Macy’s at Roosevelt Field Mall

630 Old Country Rd

Garden City, NY 11530

January 20 (Thursday) from 3pm to 10:30pm

1) Report all suspect measles cases immediately (DO NOT WAIT FOR LABORATORY CONFIRMATION) to the Bureau of Communicable Disease Control at 516.227.9496 during business hours or 516.742.6154 evenings, weekends and holidays.

2) Patients with febrile rash illness should notify staff before arriving so that they may be placed in isolation immediately.

3) Offer measles vaccine or immune globulin to susceptible exposed contacts.

4) Assure that all those eligible for MMR vaccine receive appropriate and timely

vaccination.

5) Please contact Bureau of Communicable Disease Control at 516.227.9496 during business hours or 516.742.6154 evenings, weekends and holidays.  As always, your cooperation is greatly appreciated.

Providers are encouraged to consider and test for hepatitis A in patients with jaundice, abdominal pain, fever, nausea, and diarrhea with a history of exposure at these masses. Providers should report suspected and confirmed cases of hepatitis A promptly to NCDOH at 516.227.9496. Suspected cases of hepatitis A in a food worker should bereported immediately.
BACKGROUND
Hepatitis A is caused by the hepatitis A virus. Hepatitis A virus may be spread by consuming food or drink that has been handled by an infected person. It may also be spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. Casual contact, as in sitting in church during mass, office or school setting, does not spread the virus.
The symptoms of hepatitis A may range from mild to severe and include an abrupt onset of fever, fatigue, poor appetite, nausea, stomach pain, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). The disease is rarely fatal and most people recover in a few weeks without any complications. The symptoms commonly appear within 28 days of exposure, with a range of 15-50 days. There are no special medicines or antibiotics that can be used to treat a person once symptoms appear. Generally bed rest is all that is needed. Thorough hand washing after bathroom use and before, during and after food preparation is the most important means to prevent the spread of this and other intestinal illnesses. Sharing of food and utensils should be discouraged especially whenever anyone is ill.
RECOMMENDATIONS FOR PROPHYLAXIS OF EXPOSED PERSONS
The Centers for Disease Control and Prevention (CDC) recommends that persons who are not protected and are within 14 days of exposure receive a dose of single antigen hepatitis A vaccine or immune globulin (IG).
• For healthy persons age ≥ 12 months to 40 years, hepatitis A vaccine at the age
appropriate dose is preferred to IG because of vaccine’s advantages, including long term
protection and ease of administration.
• For persons > 40 years of age, IG plus vaccine is preferred because of the absence of
information regarding vaccine performance and the more severe manifestations of
hepatitis A in this age group.
• IG should be used for immunocompromised persons, persons who have been diagnosed
with chronic liver disease, and persons for whom vaccine is contraindicated.
A clinic has been scheduled to provide post-exposure prophylaxis (PEP) for exposed persons on Friday, January 7, from 7:00 am to 12:00 pm at Our Lady of Lourdes Church School Auditorium 855 Carmans Road in Massapequa Park. PEP will also be available that day by appointment only at NCDOH, 106 Charles Lindbergh Boulevard in Uniondale. Individuals interested in making an appointment can call 516.227.9496. PEP had previously been offered at NCDOH clinics on January 4 and January 5. Persons who have been vaccinated for hepatitis A or have had the illness in the past are protected from hepatitis A infection, and there is no need for further action. Those persons eligible for vaccination or immune globulin (IG) at the NCDOH clinic must meet EACH of the following requirements:
1. Received Holy Communion at Our Lady of Lourdes Church on at any of the following
masses:
• Christmas Day, December 25, 2010 at the 10:30am, 12 Noon and 1:30 pm
• Sunday, December 26, 2010 at 7:30 am, 9:00 am, 10:30 am, 12 pm and 1:30 pm
AND
2. Have no prior history of immunization against hepatitis A or diagnosis of hepatitis A
infection.
DIAGNOSIS
NCDOH is asking providers to consider hepatitis A infection when evaluating any patient with jaundice with or without abdominal pain, fever, nausea, and/or diarrhea. Hepatitis A infection should also be considered for persons without jaundice who present with abdominal pain, fever, nausea, and/or diarrhea and have a history of receiving Holy Communion at Our Lady of Lourdes Church at the above referenced dates and times. For symptomatic persons, physicians should order serologic tests for hepatitis A virus (HAV) (total and IgM anti-HAVantibody, available commercially). Due to the possibility of false positive results, serologic tests for HAV should not be used to identify infection
in those exposed who received Holy Communion but have no symptoms. However, for exposed patients under the age of 6 with milder symptoms, especially those in daycare or school settings, testing should be considered. Positive total anti-HAV and negative IgM anti-HAV indicates past infection or vaccination and immunity.
REPORTING
Providers should report suspected and confirmed cases of hepatitis A promptly to NCDOH at 516.227.9496. Suspected cases of hepatitis A in a food worker should be reported immediately by phone.
ADDITIONAL INFORMATION
For additional information on the potential hepatitis A exposure at Our Lady of Lourdes Church, please call the Nassau County Department of Health at 516.227.9496 between the hours of 9:00 am and 4:45 pm. Additional information on hepatitis A is available on the Nassau County Department of Health web site at http://www.nassaucountyny.gov/agencies/Health/index.html

