jbs health and safety handbook 2016 - joffrey ballet · students, staff, faculty, and visitors....
TRANSCRIPT
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JoffreyBalletSchool
HealthandSafetyHandbook
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TableofContentsIntroduction.................................................................................................................................................3
Injuries.........................................................................................................................................................3
BloodandBodyFluidExposure...................................................................................................................4
CommunicableDisease................................................................................................................................5
InformationforReportingCommunicableDiseases:...............................................................................6
CrisisProcedures:........................................................................................................................................7
FireEmergencies.........................................................................................................................................7
FireSafetyTips:........................................................................................................................................8
ViolenceorCriminalBehavioronCampus..................................................................................................8
ProtectionTipswithinJBSandNYC:........................................................................................................8
ActofTerrorism...........................................................................................................................................9
Evacuation.................................................................................................................................................10
TransportingStudentstoDormitory.........................................................................................................10
ShelteringinPlaceatJBS...........................................................................................................................10
LockdownLocationsatJBS:.......................................................................................................................10
ChemicalThreat.........................................................................................................................................11
Gunman.....................................................................................................................................................11
BombThreats............................................................................................................................................12
CatastrophicEmergency............................................................................................................................14
EmotionalDistress.....................................................................................................................................15
GeneralProcedures:..............................................................................................................................15
PsychologicalEmergency.......................................................................................................................16
SexualAssault,Stalking,andDomesticViolence.......................................................................................17
SexualAssault........................................................................................................................................17
Stalking..................................................................................................................................................18
DomesticandIntimatePartnerViolence...............................................................................................18
Appendix1:MedicalResources.................................................................................................................21
Hospital:.................................................................................................................................................21
UrgentCare:..........................................................................................................................................21
DanceInjuries:.......................................................................................................................................21
Appendix2CommunicableDiseasesofconcern.......................................................................................23
Chickenpox(varicellazosterinfection)..................................................................................................23
Diptheria................................................................................................................................................25
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Impetigo.................................................................................................................................................28
Influenza(Flu)........................................................................................................................................29
Measles(Rubeola,hardmeasles,redmeasles).....................................................................................33
MeningococcalDisease.........................................................................................................................35
Methicillin-ResistantStaphylococcusAureus(MRSA)...........................................................................37
Mumps(InfectiousParotitis).................................................................................................................39
Ringworm(Tinea)..................................................................................................................................41
Rubella(GermanMeaslesorThree-DayMeasles)................................................................................42
Mononucleosis,Infectious(Mono,EBVmononucleosis)......................................................................44
Pertussis(WhoopingCough).................................................................................................................45
InfantsandChildren..........................................................................................................................47
Scabies...................................................................................................................................................48
Whenandforhowlongisapersonabletospreadscabies?.................................................................49
SARS(SevereAcuteRespiratorySyndrome)..........................................................................................49
HowlongisapersonwithSARSinfectioustoothers?..........................................................................50
SkinInfectionsinAthletes.....................................................................................................................52
SexuallyTransmittedDiseases(STDs)....................................................................................................56
Tuberculosis(TB)...................................................................................................................................58
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Introduction
ItisthepolicyofJoffreyBalletSchooltoprovideasafeandhealthyenvironmentforallstudents,staff,faculty,andvisitors.ThisHealthandSafetyHandbookdocumentsthevarioushealthandsafetyproceduresandprotocolsinplaceatJoffreyBalletSchoolforstaff,faculty,andstudents.Themanual’spurposeistoaidintheidentificationofvarioushazardoussituationsthatcouldbeencountered.Itisalsointendedtohelppromoteasafeandhealthyenvironmentforallwhovisit,attend,andareemployedbyJoffreyBalletSchool.Weallshareintheresponsibilityformaintainingasafeandhealthyworkplace,andthismanualprovidesaguidetohelpyouunderstandyourrole.
Theinformationinthismanualrepresentsonlygeneralstandards.Thisinformationdoesnotsubstituteforallspecificsituations.Instructionsfromlawenforcementoremergencyrespondersshouldalwaysbefollowedforyourprotection.
InjuriesInjuriesareanunfortunatepartofsomedancer’sexperienceduringrigoroustraining.Injuriescanrangegreatlyinappearanceandseverity.JBSisdedicatedtominimizinginjuriesthroughproperinstruction.However,sometimesinjuriesareanunavoidablepartoftraining.
Staff/FacultyPolicies:
• Weencourageallstudentstoseekmedicalattentionforinjuries,butitisultimatelythestudent’sdecision(orparentifstudentisaminor).
• Injuredstudentsaretofollowdoctor’sordersforrecovery.• JBSstaffmembersarenottodiagnoseinjuriesortreatmentunlesslicensedorcertified
todoso.JBSisnotresponsibleforanyinjuriesincurred.• Studentsarerequestedtoobtainhealthinsurance.Studentsarefinanciallyresponsible
forallmedicaltreatmentreceivedduringtrainingatJBS.• Studentsarerequestedtocompleteahealthscreeningfordancersoraphysical
examinationpriortobeginningtrainingatJBStoensurethestudentdoesnothaveanyconditionsthatcouldinterferewithtrainingoroverallhealthofthestudent.
StudentProcedure:
• IfastudentbecomesinjuredduringJBSclass,informyourinstructor.YourinstructorwillpermityoutogototheHealthandWellnessOfficeifyouareabletowalkwithoutexacerbatingtheinjury.Ifnot,theinstructorwillsendastudenttobringtheHealthandWellnessCoordinatortotheinjuredstudent.
• Staffshouldnotdiagnoseinjuriesortreatmentunlesslicensedorcertifiedtodoso.
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• TheHealthandWellnessCoordinatorwillhelpyouwithyourinsuranceifmedicalassistanceisneeded.Studentsshouldkeeptheirhealthinsurancecardsandtreatmentpaymentmethodwiththematalltimesduringtraining.
• Thedeterminationtoseekmedicaladviceisultimatelyuptostudents(orparents/guardianifstudentisaminor),solongasthestudentisconscious.StudentsarefinanciallyforallmedicaltreatmentreceivedduringtrainingatJBS.
• Intheeventofastudentexperiencingunexplainedlossofconsciousness,JBSstaffwillcall9-1-1formedicalassistance.
• Ifsomeonestopsbreathing,requesthelpfromtheneareststaffthatiscertifiedinCPRortheHealthandWellnessCoordinator.Staffmayaskyoutocall9-1-1.Pleasefollowstaffinstructionstoassistasneeded.TherearealsoCPRinstructionspostedineachstudioatJBS.
BloodandBodyFluidExposureAnyexposureofbloodorbodyfluidshouldbeavoidedwheneverpossible.Exposureisreferringtoeye,mouth,mucousmembrane,ornon-intactskincontactwithbloodorotherpotentiallyinfectiousmaterials.
Thepurposeofthispolicyistoprovideguidanceforactionstoprotectthoserespondingtoincidentsinvolvingcontactwithbloodandotherbodyfluids.
Staff/FacultyProcedures:
Ifexposed,immediately:
• Washneedlesticksandcutswithsoapandwater.• Flushsplashestothenose,mouth,orskinwithwater.• Whencontactismadewiththeeyes,immediatelyflushtheeyeswithcleanwater,
saline,orsterileirrigants.• NotifytheHealthandWellnessCoordinator.• Seekmedicalattention,especiallyifthereiscontactwithbrokenskin,suchasacutor
anyopenwound.
Removal/Cleaning:
• Anyitemsthataresaturatedwithbloodaretobedoublebaggedwithsturdyplasticbags.Ifpossibledisposeofthematerialsinaredbag,whichshouldbelabeled‘BioHazard’.Asmallamountofblood(suchasatampon,pad,orband-aid)canbedisposedofinregularwaste.
• Discardshopobjects,suchasglassorneedles,inapuncture-resistant,leakproof,redorbiohazard-labeledcontainer.
• DONOTTOUCHCONTAMINATEDOBJECTSORMATERIALS.Usedisposableglovesorothertypesofprotectivebarrierstoprotectyourskinfromtouchingtheobject.
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• Contaminatedsurfacesmustbedecontaminatedwithanappropriatedisinfectantimmediatelyorassoonaspossible.
• AsktheHealthandWellnessCoordinatorforassistancewithdisposal.
StudentProcedures:
• Pleaseinformtheneareststaffmemberoftheincident.• Pleaseaskastaffmemberorstudenttoguardthehazardousmaterial,preventingany
furthercontact.Thepersonprotectingthehazardshouldnottouchitorputthemselvesindanger.
• ThestaffmemberwillsendsomeonetonotifytheHealthandWellnessCoordinator,whowillprovideassistance.
CommunicableDiseaseJoffreyBalletSchoolisdedicatedtoprotectingandenhancingthehealthandsafetyofallinourcommunity.Thissectioncontainsinformationaboutselectdiseasesthatmayhaveapotentialthreattothepublichealthofourcommunity.Learningthesignsandsymptomsofillnesswillalloweveryonetosharejointresponsibilityinpreventingorlimitingneworincreasednumbersofcommunicableillnessesontoourcampusandsurroundingcommunity.
IfanoutbreakofahighlycommunicablediseaseweretooccuratJBS,theindividual’sprivacywillbeprotectedtotheextentensuredbylawanddisclosuresofpersonalhealthinformationwillbemadeonlytoappropriatepersonsasmandatedbyNewYorkStatePublicHealthLaw.JoffreyBalletSchooldoesnothavethetoolsnecessarytoisolateindividualssuspectedofhavingacommunicablediseasethatrequiresisolation.Administrationwillassistineverypossiblewaywithhealthofficialsinplanningalternatearrangements.
Pleasenotethatitisimportanttobeinformedofsignsandsymptomsofillnessesthatmightposeathreattopublichealth.TheCentersforDiseaseControlandPrevention(www.cdc.gov)providesdetailedinformationonmanyillnesses.
StudentAbsencePolicy:
Ifyouareill,pleasestayhometoavoidinfectingothers.Werequestthatstudentsprovidedoctor’snotesfordaysabsentduetoillnesswheneverpossible.Doctor’snotesarerequiredininstancesof3ormoreconsecutivedaysabsentduetoillness.
StudentAbsenceProtocol:
Ifyouareill,pleaseemailyourprogram’sArtisticDirector,theHealthandWellnessCoordinator,andthedesignatedadministratorforyourprogramtoinformthemofthereasoningforyourabsence,alongwithyourexpectedreturndate.Ifyouneedhelpfindinga
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doctororworkingwithyourhealthinsurance,theHealthandWellnessCoordinatorisavailabletoassistyou.
Staff/FacultyAbsenceProtocol:
• Pleasecallyoursupervisor(ArtisticDirectorortheDirectorofOperations)toprovidenoticeassoonaspossible.
• Ifabsenceisplanned,pleasemaketherequestviaemailtoyoursupervisor(ArtisticDirectorortheDirectorofOperations)withasmuchadvancepossible,atleast2weekspriortothedateofabsence.
InformationforReportingCommunicableDiseases:NewYorkStateDepartmentofHealthRegionalEpidemiologyStaffNYSDepartmentofHealth,MetropolitanRegionalAreaOffice145HuguenotStreetNewRochelle,NewYork10801-5228Hours:8:30am-5pmPhone:914-654-7000#7Fax:914-654-7169NewYorkCityHealthDepartment125WorthStreet,Room315,CN-6NewYork,NewYork10013Hours:9am-5pmPhone:212-788-9830Fax:212-788-4268AfterHoursContact:PoisonControl212-764-7667Resources:NewYorkStateDepartmentofHealthwww.health.state.ny.usCentersforDiseaseControlandPreventionwww.cdc.govNewYorkCityDepartmentofHealthandMentalHygienewww.nyc.gov/html/doh
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CrisisProcedures:
TheentireJoffreyBalletSchoolcommunitysharestheconcernthatourfacilitiesremainsafeandsecure.Pleasebealerttosuspicioussituationsandpromptlyreportthreatening,violent,orcriminalbehaviortoyourArtisticDirectorortheneareststaffmember.Allthreatsagainstthesafetyofthestudentsandstaffaretobetakenseriously.JoffreyBalletSchooliscommittedtomaintainingthesafetyofourcommunity.Theseproceduresareinplacetokeepourstudents,staff,andfacultysafe.
Ifyouseeacriminalactorsomeoneactinginasuspiciousmanner,immediatelynotifythenearestArtisticDirector.Whenreportinganincident,pleaseincludethenatureandlocationoftheincident,alongwithdescriptionsofthepeopleandpropertyinvolved.
FireEmergenciesAllfirealarmsmustbetakenseriously.Survivalshouldbethetoppriorityinafiresituation.Buildingevacuationismandatoryuntilthesignalthatitissafetore-enterthebuildinghasbeenprovidedbythefiredepartment.
StudentProcedure:
• Staff/Facultywillprovideyouwithinstructionsforexitingthebuildingbyusingthenearestsafestairwell.ELEVATORSWILLNOTBEUSED.
• Thestairwellwillbeusedtoexitthebuildingforevacuationwhenpossible.Ifthestairwellisnotsafe,thefireescapeshouldbeused.Staffwillprovideinstruction.
• Whenthealarmissounded,alloccupantsshouldusethenearestsafeexit.• Thefirealarmisaloudbellorhornsignal.• Donotpanic,anddonotrun.Exitthebuildingquickly,butstaycalm.• FollowyourJBSstaffmember:AllJBSbuildingoccupantswillmeetatthestairsofthe
NYPublicLibrary,directlyacross6thAvenue.IftheNYPublicLibrarystairsareunsafe,pleaseproceedtothenearestsafezoneyourstaffmemberorfiremenleadyouto.Itisimportanttoremainwithyourgrouptoallowstaffmemberstoaccountforyoursafety.
• DoNOTre-enterthebuildinguntiltheFireDepartmenthasdeterminedthebuildingtobesafeforre-entry.
Ifyoususpectorseeafire,soundthealarm,andevacuatethebuildingbywayofthenearestsafestairwell.Closedoorsbehindyouifpossibletodososafely.DONOTUSETHEELEVATOR.
StaffProcedure:Allfacultymembersshouldimmediatelyevacuateallstudentsfromstudiouponactivationofthefirealarm.Staycalm.Youremotionswillleadyourstudents’responses.Itisimportanttonotehowmanystudentsyouhaveatthebeginningofeachclass,soyoucanaccountforallthroughouttheprocedure.Sendstudentstothesafespotinasingle-filelineviathenearestsafestairwell,andclosedoorsandwindowsbehindifyouareabletodososafely.Ifthemainstairwellisnotsafe,usethefireescape.DONOTALLOWANYONETOUSETHE
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ELEVATOR.Allemployeesmustevacuatethebuildingandgotothedesignatedsafemeetingareawiththeirgroup.Ifsafe,meetatthestairsoftheNYPublicLibrarydirectlyacross6thAve.Ifunsafe,continuedowntowntowardtheLibrary’scourtyardortothedesignatedspottheFiremenhavedeclaredtobethesafemeetingspot.DoNOTreenterthebuildinguntildeclaredsafe.
FireSafetyTips:• Checkdoorsandmetalknobsforheatbeforeopening.Ifthehandleordoorishot,do
notopenthedoor.• Ifyoumustmovethroughthicksmoke,staylowtothegroundandcrawlifpossibleto
avoidinhalingsmoke.Covermouth&nosewithascarforshirtifpossible.• Helppreventfires:followallrulesrelatingtofiresafety.
ViolenceorCriminalBehavioronCampusIfyouseeacriminalactorsomeoneactinginasuspiciousmanner,immediatelynotifythenearestArtisticDirector.Whenreportinganincident,pleaseincludethenatureandlocationoftheincident,alongwithdescriptionsofthepeopleandpropertyinvolved.
ProtectionTipswithinJBSandNYC:• Stayalertfortheunexpected,suspiciouspersons,ordangeroussituations,especially
whenwalkingalone.Walkwithsomeoneoringroupswheneverpossible.Sometimespick-pocketersusehelperstocreateadistraction.
