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OCMA Blog

OC Health Care Agency Mumps Advisory

Mumps Advisory

September 12, 2014

An adult male living in Anaheim has been diagnosed with mumps. The case has no recent history of international travel or exposure to a known case of mumps. Orange County has 0-3 cases of mumps reported each year, and a mumps case occurring without a history of travel or known contact to a mumps case is unusual.

Providers should consider the diagnosis of mumps in patients with an appropriate clinical presentation, particularly in those with a history of international travel. Providers should notify Orange County Public Health Epidemiology at 714-834-8180 with any suspect cases. The incubation period is usually 16 to 18 days, but cases may occur 12 to 25 days after exposure. Prodromal symptoms are nonspecific and may include myalgia, anorexia, malaise, headache and low-grade fever. The most common manifestation is unilateral or bilateral swelling of one or more of the salivary glands, usually the parotid glands (parotitis). Parotitis tends to occur within the first 2 days and may be first noted as earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after 1 week and usually resolve after 10 days.

Complications include orchitis (testicular swelling), which may occur in as many as 50% of postpubertal males. 10% have symptoms of aseptic meningitis. Treatment is supportive care.

Laboratory Testing
Testing for the mumps virus can be performed by sending serum for mumps IgM and IgG and buccal swab specimens for mumps polymerase chain reaction (PCR) and virus culture to Orange County Public Health Laboratory. Mumps IgM response may be absent or short lived in immunized patients. Orange County Public Health can help coordinate testing of patients.

Infection Control
Mumps virus is transmitted by exposure to respiratory secretions or droplets of infected persons, and is generally transmitted via face-to-face contact. Communicability is probably highest from 2 days before to 5 days after onset of parotitis; the virus has been isolated in saliva from 7 days before through 9 days after onset of swelling. Suspect cases should be cared for using standard and droplet precautions.

Vaccination
Mumps vaccine is given as part of measles, mumps and rubella (MMR) vaccine. All children are recommended to receive a first dose of MMR at 12-15 months and a second dose at 4-6 years of age. Post-licensure data estimate the effectiveness of one dose of mumps vaccine at approximately 80% and two doses at 90%. Health care providers can be presumed to be immune with any of the following evidence: documented administration of 2 doses of MMR vaccine, birth before 1957, positive serum mumps IgM, or laboratory confirmed disease.

See http://ochealthinfo.com/phs/about/dcepi/epi/disease/mumps or www.cdc.gov/mumps/prev-control-settings/index.html for further information.


Communicable Disease News: Pertussis Epidemic in OC & Ebola Virus Update

Update on California's Pertussis Epidemic

Pertussis activity continues at epidemic levels in Orange County and statewide.
As of 8/16/2014, 250 pertussis cases have been reported in Orange County, compared with 43 cases at this time last year. Pertussis peaks in incidence every 3-5 years as the number of susceptible people in the population increases; the last epidemic in California was in 2010.

Infants under 12 months of age are at highest risk for severe infection and death. To protect this vulnerable population the following is recommended:

  • Immunize pregnant women with Tdap during every pregnancy at 27-36 weeks gestation. This dose protects mom and provides the infant with high levels of protective transplacental antibodies.
  • Encourage close contacts of infants to be up-to-date with their pertussis vaccine (cocooning).
  • Vaccinate infants and children with DTaP followed by Tdap according to the childhood immunization schedule: http://www.cdc.gov/vaccines/vpdvac/pertussis/recssummary.htm

Diagnostic Testing: Suspect pertussis cases should be tested by nasopharyngeal PCR. PCR is most sensitive within 3 weeks of the onset of the cough (up to 6 weeks for infants). Consider obtaining a CBC: a WBC count that is ≥ 20,000/mm3 with ≥ 10,000 lymphocytes/mm3 in a young infant with a cough illness is strongly suggestive of pertussis infection.

Management of Cases:

  • Treatment: Antimicrobial treatment should begin as soon as possible after diagnosis, particularly in infants. Treatment may lessen symptoms if begun early during illness and will shorten the period of infectivity.
  • Prophylaxis: The CDC and AAP recommend post-exposure prophylaxis for all close contacts of a pertussis case. However, during widespread community outbreaks, OCHCA will focus its efforts on postexposure prophylaxis for high-risk contacts, including infants under 1 year of age, pregnant women, and their contacts.
  • Infection control: Health care workers should use standard and droplet precautions, including a surgical or procedure mask and eye protection when evaluating suspect pertussis patients. Droplet precautions should be maintained until 5 days after the patient is placed on effective therapy, or if no treatment until 21 days after cough onset.
  • Management of cases in school settings: Cases should be excluded from childcare settings until completion of 5 days of antibiotic treatment, from K-12 grade schools until completion of 3 days of antibiotics, and for 21 days if no antibiotic treatment.

Resources:

General pertussis info for clinicians: http://www.cdc.gov/pertussis/
Tdap for pregnant women: http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

Click here for full Pertussis Newsletter.


Ebola Outbreak In West Africa

West Africa has been experiencing a large outbreak of Ebola Virus Disease (EVD) since December of 2013. As of August 15, 2,127 confirmed or suspect cases of disease including 1,145 suspected case deaths have been reported in Guinea, Liberia, Sierra Leone and Nigeria. It was reported last night (August 19) that Kaiser Permanente in Sacramento is testing a patient for suspected Ebloa Virus, aside from that, two United States citizens were transported to Emory University for further care after contracting the disease while caring for patients with EVD in Liberia. Though the risk of Ebola to the United States or Orange County is small, the potential exists for imported disease in persons traveling from countries where EVD is active. Medical providers should keep up to date on this outbreak and know which patients merit evaluation for EVD.

Providers should contact Orange County Public Health at 714-834-8180 (714-628-7008 after hours) immediately upon identifying any patient with potential EVD. Orange County Public Health can assist with assessment and testing of any case meeting the CDC-defined criteria for a Person Under Investigation, which includes:

1. Clinical criteria:

a. Fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and
b. Additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage

AND

2. Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as:

a. Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD or
b. Residence in-or travel to-an area where EVD transmission is active* or
c. Direct handling of bats, rodents, or primates from disease-endemic areas.

Persons who have had direct contact with Ebola cases through healthcare work or social exposure in West Africa are at particularly high risk for developing disease. For further description of risk factors and clinical recommendations to prepare for or manage Ebola, see www.cdc.gov/vhf/ebola/hcp/index.html.

*As of August 15, countries where EVD is active include Guinea, Liberia, Sierra Leone and Nigeria.

Infection Prevention and Control
Standard, contact and droplet precautions are indicated for suspected EVD. Personal protective equipment (PPE) should include gloves, gown, eye protection (goggles or face shield) and facemask. Additional PPE is necessary if copious blood or other fluid is present in the environment, including double gloving, disposable shoe covering, and leg covering. PPE should be discarded on leaving room taking care to avoid contamination when removing.

Laboratory Testing
The diagnostic test of choice for EVD is PCR testing of the blood. The virus is generally PCR-detectable from 3-10 days post-onset of symptoms. If the onset of symptoms is less than 3 days prior to specimen collection, a subsequent specimen will be required to completely rule out EVD. Testing is available through the CDC. Orange County Public Health can assist with assuring appropriate transport of specimens.

For updated information on the outbreak, including countries where EVD is active, go to: www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html.

Contact Orange County Public Health at 714-834-8180 with any questions.


Orange County Public Healthcare Update: OC In+Care Newsletter


OC In+Care: A newsletter for providers serving people living with HIV/AIDS in Orange County


How does ACA affect patients? 

 
There are three ways in which ACA may affect people living with HIV/AIDS (PLWH/A). 
 
1) ACA will not impact your patient if they:

  • Would like to keep their current private insurance plan
  • Have employer-based insurance
  • Are receiving Ryan White medical care and ineligible for ACA
  • Are CalOptima (Medi-Cal in Orange County) or Medicare patients

2) ACA offers an opportunity for Individuals living with HIV/AIDS to quality for CalOptima coverage based on Federal Poverty Level (FPL) which is about $15,000 per year for one person.

  • Individuals who are legal residents with income below 138% FPL.
  • Patients who are currently on Medical Services Initiative (MSI) will be automatically enrolled into CalOptima for individuals below 138% FPL.

3) ACA requires that your patient purchase insurance and enroll in the health insurance exchange through Covered California if the individual is above 138% of the FPL. Depending on the individual, financial assistance such as: subsidies, health insurance premium payment, and/or waivers may be available. 

For patients who do not qualify for private health insurance, Medi-Cal, or will receive services not covered by their current coverage, they may be eligible for the federally-funded Ryan White program. This program offers medical, supportive services, and medication assistance for individuals who have no other source of paying for care services.

Covered California Enrollment Locations- Orange County
 
AIDS Services Foundation- (949) 809-5781 -Sky Park Circle, Irvine
 
AltaMed- (877) 462-2582 - S. Bristol Ave., Santa Ana 
 
APAIT Health Center- (714) 636-1349 - Garden Grove Blvd, Garden Grove 
 
Delhi Community Center- (714) 481-9600 - E. Central Ave., Santa Ana 
 
The Center OC- (714) 953-5428 ext. 336- N. Spurgeon St., Santa Ana

Covered California
 
For patients who are interested in health insurance options other than their current plan, or their income puts them above the 138% FPL, they will have to apply through the health insurance exchange. In California, this is called Covered California.

Multiple locations in Orange County have enrollment workers who can help patients enroll in appropriate health coverage; whether it is into private insurance or Medi-Cal. Individuals can also visit the Covered California website at www.coveredca.com..

Subsidies may be available to patients who have enrolled in a Covered California approved plan.

Office of AIDS-Health Insurance Premium Payment (OA-HIPP)

OA-HIPP is a program for individuals living with HIV/AIDS and need assistance in payments for health insurance premiums. Individuals above 138% FPL who qualify for AIDS Drugs Assistance Program (ADAP), may also qualify to receive assistance with premiums. For more information on OA-HIPP, visit: www.cdph.ca.gov/programs/aids/Pages/tOAHIPPindiv.aspx

Important Reminders 

  • If the patient currently has ADAP or Ryan White coverage, s/he will be screened at their eligibility appointment for all programs s/he may be eligible. 
  • Patients should be reminded to attend their eligibility appointment.
  • If the patient has a case manager or a care coordinator, they can assist the patient in addressing questions regarding ACA.
  • Enrollment varies depending on coverage.
  • If patient is eligible for Medi-Cal, enrollment began October 1, 2013. Coverage will begin January 1, 2014, but patients can apply at any time.
  • If the patient is above 138% FPL and is eligible for a Qualified Health Plan through Covered California, enrollment began October 1, 2013 and ends March 31, 2014. Open enrollment is between October through December thereafter.
  • Remind clients to open and read their mail as important information regarding health coverage is being disseminated via mail.


Covered California Affordable Care Act Resources


Health Care Reform and YOU!

 
HIV Health Reform: www.hivhealthreform.org/ 
 
Greater Than AIDS 
www.greaterthan.org/campaign/obamacare/ 
 
Please visit Orange County Health Care Agency's website for important up-to-date resources on the Affordable Care Act: www.ochealthinfo.com/phs/about/dcepi/hiv/libehiv/aca


OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8711.
 
If you have feedback or topic suggestions for future newsletters, please contact Mindy He at Mhe@ochca.com

National Prescription Drug Take-Back Day is This Saturday

It's Time to Get Rid of Expired, Unused and Unwanted Medications

The next National Prescription Drug Take-Back Day is Saturday, October 26th from 10:00 am - 2:00 pm.  It is sponsored by the U.S. Drug Enforcement Administration (DEA) in an effort to help prevent prescription drug abuse and diversion. The majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.
 
