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For more information on disease reporting, call your local health department or the New York State Department of Health Bureau of Communicable Disease Control at (518) 473-4439 or (866) 881-2809 after hours. In New York City, 1 (866) NYC-DOH1. To obtain reporting forms (DOH-389), call (518) 474-0548. PLEASE POST THIS CONSPICUOUSLY NEW YORK STATE DEPARTMENT OF HEALTH COMMUNICABLE DISEASE REPORTING REQUIREMENTS Reporting of suspected or confirmed communicable diseases is mandated under the New York State Sanitary Code 2.10). The primary responsibility for reporting rests with the physician; moreover, laboratories (PHL 2102), school nurses 2.12), day care center directors, nursing homes/hospitals 405.3d) and state institutions 2.10a) or other locations providing health services 2.12) are also required to report the diseases listed below. Revised 10/07 SPECIAL NOTES • Diseases listed in bold type warrant prompt action and should be reported immediately to local health departments by phone followed by submission of the confidential case report form (DOH-389). In NYC use universal reporting form PD-16. • In addition to the diseases listed above, any unusual disease (defined as a newly apparent or emerging disease or that could possibly be caused by a transmissible infectious agent or microbial toxin) is reportable. • Outbreaks: while individual cases of some diseases streptococcal sore throat, head lice, impetigo, scabies and pneumonia) are not reportable, a cluster or outbreak of cases of any communicable disease is a reportable event. • Cases of HIV infection, HIV-related illness and AIDS are reportable to: Division of Epidemiology P.O. Box 2073, ESP Station Albany, NY 12220-2073 (518) 474-4284 In New York City: New York City Department of Health and Mental Hygiene For HIV/AIDS reporting, call: (212) 442-3388 Amebiasis ☎ Animal bites for which rabies prophylaxis is given1 ☎ Anthrax2 ☎ Arboviral infection3 Babesiosis ☎ Botulism2 ☎ Brucellosis2 Campylobacteriosis Chancroid Chlamydia trachomatis infection ☎ Cholera Cyclosporiasis ☎ Diphtheria E. coli O157:H7 infection4 Ehrlichiosis/Anaplasmosis ☎ Encephalitis ☎ Foodborne illness Giardiasis ☎ Glanders2 Gonococcal infection Haemophilus influenzae5 (invasive disease) ☎ Hantavirus disease Hemolytic uremic Hepatitis A ☎ Hepatitis A in a food handler Hepatitis B, C (specify acute or chronic) Pregnant hepatitis B carrier Herpes infection, infants aged 60 days or younger Hospital associated infections (as defined in section 2.2 Influenza, laboratory-confirmed Legionellosis Listeriosis Lyme disease venereum Malaria ☎ Measles ☎ Melioidosis2 Meningitis Aseptic or viral ☎ Haemophilus ☎ Meningococcal Other (specify type) ☎ Meningococcemia ☎ Monkeypox Mumps Pertussis ☎ Plague2 ☎ Poliomyelitis Psittacosis ☎ Q Fever2 ☎ Rabies Rocky Mountain spotted fever ☎ Rubella (including congenital rubella Salmonellosis ☎ Severe Acute Respiratory (SARS) Shigatoxin-producing ecoli4 Shigellosis4 ☎ Smallpox2 Staphylococcus aureus6 (due to strains showing reduced susceptibility or resistance to vancomycin) ☎ Staphylococcal enterotoxin B poisoning2 Streptococcal infection (invasive disease)5 Group A beta-hemolytic strep WHO SHOULD REPORT? Physicians, nurses, laboratory directors, infection control practitioners, health care facilities, state institutions, schools. WHERE SHOULD REPORT BE MADE? Report to local health department where patient resides. Contact Name/Address WHEN SHOULD REPORT BE MADE? Within 24 hours of diagnosis: • phone diseases in bold type, • mail case report, DOH-389, for all other diseases. • in New York City use form PD-16. 1 Local health department must be notified prior to initiating rabies prophylaxis. 2 Diseases that are possible indicators of bioterrorism. 3 Including, but not limited to, infections caused by eastern equine encephalitis virus, western equine encephalitis virus, West Nile virus, St. Louis encephalitis virus, La Crosse virus, Powassan virus, Jamestown Canyon virus, dengue and yellow fever. 4 Positive shigatoxin test results should be reported as presumptive evidence of disease. 5 Only report cases with positive cultures from blood, CSF, joint, peritoneal or pleural fluid. Do not report cases with positive cultures from skin, saliva, sputum or throat. 6 Proposed addition to list. 7 Any non-treponemal test ≥ 1:16 or any positive primary or secondary stage disease or prenatal or delivery test result regardless of titer should be reported by phone; all others may be reported by mail. 8 Including Creutzfeldt-Jakob disease. Cases should be reported directly to the New York State Department of Health Alzheimer's Disease and Other Dementias Registry at (518) 473-7817 upon suspicion of disease. In NYC, cases should also be reported to the NYCDOHMH. 9 Persons with vaccinia infection due to contact transmission, and persons with the following complications from vaccination: eczema vaccinatum, erythema multiforme major or Stevens-Johnson fetal vaccinia, generalized vaccinia, inadvertent inoculation, ocular vaccinia, post-vaccinial encephalitis or encephalomyelitis, progressive vaccinia, pyogenic infection of the infection site, and any other serious adverse events. Group B strep Streptococcus pneumoniae ☎ Syphilis, specify stage7 Tetanus Toxic shock Transmissable spongiform encephalopathies8 Trichinosis ☎ Tuberculosis current disease (specify site) ☎ Tularemia2 ☎ Typhoid Vibriosis6 ☎ Vaccinia disease9 ☎ Viral hemorrhagic fever2 Yersiniosis ---PAGE BREAK--- Vaccines Pre-kindergarten (Day Care, Nursery, Head Start, or Pre-K)2 School (k-12) Diphtheria Toxoid-Containing Vaccine 3 doses (New York City Schools – 4 doses)3 3 doses (New York City schools – 4 doses – required for kindergarten only) Tetanus Toxoid-Containing Vaccine and Pertussis Vaccine (DTaP, DTP)4 3 doses if born on or after 1/1/2005 3 doses if born on or after 1/1/2005 Tetanus, Diphtheria, and Pertussis Booster (Tdap) Not applicable Born on or after 1/1/1994 and enrolling in grades 6 through 10 for the 2011-2012 school year 5 1 dose Polio (IPV or OPV) 3 doses 3 doses Measles, Mumps and Rubella (MMR)6 1 dose 2 doses of measles-containing vaccine and 1 dose each of mumps and rubella (preferably as MMR) Hepatitis B 3 doses 3 doses7 Haemophilus influenzae type b (Hib) 3 doses if less than 15 months of age or 1 dose administered on or after 15 months of age8 Not applicable Pneumococcal Conjugate Vaccine (PCV) Born on or after 1/1/2008 4 doses by 15 months of age, given at age-appropriate times and intervals9 Not applicable Varicella (Chickenpox)6 Born on or after 1/1/2000 Born on or after 1/1/1998 or born on or after 1/1/1994 and enrolling in grades 6 through 12 for the 2011-2012 school year10 1 dose New York State Immunization Requirements for School Entrance/Attendance1 Revised 2/11 ---PAGE BREAK--- 1 Demonstrated serologic evidence of either measles, mumps, rubella, hepatitis B or varicella antibodies is acceptable proof of immunity to these diseases. Diagnosis by a physician, physician assistant or nurse practitioner that a child/student has had measles, mumps, or varicella diseases is acceptable proof of immunity to those diseases. 2 Children in a Pre-kindergarten setting should be age appropriately immunized. The number of doses depends on the schedule recommended by the Advisory Committee on Immunization Practices (ACIP). 3 Please note at this time that New York State requires 3 doses of diphtheria toxoid-containing vaccine (New York City requires 4 doses for pre-kindergarten and kindergarten only) and three doses of polio vaccine for entry into kindergarten and for any student entering a school in New York State for the first time. However, ACIP recommends 4 doses of diphtheria toxoid-containing vaccine by age 18 months and 5 doses by age 4-6 years of age. Children 4-6 years of age should receive 4 doses of polio vaccine unless the 3rd dose is given after 4 years of age. 4 DTaP is the vaccine currently recommended for diphtheria, tetanus and pertussis. 5 Students enrolling in grades 6 through 10 includes students who are entering, repeating or transferring into grades 6 through 10 and students who are enrolling in gradeless classes and are the age equivalent of grades 6 though 10. Children ages 7-10 who have not been adequately vaccinated with DTP/DTaP, and for whom no contraindications exist, should receive a single dose of Tdap. 6 The New York State Department of Health Immunization Program concurs with the ACIP which recommends that vaccine doses administered up to 4 days before the minimum interval or 12 months of age for measles, mumps, rubella and varicella be counted as valid. 7 Hepatitis B – For students in grades 7-12, 3 doses of Recombivax HB or Engerix-B is required, except for those students who received 2 doses of adult hepatitis B vaccine (Recombivax) which is recommended for children 11-15 years old. 8 Four doses of Haemophilus influenzae type b (Hib) is recommended by 15 months or more of age, however only 3 doses are required for day-care entry. If a child enters a day care on or after 15 months of age, and has not received 3 doses of Hib vaccine, only one dose on or after 15 months of age is required. 9 Unvaccinated children 7-11 months of age should receive 2 doses, at least 4 weeks apart, followed by a 3rd dose at age 12-15 months. Unvaccinated children 12-23 months of age should receive 2 doses of vaccine at least 8 weeks apart. Previously unvaccinated children 24-59 months of age should receive only 1 dose. PCV13 is the preferred vaccine for use in healthy unvaccinated/partially vaccinated children 2-71 months of age. A single supplemental dose of PCV13 is recommended for children 14-59 months who have already completed the age appropriate series of PCV7. 10 Students enrolling in grades 6 through 12 includes students who are entering, repeating or transferring into grades 6 through 12 and students who are enrolling in gradeless classes and are the age equivalent of grades 6 through 12. Two doses of varicella vaccine are recommended for all students, but not required for school entry. For further information contact: New York State Department of Health, Bureau of Immunization, Room 649, Corning Tower ESP, Albany, NY 12237, (518) 473-4437. New York City Department of Health and Mental Hygiene, Bureau of Immunization, Program Support Unit, 253 Broadway, 7th Floor, Room 703, New York, NY 10007, (212) 341-9522. 2370 New York State Department of Health/Bureau of Immunization Revised 2/11 ---PAGE BREAK--- Measles (rubeola, hard measles, red measles) Last Reviewed: October 2010 Sarampión - Medline Plus Información de Salud para Usted What is measles? Measles is a highly contagious viral disease that can be very serious or even fatal. It begins with a fever that lasts for a couple of days, followed by a cough, runny nose, and conjunctivitis (pink eye). A rash starts on the face and upper neck, spreads down the back and trunk, then extends to the arms and hands, as well as the legs and feet. After about five days, the rash fades in the same order it appeared. Serious complications of measles include pneumonia and encephalitis (inflammation of the brain). Who gets measles? As a result of widespread immunization, the measles virus does not circulate in the United States. All reported cases of measles in the United States have been brought in from other countries, usually Europe and Asia. Travelers leaving the United States should be immune to measles. Although measles is usually considered a childhood disease, it can be contracted at any age by a person who never had the disease or been vaccinated. Unvaccinated individuals are 22 times more likely to get measles than are who those who have two measles vaccines, usually given as measles, mumps and rubella vaccine (MMR). How is measles spread? Measles is highly contagious. The measles virus lives in the mucus in the nose and throat of infected people. When they sneeze, cough or talk, droplets spray into the air and the droplets remain active and contagious on infected surfaces for up to two hours. What are the of measles? Measles generally appear in two stages. In the first stage, which last two to four days, the individual may have a runny nose, cough and a slight fever. The eyes may become reddened and sensitive to light while the fever gradually rises each day, often peaking as high as 103° to 105°F. Koplik spots (small bluish white spots surrounded by a reddish area) may also appear on the gums and inside of the cheeks. The second stage begins on the third to seventh day and consists of a red blotchy rash lasting five to six days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities. Other include weight loss, diarrhea and enlarged glands throughout the body. How soon do appear? usually appear in ten to 12 days, although they may occur as early as seven or as late as 18 days after exposure. When and for how long is a person able to spread measles? An individual is able to transmit measles from four days prior to and four days after rash onset. What are the complications associated with measles? Complications occur in up to 30 percent of all cases and are more common in those younger than five and older than 20 years of age. Pneumonia occurs in up to six percent of reported cases. Encephalitis (inflammation of the brain) may also occur. Other complications include middle ear infection, diarrhea and seizures. Infection of the mother during pregnancy has been associated with an increase in low-birth weight infants, premature labor, miscarriage and birth defects. Page 1 of 2 Measles (rubeola, hard measles, red measles) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/measles/fact_sheet.htm ---PAGE BREAK--- What is the treatment for measles? There is no specific treatment for measles. Does past infection make a person immune? Yes. Immunity acquired after contracting the disease is usually permanent. Is there a vaccine for measles? Measles-containing vaccine is recommended for anyone born on or after January 1, 1957, who does not have a history of physician-diagnosed measles or a blood test confirming measles immunity. Individuals should receive 2 doses of MMR (measles, mumps, rubella) vaccine for maximum protection. The first dose should be given at 12 to 15 months of age. The second dose should be given at four to six years of age (age of school entry) at the same time as the DTaP and polio booster doses. MMR vaccine is recommended for all measles vaccine doses to provide increased protection against all three vaccine-preventable diseases: measles, mumps and rubella. Unprotected persons can get the vaccine at any age. In New York State, measles immunizations are required of all children enrolled in pre-kindergarten programs and schools. Healthcare personnel and college students are also required to demonstrate immunity against measles. Does the MMR vaccine cause autism? There is no evidence to support that measles-mumps-rubella vaccine (MMR) cause autism. What can be done to prevent the spread of measles? Maintaining high levels of measles immunization in the community is critical to controlling the spread of measles. Infected individuals should be excluded from work or school during their infectious period. Measles- containing vaccine should be provided to susceptible contacts within 72 hours of exposure. Immune Globulin (IG) can be given to susceptible persons within six days of exposure. Revised: October 2010 Page 2 of 2 Measles (rubeola, hard measles, red measles) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/measles/fact_sheet.htm ---PAGE BREAK--- Mumps Last Reviewed: October 2010 Paperas - Medline Plus Información de Salud para Usted What is mumps? Mumps is a viral disease characterized by fever, headache, muscle weakness, stiff neck, loss of appetite, swelling and tenderness of one or more of the salivary glands situated along the angle of the jaw and inside the mouth, including the parotid gland located within the cheeks just below the front of the ear. Who gets mumps? The number of cases of mumps decreased dramatically in the United States following the introduction of the mumps vaccine in 1967, from an estimated 100,000 -200,000 to fewer than 300 cases annually. In the United States, since 2001, an average of 265 mumps cases has been reported each year. Recently, there has been an increase in the number of mumps cases reported. In 2006, over 6,000 cases of mumps were reported across the nation. How is mumps spread? Mumps is transmitted by direct contact with saliva produced in the mouth and discharges from the nose and throat of infected individuals. What are the of mumps? of mumps include a low-grade fever, headache, muscle aches, stiff neck, tiredness and loss of appetite followed by swelling and tenderness of one or more of the salivary glands, including the parotid gland. Approximately one-third of infected people do not have noticeable salivary gland swelling. Up to 50% of mumps infections are not specific to any and 15-20% of all cases present without any How soon after infection do occur? The incubation period is usually 16 to 18 days, although it may vary from 12 to 25 days. What complications have been associated with mumps? Severe complications are rare. However, mumps can cause inflammation of the brain and /or tissue covering the brain and spinal cord (encephalitis/meningitis), inflammation of the testicles (orchitis), inflammation of the ovaries (oophoritis) and/or breasts (mastitis), inflammation of the pancreas (pancreatitis), spontaneous abortion and deafness, which is usually permanent. What is the treatment for mumps? There is no specific treatment for mumps. When and for how long is a person able to spread mumps? Mumps is contagious three days before until 5 days after the onset of parotitis (inflammation of the parotid gland). Does past infection with mumps make a person immune? Immunity acquired after contracting the disease is usually long term. Page 1 of 2 Mumps 2/1/2011 http://www.nyhealth.gov/diseases/communicable/mumps/fact_sheet.htm ---PAGE BREAK--- Is there a vaccine for mumps? Yes. The mumps vaccine, which is contained in the MMR (measles, mumps, and rubella) vaccine, can prevent this disease. Mumps-containing vaccine is recommended for anyone born on or after January 1, 1957, who does not have a history of physician-diagnosed mumps or a blood test confirming mumps immunity. Evidence of immunity through documentation of adequate vaccination is now defined as 1 dose of a live mumps virus vaccine for preschool-aged children and adults not at high risk and 2 doses for school-aged children grades K—12,) and for adults at high risk healthcare personnel, international travelers, and students at post-high-school educational institutions). The first dose of MMR is given at 12 to 15 months of age and the second dose is given between 4 to 6 years of age. If you do not know if you have been vaccinated or had mumps disease diagnosed by a physician, vaccination is recommended. In New York State, mumps immunization is required of all children enrolled in pre-kindergarten programs and school. College students are also required to demonstrate immunity against mumps. It is recommended that healthcare personnel demonstrate immunity against mumps. What can be done to prevent the spread of mumps? The single most effective control measure is to be vaccinated with two MMR vaccines unless there is evidence of prior immunity to mumps. Persons diagnosed with mumps should remain at home during their infectious period (until after 5 days of onset). Revised: October 2010 Page 2 of 2 Mumps 2/1/2011 http://www.nyhealth.gov/diseases/communicable/mumps/fact_sheet.htm ---PAGE BREAK--- Rubella (German Measles or Three-Day Measles) Last Reviewed: October 2010 Rubéola - Medline Plus Información de Salud para Usted What is rubella? Rubella is a highly contagious viral disease characterized by slight fever, mild rash and swollen glands. Although most cases are mild, if rubella is contracted early in pregnancy, it can spread from the mother to her developing baby through the bloodstream and result in birth defects and/or fetal death. As a result of widespread immunization, rubella does not circulate in the United States, but can be contracted through foreign travel. Who gets rubella? The number of cases of rubella decreased dramatically in the United States following the introduction of the rubella vaccine in 1969. The decrease was greatest among children. Adults account for an increasing proportion of the few cases that still occur in United States. These are often individuals who remain unvaccinated for religious reasons or are foreign-born immigrants who come from areas where rubella vaccine is not routinely used. Rubella still remains a common disease in many parts of the world and the risk of exposure to rubella outside of the United States is high. Travelers to countries where rubella cases still occur should be immune to rubella. How is rubella spread? Rubella is spread by direct contact with nasal or throat secretions of infected individuals. Rubella can also be transmitted by breathing in droplets that are sprayed into the air when an infected person sneezes, coughs or talks. What are the of rubella? Rubella is a mild illness which may present few or no may include a rash, slight fever, joint aches, headache, discomfort, runny nose, sore throat and reddened eyes. The nodes just behind the ears and at the back of the neck may swell, causing some soreness and/or pain. The rash, which may be itchy, first appears on the face and progresses from head to foot, lasting about three days. As many as half of all rubella cases occur without a rash. How soon do appear? The usual incubation period for rubella is 14 days; with a range of 12 to 23 days. What are the complications associated with rubella? Complications occur more frequently in adult women, who may experience arthritis or arthralgia, often affecting the fingers, wrists and knees. These joint rarely last for more than a month after appearance of the rash. Up to 85 percent of infants infected with rubella in the first trimester of pregnancy will suffer birth defects and/or neurologic abnormalities (Congenital Rubella CRS). What is the treatment for rubella? There is no specific treatment for rubella. When and for how long is a person able to spread rubella? Page 1 of 2 Rubella (German Measles or Three-Day Measles) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/rubella/fact_sheet.htm ---PAGE BREAK--- Rubella may be transmitted from seven days before to seven days after the rash appears. Does past infection with rubella make a person immune? Yes. Immunity acquired after contracting the disease is usually permanent. What is the vaccine for rubella? Rubella vaccine is given in combination measles, mumps, rubella (MMR) vaccine and is recommended for anyone born on or after January 1, 1957 who does not have laboratory evidence of rubella immunity. Birth before 1957 is not acceptable evidence of rubella immunity for women who could become pregnant; women of childbearing age should have their immunity checked and receive rubella vaccine if needed. Although only one dose of rubella-containing vaccine is required as acceptable evidence of immunity to rubella, children should receive two doses of MMR vaccine. Rubella vaccine is first given on or after a child's first birthday as MMR vaccine. Children usually receive the first dose between 12 and 15 months of age and the second dose prior to school entry at four to six years of age. In New York State, rubella vaccine is required of all children enrolled in all pre-kindergarten programs and schools. Healthcare personnel and college students are also required to demonstrate immunity against rubella. What is the danger of not being immunized against rubella? Rubella infection is dangerous because of its ability to damage an unborn baby. If rubella immunization was discontinued, immunity to rubella would decline and rubella disease would return. The danger would be to pregnant women who, if infected, could pass the disease to their infants (fetuses) causing CRS. What can be done to prevent the spread of rubella? Maintaining high levels of rubella immunization in the community is critical to controlling the spread. Control of the spread of rubella is needed primarily to prevent the birth defects caused by CRS. Therefore, women of childbearing age should have their immunity checked and receive rubella vaccine if needed. Infected individuals should be excluded from work or school during their infectious period. What is congenital rubella (CRS)? Congenital rubella occurs among at least 25 percent of infants born to women who had rubella during the first three months of pregnancy. Infection of a pregnant woman can result in a miscarriage, stillbirth or the birth of an infant with abnormalities which may include deafness, blindness, cataracts, heart defects, mental retardation, liver and spleen damage. Revised: October 2010 Page 2 of 2 Rubella (German Measles or Three-Day Measles) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/rubella/fact_sheet.htm ---PAGE BREAK--- Chickenpox (varicella zoster infection) Last Reviewed: October 2010 Further information on chickenpox from Wadsworth Center for Laboratories and Research Versión en español Varicela - Medline Plus Información de Salud para Usted What is chickenpox? Chickenpox is a highly contagious illness caused by the varicella-zoster virus (VZV), a type of herpes virus. It is often a mild illness, characterized by an itchy rash on the face, scalp and trunk with pink spots and tiny fluid-filled blisters that dry and become scabs four to five days later. Serious complications, although rare, can occur mainly in infants, adolescents, adults and persons with a weakened immune system. These complications include bacterial infections of skin blisters, pneumonia, and encephalitis (inflammation of the brain). In temperate climates, such as the Northeast, chickenpox occurs most frequently in the late winter and early spring. Who gets chickenpox? Chickenpox is a common childhood illness with 90 percent of the cases occurring in children younger than ten years of age. Before the availability of the varicella vaccine in the U.S., almost everyone developed chickenpox. Most people who are vaccinated will not get chickenpox. Those who are vaccinated and develop chickenpox usually have a mild form of the illness. They have fewer spots and recover faster. How is chickenpox spread? Chickenpox is transmitted from person to person by directly touching the blisters, saliva or mucus of an infected person. The virus can also be transmitted through the air by coughing and sneezing. Chickenpox can be spread indirectly by touching contaminated items freshly soiled, such as clothing, from an infected person. Direct contact with the blisters of a person with shingles can cause chickenpox in a person who has never had chickenpox and has not been vaccinated. Blisters that are dry and crusted are no longer able to spread chickenpox. What are the of chickenpox? Initial include sudden onset of slight fever and feeling tired and weak. These are soon followed by an itchy blister-like rash. The blisters eventually dry, crust over and form scabs. The blisters tend to be more common on covered than on exposed parts of the body. They may appear on the scalp, armpits, trunk and even on the eyelids and in the mouth. Mild or infections occasionally occur in children. The disease is usually more serious in young infants and adults than in children. How soon do appear? commonly appear 14 to 16 days (range of ten to 21 days) after exposure to someone with chickenpox or herpes zoster (shingles). What are the complications associated with chickenpox? Newborn children (less than one month old) whose mothers are not immune may suffer severe, prolonged or fatal chickenpox. Any person with a weakened immune system, including those with cancer, human immunodeficiency virus (HIV) or taking drugs that suppress the immune system, may have an increased risk of developing a severe form of chickenpox or shingles. Reye is an unusual complication of chickenpox that is linked to children who take aspirin or aspirin- containing products during the illness. Reye is a severe disease affecting all organ systems, but, most seriously the brain and liver and may be fatal. The exact cause of Reye is unknown. Aspirin or Page 1 of 2 Chickenpox (varicella zoster infection) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/chickenpox/fact_sheet.htm ---PAGE BREAK--- aspirin-containing products should never be given to children under 18 years of age with chickenpox. When and for how long is a person able to spread chickenpox? A person is most able to transmit chickenpox from one to two days before the rash appears until all the blisters are dry and crusted. People with a weakened immune system may be contagious for a longer period of time. Is there a treatment for chickenpox? Acyclovir is approved for treatment of chickenpox. However, because chickenpox tends to be mild in healthy children, most physicians do not feel that it is necessary to prescribe acyclovir. Acyclovir can be considered for otherwise healthy people who are at risk of moderate to severe varicella. It is important to consult with your physician for recommendations on the use of acyclovir. Does past infection with chickenpox make a person immune? Most people do not get chickenpox more than once. However, since varicella-zoster virus remains in the body after an initial infection, infection can return years later in the form of shingles in some older adults and sometimes in children. Is there a vaccine for chickenpox? A vaccine to protect children against chickenpox was first licensed in 1995. Children who have never had chickenpox should routinely be administered two doses of varicella vaccine with the first dose at 12 to 15 months and the second dose at four to six years of age. Persons 13 years of age and older who have never had chickenpox or have not received the varicella vaccine should get two doses of the varicella vaccine at least 28 days apart. The varicella vaccine may be given along with the measles-mumps-rubella (MMR) vaccine in a combination called measles-mumps-rubella-varicella (MMRV) that is approved for use in children 12 months through 12 years of age. In New York State, varicella vaccine is required for children enrolled in pre-kindergarten programs and schools. Vaccination is recommended for healthcare personnel and college students who have never had chickenpox. What can be done to prevent the spread of chickenpox? Maintaining high levels of varicella immunization in the community is critical to controlling the spread of chickenpox. To prevent further spread of chickenpox, people infected with the disease should remain home and avoid exposing others who are susceptible. Infected persons should remain home until the blisters become dry and crusted. It is very important to avoid exposing non-immune newborns and persons with a weakened immune system to chickenpox. Varicella vaccination is recommended for outbreak control. During an outbreak, persons who do not have adequate evidence of immunity should receive their first or second dose as appropriate. In 2006, a new product called VariZIG™ became available to protect patients without evidence of immunity to varicella who are at high risk for severe disease and complications and have been exposed to chickenpox. The patient groups recommended to receive VariZIG include those with a weakened immune system, pregnant women, newborns whose mothers have of varicella around the time of delivery (five days before to two days after delivery) and certain premature infants exposed to chickenpox as newborns. Revised: October 2010 Page 2 of 2 Chickenpox (varicella zoster infection) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/chickenpox/fact_sheet.htm ---PAGE BREAK--- Pertussis (whooping cough) Last Reviewed: October 2010 Tos ferina - Medline Plus Información de Salud para Usted Versión en español What is pertussis? Pertussis, or whooping cough, is a highly contagious bacterial infection that causes an uncontrollable, violent cough lasting several weeks or even months. It is caused by a bacterium that is found in the mouth, nose and throat of an infected person. Pertussis may begin with cold-like or a dry cough that progress to episodes of severe coughing. Who gets pertussis? Pertussis can occur at any age. Children who are too young to be fully vaccinated and those who have