Vermont | Hantavirus case leads to warning from health officials

The Health Department is reminding Vermonters to use caution when cleaning up rodent infested areas after an out-of-state resident recently contracted Hantavirus Pulmonary Syndrome while visiting Vermont.

The person who became ill was most likely exposed to rodent droppings while cleaning up a seasonal home in August and has since recovered from the disease.

Hantavirus Pulmonary Syndrome is a serious respiratory disease caused by an infection with a type of hantavirus. Symptoms include fatigue, fever, headaches, muscle aches, dizziness and chills followed by coughing and shortness of breath. Approximately one-third of people who have Hantavirus Pulmonary Syndrome die from the disease.

Most hantavirus infections occur in the western part of the U.S., but sporadic cases have been reported in the northeast. The Health Department recorded one other hantavirus case in 2000.

Most people are infected by breathing in dust contaminated with rodent droppings, urine, saliva or nesting materials. Sweeping or vacuuming stirs up contaminated dust and can put people at risk for hantavirus. Rodent infestation in and around the home is considered the primary risk for hantavirus.

The best way to reduce the risk of contracting HPS is to prevent rodents from entering your home by sealing up any holes inside and outside of the house, setting traps and properly storing any food. People should be particularly careful when first opening up a seasonal cabin or trailer.

If evidence of a rodent infestation is found, the Health Department recommends the following easy steps to clean up safely:

  • Air out the area by opening nearby windows for at least 30 minutes.
  • Do not sweep or vacuum up any droppings, urine or nesting material. Instead spray the materials and surrounding area with a mix of 10 parts water and one part bleach. Let it soak for at least five minutes.
  • Wear rubber or latex gloves and clean up the materials using paper towels.
  • Mop or clean hard surfaces with a diluted bleach solution. Steam clean or shampoo any furniture or carpeting.  Wash bedding or clothing that may have been contaminated with laundry detergent and hot water.

For more information on hantavirus pulmonary syndrome, visit the Vermont Department of Health website at: http://healthvermont.gov/prevent/hanta/hantavirus.aspx

Liberia | ‘Somebody had to do it’ – Turning people away from an overwhelmed Ebola treatment centre

Pierre Trbovic, an anthropologist from Belgium, arrived in the Liberian capital, Monrovia in late August to help with MSF’s response to the Ebola epidemic. Finding the treatment centre full, health staff overwhelmed, and sick people queuing in the street, Pierre volunteered for the heartwrenching job of turning people away.

Soon after arriving in Monrovia, I realised that my colleagues were overwhelmed by the scale of the Ebola outbreak. Our treatment centre – the biggest MSF has ever run – was full, and Stefan, our field coordinator, was standing at the gate turning people away. On an MSF mission, you have to be flexible. This wasn’t a job that we had planned for anyone to do, but somebody had to do it – and so I put myself forward.

For the first three days that I stood at the gate it rained hard. People were drenched, but they carried on waiting because they had nowhere else to go.

The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car. He was an educated man, and he pleaded with me to take his teenage daughter, saying that whilst he knew we couldn’t save her life, at least we could save the rest of his family from her. At that point I had to go behind one of the tents to cry. I wasn’t ashamed of my tears, but I knew I had to stay strong for my colleagues – if we all started crying, we’d really be in trouble.

Other families just pulled up in cars, let the sick person out and then drove off, abandoning them. One mother tried to leave her baby on a chair, hoping that if she did, we would have no choice but to care for the child.

I had to turn away one couple who arrived with their young daughter. Two hours later the girl died in front of our gate, where she remained until the body removal team took her away. We regularly had ambulances turning up with suspected Ebola patients from other health facilities, but there was nothing we could do. We couldn’t send them anywhere else – everywhere was, and still is, full.

Once I entered the high-risk zone, I understood why we couldn’t admit any more patients. Everyone was completely overwhelmed. There are processes and procedures in an Ebola treatment centre to keep everyone safe, and if people don’t have time to follow them, they can start making mistakes.

It can take 15 minutes to dress fully in the personal protective equipment and, once inside, you can only stay for an hour before you are exhausted and covered in sweat. You can’t overstay or it starts getting dangerous. The patients are also really unwell, and it is a lot of work to keep the tents clean of human excrement, blood and vomit, and to remove the dead bodies.

