Hot Topics in Public Health

(Updated October 2007)

During 2005, outbreaks of H5N1 among poultry were confirmed in Cambodia, China, Indonesia, Thailand, Vietnam, Russia, and Kazakhstan; poultry outbreaks were also reported in Malaysia and Laos during 2004. Since January 2004, 331 human cases of avian influenza A (H5N1) have been reported to date: one hundred in Vietnam, twenty-five in Thailand, seven in Cambodia, and 109 in Indonesia, resulting in 202 deaths worldwide, none of which were in the US. CDC remains in communication with WHO and continues to closely monitor the H5N1 situation in countries reporting human cases and animal outbreaks. We remain in a Phase 3 level of worldwide alert in which there are no (or very rare) documented cases of human to human transmission.

Most cases of H5N1 infection in humans are thought to have occurred from direct contact with infected poultry in the affected countries. Therefore, when possible, care should be taken to avoid contact with live, well-appearing, sick, or dead poultry and with any surfaces that may have been contaminated by poultry or their feces or secretions. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Therefore, uncooked poultry or poultry products, including blood, should not be consumed.

The threat of novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability to spread from one human to another in a sustained fashion. Such transmission has not yet been observed; however, a few cases of limited person-to-person spread of H5N1 viruses may have occurred.

A vaccine to protect humans against avian influenza A (H5N1) is not yet available, but one is undergoing human clinical trials.

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1. Persons visiting areas with reports of outbreaks of H5N1 among poultry or of human H5N1 cases can reduce their risk of infection by observing the following measures:

Before Any International Travel to an Area Affected by H5N1 Avian Influenza

• Visit CDC's Travelers' Health webpage on Southeast Asia to educate yourself and others who may be traveling with you about any disease risks and CDC health recommendations for international travel in areas you plan to visit. For a list of affected areas and other information about avian influenza, see these webpages provided by the Centers for Disease Control and Prevention and the Department of Health and Human Services.
• Be sure you are up to date with all your vaccinations, and see your doctor or health-care provider, ideally four to six weeks before travel, to get any additional vaccination medications or information you may need.
• Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand gel for hand hygiene. See the Travelers Health Kit page in Health Information for International Travel for other suggested items.
• Identify in-country health-care resources in advance of your trip.
• Check your health insurance plan or get additional insurance that covers medical evacuation in case you become sick. Information about medical evacuation services is provided on the U.S. Department of State webpage Medical Information for Americans Traveling Abroad.

During Travel to an Affected Area

• Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or secretions.
• As with other infectious illnesses, one of the most important preventive practices is careful and frequent hand washing. Cleaning your hands often with soap and water removes potentially infectious material from your skin and helps prevent disease transmission. Waterless alcohol-based hand gels may be used when soap is not available and hands are not visibly soiled.
• Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked.
• If you become sick with symptoms such as a fever, difficulty breathing, or cough, or with any illness that requires prompt medical attention, a U.S. consular officer can assist you in locating medical services and informing your family or friends. Inform your health-care provider of any possible exposures to avian influenza. See Seeking Health Care Abroad in Health Information for International Travel for more information about what to do if you become ill while abroad. It is advisable that you defer further travel until you are free of symptoms, unless your travel is health related.

After Your Return

• Monitor your health for ten days.
• If you become ill with fever and develop a cough or difficulty breathing or if you develop any illness during this ten-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following: 1) your symptoms, 2) where you traveled, and 3) if you have had direct contact with poultry. This way, he or she can be aware that you have traveled to an area reporting avian influenza.

For more information about H5N1 infections in humans, visit the World Health Organization avian influenza website, the CDC Avian Influenza website, or the Department of Health and Human Services website.

What are bed bugs? What do bed bugs look like?

Bed bugs are small, oval, non-flying insects that belong to the insect family Cimicidae, which includes three species that bite people. Adult bed bugs reach 5-7 mm in length, while nymphs (juveniles) are as small as 1.5 mm. Bed bugs have flat bodies, and may sometimes be mistaken for ticks or small cockroaches. Bed bugs feed by sucking blood from humans or animals. Adult bed bugs are reddish brown in color, appearing more reddish after feeding on a blood meal. Nymphs are clear in color and appear bright red after feeding. The wings of bed bugs are vestigial, so they cannot fly.

Where are bed bugs found?

Bed bugs were common in the U.S. before World War II and became rare after widespread use of the pesticide DDT began in the 1940s and 1950s. They remained prevalent in other areas of the world and, in recent years, have been increasingly observed again in the U.S. Increases in immigration and travel from the developing world, as well as restrictions on the use of stronger pesticides, may be factors that have led to the relatively recent increase in bed bug infestations. While bed bugs are often reported to be found when sanitation conditions are poor or when birds or mammals (particularly bats) are nesting on or near a home, bed bugs can also live and thrive in clean environments. Crowded living quarters also facilitate the spread of bed bugs.

Bed bugs can live in any area of the home, and can reside in tiny cracks in furniture as well as on textiles and upholstered furniture. They tend to be most common in areas where people sleep, and generally concentrate in beds, including mattresses, box springs, and bed frames. They do not infest the sleeping surfaces of beds as commonly as cracks and crevices associated with the bed frame and mattress. Other sites where bed bugs often reside include curtains, edges of carpet, corners inside dressers and other furniture, cracks in wallpaper (particularly near the bed), and inside the spaces of wicker furniture.

How are bed bugs spread?

Bed bugs live in any articles of furniture, clothing, or bedding, so they or their eggs may be present in used furniture or clothing. They spread by crawling, and may contaminate multiple rooms in a home or even multiple dwellings in apartment buildings. They may also be present in boxes, suitcases, or other goods that are moved from residence to residence or from a hotel to home. Bed bugs can live on clothing from infested homes, and may be spread by a person unknowingly wearing infested clothing.

What are the symptoms and signs of bed bug bites?

Bed bugs bite and suck blood from humans. Bed bugs are most active at night, and bite any exposed areas of skin while an individual is sleeping. The face, neck, hands, and arms are common sites for bed bug bites. The bite itself is painless and is not noticed. Small, flat, or raised bumps on the skin are the most common sign; redness, swelling, and itching commonly occur. If scratched, the bite areas can become infected. A peculiarity of bed bug bites is the tendency to find several bites lined up in a row. Infectious disease specialists refer to this as the "breakfast, lunch, and dinner" sign, signifying the sequential feeding that occurs from site to site.

Bed bug bites may go unnoticed or be mistaken for flea or mosquito bites or other types of rash or skin conditions, since they are difficult to distinguish from other bites. Bed bugs also have glands whose secretions may leave odors, and they also may leave dark fecal spots on bedsheets and around their hiding places (in crevices or protected areas around the bed or anywhere in the room).

Bed bugs have not been conclusively proven to carry infectious microbes. However, researchers have implicated bed bugs as possible vectors, and studies are ongoing to determine whether bed bugs may serve as disease carriers.

What is the treatment for bed bug bites?

Typically, no treatment is required for bed bug bites. If itching is severe, steroid creams or oral antihistamines may be used for symptom relief. Secondary bacterial infections that develop over heavily scratched areas may require the use of antibiotics.

How do I detect a bed bug infestation in my home?

You can look to see if you can identify the fecal stains, egg cases, and exuviae (shed skins) in crevices and cracks on or near beds. You should also look at other areas such as under wallpaper, behind picture frames, in couches and other furniture, in bedsprings and under mattresses, and even in articles of clothing. While fecal stains and skin casts suggest that bed bugs have been present, these do not confirm that the infestation is still active. Observing the bed bugs themselves is definitive confirmation that an area is infested. You may require professional assistance from a pest-control company in determining whether your home contains bed bugs.

How do I get rid of bed bugs in the home?

Getting rid of bed bugs is not an easy process, and most cases of bed bug infestation will require treatment by a pest-control expert. A variety of low-odor sprays, dusts, and aerosol insecticides can be used to eradicate bed bugs. These must be applied to all areas where the bugs are observed as well as spaces where they may crawl or hide. The pest-control company can help you determine if the mattress can be disinfected or must be discarded. Since beds cannot readily be treated with insecticides, it's often necessary to discard infested mattresses and beds.

The pest-control expert may recommend certain forms of deep-cleaning, such as scrubbing infested surfaces with a stiff brush to remove eggs; dismantling bed frames and furniture; filling cracks in floors, walls, and moldings; encasing mattresses within special bags; or using a powerful vacuum on cracks and crevices.

What about prevention of bed bug bites?

Avoidance of infested areas is the method for prevention of bed bug bites. Recognition of bed bug infestation and proper treatment of affected rooms (usually with the help of a pest-control specialist) is the best way to prevent bed bugs in the home. Those concerned about the potential for bed bugs bites in hotels should examine hotel beds and mattresses for signs of a bed bug infestation. Sealing your mattress in a bed bug prevention casing can be beneficial.

Bed Bugs At A Glance

• Bed bugs are small, oval, non-flying insects that feed by sucking blood from humans or animals.
• Bed bugs can live in any area of the home and can reside in tiny cracks in furniture as well as on textiles and upholstered furniture. They tend to be most common in areas where people sleep, and generally concentrate in beds, including mattresses, boxsprings, and bed frames.
• Bed bugs are most active at night, and bite any exposed areas of skin while an individual is sleeping. The face, neck, hands, and arms are common sites for bed bug bites.
• A bed bug bite is painless and is not noticed. Small, flat, or raised bumps on the skin are the most common sign; redness, swelling, and itching commonly occur.
• Typically, no treatment is required for bed bug bites. If itching is severe, steroid creams or oral antihistamines may be used for symptom relief.
• Fecal stains, egg cases, and exuviae (shed skins) of bed bugs in crevices and cracks on or near beds are suggestive that bed bugs may be present, but only observing the bugs themselves can confirm an active infestation.
• A professional pest-control company may be required to help identify and remove bed bugs from the home.

References:

Greenberg, L., and J. H. Klotz. "Pest Notes: Bed Bugs." Oakland: Univ. Calif. Nat. Agric. Res. Publ. 7454. Sept. 2002.

Harvard School of Public Health

Potter, Michael F. "Bed Bugs." University of Kentucky College of Agriculture. Aug. 2008.

Thomas, I., G.G. Kihiczak, and R.A. Schwartz. "Bedbug Bites: A Review." Int J Dermatol 43 (2004): 430.

(Updated September 2008)

What is chickenpox?