This service is free and anonymous - encourage your patients to dispose of their unwanted medications on Saturday, October 26th.  
  
There are 30 collection sites in Orange County: 

Aliso Viejo

Anaheim

Brea

Buena Park

Corona Del Mar

Costa Mesa

Cypress

Dana Point

Fountain Valley

Fullerton

 

Garden Grove

Huntington Beach

Irvine

La Habra

Laguna Beach

Laguna Hills

Laguna Niguel

Lake Forest

Mission Viejo

Newport Beach

 

Orange

Placentia

Rossmoor

San Clemente

San Juan Capistrano

Santa Ana

Seal Beach

Tustin

Westminster

Yorba Linda


To find the location of a Take Back collection site near you visit the DEA website at 
www.justice.gov/dea or call (800) 882-9539.


Orange County Public Healthcare Update: OC In+Care

OC In+Care: Newsletter for providers serving people living with HIV/AIDS in Orange County


Orange County In+Care Goals:

  • Increase the proportion of newly diagnosed individuals linked to clinical care within three months of diagnosis.
  • Increase the proportion of PLWH who are in continuous care.
  • Increase the proportion of PLWH with suppressed viral loads (less than 200 copies per mL).


Barriers to Treatment Adherence

 

Although a patient's ability to commit to a treatment plan should be assessed prior to initiating treatment, unexpected changes in the patient's life can disrupt treatment adherence. There may be many barriers that prevent a patient from adhering to their treatment regimen. Some barriers that may arise are:
 
* Active substance abuse (drugs and/or alcohol)
* Patient feels healthy
* Food requirement
* Forgot or busy
* Away from home
* Traveling
* Change in daily routine
* Side effects
* Depression or illness
* Lack of interest
* Desire to have a drug "holiday"
* Treatment fatigue 


Strategies to Treatment Adherence

 

It is important for the medical provider to understand and be aware of the patient's overall situation. During the appointment, ask the patient if there are any changes in their lifestyle or daily routine that may affect their medication intake. Education should include potential consequences of not adhering strictly to the treatment plan. Let them know that changes in lifestyle may disrupt their treatment plan and remind them of their treatment regimen. Emphasize the importance of committing to the plan even with these changes.
 
A common reason for why many patients discontinue their treatment regimen is because they do not feel sick. Encourage patients to continue their medication even when they are physically feeling well.
 
Communication between the doctor, case manager, and pharmacist (with appropriate release of information) is key to helping them continue to commit to their treatment plan.
 
Some patients may find using a diary or medication log useful in remembering what medications to take and when to take them.
 

The patient can include individuals to support them in their treatment plan. This can be a family member, peer, or friend whom they feel comfortable with and have disclosed their HIV/AIDS status.


The Pharmacist's Role
 
The pharmacist's role in HIV care is essential. A patient may see multiple providers with prescribing privileges, but typically goes to one pharmacy. Because of this, their pharmacy becomes the "hub" for the patient's care. As noted before, it is important for doctors, pharmacists, and case managers (if applicable) to have a good relationship. Doctors should contact the pharmacy to follow up on a patient's treatment plan and more importantly, learn of any other drugs the patient is taking that may lead to drug-drug interactions.
 
Pharmacists should contact the doctor if a patient's treatment plan may lead to adverse effects. Contacting the doctor or case manager may also be necessary if patients are not picking up their medications (non-adherence). 


Orange County Resources
 
Check out HIV THRIVE (hivthrive.com), for information on living with HIV/AIDS and improving overall wellness.
 
Peer Support Services (PSS) offers support to individuals who are living with HIV/AIDS. For more information on PSS, contact Bobby Avalos at (714) 868-1829 or e-mail bobbyonstage@hotmail.com 

Click here to the view the full OC In+Care newsletter.

OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8711.
 
Click here to subscribe to the OC In+Care newsletter.
 
If you have feedback or topic suggestions for future newsletters, please contact Melissa Corral at MCorral@ochca.com.

 


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