There was no way of letting more patients in without putting everyone, and all of our work, at risk. But explaining this to people who were pleading for their loved ones to be admitted, and assuring them that we were expanding the centre as fast as we could, was almost impossible. All we could do was give people home protection kits, containing gloves, gowns and masks, so that they could be cared for by their loved ones with less chance of infecting them.

After the rain came the scorching sun. One day an old man waited outside for five hours with just a broken umbrella for shade. In all that time, the only thing he said to me was, ‘too much sun’. It took him so much effort. His son was with him, but was too scared to go near him to offer any comfort. When we were finally able to admit him, his son came to thank me with tears in his eyes.

There were others who weren’t actually sick, but who weren’t sleeping or eating out of fear they might have Ebola – they just wanted a test. But if we were turning people away who were dying, how could we accept people who were healthy?

Others who came were just desperate for a job – willing to do anything, even if it meant carrying dead bodies.

When the nurses, who I have such admiration for, started pitying me and telling me that they couldn’t have done my job, I realised that what I was doing was even harder than I thought. After a week, people told me I needed to stop. They could see the emotional toll that it was taking on me.

That afternoon a colleague came to find me, saying there was something I had to see. Whenever people recover, we have a small ceremony for the patients who are discharged. Seeing the staff gather to celebrate this exceptional moment, hearing the words of the discharged patients as they thank us for what we did, gives us all a good reason to be there. Looking around I saw tears in all of my colleagues’ eyes. Sometimes there are good reasons to cry.

 

Global | Op-ed from MSF President Joanne Liu – A concrete response to the Ebola outbreak cannot wait

Six months into the worst Ebola epidemic in history, the world is losing the battle to contain the disease. Leaders are failing to come to grips with this transnational threat.

In West Africa, cases and deaths continue to surge. Riots are breaking out. Isolation centers are overwhelmed. Health workers on the front lines are becoming infected and dying in shocking numbers. Others have fled, leaving people without care for even common illnesses. Entire health systems have crumbled.

It is impossible to keep up with the sheer number of infected people pouring into facilities. Ebola treatment centers have been reduced to little more than palliative-care facilities where people go to die. In Sierra Leone, bodies are rotting in the streets. Rather than building Ebola care centers in Liberia, we are forced to build crematoriums.

Nations neighboring the worst-affected countries are closing their borders. Flights are being stopped, preventing additional relief supplies and health workers from reaching the hot zones.

The World Health Organization (WHO) projected that as many as 20,000 people could be infected over three months in the three worst-affected countries: Liberia, Sierra Leone and Guinea. This number is likely underestimated.

As the president of a medical humanitarian organization that has cared for more than two-thirds of the officially declared infected patients, I can tell you that my colleagues are completely overwhelmed. They are forced to turn away up to 30 infectious people a day.

In the face of this worsening disaster, WHO has delivered a clear road map for Ebola. But huge questions remain about who will implement elements in the plan. Who has the correct training for the tasks that are detailed?

These questions must be answered quickly. We cannot wait.

This Ebola outbreak is akin to a war, claiming lives, destroying communities and perpetuating fear. No country could be expected to manage such a disaster without additional support. We need a large-scale deployment of highly trained personnel who know the protocols for protecting themselves against highly contagious diseases and who have the necessary logistical support to be immediately operational. Private aid groups simply cannot confront this alone.

We appealed for a massive scale-up of isolation and treatment facilities 10 days ago. It is beyond time for countries with biosafety capacity to deploy civilian or military assets. These countries have a political responsibility to use these capabilities in Ebola-affected countries. This deployment must happen within days — not weeks or months.

The mobilization of such threat-containment teams would constitute a surge in trained personnel into hot zones. Their roles would be to immediately scale up the number of isolation centers, deliver protective gear to health workers, deploy mobile laboratories to improve diagnostic capabilities, move personnel and equipment to and within West Africa and build a regional network of field hospitals devoted to treating infected medical personnel.

