Definition
Acute flaccid myelitis (AFM) is a disease that affects the nervous system, specifically the spinal cord, characterized by rapid onset of weakness in one or more limbs and distinct abnormalities of spinal cord gray matter on magnetic resonance imaging (MRI).
Symptoms
Most patients will have sudden onset of limb weakness and loss of muscle tone and reflexes. In addition to limb weakness, some patients will experience:
- facial droop/weakness
- difficulty moving eyes or drooping eyelids
- difficulty with swallowing or slurred speech
- pain in arms or legs
Causes
Since 2014, two national increases in AFM have been documented and these spikes are thought to be caused by enterovirus D68 (EV-D68). The increases in AFM coincided with a national outbreak of EV-D68, and EV-D68 was the most common virus detected in patients with AFM. AFM can also be caused by other viruses such as flaviviruses (West Nile Virus, Japanese Encephalitis), herpesviruses, and adenoviruses.
Treatment
There is no specific treatment for AFM, but a neurologist may recommend certain interventions on a case-by-case basis.
Prevention
Prevention of acute flaccid myelitis includes many of the same techniques to prevent infections from many viral infections including:
- being up to date on all recommended vaccinations, including poliovirus
- mosquito protection, including repellent and avoidance
- washing your hands often with soap and water
- avoiding close contact with ill people
- cleaning surfaces with disinfectant
Specimen Collection
Clinicians should collect specimens from patients suspected of having AFM as early as possible in the course of illness, preferably on the day of onset of limb weakness.
Early specimen collection has the best chance to yield a diagnosis of AFM. Additional instructions regarding specimen collection and shipping can be found at AFM Specimen Collection Instructions.
Acute flaccid myelitis is reportable to Iowa HHS by Iowa Administrative Code 641 chapter 1.
Additional Resources
Definition
Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. A bacterium is a very small organism made up of one cell. A spore is a cell that is dormant (asleep) but may come to life under the right conditions. There are four types of anthrax:
- Skin (cutaneous)
- Lungs (inhalation)
- Digestive (intestinal)
- Injection
Anthrax is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of an anthrax infection vary depending on the type of infection:
Skin - The first symptom of cutaneous anthrax is a small sore that develops into a blister. The blister then develops into a skin ulcer with a black area in the center.
Lungs - Inhalation anthrax are like cold or flu symptoms and can include a sore throat, mild fever and muscle aches. Later symptoms include cough, chest discomfort, shortness of breath, tiredness and muscle aches.
Digestive - The first symptoms of intestinal anthrax include nausea, loss of appetite, bloody diarrhea and fever. These will be followed by bad stomach pain.
Injection – Similar to skin (cutaneous) anthrax, but the infection may be deep under the skin or in the muscle where injecting drugs were used.
Causes
Anthrax spores are formed by bacteria that occur naturally in soil. The spores can remain dormant for years until they find their way into a host such as sheep, cattle, horses and goats. Anthrax does not spread person-to-person. Anthrax can be spread naturally by exposure to contaminated soil or animals, or intentionally when used as a weapon.
Humans can become infected with anthrax by handling products from infected animals or by breathing in anthrax spores from infected animal products. People also can become infected with intestinal anthrax by eating undercooked meat from infected animals.
Anthrax also can be used as a weapon. This happened in the United States in 2001. Anthrax was deliberately spread through the postal system by sending letters with powder containing anthrax spores. This caused 22 cases of anthrax infection and resulted in 5 deaths.
Risk Factors
To become infected with anthrax you must come into direct contact with anthrax spores. Certain careers or activities can put you at a greater risk for being infected:
- Those who handle animal skins, furs or wool
- Those in the military and deployed to areas with a high risk of exposure
- Those who work with anthrax in a laboratory setting
- Veterinarians, especially if work is done with livestock
- Hunters and those who handle or dress game animals
- Mail handlers, if spores are sent through the mail
- Emergency response workers
Prevention
Anthrax is rare, and most people will never be exposed to it. There is a vaccine to prevent anthrax infection, but it is not intended for public use. Instead, the vaccine is reserved for those in the military, working with anthrax in the laboratory, or others in high risk professions. In the event of a biological attack using anthrax, people exposed may get the vaccine or antibiotics.
Treatment
Antibiotics are used to treat all three types of anthrax infection. Early identification and treatment are important.
Additional Resources
Definition
Botulism is a rare, but very serious condition. It is caused by botulinum toxin produced by bacteria such as Clostridium botulinum. These toxins are among the most poisonous substances known.
There are five forms of the disease - foodborne, infant intestinal, wound, adult intestinal, and iatrogenic. Botulism is always considered a medical emergency. It can cause death by paralyzing the muscles people use to breathe. However, over the past 50 years, the death rate for people with botulism has dropped from 50 percent to less than 5 percent.
Botulism is reportable to the Iowa HHS by Iowa Administrative Code 641/AC 1.
Symptoms
When botulism is caused by contaminated food, symptoms usually appear within 12 to 36 hours. But symptoms can start as soon as six hours later or as long as 10 days later.
Symptoms of botulism are similar for all forms and include:
- Difficulty breathing
- Double / blurry vision
- Drooping eyelids
- Slurred speech
- Difficulty swallowing
- Dry mouth
- Muscle weakness
Infants with botulism may display symptoms of muscle paralysis. They include:
- Lethargy
- Poor appetite
- Constipation
- Weak cry
- Poor muscle tone
Without treatment, people with botulism may go on to develop paralysis of the arms, legs, trunk, and the muscles used for breathing.
Causes
People can get botulism in different ways:
- Foodborne: By eating food contaminated with the toxin
- Wound: From the toxin produced when a wound is infected with the bacteria
- Infant, Adult Intestinal: When someone eats or drinks something that contains spores of the bacteria
- Iatrogenic: When too much botulinum toxin is injected for cosmetic reasons
Risk Factors
Most patients hospitalized with botulism are under one year of age. Adults may be more likely to get botulism if they have certain bowel problems.
Prevention
There is no vaccine available to protect the public against botulism.
You can prevent food-related botulism by using good food-handling practices, especially when canning foods at home. Infants under the age of 12 months should not eat honey, which can contain the bacteria.
Treatment
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks or months, plus intensive medical and nursing care. Botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. Antitoxin for infants is available from the California Department of Public Health, and antitoxin for older children and adults is available through CDC. If given before paralysis is complete, antitoxin can prevent worsening and shorten recovery time. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria followed by administration of appropriate antibiotics. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.
Botulism is reportable to Iowa HHS by Iowa Administrative Code 641 chapter 1.
Additional Resources
Definition
Brucellosis is a bacterial disease that often leads to joint pain (arthralgia), muscle pain (myalgia), fever, headache, and weakness. The bacterium can live inside animals and can be spread to people. Brucellosis is uncommon in the United States (around 100 cases per year are reported), but it can cause serious illness, especially in pregnant women, immunocompromised individuals, infants, and the elderly.
Brucellosis is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
It can take anywhere from a few days to two months before an infected person starts to see symptoms of a brucella infection. When symptoms do show up, they often resemble the flu and include:
- Fever - may be intermittent or irregular
- Headache
- Chills
- Sweats
- Weakness
- Depression
- Joint, muscle and back pain
- In some cases, symptoms may disappear for months and then return. Even after treatment, symptoms persist in some affected individuals for months to years.
Causes
Brucellosis is caused by the bacterium brucella. It normally infects people by spreading from one of its many animal reservoirs. The most common animal reservoirs are cattle, pigs, goats, sheep, and rarely dogs. This disease has been eliminated from domestic animal populations in the United States. However, it periodically infects this population after exposure to wildlife, such as wild pigs. The bacteria can spread from animals to people in three main ways:
- Direct contact. Transmission occurs through direct contact (breaks in the skin or mucosal surfaces) with infected animal tissue, blood, urine, vaginal excretions, aborted fetuses, or placentas.
- Unpasteurized dairy products. Transmission can also occur from the ingestion of raw milk and dairy products (unpasteurized) that came from an infected animal,
- Inhalation. When individuals breathe in bacteria that are in the air.
- Person-to-person transmission is rare but has been documented.
Risk Factors
Although brucellosis is rare in the United States, those most at risk for infection are people who have the potential to come into contact with infected animals. Examples include veterinarians, animal clinic employees, wildlife officers, and farm workers. Individuals who drink raw milk or eat unpasteurized dairy products are also at higher risk of infection.
Prevention
Many measures can be taken to prevent brucellosis infection:
All people who regularly interact with animals or animal carcasses should take the appropriate precautions such as wearing gloves and maintaining a well-ventilated workspace.
Consumption of all dairy products that are unpasteurized should be avoided.
Diseased animals should be identified and controlled through vaccines or slaughter of infected herds.
Treatment
Treatment for brucellosis consists of appropriate antibiotic treatment that is initiated by a health care provider.
Statistics
Brucellosis infection is rare in Iowa with only one or two cases per year. Three cases were reported in 2020, and no cases were reported in 2021.
Additional Resources
Definition
Campylobacteriosis (often called campy) is a diarrheal disease caused by infection with the bacterium Campylobacter. It is the most common cause of diarrheal disease in the United States. Most often the illness is mild and requires little to no treatment.
Symptoms
On average it takes between 2-5 days after being infected with Campylobacter before symptoms begin to appear. Symptoms tend to decline about a week after they began. The most common signs and symptoms include:
- Diarrhea (sometimes bloody)
- Abdominal pain
- Fever
- Nausea
- Vomiting
These symptoms can range from mild to severe. In a few rare cases, long-term complications can follow the normal progression of the disease and include:
- Guillain-Barre Syndrome - a rare disease that affects the nerves of the body
beginning several weeks after the diarrheal illness. This illness results in paralysis that lasts several weeks and usually requires intensive care - Arthritis
Causes
Campylobacteriosis is caused by the ingestion of the Campylobacter bacteria found in food or water sources that have been contaminated with animal or human feces. Other common causes include:
- Improperly handling raw poultry
- Eating raw or undercooked poultry
- Eating or drinking unpasteurized dairy products
Risk Factors
- People who are at higher risk of contracting campylobacteriosis include:
- People who regularly handle uncooked poultry or other meats
- Farmers who are in regular contact with infected animals
- Individuals who drink raw milk or eat unpasteurized dairy products
- Individuals who drink from untreated water sources
Prevention
- People with diarrhea should not go to school or work until diarrhea ends.
- Always refrigerate poultry and meat products.
- Always cook poultry completely (internal temperature of at least 165ºF).
- Avoid consuming unpasteurized milk and dairy products.
- Carefully wash hands before and after preparing foods.
- Avoid drinking untreated water.
- Make sure children wash their hands carefully, especially after using the toilet, having diapers changed, or handling pets.
- Always wash hands with soap and warm water after using the toilet or changing diapers.
- Always wash food preparation surfaces and utensils between cutting up poultry or raw meat and other foods.
Treatment
Rehydration and electrolyte replacement are the main treatments for Campylobacter infections. In general, antibiotics are only used in severe cases, or with immunocompromised individuals who are at risk for greater complications. Make sure to consult with a healthcare provider if you have any questions about your health or before taking any anti-diarrheal medication.
Campylobacteriosis is reportable to Iowa HHS by Iowa Administrative Code 641 chapter 1.
Additional Resources
Epi Manual Campylobacteriosis Chapter
Caring for Our Children: National Health and Safety Performance Standards
Definition
Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face, and then spreads over the entire body. Chickenpox can be serious, especially in babies, adolescents, adults, pregnant women, and people with a weakened immune system. The best way to prevent chickenpox is to get the chickenpox vaccine.
In the prevaccine era, varicella was endemic in the United States, and virtually all persons acquired varicella by adulthood. As a result, the number of cases occurring annually was about 4 million. The majority of cases (approximately 90%) occurred among children younger than age 15 years. The incidence of varicella has decreased significantly since U.S. vaccination began in 1995. Overall, varicella incidence declined an average of 97% from prevaccine years.
Only chickenpox outbreaks are reportable in Iowa. An outbreak is defined as five or more cases that are related in place and epidemiologically linked. Outbreaks are reportable by Iowa Administrative Code 641 Chapter 1.
If you are a childcare provider or school staff and think there may be an outbreak of chickenpox in your facility, please fill out this survey here or call the Center for Acute Disease Epidemiology at (800)362-2736.
Symptoms
- Generalized, itchy, rash
- Blisters containing fluid
- The blisters commonly occur in successive crops of skin and oral mucous membranes
- Blisters are more abundant on covered than exposed parts of the body
- Tiredness
- Fever
- Headache
- Loss of appetite
Causes
The varicella zoster virus replicates in the upper respiratory tract. Chickenpox is easily spread from person to person by droplet or airborne spread of respiratory tract secretions, or contact with the fluid of the blisters.
A person with chickenpox is contagious beginning one to two days before rash onset and until all blisters have crusted. Vaccinated people who get chickenpox may develop lesions that do not crust. These people are considered contagious until no new lesions have appeared for 24 hours.
Chickenpox occurs approximately 10 to 21 days after exposure.
Prevention
Varicella vaccine should be administered to all adolescents and adults 13 years of age and older who do not have evidence of varicella immunity. Two doses of varicella vaccine is more than 90% effective at preventing disease. Vaccination is recommended for all children starting at 12 to 15 months of age with a second dose at four to six years of age.
Individuals with varicella should stay home until all of their lesions have crusted. During outbreaks, it may be recommended for exposed susceptible individuals who refuse vaccination or have contraindications to the varicella vaccine, stay home from school or childcare. In these situations, exclusion is required for the duration of the period of communicability (from the eighth until the 21st day post-exposure).
Childcare and Schools
Call CADE to report chickenpox outbreaks at (800) 362-2736 or fill out this survey.
Unvaccinated children with no history of varicella disease should be instructed to be vaccinated immediately. If vaccination is contraindicated or refused, the child may be excluded from school up to 21 days after the last case is identified. A notification letter should be sent home with children informing parents and caregivers of the outbreak. The notification letter should alert the person to the possibility of exposure to varicella, describe the disease, recommend vaccination if the person is not already considered immune, and recommend exclusion if disease develops. Children with uncomplicated chickenpox who have been excluded from school or childcare may return when the rash has crusted, or in immunized people without crusts, when lesions have faded or no new lesions have appeared in the last 24 hours. The scope of those exposed will be based on whether there are multiple classrooms that do or do not intermingle.
Pregnant women, infants, and unvaccinated people with a weakened immune system that have been exposed to chickenpox may be at risk for severe disease. These individuals should be evaluated promptly for post exposure prophylaxis or treatment.