• Useshadowsandstorewindowsormirrorstostayawareofyoursurroundings.• Keepyourbelongingswithyou.TheJBSlockerroomsarenotsupervised.Eitherbringa
locktouseaJBSlockerduringtheday(lockscannotbeleftovernightunlessyouareaKeystoneblendedmodelstudent)orbringyourbelongingswithyoutoyourstudio.Donotdisplaywallets,money,orjewelry.
• Donotcarrymoremoneythannecessaryinyourbelongings.• Ifyoufeeluncomfortablewhileoutside,gointoapopulatedstoreorshoporfinda
policeofficer.• IfyoufeeluncomfortablewhileinsideJBS,alerttheneareststaffmember.• IfyoufindyourselfthevictimofacrimewhennotonJBSpremises,contactapolice
officer.Incaseofemergency,dial911.Otherwise,contact311(freefromanycitypayphone)andanofficerwillhelpyoumakeareport.311connectswithaliveoperator24hourseachday.
• Ifyouarebeingmugged,donotfightback.Yourlifeisworthmorethanwhatisinyourpocket!
• Donotpanic.Trytostaycoolandnoticeanydetailsyoucanaboutyourattacker.• Lookconfidentinwhereyouaregoing,howyouwalk,andwhatyouaredoing.• OnlyuseNYCyelloworcabs(ortheenvironmentallyfriendlygreenversions).NEVERuse
gypsycabs(typicallyblacktowncars)orcarservicesthatstopandoffertopickyouup.
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• Donotrunonsubwaystairsorwithinsubwaysystems.• Rideinthemiddlesubwaycar,whichiswheretheconductorislocated,orthefirstcar,
whichiswherethemotormanislocated.
Therearesometypicalwarningsignsofcriminalorviolentbehavior,butnoneofthebelowsignsaresufficientevidencetopredictresultingbehavior.Anoffendermayonlydemonstrateoneornoneofthefollowingsigns,aseachsituationisunique.Beawareofpotentiallyviolentwarningsignswhensomeone:
• Isuncooperativeordisrespectfultoauthorityfigures• Isusuallyargumentative,callsothersnames,curses,orusesabusivelanguage• Hasfewornoclosefriends• Ignoresthethoughtsandfeelingsorrightsofothers• Doesnotcooperatewithothers• Dwellsonperceivedrejectionsormistreatmentsfromothers• Hasbeenavictimofintimidationfromothers• Demonstrateschangesinbehavior,suchastardinessorabsenteeism• Hasahistoryofviolence• Frequentlyappearsdepressed• Hasbroughtaweapontoschoolorthreatenedtodoso
Allthreatsofviolenceshouldbetakenseriously.Mostattacksareplanned,andreportingtheissueorworrisomebehaviorcanbethekeytoaninterventionpreventingtheviolence.
Ifanemergencyoccursoncampus,pleasealertthenearestArtisticDirectororstaffmemberassoonaspossible.StaffwillimmediatelynotifyanArtisticDirector,whowillfollow-upwithstaffandpoliceasnecessary.
ActofTerrorism• Remaincalmandbepatient.Followtheadviceoflocalemergencyofficials.• Listentoyourradioortelevisionfornewsandinstructions.• Iftheeventoccursnearyou,checkforinjuries.Givefirstaidandgethelpforseriously
injuredpeople.EachJBSstudioandofficehasmedicalsuppliesavailable.• Donotlightmatchesorcandlesorturnonelectricalswitches.Checkforfires,fire
hazardsandotherhouseholdhazardsandimmediatelyalertofanyconcerns.Sniffforgasleaks,startingatthewaterheater.Ifyousmellgasorsuspectaleak,turnoffthemaingasvalve,openwindows,andgeteveryoneoutsidequickly.Shutoffanyotherdamagedutilities.Callyourfamilycontact—donotusethetelephoneagainunlessitisalife-threateningemergency.
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EvacuationIflocalauthoritiesaskyoutoleaveyourlocation,theyhaveagoodreasontomakethisrequest,andyoushouldheedtheadviceimmediately.ListentoyourradioortelevisionandfollowtheinstructionsoflocalemergencyofficialsandJBSstaff.Mostlikelytherewillbenophone,Internet,orpublictransportation.Ifpossible,wearlong-sleevedshirts,longpantsandsturdyshoes,soyoucanbeprotectedasmuchaspossible.
TransportingStudentstoDormitory• Staffbringabasicfirst-aidkit:Band-Aids,alcoholswabs,gauze,andmedicaltape.• Studentsandstaffleavebigbagsatschooltotravelfaster.Remembertobringyour
keys,ID/wallet,andhaveallphonesonsilent.• Usetravelroutesspecifiedbylocalauthorities—don'tuseshortcutsbecausecertain
areasmaybeimpassableordangerous.• Staffmovestudentsthroughneighborhoodsup11thAvetoWestEndAve.Stayaway
fromdownedpowerlines.Ifnecessary,safeplacesforstafftodirectthegrouptostopforcoverare:libraries,churches,postofficeetc.
ShelteringinPlaceatJBSClosetheschool.Followreverseevacuationprocedurestobringstudents,faculty,andstaffindoors.Iftherearevisitorsinthebuilding,providefortheirsafetybyaskingthemtostay–notleave.Whenauthoritiesprovidedirectionstoshelter-in-place,theywanteveryonetotakethosestepsnow,wheretheyare,andnotdriveorwalkoutdoors.
LockdownLocationsatJBS:3rdFloor:Costumecloset,stafflounge,3rdflooroffices4thFloor:Healthoffice,studio35ThFloor:5thflooroffices,Keystoneroom,&storagecloset
• Provideforansweringtelephoneinquiriesfromconcernedparentsbyhavingthe3rdfloorofficetelephoneavailable.Thisroomshouldalsobesealed.Staffphonesshouldbecloselymonitoredforupdates.Ifstudentshavecellphones,allowthemtousethemtocallaparentorguardiantoletthemknowthattheyhavebeenaskedtoremaininschooluntilfurthernoticeandthattheyaresafe.
• Staffshouldgatheressentialdisastersupplies,suchasnonperishablefood,bottledwater,battery-poweredradios,firstaidsupplies,flashlights,batteries,ducttape,plasticsheeting,andplasticgarbagebags.
• Bringeveryoneintothenearestlockdownroom.Shutandlockthedoor.• Writedownthenamesofeveryoneintheroom,andcallDirectorofOperationsto
reportwhoisintheroomwithyou.
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• Listenforanofficialannouncementfromschoolofficials,andstaywhereyouareuntilyouaretoldallissafeortoevacuate.Localofficialsmaycallforevacuationinspecificareasatgreatestriskinyourcommunity.
ChemicalThreatStaffuseducttapeandplasticsheeting(heavierthanfoodwrap)tosealallcracksaroundthedoor(s)andanyventsintotheroom.
Haveemployeesfamiliarwithbuilding’smechanicalsystemsturnoffallfans,heatingandairconditioningsystems.Somesystemsautomaticallyprovideforexchangeofinsideairwithoutsideair–thesesystems,inparticular,needtobeturnedoff,sealed,ordisabled.
GunmanAllthreatsagainstthesafetyofthestudentsandstaffaretobetakenseriously.JoffreyBalletSchooliscommittedtomaintainingthesafetyofourcommunity.Theseproceduresareinplacetokeepourstudents,staff,andfacultysafe.
Responsibilities:TheDirectorofOperationswillactastheactiveshootercoordinatorandwillberesponsibleformakingthedecisiontoevacuateabuilding.
StaffProcedure:
• ImmediatelyinformthenearestArtisticDirectorofathreator,ifastudent,informtheneareststaffmember.ArtisticDirectororstaffwillimmediatelyinformDirectorofOperations.
• IftheDirectorofOperationsmakesadecisiontoevacuate,thestaffwillleadtheevacuationfollowingtheevacuationproceduresoncethepoliceorDOOhavedeclaredthebuildingsafetoevacuate.
• Donotuseelevator,usestairsifpossibletoleadstudentstosafety.• Ifunabletosafelyevacuate,preparetolockdown.Immediatelylockelevatorifpossible.• Ifelevatorisoff:closeandlockhallwaydoorsoneachfloor,preventingentry.• Ifunabletolockelevator:staffshouldleadstudentstolockdownlocationsinfollowing
areas:
3rdFloor:Costumecloset,stafflounge,3rdflooroffices4thFloor:Healthoffice,Studio35ThFloor:5thflooroffices,Keystoneroom,&storagecloset
StudentProcedure:
• Studentsshouldremainquietduringlockdownandshouldnotopendoors.• Studentsshouldalwaysbewithastaffmember,andallphones/electronicsshouldbe
silenced.
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BombThreatsResponsibilities:TheDirectorofOperationswillactasthebombsearchcoordinatorandwillberesponsibleformakingthedecisiontoevacuateabuilding.
Staff/FacultyandStudentProcedure:
Ifreceivedbyphonecall:
• Trytokeepthecalleronthephone(mostcallswillbebrief).• FilloutBombThreatChecklistandfollowprotocol(followingpage)• Uponhangingup,immediatelyinformthenearestArtisticDirectoror,ifastudent,
informtheneareststaffmember.ArtisticDirectororstaffwillimmediatelyinformDirectorofOperations.
• Anyoneinthesearchareashouldnottouchunusualorsuspiciousobjects,useelevators,orcreateradioorcellphonetransmissions.
• IftheDirectorofOperationsmakesadecisiontoevacuate,thestaffwillleadtheevacuationfollowingthefireproceduresoncethepolicehavedeclaredthebuildingsafetoevacuate.DoorsandwindowsshouldNOTbeshut.Theyaretoremainopentohelpreduceshockwavesinthecaseofanexplosion.
Bombthreatbynoteorletter:
• Donothandletheletter,envelope,oranythinginthepackageorenvelope.Theitemsmaycontainimportantfingerprintsthatcouldleadtotheidentificationoftheresponsibleparty.Trynottofingerprintanyitems.
• ImmediatelynotifythenearestArtisticDirectororneareststaffmember.
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Source:FEMAhttp://emilms.fema.gov/is906/assets/ocso-bomb_threat_samepage-brochure.pdf
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CatastrophicEmergencyDesignatedstaff,onceinformed,willbeginthenotificationprocessintheeventofanaccident,illness,oractofviolenceresultingintheunexpecteddeathofaJoffreyBalletSchoolcommunitymember.TheDirectorofOperations,ArtisticDirector,andHealthandWellnesscoordinatorwillworktogethertoactivatetheprotocol.
ActsofViolenceincludebutarenotlimitedto:homicide,suicide,accidentleadingtodeath,sexualassault,assaultleadingtophysicalinjury,actofterrorism,fire,andnaturaldisaster.
ImmediateStaff/FacultyProcedures:
• Scenemanagement:DirectorofOperationswillcoordinateresponse.• DirectorofOperationswillarrangeinformingfamilyofthedeceasedorinjured.• DirectorofOperations,ArtisticDirector,andHealthandWellnessCoordinatorwillplan
supportserviceswhendeemedappropriate.
Staff/FacultyProcedures:
• DirectorofOperationswillplanandinstructArtisticDirectorsonappropriatemethodsofinformationreleasetomediaandwithintheJBScommunity.
• HealthandWellnessCoordinatorwillarrangeasymbolicactwithinonemonthoftheincident.
• DirectorofOperationswillarrangealiaisonwithexternalpolice.• TheDirectorofOperations,ArtisticDirectors,andHealthandWellnessCoordinatorwill
holdacrisiseventevaluationsession.
Resources:
ReadyNewYork:PreparingforEmergenciesinNewYorkCity
http://www.nyc.gov/html/oem/downloads/pdf/household_guide.pdf
NewYorkCityOfficeofEmergencyManagement
http://www.nyc.gov/html/oem/html/businesses/businesses.shtml
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EmotionalDistressTheHealthandWellnessCoordinatorisavailabletostudentsexperiencingemotionaldistress.Emotionaldistresscaninclude,butisnotlimitedto,thefollowing:loss,depression,eatingdisorderedbehavior,andbodyimageissues.
GeneralProcedures:SignssuggestingthatastudentshouldbereferredtotheHealthandWellnessCoordinator:
• Frequenttardinessorabsenteeism• Consistentdiscrepancybetweenpotentialandactualachievement• Uncharacteristicwork• Studentshiftsdiscussionfromadvisementontrainingtopersonalissues• Markedchangeinpersonalhygiene• Highlevelsofirritabilityand/orunruly,aggressivebehavior• DramaticWeightgainorloss• Drugand/oralcoholabuse• Behaviorthatregularlyinterfereswiththeclass• Dependencyonstaffmember• Traumaticexperiences,suchaslossordeath• Suddendistancingfromfacultyorotherstudents
EMERGENCYSITUATIONS:REQUESTHELPIMMEDIATLEY!
• Expressionofhomicidalorsuicidalthoughts• Severelossofemotionalcontrol• Grossimpairmentofthinkingability
HowtoMakeaReferralasaStaff/FacultyMember:
Ifyoubecomeawarethatastudentisdemonstratingworrisomebehavior(detailedabove)orishavingaproblem,itishelpfultoaskthestudent,“Areyoutalkingwithanyoneaboutthis?”Ifthestudenthasnotyetarrangedcounseling,itisbesttoencouragethestudenttoseekhelp.YoumayexpressyourconcernandremindthestudentthattheHealthandWellnessCoordinatorisavailabletohimorher.However,ifastudentisinneedofimmediatehelp,offertocalltheHealthandWellnessCoordinatorwiththestudentpresent.
IfyoucalltheHealthandWellnessCoordinatoronastudent’sbehalf,identifyyourselfandexplainthesituation.Provideabriefdescriptionofthebehaviorthatconcernsyouandthelevelofurgency,andthenallowthestudenttospeakdirectlytotheHealthandWellnessCoordinatortoarrangeanappointment.
Ifyouarenotcomfortablesuggestingareferral,orifthestudentisreluctanttoacceptone,feelfreetocalltheHealthandWellnessCoordinatortoshareyourconcerns.Yourinsightcanbe
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helpfulincreatingaplantoreachthestudenttodeterminehowseriousthingsmightbeforhim/her.
Youmayfollowupwiththestudenttodeterminewhetherheorshehasfolloweduponyourrecommendation,buttheHealthandWellnessCoordinatormustvaluestudentconfidentialitybykeepingmeetinginformationprivate.Checkinguponthestudentcanhelpshowyourcontinuedconcernandsupport.
HowtoMakeaReferralasaStudent:
Ifyouarecomfortable,suggesttothestudentthattheytalktosomeone,suchastheHealthandWellnessCoordinator.Ifyouarestillconcernedand/oryouworrythatthestudentwillnotseekhelp,scheduleameetingwiththeHealthandWellnessCoordinator,atwhichtimeyouwillbeabletodiscussyourconcernsconfidentially.Themostcaringthingyoucandoforafriendinneedistohelpthemtofindhelp.
Resources:
SuicidalCrisisHotline212-673-3000RapeCrisisHelpHotline
PsychologicalEmergencyTheentireJBScommunitysharesaresponsibilitytorespondtoapersoninapsychologicalemergencyandprotectthatindividualand/orthecommunity.
Pleasenotethefollowing:
AstudentisconsideredtoberesponsibleforhisorheractionsandbehavioratalltimesandissubjecttoJBSconsequencesorlegalaction.Ifthereissignificantdoubtaboutwhetherastudentiscapableofassumingresponsibilityforhisorherbehaviorornot,itisanemergencysituation.Staffshouldtakeimmediateactiontoinsurethesafetyofboththeindividualstudentandthecampuscommunity.
Ifyouencountersomeoneshowinganyofthefollowingsigns,itisanemergencysituation.Gethelpimmediatelyifsomeone:
• Expresseshomicidalorsuicidalthoughts• Demonstratesseverelossofemotionalcontrol• Demonstratesgrossimpairmentofthinkingability
StaffProtocol:Duringanemergencypsychologicalsituation,staffMembersshouldnevertransportastudentinapersonalvehicle,noraccompanythestudentinacab.Thestudentshouldbetransportedbyambulance,afamilymember,orpolice.
StaffmustNEVERsignthestudentintothehospital.