On Sunday, President Obama said the U.S. government would deploy military assets to establish isolation units and deliver additional supplies. This is an important development, but it must translate into immediate concrete action on the ground. So far, the Pentagon has pledged only one 25-bed unit for Liberia, to be used just for health workers. This is highly insufficient. In Monrovia alone, there is an immediate need for an additional 800 beds of isolation capacity. Other governments must step in in all three of the most affected countries.

One of the biggest obstacles has been restrictions on commercial air traffic. Regional flights in West Africa have virtually stopped, and several carriers have pulled out. Even the U.S. government has been relying on commercial airlines to deliver medical supplies. Civil military air assets should be mobilized to create an air bridge. The flow of aid workers and relief supplies cannot come second to commercial interests of private companies.

This emergency is going to require a sustained mobilization of resources for months to come. To maintain our current staffing levels, we have several hundred staff on standby to rotate into the affected region every six to eight weeks.

Fighting this outbreak goes beyond trying to control the virus. The health system in Liberia has collapsed. Pregnant women experiencing complications have nowhere to turn. Malaria and diarrhea, which are easily preventable and treatable, are killing people. Hospitals need to be reopened, and created.

Lastly, we must change the collective mind-set driving the response to the epidemic. Coercive measures, such as laws criminalizing the failure to report suspected cases, and forced quarantines, are driving people underground, pushing the sick away from health systems. These measures have served only to breed fear and unrest, rather than to contain the virus.

Countries cannot focus solely on measures to protect their own borders. Only by battling the epidemic at its roots can we stem it. This is a transnational crisis, with social, economic and security implications for the African continent.

We cannot cut off the affected countries and hope this epidemic will simply burn out. To put out this fire, we must run into the burning building.

Global | For the record: MSF President’s remarks to the UN Special Briefing on Ebola

United Nations Member States Briefing on the Ebola outbreak and Response in West Africa, Geneva, 16 September 2014

Remarks by Dr. Joanne Liu, International President, Médecins Sans Frontières

Ms. Under Secretary General, Mr. Special Coordinator, Mr. Assistant Director General, Distinguished Delegates, ladies and gentlemen.

Two weeks ago, I made an urgent appeal to member states of the United Nations in New York for your help in stemming the Ebola epidemic in West Africa. Many other organisations, such as the CDC, the WHO, and the UN, have also described the unfolding catastrophe.

Yet, since then, only a few countries have promised to deploy more hands-on capacity to the affected countries such as the United States of America, United Kingdom, China, France and Cuba, or the European Union. We understand President Obama will announce later today plans to deploy military and medical assistance to West Africa. If this is true – but we have no real details yet on what this deployment entails, and how fast it will be – then it shows that the US is willing to lead by example. Other countries need to follow.

Today, the response to Ebola continues to fall dangerously behind, and I am forced to reiterate the appeal I made two weeks ago:

We need you on the ground. The window of opportunity to contain this outbreak is closing. We need more countries to stand up, we need greater deployment, and we need it NOW.  This robust response must be coordinated, organized and executed under clear chain of command.

Today, in Monrovia, sick people are banging on the doors of MSF Ebola care centres, because they do not want to infect their families and they are desperate for a safe place in which to be isolated.

Tragically, our teams must turn them away.  We simply do not have enough capacity for them. Highly infectious people are forced to return home, only to infect others and continue the spread of this deadly virus.  All for a lack of international response.

As of today, MSF has sent more than 420 tonnes of supplies to the affected countries. We have 2,000 staff on the ground. We manage more than 530 beds in five different Ebola care centres. Yet we are overwhelmed.  We are honestly at a loss as to how a single, private NGO is providing the bulk of isolation units and beds.

We are unable to predict how the epidemic will spread. We are dealing largely with the unknown. But we do know that the number of recorded Ebola cases represents only a fraction of the real number of people infected.  We do know that transmission rates are at unprecedented levels. We do know that communities are being decimated. And, with certainty, we know that the ground response remains totally, and lethally, inadequate.

With every passing week, the epidemic grows exponentially. With every passing week, the response becomes all the more complicated.

More countries must deploy their civil defence and military assets, and medical teams, to contain the epidemic. Large numbers of trained staff are needed to tend to patients in basic and efficient isolation wards and tent hospitals, which can be established quickly on open ground in a comparatively straight forward logistical operation.