Chickenpox is caused by a virus called varicella zoster. People who get the virus often develop a rash of spots that look like blisters all over their bodies. The blisters are small and sit on an area of red skin that can be anywhere from the size of a pencil eraser to the size of a dime. You've probably heard that chickenpox are itchy. It's true. The illness also may come along with a runny nose and cough. But the good news is that chickenpox is a common illness for kids and most people get better by just resting like you do with a cold or the flu. And the really good news is that, thanks to the chickenpox vaccine, lots of folks don't get chickenpox at all. Those who do get it, if they got the shot, often get less severe cases, which means they get better quicker.

What happens when you have chickenpox?

Chickenpox may start out seeming like a cold: You might have a runny or stuffy nose, sneezing, and a cough. But one to two days later, the rash begins, often in bunches of spots on the chest and face. From there, it can spread out quickly over the entire body—sometimes the rash is even in a person's ears and mouth. The number of pox is different for everyone. Some people get just a few bumps; others are covered from head to toe. At first, the rash looks like pinkish dots that quickly develop a small blister on top (a blister is a bump on your skin that fills up with fluid). After twenty-four to forty-eight hours, the fluid in the blisters gets cloudy and the blisters begin to crust over. Chickenpox blisters show up in waves, so after some begin to crust over, a new group of spots may appear. New chickenpox usually stop appearing by the seventh day, though they may stop as early as the third day. It usually takes ten to fourteen days for all the blisters to be scabbed over and then you are no longer contagious. Besides the rash, someone with chickenpox might also have a stomach ache, a fever, and may just not feel well.

How does chickenpox spread?

Chickenpox is contagious, meaning that someone who has it can easily spread it to someone else. Someone who has chickenpox is most contagious during the first two to five days that he or she is sick. That's usually about one to two days before the rash shows up. So you could be spreading chickenpox without even knowing it! A person who has chickenpox can pass it to someone else by coughing or sneezing. When he or she coughs, sneezes, laughs, and even talks, tiny drops come out of the mouth and nose. These drops are full of the chickenpox virus. It's easy for someone else to breathe in these drops or get them on his or her hands. Before you know it, the chickenpox virus has infected someone new.

Itchy Itchy, Scratchy Scratchy!

If you are that unlucky person, how do you keep your chickenpox from driving you crazy? They itch, but you're not supposed to scratch them. These tips can help you feel less itchy: Keep cool because heat and sweat will make you itch more. You might want to put a cool, wet washcloth on the really bad areas. Trim your fingernails, so if you do scratch, they won't tear your skin. Soak in a lukewarm bath. Adding some oatmeal to your bath water can help relieve the itching. Apply calamine lotion, which soothes itching. Scratching the blisters can tear your skin and leave scars. Scratching can also let germs in, and the blisters could get infected. If your fever goes higher and an area of your skin gets really red, warm, and painful, tell someone right away. You'll need to see a doctor because you could have a skin infection. While you have the chickenpox, a pain reliever like acetaminophen might help you feel better. Do not take aspirin because it can cause a rare but serious illness called Reye's syndrome. Medicines and creams that may stop the itch can also be helpful. It doesn't usually happen, but let someone know if you feel especially bad. Sometimes, chickenpox leads to other, more serious illnesses.

Usually, you won't have any major problems and you'll get better in a week or two. And when all the blisters have scabs, you're not contagious anymore and you can go back to class! In a few days, the scabs will fall off. And once you've had chickenpox, it's unlikely you'll ever get it again.

Questions may be directed to the University Health Service.

Coronaviruses are a large family of viruses that are common throughout the world. These viruses can live in animals, such as camels, cats, and bats, and, at times, evolve and infect people before spreading through human to human contact. Human coronaviruses spread just like the flu or a cold—through the air by coughing or sneezing; through close personal contact, like touching or shaking hands; by touching an object or surface with the viruses on it; and, occasionally, through fecal contamination.

2019-nCoV

The 2019 novel coronavirus (2019-nCoV) is a new virus that causes respiratory illness in people and can spread from person to person. This virus was first identified during an investigation into an outbreak in Wuhan, China. The virus probably originally emerged from an animal source but now seems to be spreading from person to person. It's important to note that person to person spread can happen on a continuum. Some viruses are highly contagious, while others are less so. At this time, its unclear how easily this virus is spreading between people.

Symptoms

Patients with 2019-nCoV have reportedly had mild to severe respiratory illness along with fever, cough, and shortness of breath. Complications of the virus have been pneumonia. The best way to prevent infection is to avoid being exposed to this virus. Simple everyday preventative steps are avoid close contact with people who are sick, avoid touching your eyes, nose and mouth with unwashed hands, wash your hands often with soap and water, or use alcohol based hand sanitizers that contains at least 60 PERCENT alcohol.

• COVID-19 Testing and Positive Cases
• COVID-19 Vaccination Information

For more information about this virus, visit the Pennsylvania Department of Health or CDC website.

IUP's Rhonda H. Luckey Center for Health and Well-Being continues to monitor the Ebola outbreak in West Africa. As new information becomes available, updates will be posted on the IUP Health Service website.

International Travel

If you are planning to travel outside of the U.S., the Rhonda H. Luckey Center for Health and Well-Being encourages you to check Centers for Disease Control (CDC) travel alerts and information before traveling.

CDC continues to issue Level 3 travel warnings for Guinea, Sierra Leone, and Liberia recommending that individuals avoid all non-essential travel to these areas. IUP has temporarily suspended approval for university-related travel to these countries.

If you do travel to one of these countries in West Africa and you develop a fever or other Ebola-related symptoms, or are believed to be at risk for developing Ebola, you may not be able to depart from that foreign country until it can be determined you are not infected. Any travelers from outbreak areas will also be diverted to one of five U.S. airports monitoring all arrivals from these countries where you will again be screened. If you have any signs or symptoms, you may be detained. When you return to Pennsylvania, you will undergo monitoring by the Pennsylvania Department of Health for 21 days. Depending on your level of potential exposure, you may also be required to isolate yourself for up to 21 days. For more information, contact the Health Service at 724-357-2550.

What Is the Ebola Virus, and What Are the Symptoms of This Infection?

Ebola virus disease (also known as Ebola hemorrhagic fever) is a rare and deadly disease. It is spread by direct contact with an infected person's blood or body fluids. It is also spread by contact with contaminated objects or infected animals, including raw meat. Ebola virus disease is not spread through the air, water, or food used in the United States.

Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some people. Since this virus requires contact with blood or bodily fluid, including sweat, transmission is rare. The disease is transmitted only when symptoms are present.

Am I at Risk of Contracting the Ebola Virus?

You are not at risk of contracting this infection:

• if you have not been to Sierra Leone, Guinea, and Liberia where the outbreak is occurring; or
• if you are not in close contact with others who are sick from Ebola within the last 21 days.

How Has the University Been Monitoring This Outbreak?

Since late summer, university officials and multiple community health care providers, including Indiana Regional Medical Center and Indiana County Emergency Management, have been working together in case a person in Indiana County were to become infected with the Ebola virus.

Currently there are no students from Guinea, Sierra Leone, and Liberia, the countries impacted by the Ebola outbreak, attending IUP.

It is unlikely that a member of the university community would be exposed to the Ebola virus.

Nevertheless, IUP personnel have worked closely with other members of the Indiana health care community to be prepared if this would occur.

What Should I Do if I Have Traveled to These Countries or Have Been in Close Contact With Someone Sick With Ebola?

The Pennsylvania Department of Health is monitoring travelers who have returned to Pennsylvania from Guinea, Sierra Leone, and Liberia.

If you were exposed to a person sick with Ebola more than 21 days ago, you are no longer considered at risk for Ebola. If fewer than 21 days has passed, contact the Department of Health at 1-877-PA-HEALTH. You will be instructed how to monitor your health and the health of anyone traveling with you for 21 days after being in the outbreak area. IUP students and employees also should contact IUP's Health Service at 724-357-2550.

What Are the Levels of Exposure Risk?

The CDC has released examples of levels of risk for exposure to the Ebola virus. You can find this in their fact sheet, Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola.

Examples of No Risk

• Had contact with a person with Ebola before the person was showing symptoms.
• Traveled to a country with Ebola outbreak more than 21 days ago.
• Been in a country where there is no widespread Ebola transmission (e.g., United States), and having no other exposures to Ebola.

Examples of Low (but not Zero) Risk

Being in the same room for a brief period of time (without direct contact) with a person who has symptoms of Ebola.

Examples of Some Risk

Close contact with a person with symptoms of Ebola, such as in a household or hospital. Close contact means being within three feet of a person with Ebola for a long time without wearing personal protective equipment (gloves, masks, gowns, etc.).

Examples of High Risk

Direct contact with the infected body fluids of a person with Ebola.

How Has the IUP Health Service Responded to the Possibility of a Person Seeking Care Who May Have Been Exposed to the Ebola Virus?

The IUP Health Service has stocked personal protective equipment (PPE) and practiced using it. IUP Health Service medical personnel will screen anyone seeking care at the Health Service who has fever or other symptoms as a result of having traveled in the outbreak countries or other risks. IUP Health Service health care providers monitor the CDC (U.S. Centers for Disease Control and Prevention) website for updated information and coordinate with the local health care community, including the Indiana Regional Medical Center and the Pennsylvania Department of Health.

Does the University Have an Official Policy on University-Sponsored Travel to These Countries Where Ebola Cases Have Occurred?

It is the university's practice to require members of the IUP community who travel internationally to obtain the approval of their division's vice president and to coordinate travel through the IUP Travel Office. Until further notice, divisional vice presidents will temporarily suspend approval for university-related travel to Guinea, Sierra Leone, and Liberia.

Until the CDC lifts the travel warning to these countries, educational activities, including teaching, research, or service, will be postponed. Educational activities include, for example, faculty, staff, and students who are involved in study abroad courses, internships, field study, conferences, research endeavors (funded as a result of university affiliations), and service activities related to academic pursuits.

Is Personal Travel to Countries Where Ebola Cases Have Occurred Permitted?

CDC has issued travel warnings for Guinea, Sierra Leone, and Liberia to avoid all non-essential travel to these areas. Traveling to these countries is very risky and can be difficult. These countries are screening for potential illness as you enter and leave these areas. You may find that if you develop a fever or other Ebola-related symptoms, or are believed to be at-risk for developing Ebola, you may not be able to travel out of the country until it can be determined you are not infected. Travelers from outbreak areas will also be diverted to one of five U.S. airports monitoring all arrivals from these countries; you will be screened when you arrive at one of these airports. If you have any symptoms, you may be detained.

When you return to the United States you will undergo monitoring by the Pennsylvania Department of Health for 21 days. Depending on your level of potential exposure to the Ebola virus, you also may be required to isolate yourself for up to 21 days.

Is There Anything I Can Do to Help With This Outbreak?

Do not travel to these countries.

Learn about Ebola and help others to understand the disease. This reduces unneeded fear and possible discrimination toward people who are from these areas.

CNN offered the names of organizations that are providing support to these countries. You can read about their work at the CNN website: Ebola Outbreak: Ways to help.

How Can I Get Current Information Related to Ebola?

To learn more about Ebola, CDC guidance, prevention, and intervention related to contracting the Ebola virus, refer to the following:

• Pennsylvania Department of Health
• Centers for Disease Control and Prevention
• U.S. Department of Health and Human Services: Ebola Information for Healthcare Professionals and Healthcare Settings
• International Association of Fire Chiefs: EMS Section Resources: Ebola Virus
• Pipeline and Hazardous Materials Safety Administration
• Occupational Safety and Health Administration
• OSHA Fact Sheet: Cleaning and Decontamination of Ebola on Surfaces

What is hand, foot, and mouth disease (HFMD)?

Hand, foot, and mouth disease is a viral infection caused by a strain of Coxsackie virus which is common in children but can occur in adults. The virus that causes HFMD can be found in an infected person's:

• Nose and throat secretions (saliva, sputum, or nasal mucus)
• Blister fluid
• Feces (stool)

An infected person may spread the virus that cause HFMD to another person through:

• Close personal contact
• The air (through sneezing or coughing)
• Contact with feces (stool)
• Contact with contaminated objects and surfaces

Symptoms of hand, foot, and mouth disease?

The first symptoms of HFMD usually start three to five days after exposure to the virus and can last up to seven to 10 days. Symptoms include:

• Fever
• Reduced appetite
• Sore throat
• Feeling of being unwell

Treatment of HFMD

There is no specific treatment for HFMD. Things can be done to relieve symptoms such as:

• Take over-the-counter medications to relieve pain and fever such as acetaminophen or ibuprofen
• Drinking plenty of fluids to stay hydrated

Prevention

You can lower your risk of being infected by:

• Washing your hands well and often with soap and water, especially after using the bathroom
• Covering your mouth and nose when sneezing or coughing with a tissue and disposing of tissue
• Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with anyone that may be infected
• Disinfecting common surfaces regularly with household cleaners
• Avoiding group settings if you have a fever or rash, specifically blisters on your hands, feet, or mouth

If you have questions, concerns, or think you might have HFMD, please call Health Service at 724-357-2550.

Updated October 2018

Check out the information below, with common questions about how to stay healthy during the influenza season. Students with concerns about high risk should call or stop in at the Health Service and discuss their options.

Frequently Asked Questions and Answers

Should I get the seasonal flu shot?

Everyone over the age of six months should get a seasonal flu shot. The Center for Disease Control has identified “high risk” groups of people who should try to get vaccinated for seasonal flu. They include persons over age 65, children under two years old, nursing home patients, persons with chronic diseases (heart or lung disease, asthma, diabetes, immune system disease, emphysema, etc.), pregnant women, children on aspirin therapy, doctors, nurses, health-care providers, and parents of very young children, to name some. Anyone with conditions such as these, or more specific questions, should ask a doctor if he or she should try to receive the seasonal flu vaccine.

How can I stay healthy if I don't get the shot?

Take everyday actions to help prevent the spread of germs that cause respiratory illnesses. Try to avoid close contact with sick people. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. Avoid touching your eyes, nose and mouth. Germs spread this way.

Should I go to the doctor if I have the flu?

A person who becomes suddenly ill with headache, pain, fever, vomiting or extreme weakness, or is ill for more than a few days, or seems to be getting worse, should seek medical care. If the health center is not open, the local emergency room is your second resource. An ambulance can be called to locations on or off campus. Students should not report to the Health Service merely for an excuse for class.

What's the difference between the flu and a cold?

The major difference is the severity and duration of the illness. Both are caused by different viruses and, therefore, are easily transmitted. The flu generally involves a high fever, body aches, muscle aches, a cough, and profound weakness. Vomiting and/or diarrhea can also be present. It can begin suddenly and get worse quickly. Symptoms of the flu can last for more than a week. A cold has congestion and runny nose as classic symptoms. Sore throat, cough, and a mild fever may be present with a cold. Symptoms of a cold can last up to seven to ten days.

Are there other medicines for the flu?

Yes, antiviral drugs are prescription medicines (pills, liquid, or an inhaled powder) that fight against the flu in your body. While a flu vaccine is the first and most important step in preventing flu, antiviral drugs are a second line of defense to treat the flu if you get sick. Antiviral drugs are not sold over the counter; you must have a prescription to get them. Antiviral drugs are not a substitute for vaccination.

If my roommate gets the flu, will I get it?

Each person's immune system and general health play a part in whether you get sick. Despite all the precautions suggested, the strength of the virus involved and the amount of exposure will determine your risk of coming down with influenza.

For more information about preventing seasonal flu, visit the Centers for Disease Control website.

What Causes Measles?

Measles is caused by a virus.

How does measles spread?

Measles is spread from person to person through the air by infectious droplets; it is highly contagious.

How long does it take to show signs of measles after being exposed?

It takes an average of 10-12 days from exposure to the first symptom, which is usually fever. The measles rash doesn't usually appear until approximately 14 days after exposure, two to three days after the fever begins.

What are the symptoms of measles?

Symptoms include fever, runny nose, cough, loss of appetite, “pink eye,” and a rash. The rash usually lasts five to six days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.

How serious is measles?

Measles can be a serious disease, with 30 percent of reported cases experiencing one or more complications. Complications from measles are more common among very young children (younger than five years) and adults (older than 20 years).

What are possible complications from measles?

Diarrhea is the most common complication. Other complications include ear infections, pneumonia, and acute encephalitis (an inflammation of the brain). Measles can be especially severe in persons with compromised immune systems.

How is measles diagnosed?

Measles is diagnosed by a combination of the patient's symptoms and by laboratory tests.

Is there a treatment for measles?

There is no specific treatment for measles. People with measles need bed rest, fluids, and control of fever. Patients with complications may need treatment specific to their problem.

How long is a person with measles contagious?

Measles is highly contagious and can be transmitted from four days before the rash becomes visible to four days after the rash appears.

What should be done if someone is exposed to measles?

Notification of the exposure should be communicated to a doctor. If the person has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure.

Can someone get measles more than once?

No.

Measles can be prevented with vaccination.

MMR vaccine contains live, attenuated (or weakened) strains of the measles, mumps, and rubella viruses.

How effective is the vaccine?

The first dose of MMR produces immunity to measles and rubella in 90 to 95 percent of recipients. The second dose of MMR is intended to produce immunity in those who did not respond to the first dose.

Which adolescents and adults should receive the MMR vaccine?

All unvaccinated adolescents without a valid contraindication to the vaccine should have documentation of two doses of MMR. All adults born in or after 1957 should also have documentation of vaccination or other evidence of immunity. Adults born before 1957 are likely to have had measles and/or mumps disease as a child and are generally (but not always) considered not to need vaccination.

What if I have additional questions?

If you have questions about your immunity, you can call your primary care physician or contact the IUP Health Service at 724-357-2550. More information on measles can be found on the CDC website.

If you have heard of a university member diagnosed with meningitis, please read the following information to help answer questions you may have.

Be assured, if bacterial meningitis is diagnosed in any patient, the local health department will immediately investigate and be in touch with close personal contacts that need to receive medication as soon as possible. If a diagnosis of viral menigitis is made, there will be no public health information disseminated due to patient confidentiality issues. Learn more about viral meningitis.

Questions about Meningitis?

Meningitis is an inflammation of the space around a person's spinal cord and the fluid that surrounds the brain. It is contagious and can be caused by either a virus or bacteria; however, meningococcal meningitis can only be spread through household or close personal contacts. Casual contacts, such as those within a shared restroom or classroom, are not considered to be household contacts.

What is IUP doing?

The College and University Student Vaccination Act of Pennsylvania requires that all students, before moving into university-owned and -operated residence halls or apartments, must receive the vaccination for meningococcal meningitis or sign a document stating that the student has chosen to be exempted from receiving the vaccination for religious or other reasons. All residents are required to sign an on-line document within the housing contract before moving into campus rooms/apartments stating that they are in compliance with the law. This statement of compliance with the College and University Student Vaccination Act will be obtained on line from the Office of Housing and Residence Life. The vaccination required is the A, C, Y, W-135 vaccine. IUP recommends that residents have the vaccination prior to arrival on campus. The meningitis B vaccine is also recommended, and both can be received at the Health Service free of charge. Call 724-357-2550 to schedule an appointment.

If you have had close contact with an infected person within the last ten days and have questions or concerns about whether you should be treated, please contact the university Health Service at 724-357-2550. If you have pressing concerns and the campus Health Service is closed, please contact Indiana Regional Medical Center's Bork Emergency Center at 724-357-7121 or your family doctor.

Symptoms of meningococcal meningitis often resemble the flu and can include high fever, severe headache, stiff neck, rash, nausea, vomiting, lethargy, and confusion. For more information about meningitis, visit the Pennsylvania Department of Health website.

Questions may be directed to the Health Service.

Meningitis Law

As required by commonwealth law, students living in a university-owned or operated residence halls or apartments will need to have the vaccination for meningococcal meningitis before arriving on campus, or they will need to sign a waiver stating that they do not wish to have the vaccination. The waiver form is provided online by the Office of Housing and Residence Life for students at the time they complete a contract for a campus residence hall/apartment. Questions or information concerning this law and housing requirements can be directed to 724-357-2696.

Completing the waiver does not prohibit a student from having the vaccination at a later date. The waiver provides evidence that students have been provided information about meningococcal meningitis and about the availability of the vaccine, but have elected to move into the residence hall/apartment without having been vaccinated for the disease. The full text of the immunization policy is below.

Immunization Policy

IUP requires documentation from all new freshmen and transfer students of all immunization dates. This includes the following vaccines: measles, mumps, rubella, tetanus-toxoid, diphtheria, and polio. See additional information, below, regarding immunization requirements for students living in university-owned residences.

Documentation can take the following forms:

1. Dates of vaccinations by the health care provider who gave them
2. Date of illness with the disease diagnosed by a physician
3. Serum antibody level as determined by a blood test

Individuals who were born after 1956 should receive a measles immunization before entering college. This may be a second measles immunization or the first vaccine within six months of entering college. A tetanus immunization must also be updated every ten years.

Additionally, the College and University Student Vaccination Act requires that all students, before moving into university-owned and -operated residence halls or apartments, must receive the vaccination for meningococcal meningitis or sign a document stating that the student has chosen to be exempted from receiving the vaccination for religious or other reasons. All residents are required to acknowledge, before moving into campus rooms/apartments, that they are in compliance with the law. This statement of compliance with the College and University Student Vaccination Act will be provided on line from the Office of Housing and Residence Life. The vaccination required is the A, C, Y, W-135 vaccine.