While we have seen a 21% increase in Nassau County Medicaid enrollment for the years 2008-2010, during that time we have also seen a corresponding 580% increase in OxyContin Prescriptions filled during the same period of time, and an 800% increase specifically for  80 mg OxyContin tablets.

Nassau County Medicaid expenditures for OxyContin has doubled each year since 2007, with $1.4 million to date and projected expenditures of over $2 million in 2010.

Nassau County Department of Social Services has initiated a number of efforts to stem the tide of this rising prescription drug usage. Our Medicaid Investigative Unit’s collaborative efforts with the NYS Office of the Medicaid Inspector General (OMIG) and the Nassau County District Attorney’s office have resulted in multiple consumer and provider arrests over the last 3 years for forging or selling OxyContin and other Medicaid narcotics drugs.

We have initiated a Prescription Drug Fraud Outreach to every pharmacy in Nassau County including establishment of a tip hotline (516-227-7813) for suspicious prescriptions.

We also recommend certain recipients to the OMIG’s “Restricted Recipient Program” which limits a recipient to one doctor, one pharmacist and one hospital, so that their prescription drug usage can be more closely monitored.  The OMIG receives and approves the recommendations and then sends them back to the county to implement the restrictions.  Each recipient is typically restricted for 24 month periods and will result in $150k in cost avoidance for Nassau County.

Consumer and medical education are also vital in stemming the tide of prescription drug misuse, especially OxyContin. The Nassau County Department of Mental Health, Chemical Dependency and Developmental Disability Services does provide speakers for public education forums, as does the Long Island Council on Alcoholism and Drug Dependency (LICADD).

We appreciate that your membership will continue to support our efforts to closely monitor the inappropriate usage of prescription drugs.

If there is any further information we may provide, please feel free to contact me at 516 227 7403, ext. 5

Sincerely,

John E. Imhof, PhD

Commissioner

Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

Summary: Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF). The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas–both domestic and abroad–who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.

Background

Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean. This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific. With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.

Symptoms

Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence. A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count ≤100,000/mm³), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock. Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

Recommendations

· Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing. DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.

· Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.

· Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing.  State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.

· If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form (http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.

Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.

Type of specimen        Interval since onset of symptoms          Type of Analysis

Acute                                         until day 5                                                RT-PCR for dengue virus

Convalescent        6 to 30 days        ELISA for dengue IgM

Centers for Disease Control & Prevention

Dengue Branch

1324 Cañada Street

San Juan, Puerto Rico 00920

Tel: (787) 706-2399; Fax (787) 706-2496

For More Information

· Instructions for the preparing and delivering specimens for dengue testing to the CDC Dengue Branch is available at: www.cdc.gov/Dengue/resources/TestpolEng_2.pdf.

· Additional information about dengue is available at: www.cdc.gov/dengue

· Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636 ) TTY: (888) 232-6348, which is available 24 hours a day, every day.