- Ocular syphilis
Action requested: Continue to vaccinate against and initiate early treatment for influenza.
Background & Recommendations
As of January 17, 101 Snohomish County residents have been hospitalized for influenza this season, more than in any of the past five seasons; six have died. Please continue to urge vaccination and do not delay treatment when you suspect influenza.
For guidance on influenza management, see http://emergency.cdc.gov/han/han00375.asp.
Action requested: Be aware of a measles outbreak in the U.S. Urge anyone who may be susceptible to get vaccinated now.
Background & Recommendations
The Centers for Disease Control & Prevention (CDC) has issued a report on the measles outbreak that started in California in December 2014 and has spread to six additional states and Mexico. The initial confirmed case-patients reported visiting Disneyland Resort Theme Parks in Orange County, CA, from December 17 through December 20, 2014. From December 28, 2014, through January 21, 2015, 51 confirmed cases of measles linked to this outbreak have been reported to CDC, 42 from California and 9 from six other states (3 in UT, 2 in WA, 1 in OR, 1 in CO, 1 in NE, and 1 in AZ). In addition to the U.S. cases, one case was reported from Mexico in an unvaccinated child who visited Disneyland Resort Theme Parks on December 17 and December 20, 2014. At this time, no source case for the outbreak has been identified, but it is likely that a traveler (or more than one traveler) who was infected with measles overseas visited one or both of the Disney parks in December during their infectious period.
Providers should be vigilant for possible measles and should strongly encourage anyone who has not been vaccinated to do so now. Note that children and adolescents should have two doses of MMR vaccine; adults born after 1956 who do not have evidence of immunity should get at least one dose. For details on vaccination and disease management, see http://www.cdc.gov/measles/hcp/index.html.
Action requested: Be aware of potential listeria infections linked to consumption of Latin-style cheese.
The Washington State Department of Health is investigating another outbreak of Listeria monocytogenes infections, this one linked to consumption of Latin-style cheese produced by Queseria Bendita, a Yakima, Washington firm. As of January 16, 2015, a total of three cases have been identified from Washington in King, Pierce, and Yakima counties. One illness was pregnancy-associated, two people were hospitalized and one death was reported. The affected products made by Queseria Bendita (Queso Fresco, Panela, and Requeson) are subject to a voluntary recall and the firm has stopped producing cheese.
- Advise asymptomatic patients who report consuming the product listed above to seek care if symptoms develop within two months of eating the recalled product.
- Ask patients at high risk for complications (notably pregnant women) who present symptoms consistent with Listeriosis about consumption of the products listed above.
- If invasive Listeriosis is suspected, submit blood or cerebrospinal fluid (not stool) for laboratory testing (note that laboratories will submit Listeria isolates to the Public Health Laboratory for confirmation & typing).
- Report Listeriosis within 24 hours to the Health District at 425-339-5278.
For additional guidance, see http://www.doh.wa.gov/Portals/1/Documents/5100/ListeriaMedManage.pdf.
Action requested: Be aware of syphilis occurring in the eye and ask patients with possible or diagnosed syphilis about changes to vision or hearing.
Four cases of ocular syphilis have been diagnosed in King County residents since mid-December, 2014, and two additional cases have recently occurred elsewhere in WA. Syphilis is relatively common among men who have sex with men (MSM) in King County, particularly among HIV-infected MSM, in whom approximately 3% acquire syphilis each year. The cause for this cluster of cases of ocular syphilis is uncertain. It is not known whether some strains of T. pallidum have a greater likelihood of causing ocular infections, but the current cluster of cases raises this concerning possibility.
- Have a low threshold for syphilis (& HIV) testing of patients presenting with genital, oral, or rectal ulcers, rash, or visual complaints.
- Routinely ask patients with possible or diagnosed syphilis about changes in their vision or hearing (including hearing loss or tinnitus) in order to identify persons at high risk for complicated syphilis. Refer patients with signs or symptoms consistent with syphilis and ocular complaints for immediate ophthalmologic evaluation.
- Initiate penicillin therapy in all patients in whom syphilis is suspected without waiting for laboratory confirmation of the diagnosis. In patients with ocular findings consistent with syphilis, treat as CNS syphilis (i.e. penicillin G IV or procaine penicillin IM in conjunction with oral probencid (see CDC STD Treatment Guidelines at http://www.cdc.gov/std/treatment/2010/default.htm).
- Immediately report to 425-339-5278 all patients diagnosed with, or suspected to have, ocular syphilis.
Additional information about syphilis and recent cases occurring in our area can be found at: