How Oakland County Health Division Goes to Work When Outbreaks Happen
(Crystal A. Proxmire, Dec. 6, 2019)
Franklin, MI – When it comes to stopping the spread of dangerous diseases, Kayleigh Blaney and others in the Oakland County Health Division do more than people may realize in order to keep the community safe.
Blaney has a Masters of Public Health and works as an Epidemiologist with Oakland County Health Division. She made time Thursday morning to give a presentation at the Franklin Library about the Communicable Disease Unit.
The CDU stays busy year-round tracking data on dozens of diseases such as including chicken pox, hepatitis a, b and c, HIV, influenza, legionellosis, measles, mumps, and rubella.
Each year they track the flu, including the various strains that are reported. They are on hand for small scale clusters of cases – such as if a person sick with Hepatitis A infects customers at a restaurant, or if chicken pox gets spread at a school. And then there are the larger scale out breaks like that of measles earlier this year.
In April, cases of the measles were reported throughout Oakland County. Because doctors, hospitals, and labs automatically send data on diseases such as measles, they are able to identify clusters of infections quickly.
After identifying infected individuals, the CDU went to work interviewing the carriers and listing places where they remember having gone, to warn people who may have been exposed to be alert for symptoms and not to go out and spread the disease to others if they think they might be sick.
Exposure locations included synagogues as well as office buildings, shops, public and private schools, and even Beaumont Hospital. During the outbreak doctors had signs on doors urging those with measles-like symptoms to return to their car and call the health division for further instruction. CDU team members met people at their homes for testing to help contain the spread.
They also went to work giving vaccinations to those who wanted them. Blaney recalled that in one day the team did over 700 injections. In addition to giving shots at the office, they set up clinics in synagogues and offered Sunday hours. Over 3,000 people got their vaccinations through the Health Divisions.
By the time the disease ran its course there were 40 known cases in Oakland County, 1 in Wayne County, and four in other parts of the state. Although it was eight months ago, some of those infected are still having complications, including difficulty tolerating light.
Blaney credits the good communications, hard work, and flexibility of the department in containing the outbreak and saving people’s health and lives.
KIDS AT SCHOOLS, PEOPLE AT RESTAURANTS
While major outbreaks are rare, clusters of illness are common, especially in places with lots of people like schools, restaurants, and assisted living facilities. Offices and workplaces can also breed sickness.
Because of Electronic Lab Reporting (ELR), data goes to the state and to the county. Schools do weekly reporting of illnesses reported, though only the quantity of students, not their individual info. But even these simple reports can help track a bug through the community. “You can see if it starts in one elementary school than gets passed on to the high school by an older sibling, then passed on to another school,” she said. “We can spot patterns pretty easily.”
Understanding those patterns gives them a chance to warn parents and to let them know what virus it is that is making the rounds. If two or more kids have a disease, like chicken pox, the health department is alerted and they can access the situation and warn people what symptoms to look for, and to stay home if they have them.
Blaney was asked if she was scared that she might get sick when she went to homes of people infected with the mumps. She explained that she’d been vaccinated, and she trusted the science behind it.
She also said that some people think being vaccinated means that a person won’t get sick, but in some cases being vaccinated doesn’t prevent it completely, but that the immune system is already prepared to fight it so an illness is milder if someone does get it.
Members of the audience were curious about the rules regarding vaccination and children. Blarney responded that in public schools parent may opt out of vaccination by signing a waiver, but that the local health department does have a right to temporarily bar unvaccinated children from school in the event of an outbreak. Private schools can handle the matter of vaccinations however they want, with some private schools requiring it and other not.
The epidemiologist also talked about the flu, sharing a wealth of information about how to prevent, test for, and treat this annual wave of fever, cough, sore throat, achy heads, sore muscles, and exhaustion.
“There are two strains of influenza,” Blaney said. “A strain mutates quickly and is usually worse than B strain. Most people who have had flu vaccines have built up immunity to them, and when people do get a B strain you may feel sick but with A you’re a lot sicker.” Both A and B are making the rounds in Michigan.
The flu is monitored worldwide, and the southern hemisphere’s flu season comes before Michigan’s so it can be a good predictor of what is coming.
“One of the reasons the flu vaccine was so late this year was because there were some late cases of a type of flu, so they changed the vaccine to include that,” she said. Vaccines take at least six months to produce, and a new vaccine is created each year.
The Centers for Disease Control (CDC) explains the process on their website, saying “The seasonal influenza (flu) vaccine is designed to protect against the three or four influenza viruses research indicates are most likely to spread and cause illness among people during the upcoming flu season. Flu viruses are constantly changing, so the vaccine composition is reviewed each year and updated as needed based on which influenza viruses are making people sick, the extent to which those viruses are spreading, and how well the previous season’s vaccine protects against those viruses.
“More than 100 national influenza centers in over 100 countries conduct year-round surveillance for influenza. This involves receiving and testing thousands of influenza virus samples from patients.”
One of those centers is at the University of Michigan, meaning that the region’s flu needs are particularly well-understood.
As far as testing for the flu, there are two approaches. The first is a rapid response test which quickly tells if a patient has the flu. A PCR (polymerase chain reaction) tests the flu virus to determine the specific strain. Both require a sample to be swabbed from deep inside the nose. Many doctors do the quick test and prescribe Tamilfu which is effective against almost all types of flu. However, the more detailed test results help with tracking and preventing the spread of the virus, as well as in the efforts to determine what strains to include in next year’s vaccination.
The presentation touched briefly on bioterrorism. While it may make for good cinema, in reality it is rare, with only a handful of cases ever occurring. However there is the potential for it to happen, so officials remain trained and prepared. Blaney mentioned the anthrax cases that she and others learned from as an example.
In the fall of 2001 five people were killed by letters that included anthrax.
Envelopes with white powder were mailed to U.S. Senators Tom Daschle and Patrick Leahy, as well as to the offices of ABC News, CBS News, NBC News, the New York Post, and the National Enquirer following the Sept. 11, 2001 attack.
The powder in the envelopes contained anthrax spores. People were contaminated in the post office who handled the mail, as well as in the offices where the letters were opened. 43 people tested positive for anthrax. 22 got sick. And 5 of them died. The spores were traced back to a research lab, and a scientist there was being investigated for the crime when he died of an overdose of Tylenol with codeine in an apparent suicide.
Bioterrorism could include viruses sent by mail, spread in a food or water source, put into a ventilation system, or otherwise introduced to people intentionally.
If an outbreak were to occur, the CDU would work with law enforcement and other organizations to come up with ways to prevent the spread.
Whether it’s a major outbreak or a typical round of the flu, the CDU is there to learn, to educate, and to fight.
The Oakland County Health Division provides many services for the community. Learn more at https://www.oakgov.com/health/Pages/default.aspx
Note: This story has been updated at the request of the Health Division to remove a quote that was given in the presentation but was not accurate.