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MONTANA STATE LIBRARY
1515 E. 6th AVE.
HELENA, MONTANA 59620 •Xq^
VOL. 15:1 • •• /
JAM(jA^Yv-^1991
Montana State Department of Health and Environmental Sciences
************************** **************************
* HIV/AIDS INFORMATION * * INDEX t
* * * *
************************** **************************
AIDS Funding
AIDS FUNDING
l
The Montana Department of Health and
Environmental Sciences held an informa- SYPHILIS CASE DEFINITION 2
tional public hearing to solicit input on
the Title II Comprehensive Plan for RESIDENT & NON-RESIDENT AIDS. 3
Montana, which describes the proposed use
and distribution of assistance received MONTANA MORBIDITY 4
under Title II of the Ryan White Compre-
hensive AIDS Resources Emergency Act of EPIDEMIOLOGY WORKSHOP 5
1990. The grant is to improve the quality,
availability and organization of health
care and support services for individuals
and families with HIV infection, subsequent
to the diagnosis of HIV infection. The
hearing was held on February 20, 1991 in
Helena.
2) Provide home-and community-based ser-
A written copy of the proposed plan is vices for individuals with HIV disease.
available and written comments are still (Similar to the current award granted
invited by writing to Bruce Desonia, through 9/30/91, with the inclusion of
AIDS/STD Program Manager, MDHES, Cogswell appropriate mental health, develop-
Building, Helena, Mt. 59620. The mental and rehabilitative services as
Department expects announcement of the an additional service available).
award by April 1, 1991. 3) Provide assistance to assure the con-
tinuity of health insurance coverage
The services available under the grant are for individuals with HIV disease (we
must demonstrate the funds are targeted
1) Establish and operate HIV care consor- to individuals who would not otherwise
tia (of one or more public, one or more be able to afford'health insurance).
nonprofit private, health care and sup- 4) Provide treatments, that have been
port service providers and community- determined to prolong life or prevent
based organizations) within areas most serious deterioration of health, to
affected by HIV disease that shall be individuals with HIV disease, (similar
designed to provide a comprehensive to our current AIDS Drug Reimbursement
continuum of care to individuals and Program)
families with HIV disease.
Syphilig Case Definition Latent Syphilis
Syphilis is a complex, sexually transmitted Clinical description: A stage of infection
disease with a highly variable clinical due to Treponema pallidum in which organ-
course, classification by a clinician with isms persist in the body of the infected
expertise in syphilis may take precedence person without causing symptoms or signs.
over the following case definitions Latent syphilis is subdivided into early,
developed for surveillance purposes. late, and unknown syphilis categories based
upon the length of elapsed time from init-
Primary Syphilis ial infection.
Clinical description: The characteristic Case classification:
lesion of primary syphilis is the chancre,
but atypical primary lesions may occur. Presumptive; no clinical signs or
symptoms of syphilis and the presence
Laboratory criteria for diagnosis: Demon- of one of the following:
stration of Treponema pallidum in clinical
specimens by darkfield, fluorescent anti- No past diagnosis of syphilis and
body, or equivalent microscopic methods. a reactive nontreponemal test, and
a reactive treponemal (fluorescent
Case classification: treponemal antibody-absorbed [FTA-
ABS], microhemagglutination assay
Probable: a clinically compatible case for antibody to Treponema pallidum
with one or more ulcers (chancres) con- [MHA-TP]) test,
sistent with primary syphilis and a
reactive serologic test. A past history of syphilis therapy
and a current nontreponemal test
Confirmed: a clinically compatible titer demonstrating fourfold or
case that is laboratory confirmed. greater increase from the last
nontreponemal test titer.
Secondary Syphilis
(STD case definitions taken from CDC's
Clinical description: A stage of infection Morbidity and Mortality Weekly Report, Vol.
due to Treponema pallidum, characterized by 39, no. RR-13, October 19, 1990.)
localized or diffuse mucocutaneous lesions
and generalized lymphadenopathy. Constitu-
tional symptoms are common, and clinical
manifestations are protean. The primary
chancre may still be present. **************************
Laboratory criteria for diagnosis: Demon-
stration of T. pallidum in clinical
specimens by darkfield, fluorescent anti-
body, or equivalent microscopic methods.
Vaccine Orders
Case classification:
We would like to remind the clinics it's
Probable: a clinically compatible case time to place your vaccine orders again for
with a reactive nontreponemal (VDRL, the next six months. The earlier we
RPR) test titer of >4. receive your order, on the correct order
form, the earlier we can fill your order.
Confirmed: a clinically compatible If your have any questions in regards to
case that is laboratory confirmed. your order, please call 444-5580.
2.