Treatment
Calamine lotion and a cool bath with added baking soda, uncooked oatmeal, or colloidal oatmeal may help relieve some of the itching. Try to minimize scratching to prevent the virus from spreading to others and potential bacterial infection from occurring. Keeping fingernails trimmed short may help prevent skin infections caused by scratching blisters.
Appropriate antiviral drugs appear useful in preventing or modifying varicella in exposed individuals if given for seven days starting seven to 10 days after exposure. Always consult your health care provider if you have questions about your health or before starting any treatment.
Additional Resources
Definition
Cholera is an acute diarrhea disease caused by toxins produced by Vibrio cholerae bacteria. In the United States, because of advanced water and sanitation systems, cholera is not a major threat; however, everyone, especially travelers, should be aware of how the disease is transmitted and what can be done to prevent it.
Cholera is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Most individuals infected with cholera develop mild illness involving only diarrhea. Less commonly, infected individuals will develop more severe illnesses characterized by profuse watery stools, nausea, some vomiting and leg cramps. These symptoms may become more severe because of rapid loss of body fluids, dehydration and shock can occur in the most severe cases. Without rehydration therapy, death may occur within hours if severe illness is untreated. With proper treatment, the risk of fatal illness is significantly reduced.
Causes
V. cholerae is usually transmitted by eating or drinking food or water contaminated by stool or vomit of infected persons (e.g., via sewage). The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The bacteria may live in the environment in brackish rivers and coastal waters so individuals may also become ill by ingesting raw or undercooked shellfish harvested from polluted waters. A few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.
Risk Factors
Any person who eats or drinks food or water contaminated by the bacteria is at risk of becoming ill. Those traveling to areas where cholera is more common and those with weakened immune systems are at an increased risk of becoming ill.
Prevention
Although the risk of cholera infection is low in the United States, travelers to coastal regions and those traveling to areas where cholera is typically found are at an increased risk of becoming ill.
General Tips:
- Do not eat raw or undercooked fish or shellfish, including ceviche.
- Always wash hands thoroughly with soap and water before eating or preparing food, after using the toilet, and after changing diapers.
- After changing diapers, wash the child’s hands and your own.
- In a child care, dispose of feces in a sanitary manner.
- When traveling:
- “Boil it, cook it, peel it, or forget it.”
- Drink only bottled or boiled water, keeping in mind that bottled carbonated water is safer than un-carbonated water.
- Ask for drinks without ice unless the ice is made from bottled or boiled water.
- Avoid popsicles and flavored ices that may have been made with contaminated water.
- Eat foods that have been thoroughly cooked and that are still hot and steaming.
- Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
- Peel your own raw fruits or vegetables and do not eat the peelings.
- Avoid foods and beverages from street vendors.
- Do not bring any perishable food back to the United States.
Treatment
When diarrhea is present, aggressive fluid replacement is the mainstay of treatment. In addition, your physician may prescribe certain antibiotics.
Statistics
No cases of cholera were reported in 2021.
Additional Resources
Definition
COVID-19 is a coronavirus that spreads via respiratory droplets and often causes respiratory illness resulting in mild to severe symptoms.
Symptoms
COVID-19 infection typically presents as an acute febrile illness with varying severity. Symptoms include:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
- Testing
Testing for COVID-19 is widely available in Iowa through hospitals, clinics, and other providers.
Definition
Cryptosporidiosis (often called crypto) is a diarrheal disease caused by a parasite called Cryptosporidium. The parasite can cause disease in both animals and humans. People are usually exposed to crypto by coming into contact with people or animals shedding the parasite or drinking contaminated water.
Symptoms
The most common symptom of crypto is frequent, watery diarrhea. Other symptoms include:
- Abdominal cramping
- Headache
- Nausea
- Vomiting
- Fever
Symptoms often come and go and tend to last about 30 days or less in most people. People with weakened immune systems can develop chronic illness or severe life-threatening complications.
Causes
Cryptosporidium is found in the feces of infected people and animals. The typical ways crypto spreads include:
- Person-to-person: Many people are infected by hand-to-mouth transfer of the parasite from the feces of an infected person. This method of infection is especially common in day care centers. Sexual contact is another way one person can infect another person with this parasite.
- Animal-to-person: People interacting with farm animals can become infected when they do not take the proper precautions such as washing their hands afterwards.
- Foodborne: Food can become contaminated when a food handler does not properly wash their hands. Unpasteurized apple cider and dairy products have also been cited as sources of infection.
- Waterborne: Cryptosporidium is resistant to some disinfectants and can survive in recreational and drinking water sources. Swallowing contaminated water from recreational water sites, such as in pools or lakes, can make people sick.
Risk Factors
Anyone can become infected with Cryptosporidium. However, the most likely people to become infected are:
- Children aged 3 to 11
- Animal handlers such as veterinarians or farmers
- International travelers
- Close contacts of infected people
Prevention
Cryptosporidiosis may be prevented by:
- washing hands after using the bathroom and before handling food
- making sure infants and children wash their hands after diapering or going to the bathroom
- avoiding unpasteurized apple cider and dairy products
- avoiding sexual contact with people who have crypto
- washing hands after caring for someone with crypto
- avoiding swallowing water while swimming
- not swimming with diarrhea.
- People diagnosed with crypto should wait 2 weeks after diarrhea has stopped before swimming.
Treatment
People who are healthy often improve without taking any medications. They should drink plenty of fluids to prevent dehydration due to diarrhea. Make sure to consult with a health care provider if you have any questions about your health or before taking any anti-diarrheal medication. Nitazoxanide is a medication that has been approved by the U.S. Food and Drug Administration (FDA) to treat cryptosporidiosis in people with healthy immune systems who are at least one year old. Nitazoxanide is available by prescription. The effectiveness of nitazoxanide to treat cryptosporidiosis in people with weakened immune systems is unclear.
Cryptosporidiosis is reportable to Iowa HHS by Iowa Administrative Code 641 chapter 1.
Additional Resources
Epi Manual Cryptosporidiosis Chapter
Caring for Our Children: National Health and Safety Performance Standards
Definition
Cyclosporiasis is a parasitic infection of the small intestine caused by the protozoa Cyclospora cayetanensis. It usually causes a watery diarrheal illness that can last anywhere from nine to 43 days if left untreated. Increasing frequency of cyclosporiasis has been reported in the United States and Canada since the mid-1980s.
Cyclosporiasis is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
On average, it will take about one week after being infected with C. cayetanensis to start showing signs and symptoms. If left untreated, illness can last for a month or longer and may come back one or more times. Symptoms include, but are not limited to:
- Watery diarrhea
- Loss of appetite
- Weight loss
- Bloating
- Increased gas
- Stomach cramps
- Nausea
- Vomiting
- Tiredness
- Muscle aches
- Low-grade fever
Causes
C. cayetanensis is a protozoa that is spread by swallowing water or food that has been contaminated with infected human feces. Direct person-to-person spread is unlikely to occur as the protozoa that are found in the feces of sick people are not infectious until days to weeks after excretion.
Risk Factors
Persons of all ages are at risk for infection. However, people living or traveling in developing countries may be at increased risk. Infection is also more common in the spring and summer than other seasons.
Prevention
Avoid water or food that may be contaminated with feces.
Infected people should wash their hands thoroughly and often to prevent spread of the infection.
Thoroughly wash all fruits and vegetables before eating.
Treatment
Before treatment can occur, C. cayetanensis must be identified by a health care provider. Once identified, antibiotic treatment is started along with fluid and electrolyte replacement if necessary.
Statistics
There were 88 cyclosporiasis cases reported in 2021.
Additional Resources
Definition
Diphtheria is a toxin-mediated disease caused by the bacteria Corynebacterium diphtheria. Disease occurs in two main forms: respiratory and cutaneous (skin). Diphtheria is uncommon in the United States due to widespread vaccination and cases usually occur among unvaccinated or inadequately-vaccinated individuals.
Diphtheria is reportable to Iowa HHS by Iowa Administrative Code 641/AC 1.
Symptoms
Symptoms of respiratory diphtheria usually appear two to five days after infection and may include:
- Weakness
- Sore throat
- Mild Fever
- Swollen glands in the neck
- Formation of a thick, gray coating in the throat or nose
- Can cause heart, nerve, and kidney damage
Cutaneous diphtheria appears as open sores or ulcers on the skin, and this type rarely results in severe disease.
Infected individuals remain contagious for two to four weeks if they do not receive treatment. Persons treated with antibiotics are usually only contagious for about four days but there have been reports of people becoming carriers of the disease for up to six months after infection.
Causes
Diphtheria is transmitted person-to-person usually through respiratory droplets or direct contact with nasal secretions from an infected person.
People can also become infected by indirect or direct contact with infected skin lesions. This form of the disease is usually mild and only rarely involves toxic complications.
Risk Factors
In the United States, diphtheria is most commonly seen in individuals who are unvaccinated or inadequately-vaccinated against the disease. Travel to areas where diphtheria is endemic, such as the Caribbean, Asia and the South Pacific, Eastern Europe, and the Middle East, also increases the risk of infection. All those who share living space, food, drink, eating utensils, and/or saliva with an infected person are at risk of becoming infected.
Prevention
Receiving adequate diphtheria vaccination is the best way to prevent the disease. This vaccine is one of the recommended childhood immunizations and should begin during infancy. The vaccine is usually coupled with the tetanus and pertussis (whooping cough) vaccines (DTaP vaccine).
For more information about immunizations, please visit the Iowa HHS Immunizations page.
Treatment
Any person who suspects they may have this disease should contact their health care provider immediately as treatment should begin as soon as possible. Treatment includes:
- Diphtheria antitoxin neutralizes the diphtheria toxin circulating in the body.
- Diphtheria is also treated with antibiotics such as erythromycin or penicillin.
Diphtheria is reportable to Iowa HHS by Iowa Administrative Code 641 chapter 1.
Additional Resources
Epi Manual Diphtheria Chapter
CDC: Diphtheria
Caring for Our Children: National Health and Safety Performance Standards
Definition
Shiga toxin-producing Escherichia coli (STEC) are bacteria that can cause bloody diarrhea in infected people. In rare cases, the same bacterium can also cause a kidney disease known as Hemolytic Uremic Syndrome. The most well known member of this group of bacteria is E. coli O157:H7.
Pathogenic E. coli is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Infection may lead to a wide variety of symptoms. Most symptoms start three to four days after exposure to the bacterium. Some people are asymptomatic, whereas others display all of the symptoms listed below. Fever is usually rare, but more common symptoms include:
- Diarrhea (usually bloody)
- Abdominal cramps
- Nausea
- Vomiting
- Chills
A rare complication that can occur with STEC infection is called Hemolytic Uremic Syndrome (HUS). HUS is a kidney disease which can lead to kidney failure and death. This complication is most common in younger children. About 15 percent of children infected with E. coli O157:H7 will develop HUS.
Causes
STEC are members of the species Escherichia coli bacteria. Many E. coli strains are routinely found in the colons of humans and do not cause disease. However, unlike other E. coli strains, STEC produces a toxin called “Shiga toxin.” This toxin is responsible for the bloody diarrhea, HUS, and other symptoms that occur with this infection.
Spread of the bacteria occurs in many ways and includes:
- Drinking water contaminated with human or animal feces containing the bacterium
- Eating undercooked contaminated ground beef or unpasteurized dairy products
- Drinking unpasteurized apple juice, cider, or dairy products
- Eating raw fruits and vegetables that have been contaminated with feces of infected animals
- Person-to-person transmission
Risk Factors
Infection occurs in all age groups but tends to be diagnosed more in children five years old and younger. This age group is at increased risk of developing HUS and the complications associated with it. Elderly people also appear to be at increased risk for complications.
Prevention
- Do not fix food for other while having diarrhea.
- Wash hands after using the toilet and after changing diapers. Wash the diapered child’s hands also.
- When caring for someone with diarrhea, wash your hands with plenty of soap and water after cleaning the bathroom, helping the person use the toilet, or changing diapers, soiled clothes, or soiled sheets. Be sure to wash their hands also.
- Always refrigerate meat. Never leave raw meat at room temperature
- Cook all ground beef and hamburger thoroughly; to a temperature of 155º F for at least 15-16 seconds or until juices run clear and no pink is visible. Never eat raw meat.
- Always wash hands, cutting boards, and utensils between fixing raw meat or poultry and other items.
- Keep food that will be eaten raw from being in contact food products from animals. Wash these foods thoroughly before eating.
- Drink only pasteurized milk, juice, or cider
- Avoid sexual practices that permit fecal-oral transmission. Latex barrier protection (condoms) should be used to prevent the spread of STEC, as well as other pathogens, to sexual partners.
Treatment
Fluid and electrolyte replacement is the cornerstones of treatment for most STEC infections. Antibiotics have not been shown beneficial, and some may actually be harmful. However, because of the potential for complications, people with suspected STEC infections should be monitored closely. If any signs or symptoms are present that resemble HUS, the patient should be brought to the doctor immediately for observation and treatment.
Statistics
There were 494 cases reported in 2021, 15.4 cases per 100,000 population.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standards
Definition
Enteroviruses are a group of small viruses that include over 60 types of viruses, which cause a wide variety of illnesses with fever, including three vaccine preventable enteroviruses that cause polio. Non-polio enteroviruses are very common. They are second only to the "common cold" viruses, the rhinoviruses, as the most common viral infectious agents in humans. The enteroviruses cause an estimated 10-15 million or more symptomatic infections a year in the United States.
Symptoms
Most people infected with an enterovirus have no symptoms. Some enteroviruses cause symptoms similar to the cold or flu such as fever, body aches, sore throat and mild to moderate skin rash. Less often these viruses can cause more serious symptoms such as meningitis (swelling of the spinal nerve cords) or encephalitis (inflammation of the brain).
Causes
Enteroviruses can be found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person. Other persons may become infected by direct contact with secretions or stool from an infected person or by contact with contaminated surfaces or objects, such as a drinking glass or telephone. Parents, teachers, and child care center workers may also become infected by contamination of the hands with stool from an infected infant or toddler during diaper changes.
Risk Factors
Everyone is at risk of infection. Infants, children and adolescents are more likely to become infected and develop illness from enteroviruses than adults.
Prevention
Unfortunately, there are no vaccines for these viruses. Good personal hygiene, especially handwashing before handling food and after using the bathroom and/or changing diapers, can reduce the spread of these viruses.
Treatment
There are no specific drugs to fight these viruses, but some medications can be used to make the person feel better. Although you can develop immunity to one virus, you can still get sick with any of the other enteroviruses.
Definition
Giardiasis is an illness caused by a microscopic parasite that lives in the intestines of people and animals. Giardia is one of the most common causes of waterborne disease in the United States. The parasite can be found in streams, lakes, wells, and recreational waters.
Giardiasis is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms include:
- Watery diarrhea
- Vomiting
- Stomach cramps
- Loss of appetite
- Weight loss
Symptoms generally begin seven to 10 days after infection but can range from three to 25 days. Some people have no symptoms. The illness usually lasts about two to six weeks in healthy persons.
Causes
Giardia can be found in soil, food, water, or any surfaces that have been contaminated with the feces from infected humans or animals. Infection occurs when you accidentally ingest the parasite. Three common ways for this to happen is by eating contaminated food, drinking contaminated water, or through person-to-person contact.
Risk Factors
Anyone can become infected with Giardia, but children are infected more often than adults. It occurs frequently in hospitals, prisons, or child cares. Persons who travel overseas or who drink untreated water also have a higher risk of giardiasis.
Prevention
Ways you can prevent giardiasis include:
- Hand washing after using the bathroom
- Hand washing after changing diapers
- Hand washing before food handling or eating
- Hand washing after contact with farm animals or playing with pets
- Don’t drink untreated water
- Avoid swallowing water in rivers and lakes unless you filter it or boil it for 10 minutes at 158 degrees F.
Treatment
Many people who experience symptoms often get better without treatment. If signs and symptoms persist or become more severe, oral antibiotics can be prescribed.
Statistics
Giardiasis activity typically peaks in late summer or early fall. In 2021, there were 173 cases reported in Iowa, 5.4 per 100,000 population.
Additional Resources
Caring for our Children: National Health and Safety Performance Standards
Definition
Haemophilus influenzae type b (Hib) is a disease caused by a bacterium. It can cause several kinds of severe illness, including meningitis, pneumonia, and airway obstruction. Hib can be unpredictable and cause different illnesses in different people, including death. It is most common in unvaccinated infants less than two years old.
Invasive Hib is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Symptoms commonly appear between two and four days after exposure. Symptoms may include (depending on where a person is infected):
- Fever
- Vomiting
- Difficulty breathing
- Headache
- Confusion
Children infected with Hib may get seriously ill very quickly.
Causes
Hib is caused by breathing in bacteria carried on droplets from other people’s coughs and sneezes.
Once inside the body, Hib can act in different ways causing a variety of illnesses. If the bacteria stays in the nose or throat, it may cause infections there, but if it spreads throughout the body, it can cause more serious disease such as brain or blood infections.
Risk Factors
Unimmunized or underimmunized infants and children are at the highest risk.
Prevention
The best way to prevent Hib is to get vaccinated with Hib-containing vaccine. Click here for the Bureau of Immunization. In addition:
- Keep children up to date on their immunizations. By five years of age, the risk of Hib is almost nonexistent, except in people with immunity problems. Adults normally don’t have to worry about getting sick from Hib.
- Hand washing is important for preventing all illnesses including Hib.
- Cover your mouth and nose when you cough or sneeze.
- Avoid others when coughing.
In general, children should stay home when they are sick. If a person is diagnosed with Hib or is in contact with a known case of Hib and has symptoms, they should stay home until at least 24 hours after starting an appropriate antibiotic.
Treatment
An appropriate antibiotic can be given to stop people from carrying the disease if they are ill. Antibiotics are also used to treat people who have been exposed to Hib, especially those who live with someone with Hib. Fluids, rest, and observation of ill children with Hib is important. Children diagnosed with Hib and their close contacts still need to be sure to receive all of their proper immunizations.
Additional Resources
Caring for our Children: National Health and Safety Performance Standards
Definition
Hantaviruses infect rodents around the world. Many species can cause illness in people including hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). The virus is in the saliva, feces and urine of infected rodents and anyone who comes into frequent contact with rodents or their droppings are at risk.
HFRS is primarily seen in Europe and Asia and results in kidney failure and bleeding disorders which are usually not seen in individuals with HPS.
HPS occurs in the United States. The disease can lead to severe respiratory failure and shock. HPS was first recognized in 1993 and 366 cases have been identified in the U.S. as of June 2004.
Hantavirus syndromes are reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms first appear between a few days to six weeks after contact with the virus and include a flu-like illness with any of the following signs:
- Fever
- Muscle and body aches
- Chills
- Cough
- Headaches
- Nausea
- Vomiting
- Diarrhea
- Dizziness
- Fatigue
The lungs may then begin to fill with fluid, making breathing difficult. Once this phase of illness begins, the disease can progress rapidly and may result in severe respiratory failure and shock. If you have been exposed to rodents and experience these symptoms, you should contact your health care provider immediately.
Causes
The virus is carried in wild rodents such as deer mice. Rodents carrying the virus do not show any signs of illness. People become infected after breathing in airborne particles contaminated with urine, droppings or saliva from infected rodents. Disease transmission can also occur if dried materials contaminated by rodent feces or urine are disturbed and are directly introduced into broken skin or the eyes, nose, or mouth. Person-to-person spread is not reported in the U.S.
Risk Factors
Anyone whose occupational or recreational activities bring them into frequent contact with rodents or their droppings is at an increased risk of contracting this disease. Most cases have been associated with occupying rodent-infested vacant dwellings, cleaning rodent-infested outbuildings or living in areas where there has been an increase in the number of rodents.
Prevention
The best way to prevent this disease is by eliminating or minimizing human contact with rodents. The following precautions should be taken when cleaning rodent-contaminated areas:
- Clean rodent droppings using a wet method rather than a dry method as this will decrease the amount of dust produced.
- Open windows or allow areas to air out for 24 hours for better ventilation before cleaning.
- In areas of heavy rodent infestation, gloves, dust masks, long sleeves and protective eyewear should be worn to prevent exposure.
- Floors, countertops, cabinets and other surfaces should be cleaned with a 1:10 bleach solution.
The following precautions should be taken to decrease rodent infestations and contact with rodents:
- Clear brush and garbage from around building foundations to decrease the availability of rodent nesting materials.
- Seal all entry holes ¼ inch wide or wider with lath screen or lath metal, cement, wire screening or other patching materials, inside and out.
- Elevate hay, woodpiles and garbage cans at least one foot off the ground to eliminate potential nesting sites and keep all wood piles at least 100 feet from the house.
- Live trapping of rodents is not recommended. Instead, use an EPA-approved rodenticide with bait under plywood or plastic shelter around baseboards.
- Clean all food preparation areas and store all food in rodent-proof containers.
- Do not leave open bowls of pet food outside and discard any uneaten food properly at the end of the day.
Treatment
No specific treatment for this disease is available but early recognition and treatment improves the prognosis. Thus, anyone with rodent exposure that is suffering from the above symptoms should contact their health care provider immediately. In severe cases, admission into an intensive care unit for respiratory support and oxygen therapy may be necessary. Even with aggressive treatment, more than half of hantavirus cases are fatal.
Statistics
There was one case of hantavirus reported in Iowa in 2021.
Additional Resources
What do head lice look like?
Adult lice are the size of a sesame seed (2-3mm) and can be seen by the human eye. They live in human hair, draw blood from the skin, and lay eggs (called nits) on the hair shaft. Live nits are found close to the scalp and most often on hair at the back of the head in the neck region. Some children with lice complain of itchiness but many have no symptoms.
Is your child at risk?
Yes. Head lice will spread as long as children play together. They spread almost completely through human hair-to-hair contact, and pets do not spread lice. Anyone can get head lice. Children in child care, preschools, elementary, or middle schools are at risk. Head lice are NOT a sign of being dirty. Head lice are not dangerous and DOES NOT spread diseases.
Do head lice spread in swimming pools?
Data show that head lice can survive under water for several hours but are unlikely to be spread by the water in a swimming pool. Head lice have been seen to hold tightly to human hair and not let go under water. Chlorine levels found in pool water do not kill head lice.
Head lice may be spread by sharing towels or other items that have been in contact with an infested person's hair, although such spread is uncommon. Children should be taught not to share towels, hair brushes, and similar items either at poolside or in the changing room.
Swimming or washing the hair within 1-2 days after treatment with some head lice medicines might make some treatments less effective. Talk to your health care provider if you have questions.
What can you do?
Parents are the key to looking for and treating head lice! The Iowa Department of Public Health advises parents to spend 15 minutes each week on each child carefully looking for head lice or nits. Persons with nits close to the scalp or live lice should be treated. Careful use of a nit comb can potentially remove all lice. Each child should have his or her own comb or brush. Teach your child NOT to share hats, scarves, brushes, combs, and hair fasteners.
Treatment Options
Never initiate treatment unless there is a clear diagnosis of a head lice infestation. Always read and follow product instructions to their fullest.
Reasons Treatment Did Not Work
- Wrong diagnosis – dandruff, hair products, dust, and other objects can seem like nits (the white eggs) and other insects can look like lice.
- Poor treatment – directions on the treatment product were not correctly followed.
- Resistance to treatment – some lice are not killed by the chemicals in the over-the-counter treatments (permethrin and pyrethrin).
- Timing – the lice may take a few days to die; nits alone do not mean the child still has lice, look for crawling lice.
- New lice – child got head lice again from playmate or family member.
If after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. Do not re-treat until speaking with your healthcare provider; a different treatment may be necessary.
What about school?
Students diagnosed with live head lice do not need to be sent home early from school; they can go home at the end of the day.
Students should start treatment as soon as possible but should not be excluded from attending school.
Order the free "Getting Rid of Head Lice" brochures
Additional Resources
Definition
HUS is an illness in which the red blood cells are destroyed and the kidneys fail. HUS is a condition that can follow diarrhea caused by E. coli O157:H7 or Shigella dysenteriae. It can be serious, however, only a small percent of people with E. coli O157:H7 or Shigella dysenteriae develop HUS. Not all cases of HUS are caused by infection with these bacteria.
Pathogenic E. coli and Shigella including HUS is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Infection with the bacteria E. coli O157:H7 and Shigella dysenteriae may produce symptoms that include:
- Stomach cramps
- Vomiting
- Bloody diarrhea
- Mild fever
If a person goes on to develop HUS they will then become lethargic (feeling very tired) and pass decreasing amounts of urine. Other features include:
- High blood pressure
- Kidney failure
- Jaundice (yellowish discoloration of the skin and the whites of the eyes)
- Seizures
- Bleeding into the skin
HUS, if it occurs, develops an average 7 days (but up to 3 weeks) after the first symptoms, when the diarrhea is improving.
Causes
HUS cannot be spread. However, the bacteria E. coli O157:H7 and Shigella dysenteriae, that can cause HUS, can be spread to others if personnel hygiene is not practiced.
Risk Factors
Anyone can get HUS, but children under five and the elderly are at higher risk.
Prevention
There is no known medical treatment that will prevent the development of HUS. You can greatly reduce the risk of HUS by reducing the chances of becoming infected with E. coli O157:H7 or Shigella dysenteriae:
- Do not fix food for others while having diarrhea.
- Always wash hands thoroughly with soap and water before eating and before and after fixing any food, especially raw meat.
- Wash hands after using the toilet and after changing diapers. (Wash the diapered child’s hands also)
- When caring for someone with diarrhea, wash your hands with plenty of soap and water after cleaning the bathroom, helping the person use the toilet, or changing diapers, soiled clothes or soiled sheets. Be sure to wash their hands also.
- Always refrigerate meat. Never leave raw meat at room temperature.
- Keep food that will be eaten raw, such as fruits and vegetables, from being in contact with food products from animals. (Wash thoroughly, especially those that will not be cooked).
- Never eat raw meat. If you are served an undercooked hamburger or other ground beef product in a restaurant, send it back for further cooking.
- Cook all ground beef and hamburger thoroughly - to a temperature of 155 degrees F until juices run clear and no pink is visible.
- Always wash hands, cutting boards and utensils between fixing raw meat or poultry and other items such as fruits and vegetables.
- Drink only pasteurized milk, juice, or cider.
- Avoid sexual practices that may permit fecal-oral transmission. Latex barrier protection (condoms) should be used to prevent the spread of pathogenic E. coli to sexual partners as well as other pathogens.
Treatment
In severe cases, kidney function is greatly reduced, and dialysis may be necessary. Abnormalities of the blood clotting system can cause a tendency to bleed, and the red blood count may be low (anemia). Transfusions are often needed in severe cases. Fortunately, most people with HUS recover completely, and kidney function returns to normal. However, a prolonged hospital stay is often required.
Additional Resources
Definition
Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus. It is the most common form of viral hepatitis and one of the most frequently reported vaccine preventable diseases in the United States.
Hepatitis A is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of hepatitis A usually do not appear until you have had the virus for about a month. Adults are more likely to develop severe symptoms than children. Infected children under three years of age often do not become ill. Initial symptoms can range from mild to severe and may include the following:
- Abrupt onset of fever
- Malaise
- Poor appetite
- Nausea
- Stomach and abdominal pain
After a few days, these symptoms are typically followed by dark (“tea-colored”) urine and jaundice (a yellow discoloration of the skin and whites of the eyes). The disease is rarely fatal and most people recover with no complications within one to two weeks, although they may continue to feel tired for a few more weeks.
Infected individuals can spread the virus for one to two weeks before showing any symptoms and for one week after jaundice occurs. Children and infants may occasionally be contagious for longer periods of time.
Causes
Hepatitis A is caused by the hepatitis A virus and is highly contagious. The virus is found in the feces of infected people and can be spread in several ways:
- When a person with the virus handles food you eat without washing their hands after using the toilet
- Drinking contaminated water
- Being in close contact with an infected person (even if that person does not seem sick)
- Having sex with an infected person
- Eating raw shellfish from water polluted with raw sewage
Risk Factors
Anyone can become infected with hepatitis A but some people are at an increased risk of contracting the disease. Those people include the following:
- People who live in or travel to areas where hepatitis A is common (certain U.S. western states, Central and South America, Africa, the Middle East, Asia, and the Western Pacific)
- Intimate and household contacts of infected individuals
- Men who have sex with men
- Illegal drug users (injection and non-injection users)
- Prevention
- A hepatitis A vaccine is available and is recommended for the following persons:
- All children aged 12 to 23 months
- Travelers to areas with increased incidence of hepatitis A
- Men who have sex with men
- Illegal drug users (injection and non-injection users)
- People with blood clotting disorders (e.g., hemophilia)
- People with chronic liver disease (including persons with chronic hepatitis B or chronic hepatitis C infection)
- Residents of a community experiencing an outbreak of hepatitis A
- Hepatitis A vaccine or immune globulin administration is also recommended for close contacts of infected individuals within two weeks of exposure. Close contacts include the following:
- Household contacts
- Sexual contacts
- Playmates
- Attendees at childcare centers
- Persons sharing illegal drugs
- Persons sharing food or beverages
- Persons in common source exposure situations (i.e., co-workers or restaurant patrons where an infected food workers has been identified
The following precautions should also be observed to help prevent the spread of this disease:
- Always wash hands thoroughly with soap and warm water after using the toilet or changing diapers
- Wash children’s hands with soap and warm water after a diaper change
- Teach children to always wash their hands with soap and warm water after using the toilet
- Always wash hands thoroughly with soap and warm water before and after preparing any food
- People with diarrhea should NEVER prepare food for others
Once an infected individual recovers from hepatitis A, they are immune for life and do not continue to carry the virus.
Treatment
Once a person is ill from hepatitis A, there are no special medications available to cure the disease. Bed rest is typically all that is needed. Because this disease affects the liver, infected persons should avoid drinking alcohol and should contact their health care provider before taking drugs or medicines (such as aspirin or Tylenol) since certain drugs must be broken down by the liver. Anyone who suspects they may be infected with this disease should contact their health care provider.
Statistics
In 2021, 8 cases of hepatitis A were reported in Iowa.
Additional Resources
Visit the Hepatitis Program page to learn more about hepatitis B.
Visit the Hepatitis Program page to learn more about hepatitis C.
Definition
Hepatitis D is a virus that infects the liver. Hepatitis D, or Delta hepatitis, is always associated with a hepatitis B infection. A person may recover from Delta hepatitis or it may progress to chronic hepatitis.
Hepatitis D is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Onset of hepatitis D is usually sudden. Symptoms include:
- Tiredness
- Nausea
- Vomiting
- Fever
- Stomach pain
- Tea-colored urine
- Yellowing of the skin and eyes (jaundice).
Hepatitis D infection in someone with chronic hepatitis B may be misdiagnosed as a worsening of chronic hepatitis B.
Causes
The hepatitis D virus is spread by exposure to blood and serous body fluids, contaminated needles and syringes, and via sexual transmission.
Risk Factors
Hepatitis D can only occur if the person has hepatitis B. Hepatitis D virus (HDV) and hepatitis B virus (HBV) may infect a person at the same time or HDV infection may occur in persons with chronic HBV infection. Others risk groups include:
- Injection drug users
- Persons with hemophilia
- Infants/children of immigrants from areas with high rates of HBV infection
- Household contacts of chronically infected persons
- Persons with multiple sex partners or diagnosis of a sexually transmitted disease
- Men who have sex with men
- Sexual contacts of infected persons
- Infants born to infected mothers
- Health care and public safety workers
- Hemodialysis patients
Prevention
- There is no vaccine for hepatitis D. Hepatitis B vaccine is the best protection. Protection is given because only people infected with hepatitis B virus can become infected with hepatitis D virus.
- Latex condoms are recommended for sexually active individuals, especially those having sex with more than one partner. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission.
- Pregnant women should get a blood test for hepatitis B infection (HBV). Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.
- Injection drug users should be encouraged to discontinue injection drug use and to enroll in a treatment program; to never share needles, syringes, water, or "works;" and to get vaccinated against hepatitis A virus (HAV) and HBV.
- Individuals should not share personal care items that might be contaminated with blood (i.e. razors, toothbrushes).
- Patients should be encouraged to consider the risks of tattoos or body piercings.
- Patients who have had HBV should not donate blood, organs, or tissue.
Health care or public safety workers should get vaccinated against HBV, always follow routine barrier precautions, and safely handle needles and other sharps
Treatment
There is no specific treatment that can make the infection go away. People who are sick with hepatitis D should see a doctor for advice about how to control their symptoms.
Additional Resources
Definition
Hepatitis E (HEV) is a liver disease caused by the hepatitis E virus (HEV). Hepatitis E, however, does not occur often in the United States.
Hepatitis E is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Persons with hepatitis E infection may have no symptoms at all. Typical symptoms of acute hepatitis E include:
- Abdominal pain
- Anorexia
- Dark urine
- Fever
- Enlarged liver
- Jaundice
- Tiredness
- Nausea
- Vomiting
Causes
HEV is transmitted primarily by the fecal-oral route. Fecally contaminated drinking water or food are the most commonly documented methods of transmission.
Risk Factors
People who travel primarily in developing countries (Asia, Africa, Mexico) with inadequate environmental sanitation are at risk for disease. Infection is more common among adults than children. Symptom severity increases with age.
Prevention
There is no vaccine to prevent hepatitis E. Travelers to areas where HEV is found should drink only bottled or boiled water or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes if water purity is unknown. Also avoid uncooked shellfish, and uncooked fruits/vegetables not peeled or prepared by traveler.
Treatment
Supportive care only. The person usually gets well without treatment.
Additional Resources
Definition
Histoplasmosis is an infection that is spread by the spores of the mold, Histoplasma capsulatum. Once the spore has infected a person, it turns into a yeast form which causes disease in humans. There are five forms of the disease that are recognized. Each form of the disease is characterized by unique signs and symptoms. However, generally H. capsulatum is recognized as causing a lung infection similar to other common respiratory infections.
Symptoms
Most people infected with H. capsulatum have no recognized illness. However, histoplasmosis is generally considered a lung infection that has five recognized forms. Each form has its own unique signs and symptoms. Symptoms normally appear within 3 to 17 days after infection and include:
- Asymptomatic Form. No signs and symptoms are seen, but laboratory results are positive for infection.
- Acute Benign Respiratory Form. Flu-like symptoms that include:
- General tiredness
- Fever
- Chills
- Headache
- Muscle aches
- Chest pains
- Non-productive cough
Acute Disseminated Form. A form of infection that affects the entire body and may lead to death if left untreated. Symptoms include:
- Fever
- Vomiting
- Diarrhea
- Enlarged lymph nodes
- Enlarged spleen
Chronic Disseminated Form. A form of infection that affects the entire body and may lead to death if left untreated. This form of infection usually develops over 10 to 11 months and includes the following symptoms:
- Fever that may come and go
- Weight loss
- Weakness
- Enlarged liver and spleen
- Blood abnormalities
- Chronic Pulmonary Form. This form of the disease resembles tuberculosis of the lungs. Symptoms include:
- Night sweats
- Loss of weight
- Loss of appetite
- Cough lasting longer than three weeks
Causes
Histoplasma capsulatum is a fungus found in the soil. It is especially abundant in soil contaminated with bird and bat feces. In the United States, the fungus is most commonly found in the Ohio, Missouri, and Mississippi River valleys. H. capsulatum produces spores which, when breathed in by a human, cause the disease histoplasmosis as described above.
Risk Factors
Infection by H. capsulatum can occur in anyone. People who are likely to inhale large amounts of spores found in dirt are more likely to develop signs and symptoms. These people include:
- Farmers
- Pest control workers
- Construction workers
- Roofers
- Landscapers and gardeners
- Anyone who has close contact with birds, including chickens, bats, or bat caves
- Archeologists
- Geologists
- People with weakened or inhibited immune systems are at greater risk for getting severe disease. These people include:
- People with HIV/AIDS
- The elderly (> 65 years old)
- Infants or young children
- People with organ transplants
- People on chemotherapy
Prevention
Histoplasmosis is a relatively rare disease. Risk of exposure can be minimized by taking the following precautions:
- Spray soil with water or oil to reduce dust before working
- Anyone cleaning up sites that could be contaminated should wear masks or respirators
- Decontamination of suspected sites with 5 percent formaldehyde solutions can be performed if deemed necessary
Treatment
H. capsulatum is sensitive to many antifungals. Treatment is long-term and may require several months to a year.
Additional Resources
Visit the Iowa Influenza Surveillance Network page for additional information.
Definition
Legionellosis is a disease caused by a bacterium. It causes two different forms of illness: Legionnaire’s Disease and Pontiac Fever. Legionnaire’s Disease is the more serious illness.
Legionellosis is reportable to the Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Both Legionnaires' disease and Pontiac fever present with anorexia, malaise, muscle aches, headache and fever. Abdominal pain and diarrhea are also common. It will take between 2 to 10 days after being infected with this bacterium to show symptoms of Legionnaire’s Disease. Pontiac Fever takes 5 to 72 hours. Onset of symptoms can be rapid.
Pontiac fever is self-limited. Patients recover spontaneously in 2-5 days without treatment.
Legionnaires' disease is a more serious illness and requires treatment. Symptoms progress to include:
- Fever up to 105° F
- Chills
- Non-productive cough
- Stomach pain
- Diarrhea
Legionnaire’s Disease often turns into pneumonia and some people can die from this if not treated carefully.
Causes
Legionnaire’s Disease is caused by breathing in bacteria from sources of contaminated water. It is not spread person-to-person. This bacterium has been found in many different kinds of water systems, such as hot and cold-water taps and showers, creeks, ponds, whirlpool spas, cooling towers and evaporative condensers of large air-conditioning systems. Outbreaks have also been linked to decorative fountains, humidifiers, respiratory therapy devices and grocery store vegetable misters. These bacteria are more likely to reproduce in high numbers in warm, stagnant water and can be difficult to remove from a water supply.
Risk Factors
Not everyone exposed to legionella bacteria will become ill. You have an increased risk of becoming ill if you:
- Smoke. Smoking damages the lungs and makes you more susceptible to all types of lung infections.
- Have chronic lung diseases such as emphysema
- Immunocompromised
- Males become ill 2.5 times more than females
- Adults >50 years old
Prevention
- If a water supply is thought to have caused disease in people, careful treatment of the water source is needed.
- Stopping smoking reduces risk of this disease.
- Hotels, cruise ships and other owners of whirlpool spas and decorative fountains should maintain them according to the manufacturer’s recommendations, have adequate levels of proper disinfectant at all times, and keep current on protocols for public health safety.
- Tap water should not be used in respiratory therapy devices.
Treatment
Legionnaire’s Disease is treated with antibiotics.
Pontiac Fever goes away on its own without treatment.
Statistics
There were 44 cases of legionellosis reported to Iowa HHS in 2021.
Additional Resources
Epi Manual Legionellosis Chapter
Caring for Our Children: National Health and Safety Performance Standards
Definition
Hansen’s disease, also known as Leprosy, is a chronic disease resulting from infection with a bacterium known as Mycobacterium leprae. The bacterium multiplies very slowly and mainly affects the skin, nerves, and mucous membranes. There are two common forms of the disease, tuberculoid and lepromatous, and both forms produce sores on the skin.
New cases of Hansen’s disease in the U. S. are few, diagnosed mainly in California, Florida, Hawaii, Louisiana, Texas, New York City, and Puerto Rico.
Hansen’s disease is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of Hansen’s disease can appear anywhere from nine months to 20 years after exposure. Symptoms include:
- Skin lesions (located identically on both sides of your body) that are numb and do not heal after several weeks or months
- Numbness or absent sensation in the hands, feet, or legs
- Muscle weakness and paralysis
The lepromatous form can also result in a chronically stuffy nose.
Causes
Although how Hansen's disease is spread remains uncertain, most investigators think that M. leprae is usually spread person-to-person in respiratory droplets after prolonged close contact. Most people probably are not susceptible.
Risk Factors
Children are more susceptible to Hansen’s disease than adults. Also, people in close contact with infected individuals for long periods of time are at an increased risk of becoming infected.
Prevention
Prevention consists of avoiding close physical contact with infected individuals who are not being treated. Patients who have been treated with effective antibiotics for three days are no longer considered contagious. People with Hansen’s disease, including health care providers, can return to their regular activities (including work and school) after receiving effective treatment for three days.
Treatment
There are effective antibiotics available to treat Hansen’s disease. These drugs must be given long-term (at least two years) in order to be successful. Anyone who suspects they may be suffering from this disease should consult their health care provider.
Statistics
There was one case of Hansen's disease reported in 2020, and no cases reported in 2021.
Additional Resources
Definition
Listeriosis is an uncommon bacterial infection caused by the bacteria Listeria monocytogenes. This bacterium is widespread in nature and most cases are sporadic, although food borne outbreaks and person-to-person spread have been documented. L. monocytogenes is most commonly found in the soil, water, mud, cattle forage, and silage. Infected humans and animals can also shed the bacteria.
Listeriosis is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Symptoms can occur anywhere from 3 to70 days after exposure, but the average incubation period is about three weeks. Infection may result in acute, mild illness with fever or may be more severe and result in infection of the brain causing the following signs:
- Sudden fever
- Intense headache
- Nausea and vomiting
- Diarrhea
- Delirium
- Coma
Infection in the heart muscle or lesions in the liver or skin have also been reported. Spontaneous abortion in pregnant women is also possible.
Causes
Listeriosis is caused by eating food contaminated with the bacterium. L. monocytogenes, which can be found in soil, water, and animals. L. monocytogenes can multiply at refrigerator temperatures unlike most other food borne pathogens. Most cases of Listeriosis are associated with the consumption of raw milk, soft cheeses, ready-to-eat foods, processed meats, or contaminated vegetables. Infected individuals may shed the bacteria in their urine and feces but human-to-human transmission is uncommon. Listeriosis may be acquired by the fetus in utero or during passage through the birth canal. Mothers can shed the bacteria in their vaginal secretions and urine for up to 10 days after delivery and newborns may become infected before birth or as they pass through the birth canal.
Risk Factors
Immunosuppressed individuals such as newborns, the elderly, and pregnant women are at an increased risk for Listeriosis. Approximately 30 percent of diagnosed cases occur within the first three weeks of life. The case-fatality rate in infected newborn infants is about 30 percent and approaches 50 percent when onset occurs in the first four days of life.
Prevention
Prevention recommendations for high risk individuals, including those that are immunosuppressed, are as follows:
- Avoid unpasteurized milk and soft cheeses such as feta, Brie and blue cheese
- Thoroughly heat leftover foods or ready-to-eat foods such as hot dogs or processed lunch meats before eating
- Avoid foods from delicatessen counters or thoroughly re-heat cold cuts before eating
- Prevention recommendations for all individuals include the following:
- Keep uncooked meats separate from vegetables, cooked food, and ready-to-eat foods
- Avoid raw/unpasteurized milk or foods made from raw milk
- Thoroughly wash raw vegetables before eating
- Wash hands, knives, and cutting boards after handling uncooked foods
- Read and follow label instructions to “keep refrigerated” and “use by” a certain date
- Because this bacterium can be shed in the feces of infected individuals, people with diarrhea (especially children in child care settings or people who handle food) should not go to school or work. Individuals may usually return when their diarrhea stops if they carefully wash their hands after using the toilet, diapering, and before and after handling food.