The fight against this outbreak is more than just about controlling the virus.  While thousands have died of Ebola, many more are dying from easily treatable conditions and diseases because health centres no longer function.Health structures need support to start working again and reduce death rates and suffering caused by other untreated ailments.

Meanwhile, efforts towards producing an effective vaccine must continue, in order to cut the chain of transmission. But it must be a vaccine of proven safety and efficiency and of wide availability.  Until that day comes, we must act as if no vaccine exists.

How the world deals with this unprecedented epidemic will be recorded in history books.  This is a regional crisis with economic, social and security implications that reach far beyond the borders of the affected countries.

States have a political and humanitarian responsibility to halt this mounting disaster

It can only be done by massively deploying assets to the field, and battling the epidemic at its roots.

The first pledges have been made, now more countries must urgently also mobilise. The clock is ticking.

West Africa | Widespread and intense transmission of Ebola continues

According to the WHO, widespread and intense transmission of Ebola continues in Guinea, Liberia and Sierra Leone.

A second meeting of the Emergency Committee convened by the Director-General under the International Health Regulations regarding the 2014 Ebola outbreak in West Africa will begin discussion via email this week. The meeting will review the status of the outbreak as a public health emergency of international concern, and assess the impact of current temporary measures to contain the outbreak and reduce international spread.

Countries with widespread and intense transmission

4963 probable, confirmed and suspected cases and 2453 deaths have been reported in the current outbreak of Ebola virus disease as of 13 September 2014 by the Ministries of Health of Guinea and Sierra Leone, and as of 9 September by the Ministry of Health of Liberia.

There are several points to be considered when interpreting epidemiological data for the Ebola outbreak. Many of the deaths attributed to Ebola virus in this outbreak occurred in people who were suspected, but not confirmed, to have died from the disease. Ebola cases are only confirmed when a sample tests positive in the laboratory. If samples taken from a body test negative for Ebola, that person is no longer counted among Ebola deaths and the figures are adjusted accordingly.

However, because laboratory services and treatment centres are currently overwhelmed in several countries, the numbers of probable and suspected cases, together with those confirmed, may be a more accurate reflection of case numbers.

 

 

Alabama | Positive cases of Enterovirus D68 confirmed

The Alabama Department of Public Health is investigating clusters of children with suspected Enterovirus D68 (EV-D68).

As of Sept. 15, results show 4 of 6 specimens from Mobile County
sent to the Centers for Disease Control and Prevention are positive for EV-D68. One of the specimens was positive for Coxsackievirus B3 and the remaining one was negative.

Health care providers have been asked to report clusters of cases. While individual cases of EV-D68 do not require reporting, a cluster must be reported.

In general, enteroviruses have various symptoms, including mild respiratory, fever, rash and neurologic illness. EV-D68 has more severe respiratory symptoms. There is no vaccine; treatment depends on the symptoms, and prevention is very important.

To prevent EV-D68 and all other communicable viruses like influenza, people need to
• Wash their hands frequently
• Cover their cough
• Keep children home if ill
• Avoid touching eyes, nose and mouth with unwashed hands
• Avoid kissing, hugging, and sharing cups and eating utensils with sick people
• Disinfect frequently touched surfaces, such as toys and doorknobs

If you or a family member has severe respiratory symptoms, please contact your doctor and follow his/her advice.

British Columbia | Take Home Naloxone program saves more lives

BC’s pilot Take Home Naloxone (THN) program has reversed 125 opioid drug overdoses over the past two years, according to the BC Centre for Disease Control.

Naloxone is a safe medication that can reverse the effects of an overdose of an opioid drug, such as heroin, morphine, fentanyl or oxycodone. Without action, an overdose can cause a person’s breathing to slow or stop which can eventually lead to severe brain damage or death. In the event of an opioid overdose, naloxone restores normal breathing within 2-5 minutes.

Since the program began in August 2012, 1215 naloxone kits have been distributed in 51 sites throughout BC. In addition, the program has trained more than 2,200 people, including people who use drugs, friends, family members, and service providers, to recognize and respond to an opioid overdose using the kit and medication. Eligible participants are prescribed a naloxone kit.