not yet completed the primary vaccination series are at highest risk for severe illness. Since the 1980s, the number of reported pertussis cases has gradually increased in the United States. In 2005, over 25,000 cases of pertussis cases were reported in the United States, the highest number of reported cases since 1959. Approximately 60 percent of the cases were in adolescents and adults and may be a result of decreasing immunity in this population. How is pertussis spread? Pertussis is primarily spread from person to person by direct contact with mucus or droplets from the nose and throat of infected individuals. Frequently, older siblings who may be harboring the bacteria in their nose and throat can bring the disease home and infect an infant in the household. What are the of pertussis? Pertussis begins as a mild upper respiratory infection. Initially, resemble those of a common cold, including sneezing, runny nose, low-grade fever and a mild cough. Within two weeks, the cough becomes more severe and is characterized by episodes of numerous rapid coughs followed by a crowing or high pitched whoop. A thick, clear mucous may be discharged from the nose. These episodes may recur for one to two months, and are more frequent at night. Older people or partially immunized children generally have milder How soon after infection do appear? The incubation period is usually seven to ten days with a range of four to 21 days and rarely may be as long as 42 days. When and for how long is a person able to spread pertussis? If untreated, a person can transmit pertussis from onset of to three weeks after the onset of coughing episodes. The period of communicability is reduced to five days after treatment with antibiotics. What are the complications associated with pertussis? Major complications of pertussis are more common among infants and young children and may include pneumonia, middle ear infection, loss of appetite, sleep disturbance, syncope (temporary loss of consciousness), dehydration, seizures, encephalopathy (a disorder of the brain), apneic episodes (brief delay in breathing) and death. What is the treatment for pertussis? Page 1 of 3 Pertussis (whooping cough) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/pertussis/fact_sheet.htm ---PAGE BREAK--- The recommended antibiotics for the treatment and postexposure prevention of pertussis include azithromycin (Zithromax), and clarithromycin (Biaxin). Alternately, trimethoprim-sulfamethoxazole (Bactrim) can be used. Does past infection with pertussis make a person immune? Neither vaccination nor natural infection with pertussis guarantees lifelong protective immunity against pertussis. Since immunity decreases after five to ten years from the last pertussis vaccine dose, older children, adolescents and adults are at risk of becoming infected with pertussis and need vaccination. What is the vaccine for pertussis? Infants and Children The childhood vaccine for pertussis is usually given in combination with diphtheria and tetanus. Immunization authorities recommend that DTaP (diphtheria, tetanus, acellular pertussis) vaccine be given at two, four, and six and 15 to 18 months of age and between four and six years of age. Pre-teens and Adolescents In 2005, a new vaccine was approved as a single booster vaccination for adolescents and adults called Tdap (tetanus, diphtheria, and acellular pertussis). The preferred age for routine vaccination with Tdap is 11 or 12 years old. Adolescents, aged 11 through 18 should receive a single dose of Tdap instead of Td (tetanus, diphtheria) for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTP/DTaP vaccination series. Adults For adults who are 19 through 64 years of age and have not previously received a dose of Tdap, a single dose of Tdap should replace a single dose of Td for booster immunization if the most recent tetanus toxoid- containing vaccine was received at least ten years earlier. Adults in close contact with an infant aged under 12 months who have not previously received Tdap should receive a dose of Tdap; an interval as short as two years since the most recent Td is suggested. Healthcare personnel in hospitals and ambulatory care settings with direct patient contact who have not previously received Tdap should receive a dose of Tdap; an interval as short as two years since the most recent Td is recommended. In New York State, pertussis vaccine is required of all children born after 1/1/2005 who will be enrolled in pre- kindergarten programs and schools. Tdap vaccine is required for children born on or after 1/1/1994 and enrolling in the sixth grade. What can be done to prevent the spread of pertussis? The single most effective control measure is maintaining the highest possible level of immunization in the community. Treatment with appropriate antibiotics, such as Zithromax, will shorten the time a person can spread pertussis to five days after the beginning of treatment. People who have or may have pertussis should stay away from young children and infants until properly treated. Treatment of people who are close contacts of pertussis cases is also an important part of prevention. What is parapertussis? Parapertussis is a bacterial illness that is similar to pertussis (whooping cough) but is not as common and generally causes less severe Up to 40 percent of all cases of parapertussis will present with no Very young infants (less than six months of age) may