Treatment
Listeriosis is treated with antibiotics. Severe infections may result in hospitalization and require intravenous antibiotic administration, especially for immunosuppressed individuals.
Statistics
There were three cases of Listeria monocytogenes reported in 2021.
Additional Resources
Definition
Lyme disease is a common tick-borne illness. Lyme disease is mainly found in the eastern United States and upper Midwest. Lyme disease is caused by the bacterium Borrelia burgdorferi. The bacteria is transmitted to humans by the bite of an infected tick, primarily Ixodes scapularis (also known as the black legged or deer tick). Photos of the tick can be seen by visiting bugguide.net.
Lyme disease is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Lyme disease affects various parts of the body. Not everyone who gets Lyme disease will experience the same symptoms.
Early Infection
The best and earliest sign of infection is a rash, called erythema migrans (EM). EM will appear in around 60% - 80% of patients. EM may appear within a few days to a month, usually at the site of the tick bite. The rash will first appear as a small, red bump. Over the next few days, the redness expands. As the rash expands, it begins to look like a bull’s eye, with a red center and a red ring surrounding a clear area. EM should not be mistaken for any initial skin irritation at the site of the bite which fades within about a week.
Early Spread
If left untreated, multiple EM rashes may appear within 3-5 weeks after the tick bite. The onset of more than one rash shows that the infection has spread into the blood. The secondary rashes look like the first bull’s eye rash, but usually smaller in size. A person may experience additional symptoms like:
- Mild eye infections
- Paralysis of the facial muscles (Bell’s palsy)
- Headache
- Fatigue
- Muscle and joint pain
- Abnormal heart rhythm (<10% of cases)
Late Disease
Later symptoms of Lyme disease can present days to months after infection and last for several years, but tend to resolve on their own. Symptoms that may be seen in late disease include:
- Recurrent arthritis commonly in the knees and shoulders
- Impairment of mood, sleep, or memory
- Paralysis of the muscles in the face
- Pain or tingling in the extremities
- Meningitis and encephalitis
Causes
In the United States, the Lyme disease bacterium is carried mostly by deer ticks. Ticks are most likely to spread the Lyme disease bacterium during their pre-adult stage (nymph). Nymphs are brown, very small and difficult to see. Nymphs are most common between May and July and found in tall grasses and brush of wooded areas. Towards the end of summer and into fall, ticks mature and are less likely to spread disease.
Ticks painlessly attach themselves to a host and feed on the host's blood until they're swollen to many times their normal size. Scientific data suggests that ticks need to remain attached for 24 – 48 hours before the host is infected with the bacterium. An attached tick that looks swollen could have been attached long enough to transmit bacteria. A tick should be removed as soon as possible. See prevention for the proper removal technique.
Risk Factors
- Spending time outdoors can increase your chances of getting Lyme disease. The most common risk factors for Lyme disease include:
- Spending time in wooded or grassy areas. Deer ticks are found in wooded areas, so people who spend time in these areas should take precautions.
- Exposed skin. Ticks attach easily to bare skin. If you're in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants and keep your pets out of tall grasses and brush.
- Not removing ticks quickly or correctly. A person can only be infected with the bacterium if the tick stays attached for 24-48 hours. If a tick is removed before that time, your risk of infection is reduced.
Prevention
The best way to prevent Lyme disease is to avoid tick-infested areas. If you do spend time in these areas, the following can reduce your risk of infection:
- Wear long-sleeved shirts and long, light-colored pants tucked into socks or boots.
- Stay on trails when walking or hiking and avoid high grass.
- Use insect repellants. Repellants that contain DEET should be used in concentrations no higher than 15% for children and 30% for adults. Remember, repellants are not recommended to be used on infants. Permethrin is a repellant that can only be applied to clothing, not exposed skin.
- After each day spent in tick-infested areas, check yourself your children, and your pets for ticks. Ticks tend to prefer the back of the knee, armpit, scalp, groin, and back of the neck.
- Promptly remove any attached tick. Folk remedies, such as burning the tick with a match or covering it with petroleum jelly or nail polish, are not effective and can be dangerous because they may force the tick to regurgitate its gut contents, increasing the risk of disease transmission. The tick removal method described below is proven to be effective, and is recommended by the Centers for Disease Control and Prevention.
- Carefully grasp the tick by using tweezers to grip the tick by its mouthparts which are close to the skin. Do not squeeze the tick’s body.
- Pull steadily directly away from your skin. Because removing the tick is your main goal, do not be overly concerned if its mouthparts break off in the process (as they will be shed naturally).
- Clean the wound and disinfect the site of the bite.
- Prevention of Lyme disease also involves keeping wildlife (especially deer and rodents) out of your backyard and making your yard less attractive to ticks.
- Remove leaf litter and brush from around your home.
- Prune low-lying bushes to let in more sunlight.
- Keep your grass short.
- Plant deer resistant plants near your home.
- Keep woodpiles in sunny areas off the ground.
- Clean up the ground around bird feeders.
- If you are going to use insecticides around your home, always follow the label instructions and never apply these chemicals near streams or other bodies of water.
Treatment
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. Treatment guidelines for acute lyme disease are posted on the CDC website.
Statistics
Additional Resources
Epi Manual Lyme Disease Chapter
Iowa State University Center for Food Security and Public Health
Definition
Malaria is caused by a parasite (Plasmodium) that is transmitted to humans via the bite of an infected female Anopheles mosquito. In humans, the parasites grow and multiply first in the liver and then in the red blood cells. Eventually, the red blood cell is destroyed, releasing daughter parasites which go on to invade other red cells.
Malaria is most often reported in the tropical areas of the world but can still occur in more temperate climates such as in the United States where Anopheles mosquitoes are present. However, nearly all of the 1000 cases reported in the United States annually are acquired abroad.
Malaria is reportable to the Iowa Department of Public Health by Iowa Administrative Code 641 IAC 1 .
Symptoms
Symptoms of malaria can occur between 7 to 40 days after infection. Typical symptoms include the following:
- High fever with chills
- Sweats
- Headache
- Other, less common, symptoms may include:
- Nausea
- Vomiting
- Diarrhea
- Cough
- Joint aches
- Respiratory distress
- Abdominal pain
- Back pain
- Paleness
- Jaundice
Symptoms may vary depending on the species of parasite the individual was infected with. Infection with some species of Plasmodium parasites may result in a potentially fatal, acute illness with the following symptoms:
- Blood clotting defects
- Shock
- Kidney and liver failure
- Fluid in the lungs or around the brain
- Coma
Infections may last from a week to a month or longer and relapses are possible. Chronic infections may also occur with or without recurrent episodes of fever and often result in enlargement of the liver and spleen.
Causes
People usually become infected with malaria from the bite of an infected mosquito. Only mosquitoes infected with malaria parasites (from a previous blood meal taken from an infected person) can transmit the disease. Rarely, malaria can also be transmitted through blood transfusions, organ transplants, or shared use of contaminated needles and syringes. It may also be transmitted from a mother to her fetus before or during delivery.
Risk Factors
People who are living in or travel to tropical areas where malaria is common are at an increased risk of becoming infected.
Prevention
In tropical areas where malaria is common, people should protect themselves from being bitten by mosquitoes as follows:
- Sleep inside bed nets and treat bed nets with insecticides
- Sleep in houses that are screened or air-conditioned
- Avoid exposure to mosquitoes between dusk and dawn
- If outdoors, apply insect repellants containing DEET to exposed skin
- Wear long-sleeved clothing or clothing treated with permethrin
The use of anti-malarial drugs, which can be obtained from your health care provider if you are traveling to a malaria-infected region, is also recommended.
Treatment
Treatment varies widely and is dependent on the severity of the disease, the species of parasite infecting the individual and much more. There are several different kinds of anti-malarial drugs available but some species of Plasmodium parasites have become resistant to many of these drugs. Severe infections may result in hospitalization and require IV drug treatments. If you suspect you may have been infected, seek care from your health care provider immediately.
Statistics
In 2021, 17 cases of malaria were identified in Iowa. All infections were acquired outside of the United States.
Additional Resources
Definition
Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of red bumps and flat spots breaks out. It starts at the head and spreads to the rest of the body.
Before the measles vaccination program started in 1963, an estimated 3 to 4 million people were infected with measles each year in the United States. Since then, widespread use of measles virus-containing vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. Measles is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Signs and symptoms begin to appear about 7-21 days after being infected. The rash usually appears about 14 days after being infected.
- Cough
- Runny nose
- Red, watery eyes
- Nasal congestion
- Fever (higher than 101° F)
- Rash (flat red areas all over the body, with raised bumps)
- Koplik spots (small spots with white or bluish-white centers on the inside of the cheeks)
If you think that you have measles or have been exposed to someone with measles, isolate yourself from others and call your healthcare provider, urgent care, or emergency room before arriving to be tested. Do not arrive at a health care facility without giving advance notice.
Causes
Measles is caused by breathing in a virus carried on droplets from other people’s coughs and sneezes and less commonly from objects recently contaminated with infected droplets. Measles is one of the most contagious infections known to exist. People can spread measles for several days before they get the rash until several days after the rash develops.
Risk Factors
It is routine for children to be vaccinated against measles at 12 months and 4 years of age. Those who have not had these two doses of vaccine are at risk for measles. People born before 1957 likely had measles as children and are less likely to catch measles, but being vaccinated is a good way to be sure. Measles vaccine is one of the most effective vaccines used today.
Prevention
The best way to prevent measles is to get vaccinated with a measles containing vaccine. Because of high immunization rates, measles is rare in Iowa.
CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. The MMR vaccine is very safe and effective. Two doses of vaccine are about 97% effective at preventing measles. One dose is about 93% effective.
Measles vaccine is required for entry into Iowa public and private schools, as well as licensed child care centers and preschools. Following the Iowa requirements on immunization greatly reduces the risk of children catching measles.
For more information, visit the Iowa Immunization webpage.
Treatment
There is no treatment for measles. However, there are actions that can be taken to protect those who have been recently exposed.
Immune globulin (IG) is sometimes used to treat someone who has been exposed and thought to likely get sick. If given within six days of exposure IG can either prevent the disease or make the symptoms less severe.
Measles vaccine can be given to unvaccinated people within 72 hours of exposure. The vaccine will either prevent the disease or make symptoms less severe.
Laboratory Testing
Immediately call the Iowa Department of Health and Human Services, Center for Acute Disease Epidemiology at (800) 362-2736 if you suspect measles in a patient. Iowa HHS will assist in determining the appropriate testing to be done based upon the patient history. Iowa HHS will provide a test request form.
Both serology specimens for IgG and specimens for PCR testing may be requested.
Additional Resources
What Should Iowans Know About Measles
MMR Vaccination: What Everyone Should Know
Measles: Questions and Answers
MMR Vaccine Information Statement
MMRV Vaccine Information Statement
Q&A Measles: What You Should Know
CDC: Manual for Surveillance of Vaccine-Preventable Disease
Measles: Make Sure Your Child is Fully Immunized
Frequently Asked Questions for K-12 Schools
Frequently Asked Questions for Colleges
Frequently Asked Questions for Childcare Centers
Caring for Our Children: National Health and Safety Performance Standards
Definition
Meningitis is a general term describing an inflammation around the membranes (meninges) surrounding the brain. Most cases of meningitis are caused by a viral infection, but bacterial and fungal infections can also occur. Meningitis can resolve on its own in a couple of weeks or can become a life-threatening emergency. Only some types of bacterial meningitis are reportable to Iowa HHS and require public health follow-up.
The life-threatening disease known as meningococcal invasive disease is what this section focuses on. Meningococcal disease is an illness caused by the bacteria Neisseria meningitidis which causes inflammation of the tissue surrounding the brain and spinal cord (the meninges) resulting in meningitis. N. meningitidis can also infect the blood causing meningococcemia, or rarely other parts of the body.
N. meningitidis is found in the noses and throats of 5 to 10 percent of the normal human population and rarely causes serious disease. However, rarely the bacterium can get through the mucous membranes of the nose and throat and spread throughout the body causing meningococcal “invasive” disease.
Meningococcal invasive disease is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1 .
Symptoms
Symptoms of meningococcal disease include fever, headache, and stiff neck. Other symptoms may include nausea, vomiting, increased sensitivity to light, and confusion. Children and infants may show different signs and symptoms, such as inactivity, irritability, vomiting, or poor reflexes. Later symptoms meningococcal disease can be very severe (e.g., seizures, coma). For this reason, if you think you or someone else may have meningitis, see a physician as soon as possible.
Symptoms of meningococcemia may include fever, fatigue, vomiting, cold hands and feet, cold chills, severe aches or pain in the muscles, joints, chest or abdomen, rapid breathing, diarrhea - and, in the later stages, a puerperal rash or a petechial rash.
Approximately 10 to 15 percent of people with meningococcal disease die, even with appropriate treatment. Of those who recover, up to 20 percent suffer from serious after-effects, such as permanent hearing loss, limb loss, or brain damage.
There are multiple meningococcal vaccines licensed and available in the United States. Keeping up to date with recommended vaccines is the best protection against meningococcal disease.
Causes
Meningococcal invasive disease is caused by the bacterium Neisseria meningitidis. The disease typically spreads among people through the exchange of saliva and other respiratory secretions through activities such as kissing, coughing and chewing on toys. It sometimes also spreads to people with close or lengthy contact such as people in the same household
Risk Factors
People in close contact with infected individuals have a higher risk of becoming infected. Risk varies by the following:
- Age - Infants, teens and young adults, and older adults have the highest rates.
- Immunocompromised - Medical conditions that weaken the immune system increase risk, including persistent complement component deficiencies, asplenia, and HIV.
- Complement inhibitors - People who receive complement inhibitors are at increased risk.
- Living in crowded conditions - College students and military recruits, for example, are at higher risk.
Prevention
The best way to prevent meningococcal disease is to get vaccinated. CDC recommends meningococcal vaccination for all preteens and teens and persons at increased risk for meningococcal disease. For more information on the meningococcal vaccine, visit the CDC’s meningococcal vaccination page.
When meningococcal disease cases are reported, public health will identify and notify close contacts who need urgent antibiotics to prevent meningococcal disease.