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Thestudentisresponsibleforanyandallcostsincurredformedicalvisit,treatment,ortransportation.JBSstaffmustnotsignthestudentintothehospital.
IfthestudentisaresidentinaJBSfacilityandisnotadmittedtothehospital,thestudentwillnotbeallowedtoreturntoJBSresidenceuntilheorshehascompletedanevaluationwithanoutsidepsychologist.TheDirectorofOperations,DirectorofResidence,andHealthandWellnessCoordinatorwillreviewtheevaluationresultsbeforedeterminingthesafetyofhisorherreturntoJBShousing.JBSreservestherighttorequirehimorhertocompleteasecondevaluationbyalicensedmentalhealthprofessionalbeforethedecisionregardingthestudentsreturntohousingmaybemade.
SuicideCrisisHotline:212-673-3000
SexualAssault,Stalking,andDomesticViolenceItisJBSpolicytoprovideanenvironmentthatissafeandfreefromviolence.JBSprohibitsanddoesnottolerateactsofviolencethatoccuronourownedorcontrolledpremisesoratschooleventsorprograms.Theviolentactsreferredtointhissectionincludesexualassault,domesticandintimatepartnerviolence,andstalkingagainstanymemberoftheJBScommunity.
Thispolicyisapplicabletoallstudents,staff,faculty,visitors,vendors,contractors,guests,andallthirdparties.ThoseinviolationaresubjecttocriminalprosecutionaswellasJBSdisciplinaryactionincludingbutnotlimitedtoexpulsion,terminationofemployment,andotherappropriatesanctions.
RapeCrisisHelpHotline212-577-7777914-345-9111
TheEmotionalDistresssectionishelpfulhere.
SexualAssault
Sexualviolenceisanysexualact,attempttoobtainasexualact,unwantedsexualcommentsoradvances,actstotraffic,orotheractivitiesdirectedagainstapersonusingcoercionbyanyperson,regardlessoftheirrelationshiptothevictim,inanysetting,includingbutnotlimitedtohomeandwork.Theabilitytogiveconsentisanimportantconsiderationinanysexualact.Apersonwhoisunabletounderstandthenatureorconditionoftheactinordertodeclineparticipation,ortocommunicateunwillingnesstoengageinthesexualact,e.g.,becauseofillness,disability,ageortheinfluenceofalcoholorotherdrugs,orduetointimidationorpressure,isunabletogiveconsent.
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Source:NewYorkStateDepartmentofHealthhttps://www.health.ny.gov/prevention/sexual_violence/what_to_do.htm#safe_program
Stalking
Insimplestterms,stalkingistheunwantedpursuitofanotherperson.Byitsnature,stalkingisnotaone-timeevent.Theindividual'sactionsmustbeconsideredinconnectionwithotheractionstodetermineifsomeoneisbeingstalked.Itincludesrepeatedharassingorthreateningbehaviortowardanotherperson,whetherthatpersonisatotalstranger,slightacquaintance,currentorformerintimatepartner,oranyoneelse.
Stalkingisalso:
• Aterrorizingcrimewithnorealidentifiedbeginningandseeminglynoend;• Acrimethatcancausetremendousfearwithouttheslightestphysicalinjury;• Abehaviorwithahighcorrelationtophysicalandsexualviolence1;• Acrimethatcanbelethal;and• Averyeffectivetacticofcontrolfordomesticviolenceabusers.
DomesticandIntimatePartnerViolenceDomesticviolenceiswhenonepersondoesavarietyofthingstocontrolanotherpersoninanintimaterelationship.Theshiftinpowercanhappenveryslowly,overaperiodoftime,sothattheotherpersoncannotevenrememberwhenithappened.Oritcanhappenveryquicklyafterthereissomesortofcommitmentorsomechangeinthelevelofintimacy.
PreventionofSexualAssaultandViolentAssaults:
Crimemaynotalwaysbeprevented,butactionsthatcanreducetheriskofbecomingavictimareimportantandinclude,butarenotlimitedto,thefollowing:
• Avoidwalkingalone,especiallyafterdark.• Alwayskeepyourapartment/roomlockedwhensleeping.• Followallresidencehallrules.Neverallowanyoneinthebuildingunlesstheyareyour
permittedguest.• Neverpropopenexteriordoors.• Callforhelpifyouseeanyoneinaresidencehallwhoappearssuspiciousordoesnot
belongthere.• Neverhideyourkeysoutsideyourapartment.• Clearlycommunicateyoursexualintentionsandlimits.• Trustyourself.Ifyouareuncomfortableorfeelthatsomethingiswrong,immediately
removeyourselffromthesituation.
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Policy:
IfaJBSstudentorstaffmembercommitssexualassaultonaJBSstudentorstaffmember,theassaulterwillfaceimmediateterminationorexpulsion.JBSwillreporttheincidenttolawenforcement.
Resource:
NewYorkStateDomesticViolenceHotline1-800-942-69061800-621-HOPE(4673)311TTY:1-866-604-5350
NewYorkStateResources
• AlphabeticalListingofNewYorkStateAgencieswithwebsites• EmpireJusticeCenter• NewYorkAsianWomen'sCenter• NewYorkCityGayandLesbianAnti-ViolenceProject• NewYorkCityMayor'sOfficetoCombatDomesticViolence• NewYorkStateCoalitionAgainstDomesticViolence• PaceWomen’sJusticeCenter
NationalOrganizationsandResources
• AmericanBarAssociationCommissiononDomesticViolence• BureauofJusticeStatisticsAboutCrimeandVictims• FuturesWithoutViolence(FormerlyTheFamilyViolencePreventionFund)• FeministMajorityFoundationDomesticViolenceInformationCenter• InstituteonDomesticViolenceintheAfricanAmericanCommunity• NationalCenterforVictimsofCrime• NationalCoalitionAgainstDomesticViolence• NationalCouncilofJuvenileandFamilyCourtJudges• TheNationalDomesticViolenceProBonoDirectory• NationalLatinoAlliancefortheEliminationofDomesticViolence• U.S.DepartmentofJusticeViolenceAgainstWomenOffice• ViolenceAgainstWomenOnlineResources• WomenofColorNetwork
GeneralInformationonDomesticViolence
• Feminist.comAnti-ViolenceResources• MINCAVA(MinnesotaCenterAgainstViolenceandAbuse):DomesticViolenceandViolence
AgainstWomen• NationalCenterforVictimsofCrime:
o StalkingResourceCenter
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o GetHelpSeries-DomesticViolence
DomesticViolenceandSpecificPopulations
• MINCAAResourceso DisabilitiesandViolenceo ElderAbuseo Same-sexdomesticviolencereferences
• TheRuralWomynZone:ViolenceAgainstRuralWomen• SurvivorProject:Transsexual,Transgender,andIntersexVictims
NewYorkStateDomesticViolenceResources
• NewYorkStateDomesticViolenceProgramsAcountybycountylistingofresidentialandnon-residentialdomesticviolenceprogramsinNewYorkState.
• NewYorkStateOrganizationsandHotlinesAlistofdomesticviolence-relatedstatewidehotlinesandresources.
SourceforSexualAssaultsectionofhandbook:OfficeforthePreventionofDomesticViolencehttp://opdv.ny.gov/whatisdv/about_dv/index.html
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Appendix1:MedicalResourcesEmergency:DIAL9-1-1
Hospital:BethIsraelMedicalCenter1stAvenueand16thSt.NewYork,NY10003-380Phone:212-420-2840Mt.SinaiHospital1005thAveNewYork,NY10011212-241-0043
UrgentCare:NewYorkDoctorsWalk-InUrgentCare65West13thSt.NewYork,NY10011Phone:212-414-2800Fax:212-414-2822LocatedinGreenwichVillageon13thSt.between5thand6thAvenearUnionSquare.http://www.nydoctorsurgentcare.com/ContactUs/tabid/19427/Default.aspxCityMDUrgentCare14W.14thSt.NewYork,NY10011Phone:212-390-0558Citymd.comUrgentMedicalCareUnionSquare110W.14thSt.NewYork,NY10011Phone:212-242-4333http://www.urgentmedicalcareunionsquare.com/urgent-care/
DanceInjuries:HarknessCenterforDanceInjuriesatNYUHospitalforJointDiseases6142ndAveSuiteGFloor2NewYork,NY10016Phone:(212)[email protected]:
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Dr.DonaldRose,M.D.–specialtyindancers;DirectorofHarknessCenterHarknessMedicalCenter:DanceClinic240East18thSt.(at2ndave)NewYork,NY10003Phone:(212)598-6022http://www.donaldrosemd.com/Meet/
SportsMedicinePhysician,InternalMedicine,&Acupuncturist:Dr.JeffreyDelson,M.D.WashingtonSquareSportsMedicine7GaySt.NewYork,NY10014Phone:(212)[email protected]:Dr.LindaHamiltonEmail:[email protected]:(917)841-2169
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Appendix2CommunicableDiseasesofconcern
Thefollowingisnotacompletelistofallcommunicablediseasesofconcern,butinsteadinformationonthemoreprevalentorlikelydiseasesofconcernatJBS.
Chickenpox(varicellazosterinfection)
Whatischickenpox?
Chickenpoxisahighlycontagiousillnesscausedbythevaricella-zostervirus(VZV),atypeofherpesvirus.Itisoftenamildillness,characterizedbyanitchyrashontheface,scalpandtrunkwithpinkspotsandtinyfluid-filledblistersthatdryandbecomescabsfourtofivedayslater.Seriouscomplications,althoughrare,canoccurmainlyininfants,adolescents,adultsandpersonswithaweakenedimmunesystem.Thesecomplicationsincludebacterialinfectionsofskinblisters,pneumonia,andencephalitis(inflammationofthebrain).Intemperateclimates,suchastheNortheast,chickenpoxoccursmostfrequentlyinthelatewinterandearlyspring.
Whogetschickenpox?
Chickenpoxisacommonchildhoodillnesswith90percentofthecasesoccurringinchildrenyoungerthantenyearsofage.BeforetheavailabilityofthevaricellavaccineintheU.S.,almosteveryonedevelopedchickenpox.Mostpeoplewhoarevaccinatedwillnotgetchickenpox.Thosewhoarevaccinatedanddevelopchickenpoxusuallyhaveamildformoftheillness.Theyhavefewerspotsandrecoverfaster.
Howischickenpoxspread?
Chickenpoxistransmittedfrompersontopersonbydirectlytouchingtheblisters,salivaormucusofaninfectedperson.Theviruscanalsobetransmittedthroughtheairbycoughingandsneezing.Chickenpoxcanbespreadindirectlybytouchingcontaminateditemsfreshlysoiled,suchasclothing,fromaninfectedperson.Directcontactwiththeblistersofapersonwithshinglescancausechickenpoxinapersonwhohasneverhadchickenpoxandhasnotbeenvaccinated.Blistersthataredryandcrustedarenolongerabletospreadchickenpox.
Whatarethesymptomsofchickenpox?
Initialsymptomsincludesuddenonsetofslightfeverandfeelingtiredandweak.Thesearesoonfollowedbyanitchyblister-likerash.Theblisterseventuallydry,crustoverandformscabs.Theblisterstendtobemorecommononcoveredthanonexposedpartsofthebody.Theymayappearonthescalp,armpits,trunkandevenontheeyelidsandinthemouth.Mildor
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asymptomaticinfectionsoccasionallyoccurinchildren.Thediseaseisusuallymoreseriousinyounginfantsandadultsthaninchildren.
Howsoondosymptomsappear?
Symptomscommonlyappear14to16days(rangeoftento21days)afterexposuretosomeonewithchickenpoxorherpeszoster(shingles).
Whatarethecomplicationsassociatedwithchickenpox?
Newbornchildren(lessthanonemonthold)whosemothersarenotimmunemaysuffersevere,prolongedorfatalchickenpox.Anypersonwithaweakenedimmunesystem,includingthosewithcancer,humanimmunodeficiencyvirus(HIV)ortakingdrugsthatsuppresstheimmunesystem,mayhaveanincreasedriskofdevelopingasevereformofchickenpoxorshingles.
ReyeSyndromeisanunusualcomplicationofchickenpoxthatislinkedtochildrenwhotakeaspirinoraspirin-containingproductsduringtheillness.ReyeSyndromeisaseverediseaseaffectingallorgansystems,but,mostseriouslythebrainandliverandmaybefatal.TheexactcauseofReyeSyndromeisunknown.Aspirinoraspirin-containingproductsshouldneverbegiventochildrenunder18yearsofagewithchickenpox.
Whenandforhowlongisapersonabletospreadchickenpox?
Apersonismostabletotransmitchickenpoxfromonetotwodaysbeforetherashappearsuntilalltheblistersaredryandcrusted.Peoplewithaweakenedimmunesystemmaybecontagiousforalongerperiodoftime.
Isthereatreatmentforchickenpox?
Acyclovirisapprovedfortreatmentofchickenpox.However,becausechickenpoxtendstobemildinhealthychildren,mostphysiciansdonotfeelthatitisnecessarytoprescribeacyclovir.Acyclovircanbeconsideredforotherwisehealthypeoplewhoareatriskofmoderatetoseverevaricella.Itisimportanttoconsultwithyourphysicianforrecommendationsontheuseofacyclovir.
Doespastinfectionwithchickenpoxmakeapersonimmune?
Mostpeopledonotgetchickenpoxmorethanonce.However,sincevaricella-zostervirusremainsinthebodyafteraninitialinfection,infectioncanreturnyearslaterintheformofshinglesinsomeolderadultsandsometimesinchildren.
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Isthereavaccineforchickenpox?
Avaccinetoprotectchildrenagainstchickenpoxwasfirstlicensedin1995.Childrenwhohaveneverhadchickenpoxshouldroutinelybeadministeredtwodosesofvaricellavaccinewiththefirstdoseat12to15monthsandtheseconddoseatfourtosixyearsofage.Persons13yearsofageandolderwhohaveneverhadchickenpoxorhavenotreceivedthevaricellavaccineshouldgettwodosesofthevaricellavaccineatleast28daysapart.
Thevaricellavaccinemaybegivenalongwiththemeasles-mumps-rubella(MMR)vaccineinacombinationcalledmeasles-mumps-rubella-varicella(MMRV)thatisapprovedforuseinchildren12monthsthrough12yearsofage.
InNewYorkState,varicellavaccineisrequiredforchildrenenrolledinpre-kindergartenprogramsandschools.Vaccinationisrecommendedforhealthcarepersonnelandcollegestudentswhohaveneverhadchickenpox.
Whatcanbedonetopreventthespreadofchickenpox?
Maintaininghighlevelsofvaricellaimmunizationinthecommunityiscriticaltocontrollingthespreadofchickenpox.Topreventfurtherspreadofchickenpox,peopleinfectedwiththediseaseshouldremainhomeandavoidexposingotherswhoaresusceptible.Infectedpersonsshouldremainhomeuntiltheblistersbecomedryandcrusted.Itisveryimportanttoavoidexposingnon-immunenewbornsandpersonswithaweakenedimmunesystemtochickenpox.
Varicellavaccinationisrecommendedforoutbreakcontrol.Duringanoutbreak,personswhodonothaveadequateevidenceofimmunityshouldreceivetheirfirstorseconddoseasappropriate.
In2006,anewproductcalledVariZIG™becameavailabletoprotectpatientswithoutevidenceofimmunitytovaricellawhoareathighriskforseverediseaseandcomplicationsandhavebeenexposedtochickenpox.ThepatientgroupsrecommendedtoreceiveVariZIGincludethosewithaweakenedimmunesystem,pregnantwomen,newbornswhosemothershavesymptomsofvaricellaaroundthetimeofdelivery(fivedaysbeforetotwodaysafterdelivery)andcertainprematureinfantsexposedtochickenpoxasnewborns.
Diptheria
Whatisdiphtheria?
Diphtheriaisahighlycontagiousandpotentiallylife-threateningbacterialdiseasecausedbyCorynebacteriumdiphtheriae.Therearetwotypesofdiphtheria:respiratoryandcutaneous.Respiratorydiphtheriainvolvesthenose,throatandtonsils,andcutaneousdiphtheriainvolvestheskin.Cutaneousdiphtheriaisdiscussedbelow.