“Illicit and prescription drug overdose deaths continue to be a preventable tragedy in British Columbia. The BC Take Home Naloxone program has proven that it saves lives by equipping people with training and a safe medication that can reverse the effects of opioids,” said Dr. Jane Buxton, harm reduction lead, BC Centre for Disease Control.

Royal Inland Hospital in Kamloops, a BCTHN site, recently became the first emergency department in Canada to provide overdose prevention and response training and naloxone kits to at-risk patients.

“Emergency departments often see opioid users who are at highest risk for overdose deaths. Royal Inland Hospital is at the cutting edge of harm reduction, integrating an effective prevention manoeuvre [THN] with acute care services. Staff have wholeheartedly embraced the program. I am struck by the leadership, pragmatism, and compassion of the RIH physicians and nurses who stop and take the time to offer a simple yet lifesaving tool to some of their most marginalized patients,” said Dr. Tevor Corneil, Medical Health Officer, Interior Health Authority.

The Inner City Youth Program at St. Paul’s Hospital in Vancouver began a research study this summer to understand the experience of youth with the THN program which will help to inform future programs for youth.

“The Take Home Naloxone initiative has seen a remarkable number of youth in the Inner City Youth Program participate in the training and apply this intervention in critical, life-saving situations. It has contributed to their personal sense of autonomy and fostered our dialogue with them,” said Dr. Steve Mathias, Medical Manager, Inner City Youth Program.

Naloxone is currently used in harm reduction programs in the U.K, Italy, Germany, Australia and 17 US states. In Canada, naloxone programs are also available in Alberta and Ontario.

Facts:

· In 2013, there were 308 deaths in BC due to illicit drug overdoses, the majority involving opioids.

· The BC Coroners Service has reported 27 deaths from January to April 2014 where fentanyl, a very strong opioid, was detected.

· Canada has the highest consumption of opioid prescription drug use in the world. Overdoses can occur with both prescription and illicit opioids.

Learn more:
http://towardtheheart.com/naloxone/
Recently published evaluation of Take Home Naloxone program

Michigan | Community health officials receiving reports of increase in severe respiratory illness in children

The Michigan Department of Community Health (MDCH) is receiving reports indicating an increase in severe respiratory illness in children ages 5-17 across the state. MDCH is working with local health departments and hospitals to investigate these cases.

At this time, Michigan has no confirmed cases of Enterovirus D68 (EV-D68) associated with the national outbreak, but MDCH is forwarding samples to the Centers for Disease Control and Prevention (CDC) for testing.

Nationally, clusters of EV-D68 infections have recently impacted the pediatric population in multiple states. Original reports described clusters of illness in Missouri and most recently Illinois. The majority of those cases had a previous medical history of asthma or prior wheezing. Currently, suspected cases are also being investigated in Alabama, Colorado, Georgia, Iowa, Kansas, Kentucky, Michigan, Ohio, Oklahoma and Utah.

Enteroviruses are very common viruses; there are more than 100 types. It is estimated that 10 to 15 million enterovirus infections occur in the United States each year. Symptoms of EV-D68 infection can include wheezing, difficulty breathing, fever and racing heart rate. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious requiring hospitalization. Enteroviruses are transmitted through close contact with an infected person, or by touching objects or surfaces that are contaminated with the virus and then touching the mouth, nose, or eyes. There is no specific treatment for EV-D68 infections but supportive care can be provided.

Young residents with asthma are encouraged to be vigilant in taking their asthma controlling medications. Further, Michiganders can protect themselves from enterovirus by taking general hygiene precautions:

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands.
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.
  • Disinfect frequently touched surfaces, such as doorknobs, especially if someone is sick.

Additional information about human EV-D68 can be found in today’s CDC Morbidity and Mortality Weekly Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm.

Massachusetts | Second human case of West Nile virus announced

The Massachusetts Department of Public Health (DPH) today announced the second human case of West Nile virus (WNV) in the state this year. The woman is a resident of Middlesex County in her 40’s who was hospitalized, but has been released and is recovering.

This finding raises the risk level to “Moderate” in the following communities: Melrose, Reading, Saugus, Stoneham, Wakefield, Winchester and Woburn.