Treatment
Meningococcal disease often requires hospitalization and urgent administration of antibiotics. Anyone who suspects they may be suffering from this disease should seek immediate treatment from their health care provider. Without treatment, most people infected with meningococcal invasive disease will die.
Specimen Collection
Optimally, clinical specimens should be obtained before antimicrobial therapy commences in order to avoid loss of viability. Treatment of the patient, however, should not be delayed while awaiting collection of specimens, and a specimen should be obtained in all suspect cases as bacterial pathogens can still be detected even after antimicrobial therapy has begun.
The State Hygienic Laboratory will confirm and serogroup isolates of N. meningitidis. Laboratories are required to submit all isolates cultured from normally sterile sites for serogrouping. This serogrouping aids in public health surveillance and prevention of transmission. In addition, SHL will isolate the organism from appropriate clinical samples upon request.
For more information on submitting specimens, contact SHL at (319) 335-4500, or visit: www.shl.uiowa.edu/
Note: Isolates obtained from sputum or throat cultures are not considered to come from sterile sites; therefore N. meningitidis from these sites is in itself not indicative of invasive disease and is not reportable. If a patient with culture-positive sputum has an illness compatible with invasive meningococcal disease, this should be reported and the appropriate sterile sites should then be cultured.
Additional Resources
Definition
Germs called Staphylococcus aureus are bacteria. They are often just called “staph.” Many healthy people carry staph in their noses or on their skin. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph that has changed (become resistant) due to overuse and abuse of antibiotics. Antibiotics are drugs that kill bacteria. This resistant staph can’t be killed by the usual antibiotics, like penicillin and methicillin. Certain other antibiotics will still kill MRSA.
In the past, most infections caused by MRSA were in hospitals or nursing homes. Now, healthy people who have not recently been in the hospital are getting infections caused by MRSA. These are called community-associated MRSA infections.
Symptoms
MRSA may cause a skin infection that looks like a pimple or boil. The infection often looks like a spider bite and can be red, swollen, painful, and may drain pus. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, beard area of men). If you think you may have a skin infection, see your health care provider. Sometimes MRSA causes more severe and potentially life-threatening infections, such as bloodstream infections, surgical wound infections, or pneumonia.
Causes
The bacteria enter the body through open cuts and scrapes on the skin. The bacteria usually spread when a person with MRSA on their skin comes into contact with another person’s skin. Hand washing and keeping wounds covered is important in stopping a possible spread of the infection. A less common way to spread MRSA is to share towels and sports equipment.
Risk Factors
MRSA infections are most common in hospitals and nursing homes. Conditions that help MRSA spread are skin touching skin, cuts or scrapes, and crowded living conditions. If a person not in the hospital has a MRSA infection, it is more likely to spread if this person is a member of certain groups. These groups include athletes, military recruits, children, prisoners, and men who have sex with men.
Prevention
- Keep wounds that are draining covered with clean, dry, bandages.
- Clean hands regularly with soap and water or alcohol-based hand gel (if hands are not visibly soiled). Always clean hands immediately after touching infected skin or any item that has come in direct contact with a draining wound.
- Maintain good general hygiene with regular bathing.
- Do not share items that may become contaminated with wound drainage, such as towels, clothing, bedding, bar soap, razors, and athletic equipment that touches the skin.
- Wash clothing that has come in contact with wound drainage after each use and dry thoroughly.
- If you are not able to keep your wound covered with a clean, dry bandage at all times, do not join in activities where you have skin to skin contact with other persons (such as sports or in child care centers) until your wound is healed.
- Clean equipment and other environmental surfaces with which multiple individuals have bare skin contact with an over the counter detergent/disinfectant that specifies Staphylococcus aureus on the product label and is suitable for the type of surface being cleaned.
Treatment
Your health care provider will decide the best way to treat your infection. Some infections may need to be drained. Only a health care provider should drain sores. Some infections may need antibiotics. Tell your health care provider if you are not getting better in a few days. You may need to go to the hospital to receive antibiotics directly into your veins. Be sure to tell any health care provider you see if you have had an MRSA infection in the past. If anyone you know gets a similar skin infection, have them see their health care provider.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standards
Visit the Mpox immunization page.
Definition
Multisystem inflammatory syndrome in children (MIS-C) is a rare condition associated with SARS-CoV-2 (the virus that causes COVID-19), that usually occurs 2-6 weeks after a child is infected with SARS-CoV-2. MIS-C causes different internal and external body parts to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal tract.
MIS-C should be considered when any illness in a person ages less than 21 years that meets the following criteria:
The clinical AND the laboratory criteria, OR
The clinical criteria AND epidemiologic linkage criteria, OR
The vital records criteria
Symptoms
- Fever
- Abdominal pain
- Bloodshot eyes
- Diarrhea
- Dizziness or lightheadedness
- Skin rash
- Vomiting
- Neck pain
- Headache or altered mental status
Not all children will have the same signs and symptoms, and some children may have symptoms not listed here. MIS-C may begin weeks after a child is infected with SARS-CoV-2.
Prevention
The best way to prevent MIS-C is to protect against getting SARS-CoV-2 infection, including staying up to date with COVID-19 vaccinations and techniques to prevent many other viral infections including:
- Washing hands often with soap and water
- Avoid close contact with ill people
- Cleaning surfaces with disinfectant
Reporting
As of May 15th, 2020, MIS-C was made a temporarily reportable disease.
Clinicians should report by emailing the case report form to Amanda Mandi at amanda.mandi@idph.iowa.gov or calling (515) 480-5680.
Definition
Mumps is an infection caused by the mumps virus. Before a routine vaccination program was introduced in the United States, mumps was a common illness in infants, children and young adults. Because most people have now been vaccinated, mumps has become a rare disease in the United States.
Mumps is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
The most common symptoms are fever, headache, muscle aches, tiredness, and loss of appetite and swollen salivary glands under the jaw. The disease can lead to hearing loss, aseptic meningitis (infection of the covering of the brain and spinal cord) and, in 20% to 30% of males who have reached puberty, the disease can cause painful, swollen testicles.
Causes
Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes or talks. Items used by an infected person, such as cups or soft drink cans, can also be contaminated with the virus, which may spread to others if those items are shared. In addition, the virus may spread when someone with mumps touches items or surfaces without washing their hands and someone else then touches the same surface and rubs their mouth or nose.
Risk Factors
Vaccination is the best way to avoid infection with the mumps virus. International travel, and close-contact living, such as dormitories are some of the risk factors for mumps infection.
Prevention
- Vaccination
- Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash can. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
- Wash hands well and often with soap, and teach children to wash their hands too.
- Don’t share drinks or eating utensils.
- Regularly clean surfaces that are frequently touched (such as toys, doorknobs, tables, counters) with soap and water or with cleaning wipes.
- People infected with mumps should not go back to child care, school, work, or other public places until 5 days after symptoms began or until they are well whichever is longer.
Contacts to a mumps case should have their immunization status evaluated. Anyone who is not immune and has not received 2 doses of a mumps-containing vaccine should be vaccinated. Two doses of mumps-containing vaccine, given as combination MMR vaccine, separated by at least 4 weeks, are routinely recommended for all children. The first dose is given on or after the first birthday; the second is given at 4 - 6 years of age. MMR is a live, attenuated vaccine. Pregnant women and persons with immunodeficiency or immunosuppression should not receive live attenuated vaccines.
Persons who may have been exposed should be educated on the signs and symptoms of mumps disease and should seek medical attention as soon as any of these symptoms begin.
Treatment
There is no specific treatment. Supportive care should be given as indicated.
Statistics
In 2021, there were 10 cases of mumps reported in Iowa.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standards
Definition
Norovirus is the most common cause of acute gastroenteritis in the United States. The most common symptoms of norovirus include nausea, vomiting, diarrhea, and stomach cramps. Illness often begins suddenly but is often brief, with symptoms usually lasting 1 to 2 days. Dehydration may result in individuals with this illness, but the disease is generally self-limiting and there are rarely long-term health effects.
Symptoms
Symptoms of norovirus usually begin 24 to 48 hours after exposure but may appear in as little as 12 hours after exposure. The illness is usually brief, lasting 1 to 2 days; however, individuals may remain contagious from the moment they become ill to three days after recovery. The most common symptoms of norovirus illness include:
- Nausea
- Vomiting
- Diarrhea
- Stomach cramping
Sometimes, norovirus can cause a low-grade fever, chills, headache, muscle aches, and fatigue. Dehydration can also occur, which may require hospitalization. There are usually no long-term effects resulting from norovirus illness.
Causes
Norovirus is very contagious. The virus is found in the feces and vomit of infected individuals. Norovirus is caused by consumption of the virus from contaminated food or water or by direct person-to-person spread. Other common sources of infection include:
- Poorly cooked shellfish
- Touching a contaminated surface and then touching the mouth or eating without washing hands first
- Vomit that contaminates surfaces or the ingestion of vomit particles in the air
Risk Factors
People with increased risk of norovirus include:
- Those caring for or that are in direct contact with an infected individual
- Children and providers in childcare settings
- Residents and staff of nursing homes
Prevention
- Wash hands with warm, soapy water for 20 seconds after using the bathroom or changing diapers and before preparing or eating food. Alcohol based hand sanitizers are not effective against norovirus.
- Immediately clean and disinfect surfaces in the household that have become contaminated with feces or vomit using bleach solution.
- Carefully wash fruits/vegetables and thoroughly cook oysters before consumption.
- Stay home from school and work while ill, and do not prepare food for others while ill.
Treatment
Rehydration and electrolyte replacement are the main treatments for norovirus. The illness is generally self-limiting.
Additional Resources
Definition
Pertussis is a disease caused by a bacteria which causes severe spells of coughing. These spells can interfere with eating, drinking, and breathing. Pertussis can lead to pneumonia, convulsions, inflammation of the brain (encephalitis) and sometimes death. It is most common in infants less than one year old, but anyone can get it. It is also known as whopping cough because of the high-pitched whooping sound made when breathing in during coughing spells.
Pertussis is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
On average, it will take 9-10 days after being infected with pertussis to start to show signs and symptoms. At first, symptoms will look a lot like the common cold:
- Runny nose
- Nasal congestion
- Sneezing
- Red, watery eyes
- A mild fever
- Dry cough
Within two weeks, symptoms worsen and a severe cough develops that might:
- Become a series of violent coughs making it hard to breathe
- Be more severe at night
- Expel thick phlegm
- Cause vomiting
- End with a high-pitched "whoop" sound when breathing in after a series of coughs
However, infants under 6 months old may not develop a whoop but may temporarily stop breathing or have a bluish tint to their skin. Older children and adults also may not develop a whoop but will have a long lasting cough, or have symptoms like bronchitis or asthma. Vaccinated people might also have milder symptoms.
Causes
- Pertussis is caused by breathing in a bacteria carried on droplets from other’s coughs and sneezes.
- Once inhaled into the lungs, the bacteria grows and produces a toxin that keeps your lungs from moving fluids and germs out. Thick mucus accumulates inside the airways and results in an uncontrollable cough.
- The “whoop” sound is caused by the sucking in of air through the restricted airways after a coughing fit.
Risk Factors
Though a vaccine is available against pertussis, protection wears off 5-10 years after the last dose leaving most teenagers and adults not fully protected. Also, a person is not fully immune until after three doses of a pertussis vaccine.
Prevention
There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Several other combination vaccines contain DTaP along with other childhood vaccines. Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine. Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 through 64 years of age should receive a single dose of Tdap. For adults 65 and older who have close contact with an infant and have not previously received Tdap, one dose should be received. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received. [Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.]
Handwashing is important for preventing all illness including pertussis
Cover your mouth and nose when you cough or sneeze
Avoid others when coughing
In general, you should stay home when you are sick. If you are diagnosed with pertussis or are a contact to a known case of pertussis and have symptoms, you should stay home for 21 days or until you have completed 5 full days of antibiotics
Treatment
An appropriate antibiotic can be taken if given early in illness
Fluids, oxygen, and mild sedation may help a child during prolonged periods of severe coughing
Always consult your health care provider if you have questions about your health or before starting any treatment
Statistics
In 2021, there were 23 cases of pertussis reported to Iowa HHS.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standards
Definition
Plague is a disease caused by the bacterium Yersinia pestis. In its most common form, plague is also known as the bubonic plague. Buboes are the painful, swollen lymph nodes that are often found in people infected with Y. pestis. However, the bacterium can also cause disease in the lungs, and the blood stream. These diseases are referred to as pneumonic plague, and septicemic plague.
Plague is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of plague typically begin within two to six days after a bite from an infected flea or contact with an infected animal. These symptoms include:
- Swollen, painful lymph nodes (called “buboes”)
- Fever
- Chills
- Severe headache
- Muscle aches
- Nausea
- Causes
Yersinia pestis is a bacterium that normally infects rodents such as rats, rock squirrels, woodrats, prairie dogs, and occasionally dogs and cats. It can be spread to humans in one of four main ways:
- Flea bites. If an infected flea bites a human, that person may become infected.
- Infected animals. Handling infected animals may lead to infection of a person. Infected animals in the United States are most commonly rodents, cats, and dogs.
- Airborne. Breathing in airborne particles containing Y. pestis has been documented to cause disease.
- Person-to-person. Close contact with an infected person can lead to spread of disease
Risk Factors
Anyone can be infected with Y. pestis. People who regularly handle animals that may be infected are at greater risk of contracting the disease. These people include:
- Veterinarians and veterinary personnel
- Hunters
- Farmers
- Anyone regularly in close contact with rodents or fleas
Prevention
Prevention of plague mainly relies on the control of the flea and rodent populations. In areas where plague is commonly seen, flea control for dogs, cats, as well as the home or yard, will reduce the number of fleas that could spread the disease. A vaccine is available for laboratory workers or biologists working in areas where plague is commonly seen.
Treatment
Plague can be treated with antibiotics. Early diagnosis and treatment is the key because some untreated forms of plague are often fatal.
Additional Resources
Definition
Polio, short for poliomyelitis, is a disease that can damage the nervous system and cause paralysis. Since polio immunization has become widespread in the United States, cases of polio are rare. However, polio remains a problem in many parts of the world.
Polio is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
The majority of persons infected with polio will have no symptoms. Of those infected who do have symptoms, the symptoms are minor and may include fever, fatigue, nausea, headache, flu-like symptoms, stiffness in the neck and back, and pain in the limbs which often resolves completely.
Causes
Polio is usually spread from person-to-person primarily through the fecal-oral route. The virus is transmitted from the stool of an infected person to the mouth of another person from contaminated hands or such objects as eating utensils. Some cases may be spread directly through the oral-oral route.