MONTANA DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES
MONTANA
RESIDENT AND NON-RESIDENT AIDS CASES^
Acquired Immunodeficiency Syndrome (AIDS)
Definitive and Presumptive AIDS Cases
Surveillance Report - As of January 31, 1991
Adult/Adolescent/Pediatric
Disease Category Cases %) Deaths %)
( (
POP '-34 43) 26 76)
( {
Other Disease w/o PCP 44 55) 25 57)
( (
KS Alone 2 3) 0)
( (
No Diseases Listed 01 _Q_J Oi
(
Total 80 100) 51 64)
( (
2. Age Cases 11
(
Under
JANUARY
1991
*****************************
t EPIDEMIOLOGY WORKSHOP *
* *
**************************
Hutchinson Cancer Research Center in
A two-part chronic disease epidemiology Seattle. His primary research activity has
workshop will be held March 13-15, and May focused on cancer epidemiology. He is
15-17, 1991 at the Coach House East in presently involved in studies of adverse
Helena. The workshop is co-sponsored by reproductive outcomes and cardiovascular
the Montana Department of Health and disease.
Environmental Sciences, the Montana Medical
Association, the University of Washington Applications have been submitted for con-
School of Public Health and Community tinuing education credit for nurses and
Medicine and the Montana Area Health dietitians. MMA has approved 26 hours of
Education Center. Registration for the CMEU's for full attendance at the 4-day
two-part course is $25. workshop. For more information about the
epidemiology workshop, contact Bob Moon at
Targeted to state and local health program 444-4488 or Marsha McFarland at 444-2555.
managers, the workshop is designed to
provide the skills and knowledge needed to
plan, implement and integrate programs to
reduce chronic disease in Montana. The 4-
****************************
day workshop will be most effective for
those whose job responsibilities include
making program and policy decisions based
on surveillance data or allocating
resources for chronic disease programs.
SalmonelloaJB Surveillance
Faculty members include Steven Helgerson,
This is to alert you to a potential problem
MD, MPH; Mark W. Oberle, MD, MPH; Stephen and ask you to increase surveillance for
Schwartz, PhD, MPH; and Todd Damrow, PhD, Salmonellosis for several months. We would
MPH. Todd Damrow, PhD, MPH, is the newly- also encourage you to obtain testing on
assigned Montana state epidemiologist. Dr. diarrhea stools in patients who present
Damrow was formerly a microbiologist and with at least 2 days of diarrhea and other
epidemiologist with the Washington Depart-
symptoms consistent with a bacterial
ment of Health.
infection, such as fever. We encourage
laboratories to refer Salmonella isolates
Dr. Helgerson is senior epidemiologist for to the Montana Department of Health and
the Indian Health Service and area epi- Environmental Sciences Public Health
demiologist for the Portland and Billings Laboratory for further analysis.
Indian Health Service Headquarters. He has
17 years of field experience in epidemio- After discussions with the Centers for
logy and has contributed many research Disease Control, we would also like to take
articles to the science of epidemiology. this opportunity to remind you raw shell
eggs are now considered a hazardous food.
Dr. Oberle is Assistant Dean for Public This means they must be refrigerated during
Health Practice, School of Public Health storage and thoroughly cooked before eating
and Community Medicine, University of to minimize the risk of transmission of
Washington. He previously was acting pathogens, primarily Salmonella The
.
director for Science, Center for Health northeastern United State has been having
Promotion and Education at the Centers for a Salmonellosis outbreak for approximately
Disease Control He has both international 5 years and the source has been traced to
and domestic experience in epidemiology. shell eggs from infected flocks. Persona
whose health is compromised by various
Stephen M. Schwartz, PhD, MPH, is Assistant conditions are at greater risk of
Professor of Epidemiology at the University developing Salmonellosis and subsequent
of Washington. Dr. Schwartz also serves as severe sequelae such as sepsis.
affiliate investigator at the Fred
AIDS cases per 100.000 population - United States, January-December 1990
)
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VOL. 15:2 "^LENA. MONMNA^Igg^o February, 1991
Montana State Department of Healt±L and Environmental Sciences
New Staff and Position Changes INDEX
at MDHES AIDS/STD Program
AIDS/STD STAFF CHANGES 1
Kathy Anderson has recently been promoted HOTLINE UPDATE 1
from Public Health Educator to the Program CASE DEFINITIONS 2
Officer. CONGRATULATIONS KATHY Kathy can RESIDENT & NONRESIDENT AIDS 3
1
still be reached at 444-3556. MONTANA MORBIDITY 4
LEGIONELLOSIS & HOT TUBS? 5
We also have a new administrative aide. NEW STATE EPIDEMIOLOGIST 5
Jeannie Thrush comes to our department from
the Department of Revenue, Property
Assessment Division. She is a Montana
native who moved to Helena 4 1/2 years ago if-k-k-k-k-k-k-k-k-k-k-tt-k-k-k-k-k-k-k-klt
from her hometown of Missoula. She is a *******H*IV*/A*ID*S *IN*FO*RM*AT*IO*N******
newlywed who loves to play the piano and
ride horses. Welcome to the program!
Hotline Update!
