County’s disease detectives get to root of health issues

02/28/2013 11:33 AM

02/28/2013 11:34 AM

Most people who get bitten by a virus-carrying mosquito exhibit no symptoms, and some experience mild flu-like symptoms. So when 21 cases of arboviral disease – including West Nile – hit the books in Sedgwick County last summer, including one case of encephalitis, health officials jumped on it.

“The West Nile virus was a little surprising last year when people started getting sick,” said Chris Steward, an epidemiologist with the Sedgwick County Health Department and member of a team of health experts who research the origin and causes of diseases in the community. “It was a dry summer, so that took us by surprise. That’s why we’re already planning for (this) summer.”

Other eyebrow-raising trends in the greater Wichita area last year included an unusually high number of suspected or confirmed salmonella infections (49), chickenpox cases (71) and pertussis, or whooping cough (87), outbreaks.

These diseases – and a host of other scary and sometimes life-threatening illnesses that periodically surface throughout the year – keep health officials on their toes. These behind-the-scenes investigators work every day to stem outbreaks, prevent illness and protect Sedgwick County residents from myriad germs and viruses.

“Our mission is to improve the health of the residents of Sedgwick County by promoting wellness, preventing disease and protecting the public from health threats,” said county Health Director Claudia Blackburn. “Communicable disease control is one of our major responsibilities, and monitoring the community for health threats is part of that.”

County and state health officials essentially are disease detectives. They employ investigative science to get to the root of a health problem or outbreak in the community. They partner with schools, hospitals and physicians around the area to help provide clues as to what’s infecting residents. And then they try to stop it.

“We are trying to (keep) people from getting sicker,” said Seth Konkel, county health protection coordinator. “We’re doing the work so we can stop the spread of disease.”

Most of the time, health officials said, it starts with a lab report showing a positive result for a certain disease whose existence, by law, must be reported to local, state or federal health agencies. The list contains more than 50 reportable diseases, including rabies, mumps, food-borne illnesses, Lyme disease and sexually transmitted diseases.

Last year, the state Bureau of Epidemiology, through its Infectious Disease Epidemiology and Response Program, investigated 73 infectious disease outbreaks in Kansas. That included 11 vaccine-preventable disease outbreaks, including one measles outbreak, one chickenpox outbreak and eight pertussis outbreaks involving at least 649 cases. They also investigated 28 food-borne illness outbreaks, two outbreaks associated with animal contact and one water-borne disease.

When reports come in, the health department begins collecting information about the patient and the illness so it can try to pinpoint helpful clues such as infection origins or who else might have come in contact with the patient.

Some diseases are easily transmitted from person to person and can be difficult to manage. Most infections are better controlled when people are aware and take preventive measures.

In any case, “there’s a public health concern,” Steward said, “and there are prevention measures the public can take. Like with West Nile virus, we can put out prevention messages of spraying yourself and going outside with long sleeves. Those are the main reasons diseases are reportable.”

In addition to tracking disease trends and investigating outbreaks, health officials conduct targeted surveillance for unusual diseases or indicators of public health threats.

They knew pertussis was heading for Wichita last year when it popped up in the Kansas City area following several outbreaks throughout the country. Then it was a matter of time. The health department sent an informational warning letter to physicians through the Medical Society of Sedgwick County.

“We weren’t taken by complete surprise,” Steward said. “When we knew pertussis was probably going to come, we started planning. The first thing we wanted was doctors to know how to test for it and … to make sure we were all on the same wavelength for treatments.”

Steward noticed from various epidemiology reports from around the country that people who reportedly had been vaccinated were still getting ill with pertussis, which helped shape the county’s education strategy to include pertussis booster shot reminders, targeting public education about basic germ safety and awareness efforts among school nurses and others who work with children.

“Because of our surveillance, we saw what was happening and were able to increase public awareness,” Konkel said. “That’s why we monitor the systems we do.”

Monitoring includes hospitals and schools to help keep tabs on why residents are visiting emergency rooms or are absent from school. That helps health officials determine when there are bugs going around, such as influenza or gastro-intestinal problems.

Surveillance might also include reports from residents, restaurants and grocery stores.

Occasionally an unknown or unexpected health threat turns up that is so new, health experts don’t know yet how to deal with it.

An unknown or little understood virus can spread like wildfire across the country. That happened a few years ago when SARS first came out and again two years ago with H1N1, when county health officials had to deal with the disease before a vaccine was available.

“Anything that’s new, that we don’t have a lot of science behind but starts affecting people, we have to react very cautiously,” Konkel said.

When that happens, health officials fall back on traditional public health measures: quarantine, isolation and education.

“We make sure we take the science and communicate it in a way the public can understand,” Konkel said. “We are not looking to scare them, but we want them to be concerned enough that they take the recommended actions to protect themselves and their families.”

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