Risk Factors
Polio is more common in infants and young children and occurs under conditions of poor hygiene. However, complications and more severe infection are more likely to occur in older individuals.
Prevention
There are two types of vaccine that can prevent polio: inactivated polio vaccine (IPV) and oral polio vaccine (OPV). IPV has been used in the United States since 2000; however OPV is still used throughout much of the world although it is no longer available in the United States.
Treatment
There is no specific treatment for polio. Persons infected with polio need supportive therapy, such as bed rest and fluids.
Additional Resources
Definition
Psittacosis is a bacterial infection caused by the bacterium Chlamydia psittaci, which is found mainly in birds of the parrot family (psittacine) including parrots, parakeets, love birds, macaws, and cockatoos. The bacterium has also been found in poultry, pigeons, canaries, and sea birds.
Psittacosis is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of psittacosis can take from one to four weeks to appear after exposure but usually occur within one to two weeks. Symptoms can include any of the following:
- Fever
- Headache
- Rash
- Muscle aches
- Chills
- Dry cough
- Upper or lower respiratory disease
Human disease is most often mild or moderate but can be severe, especially for untreated patients.
Causes
Psittacosis is caused by the bacterium Chlamydia psittaci which is carried in bird droppings. People become infected by breathing in bacteria from dried droppings, secretions, and dust from feathers of infected birds. Infected birds often appear healthy and can have lifelong infections. Pet birds are frequently the source of human infection. It isn’t known how long people remain contagious. The disease is not typically spread from person-to-person and usually occurs only where there is severe coughing from the disease.
Risk Factors
Pet birds, especially psittacine birds, are often the cause of infection, especially when owners clean a cage with dried droppings. Occupational exposure can also occur when workers are exposed to areas with contaminated dust during clean up, repair or demolition. Laboratory infections have occurred as well. Farms or rendering plants may be a source of exposure for workers. Many seemingly healthy birds may shed the agent when stressed by crowding or transport. Dramatic outbreaks may occur in poultry packing plant workers. Anyone exposed to the dust and droppings of infected birds is at risk for becoming infected.
Prevention
The following precautions should be observed to prevent the spread of psittacosis:
- Obtain birds only from a licensed pet store or aviary.
- Pet owners and animal handlers should be made aware of the dangers of household or work-related exposure to infected birds and the risk of inhalation of dried bird droppings, even from seemingly healthy birds.
- Special care should be taken by bird owners to clean cages, etc. with the least amount of disturbance of dried droppings, feathers, and dust.
- Birds that are bought, traded, or otherwise acquired should be raised and handled in a way that prohibits psittacosis spread.
Treatment
Psittacosis is treated with tetracycline type antibiotics. If you suspect you have been exposed, contact your healthcare provider immediately.
Statistics
One case of psittacosis was reported in Iowa in 2021.
Additional Resources
Epi Manual Psittacosis Chapter
National Association of State Public Health Veterinarians psittacois resources
Visit the Iowa HHS rabies information page.
Definition
Rocky Mountain Spotted Fever (RMSF) is a disease caused by the bacterium Rickettsia rickettsii. It causes fever, nausea, muscle ache, headache and a rash. It can lead to loss of blood cells (anemia) and other serious blood disorders. It is most common from April through September when people are exposed to ticks outdoors. Most cases occur in children under age 15 since they tend to spend more time in tick-infested areas.
RMSF is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
It will take about one week after being infected with RMSF to start to show signs and symptoms. Early symptoms can include:
- Fever/chills
- Nausea/vomiting
- Muscle ache
- Feeling poorly
- Headache
- Swelling in eye
- As the disease progresses symptoms include:
- Rash (3-5 days after start of illness)
- Stomach and joint pain
- Diarrhea
- Complications from RMSF may include:
- Decrease in red blood count (anemia) and other blood disorders
- Long term nerve damage
- Death
- Causes
Rocky Mountain Spotted Fever is caused by a tick bite. Usually a tick has to be attached to a person for four to six hours for infection to occur. Less often, infection occurs when crushed tick tissues or fluids get into a person’s cuts or scratches.
Risk Factors
People, especially children, who are outside in places where ticks are common are most at risk. The months of April to September are the most common times to be infected.
Prevention
- The best way to avoid RMSF is to avoid tick-infested areas such as woody and grassy areas.
- In areas where ticks may occur, people should: Wear long-sleeved shirts and long, light-colored pants tucked into socks or boots to make it easier to see ticks crawling on clothing, and to prevent ticks from crawling up the inside of pants legs.
- Stay on trails when hiking
- Use insect repellants properly. Repellants that contain DEET (diethyltoluamide) should be used in concentrations no higher than 30 percent for children. Repellants should never be used on infants. Permethrin is a repellant that can be applied only to clothing, not exposed skin.
- After each day spent in a tick-infested area, thoroughly check yourself, children, and pets for ticks. Remove any tick you find on your body. Clothing should also be checked.
- Promptly remove any attached tick using fine-point tweezers. The tick should not be squeezed or twisted, but grasped close to the skin and pulled straight out with steady pressure. Once removed, the tick should be drowned in rubbing alcohol or the toilet.
Treatment
Appropriate antibiotics can successfully treat Rocky Mountain Spotted Fever.
Seeking good follow up care from a medical provider is the best way to make sure someone recovers.
Statistics
In 2021, 4 cases of Rocky Mountain spotted fever (RMSF) were reported in Iowa.
Additional Resources
Definition
Rubella is a disease caused by a virus. It causes a mild illness with swollen glands, slight fever and a rash. The biggest threat from Rubella is to the fetus if the mother gets infected. Many babies born to a mother who gets infected during pregnancy will develop severe birth defects known as congenital rubella syndrome.
Rubella is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Signs and symptoms will begin about 14 to 17 days after being infected with rubella and include:
- Fever
- Joint pain
- Red swollen eyes
- Swollen lymph glands
- Rash (flat red areas, with raised bumps )
The following complications may occur with unborn babies:
- Blindness
- Heart defects
- Deafness
- Mental or growth retardation
- Bone disease
- Enlarged liver and spleen
- Low platelet count (thrombocytopenia)
- Purple skin lesions
Causes
Rubella is caused by breathing in a virus carried on droplets from an infected person's coughs and sneezes or in the blood stream to the fetus of a pregnant woman. People can spread rubella for several days before they get the rash until several days after the rash develops.
Risk Factors
It is recommended that children be vaccinated against rubella at 12 months and 4 years of age. Those who have not had these two doses of vaccine are at risk for rubella. Rubella vaccine is one of the most effective vaccines used today.
Prevention
The best way to prevent rubella is to get vaccinated with a rubella containing vaccine. Visit CDC’s 2012 Child & Adolescent Immunization Schedules website details on vaccination schedules.
Rubella vaccine is usually given at 12 months and 4 years of age. Usually it is combined with mumps and measles vaccine (MMR). Two doses of MMR vaccine are very effective at preventing rubella infection throughout life.
Rubella vaccine is required for entry into Iowa public and private schools, as well as licensed child care centers and preschools. Following the Iowa requirements on immunization greatly reduces the risk of children catching rubella.
A person thought to have rubella will usually be isolated (kept away from other people or public places) for a period of time. Those people who have been exposed to rubella and are thought they may be susceptible to the disease may be quarantined (kept away from other people from day 7 though day 21 after their last exposure).
Treatment
There is no cure for rubella.
Children with congenital rubella syndrome usually will be kept away from other people until tests show they no longer can spread rubella.
Administration of vaccine after someone has been exposed to rubella will usually not prevent the disease, but it may help to give vaccine to unimmunized people to prevent future cases.
Statistics
No cases of rubella have been reported in Iowa since 2001.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standard
Definition
Salmonella infection (Salmonellosis) is a common bacterial disease. Salmonella bacteria live in the gut of animals and humans and can be found in the feces of an infected animal or person.
Salmonella is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
There are many kinds of Salmonella bacteria, but only a few cause illnesses in people. Most of the illnesses caused by Salmonella are grouped as gastroenteritis (or sometimes incorrectly referred to as “stomach flu”).
Usually, people who get salmonellosis develop symptoms within 12-36 hours but can experience symptoms as early as 6 hours to as late as 3 days after ingestion of the bacteria.
Signs and symptoms of Salmonella infection generally last 4-7 days. Most people get better without treatment. In some cases, the diarrhea associated with a Salmonella infection can be dangerously dehydrating. In that event, see a doctor immediately.
Signs and symptoms may include:
- Diarrhea
- Headache
- Fever
- Nausea
- Abdominal pain
- Dehydration
- Vomiting
- Muscle pains
- Bloody stools
Typhoid fever is a more severe disease caused by Salmonella.
Causes
Salmonella bacteria live in the intestines of people and animals, including birds. Most people are infected with Salmonella by eating foods that have been contaminated by feces. Commonly infected foods include:
- Beef
- Poultry
- Milk
- Eggs
- Fruits and vegetables
Foods can become contaminated when handled by people who do not wash their hands with soap and water after using the bathroom or changing a diaper.
Reptiles, like turtles, lizards and snakes, often carry Salmonella. Many chicks and young birds carry Salmonella in their feces. People should always wash their hands immediately after handling a reptile or bird, even if the animal is healthy. Adults should also assure that children wash their hands after handling a reptile or bird or after touching its environment.
Risk Factors
Factors that may increase your risk of Salmonella infection include activities that bring you into contact with Salmonella bacteria and certain health conditions that weaken your body’s ability to fight the infection.
Exposure
- International Travel. Salmonellosis is one of the most common foodborne diseases. The risk of Salmonella infection increases when traveling to developing countries with poor sanitation.
- Pet birds or reptiles. Many pets, particularly birds and reptiles, can be infected with Salmonella bacteria.
- Stomach and bowel disorders
- Antacids. Stomach acid kills many kinds of bacteria including Salmonella. Lowering your stomach’s acidity allows more Salmonella bacteria to survive.
- Inflammatory bowel diseases. This group of disorders damage the lining of the intestines, which makes it easier for Salmonella bacteria to take hold.
- Recent antibiotic use. Antibiotics can reduce the number of “good” bacteria in the intestines, which allows Salmonella to grow.
- Immunity problems
- HIV/AIDS
- Sickle cell disease
- Immunosuppressive treatment
Prevention
- Handwashing is important for preventing all illness including Salmonellosis. Always wash your hands carefully with soap and warm water before preparing food, after using the toilet, after handling pets, especially reptiles, and after handling dirty diapers.
- Make sure that infant’s and children’s hands are washed.
- Always refrigerate meats.
- Always cook meats completely. Never eat raw meat.
- Always cook eggs or food containing raw eggs.
- Avoid unpasteurized milk or foods made with unpasteurized milk.
- Wash counter tops, cutting boards, and any utensil after use on raw meat or eggs.
- If making foods such as eggnog, homemade ice cream, or sauces that include raw eggs, use pasteurized eggs. These can be found at grocery stores, in the refrigerated section , as liquid or shell eggs.
Treatment
Salmonellosis usually last 5-7 days and usually do not need treatment other than drinking plenty of fluids. Persons with more severe illness may need rehydration with intravenous (IV) fluids and/or treatment with antibiotics. Always consult your health care provider if you have questions about your health or before starting any treatment.
Statistics
There were 669 cases of salmonellosis in 2021.
Additional Resources
Foodborne Outbreak Investigation Manual
Caring for Our Children: National Health and Safety Performance Standards
Since 2004, there have not been any known cases of SARS reported anywhere in the world. For more information visit the archived CDC Severe Acute Respiratory Syndrome (SARS) page.
Definition
Shigellosis is a disease of the gut caused by the bacterium, Shigella. There are four main species of shigella that cause disease in humans. Many of these organisms can produce toxins once inside the colon of a person. These toxins cause ulcers inside the colon, leading to the watery (and sometimes bloody) diarrhea.
Shigellosis is reportable Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
The symptoms of shigellosis usually appear 1-3 days after infection occurs. Symptoms include, but are not limited to:
- Diarrhea – watery, bloody, and/or covered with mucus; stools are often accompanied by pain
- Fever
- Nausea
- Vomiting
- Abdominal cramps
Causes
Shigella are the group of bacteria that cause shigellosis. There are four main species that cause human disease. All four of these species are found in the feces (stool) of infected people. They live inside the small and large intestines of infected people, where they damage the intestinal wall. It is this damage that leads to the characteristic diarrhea found in shigellosis.
There are three main ways that shigella are spread:
- Person-to-Person. Any infected person can infect others by failing to properly wash their hands before handling food or coming into close contact with another person. Infections in households, pre-schools, child care facilities, and elderly and developmentally disabled living facilities commonly spread in this manner.
- Foodborne. Flies can potentially spread the bacteria by landing on contaminated feces and then food
- Waterborne. Fecal contaminated recreational water, such as fill and drain wading pools, can be a source for spread.
Risk Factors
Any age group can become infected with shigella. The most commonly affected groups of people are:
- Young children, especially those in child care centers and pre-schools
- People living in crowded conditions
- People living in long-term care facilities
- Men who have sex with men
- The elderly, the debilitated, and the malnourished of all ages are particularly susceptible to severe disease and death.
Prevention
Shigellosis is an extremely contagious disease. Because of this, measures should be taken to prevent its spread. Some ways to prevent infection are:
- Thoroughly wash hands with soap and running warm water for no less than 15 seconds. This should be done every time people use the toilet, change diapers, or before they eat or prepare any food.
- Infants and children should have their hands washed as above after a diaper change, after using the toilet, or before eating
- Infected people should stay away from school, child care, or work while they have diarrhea
- Food handlers, child care workers, or health care workers should consider treatment
Treatment
Shigellosis is usually considered a mild infection that will go away between four to seven days without treatment. Staying hydrated and replacing electrolytes are generally considered the main treatments. However, antibiotic treatment may be necessary if the infection is severe or the infected person has a poor immune system. Antibiotics have been shown to decrease length of illness, the severity of disease, and the amount of time that the bacteria are excreted in the feces.
Statistics
In 2021, 70 cases of Shigella infection were reported in Iowa.
Additional Resources
Epi Manual Shigellosis Chapter
Caring for our Children: National Health and Safety Performance Standard
Definition
Smallpox is a contagious and potentially fatal infectious disease caused by a variola virus that emerged thousands of years ago in human populations. After a worldwide vaccination campaign, the disease has now been eliminated. Smallpox is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
A person infected with smallpox will usually begin to notice signs and symptoms between 7 to 17 days following exposure.