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Whatisrespiratorydiphtheria?
Respiratorydiphtheriapresentsasasorethroatwithlow-gradefeverandamembraneattachedtothetonsils,pharynx,ornose.Neckswellingisusuallypresentinseveredisease.Respiratorydiphtheriacanleadtoseverebreathingproblems,heartfailure,blooddisorders,paralysis,comaandevendeath.
Whogetsrespiratorydiphtheria?
RespiratorydiphtheriaisextremelyrareintheUnitedStatesbecauseofwidespreadimmunization.MostoftheinfrequentcasesofdiphtheriaintheU.S.areamongunvaccinatedorinadequatelyvaccinatedpersons,particularlythosewhotraveltoareaswherediphtheriaiscommonandthosewhocomeintoclosecontactwithtravelersfromsuchareas.
Howisdiphtheriaspread?
Diphtheriaistransmittedfrompersontopersonthroughclosecontactwiththedischargefromaninfectedperson'seyes,nose,throatorskin.
Whatarethesymptomsofrespiratorydiphtheria?
Symptomsincludesorethroat,low-gradefever,muscleweakness,lossofappetiteandenlargedlymphnodeslocatedintheneck.Agrayishcoloredmembranemayformoverthenose,throatandtonsilsblockingtheairwayandmakingitdifficulttoswallow.Personsmaydevelopabarkingcoughandhoarsenesswithextensiveinvolvementofthethroat.
Howsoondosymptomsappear?
Symptomsusuallyappeartwotofivedaysafterinfection,witharangeofonetotendays.
Whatarethecomplicationsofuntreatedrespiratorydiphtheria?
Deathoccursinapproximatelyfivetotenpercentofallrespiratorycaseswithhigherdeathrates(ofupto20percent)amongpersonsyoungerthanfiveandolderthan40yearsofage.
Whatisthetreatmentforrespiratorydiphtheria?
Diphtheriademandsimmediatemedicalattention;anydelayintreatmentcanresultindeath.Apersonwithdiphtheriashouldbehospitalized,isolatedandtreatedwithdiphtheriaantitoxinandantibiotics,suchaspenicillinanderythromycin.
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Whenandforhowlongisapersonabletospreadrespiratorydiphtheria?
Untreatedpatientswhoareinfectedwiththediphtheriagermmaybecontagiousforuptofourweeks.Ifthepatientistreatedappropriately,thecontagiousperiodcanbelimitedtolessthanfourdays.
Doespastinfectionwithdiphtheriamakeapersonimmune?
Recoveryfromdiphtheriaisnotalwaysfollowedbylastingimmunity.
Isthereavaccinefordiphtheria?
DiphtheriavaccineforchildreniscombinedwithtetanusandacellularpertussistoformatriplevaccineknownasDTaP(diphtheria,tetanus,acellularpertussis).In2005,anewvaccinewasapprovedasasingleboostervaccinationforadolescentsandadultscalledTdap(tetanus,diphtheriaandacellularpertussis).Td(tetanusanddiphtheria)isalsoavaccineusedasaboostervaccinationinadolescentsandadults,however,itdoesnotcontainthepertussisvaccine.
DTaPshouldbegivenattwo,four,six,15to18monthsofage,andbetweenfourandsixyearsofage.
ThepreferredageforTdapvaccinationis11to12years.However,alladolescentsaged11to18yearsshouldreceiveasingledoseofTdapinsteadoftheTdforboosterimmunizationiftheyhavecompletedtherecommendedchildhoodDTaPvaccinationseriesandhavenotreceivedTdorTdap.AnintervaloffiveyearsbetweenTdandTdapisencouraged;howeveranintervaloflessthanfiveyearsbetweenTdandTdapadministrationcanbeused.Thereafter,Tdshouldbegiveneverytenyearstomaintainimmunity.
Adultsaged19to64yearsshouldreceiveasingledoseofTdaptoreplaceasingledoseofTdforactiveboostervaccinationiftheyreceivedtheirlastdoseofTdgreaterthantenyearsearlier.Thereafter,Tdshouldbegiveneverytenyearstomaintainimmunity.
InNewYorkState,diphtheriavaccineisrequiredforallchildreninpre-kindergartenprogramsandschools.
Whatcanbedonetopreventdiphtheria?
Thesinglemosteffectivecontrolmeasureismaintainingthehighestpossiblelevelofimmunizationinthecommunity.Othermethodsofcontrolincludeprompttreatmentofcasesandacommunitysurveillanceprogram.
Whatiscutaneous(skin)diphtheria?
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IntheUnitedStates,cutaneousdiphtheria,althoughrare,ismostoftenseenamongpersonswithpoorhygienewholiveincrowdedconditions.Skininfectionswithdiphtheriaarestillcommonintropicalcountriesandareevenmorecontagiousthanrespiratorydiphtheria.Skinwoundsarecharacterizedbyascalingrash,soresorbyblisterswhichcanoccuranywhereonthebody.Skinwoundsmaybepainful,swollenandreddened.Theskininfectionistreatedbythoroughcleansingwithsoapandwaterandappropriateantibiotics.
Impetigo
Whatisimpetigo?
ImpetigoisacommonbacterialskininfectioncausedbyGroupAStreptococcus(GAS)or"strep."
WhatisGroupAStreptococcus(GAS)?
GroupAStreptococcus(GAS)or"strep"isacommonbacterium(bacteriumisthesingularformoftheplural,bacteria)thatisfoundontheskinorinthethroat("strepthroat").PeoplecancarryGASandhavenosymptomsofillnessortheymaydeveloprelativelymildskininfections,includingimpetigo.
Howdoesimpetigospread?
GroupAStreptococcus(GAS)or"strep"canbetransmittedthroughdirectperson-to-personcontactwithsomeonewhohastheinfection.GAScanalsobepickedupindirectlythroughcontactwithanitem(suchasawrestlingmat,gear,towel,razor,orcellphone)thatiscontaminatedwiththebacterium.
Whatarethesymptomsofimpetigo?
• Symptomsusuallybegan1-3daysafterinfection.• Sores(lesions)beginassmallredspots,usuallyontheface(especiallyaroundthenose
andmouth),butcanappearanywhereonthebody.• Thesoresareoftenitchy,butusuallynotpainful.• Thesoresdevelopintoblistersthatbreakopenandoozefluid--thisfluidcontains
infectiousbacteriathatcaninfectothersiftheyhavecontactwithit.• Afterafewdays,therupturedblistersformaflat,thick,honey-colored(yellowish-
brown)crustthateventuallydisappears,leavingredmarksthathealwithoutscarring.• Theremaybeswollenglands(enlargedlymphnodes),butusuallynofever.
ClickheretoviewaphotographofimpetigoonthefacefromDermAtlas.
Whatshouldathletesdoiftheythinktheyhaveimpetigo?
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Whilemildcasesofimpetigomaybetreatedwithoutseeingahealthcareprovider,athletesarerecommendedtohaveamedicalprofessionaldeterminewhattypeofinfectiontheyhave,howtotreatit,andifitiscontagious.Iftheinfectioniscontagious,athletesshouldnotpracticeorcompeteuntiltheirmedicalproviderclearsthemtoreturn.
Influenza(Flu)
Whatistheflu?
Thefluisacontagiousrespiratoryillnesscausedbyinfluenzaviruses.Itcancausemildtosevereillness,andattimescanleadtodeath.Somepeople,suchasolderpeople,youngchildren,andpeoplewithcertainhealthconditions,areathighriskforseriousflucomplications.
EveryyearintheUnitedStates:
• Onaveragemorethan200,000peoplearehospitalizedfromflucomplications,and;• Morethan23,600peoplediefromflu(witharangeof3,349-48,614people);about90%ofsuch
deathsoccurinpersonsaged65yearsandolder.
Thebestwaytopreventthisillnessisbygettingafluvaccination.
Whatarethesymptomsoftheflu?
Thefluusuallystartssuddenlyandmayincludethesesymptoms:
• Fever*orfeelingfeverish/chills• Cough• Sorethroat• Runnyorstuffynose• Muscleorbodyaches• Headaches• Fatigue(tiredness)• Somepeoplemayhavevomitinganddiarrhea,thoughthisismorecommoninchildrenthan
adults
*It'simportanttonotethatnoteveryonewithfluwillhaveafever.
Whatarethecomplicationsassociatedwiththeflu?
Someofthecomplicationscausedbyfluincludepneumonia,earinfections,sinusinfections,dehydration,andworseningofchronicmedicalconditions,suchasheartorlungdisease,asthmaordiabetes.
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Howisthefluspread?
Thefluisspreadindropletsreleasedbycoughingandsneezing.Itusuallyspreadsfrompersontoperson,thoughoccasionallypeoplemaybeinfectedbytouchingsomethingwithvirusonitandthentouchingtheireyes,nose,ormouth.
Whenandforhowlongisapersonabletospreadtheflu?
Youmaybeabletopassontheflutosomeoneelsebeforeyouknowyouaresick,aswellaswhileyouaresick.Mostadultsmaybeabletoinfectothersbeginning1daybeforesymptomsdevelopandupto5to7daysafterbecomingsick.Somepeople,especiallyyoungchildrenandpeoplewithweakenedimmunesystems,mightbeabletoinfectothersforanevenlongertime.
ColdVersusFlu
Whatisthedifferencebetweenacoldandtheflu?
Thefluandthecommoncoldarebothrespiratoryillnessesbuttheyarecausedbydifferentviruses.Becausecoldsandflusharemanysymptoms,itcanbedifficult(orevenimpossible)totellthedifferencebetweenthembasedonsymptomsalone.Mostpeoplewhohaveflusymptomswillnotbetested,anddonotneedtobetested,becausetestresultsusuallydonotchangehowapatientistreated.Treatment,ifdecideduponbythehealthcareprovider,willusuallybebasedonseverityofsymptomsandhowlikelyapersonistohavecomplicationsofflu–notonthebasisofatestresult.Whatarethesymptomsofthefluversusthesymptomsofacold?
• Theflutendstostartverysuddenly,whilecoldstendtodevelopgradually.• Thefluisworsethanthecommoncold,andsymptomssuchasfever,bodyaches,extreme
tirednessanddrycougharemorecommonandintense.• Peoplewithcoldsaremorelikelytohavearunnyorstuffynose.• Coldsgenerallydonotresultinserioushealthproblems,suchaspneumonia,bacterial
infections,orhospitalizations.
PreventingtheFlu
Whatisthebestwaytoprotectmyselfagainsttheflu?
Thesinglebestwaytopreventthefluistogetafluvaccinationeachfall.Therearetwotypesofvaccines:
• The"flushot"isaninactivatedvaccine(containingkilledvirus)thatisgivenwithaneedle.Itcanbegiveninthemuscleorjustundertheskin.Theflushotthatisgiveninthemuscleisapprovedforuseinpeopleolderthan6months,includinghealthypeopleandpeoplewithchronicmedicalconditions.Theflushotthatisgivenbelowtheskinisforthose18-64yearsofage.
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• Thenasal-sprayfluvaccineisavaccine(sometimescalledLAIVfor"LiveAttenuatedInfluenzaVaccine")madewithlive,weakenedfluvirusesthatdonotcausetheflu.LAIVisapprovedforuseinhealthypeople2yearsto49yearsofagewhoarenotpregnant.
Talktoyourprovidertofindoutwhichvaccineisrightforyouandyourfamily.
Abouttwoweeksaftervaccination,antibodiesdevelopthatprotectagainstfluvirusinfectionfortheentireseason.Fluvaccineswillnotprotectagainstillnessescausedbyotherviruses,suchasthecommoncold.
Whoshouldgetthefluvaccine?
Everyone6monthsofageandoldershouldgetvaccinatedagainsttheflu.Vaccinationshouldbeginassoonasthevaccineisavailable.
Vaccinationtopreventfluisparticularlyimportantforpersonswhoareatincreasedriskforseverecomplicationsfromfluorathigherriskforflu-relatedoutpatient,emergencydepartment,orhospitalvisits.Thelistbelowincludesthegroupsofpeoplemorelikelytogetflu-relatedcomplicationsiftheygetsickfrominfluenza:
• Childrenyoungerthan5,butespeciallychildrenyoungerthan2yearsofage• Adults50yearsofageandolder,butespeciallythose65yearsofageandolder• Womenwhoareorwillbepregnantduringfluseason• AmericanIndiansandAlaskanNatives• Residentsofnursinghomesandotherchroniccarefacilities• Peoplewhohavethefollowingmedicalconditions:
o Neurologicalandneurodevelopmentalconditions[includingdisordersofthebrain,spinalcord,peripheralnerve,andmusclesuchascerebralpalsy,epilepsy(seizuredisorders),stroke,intellectualdisability(mentalretardation),moderatetoseveredevelopmentaldelay,musculardystrophy,orspinalcordinjury].
o Chroniclungdisease(suchaschronicobstructivepulmonarydisease[COPD]andcysticfibrosis)andAsthma
o Heartdisease(suchascongenitalheartdisease,congestiveheartfailureandcoronaryarterydisease)
o Blooddisorders(suchassicklecelldisease)o Endocrinedisorders(suchasdiabetesmellitus)o Kidneydisorderso Liverdisorderso Metabolicdisorders(suchasinheritedmetabolicdisordersandmitochondrialdisorders)o Weakenedimmunesystemduetodiseaseormedication(suchaspeoplewithHIVor
AIDS,orcancer,orthoseonchronicsteroids)o Peopleyoungerthan19yearsofagewhoarereceivinglong-termaspirintherapyo Peoplewhoaremorbidlyobese(BodyMassIndex,orBMI,of40orgreater)
Vaccinationeffortsshouldalsofocusondeliveringvaccinetothefollowingpersons:
• Healthcarepersonnel;
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• Householdcontactsandcaregiversofchildrenyoungerthan5yearsandadultsaged50yearsorolder,withparticularemphasisonvaccinatingcontactsofchildrenyoungerthan6months
Doesmychildneedtoreceivemorethanonedoseoffluvaccinethisseason?
Somechildrenaged6monthsthrough8yearsrequiretwodosesoffluvaccine(givenaminimumoffourweeksapart).Childreninthisagegroupwhoaregettingvaccinatedforthefirsttimewillneedtwodoses.Ifthisisnotthefirstseasonthatyourchildisreceivingfluvaccine,talkwithyourchild'sprovidertodeterminehowmanydosesyourchildneedstoprotectthemfromthefluthisyear.
WhoshouldNOTbevaccinated?
Therearesomepeoplewhoshouldnotbevaccinated.Theyinclude:
• Peoplewhohavehadaseverereactiontoafluvaccination;• Childrenlessthan6monthsofage.
Somepeopleshouldwaittogetvaccinateduntiltheytalkwiththeirprovider.Theyinclude:
• Peoplewhohaveasevereallergytochickeneggs;• Peoplewhoaresickwithafever.(Thesepeoplecangetvaccinatedoncetheirsymptomslessen.
Peoplewithamildillnesscanusuallygetthevaccine.)• PeoplewhodevelopedGuillain-Barresyndrome(GBS)withinsixweeksofgettingfluvaccine.
Whatothermethodscanhelppreventtheflu?
Althoughthesinglebestwaytopreventseasonalfluistogetvaccinatedeachyear,goodhealthhabitsoftencanhelpstopthespreadofgermsandpreventrespiratoryillnessesliketheflu.
• Avoidclosecontactwithpeoplewhoaresick.Whenyouaresick,keepyourdistancefromotherstoprotectthemfromgettingsicktoo.
• Stayhomewhenyouaresick.Ifpossible,stayhomefromwork,school,anderrandswhenyouaresick.Youwillhelppreventothersfromcatchingyourillness.
• Coveryourmouthandnose.Coveryourmouthandnosewithatissuewhencoughingorsneezing.Ifnotissueisavailable,coughorsneezeintothebendofyourarm.Itmaypreventthosearoundyoufromgettingsick.
• Cleanyourhands.Washingyourhandsoftenwillhelpprotectyoufromgerms.Ifsoapandwaterarenotavailable,useanalcohol-basedhandsanitizerthatcontainsatleast60%alcoholtocleanyourhands.
