in the body: the tuberculin
skin test (TST) and TB blood tests. These tests
can be accessed through your health care
provider or, in certain cases, through TB staff in
your public health area.
• If you have a positive reaction to either of the
tests, a chest X-ray is indicated to see if you have
TB disease.
Treatment for TB Infection
• If your chest X-ray is clear and TB disease
is ruled out, we may want to treat you to
keep you from developing TB disease
• Treatment of TB infection is often called
“preventive therapy” because it reduces the
risk that TB infection will progress to
active TB disease in the future
How TB Control is Organized in
Alabama
• Each Public Health Area has a TB team: this team
may include a Manager, a Nurse, a Disease
Intervention Specialist, and an Administrative
Support Assistant
• This team is responsible for executing the TB
Protocol and the provision of TB control services
in their respective area
• One important take away point is that your local
TB expert is just a phone call away!
Take away points…
• TB is an infectious disease that touches the lives
of hundreds of Alabamians each year.
• TB cases and their contacts receive expert care at
no cost from dedicated public health physicians,
nurses and staff.
• TB control efforts have been successful, but
continued vigilance and response capacity is
required to protect the public health.
Take away points…
• TB screening for school employees should
be reserved for new hires with risk factors
for tuberculosis
• Contact your local TB expert if anyone
(i.e., student, faculty, or other staff) exhibit
symptoms of active TB disease.
DISCUSSION AND QUESTIONS