Symptoms usually include, but may not be limited to:
- High fever (101-104 degrees Fahrenheit)
- Malaise
- Head and body aches
- Vomiting (less common)
Causes
Smallpox is caused by a variola virus. In general, direct and fairly prolonged face-to-face contact is required to spread the disease from person to person.
Risk Factors
People who are in close contact with an infected person for prolonged periods of time are at an increased risk of contracting the disease. However, because the disease has been eliminated worldwide, the risk factors are quite low.
Prevention
Routine vaccination for smallpox ended in 1972 because the vaccine was causing more disease than natural occurrences of the disease itself. It is no longer recommended to prevent disease in the public and therefore the vaccine is no longer routinely available.
Treatment
There is no proven treatment for smallpox. If you suspect you are suffering from this disease or may have been exposed, contact your health care provider immediately.
Additional Resources
Definition
Tetanus, also called “lockjaw”, is a vaccine-preventable disease caused by a toxin formed by the bacterium Clostridium tetani. It attacks the nervous system and results in painful muscle contractions. The bacterium typically enters the body through wounds contaminated with soil or human or animal feces. It does not require oxygen to grow and the disease course is often short, severe, and can be fatal.
Tetanus is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms of tetanus begin between 1 to 21 days after exposure. Symptom onset depends on the location of the wound. A shorter time to illness and more severe disease has been observed with dirtier wounds.
A common first symptom in older children and adults is painful contraction of stomach muscles. Other symptoms include painful muscle contractions, especially stiffness and convulsive spasms of the jaw and neck muscles and the upper body or trunk muscles. Symptoms may progress to generalized seizure-like activity.
Causes
Tetanus is caused by toxic spores formed by the bacterium Clostridium tetani. Spores typically enter the body through a puncture wound contaminated with soil or human or animal feces. Less commonly, spores may also enter the body via one of the following routes:
- Cuts, scrapes, burns, or unnoticed wounds
- Infected, contaminated street drugs
- Following elective surgery, ear infections, or dental infections
Tetanus is not spread from person to person.
Risk Factors
Individuals who have suffered a wound or injury and are inadequately vaccinated against tetanus and have not received a booster vaccine every ten years are at an increased risk of becoming infected. Most current cases are identified in older adults who have not received a tetanus booster to maintain protection against this disease.
Prevention
There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Several other combination vaccines contain DTaP along with other childhood vaccines.
Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine.
Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 through 64 years of age should receive a single dose of Tdap. For adults 65 and older who have close contact with an infant and have not previously received Tdap, one dose should be received. Tdap should also be given to 7–10-year-olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received.
[Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.]
Treatment
There is no cure for tetanus. Treatment consists of proper wound care and medications to ease symptoms. If you are wounded, especially if your wound is contaminated with dirt or human or animal feces, you should seek treatment from your health care provider immediately.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standards
Definition
Tularemia is caused by the bacteria Francisella tularensis and can affect both humans and animals. This bacterium can survive in mud, water, or the carcasses of dead animals for up to three to four months. Humans can also catch this disease through the bites of infected ticks, mosquitoes, or flies.
In the United States, tularemia is widespread in animals and infects approximately 200 humans each year.
Tularemia is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Symptoms of tularemia appear between three to five days after exposure to the bacteria but can take as long as 14 days. There are at least six types of clinical symptoms, depending on the route of infection and the strain of bacteria.
Ulceroglandular: Patients have large, tender lymph nodes and a non-healing skin ulcer at the site of infection, often with fatigue, chills, and malaise.
Glandular: Patients have one or more enlarged painful nodes that may be filled with pus.
Pneumonic (pulmonary): This may be a primary infection following inhalation of the organisms or secondary to blood infection; with symptoms that may include a non-productive cough, difficulty breathing and chest pain.
Typhoidal: This is a rare form, with enlarged and inflamed lymph nodes, blood poisoning, abdominal pain, diarrhea, vomiting and gastrointestinal bleeding.
Oropharyngeal: This form results from ingestion of bacteria in food or water leading to painful sore throat (pharyngitis), abdominal pain, diarrhea, and vomiting.
Oculoglandular: Patients have eye pain, redness, and discharge with enlarged lymph nodes of the neck or near the ears and usually accompanied with fever, chills and malaise.
Causes
Tularemia is caused by the bacteria Francisella tularensis. People may become infected through the following methods:
- Handling infected animals or their carcasses (i.e., hunters while skinning the animal)
- Bites of infected flies, mosquitoes, or ticks
- Contact with infected animals such as rabbits, hares, rodents, or birds (although it is not usually transmitted through the bite of an infected animal)
- Ingesting undercooked infected meat
- Drinking contaminated water
- Inhalation of dust from contaminated soil, grain, or hay
This disease does not spread from person to person.
Risk Factors
People who spend a lot of time outdoors or hunt or trap wild animals are at risk for being infected. Gardeners and landscapers are also at risk if they inhale bacteria stirred up when soil is disturbed.
- Prevention
The following precautions should be observed to prevent infection with tularemia:
- wear rubber gloves when skinning or handling wild animals, especially rabbits
- cook wild rabbit and rodent meat completely before eating
- use insect and tick repellents and wear long sleeves and pants when outdoor for long periods of time to avoid tick bites
- during the spring and summer, check yourself for attached ticks every two to three hours when spending time outside and remove any attached ticks immediately
- avoid swimming, drinking, or bathing in untreated water in areas where tularemia infections are prevalent in wild animals
Laboratory employees who work with this bacterium should take the following precautions:
- Wear a face mask, gown, and impervious gloves when working with the organism
- Conduct all procedures using the organism in a negative pressure microbiological cabinet
Treatment
Tularemia is treated with antibiotics. When treated promptly and appropriately, most people fully recover. If you suspect you have been exposed, seek treatment from your healthcare provider immediately.
Statistics
There were two cases of tularemia reported to IDPH in 2021.
Additional Resources
Caring for Our Children: National Health and Safety Performance Standards
Definition
Typhoid fever is a disease caused by Salmonella typhi bacteria. It causes fever, headache, loss of appetite and stomach pain and can lead to serious complications like kidney failure or a perforation of the bowel if untreated.
Typhoid fever is reportable Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
Symptoms can appear anywhere between 3 to 60 days after being infected with S. typhi. At first, symptoms may begin with mild illness and a low fever, but some people do get severe illness right away. Symptoms of typhoid fever include:
- Fever
- Headache
- Malaise
- Loss of appetite
- Slowed heart beat
- Enlarged spleen
- Constipation
- Cough
- Rose colored spots on the trunk
If not treated rapidly, these complications can develop:
- Bowel perforation
- Kidney failure
Causes
Typhoid fever is caused by eating or drinking food or water contaminated with S. typhi. Some ways to catch typhoid fever include eating shellfish from sewage contaminated beds, vegetables fertilized by human feces, and contaminated raw fruit or milk products. Flies may contaminate foods also.
You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding Salmonella Typhi or if sewage contaminated with Salmonella Typhi bacteria gets into the water you use for drinking or washing food.
Risk Factors
Typhoid fever is common in most parts of the world except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan. Therefore, if you are traveling to the developing world, you should consider taking precautions. Other areas of risk include East and Southeast Asia, Africa, the Caribbean, and Central and South America.
Prevention
Proper sanitation of public and private facilities is important to prevent typhoid fever. Routine sanitation includes:
- Proper hand washing, including good hand washing facilities in public places, especially in food service, child care, or health care settings.
- Proper disposal and treatment of human sewage. Restrooms should be fly-proof and properly designed and situated.
- Public and private water supplies should be protected, purified, and chlorinated (as needed). Backflow prevention devices should be installed between potable (for drinking) water and non-potable water systems.
- Cleanliness in food preparation and handling. Proper temperature of raw and cooked foods is critical, as well as avoiding contact between raw meats and items already prepared to eat.
- All milk and milk products should be pasteurized.
- Shellfish should be obtained from approved sources.
- Keep food that will be eaten raw, such as fruit and vegetables, from becoming contaminated by products from animals. Wash all foods eaten raw before eating.
Receiving typhoid vaccination when traveling to high-risk areas. Visit www.cdc.gov/travel/ for current information on high-risk areas.
Treatment
Certain antibiotics are used to treat typhoid fever. Sometimes steroid medications are used for those who are seriously ill.
Statistics
There was one case of typhoid fever in Iowa in 2021.
Additional Resources
Epi Manual Typhoid Fever Chapter
Caring for Our Children: National Health and Safety Performance Standards
Definition
Viral hemorrhagic fevers (VHF) refer to a group of illnesses that are caused by several distinct families of viruses. VHF is used to describe a severe syndrome of illnesses that may affect multiple organ systems in the body. Usually the overall vascular system is damaged and the body’s ability to regulate itself is impaired. Some types of VHF cause relatively mild illnesses, but many of these viruses cause severe, life-threatening disease such as:
- Ebola
- Lassa
- Crimean-Congo
- Marburg
VHFs are reportable to Iowa HHS by Iowa Administrative Code 641 Chapter
Symptoms
Symptoms of VHFs begin 1-21 days after exposure, depending on the type of virus. Symptoms vary by virus but generally include:
- Fever
- Fatigue
- Dizziness
- Muscle aches
- Weakness
- Exhaustion
- Bleeding under the skin, in internal organs, or from body orifices (mouth, ears and eyes)
- Shock, nervous system malfunction, coma, delirium and seizures
Causes
Viruses that cause VHFs are distributed over much of the globe. However, since each virus is associated with one or more particular host species, the virus and the disease it causes are usually seen only where the host species lives. Therefore, the risk of getting VHFs caused by these viruses is restricted to those areas. Although people usually become infected only in areas where the host lives, occasionally people become infected by a host that has been exported from its native habitat, or by a person who gets infected and travels elsewhere.
Risk Factors
Living in or traveling to locations where a particular VHF exists will increase the risk of becoming infected. Viral hemorrhagic fevers method of spread depends on the resident animal host:
- Contact with rodent urine, feces, saliva or other secretions
- Getting a bite from an infected Mosquito
- Getting a bite from an infected tick or an infected one is crushed
- Contact with an infected animal during care or slaughtering
- Person-to-person contact with infected bodily fluids or indirectly through contaminated objects such as needles
Prevention
If you live in or travel to areas where viral hemorrhagic fevers are common, you should take precautions to protect yourself from infection by:
- Avoiding close physical contact with infected people and their bodily fluids
- Control rodent populations
- Discourage rodents from entering or living in homes and workplaces
- Avoid mosquitoes and ticks and use insect repellents such as DEET
Treatment
There are no specific drugs available for the treatment of VHFs. Some antiviral drugs have been effective in treating individuals with VHFs. Supportive care is essential.
Additional Resources
Definition
West Nile Virus (WNV) is transmitted by mosquitoes. People who are infected with WNV may not experience any signs or symptoms. Some people experience minor symptoms like fever and mild headache. Others, however, can develop a life-threatening illness that includes inflammation of the brain.
People who experience mild signs and symptoms of a WNV infection generally recover on their own. But severe illness that includes a severe headache, disorientation or sudden weakness require immediate medical attention.
Program Overview
In a joint effort with the State Hygienic Laboratory, the Iowa State University Department of Entomology, the Iowa Department of Agriculture and Land Stewardship, and several local health departments, the Iowa Department of Public Health has instituted a number of programs which have allowed Iowa to monitor West Nile virus activity in sentinel chickens, mosquitoes, horses, and humans.
Additional Resources
Definition
Western equine encephalitis (WEE) is a viral disease carried by mosquitoes. WEE occurs in the western parts of the United States, including Iowa and Canada. WEE causes “sleeping sickness” in horses.
WEE is reportable to Iowa HHS by Iowa Administrative Code 641 IAC 1.
Symptoms
An infected person may have no symptoms or symptoms may be mild or non-specific. Symptoms usually occur within 5-15 days after being bitten by an infected mosquito and include:
- Fever
- Nausea
- Vomiting
- Headache
- Loss of appetite
- Extreme tiredness
- Weakness
- Confusion
Causes
Western equine encephalitis is caused by the bite of an infected mosquito.
Risk Factors
Anyone can get western equine encephalitis, but some people are at increased risk:
- People living in or visiting areas where the disease is common
- People who work outside or participate in outdoor recreational activities in areas where the disease is common
Western equine encephalitis occurs in all age groups.
Prevention
Recommendations to reduce the spread of western equine encephalitis include:
- Avoid mosquito bites
- Remove all standing water from your property
- Wear lightweight long-sleeved shirt and long pants when outdoors
- Personal protection is the best way to prevent exposure to any virus spread by mosquitoes. Review the DEET Fact Sheet and follow the recommendations outlined to reduce your risk of being bitten.
- Vaccinate your horses
Treatment
There are no specific drugs available for the treatment of western equine encephalitis. Always consult your health care provider if you have questions about your health or before starting any treatment.
Additional Resources
See the pertussis section.
Definition
Yellow fever is a hemorrhagic fever caused by a virus spread by certain mosquitoes. The disease is common in tropical areas of Africa and South America.
Yellow fever is a rapidly occurring viral illness of short duration with symptoms that may be mild to severe.
Yellow fever is reportable to Iowa HHS by Iowa Administrative Code 641 Chapter 1.
Symptoms
Symptoms usually occur within 3-6 days after being bitten by an infected mosquito. Yellow fever symptoms include:
- Fever
- Chills
- Headache
- Backache
- General muscle pain
- Weakness
- Nausea
- Vomiting
Symptoms of more severe illness include:
- Jaundice (yellowing of the skin)
- Albuminuria (protein in the urine)
- Anuria (absence of urine)
Causes
Yellow fever is spread by the bite of an infected mosquito.
Risk Factors
Traveling to an area in which the yellow fever virus is known to be puts you at risk of the disease. These areas include tropical areas of South America and Africa.
Prevention
Recommendations to reduce the spread of yellow fever include:
- Avoiding exposure to infected mosquitoes is the best means of protection from the virus causing yellow fever. Mosquitoes in Iowa do not carry yellow fever but they carry other viruses.
- Personal protection is the best way to prevent exposure to any virus spread by mosquitoes. Review the DEET Fact Sheet and follow the recommendations outlined to reduce your risk of being bitten.
- Anyone traveling to South America or Africa should be vaccinated before traveling to those areas.
Treatment
There are no specific drugs available for the treatment of yellow fever. Always consult your health care provider if you have questions about your health or before starting any treatment.
Statistics
No cases of yellow fever were reported in Iowa in 2021.