have a more severe course of parapertussis than older persons. Parapertussis is spread through the air in droplets produced during coughing and sneezing. A person can be infected with parapertussis and pertussis at the same time. Parapertussis can be distinguished from pertussis by certain laboratory tests. Antibiotic treatment should be started as soon as Page 2 of 3 Pertussis (whooping cough) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/pertussis/fact_sheet.htm ---PAGE BREAK--- parapertussis is suspected. All infants less than six months of age should receive antibiotics as a preventive measure if they have been in contact with a person who has parapertussis. Revised: October 2010 Page 3 of 3 Pertussis (whooping cough) 2/1/2011 http://www.nyhealth.gov/diseases/communicable/pertussis/fact_sheet.htm ---PAGE BREAK--- Meningococcal Disease Last Reviewed: October 2010 Versión en español Additional Information on Meningococcal Disease and College Students - cdc.gov What is meningococcal disease? Meningococcal disease is a severe bacterial infection of the bloodstream or meninges (a thin lining covering the brain and spinal cord) caused by the meningococcus germ. Who gets meningococcal disease? Anyone can get meningococcal disease, but it is more common in infants and children. For some adolescents, such as first-year college students living in dormitories, there is an increased risk of meningococcal disease. Every year in the United States approximately 2,500 people are infected and 300 die from the disease. Other persons at increased risk include household contacts of a person known to have had this disease, immunocompromised people, and people traveling to parts of the world where meningococcal meningitis is prevalent. How is the meningococcus germ spread? The meningococcus germ is spread by direct close contact with nose or throat discharges of an infected person. What are the High fever, headache, vomiting, stiff neck and a rash are of meningococcal disease. The may appear two to 10 days after exposure, but usually within five days. Among people who develop meningococcal disease, 10 to 15 percent die, in spite of treatment with antibiotics. Of those who live, permanent brain damage, hearing loss, kidney failure, loss of arms or legs, or chronic nervous system problems can occur. What is the treatment for meningococcal disease? Antibiotics, such as penicillin G or ceftriaxone, can be used to treat people with meningococcal disease. Should people who have been in contact with a diagnosed case of meningococcal meningitis be treated? Only people who have been in close contact (household members, intimate contacts, health care personnel performing mouth-to-mouth resuscitation, daycare center playmates, etc.) need to be considered for preventive treatment. Such people are usually advised to obtain a prescription for a special antibiotic (either rifampin, ciprofloxacin or ceftriaxone) from their physician. Casual contact, as might occur in a regular classroom, office or factory setting, is not usually significant enough to cause concern. Is there a vaccine to prevent meningococcal meningitis? In February 2005 the CDC recommended a new vaccine, known as Menactra™, for use to prevent meningococcal disease in people 11 to 55 years of age. The previously licensed version of this vaccine, Menomune™, is available for children two to 10 years old and adults older than 55 years. Both vaccines are 85 to 100 percent effective in preventing the four kinds of the meningococcus germ (types A, C, Y, W-135). These four types cause about 70 percent of the disease in the United States. Because the vaccines do not include type B, which accounts for about one-third of cases in adolescents, they do not prevent all cases of meningococcal disease. Page 1 of 2 Meningococcal Disease 2/1/2011 http://www.nyhealth.gov/diseases/communicable/meningococcal/fact_sheet.htm ---PAGE BREAK--- Is the vaccine safe? Are there adverse side effects to the vaccine? Both vaccines are currently available and both are safe and effective vaccines. However, both vaccines may cause mild and infrequent side effects, such as redness and pain at the injection site lasting up to two days. Who should get the meningococcal vaccine? The vaccine is recommended for all adolescents entering middle school (11 to 12 years old) and high school (15 years old), and all first-year college students living in dormitories. However, the vaccine will benefit all teenagers and young adults in the United States. Also at increased risk are people with terminal complement deficiencies or asplenia, some laboratory workers and travelers to endemic areas of the world. What is the duration of protection from the vaccine? Menomune™, the older vaccine, requires booster doses every three to five years. Although research is still pending, the new vaccine, Menactra™, will probably not require booster doses. How do I get more information about meningococcal disease and vaccination? Contact your physician or your student health service. Additional information is also available on the Web sites of the New York State Department of Health, www.nyhealth.gov; the Centers for Disease Control and Prevention www.cdc.gov/ncidod/diseases/index.htm; and the American College Health Association, www.acha.org. Revised: October 2010 Page 2 of 2 Meningococcal Disease 2/1/2011 http://www.nyhealth.gov/diseases/communicable/meningococcal/fact_sheet.htm