“While cooler weather reduces mosquito activity, risk for mosquito-borne illness remains a concern until the first hard overnight frost,” said State Public Health Veterinarian Dr. Catherine Brown. “Residents need to continue to take steps to protect themselves against mosquito bites: use insect repellant, cover up, and avoid outdoor activities at dusk and after nightfall when mosquitoes are at their most active.”

This is the second human case of WNV in the state this year. In 2013, there were eight human cases of WNV infection identified in Massachusetts. While WNV can infect people of all ages, people over the age of 50 are at higher risk for severe disease. WNV is usually transmitted to humans through the bite of an infected mosquito. Most people infected with WNV will have no symptoms. When present, WNV symptoms tend to include fever and flu-like illness. In rare cases, more severe illness can occur.

People have an important role to play in protecting themselves and their loved ones from illnesses caused by mosquitoes.

Avoid Mosquito Bites

Apply Insect Repellent when Outdoors. Use a repellent with DEET (N, N-diethyl-m-toluamide), permethrin, picaridin (KBR 3023), oil of lemon eucalyptus [p-methane 3, 8-diol (PMD)] or IR3535 according to the instructions on the product label. DEET products should not be used on infants under two months of age and should be used in concentrations of 30% or less on older children. Oil of lemon eucalyptus should not be used on children under three years of age.

Be Aware of Peak Mosquito Hours. The hours from dusk to dawn are peak biting times for many mosquitoes. Consider rescheduling outdoor activities that occur during evening or early morning.

Clothing Can Help Reduce Mosquito Bites. Wearing long-sleeves, long pants and socks when outdoors will help keep mosquitoes away from your skin.

Mosquito-Proof Your Home

Drain Standing Water. Mosquitoes lay their eggs in standing water. Limit the number of places around your home for mosquitoes to breed by either draining or discarding items that hold water. Check rain gutters and drains. Empty any unused flowerpots and wading pools, and change water in birdbaths frequently.

Install or Repair Screens. Keep mosquitoes outside by having tightly-fitting screens on all of your windows and doors.

Protect Your Animals

Animal owners should reduce potential mosquito breeding sites on their property by eliminating standing water from containers such as buckets, tires, and wading pools — especially after heavy rains. Water troughs provide excellent mosquito breeding habitats and should be flushed out at least once a week during the summer months to reduce mosquitoes near paddock areas. Horse owners should keep horses in indoor stalls at night to reduce their risk of exposure to mosquitoes. Owners should also speak with their veterinarian about mosquito repellents approved for use in animals and vaccinations to prevent WNV and EEE. If an animal is diagnosed with WNV or EEE, owners are required to report to DAR, Division of Animal Health by calling 617-626-1795 and to the Department of Public Health (DPH) by calling 617-983-6800.

More information, including all WNV and EEE positive results from 2013, can be found on the Arbovirus Surveillance Information web page at www.mass.gov/dph/mosquito or by calling the DPH Epidemiology Program at 617-983-6800.

DPH has produced a series of 30-second videos on how to prevent mosquito and tick bites and the illnesses that can result. All videos can be found at www.mass.gov/MosquitoesAndTicks. Media outlets are encouraged to share these videos on their websites. Instructions on how to embed the videos into external websites are included on this webpage.

Louisiana | DHH testing confirms presence of Naegleria Fowleri ameba in St John Water District 1 water system

The Louisiana Department of Health and Hospitals (DHH) announced that its testing confirmed the presence of the Naegleria fowleri ameba in the St. John Water District 1 water system. This water system serves 12,577 people in the towns of Reserve, Garyville and Mt. Airy. There are no known cases of illness related to the ameba in St. John the Baptist Parish or elsewhere in the state currently.

The water system was sampled as part of DHH’s surveillance program that just launched earlier this month. During the ameba testing, DHH discovered the system was not in compliance with the State’s emergency rule, which requires water systems to maintain a minimum disinfectant residual level of 0.5 milligrams per liter throughout all of their distribution lines. This 0.5 mg/L level is known to control the Naegleria fowleri ameba.