Another change is that we have recently
changed our phone system. Please do not The Montana Department of Health and
use the 444-4740 number any longer. You Environmental Sciences AIDS Hotline has
may reach our program through 444-3565 (STD been updated! The AIDS Hotline is recorded
Program at 444-3949) or through the staff's messages on a variety of HIV-related
extensions, which are as follows: issues. The changes to the hotline are not
only new information but new categories as
Judy Gedrose 444-4748, Bureau Chief well. We have combined "How to Protect
Bruce Desonia 444-2457, Program Manager Yourself" and "How to Use a Condom
Kathy Anderson 444-3566, Program Officer II Correctly," in order to make space for a
Jim Murphy 444-4744, Health Officer I section on Infection Control to prevent HIV
(Surveillance and ADRP) and HBV exposure. This section will also
Amy E. Harris 444-2675, Public Health be updated as soon as the CDC proposes it's
Educator (CEOs, CTS, etc) new recommendations on preventing patient
Karen Winden 444-2454, Administrative exposure from Health Care Workers with HIV.
Assistant (Contract info. The MDHES AIDS Hotline's number is 1-800-
Jeannie Thrush 444-3565, Administrative 233-MONT (6668). Other local Hotline
Aide (brochures, videos etc) numbers are: Out In Montana 1-800-336-4297
and for eastern Montana Yellowstone AIDS
Valinda Holmes 444-3949, Administrative
Project, 1-800-675-2437. The National AIDS
Clerk
Hotline is 1-800-342-2437.
Paul Lamphier 444-1604, Field Health
Officer
\
i".-.^'- fe» ^rt -N :' »
Case Definitiong
(STD case definitions taken from CDC's Case classification:
Morbidity and Mortality Weekly Report vol.
,
29, no. RR-13, October 19, 1990) Probable: A clinically compatible case
(in which primary and secondary syph-
CHLAMYDIA TRACHOMATIS INFECTION ilis has been ruled out by serology and
darkfield microscopy, when available)
Clinical description: Infection with Chla- with either a diagnosis of genital
mydia trachomatis may result in urethritis, herpes based on clinical presentation
epididymitis, ceryicitis, acute salpin- (without laboratory confirmation) or a
gitis, or other syndromes when sexually history of one or more previous epi-
transmitted. Perinatal infections may sodes of similar lesions.
result in inclusion conjunctivitis and
pneumonia among newborns. Other syndromes Confirmed: A clinically compatible
that can be caused by C. trachomatis case that is laboratory confirmed.
include lymphogranuloma venereum (see
Lymphogranuloma Venereum Infection) and Comment: Herpes should be reported only
trachoma. once per patient. The first diagnosis for
a patient with no previous diagnosis should
Laboratory criteria for diagnosis: be reported.
Isolation of C. trachomatis by culture,
or
GONORRHEA
Demonstration of C. trachomatis in a Clinical description: A sexually trans-
clinical specimen by antigen detection
mitted infection commonly manifested by
methods.
urethritis, ceryicitis or salpingitis.
Infection may be asymptomatic.
Case classification:
Laboratory criteria for diagnosis:
Confirmed: A case that is laboratory
confirmed.
Isolation of Neisseria gonorrhoeae from
a clinical specimen or
GENITAL HERPES (HERPES SIMPLEX VIRUS)
Observation of gram-negative intra-
cellular diplococci in a urethral smear
Clinical description: An illness charac-
obtained from a man.
terized by visible, painful genital or
anogenital lesions.
Case classification:
Laboratory criteria for diagnosis:
Probable: Demonstration of gram-
negative intracellular diplococci in an
Isolation of herpes simplex virus from
endocervical smear obtained from a
cervix, urethra or anogenital lesions,
woman, or a written (morbidity) report
or
of gonorrhea submitted by a physician.
Demonstration of virus by antigen
Confirmed: A clinically compatible
detection technique in clinical
case that is laboratory confirmed.
specimens from cervix, urethra, or
anogenital lesion, or
Demonstration of multinucleated giant
cells on a Tzanck smear of scrapings
from an anogenital lesion.
MONTANA DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES
NONTANA
J
RESIDENT AND NON-RESIDENT AIDS CASES'
Acquired Immunodeficiency Syndrome (AIDS)
Definitive and Presumptive AIDS Cases
Surveillance Report - As of February 28, 1991
f t
Ul
FEBRUARY
1991
6
Boaverhead
BigHorn
Blaine
Broadwater
Carbon
CaMer
Cascade
Chouteau
Cusler
Daniels
Oavwson
DeerLodoe
Fallon
Ferous
Flc'nead
Gallatin
GarJield
Glacier
GoldenValtey
Granite
Hill
Jetlerson
JudithBasin
Lewis&Clark
Liberty
Lincoln
McCone
Madison
Meagher
Mineral
Missoula
Musselshell
Park
Petroleum
Philliigs_
Pondera
PowderRiver
Powell
Prairie
Ravall
Richland
Roosevelt
Rosebud
Sanders
Sheridan
SilverBow
Stillwater
SweetGrass
Teton
Toole
Treasure
Valley
Wheatland
Wibaux
Yellowstone