Questions or requests for information about exemptions to this policy should be directed to the Health Service at 724-357-6475.

MERS, or Middle East Respiratory Syndrome Coronavirus, causes respiratory illness. It was first diagnosed in Saudia Arabia in 2012. MERS begins with respiratory symptoms and can rapidly progress to pneumonia within one week, then respiratory failure and septic shock. MERS is spread from respiratory secretions or close contact with an infected person.

Symptoms:

Cough, fever, chills, shortness of breath, and headache. The virus is spread by airborne transmission.

Diagnosis:

MERS can be confirmed by sputum, blood, and stool cultures. Early diagnosis and isolation is critical.

Frequently Asked Questions about MERS

What should I do if I have traveled internationally?

If you develop a fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in the Arabian Peninsula or South Korea , you should seek health care and mention your recent travel. To notify IUP of the illness, contact the IUP Health Service at the Rhonda H. Luckey Center for Health and Well-Being at 724-357-2550. Countries in the Arabian Peninsula include: Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Palestinian territories, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

Can I still travel to countries where MERS cases have occurred?

At the time of this letter, WHO (World Health Organization) and CDC (U.S. Centers for Disease Control Prevention) have not issued travel warnings for any country related to MERS. If you do travel to a country and think you may have been exposed to MERS, you should seek medical treatment and advice before returning to the U.S.

Can I reduce my risk of contracting MERS?

The virus that causes MERS is spread between people who are in close contact. There is no vaccine to prevent this illness. Treatment is supportive and to help relieve symptoms. No specific treatments for MERS are available.

• CDC advises that people follow these tips to help prevent respiratory illnesses:
• Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer.
• Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact, such as kissing, or sharing cups or eating utensils with sick people.
• Clean and disinfect frequently touched surfaces, such as toys and doorknobs.

How can I get current information related to MERS?

The most up-to-date information, including travel alerts, is available at:

• Centers for Disease Control and Prevention.
• World Health Organization

Health Service is monitoring updates regarding monkeypox, a rare disease caused by an infection with the monkeypox virus. Monkeypox has become a public health concern because the illness is similar to smallpox and can be spread from infected humans, animals, and materials contaminated with the virus.

According to the CDC, symptoms of monkeypox can include fever, headache, body aches, swollen lymph nodes, chill, exhaustion, and a rash on the face, mouth, hands, feet, chest, or genitals. The rash will go through several stages and can look like pimples or blisters and may be painful or itchy.

Monkeypox can spread through close, personal, skin-to-skin contact with an infected person's infectious sores, scabs, or body fluids. It can be spread by touching objects, fabrics, and surfaces that have been used by someone with monkeypox. It can also be spread by respiratory secretions during prolonged face-to-face contact. The virus can be spread from the time symptoms start until the rash has healed. The illness typically lasts two to four weeks.

To prevent getting monkeypox, CDC recommends avoiding close, skin-to-skin contact with people who have a rash that looks like monkeypox. Avoid contact with objects and materials that a person with monkeypox has used. Do not share eating utensils, cups, bedding, towels, or clothing with a person who has monkeypox symptoms. Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom.

Health Service will consult with the PA Department of Health regarding any suspected cases of monkeypox. If someone develops symptoms of monkeypox or has questions about the virus, please call or email Health Service.

For more information about monkeypox, see the links below from the CDC:

Monkeypox signs and symptoms

Frequently asked questions about monkeypox

(Updated September 2008)

The possibliity of IUP students or university staff having an MRSA infection always exists. It does not constitute a public health emergency or crisis. If you have heard of a university member with this type of infection, please read the following information to help answer your questions.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by Staphylococcus aureus bacteria—often called “staph.” Decades ago, a strain of staph emerged in hospitals that was resistant to the broad-spectrum antibiotics commonly used to treat it. Dubbed Methicillin-resistant Staphylococcus aureus, it was one of the first germs to outwit all but the most powerful drugs. MRSA infection can be fatal.

Staph bacteria are normally found on the skin or in the nose of about one-third of the population. If you have staph on your skin or in your nose but aren't sick, you are said to be “colonized” but not infected with MRSA. Healthy people can be colonized with MRSA and have no ill effects; however, they can pass the germ to others.

Staph bacteria are generally harmless, unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. But in older adults and people who are ill or have weakened immune systems, ordinary staph infections can cause a serious illness, MRSA.

In the 1990s, a type of MRSA began showing up in the wider community. Today, that form of staph, known as community-associated MRSA, or CA-MRSA, is responsible for many serious skin and soft tissue infections and for a serious form of pneumonia.

Vancomycin is one of the few antibiotics still effective against hospital strains of MRSA infection, although the drug is no longer effective in every case. Several drugs continue to work against CA-MRSA, but CA-MRSA is a rapidly evolving bacterium, and it may be a matter of time before it, too, becomes resistant to most antibiotics.

Signs and symptoms

Staph infections, including MRSA, generally start as small red bumps that resemble pimples, boils, or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves, and lungs.

Causes

Although the survival tactics of bacteria contribute to antibiotic resistance, humans bear most of the responsibility for the problem. Leading causes of antibiotic resistance include the following:

• Unnecessary antibiotic use in humans. Like other superbugs, MRSA is the result of decades of excessive and unnecessary antibiotic use. For years, antibiotics have been prescribed for colds, flu, and other viral infections that don't respond to these drugs, as well as for simple bacterial infections that normally clear on their own.
• Antibiotics in food and water. Prescription drugs aren't the only source of antibiotics. In the United States, antibiotics can be found in beef cattle, pigs, and chickens. The same antibiotics then find their way into municipal water systems when the runoff from feedlots contaminates streams and groundwater. Routine feeding of antibiotics to animals is banned in the European Union and many other industrialized countries. Antibiotics given in the proper doses to animals who are sick don't appear to produce resistant bacteria.
• Germ mutation. Even when antibiotics are used appropriately, they contribute to the rise of drug-resistant bacteria because they don't destroy every germ they target. Bacteria live on an evolutionary fast track, so germs that survive treatment with one antibiotic soon learn to resist others. And because bacteria mutate much more quickly than new drugs can be produced, some germs end up resistant to just about everything. That's why only a handful of drugs are now effective against most forms of staph.

Risk factors

Because hospital and community strains of MRSA generally occur in different settings, the risk factors for the two strains differ.

These are the main risk factors for community-acquired CA-MRSA:

• Young age. CA-MRSA can be particularly dangerous in children. Often entering the body through a cut or scrape, MRSA can quickly cause a widespread infection. Children may be susceptible because their immune systems aren't fully developed, or they don't yet have antibodies to common germs. Children and young adults are also much more likely to develop dangerous forms of pneumonia than older people are.
• Participating in contact sports. CA-MRSA has crept into both amateur and professional sports teams. The bacteria spread easily through cuts and abrasions and skin-to-skin contact.
• Sharing towels or athletic equipment. Although few outbreaks have been reported in public gyms, CA-MRSA has spread among athletes sharing razors, towels, uniforms, or equipment.
• Having a weakened immune system. People with weakened immune systems, including those living with HIV/AIDS, are more likely to have severe CA-MRSA infections.
• Living in crowded or unsanitary conditions. Outbreaks of CA-MRSA have occurred in military training camps and in American and European prisons.
• Association with health-care workers. People who are in close contact with health-care workers are at increased risk of serious staph infections.

When to seek medical advice

Keep an eye on minor skin problems—pimples, insect bites, cuts, and scrapes—especially in children. If wounds become infected, see your doctor. Ask to have any skin infection tested for MRSA before starting antibiotic therapy. Drugs that treat ordinary staph aren't effective against MRSA, and their use could lead to serious illness and more resistant bacteria.

Screening and diagnosis

Doctors diagnose MRSA by checking a tissue sample or nasal secretions for signs of drug-resistant bacteria. The sample is sent to a lab, where it's placed in a dish of nutrients that encourage bacterial growth (culture). But because it takes about forty-eight hours for the bacteria to grow, newer tests that can detect staph DNA in a matter of hours are now becoming more widely available.

Treatment

Both hospital and community associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors generally rely on the antibiotic vancomycin to treat resistant germs. CA-MRSA may be treated with vancomycin or other antibiotics that have proven effective against particular strains. Although vancomycin saves lives, it may grow resistant as well; some hospitals are already seeing outbreaks of vancomycin-resistant MRSA. To help reduce that threat, doctors may drain an abscess caused by MRSA rather than treat the infection with drugs.

Preventing MRSA

Protecting yourself from MRSA—which might be just about anywhere—may seem daunting, but these common-sense precautions can help reduce your risk:

• Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing, and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.
• Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores often contains MRSA, and keeping wounds covered will help keep the bacteria from spreading.
• Sanitize linens. If you have a cut or sore, wash towels and bed linens in hot water with added bleach, and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.
• Wash your hands. In or out of the hospital, careful hand washing remains your best defense against germs. Scrub hands briskly for at least fifteen seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 62 percent alcohol for times when you don't have access to soap and water.
• Get tested. If you have a skin infection that requires treatment, ask your doctor if you should be tested for MRSA. Many doctors prescribe drugs that aren't effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs.

© 1998-2007 MayoClinic.com

Questions may be directed to the University Health Service.

(Updated April 2006)

What is mumps?

It is an infection caused by the mumps virus.

Who can get mumps?

Anyone who is not immune from either previous mumps infection or from vaccination can get mumps. Before the 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 is now a rare disease in the United States. Of those people who do get mumps, up to half have very mild, or no symptoms, and therefore do not know they were infected with mumps.

What are the symptoms of mumps?

The most common symptoms are fever, headache, muscle aches, tiredness, and loss of appetite, followed by onset of parotitis (swollen and tender salivary glands under the ears, on one or both sides).

Mumps can lead to hearing loss; aseptic meningitis (infection of the covering of the brain and spinal cord) in about 10 percent of cases; painful, swollen testicles in 20 percent to 30 percent of males who have reached puberty (orchitis) but rarely does this lead to fertility problems; and painful, swollen breasts in about 30 percent of women who have reached puberty (mastitis); and in a very few cases, inflammation of the ovaries.

Are there complications of mumps?

Severe complications are rare. However, mumps can cause the following:

Inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis); inflammation of the testicles (orchitis); inflammation of the ovaries and/or breasts (oophoritis and mastitis); spontaneous abortion, particularly in early pregnancy (miscarriage); deafness, usually permanent.

How soon do symptoms appear?

Symptoms typically appear sixteen to eighteen days after infection, but this period can range from twelve to twenty-five days after infection.