• Avoidtouchingyoureyes,nose,ormouth.Germsareoftenspreadwhenapersontouchessomethingthatiscontaminatedwithgermsandthentoucheshisorhereyes,nose,ormouth.
• Practiceothergoodhealthhabits.Cleananddisinfectfrequentlytouchedsurfacesathome,workorschool,especiallywhensomeoneisill.Getplentyofsleep,bephysicallyactive,manageyourstress,drinkplentyoffluids,andeatnutritiousfood.
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Cantheflubetreated?
Incertaincircumstances,yourdoctororhealthcareprovidermightprescribeantiviraldrugstohelpreducetheseverityanddurationofyourillness.Antiviraldrugsarenotsoldover-the-counterandaredifferentfromantibiotics.Youcangetthemonlyifyouhaveaprescriptionfromyourdoctororhealthcareprovider.Yourhealthcareprovidercanhelpdecidewhetheryoushouldtakeanantiviraldrug,and,ifso,whichoneyoushouldtake.
Antiviraldrugsareasecondlineofdefensetotreatthefluifyougetsick.NYSDOHrecommendsfluvaccinationasthefirstandbestwaytopreventinfluenza.
Measles(Rubeola,hardmeasles,redmeasles)
Whatismeasles?
Measlesisahighlycontagiousviraldiseasethatcanbeveryseriousorevenfatal.Itbeginswithafeverthatlastsforacoupleofdays,followedbyacough,runnynose,andconjunctivitis(pinkeye).Arashstartsonthefaceandupperneck,spreadsdownthebackandtrunk,thenextendstothearmsandhands,aswellasthelegsandfeet.Afteraboutfivedays,therashfadesinthesameorderitappeared.Seriouscomplicationsofmeaslesincludepneumoniaandencephalitis(inflammationofthebrain).
Whogetsmeasles?
Asaresultofwidespreadimmunization,themeaslesvirusdoesnotcirculateintheUnitedStates.AllreportedcasesofmeaslesintheUnitedStateshavebeenbroughtinfromothercountries,usuallyEuropeandAsia.TravelersleavingtheUnitedStatesshouldbeimmunetomeasles.Althoughmeaslesisusuallyconsideredachildhooddisease,itcanbecontractedatanyagebyapersonwhoneverhadthediseaseorbeenvaccinated.Unvaccinatedindividualsare22timesmorelikelytogetmeaslesthanarewhothosewhohavetwomeaslesvaccines,usuallygivenasmeasles,mumpsandrubellavaccine(MMR).
Howismeaslesspread?
Measlesishighlycontagious.Themeaslesviruslivesinthemucusinthenoseandthroatofinfectedpeople.Whentheysneeze,coughortalk,dropletssprayintotheairandthedropletsremainactiveandcontagiousoninfectedsurfacesforuptotwohours.
Whatarethesymptomsofmeasles?
Measlessymptomsgenerallyappearintwostages.Inthefirststage,whichlasttwotofourdays,theindividualmayhavearunnynose,coughandaslightfever.Theeyesmaybecome
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reddenedandsensitivetolightwhilethefevergraduallyriseseachday,oftenpeakingashighas103°to105°F.Koplikspots(smallbluishwhitespotssurroundedbyareddisharea)mayalsoappearonthegumsandinsideofthecheeks.Thesecondstagebeginsonthethirdtoseventhdayandconsistsofaredblotchyrashlastingfivetosixdays.Therashusuallybeginsonthefaceandthenspreadsdownwardandoutward,reachingthehandsandfeet.Therashfadesinthesameorderthatitappeared,fromheadtoextremities.Othersymptomsincludeweightloss,diarrheaandenlargedlymphglandsthroughoutthebody.
Howsoondosymptomsappear?
Symptomsusuallyappearintento12days,althoughtheymayoccurasearlyassevenoraslateas18daysafterexposure.
Whenandforhowlongisapersonabletospreadmeasles?
Anindividualisabletotransmitmeaslesfromfourdayspriortoandfourdaysafterrashonset.
Whatarethecomplicationsassociatedwithmeasles?
Complicationsoccurinupto30percentofallcasesandaremorecommoninthoseyoungerthanfiveandolderthan20yearsofage.Pneumoniaoccursinuptosixpercentofreportedcases.Encephalitis(inflammationofthebrain)mayalsooccur.Othercomplicationsincludemiddleearinfection,diarrheaandseizures.Infectionofthemotherduringpregnancyhasbeenassociatedwithanincreaseinlow-birthweightinfants,prematurelabor,miscarriageandbirthdefects.
Whatisthetreatmentformeasles?
Thereisnospecifictreatmentformeasles.
Doespastinfectionmakeapersonimmune?
Yes.Immunityacquiredaftercontractingthediseaseisusuallypermanent.
Isthereavaccineformeasles?
Measles-containingvaccineisrecommendedforanyonebornonorafterJanuary1,1957,whodoesnothaveahistoryofphysician-diagnosedmeaslesorabloodtestconfirmingmeaslesimmunity.Individualsshouldreceive2dosesofMMR(measles,mumps,rubella)vaccineformaximumprotection.Thefirstdoseshouldbegivenat12to15monthsofage.Theseconddoseshouldbegivenatfourtosixyearsofage(ageofschoolentry)atthesametimeastheDTaPandpolioboosterdoses.MMRvaccineisrecommendedforallmeaslesvaccinedosesto
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provideincreasedprotectionagainstallthreevaccine-preventablediseases:measles,mumpsandrubella.Unprotectedpersonscangetthevaccineatanyage.
InNewYorkState,measlesimmunizationsarerequiredofallchildrenenrolledinpre-kindergartenprogramsandschools.Healthcarepersonnelandcollegestudentsarealsorequiredtodemonstrateimmunityagainstmeasles.
DoestheMMRvaccinecauseautism?
Thereisnoevidencetosupportthatmeasles-mumps-rubellavaccine(MMR)causeautism.
Whatcanbedonetopreventthespreadofmeasles?
Maintaininghighlevelsofmeaslesimmunizationinthecommunityiscriticaltocontrollingthespreadofmeasles.Infectedindividualsshouldbeexcludedfromworkorschoolduringtheirinfectiousperiod.Measles-containingvaccineshouldbeprovidedtosusceptiblecontactswithin72hoursofexposure.ImmuneGlobulin(IG)canbegiventosusceptiblepersonswithinsixdaysofexposure.
MeningococcalDisease
Whatismeningococcaldisease?
Meningococcaldiseaseisaseverebacterialinfectionofthebloodstreamormeninges(athinliningcoveringthebrainandspinalcord)causedbythemeningococcusgerm.
Whogetsmeningococcaldisease?
Anyonecangetmeningococcaldisease,butitismorecommonininfantsandchildren.Forsomeadolescents,suchasfirst-yearcollegestudentslivingindormitories,thereisanincreasedriskofmeningococcaldisease.EveryyearintheUnitedStatesapproximately2,500peopleareinfectedand300diefromthedisease.Otherpersonsatincreasedriskincludehouseholdcontactsofapersonknowntohavehadthisdisease,immunocompromisedpeople,andpeopletravelingtopartsoftheworldwheremeningococcalmeningitisisprevalent.
Howisthemeningococcusgermspread?
Themeningococcusgermisspreadbydirectclosecontactwithnoseorthroatdischargesofaninfectedperson.
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Whatarethesymptoms?
Highfever,headache,vomiting,stiffneckandarasharesymptomsofmeningococcaldisease.Thesymptomsmayappeartwoto10daysafterexposure,butusuallywithinfivedays.Amongpeoplewhodevelopmeningococcaldisease,10to15percentdie,inspiteoftreatmentwithantibiotics.Ofthosewholive,permanentbraindamage,hearingloss,kidneyfailure,lossofarmsorlegs,orchronicnervoussystemproblemscanoccur.
Whatisthetreatmentformeningococcaldisease?
Antibiotics,suchaspenicillinGorceftriaxone,canbeusedtotreatpeoplewithmeningococcaldisease.
Shouldpeoplewhohavebeenincontactwithadiagnosedcaseofmeningococcalmeningitisbetreated?
Onlypeoplewhohavebeeninclosecontact(householdmembers,intimatecontacts,healthcarepersonnelperformingmouth-to-mouthresuscitation,daycarecenterplaymates,etc.)needtobeconsideredforpreventivetreatment.Suchpeopleareusuallyadvisedtoobtainaprescriptionforaspecialantibiotic(eitherrifampin,ciprofloxacinorceftriaxone)fromtheirphysician.Casualcontact,asmightoccurinaregularclassroom,officeorfactorysetting,isnotusuallysignificantenoughtocauseconcern.
Isthereavaccinetopreventmeningococcalmeningitis?
Therearethreevaccinesavailableforthepreventionofmeningitis.Thepreferredvaccineforpeopleages2-55yearsisMeningococcalconjugatevaccine(MCV4).ThisvaccineislicensedasMenactra(sanofipasteur)andMenveo(Novartis).Meningococcalpolysaccharidevaccine(MPSV4;Menomune[sanofipasteur]),shouldbeusedforadultsages56andolder.Thevaccinesare85to100percenteffectiveinpreventingthefourkindsofmeningococcusgerm(typesA,C,Y,W-135).Thesefourtypescauseabout70percentofthediseaseintheUnitedStates.BecausethevaccinesdonotincludetypeB,whichaccountsforaboutone-thirdofcasesinadolescents,theydonotpreventallcasesofmeningococcaldisease.
Isthevaccinesafe?Arethereadversesideeffectstothevaccine?
Thethreevaccinesavailabletopreventmeningococcalmeningitisaresafeandeffective.However,thevaccinesmaycausemildandinfrequentsideeffects,suchasrednessandpainattheinjectionsitelastinguptotwodays.
Whoshouldgetthemeningococcalvaccine?
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Thevaccineisroutinelyrecommendedforalladolescentsages11-12years,allunvaccinatedadolescents13-18years,andpersons19-21yearswhoareenrollingincollege.Thevaccineisalsorecommendedforpeopleages2yearsandolderwhohavehadtheirspleenremovedorhaveotherchronicillnesses,aswellassomelaboratoryworkersandtravelerstoendemicareasoftheworld.
Whoneedsaboosterdoseofmeningococcalvaccine?
CDCrecommendsthatchildrenage11or12yearsberoutinelyvaccinatedwithMenactraorMenveoandreceiveaboosterdoseatage16years.Adolescentswhoreceivethefirstdoseatage13-15yearsshouldreceiveaone-timeboosterdose,preferablyatages16-18years.Teenswhoreceivetheirfirstdoseofmeningococcalconjugatevaccineatorafterage16yearsdonotneedaboosterdose,aslongastheyhavenoriskfactors.
Allpeoplewhoremainathighestriskformeningococcalinfectionshouldreceiveadditionalboosterdoses.Ifthepersonisage56yearsorolder,theyshouldreceiveMenomune.
HowdoIgetmoreinformationaboutmeningococcaldiseaseandvaccination?
Contactyourphysicianoryourstudenthealthservice.AdditionalinformationisalsoavailableonthewebsitesoftheNewYorkStateDepartmentofHealth,http://www.health.state.ny.us/;theCentersforDiseaseControlandPrevention,http://www.cdc.gov/DiseasesConditions/;andtheAmericanCollegeHealthAssociation,http://www.acha.org.au/info/general/Home/get/0/0/.
Methicillin-ResistantStaphylococcusAureus(MRSA)
WhatisStaphylococcusaureus?
Staphylococcusaureus("staph")isabacteriumthatiscarriedontheskinorinthenoseofapproximately25%to30%ofhealthypeoplewithoutcausinginfection--thisiscalledcolonization.StaphbacteriaareoneofthemostcommoncausesofskininfectionsintheU.S.Mostoftheseskininfectionsareminor(suchaspimplesandboils),arenotspreadtoothers(notinfectious),andusuallycanbetreatedwithoutantibiotics.However,somestaphbacteriaareresistanttocertainantibiotics--onetypeiscalledMRSA.
WhatisMRSA?
MRSAstandsformethicillin-resistantStaphylococcusaureus.MRSAisastaphbacteriumthatcertainantibioticsinthepenicillinfamilyshouldbeabletotreat,butcannot.Whentheinfectionisresistanttothemedication,itiscalledresistance.However,othernon-penicillinantibioticscaneffectivelytreatmostMRSAinfections.
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Whatcausesantibioticresistance?
Mostresistancetoantibioticsdevelopsfromtakingthemimproperly.Examplesare:
• Incompleteuse:Notfinishingtheentireantibioticprescription(oftenbecausepeoplestarttofeelbetterandstoptakingthemedication).
• Inappropriateuse:Takingantibioticsforaviralinfection(antibioticsdoNOTtreatviralinfectionssuchascoldsortheflu).
• Unnecessaryuse:Takingantibiotics"justincase"(forexample,takingthempriortoavacationorspecialeventtotrytopreventillness).
Itisimportanttotakeprescriptionmedicationonlywhenprescribedforyoubyahealthprofessionalandtotakeallthemedicineevenifyoufeelbetterbeforeyouhavecompletedtheprescription.
HowseriousisMRSA?
AlthoughhealthcareproviderscantreatmostMRSAskininfectionsintheiroffices,MRSAcanbeveryseriousandevencausedeath.MRSAcancausepneumoniaorsevereinfectionsoftheblood,bones,surgicalwounds,heartvalves,andlungs.MRSAcanbefatalifnotidentifiedandtreatedwitheffectiveantibiotics.
HowdoessomeonegetMRSAinfection?
Mostoften,MRSAistransmittedbydirectskin-to-skincontactwithsomeonewhohastheinfection.
MRSAcanbespreadbyindirectcontacttoo(forexamplecontactwithamatthathasinfecteddrainageonitorbysharingatowelorcellphonewithsomeonewhohasMRSA).Becauseofthis,neversharepersonalhygieneandhealthitems.
WhereontheskindoesMRSAappearandwhatarethesymptoms?
MRSAinfectionscommonlyoccurwherethereisabreakintheskin(forexample,acutorwound),especiallyinareascoveredbyhair(forexample,thebeardarea,backoftheneck,armpit,groin,legs,orbuttocks)
MRSAmaylooklikeabumpontheskinthatmaybered,swollen,warmtothetouch,painful,filledwithpus,ordraining.Thepusordrainagecontainstheinfectiousbacteriathatcanbespreadtoothers.PeoplewithMRSAmayhaveafever.
HowisMRSAdiagnosedandtreated?
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Dependingonyoursymptoms,yourhealthcareprovidermaysendanasalswaborskintissuespecimentoalaboratorytoidentifytheinfectionorconfirmthatyouhaveMRSA.
Yourhealthcareprovidermaydrainthepusfromthelesion--donotdothisyourself.
Ifyouareprescribedanantibiotic,takeitexactlyasdirectedandtakeallofthemedicineeveniftheinfectionimprovesorgoesawaybeforeyouhavefinishedtheentireprescription.Iftheinfectiondoesnotbegintoimprovewithinafewdays,contactyourhealthcareprovider.
Mumps(InfectiousParotitis)
Whatismumps?
Mumpsisaviraldiseasecharacterizedbyfever,headache,muscleweakness,stiffneck,lossofappetite,swellingandtendernessofoneormoreofthesalivaryglandssituatedalongtheangleofthejawandinsidethemouth,includingtheparotidglandlocatedwithinthecheeksjustbelowthefrontoftheear.
Whogetsmumps?
ThenumberofcasesofmumpsdecreaseddramaticallyintheUnitedStatesfollowingtheintroductionofthemumpsvaccinein1967,fromanestimated100,000-200,000tofewerthan300casesannually.IntheUnitedStates,since2001,anaverageof265mumpscaseshasbeenreportedeachyear.
Recently,therehasbeenanincreaseinthenumberofmumpscasesreported.In2006,over6,000casesofmumpswerereportedacrossthenation.
Howismumpsspread?
Mumpsistransmittedbydirectcontactwithsalivaproducedinthemouthanddischargesfromthenoseandthroatofinfectedindividuals.
Whatarethesymptomsofmumps?