DHH has issued an emergency order requiring St. John Water District 1 to perform a free-chlorine burn (maintain 1.0 mg/l of free chlorine throughout the system for 60 days) to kill the amebae within the water system.  The water will remain safe to drink during this time.  At the end of 60 days, DHH will sample the system again for presence of the ameba.  In previous cases in Louisiana, this action has been effective in controlling the ameba. The emergency order also requires the system to achieve and maintain compliance with the state’s minimum chlorine residual of 0.5 mg/l throughout their system.

St. John Water District 1 is the third water system in Louisiana to test positive for the ameba. Last year, testing by the Centers for Disease Control and Prevention (CDC) confirmed the presence of the ameba in the St. Bernard Parish Water System and DeSoto Parish Waterworks District No. 1. The testing followed last summer’s death of a child in St. Bernard Parish and the 2011 deaths of two individuals in DeSoto and St. Bernard parishes. At the time of the 2011 deaths in DeSoto and St. Bernard parishes, health officials could only confirm the presence of the ameba in the homes of the deceased, but not in the water systems. In 2013, following the DeSoto and St. Bernard parish incidents, more advanced sampling technology was developed, which DHH used in this case. No known additional infections have occurred in DeSoto or St. Bernard parishes, as incidences of infection are extremely rare. Testing in May on DeSoto Parish Waterworks District No. 1 and St. Bernard Parish Water System did not detect the ameba.

Once St. John Water District 1 begins the chlorine burn, residents served by this water system may notice a change in the smell and taste of the water throughout the chlorine burn. However, the water will remain safe to drink. The St. John Water District 1 is one of several community water systems in the parish and services 12,577 customers. If residents are uncertain as to what water system they are served by, they should review their most recent water statement.

“We are working closely with the water system and parish officials to ensure that the chlorine levels are increased to a level that will reduce the risk of exposure to the ameba,” said DHH Public Health Assistant Secretary J.T. Lane. “Water from St. John Water District 1 remains safe to drink; however, we do have guidance for residents on steps they can take to reduce their risk.”

“Residents in Reserve, Garyville and Mt. Airy are advised to take all recommended pre-cautions to avoid having water enter their nose,” said St. John the Baptist Parish President Natalie Robottom.  “The parish Utilities Department is taking immediate actions to fully chlorinate the water system and eliminate the threat.  As more information becomes available, it will be released to the public.”

“Families can take simple steps to protect themselves from exposure to this ameba, the most important being to avoid allowing water to go up your nose while bathing or swimming in a pool,” said Louisiana State Health Officer Jimmy Guidry. “It is important to remember that the water is safe to drink; the ameba cannot infect an individual through the stomach.”

PRECAUTIONARY MEASURES FOR FAMILIES

According to the CDC, personal actions to reduce the risk of Naegleria fowleri infection should focus on limiting the amount of water going up a person’s nose and lowering the chances that Naegleria fowleri may be in the water. Preventative measures recommended by the CDC include the following:

  • DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow-up pools.
  • DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools) – walk or lower yourself in.
  • DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose.
  • DO run bath and shower taps and hoses for five minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level.
  • DO keep small hard plastic/blow-up pools clean by emptying, scrubbing, and allowing them to dry after each use.
  • DO use only boiled and cooled, distilled or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.
  • DO keep your swimming pool adequately disinfected before and during use. Adequate disinfection means:
    • Pools: free chlorine at 1-3 parts per million (ppm) and pH 7.2-7.8, and
    • Hot tubs/spas: free chlorine 2-4 parts per million (ppm) or free bromine 4-6 ppm and pH 7.2-7.8.
  • If you need to top off the water in your swimming pool with tap water, place the hose directly into the skimmer box and ensure that the filter is running. Do not top off by placing the hose in the body of the pool.

Residents should continue these precautions until testing no longer confirms the presence of the ameba in the water system. Residents will be made aware when that occurs. For further information on preventative measures, please visit the CDC website here: http://www.cdc.gov/parasites/naegleria/prevention.html

FOR UPDATES

For more information on how to protect yourself and on the current status of testing, visit DHH’s Water Facts website at www.dhh.la.gov/WaterFacts. DHH launched the website to provide the public with accurate information about the ameba. DHH is also accepting questions from the public for using a form on this Website or via e-mail to DHHInfo@la.gov.

Be well. Practice big medicine.