How is mumps spread?

Mumps is spread by mucus or droplets from the nose or throat of an infected person, usually when a person coughs or sneezes. Surfaces of items (e.g. toys) can also spread the virus if someone who is sick touches them without washing his/her hands, and someone else then touches the same surface and rubs his/her eyes, mouth, nose, etc. (This is called fomite transmission.)

How long is an infected person able to spread the disease?

Mumps virus has been isolated from respiratory secretions three days before the start of symptoms until nine days after onset.

What is the treatment for mumps?

There is no specific treatment. Supportive care should be given as needed. If someone becomes very ill, he/she should seek medical attention. Those who seek medical attention should call their doctor in advance, so that they don't have to sit in the waiting room for a long time and possibly infect other patients.

How do I protect myself (my kids/my family)?

Mumps vaccine (usually MMR) is the best way to prevent mumps. Other things people can do to prevent mumps and other infections is to wash hands well and often with soap and teach children to wash their hands, too. Eating utensils should not be shared, and surfaces that are frequently touched (toys, doorknobs, tables, counters, etc.) should also be regularly cleaned with soap and water, or with cleaning wipes.

Is there a vaccine to prevent mumps?

Yes. Two doses of mumps-containing vaccine, given as combination measles, mumps, rubella (MMR) vaccine, separated by at least twenty-eight days, are routinely recommended for all children. The first dose is given on or after the first birthday; the second is given at four to six years of age. MMR is a live, weakened (attenuated) vaccine. Most adults who have not been vaccinated should also receive one dose of MMR vaccine, but adults who work in health care, a school/university setting, and persons at high risk of exposure to mumps should get two doses. Pregnant women and persons with an impaired immune system should not receive live attenuated vaccines (MMR vaccine).

Is the vaccine effective/does it work?

One dose of mumps vaccine will “take” (be effective) in approximately 80 percent of people vaccinated, but two doses of mumps vaccine will take in approximately 90 percent of people. Therefore, two doses are better at preventing mumps than one dose.

Where can I get the vaccine?

IUP does not carry the mumps vaccine. Most family and pediatric doctors keep vaccine in their clinics, and local health departments usually have vaccine. If someone isn't sure where to get vaccine, he/she can call the local or state health department.

What should I do if I don't know if I've been vaccinated?

Get vaccinated. The MMR vaccine is safe, and there is no increased risk of side effects if a person gets another vaccination.

If I had mumps as a child, can I get it again? Should I get vaccinated?

Most people who have mumps will be protected (immune) from getting mumps again. There is a small percentage of people, though, who could get reinfected with mumps and have a milder illness. If the case of mumps was not diagnosed by a physician, that person is not considered immune, and vaccination is recommended.

If I was exposed to someone with mumps, what should I do?

Not everyone who is exposed to someone with mumps will get sick. If a person has been vaccinated with two doses of mumps vaccine, it is very unlikely he/she will get mumps. However, if a person hasn't been vaccinated, it is possible he/she could get sick and that person should watch for symptoms of mumps. Additionally, if a person hasn't been vaccinated, this is a good time to get another dose of mumps vaccine and to make sure that everyone else in the house is also vaccinated. Mumps vaccine has not been shown to be effective in preventing disease after exposure, but vaccination of exposed susceptible persons will reduce the risk of disease from possible future exposures. If symptoms develop (generally sixteen to eighteen days after exposure), the person should not go to school or work for at least nine days and should contact his/her medical provider.

Last updated September 2009

What is pertussis (whooping cough)?

Pertussis is a highly contagious disease involving the lungs and airways. It is caused by the bacteria Bordetella pertussis, which is found in the nose, mouth, and throat of an infected person. More than two hundred cases are reported each year in Pennsylvania, mostly in children. Other cases of pertussis occur but are not diagnosed, especially in adults, since illness in adults may be milder than in children.

Who gets pertussis?

Pertussis can occur at any age, but is usually seen in children. There has been an overall increase in cases in recent years, with a disproportionate increase in adolescents and adults.

How do you get pertussis?

People get pertussis by breathing in airborne droplets from the nose and mouth of already infected persons. Older children and adults may have milder disease and may spread it to unimmunized infants and young children. An infected person is most contagious early in the course of illness. If untreated, an infected person can spread pertussis for up to three weeks after coughing starts. Antibiotic treatment limits contagiousness to five days after treatment is started.

How soon do symptoms start?

Symptoms usually start five to ten days after exposure to another person with the disease, but may take as long as twenty days to develop.

What are the symptoms of pertussis?

Pertussis begins as a mild illness like the common cold. Sneezing, runny nose, low-grade fever, and mild coughing progress to severe coughing. Some persons have episodes of rapid coughing followed by a high-pitched whoop as they take a deep breath. However, not everyone with pertussis has a whooping cough, especially very young infants. Severe cough may continue for many weeks despite proper treatment. Symptoms may be milder in older children and adults. However, pertussis can be a serious disease, especially in infants and young children. Complications can include pneumonia, dehydration, seizures, encephalopathy (a disorder of the brain), and death.

How is pertussis diagnosed?

Diagnosis is based on the recovery of the bacteria from nasopharyngeal specimens obtained early in the course of the disease.

How is pertussis treated?

Antibiotics may be useful early in the disease. Antibiotics are particularly helpful in reducing spread of the disease to other persons. However, once severe symptoms begin, antibiotics may not have any effect on symptoms.

How can pertussis be prevented?

The single best control measure is adequate vaccination of children. The Pertussis vaccine is usually given together with other vaccines, such as diphtheria and tetanus (DTaP vaccine). Recent changes in the Pertussis vaccine have improved its safety while keeping a high level of protection. Children should be routinely immunized at ages two, four, six, and fifteen months, and again at four to six years. In Pennsylvania and many other states, adequate Pertussis immunization is required for school entry.

In 2005, a new combination tetanus, diphtheria, and acellualar Pertussis vaccine (Tdap) was approved for use in adolescents and adults. Tdap is recommended for use in all eleven to eighteen year olds, preferably at a preventive care visit at age eleven or twelve years. Adults under sixty-five years of age should receive a single dose of Tdap to replace a single dose of tetanus-diphtheria (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their most recent Td = 10 years earlier. Tdap may be given at an interval shorter than ten years since receipt of the last Td to protect against pertussis. There is no Pertussis vaccine approved for adults aged sixty-five years and older.

Adults under sixty-five years of age who have or anticipate having close contact with an infant under twelve months of age (e.g., parents, childcare providers, healthcare providers) should receive a single dose of Tdap. Ideally, Tdap should be given at least one month before beginning contact with the infant. Women should receive a dose of Tdap immediately after giving birth to a child if they have not previously received Tdap. Any woman who might become pregnant is encouraged to receive a single dose of Tdap.

Healthcare personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. Priority should be given to vaccination of healthcare personnel with direct contact with infants aged less than twelve months. An interval as short as two years from the last dose of Td is recommended for the Tdap dose. Other healthcare personnel (i.e., those who do not work in hospitals or ambulatory care settings or who do not have direct patient contact) should receive a single dose of Tdap according to the routine recommendation and interval guidance for use of Tdap among adults. However, these personnel are encouraged to receive the Tdap dose at an interval as short as two years following the last Td. Hospitals and ambulatory care facilities should provide Tdap for healthcare personnel and use approaches that maximize vaccination rates such as education about the benefits of vaccination, convenient access, and provision of Tdap at no charge.

When pertussis does occur, preventive antibiotic treatment is sometimes recommended for household and other close contacts of the person with pertussis.

Information from the Pennsylvania Department of Health. More information about pertussis.

This fact sheet provides general information. Please contact your physician for specific clinical information.

Information about IUP's SARS Response Team

Have a question or concern? Send your e-mail to health-inquiry@iup.edu

IUP Response Team Concludes Work Addressing Issues Related to SARS

In response to concerns about Severe Acute Respiratory Syndrome (SARS), Indiana University of Pennsylvania's SARS Response Team has completed its charge of developing recommendations regarding prevention and intervention procedures for the IUP campus in 2003. This group, composed of faculty members and administrators, reviewed the existing policies and updated them to reflect appropriate responses to a SARS-like illness.

“Fortunately, given the state of SARS worldwide, and with the World Health Organization's lifting of alerts and advisories regarding SARS, the team believes that the threat of SARS to the university community is not a serious one at this time, so implementation of these recommendations is not necessary,” said Dr. Rhonda Luckey, SARS Response Team chair and vice president for Student Affairs. “The team has done excellent work, and the guidelines and recommendations members have developed do offer a general guide for campuswide readiness in case of SARS or a SARS-like epidemics in the future,” she said.

Guidelines from the Centers for Disease Control and Prevention were followed closely by the IUP team as it designed systems to be responsive to the SARS epidemic. The IUP team also worked closely with the local community to coordinate policies and planning. Basic information about SARS was shared with parents and students during orientation events scheduled for Thursday, May 29, and continuing throughout the summer months. “SARS did not pose a serious concern for our immediate IUP community, but like many other colleges and universities in this country, IUP felt challenged to identify procedures to respond to public health concerns and fears about SARS,” said Dr. Luckey.

Frequently Asked Questions about IUP's Response to and Prevention of Severe Acute Respiratory Syndrome (SARS) on Campus

Especially for the IUP community:

How has the university worked to reduce the risk of SARS?

Representatives from a cross-section of the IUP community, the SARS Response Team, developed an environmental management plan during the summer months in response to the threat of SARS. In all of its work, the team took guidance from the Centers for Disease Control and Prevention (see the CDC website).

The IUP student health service, Pechan Health Center, followed the recommendations of the Centers for Disease Control and Prevention and was prepared to respond in the event SARS cases are diagnosed by working cooperatively with the local hospital (Indiana Regional Medical Center) and the local Department of Health.

What is the university's plan in the event that SARS cases are diagnosed?

Any diagnosed cases of SARS will be managed by the IUP student health center through the recommendations of the Infection Control personnel at the local hospital, Indiana Regional Medical Center, and the local Department of Health. If there is a reason for the university community to be concerned about a case of SARS, the local Department of Health and the university would work collaborative to communicate all necessary information to students, faculty, and staff.

What should students do if they have a roommate who has traveled internationally, even though the travel advisories have been lifted?

Exposure to someone who is from or has traveled to the designated areas does not necessarily put a person at risk for SARS. According to the Centers for Disease Control and Prevention (CDC), persons exposed to SARS are not considered infectious until the onset of symptoms. Also, only certain designated cities and countries are included in the CDC's case definition. If your roommate has traveled to one of the designated areas but is not ill, there is no need to be concerned. If your friend or neighbor is from one of these designated areas but has not been to one of these areas in the past ten days, he/she is not at risk of SARS. SARS is not caused by being from a particular area of the world. SARS is a virus; contracting SARS is not related to country of origin. In order to contract SARS, you must come into contact with the virus that causes the disease.