Symptomsofmumpsincludealow-gradefever,headache,muscleaches,stiffneck,tirednessandlossofappetitefollowedbyswellingandtendernessofoneormoreofthesalivaryglands,includingtheparotidgland.Approximatelyone-thirdofinfectedpeopledonothavenoticeablesalivaryglandswelling.Upto50%ofmumpsinfectionsarenotspecifictoanysymptomsand15-20%ofallcasespresentwithoutanysymptoms.
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Howsoonafterinfectiondosymptomsoccur?
Theincubationperiodisusually16to18days,althoughitmayvaryfrom12to25days.
Whatcomplicationshavebeenassociatedwithmumps?
Severecomplicationsarerare.However,mumpscancauseinflammationofthebrainand/ortissuecoveringthebrainandspinalcord(encephalitis/meningitis),inflammationofthetesticles(orchitis),inflammationoftheovaries(oophoritis)and/orbreasts(mastitis),inflammationofthepancreas(pancreatitis),spontaneousabortionanddeafness,whichisusuallypermanent.
Whatisthetreatmentformumps?
Thereisnospecifictreatmentformumps.
Whenandforhowlongisapersonabletospreadmumps?
Mumpsiscontagiousthreedaysbeforeuntil5daysaftertheonsetofparotitis(inflammationoftheparotidgland).
Doespastinfectionwithmumpsmakeapersonimmune?
Immunityacquiredaftercontractingthediseaseisusuallylongterm.
Isthereavaccineformumps?
Yes.Themumpsvaccine,whichiscontainedintheMMR(measles,mumps,andrubella)vaccine,canpreventthisdisease.Mumps-containingvaccineisrecommendedforanyonebornonorafterJanuary1,1957,whodoesnothaveahistoryofphysician-diagnosedmumpsorabloodtestconfirmingmumpsimmunity.Evidenceofimmunitythroughdocumentationofadequatevaccinationisnowdefinedas1doseofalivemumpsvirusvaccineforpreschool-agedchildrenandadultsnotathighriskand2dosesforschool-agedchildren(i.e.,gradesK—12,)andforadultsathighrisk(i.e.,healthcarepersonnel,internationaltravelers,andstudentsatpost-high-schooleducationalinstitutions).ThefirstdoseofMMRisgivenat12to15monthsofageandtheseconddoseisgivenbetween4to6yearsofage.Ifyoudonotknowifyouhavebeenvaccinatedorhadmumpsdiseasediagnosedbyaphysician,vaccinationisrecommended.
InNewYorkState,mumpsimmunizationisrequiredofallchildrenenrolledinpre-kindergartenprogramsandschool.Collegestudentsarealsorequiredtodemonstrateimmunityagainstmumps.Itisrecommendedthathealthcarepersonneldemonstrateimmunityagainstmumps.
Whatcanbedonetopreventthespreadofmumps?
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ThesinglemosteffectivecontrolmeasureistobevaccinatedwithtwoMMRvaccinesunlessthereisevidenceofpriorimmunitytomumps.Personsdiagnosedwithmumpsshouldremainathomeduringtheirinfectiousperiod(untilafter5daysofsymptomonset).
Ringworm(Tinea)
Whatisringworm?
Ringwormisacommon,contagiousskininfection.RingwormisNOTcausedbyaworm.Atypeoffunguscalledadermatophytecausesit.Dermatophytesalsocauseothercommonskin,hair,andnailinfections,includingathlete'sfootandjockitch.
Howdoesringwormspread?
Thedermatophytethatcausesringwormcanbepassedfrompersontopersonbydirectskin-to-skincontactorbycontactwithcontaminateditemssuchascombs,unwashedclothing,andshowersurfaces.Somepets(includingcatsanddogs)andlivestock(suchascows,goats,horses,andpigs)cancarrythefungusandtransmitittopeople.Becausedermatophytesthriveinwarm,moistareas,athletesareatriskforringwormbecausetheyarelikelytosweatandbearoundotherswhoaresweating.Thisiswhypreventionissoimportant.
Whatarethesymptomsofringworm?
• Itchy,red,raised,scalypatchesthatmayblisterandooze.• Sharply-definededgesintheshapeofacircleoraring.• Oftenredderaroundtheoutsidewithnormalskintoneinthecenter.• Skinmayappearunusuallydarkorlight.• Baldpatchesonscalp.• Fingerandtoenailsthatarediscolored,thick,orcrumble.
Howisringwormdiagnosed?
Medicalprofessionalshaveseveralwaystodetermineifyouhaveringworm.Theycan:
• Diagnoseitbasedonhowtherashoraffectedarealooks.• Examineyourskininadarkroomwithaspecialbluelight(calledaWood'slamp)that
usesultravioletlighttolookforchangesinyourskincolor.• Scrapesomeoftheaffectedareafromyourskinandexaminethecellsundera
microscope.
Howisringwormtreated?
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Athleteswithrashesshouldcontacttheirdoctor.Ifadoctordiagnosestherashasringworm,theymayprescribeafungicidalmaterialtoswallowastabletsorpowdersthatcanbeapplieddirectlytotheaffectedareas.
Rubella(GermanMeaslesorThree-DayMeasles)
Whatisrubella?
Rubellaisahighlycontagiousviraldiseasecharacterizedbyslightfever,mildrashandswollenglands.Althoughmostcasesaremild,ifrubellaiscontractedearlyinpregnancy,itcanspreadfromthemothertoherdevelopingbabythroughthebloodstreamandresultinbirthdefectsand/orfetaldeath.Asaresultofwidespreadimmunization,rubelladoesnotcirculateintheUnitedStates,butcanbecontractedthroughforeigntravel.
Whogetsrubella?
ThenumberofcasesofrubelladecreaseddramaticallyintheUnitedStatesfollowingtheintroductionoftherubellavaccinein1969.Thedecreasewasgreatestamongchildren.AdultsaccountforanincreasingproportionofthefewcasesthatstilloccurinUnitedStates.Theseareoftenindividualswhoremainunvaccinatedforreligiousreasonsorareforeign-bornimmigrantswhocomefromareaswhererubellavaccineisnotroutinelyused.RubellastillremainsacommondiseaseinmanypartsoftheworldandtheriskofexposuretorubellaoutsideoftheUnitedStatesishigh.Travelerstocountrieswhererubellacasesstilloccurshouldbeimmunetorubella.
Howisrubellaspread?
Rubellaisspreadbydirectcontactwithnasalorthroatsecretionsofinfectedindividuals.Rubellacanalsobetransmittedbybreathingindropletsthataresprayedintotheairwhenaninfectedpersonsneezes,coughsortalks.
Whatarethesymptomsofrubella?
Rubellaisamildillnesswhichmaypresentfewornosymptoms.Symptomsmayincludearash,slightfever,jointaches,headache,discomfort,runnynose,sorethroatandreddenedeyes.Thelymphnodesjustbehindtheearsandatthebackoftheneckmayswell,causingsomesorenessand/orpain.Therash,whichmaybeitchy,firstappearsonthefaceandprogressesfromheadtofoot,lastingaboutthreedays.Asmanyashalfofallrubellacasesoccurwithoutarash.Howsoondosymptomsappear?
Theusualincubationperiodforrubellais14days;witharangeof12to23days.
Whatarethecomplicationsassociatedwithrubella?
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Complicationsoccurmorefrequentlyinadultwomen,whomayexperiencearthritisorarthralgia,oftenaffectingthefingers,wristsandknees.Thesejointsymptomsrarelylastformorethanamonthafterappearanceoftherash.
Upto85percentofinfantsinfectedwithrubellainthefirsttrimesterofpregnancywillsufferbirthdefectsand/orneurologicabnormalities(CongenitalRubellaSyndrome,CRS).
Whatisthetreatmentforrubella?
Thereisnospecifictreatmentforrubella.
Whenandforhowlongisapersonabletospreadrubella?
Rubellamaybetransmittedfromsevendaysbeforetosevendaysaftertherashappears.
Doespastinfectionwithrubellamakeapersonimmune?
Yes.Immunityacquiredaftercontractingthediseaseisusuallypermanent.
Whatisthevaccineforrubella?
Rubellavaccineisgivenincombinationmeasles,mumps,rubella(MMR)vaccineandisrecommendedforanyonebornonorafterJanuary1,1957whodoesnothavelaboratoryevidenceofrubellaimmunity.Birthbefore1957isnotacceptableevidenceofrubellaimmunityforwomenwhocouldbecomepregnant;womenofchildbearingageshouldhavetheirimmunitycheckedandreceiverubellavaccineifneeded.
Althoughonlyonedoseofrubella-containingvaccineisrequiredasacceptableevidenceofimmunitytorubella,childrenshouldreceivetwodosesofMMRvaccine.Rubellavaccineisfirstgivenonorafterachild'sfirstbirthdayasMMRvaccine.Childrenusuallyreceivethefirstdosebetween12and15monthsofageandtheseconddosepriortoschoolentryatfourtosixyearsofage.
InNewYorkState,rubellavaccineisrequiredofallchildrenenrolledinallpre-kindergartenprogramsandschools.Healthcarepersonnelandcollegestudentsarealsorequiredtodemonstrateimmunityagainstrubella.
Whatisthedangerofnotbeingimmunizedagainstrubella?
Rubellainfectionisdangerousbecauseofitsabilitytodamageanunbornbaby.Ifrubellaimmunizationwasdiscontinued,immunitytorubellawoulddeclineandrubelladiseasewouldreturn.Thedangerwouldbetopregnantwomenwho,ifinfected,couldpassthediseasetotheirinfants(fetuses)causingCRS.
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Whatcanbedonetopreventthespreadofrubella?
Maintaininghighlevelsofrubellaimmunizationinthecommunityiscriticaltocontrollingthespread.ControlofthespreadofrubellaisneededprimarilytopreventthebirthdefectscausedbyCRS.Therefore,womenofchildbearingageshouldhavetheirimmunitycheckedandreceiverubellavaccineifneeded.Infectedindividualsshouldbeexcludedfromworkorschoolduringtheirinfectiousperiod.
Whatiscongenitalrubellasyndrome(CRS)?
Congenitalrubellasyndromeoccursamongatleast25percentofinfantsborntowomenwhohadrubelladuringthefirstthreemonthsofpregnancy.Infectionofapregnantwomancanresultinamiscarriage,stillbirthorthebirthofaninfantwithabnormalitieswhichmayincludedeafness,blindness,cataracts,heartdefects,mentalretardation,liverandspleendamage.
Mononucleosis,Infectious(Mono,EBVmononucleosis)
Whatisinfectiousmononucleosis?
Infectiousmononucleosisisaviraldiseasethataffectscertainbloodcells.ItiscausedbytheEpstein-Barrvirus(EBV),whichisamemberoftheherpesvirusfamily.Mostcasesoccursporadically.Outbreaksarerare.
Whogetsinfectiousmononucleosis?
WhilemostpeopleareexposedtotheEpstein-Barrvirussometimeintheirlives,veryfewgoontodevelopthesymptomsofinfectiousmononucleosis.Inunderdevelopedcountries,peopleareexposedinearlychildhoodwheretheyareunlikelytodevelopnoticeablesymptoms.IndevelopedcountriessuchastheUnitedStates,theageoffirstexposuremaybedelayedtoolderchildhoodandyoungadultagewhensymptomsaremorelikelytoresult.Forthisreason,itisrecognizedmoreofteninhighschoolandcollegestudents.
Howisinfectiousmononucleosisspread?
Thevirusisspreadbyperson-to-personcontact,viasaliva(onhandsortoys,orbykissing).Inrareinstances,thevirushasbeentransmittedbybloodtransfusion.
Whatarethesymptomsofinfectiousmononucleosis?
Symptomsincludefever,sorethroat,swollenglandsandfeelingtired.Sometimes,theliverandspleenareaffected.Durationisfromonetoseveralweeks.Thediseaseisveryrarelyfatal.
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Howsoondosymptomsappear?
Symptomsappearfromfourtosixweeksafterexposure.
Whenandforhowlongisapersonabletospreadinfectiousmononucleosis?
Thevirusisshedinthethroatduringtheillnessandforuptoayearafterinfection.Aftertheinitialinfection,thevirustendstobecomedormantforaprolongedperiodandcanlaterreactivateandbeshedfromthethroatagain.
Whatisthetreatmentforinfectiousmononucleosis?
Notreatmentotherthanrestisneededinthevastmajorityofcases.
Whatcanapersondotominimizethespreadofinfectiousmononucleosis?
Avoidactivitiesinvolvingthetransferofbodyfluids(commonlysaliva)withsomeonewhoiscurrentlyorrecentlyinfectedwiththedisease.Atpresent,thereisnovaccineavailabletopreventinfectiousmononucleosis.
Pertussis(WhoopingCough)
Whatispertussis?
Pertussis,orwhoopingcough,isahighlycontagiousbacterialinfectionthatcausesanuncontrollable,violentcoughlastingseveralweeksorevenmonths.Itiscausedbyabacteriumthatisfoundinthemouth,noseandthroatofaninfectedperson.Pertussismaybeginwithcold-likesymptomsoradrycoughthatprogresstoepisodesofseverecoughing.Whogetspertussis?
Pertussiscanoccuratanyage.Childrenwhoaretooyoungtobefullyvaccinatedandthosewhohavenotyetcompletedtheprimaryvaccinationseriesareathighestriskforsevereillness.Sincethe1980s,thenumberofreportedpertussiscaseshasgraduallyincreasedintheUnitedStates.In2005,over25,000casesofpertussiscaseswerereportedintheUnitedStates,thehighestnumberofreportedcasessince1959.Approximately60percentofthecaseswereinadolescentsandadultsandmaybearesultofdecreasingimmunityinthispopulation.
Howispertussisspread?
Pertussisisprimarilyspreadfrompersontopersonbydirectcontactwithmucusordropletsfromthenoseandthroatofinfectedindividuals.Frequently,oldersiblingswhomaybeharboringthebacteriaintheirnoseandthroatcanbringthediseasehomeandinfectaninfantinthehousehold.
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Whatarethesymptomsofpertussis?
Pertussisbeginsasamildupperrespiratoryinfection.Initially,symptomsresemblethoseofacommoncold,includingsneezing,runnynose,low-gradefeverandamildcough.Withintwoweeks,thecoughbecomesmoresevereandischaracterizedbyepisodesofnumerousrapidcoughsfollowedbyacrowingorhighpitchedwhoop.Athick,clearmucousmaybedischargedfromthenose.Theseepisodesmayrecurforonetotwomonths,andaremorefrequentatnight.Olderpeopleorpartiallyimmunizedchildrengenerallyhavemildersymptoms.
Howsoonafterinfectiondosymptomsappear?
Theincubationperiodisusuallyseventotendayswitharangeoffourto21daysandrarelymaybeaslongas42days.
Whenandforhowlongisapersonabletospreadpertussis?
Ifuntreated,apersoncantransmitpertussisfromonsetofsymptomstothreeweeksaftertheonsetofcoughingepisodes.Theperiodofcommunicabilityisreducedtofivedaysaftertreatmentwithantibiotics.
Whatarethecomplicationsassociatedwithpertussis?
Majorcomplicationsofpertussisaremorecommonamonginfantsandyoungchildrenandmayincludepneumonia,middleearinfection,lossofappetite,sleepdisturbance,syncope(temporarylossofconsciousness),dehydration,seizures,encephalopathy(adisorderofthebrain),apneicepisodes(briefdelayinbreathing)anddeath.
Whatisthetreatmentforpertussis?
Therecommendedantibioticsforthetreatmentandpostexposurepreventionofpertussisincludeazithromycin(Zithromax),erythromycinandclarithromycin(Biaxin).Alternately,trimethoprim-sulfamethoxazole(Bactrim)canbeused.
Doespastinfectionwithpertussismakeapersonimmune?
Neithervaccinationnornaturalinfectionwithpertussisguaranteeslifelongprotectiveimmunityagainstpertussis.Sinceimmunitydecreasesafterfivetotenyearsfromthelastpertussisvaccinedose,olderchildren,adolescentsandadultsareatriskofbecominginfectedwithpertussisandneedvaccination.
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Whatisthevaccineforpertussis?
InfantsandChildren
Thechildhoodvaccineforpertussisisusuallygivenincombinationwithdiphtheriaandtetanus.ImmunizationauthoritiesrecommendthatDTaP(diphtheria,tetanus,acellularpertussis)vaccinebegivenattwo,four,andsixand15to18monthsofageandbetweenfourandsixyearsofage.
Pre-teensandAdolescents
In2005,anewvaccinewasapprovedasasingleboostervaccinationforadolescentsandadultscalledTdap(tetanus,diphtheria,andacellularpertussis).
ThepreferredageforroutinevaccinationwithTdapis11or12yearsold.Adolescents,aged11through18shouldreceiveasingledoseofTdapinsteadofTd(tetanus,diphtheria)forboosterimmunizationagainsttetanus,diphtheria,andpertussisiftheyhavecompletedtherecommendedchildhoodDTP/DTaPvaccinationseries.
AsingledoseofTdapvaccineisalsorecommendedforchildrenaged7through10yearswhoarenotfullyvaccinatedagainstpertussis.
Adults
Alladultsover19yearsofagewhohaveorwhoanticipatehavingclosecontactwithaninfantshouldreceiveasingledoseofTdaptoprotectagainstpertussisandreducethelikelihoodoftransmission.Forotheradultsaged65yearsandolder,asingledoseofTdapvaccinemaybegiveninsteadofTdvaccineinpersonswhohavenotpreviouslyreceivedTdap.TdapcanbeadministeredregardlessofintervalsincethelastTdvaccine.
Healthcarepersonnel,regardlessofage,shouldreceiveasingledoseofTdapiftheyhavenotpreviouslyreceivedTdapandregardlessofthetimesincetheirmostrecentTdvaccination.
InNewYorkState,pertussisvaccineisrequiredofallchildrenbornafter1/1/2005whowillbeenrolledinpre-kindergartenprogramsandschools.Tdapvaccineisrequiredforchildrenbornonorafter1/1/1994andenrollinginthe6ththrough11thgrade.
Whatcanbedonetopreventthespreadofpertussis?
Thesinglemosteffectivecontrolmeasureismaintainingthehighestpossiblelevelofimmunizationinthecommunity.Treatmentwithappropriateantibiotics,suchasZithromax,willshortenthetimeapersoncanspreadpertussistofivedaysafterthebeginningoftreatment.Peoplewhohaveormayhavepertussisshouldstayawayfromyoungchildrenandinfantsuntilproperlytreated.Treatmentofpeoplewhoareclosecontactsofpertussiscasesisalsoanimportantpartofprevention.
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Whatisparapertussis?
Parapertussisisabacterialillnessthatissimilartopertussis(whoopingcough)butisnotascommonandgenerallycauseslessseveresymptoms.Upto40percentofallcasesofparapertussiswillpresentwithnosymptoms.Veryyounginfants(lessthansixmonthsofage)mayhaveamoreseverecourseofparapertussisthanolderpersons.Parapertussisisspreadthroughtheairindropletsproducedduringcoughingandsneezing.Apersoncanbeinfectedwithparapertussisandpertussisatthesametime.Parapertussiscanbedistinguishedfrompertussisbycertainlaboratorytests.Antibiotictreatmentshouldbestartedassoonasparapertussisissuspected.Allinfantslessthansixmonthsofageshouldreceiveantibioticsasapreventivemeasureiftheyhavebeenincontactwithapersonwhohasparapertussis.
Scabies
Whatisscabies?
Scabiesisafairlycommoninfectiousdiseaseoftheskincausedbyamite.Scabiesmitesburrowintotheskinproducingpimple-likeirritationsorburrows.
Whogetsscabies?
Scabiesinfestationscanaffectpeoplefromallsocioeconomiclevelswithoutregardtoage,sex,raceorstandardsofpersonalhygiene.Clustersofcasesoroutbreaksareoccasionallyseeninnursinghomes,institutionsandchildcarecenters.
Howisscabiesspread?
Scabiesmitesaretransferredbydirectskin-to-skincontact.Indirecttransferfromundergarmentsorbedclothescanoccuronlyifthesehavebeencontaminatedbyinfestedpeopleimmediatelybeforehand.Scabiescanalsobetransmittedduringsexualcontact.
Whatarethesymptomsofscabies?
Themostprominentsymptomofscabiesisintenseitchingparticularlyatnight.Theareasoftheskinmostaffectedbyscabiesincludethewebsandsidesofthefingers,aroundthewrists,elbowsandarmpits,waist,thighs,genitalia,nipples,breastsandlowerbuttocks.
Howsoondosymptomsappear?
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Symptomswillappearfromfourtosixweeksinpeoplewhohavenotpreviouslybeenexposedtoscabiesinfestations.Peoplewhohavehadapreviousboutwithscabiesmitesmayshowsymptomswithinonetofourdaysaftersubsequentre-exposures.
Whenandforhowlongisapersonabletospreadscabies?
Apersonisabletospreadscabiesuntilmitesandeggsaredestroyedbytreatment.
Whatisthetreatmentforscabies?
Skinlotionsorcreamscontainingscabicidesareavailablethroughaphysician'sprescriptionforthetreatmentofscabies.Thelotionsareappliedtothewholebodybelowthehead.Sometimes,itchingmaypersistbutshouldnotberegardedastreatmentfailureorreinfestation.Personswhohavehadskincontactwithaninfestedperson(includingfamilymembers,roommates,directcareprovidersandsexualcontacts)shouldalsobetreated.Whatcanbedonetopreventthespreadofscabies?
Avoidphysicalcontactwithinfestedindividualsandtheirbelongings,especiallyclothingandbedding.Healtheducationonthelifehistoryofscabies,propertreatmentandtheneedforearlydiagnosisandtreatmentofinfestedindividualsandcontactsisextremelyimportant.
SARS(SevereAcuteRespiratorySyndrome)WhatisSARS?
Severeacuterespiratorysyndrome(SARS)isaviralrespiratoryillnessthatwasfirstreportedinAsiainFebruary2003.Overthenextfewmonths,theillnessspreadtomorethantwodozencountriesinNorthAmerica,SouthAmerica,EuropeandAsia.BylateJuly2003,nonewcaseswerebeingreportedandtheoutbreakwasconsideredcontained.Duringthisoutbreak,8,098peopleworldwidebecamesickwithSARS,resultingin774deaths.ThemostrecentcasesofSARSwerereportedinChinainApril2004inanoutbreakresultingfromexposurestothevirusthatoccurredinalaboratory.
WhatarethesymptomsandsignsofSARS?
Theillnessusuallybeginswithahighfever(temperaturegreaterthan100.4degreesF).Thefeverissometimesassociatedwithchillsorothersymptoms,includingaheadache,ageneralfeelingofdiscomfortandbodyaches.Somepeoplealsoexperiencemildrespiratorysymptomsattheoutset.Approximately10-20percentofpatientshavediarrhea.Aftertwotosevendays,SARSpatientsmaydevelopadrycoughwithmostdevelopingpneumonia.
WhatisthecauseofSARS?
SARSiscausedbyacoronaviruscalledSARS-associatedcoronavirus.Coronavirusesareacommoncauseofmildtomoderateupperrespiratoryillnessinhumans.Thereisnotenoughinformationaboutthevirustodeterminethefullrangeofillnessthatitmightcause.
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Coronaviruseshaveoccasionallybeenlinkedtopneumoniainhumans,especiallypeoplewithweakenedimmunesystems.Thevirusesalsocancauseseverediseaseinanimals,includingcats,dogs,pigs,miceandbirds.
HowisSARSSpread?
SARSismainlyspreadbycloseperson-to-personcontact.ThevirusthatcausesSARSisthoughttobetransmittedmostreadilybybeingwithin3feetofrespiratorydropletsproducedwhenaninfectedpersonsneezesand/orbytouchingasurfaceorobjectcontaminatedwithinfectiousdroplets.ClosecontactisdefinedashavingcaredfororlivedwithapersonknowntohaveSARSorhavingdirectcontactwithsecretionsand/orbodyfluidsofapatientknowntohaveSARS.Examplesincludekissingorembracing,sharingeatingordrinkingutensils,closeconversation(withinthreefeet)orphysicalcontact.Closecontactdoesnotincludewalkingnearapersonorsittingacrossawaitingroomorofficeforabrieftime.
WhoisatriskforgettingSARS?
MostexposurestoSARSoccurinhealthcarefacilitiesandhouseholds.Communitytransmissionoutsideofthesesettingshasbeenreported,buttheseoccurredrarely.Personsatriskinhealthcarefacilitiesincludehealthcareworkers,patientsandvisitors.Inhouseholds,thegreatestriskistofamilymembersofSARSpatients.Transmissioncouldoccurinalaboratoryifpropersafetyproceduresarenotstrictlyfollowed.
Inaddition,itispossiblethatSARSvirusmightbespreadmorebroadlythroughtheairorbyotherwaysthatarenotyetknown.
IfIwereexposedtoSARS,howlongwouldittakeformetobecomesick?
Theincubationperiod(thetimebetweenexposuretotheSARSvirusandonsetofsymptoms)istypicallytwotosevendays,althoughinsomecasesitmaybeaslongas10days.
HowlongisapersonwithSARSinfectioustoothers?
InformationsuggeststhatpeoplewithSARSaremostlikelytobeinfectiousonlywhentheyhavesymptomssuchasfeverorcough.However,asaprecautionagainstspreadingthedisease,CDCrecommendsthatpeoplewithSARSlimittheirinteractionsoutsidethehome(stayhomefromworkandschool)until10daysaftertheirsymptomshavegoneaway.
DosomepeoplewhorecoverfromSARSbecomesickagainorrelapse?
CDCandotherscientistsaretryingtogainafullunderstandingofwhatfactorsmightinfluenceillnessprogressionandrecovery.Suchfactorscouldberelatedtothevirusitself,howthebody'simmunesystemreactstothevirusorhowinfectionwiththevirusistreated.HowwidespreadwastheSARSoutbreakintheUnitedStates?
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ThroughJuly2003,atotalof192SARScaseshadbeenreportedintheUnitedStates,including159suspectand33probablecases;ofthe33probablecasesonly8hadlaboratoryevidenceoftheSARSvirus.NoSARS-relateddeathsoccurredintheU.S.SARScasesreportedintheU.S.occurredprimarilyamongpeoplewhotraveledtoSARS-affectedareas;asmallnumberofpeoplebecameillafterbeinginclosecontactwith(havingcaredfororlivedwith)aSARSpatientwhileintheU.S.
WhatwasdonetocontaintheSARSoutbreakintheU.S.?
TominimizetheriskforSARSamongU.S.residents,thepublichealthsystemtookcarefulandthoroughprecautionstopreventthespreadofSARS.PeoplewhoweresuspectedofhavingSARSwereisolatedfromothersandreceivedcare.Peoplearrivingfromaffectedpartsoftheworld(whomighthavebeenexposedtoSARS)receivedinformationaboutSARSandinstructionsonwhattheyshoulddoiftheybecameill.SARSpatientsandtheircontactsweremonitoredtohelppreventspreadofthedisease.
WhatdidCDCdotocombattheSARSoutbreak?
CDCworkedcloselywiththeWorldHealthOrganization(WHO)andotherpartnersinaglobalefforttoaddresstheSARSoutbreak.Foritspart,CDCtookthefollowingactions:
• ActivateditsEmergencyOperationsCentertoprovideround-the-clockcoordinationandresponse.
• Committedmorethan900medicalexpertsandsupportstafftoworkonSARSresponse.
• Deployedmedicalofficers,epidemiologistsandotherspecialiststoassistwithon-siteinvestigationsaroundtheworld
• ProvidedassistancetostateandlocalhealthdepartmentstoinvestigatepossiblecasesofSARSintheUnitedStates.
• ConductedextensivelaboratorytestingofclinicalspecimensfromSARSpatientstoidentifythecauseofthedisease.
• InitiatedasystemfordistributinghealthalertnoticestotravelerswhohavebeenexposedtocasesofSARS.
Inaddition,CDCiscontinuingtoworkwithfederal,stateandlocalhealthdepartmentsandotherprofessionalorganizationstoplanforarapidrecognitionandresponseshouldSARSre-emerge.
WhatisNewYorkStatedoingtoprepareitscitizensforapossiblereappearanceofSARS?
NewYorkStateispreparingforthepossiblereappearanceofSARSby:
1. EducatinghealthcareworkersaboutSARSdiagnosisandreporting,
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2. DevelopingSARSsurveillancesystemstodetermineifandwhereSARShasre-emerged,
3. Developingguidelinesforpreventingtransmissionindifferentsettings,and
4. ImprovinglaboratorytestsforSARS.
IfthereisanotheroutbreakofSARS,howcanIprotectmyselfandmyfamily?
IfSARSweretoreemerge,therearesomecommonsenseprecautionsthatyoucantakethatapplytomanyinfectiousdiseases.Themostimportantisfrequenthandwashingwithsoapandwateroruseofalcohol-basedhandrubs.Youshouldavoidtouchingyoureyes,noseandmouthwithuncleanhandsandencouragepeoplearoundyoutocovertheirnoseandmouthwithatissuewhencoughingorsneezing.
IsitsafetotraveltoothercountriesoutsideoftheU.S.?
Atthistime,thereisnoevidenceofongoingtransmissionofSARSanywhereintheworld.IntheabsenceofSARStransmission,thereisnoneedforconcernabouttravelorotheractivities.
SkinInfectionsinAthletes
Howcanskininfectionsaffectathletes?
Skininfectionscantakeathletesoutoftheactionandputthemonthesidelines.Wrestlers,rugbyplayers,andotherswhoparticipateinsportswherethereisdirectskin-to-skincontacthaveanincreasedriskofgettingcontagiousskininfections.However,athletes,coaches,trainers,schoolathleticprograms,andathleticclubscantakestepstopreventthespreadofskininfections.
Howseriousareskininfections?
Mostcasesofskininfectionsinathletesaremildandtreatable.Butwithouttherighttreatment,certainskininfectionscanbeveryseriousandevenlifethreatening.
WhatshouldIdoifIhavearashorskincondition?
• Tellyourcoachandyourparentorguardianifyouareaminor(under18yearsofage).Becauseitcanbedifficulttotellskinconditionsapart,haveahealthcareproviderdeterminewhatkindofrash,condition,orinfectionyouhaveandhowtotreatit.
• Donotpracticeorcompeteuntilyouaretoldbyamedicalprofessionalthatyourrashorskininfectioncannotbetransmittedtoothers.
• Donotcovercontagiousskininfectionsandcontinuetopracticeorcompete--bandagescanfalloffandyoucouldunintentionallyspreadtheinfectiontoanotherathlete.
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• Ifahealthcareproviderdeterminesthatyourrashorconditionisnotcontagious(suchaspsoriasis,eczema,acne,orheatrash),youcancontinuetoparticipateinyoursport.However,covertheaffectedareascompletelyandsecurelytoprotectyourskinbeforeyoupractice,play,orcompete.
• Ifyourrashorskinconditionisnotcontagious,butispainfulduringpracticeorcompetition,waituntilyoufeelbetterbeforeresumingyoursport.
Whatisthemostimportantwaytopreventthespreadofskininfections?
Handwashing(handhygiene)isthemostimportantwaytopreventthespreadofskininfectionsinanysetting.
Towashyourhandsproperly:
• Wetyourhandswithcleanwaterandapplysoap.Usewarmwaterifitisavailable.
• Rubhandstogethertomakealatherandscruballsurfaces.
• Continuerubbinghandsfor20seconds(thetimeittakestosing"HappyBirthday"twice).
• Rinsehandswellwithcleanwater.
• Dryyourhandsusingapapertowelorairdryer.
• Ifpossible,useyourpapertoweltoturnoffthefaucet.
Ifsoapandwaterarenotavailableandyourhandsarenotvisiblydirty,useanalcohol-basedhandsanitizer(60%alcoholorgreater)ifpermittedbyyourschoolorathleticclub.Ifalcohol-basedhandsanitizersarenotallowedorareunavailable,handsanitizersthatdonotcontainalcoholmayalsobeuseful.