I am a student with plans to travel, for either personal or academic purposes, to areas that were affected. What should I do?

Travel decisions are a personal choice. Refer to the U.S. Department of State website for the most up-to-date travel warnings. In addition, please consult the Centers for Disease Control and Prevention website for updated travel advisories and information.

Were the unions involved with the development of the SARS Team recommendations?

The SARS Team consists of fifteen faculty, staff, and management employees. All union representatives were informed of the SARS Team in June 2003 and were informed of the approved recommendations of the president in August 2003.

General Questions about SARS

What should someone who has visited or is from a SARS-affected area do if he/she becomes ill? Are there any special guidelines for seeking medical attention?

Yes. If someone who recently traveled to one of the affected areas has symptoms of SARS (fever, cough, difficulty breathing) he/she should contact a health-care professional immediately. If staying at a hotel, he or she should stay in the room and call for emergency medical help by dialing 911 (follow the directions printed on or near the hotel telephone about calling 911).

If the person is staying in a private home or room, he or she should should stay in the home or room and call for emergency medical help by dialing 911. When the emergency operator answers the telephone, it is important that the following information is shared:

• Provide the travel history about the person who is sick
• State the symptoms of the person who is sick
• Inform the emergency operator if the person who is sick came into contact with any individual(s) who were diagnosed with SARS or who had symptoms of SARS (fever, cough, difficulty breathing) while in one of the countries classified by the Centers for Disease Control and Prevention (CDC) and World Health Organization as SARS-affected areas (see listing of countries at the CDC website).

Follow the directions of the person who answers the telephone.

How can I get current information related to SARS?

The most up-to-date information is available at the Centers for Disease Control and Prevention website.

Use these links for up-to-date information about CDC travel advisories and travel alerts.

Contact Information:

University Health Service, (724) 357-6475
Department of Health, (724) 357-2995
Indiana Regional Medical Center, (724) 357-7000
Centers for Disease Control and Prevention
World Health Organization

What is scabies?

Scabies is an itchy, highly contagious skin condition caused by an infestation by the itch mite Sarcoptes scabiei. Mites are small, eight-legged parasites (in contrast to insects, which have six legs). They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching, which tends to be worse at night. The mites that infest humans are female and are 0.3 mm to 0.4 mm long; the males are about half this size. Scabies mites can be seen with a magnifying glass or microscope. The scabies mites crawl but are unable to fly or jump. They are immobile at temperatures below 20º C, although they may survive for prolonged periods at these temperatures.

Scabies infestation occurs worldwide and is very common. It has been estimated that worldwide, about 300 million cases occur each year. Human scabies has been reported for over 2,500 years. Scabies has been reported to occur in epidemics in nursing homes, hospitals, long-term care facilities, and other institutions. In the U.S., it is seen frequently in the homeless population, but occurs episodically in other populations of all socioeconomic groups as well.

How do you get scabies?

Direct skin-to-skin contact is the mode of transmission. Scabies mites are very sensitive to their environment. They can only live off of a host body for 24 to 36 hours under most conditions. Transmission of the mites involves close person-to-person contact of the skin-to-skin variety. It is hard, if not impossible, to catch scabies by shaking hands, hanging your coat next to someone who has it, or even sharing bedclothes that had mites in them the night before. Sexual physical contact, however, can transmit the disease. In fact, sexual contact is the most common form of transmission among sexually active young people, and scabies has been considered by many to be a sexually transmitted disease (STD). However, other forms of physical contact, such as mothers hugging their children, are sufficient to spread the mites. Over time, close friends and relatives can contract it this way, too. School settings typically do not provide the level of prolonged personal contact necessary for transmission of the mites.

Can you catch scabies from a dog or cat?

Dogs and cats are infected by different types of mites than those which infect humans. Animals are not a source of spread of human scabies. Scabies on dogs is called mange. When canine or feline mites land on human skin, they fail to thrive and produce only a mild itch that goes away on its own. This is unlike human scabies, which gets worse and worse unless the condition is treated.

What does scabies look like? What are the signs and symptoms of scabies?

Scabies produces a skin rash composed of small red bumps and blisters and affects specific areas of the body. Scabies may involve the webs between the fingers, the wrists and the backs of the elbows, the knees, around the waist and umbilicus, the axillary folds, the areas around the nipples, the sides and backs of the feet, the genital area, and the buttocks. The bumps (medically termed papules) may contain blood crusts. It is helpful to know that not every bump is a bug. In most cases of scabies affecting otherwise healthy adults, there are no more than ten to fifteen live mites, even if there are hundreds of bumps and pimples.

The scabies rash is often apparent on the head, face, neck, palms, and soles of the feet in infants and very young children, but usually not in adults and older children.

Textbook descriptions of scabies always mention "burrows" or "tunnels." These are tiny threadlike projections, ranging from 2 mm to 15 mm long, which appear as thin gray, brown, or red lines in affected areas. The burrows can be very difficult to see. Often mistaken for burrows are linear scratch marks that are large and dramatic and appear in people with any itchy skin condition. Scratching actually destroys burrows.

What does scabies feel like?

It is important to note that symptoms may not appear for up to two months after being infested with the scabies mite. Even though symptoms do not occur, the infested person is still able to spread scabies during this time. When symptoms develop, itching is the most common symptom of scabies. The itch of scabies is insidious and relentless. The itch is typically worse at night. For the first weeks, the itch is subtle. It then gradually becomes more intense until, after a month or two, sleep becomes almost impossible.

What makes the itch of scabies distinctive is its relentless quality, at least after several weeks. Other itchy skin conditions—eczema, hives, and so forth—tend to produce symptoms that wax and wane. These types of itch may keep people from falling asleep at night for a little while, but they rarely prevent sleep or awaken the sufferer in the middle of the night.

What is the treatment for a scabies infestation?

Curing scabies is rather easy with the administration of prescription scabicide drugs. There are no approved over-the-counter preparations that have been proved to be effective in eliminating scabies. The following steps should be included in the treatment of scabies:

1. Apply a mite-killer like permethrin (Elimite). These creams are applied from the neck down, left on overnight, then washed off. This application is usually repeated in seven days. Permethrin is approved for use in people two months of age and older.
2. An alternative treatment is one ounce of a 1% lotion or thirty grams of cream of lindane, applied from the neck down and washed off after approximately eight hours. Since lindane can cause seizures when it is absorbed through the skin, it should not be used if skin is significantly irritated or wet, such as with extensive skin disease, rash, or after a bath. As an additional precaution, lindane should not be used in pregnant or nursing women, the elderly, people with skin sores at the site of the application, children younger than two years of age, or people who weigh less than 110 pounds. Lindane is not a first-line treatment, and is only recommended if patients cannot tolerate other therapies or if other therapies have not been effective.
3. Ivermectin, an oral medication, is an antiparasitic medication that has also been shown to be an effective scabicide, although it is not FDA-approved for this use. The CDC recommends taking this drug at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. Although taking a drug by mouth is more convenient than application of the cream, ivermectin has a greater risk of toxic side effects than permethrin and has not been shown to be superior to permethrin in eradicating scabies. It is typically used only when topical medications have failed or when the patient cannot tolerate them.
4. Crotamiton lotion 10% and cream 10% (Eurax, Crotan) is another drug that has been approved for the treatment of scabies in adults, but it is not approved for use in children. However, treatment failures have been documented with the use of crotamiton.
5. Sulfur in petrolatum applied as a cream or ointment is one of the earliest known treatments for scabies. It has not been approved by the FDA for this use, and sulfur should only be used when permethrin, lindane, or ivermectin cannot be tolerated. However, sulfur is safe for use in pregnant women and infants.
6. Antihistamines, such as diphenhydramine (Benadryl), can be useful in helping provide relief from itching. Sometimes, a short course of topical or oral steroids is prescribed to help control the itching.
7. Wash linens and bedclothes in hot water. Because mites don't live long away from the body, it is not necessary to dry clean the whole wardrobe, spray furniture and rugs, and so forth.
8. Treat sexual contacts or relevant family members (who either have either symptoms or have the kind of relationship that makes transmission likely).

Just as the itch of scabies takes a while to reach a crescendo, it takes a few days to subside after treatment. After a week or two, relief is dramatic. If that doesn't happen, the diagnosis of scabies must be questioned.

Are cases of scabies often misdiagnosed?

Scabies is very easy to misdiagnose because early subtle cases may look like small pimples or mosquito bites. Over a few weeks, however, mistakes like this become evident as patients feel worse and worse with symptoms they can't ignore.

What are possible complications of scabies?

The intense itching of scabies leads to prolonged and often intense scratching of the skin. When the skin is broken or injured due to scratching, secondary bacterial infections of the skin can develop from bacteria normally present on the skin, such as Staphylococcus aureus or beta-hemolytic streptococci.

In what special situations can scabies be more easily spread?

Elderly and weakened people in nursing homes and similar institutional settings may harbor scabies without showing significant itching or visible signs. In such cases, there can be widespread epidemics among patients and healthcare workers. Such cases are dramatic but, fortunately, uncommon.

Scabies At A Glance

• Scabies is an itchy, highly contagious skin condition caused by an infestation by the itch mite Sarcoptes scabiei.
• Direct skin-to-skin contact is the mode of transmission.
• A severe and relentless itch is the predominant symptom of scabies.
• Sexual contact is the most common form of transmission among sexually active young people, and scabies has been considered by many to be a sexually transmitted disease (STD).
• Scabies produces a skin rash composed of small red bumps and blisters and affects specific areas of the body.
• Treatment includes oral or topical scabicidal drugs.

Medically reviewed by Norman Levine, M.D., Board Certified - American Board of Dermatology

References:

Chosidow, O. "Clinical Practices. Scabies." N Engl J Med 354.16 Apr. 2006: 1718-1727.

Dourmishev, A.L., L.A. Dourmishev, and R.A. Schwartz. "Ivermectin: Pharmacology and Application in Dermatology." Int J Dermatol 44.12 Dec. 2005: 981-988.

McCroskey, Amy L., and Adam J. Rosh. "Scabies." eMedicine.com. Apr. 5, 2010.

United States. Centers for Disease Control and Prevention. "Scabies." Nov. 10, 2008.

(Last updated 9/1/10)

The acting Health and Human Services secretary declared a public health emergency nationwide involving H1N1 (swine) Influenza A as of April 26, 2009. The 2009 H1N1 Swine Flu public emergency ended in the summer of 2010. To see the current status in the U.S., visit the CDC Swine Flu website.

To learn more about H1N1 (swine) flu, please visit the CDC H1N1 website or flu.gov.

The World Health Organization also posted information on H1N1 (swine) flu.

Those with questions or concerns are encouraged to speak to a health-care provider or contact the IUP Center for Health and Well-Being.

What You Can Do to Stay Healthy Today

There are everyday actions people can take to stay healthy:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose, or mouth. Germs spread that way.
• Try to avoid close contact with sick people.
  • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
  • If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

How Can I Get Current Information Related to H1N1 (Swine) Flu?

The most up-to-date information is available at the Centers for Disease Control and Prevention website.

Use these links for up-to-date information about CDC travel advisories and travel alerts.

Contact information:

• IUP Health Service, 724-357-6475
• Pennsylvania Department of Health, 724-357-2995
• Indiana Regional Medical Center, 724-357-7000
• Centers for Disease Control and Prevention
• World Health Organization

(Updated February 2007)

What is TB?

Tuberculosis (often called TB) is an infectious disease that usually attacks the lungs but can attack almost any part of the body. Tuberculosis is spread from person to person through the air.

When people with TB in their lungs or throat cough, laugh, sneeze, sing, or even talk, the germs that cause TB may be spread into the air. If another person breathes in these germs, there is a chance that he or she will become infected with tuberculosis. Repeated contact is usually required for infection.

It is important to understand that there is a difference between being infected with TB and having TB disease. Someone who is infected with TB has the TB germs, or bacteria, in his or her body. The body's defenses are protecting that person from the germs, and he or she is not sick. This is referred to as latent TB.

Someone with TB disease is sick and can spread the disease to other people. A person with TB disease needs to see a doctor as soon as possible. This is referred to as active TB.

It is not easy to become infected with tuberculosis. Usually a person has to be close to someone with TB disease for a long period of time. TB is usually spread between family members, close friends, and people who work or live together. TB is spread most easily in closed spaces over a long period of time. However, transmission in an airplane, although rare, has been documented.

Even if someone becomes infected with tuberculosis, that does not mean he or she will get TB disease. Most people who become infected do not develop TB disease because their body's defenses protect them. Most active cases of TB disease result from activating old infection in people with impaired immune systems.

Experts believe that about 10 million Americans are infected with TB germs. Only about 10 percent of these people will develop TB disease in their lifetime. The other 90 percent will never get sick from the TB germs or be able to spread them to other people.

TB is an increasing and major worldwide problem, especially in Africa, where the spread has been facilitated by AIDS. It is estimated that nearly 1 billion people will become newly infected, more than 150 million will become sick, and 36 million will die worldwide between now and 2020—if control is not further strengthened. Each year there are more than 9 million cases and close to 2 million deaths attributed to TB; 100,000 of those 2 million deaths occur among children.

Who gets it?

Anyone can get TB. However, some groups are at higher risk to get active TB disease. The groups that are at high risk include the following:

• People with HIV infection (the AIDS virus)
• People in close contact with those known to be infectious with TB
• People with medical conditions that make the body less able to protect itself from disease (for example, diabetes, the dust disease silicosis, or people undergoing treatment with drugs that can suppress the immune system, such as long-term use of corticosteroids)
• Foreign-born people from countries with high TB rates
• Some racial or ethnic minorities
• People who work in or are residents of long-term care facilities (nursing homes, prisons, some hospitals)
• Health-care workers and others such as prison guards
• People who are malnourished
• Alcoholics, IV drug users, and people who are homeless

What are the symptoms of TB?

A person with TB infection will have no symptoms. A person with TB disease may have any, all, or none of the following symptoms:

• A cough that will not go away
• Feeling tired all the time
• Weight loss
• Loss of appetite
• Fever
• Coughing up blood
• Night sweats

These symptoms can also occur with other diseases, so it is important to see a doctor and let the doctor determine if you have TB.

It is also important to remember that a person with TB disease may feel perfectly healthy or may have a cough only from time to time. If you think you have been exposed to TB, get a TB skin test.

How does TB disease develop?

There are two possible ways a person can become sick with TB disease:

1. The first applies to a person who may have been infected with TB for years and has been perfectly healthy. The time may come when this person suffers a change in health. The cause of this change in health may be another disease like AIDS or diabetes. Or it may be drug or alcohol abuse or a lack of health care because of homelessness. Whatever the cause, when the body's ability to protect itself is compromised, TB infection can become active TB disease. In this way, a person may become sick with TB disease months or even years after he or she first breathed in the TB germs.
2. The other way TB disease develops happens much more quickly. Sometimes when a person first breathes in the TB germs, the body is unable to protect itself against the disease. The germs then develop into active TB disease within weeks.

What is the TB skin test?

The TB skin test is a way to find out if a person has TB infection. Although there is more than one TB skin test, the preferred method of testing is to use the Mantoux test.

For this test, a small amount of testing material is placed just below the top layers of skin, usually on the arm. Two to three days later, a health-care worker checks the arm to see if a bump has developed and measures the size of the bump. The significance of the size of the bump is determined in conjunction with risk factors for TB.

Once the doctor knows that a person has TB infection, he or she will want to determine if the person has TB disease. This is done by using several other tests including a chest X-ray and a test of a person's mucus (the material that is sometimes coughed up from the lungs).

Should you get a skin test each year to check on TB?

Only if you are at high risk for getting or transmitting TB or your jobs request it.

The advice for most people is to get a tuberculin test if you have symptoms or if you are living in close contact or have otherwise been in close contact with someone who recently came down with active TB disease. (Some people get skin tests because of their jobs, in a school or hospital, for example, to make sure they have not contracted TB and will not infect others if they have TB).

If you fall into one or more of the high-risk categories for TB noted earlier—for example, if you are HIV positive, you have never had a skin test before, or there is no record of the last result—you should be tested.

If you're not sure, ask your doctor. TB can be prevented, even if you are at risk.

What is the treatment for TB?

Treatment for TB depends on whether a person has active TB disease or only TB infection.

A person who has become infected with TB but does not have active TB disease may be given preventive therapy. Preventive therapy aims to kill germs that are not doing any damage right now, but could do so in the future.

If a doctor decides a person should receive preventive therapy, the usual prescription is a daily dose of isoniazid (also called INH), an inexpensive TB medicine. The person takes INH for nine months (up to a year for some patients), with periodic checkups to make sure the medicine is being taken as prescribed.

What if the person has active TB disease?

Then treatment is needed. Years ago a patient with TB disease was placed in a special hospital for months, maybe even years, and would often have surgery. Today, TB can be treated with very effective drugs.

Often the patient will have to stay only a short time in the hospital and can then continue taking medication at home. Sometimes the patient will not have to stay in the hospital at all. After a few weeks, a person can probably even return to normal activities and not have to worry about infecting others.

The patient usually gets a combination of several drugs (most frequently INH plus two to three others including rifampin, pyrazinamide, and ethambutol). The patient will probably begin to feel better only a few weeks after starting to take the drugs.

It is very important, however, that the patient continue to take the medicine correctly for the full length of treatment. If the medicine is taken incorrectly or stopped, the patient may become sick again and will be able to infect others with TB. As a result, public health authorities recommend Directly Observed Therapy (DOT), in which a health-care worker ensures that the patient takes his/her medicine.

If the medicine is taken incorrectly and the patient becomes sick with TB a second time, the TB may be harder to treat because it has become drug resistant. This means that the TB germs in the body are unaffected by some drugs used to treat TB.

Multidrug-resistant TB is very dangerous, so patients should be sure that they take all of their medicine correctly.

Regular checkups are needed to see how treatment is progressing. Sometimes the drugs used to treat TB can cause side effects. It is important both for people undergoing preventive therapy and people being treated for TB disease to immediately let a doctor know if they begin having any unusual symptoms.

What is multidrug-resistant TB?

Multidrug-resistant tuberculosis (called MDR-TB for short) is a very dangerous form of tuberculosis. Some TB germs become resistant to the effects of some TB drugs. This happens when TB disease is not properly treated.

These resistant germs can then cause TB disease. The TB disease they cause is much harder to treat because the drugs do not kill the germs. MDR-TB can be spread to others, just like regular TB.

It is important that patients with TB disease follow their doctor's instructions for taking their TB medicine, so that they will not develop MDR-TB.

Can a TB patient infect others?

Yes, if the patient has TB disease and it is not being treated. Once treatment begins, a patient ordinarily quickly becomes noninfectious; that is, he or she cannot spread the disease to others.

There is little danger from the TB patient who is being treated, is taking his or her medication as scheduled, and is responding well. The drugs usually make the patient noninfectious within weeks.

TB is spread by germs in the air—germs put there by coughing or sneezing. Handling a patient's bed sheets, books, furniture, or eating utensils does not spread infection.

Brief exposure to a source of TB rarely infects a person. It's day-after-day, close contact that usually does it.

TB: What you should do?

Certain people, such as those infected with HIV or health-care workers, should be tested regularly. You should be tested if there's any chance you have been infected, recently or many years ago.

If the test is negative:

A negative reaction usually means that you are not infected and no treatment is needed. However, if you have TB symptoms, your doctor must continue to look for the cause. Sometimes, when a person has only recently been infected or when his or her immune system isn't working properly, the test may be falsely negative.

If the test is positive:

A significant reaction usually means that you have been infected with the TB germ. It does not necessarily mean that you have TB disease. Cooperate with the doctor when he or she recommends a chest X-ray and possibly other tests.

If the doctor recommends treatment to prevent sickness, follow the recommendations. If medicine is prescribed, be sure to take it as directed.

If you don't need treatment, do what the doctor tells you to do about follow-up. The doctor may simply say to return for another checkup if you get into a special risk situation for TB sickness or develop symptoms.

If you are sick with TB disease, follow the doctor's recommendations for treatment.

—This information was taken from the American Lung Association website.

For more information about TB and TB infections, visit the American Lung Association website, the Centers for Disease Control and Prevention website, or the Department of Health and Human Services website.

If you have heard of a university member diagnosed with meningitis, please read the following information to help answer questions you may have.

Be assured, if bacterial meningitis is diagnosed in any patient, the local health department will immediately investigate and be in touch with close personal contacts that need to receive medication as soon as possible. If a diagnosis of viral menigitis is made, there will be no public health information disseminated due to patient confidentiality issues.

What is meningitis?

Meningitis is an illness in which there is inflammation of the tissues that cover the brain and spinal cord. Viral (aseptic) meningitis, which is the most common type, is caused by an infection with one of several types of viruses. Meningitis can also be caused by infections with several types of bacteria or fungi. In the United States, there are between twenty-five thousand and fifty thousand hospitalizations caused by viral meningitis each year.