Touseanalcohol-basedhandsanitizer:
• Applyproducttothepalmofonehand.
• Rubhandstogether.
• Rubtheproductoverallsurfacesofhandsandfingersuntilhandsaredry.
Asanathlete,whatcanIdotopreventgettingorspreadingskininfections?
• Reportanyskinlesionsorsorestoyourcoachingstaffimmediately(andparentorguardianifyouareunder18yearsofage).
• Haverashesandsoresevaluatedbyamedicalproviderbeforeresumingpracticeorcompetition.
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• Washyourhandsfrequentlyoruseanalcohol-basedhandsanitizer(ifapprovedbyyourschoolorclub)intheabsenceofsoapandcleanwater.
• Washyourhandsafterusingsharedequipment(suchasbarbellsandfreeweights).
• Useacleantowelasabarrierbetweenyourbareskinandsharedsurfaces(forexample,exerciseequipment,saunabenches,orphysicaltherapytablesandequipment).
• Avoidcontactwithothers'lesionsandpossiblycontaminateditems(forexample,bandages,towels,orgear).
• Washyourhandsaftercontactwithothers'potentiallyinfectiouswounds,skin,orsoiledbandages.
• Useyourowncontainerofliquidsoap(donotshare!)andshowerbeforeandassoonaspossibleafterEVERYpractice,game,ortournament.
• Avoidtouchingyoureyes,nose,ormouthwithyourhandstohelppreventthespreadofinfections.
• Donotpickorsqueezeskinsores,whichcanworsenaninfectionandpossiblyspreadittoothers.
• Completelyandsecurelycoverskininfectionsthatarenotcontagious(suchaseczema)beforepractice,meets,orgames.
• Donotsharetowels,washcloths,soap,razors,toothbrushes,ortopicalpreparations(includingdeodorants,lotions,ointments,gels,orcreams).
• Washtowelsaftereachuse,usinghotwaterwithdetergent(andbleachifpossible)anddrycompletelyonhighheatsetting.
• Washanddisinfect,asindicated,personalandsharedathleticgearandequipment(includingwrestlingmats).
• Launderuniformsandotherclothingaftereveryuse.
• Showerwithsoap(preferablyliquid,notbar,soap)beforeusingwhirlpools,coldtubs,steamrooms,orsaunas.
• Donotusewhirlpools,coldtubs,steamrooms,orsaunasifsores,scratches,scrapes,orwoundsarepresentanywhereonyourbody.
• Donotsharecellphones,beveragecontainers(suchaswaterbottlesorsportsdrinks),cigarettes,oranythingelsethattouchesthelips,entersthemouth,orhascontactwithanaffectedskinarea.
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Whatshouldcoaches,trainers,orotherauthorizedpersonsdotoreducethespreadofskininfectionsinathletes?
• Examineathletesforskininfectionsbeforeeachpracticeorcompetition:
o Excludeathleteswhohavecontagiousskininfectionsfrompracticeorcompetitionuntilamedicalproviderdeterminesthattheinfectionisnolongerinfectious.
o Complywithyourdistrict'sorclub'sstandardclearanceprocessbeforeallowingathletestoreturntosportsorphysicaleducationclass.
• Knowandusehandhygieneandteachathleteshowtoproperlywashtheirhandswithsoapandcleanwateroruseanalcohol-basedhandsanitizer(ifapprovedbytheschoolorclubadministration).Inaddition:
o Knowtheschoolorclubpolicyontheuseofalcohol-basedhandsanitizer.Iftheyareapprovedforuse,provideappropriatestudentsupervision.Insituationswhereaccesstosinksislimited(e.g.,inagymnasium),provideindividualcontainersofalcohol-basedhandsanitizertoeachteammember.
o Usehandhygieneaftercontactwithplayers,especiallyafterchangingbandagesorprovidingwoundcare.Authorizedpersonswhoassistwiththeapplicationofcleandressingsshouldweardisposableglovesandwashtheirhandsandforearmsimmediatelyafterremovinggloves.
o Remindathletestouseacleantowelasabarrierbetweenbareskinandsharedsurfacessuchasexerciseequipmenttoreducetheneedforfrequentsanitizerapplication.
• Forathleteswithskinwounds:
o Ensurethatnon-contagiousskinwoundsorconditionsarecoveredcompletelyandsecurely(bandagedandcoveredwithaprotectivesleeve)duringpracticesandmeets.
o Makesureallwounds(e.g.,cuts,scrapes,abrasions)arecoveredwithabandageuntilhealed--especiallywhencontactwithshareditems(suchasphysicaltherapyorweightequipment)mayoccur.
o Excludeathleteswithdraininglesionsoropenwounds(regardlessiftheyarecovered)fromswimmingpools,whirlpools,icetubs,saunas,andhottubs.
• Provideenoughcleantowelstoyourteamsothatnoonehastoshare,andremindathletesnottosharetowels,eveninthegymduringpracticeorcompetition.
Whatshouldschoolsandclubsdotopreventthespreadofskininfections?
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• Environmentalsurfacesintheathleticsettingshouldbecleanedanddisinfected.Establisharegularcleaningscheduleforsharedenvironmentalsurfacessuchaswrestlingmatsorstrength-trainingequipment:
o Sanitizematsandotherhigh-useequipmentbeforeeachpracticeandseveraltimesadaythroughoutatournament.
o Sanitizeallskin-contactpointsofweightequipmentatleastonceaday.
o UseasanitizerorUSEnvironmentalProtectionAgency(EPA)registereddisinfectantforuseagainstMRSAonsurfacesoruseafreshlymixedsolutionofonepartbleachto100partswater(1tablespoonbleachto1quartofwater).
o Followthedirectionslistedonthelabelsofallcleaninganddisinfectingproducts.Payparticularattentiontothecontacttimesfortheseproducts.
• Repairordiscardequipmentwithdamagedsurfacesthatcannotbeadequatelycleaned(e.g.,equipmentwithexposedfoam).
• Covertreatmenttables.Discardorlaundercoveringsaftereachuse.
• Ifsoiledlinensandclothingarewashedonschoolpremises,washwithregularlaundrydetergentinhotwater(minimum160°F).Ifthewatertemperatureisnot160°Forhigher,addonecupofbleachtothewash.Dryinahotdryer.Considerwearinggloveswhenhandlingdirtylaundry.
SexuallyTransmittedDiseases(STDs)Thetermsexuallytransmitteddiseaseisusedtocoverthemorethan25-30infectiousorganismsthatarespreadthroughsexualactivity.STDsarealmostalwaysspreadfrompersontopersonbysexualactivity.Theseinfectionsaremosteasilyspreadbyvaginaloranalintercourse,andsometimesbyoralsex.SomeSTDscanalsobespreadthroughblood,particularlyamongintravenous(IV)druguserswhomaybesharingdrugequipment(needles,syringes,or"works").Inaddition,pregnantwomenwithSTDsmaypasstheirinfectiontoinfantsintheuterus(womb),duringbirth,orthroughbreast-feeding.
MostpeoplewithSTDshavenosymptoms.Withouttreatmentthesediseasescanleadtomajorhealthproblemssuchasnotbeingabletogetpregnant(infertility),permanentbraindamage,heartdisease,cancer,andevendeath.Ifyouthinkyouhavebeenexposedtoasexuallytransmitteddisease,youandyoursexpartner(s)shouldvisitahealthclinic,hospitalordoctorfortestingandtreatment.
WheretoGoforSTDScreeningandTreatment
ManylocalandcountyhealthdepartmentshaveclinicswhereyoucangettestedandtreatedforSTDs.Someclinicsarefree,atothers,youmayhavetopaytogetSTDtestingandtreatment.TheSTDClinicsinNewYorkStatepagecontainslinkstocontactinformationforSTDclinicsorganizedbycounty.YoualsocancalltheNationalSTDhotline(1-800-232-4636)tofindaclinicnearyou.Link:http://www.health.ny.gov/diseases/communicable/std/clinics/
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YourdoctororhealthcareprovidermayalsodoSTDtestingandtreatment.Seeyourdoctororhealthcareproviderrightawayifyouhavesymptoms.Ifyoudonothaveadoctororhealthcareproviderandneedtogettestedrightaway,gotoalocalUrgentCarecenter,walkinclinicorhospitalemergencyroom.
STDLinksInformationonSTDsMoreinformationonspecificSTDsandtheirprevention,symptomsandtreatmentInformationonPartnerServicesInformationonExpeditedPartnerTherapyInternetResourcesSexuallyTransmittedDiseases-CentersforDiseaseControlandPreventionDivisionofSTDPrevention,NationalCenterforHIV,STDandTBPrevention-CDCIwannaknow.org-InformationAboutTeenSexualHealthandSTDsAmericanSocialHealthAssociationHepatitisInformation(NYSDOH)HIV/AIDSInformation(NYSDOH)ProviderResourcesClinicianReportingProceduresProviderHIVReportingandPartnerServicesTreatmentandLaboratoryGuidelinesCDCSTDTreatmentGuidelines2010Update:TetracyclineandDoxycyclineShortageandImpactstoRecommendedSTDTherapy(CDC)Update:OralCephalosporinsNoLongeraRecommendedTreatmentforGonococcalInfectionsMorbidityandMortalityWeeklyReport(MMWR)(August10,2012)HealthAdvisory:OralCephalosporinsnolongerrecommendedfortreatmentofgonoccalinfectionsintheUnitedStates(September2012)(PDF,105KB,3pg.)CongenitalSyphilisSurveillanceinUpstateNewYork,1989-1992TheJournalofInfectiousDiseases1995;171:732-52002LaboratoryGuidelinesScreeningTestsToDetectChlamydiatrachomatisandNeisseriagonorrhoeaeInfectionsProtocolfortheAcuteCareoftheAdultPatientReportingSexualAssaultExpeditedPartnerTherapyExpeditedPartnerTherapyforChlamydiatrachomatisPartnerServicesforSTD/HIVPreventionInformationonPartnerServicesRecommendationsforPartnerServicesProgramsforHIVInfection,Syphilis,Gonorrhea,andChlamydialInfection-November2008MMWR(PDF,698KB,92pg.)IntegratedSTD,HIVandViralHepatitisRiskAssessmentQuestionnaireEnglish(PDF,182KB,1pg.)Español(PDF,788KB,1pg.)HaitianCreole(PDF,433KB,1pg.)RiskQuestionnaire-Instructionsforstaff(PDF,23KB,3pg.)AnswerGuideforRiskQuestionnaire(PDF,31KB,1pg.)TrainingandReferenceNationalNetworkofSTD/HIVPreventionTrainingCentersSTD101inaBox-ReadytoUsePresentations-CDCThePractitioner'sHandbookfortheManagementofSTDs-SeattleSTD/HIVPreventionTrainingCenterStatisticsSTDDataandStatisticsSTDMaterialsOrderForm
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STDeducationmaterialsorderform
Tuberculosis(TB)Whatistuberculosis?
Tuberculosisisabacterialdiseaseusuallyaffectingthelungs(pulmonaryTB).Otherpartsofthebodycanalsobeaffected,forexamplelymphnodes,kidneys,bones,joints,etc.(extrapulmonaryTB).Approximately1,300casesarereportedeachyearinNewYorkState.
Whogetstuberculosis?
Tuberculosiscanaffectanyoneofanyage.Peoplewithweakenedimmunesystemsareatincreasedrisk.
Howistuberculosisspread?
TuberculosisisspreadthroughtheairwhenapersonwithuntreatedpulmonaryTBcoughsorsneezes.ProlongedexposuretoapersonwithuntreatedTBusuallyisnecessaryforinfectiontooccur.
Whatisthedifferencebetweenlatenttuberculosisinfectionandtuberculosisdisease?
Latenttuberculosisinfection(LTBI)meansthepersonhastheTBgermintheirbody(usuallylungs),buthasyettodevelopobvioussymptoms.InlatentTB,thepersonhasasignificantreactiontotheMantouxskintestwithnosymptomsoftuberculosis,andnoTBorganismsfoundinthesputum.Tuberculosisdiseaseindicatesthepersonhassymptoms,asignificantreactiontoaMantouxskintestandorganismsfoundinthesputum.InordertospreadtheTBgerms,apersonmusthaveTBdisease.HavinglatentTBinfectionisnotenoughtospreadthegerm.Tuberculosismaylastforalifetimeasaninfection,neverdevelopingintodisease.
Whatarethesymptomsoftuberculosis?
ThesymptomsofTBincludealow-gradefever,nightsweats,fatigue,weightlossandapersistentcough.Somepeoplemaynothaveobvioussymptoms.
Howsoondosymptomsappear?
MostpeopleinfectedwiththegermthatcausesTBneverdevelopactiveTB.IfactiveTBdoesdevelop,itcanoccurtwotothreemonthsafterinfectionoryearslater.Theriskofactivediseaselessensastimepasses.
Whenandforhowlongisapersonabletospreadtuberculosis?
ApersonwithTBdiseasemayremaincontagiousuntilhe/shehasbeenonappropriatetreatmentforseveralweeks.However,apersonwithlatentTBinfection,butnotdisease,cannotspreadtheinfectiontoothers,sincetherearenoTBgermsinthesputum.
Whatisthetreatmentfortuberculosis?
PeoplewithlatentTBinfectionshouldbeevaluatedforacourseofpreventivetherapy,whichusuallyincludestakingantituberculosismedicationforseveralmonths.PeoplewithactiveTBdiseasemustcompleteacourseoftreatmentforsixmonthsormore.Initialtreatmentincludesatleastfouranti-TB
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drugs,andmedicationsmaybealteredbasedonlaboratorytestresults.Theexactmedicationplanmustbedeterminedbyaphysician.Directlyobservedtherapy(DOT)programsarerecommendedforallTBpatientstohelpthemcompletetheirtherapy.
Whatcanbetheeffectofnotbeingtreatedfortuberculosis?
Inadditiontospreadingthediseasetoothers,anuntreatedpersonmaybecomeseverelyillordie.
Whatcanbedonetopreventthespreadoftuberculosis?
ThemostimportantwaytostopthespreadoftuberculosisisforTBpatientstocoverthemouthandnosewhencoughing,andtotakealltheTBmedicineexactlyasprescribedbythephysician.
Whatismultidrug-resistanttuberculosis(MDR-TB)?
ThisreferstotheabilityofsomestrainsofTBtogrowandmultiplyeveninthepresenceofcertaindrugswhichwouldnormallykillthem.
Whatisextensivelydrug-resistanttuberculosis(XDR-TB)?
Extensivelydrug-resistantTB(XDR-TB)isasubsetofMDR-TBinwhichthestrainsofTBbacteriaareresistanttoseveralofthebestsecond-linedrugsforTB.Thesestrainsareverydifficulttotreat.XDR-TBcasesmakeupapproximately10percentofMDR-TBcases.
WhogetsMDR-TB?
TBpatientswithdrugsensitivediseasemaydevelopdrugresistanttuberculosisiftheyfailtotakeantituberculosismedicationsasprescribed,aswellasTBpatientswhohavebeenprescribedanineffectivetreatmentplan.TBcasesdiseasedwithMDR-TBcantransmitthedrugresistantinfectiontootherindividuals.
Whatisthetreatmentformultidrug-resistanttuberculosis?
Forpatientswithdiseaseduetodrugresistantorganisms,expertconsultationfromaspecialistintreatingdrugresistantTBshouldbeobtained.Patientswithdrugresistantdiseaseshouldbetreatedwithdrugstowhichtheirorganismsaresusceptible.TheeffectivenessoftreatmentforlatentinfectionwithMDR-TBisuncertain.
WhatcanbedonetopreventthespreadofMDR-TB?
EnsuringpeoplewithMDR-TBtakealltheirmedicationandteachingpatientstocovertheirmouthandnosewhencoughingandsneezingcanreducetheriskofspreadofMDR-TB.Inaddition,directlyobservedtherapyshouldbeusedtoensurepatientscompletetherecommendedcourseoftherapy.
AlloftheaboveCommunicableDiseaseFactSheetinformationisfromtheNewYorkStateDepartmentofHealth.Furtherinformationcanbefoundattheirwebsite:http://www.health.ny.gov/diseases/communicable/index.htm