What are the symptoms of meningitis?

The more common symptoms of meningitis are fever, severe headache, stiff neck, bright lights hurting the eyes, drowsiness or confusion, and nausea and vomiting. In babies, the symptoms are more difficult to identify. They may include fever, fretfulness or irritability, difficulty in awakening the baby, or the baby refuses to eat. The symptoms of meningitis may not be the same for every person.

Is viral meningitis a serious disease?

Viral (aseptic) meningitis is serious but rarely fatal in persons with normal immune systems. Usually, the symptoms last from seven to ten days, and the patient recovers completely. Bacterial meningitis, on the other hand, can be very serious and result in disability or death if not treated promptly. Often, the symptoms of viral meningitis and bacterial meningitis are the same. For this reason, if you think you or your child has meningitis, see your doctor as soon as possible.

What causes viral meningitis?

Many different viruses can cause meningitis. About 90 percent of cases of viral meningitis are caused by members of a group of viruses known as enteroviruses, such as coxsackieviruses and echoviruses. These viruses are more common during summer and fall months. Herpesviruses and the mumps virus can also cause viral meningitis.

How is viral meningitis diagnosed?

Viral meningitis is usually diagnosed by laboratory tests of spinal fluid obtained with a spinal tap. The specific cause of viral meningitis can be determined by tests that identify the virus in specimens collected from the patient, but these tests are rarely done.

How is viral meningitis treated?

No specific treatment for viral meningitis exists at this time. Most patients completely recover on their own. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

How is the virus spread?

Enteroviruses, the most common cause of viral meningitis, are most often spread through direct contact with respiratory secretions (e.g., saliva, sputum, or nasal mucus) of an infected person. This usually happens by shaking hands with an infected person or touching something he or she has handled, and then rubbing your own nose or mouth. The virus can also be found in the stool of persons who are infected. The virus is spread through this route mainly among small children who are not yet toilet trained. It can also be spread this way to adults changing the diapers of an infected infant. The incubation period for enteroviruses is usually between three and seven days from the time you are infected until you develop symptoms. You can usually spread the virus to someone else beginning about three days after you are infected until about ten days after you develop symptoms.

Can I get viral meningitis if I'm around someone who has it?

The viruses that cause viral meningitis are contagious. Enteroviruses, for example, are very common during the summer and early fall, and many people are exposed to them. However, most infected persons either have no symptoms or develop only a cold or rash with low-grade fever. Only a small portion of infected persons actually develop meningitis. Therefore, if you are around someone who has viral meningitis, you have a moderate chance of becoming infected, but a very small chance of developing meningitis.

How can I reduce my chances of becoming infected?

Because most persons who are infected with enteroviruses do not become sick, it can be difficult to prevent the spread of the virus. However, adhering to good personal hygiene can help to reduce your chances of becoming infected. If you are in contact with someone who has viral meningitis, the most effective method of prevention is to wash your hands thoroughly and often (see “Handwashing: Clean Hands Save Lives” on the Center for Disease Control and Prevention website). Also, cleaning contaminated surfaces and soiled articles first with soap and water, and then disinfecting them with a dilute solution of chlorine-containing bleach (made by mixing approximately a quarter cup of bleach with one gallon of water) can be a very effective way to inactivate the virus, especially in institutional settings such as child care centers.

Questions can be directed to the University Health Service.

(Last updated June 2012)

What are West Nile virus, West Nile fever, and West Nile encephalitis?

West Nile virus is a flavivirus commonly found in Africa, West Asia, and the Middle East. It is closely related to St. Louis encephalitis virus found in the United States. The virus can infect humans, birds, mosquitoes, horses, and some other mammals.

West Nile fever is a case of mild disease in people, characterized by flu-like symptoms. West Nile fever typically lasts only a few days and does not appear to cause any long-term health effects.

More severe disease caused by a person's being infected with this virus can be West Nile encephalitis, West Nile meningitis, or West Nile meningoencephalitis. Encephalitis refers to an inflammation of the brain; meningitis is an inflammation of the membrane around the brain and the spinal cord; and meningoencephalitis refers to inflammation of the brain and the membrane surrounding it.

Where did West Nile virus come from?

West Nile virus has been commonly found in humans and birds and other vertebrates in Africa, Eastern Europe, West Asia, and the Middle East, but until 1999 had not previously been documented in the Western Hemisphere. It is not known where the U.S. virus originated, but genetically, it is most closely related to strains found in the Middle East.

Is West Nile virus now established in the Western Hemisphere?

The continued expansion of West Nile virus in the United States indicates that it is permanently established in the Western Hemisphere.

Is the disease seasonal in its occurrence?

In the temperate zone of the world (i.e., between latitudes 23.5° and 66.5° north and south), West Nile encephalitis cases occur primarily in the late summer or early fall. In the southern climates where temperatures are milder, West Nile virus can be transmitted year round.

I understand West Nile virus has been found in mosquitoes in this area. What does this mean?

One of the species of mosquitoes found to carry West Nile virus is the Culex species, which survives through the winter, or overwinters, in the adult stage. The virus, along with the mosquitoes, have been documented in Western Pennsylvania in the past. This does not mean that if you are bitten by a mosquito, you will get the disease.

Who is at risk for getting West Nile encephalitis?

All residents of areas where virus activity has been identified are at risk of getting West Nile encephalitis; persons over 50 years of age have the highest risk of severe disease. It is unknown if immunocompromised persons are at increased risk for WNV disease.

What are the symptoms of West Nile virus infection?

Most people who are infected with the West Nile virus will not have any type of illness. It is estimated that 20 percent of the people who become infected will develop West Nile fever—mild symptoms including fever, headache, and body aches, occasionally with a skin rash on the trunk of the body and swollen lymph glands.

The symptoms of severe infection (West Nile encephalitis or meningitis) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. It is estimated that one in 150 persons infected with the West Nile virus will develop a more severe form of disease.

What is the incubation period in humans (i.e., time from infection to onset of disease symptoms) for West Nile encephalitis?

Usually three to fourteen days.

How long do symptoms last?

Symptoms of West Nile fever will generally last a few days, although even some healthy people report having been sick for several weeks. Symptoms of severe disease (encephalitis or meningitis) may last several weeks, although neurological effects may be permanent.

What can I do to reduce my risk of becoming infected with West Nile virus?

Here are preventive measures that you and your family can take:

Protect yourself from mosquito bites

• Apply insect repellent sparingly to exposed skin. The more DEET a repellent contains, the longer time it can protect you from mosquito bites. A higher percentage of DEET in a repellent does not mean that your protection is better—just that it will last longer. DEET concentrations higher than 50 percent do not increase the length of protection. Choose a repellent that provides protection for the amount of time that you will be outdoors.
• Repellents may irritate the eyes and mouth, so avoid applying repellent to the hands of children.
• Whenever you use an insecticide or insect repellent, be sure to read and follow the manufacturer's directions for use, as printed on the product.
• Spray clothing with repellents containing permethrin or DEET, as mosquitoes may bite through thin clothing. Do not apply repellents containing permethrin directly to exposed skin. If you spray your clothing, there is no need to spray repellent containing DEET on the skin under your clothing.
• When possible, wear long-sleeved shirts and long pants whenever you are outdoors.
• Place mosquito netting over infant carriers when you are outdoors with infants.
• Consider staying indoors at dawn, dusk, and in the early evening, which are peak mosquito-biting times.
• Install or repair window and door screens so that mosquitoes cannot get indoors.
• Help reduce the number of mosquitoes in areas outdoors where you work or play by draining sources of standing water. In this way, you reduce the number of places mosquitoes can lay their eggs and breed.
• At least once or twice a week, empty water from flower pots, pet food and water dishes, birdbaths, swimming pool covers, buckets, barrels, and cans.
• Check for clogged rain gutters and clean them out.
• Remove discarded tires and other items that could collect water.
• Be sure to check for containers or trash in places that may be hard to see, such as under bushes or under your home. Note: Vitamin B and ultrasonic devices are not effective in preventing mosquito bites.

What can be done to prevent outbreaks of West Nile virus?

Prevention and control of West Nile virus and other arboviral diseases are most effectively accomplished through integrated vector management programs. These programs should include surveillance for West Nile virus activity in mosquito vectors, birds, horses, other animals, and humans, and implementation of appropriate mosquito-control measures to reduce mosquito populations when necessary. Additionally, when virus activity is detected in an area, residents should be alerted and advised to increase measures to reduce contact with mosquitoes.

Is there a vaccine against West Nile encephalitis?

No, but several companies are working toward developing a vaccine.

What is the basic transmission cycle of West Nile virus?

Mosquitoes become infected when they feed on infected birds, which may circulate the virus in their blood for a few days. Infected mosquitoes can then transmit West Nile virus to humans and animals while biting to take blood. The virus is located in the mosquito's salivary glands. During blood feeding, the virus may be injected into the animal or human, where it may multiply, possibly causing illness.

If I live in an area where birds or mosquitoes with West Nile virus have been reported and a mosquito bites me, am I likely to get sick?

No. Even in areas where the virus is circulating, very few mosquitoes are infected with the virus. Even if the mosquito is infected, less than 1 percent of people who get bitten and become infected will get severely ill. The chances you will become severely ill from any one mosquito bite are extremely small.

Can you get West Nile encephalitis from another person?

No. West Nile encephalitis is not transmitted from person to person. For example, you cannot get West Nile virus from touching or kissing a person who has the disease or from a health-care worker who has treated someone with the disease.

—This information is from the Bayer Advanced website.

Travel Alert

The Centers for Disease Control and Prevention (CDC) has recently issued a travel alert to highlight countries where Zika virus is prevalent. The Zika virus is spread by mosquitos and is therefore most prevalent in tropical environments.

Areas with Zika

Americas

Transmission

The Zika virus has been linked to a specific birth defect called microcephhaly (small head/brain). This link is so strong that the CDC has issued a warning for pregnant women and women trying to become pregnant to avoid visiting places where the virus is currently circulating. Any pregnant woman or trying to become pregnant should consult with their doctor before traveling.

Symptoms

Usually mild and include fever, fash, joint pain, headache, and conjunctivitis (red eyes), lasting several days to a week. Currently there is no vaccine or medicine to treat Zika. Severe disease may require hospitalization.

Prevention

Travelers can limit their exposure to Zika (and other mosquito-borne illnesses like malaria, dengue fever, and chikungunya) by taking the following precautions: stay in places with air conditioning, use window or door screens when indoors, wear long sleeves and pants, and use insect repellant when outdoors.

For more information on the Zika virus, please visit the CDC website.