For Healthcare Providers

Measles infections classically are described as having a prodromal period with a fever of 103-105°F, runny nose (coryza), red, watery eyes (conjunctivitis), cough, and photophobia for 2-4 days. Then a maculopapular rash appears on the face which spreads to the trunk and finally to the extremities. The rash and other symptoms normally subside in 7-9 days. Koplik spots may be observed on the buccal mucosa just prior to and on the first day of the rash. Complications of measles include otitis media, pneumonia, cardiac manifestations, encephalitis, and occasionally death.

Measles can be dangerous, especially for babies and young children.

For individuals with documentation of one or two doses of measles-containing vaccine: Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is able 93% effective.

Clark County has had ONE confirmed case of measles, which is linked to the Central Ohio outbreak.

If you suspect measles case, call the health department immediately, 937-390-5600. If it is after hours call 937-390-5600 then dial *500 to leave a message.

Resources:

• CDC Fact Sheet
• Infectious Disease Control Manual: Measles
• CDC: Signs and Symptoms
• CDC: Vaccine for Measles

If you have any questions or concerns, please give CCCHD a call at 937-390-5600 and ask for a member of the CD Team.

The Ohio Department of Health Ohio Syphilis Info is a free consultative service that provides practicing clinicians in the state of Ohio with prompt, expert consultation on clinical questions about syphilis.

Clark County has been in a syphilis outbreak since September 2020. Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. Syphilis can have very mild symptoms to the point that the patient may not realize they were ever infected. Men who have sex with men (MSM) are experiencing extreme effects of syphilis and they account for 43 percent of all primary and secondary syphilis cases in the 2020 STD Surveillance Report. However, case rates are increasing among heterosexual men and women in recent years. Congenital Syphilis continues to be a concern in Clark County and the State of Ohio. Congenital syphilis occurs when a pregnant person passes syphilis to their baby. All pregnant people should receive testing for syphilis at the first prenatal visit. Some people will need testing again during the third trimester (28 weeks gestation) and at delivery. Untreated syphilis in a pregnant person can infect their developing baby and can cause fetal blindness, birth defects, and even fetal death.

Syphilis can cause serious health effects without adequate treatment. Any person with signs or symptoms suggestive of syphilis should receive a test for syphilis. Also, anyone with an oral, anal, or vaginal sex partner who receives a recent syphilis diagnosis should receive testing. Some people should receive testing for syphilis even if they do not have symptoms or know of a sex partner who has syphilis. As a healthcare provider, you should speak with anyone who is sexually active and should discuss their risk factors and importance of testing.

In addition, healthcare providers should routinely test for syphilis in people who:

• are pregnant;
• are sexually active MSM;
• are living with HIV and are sexually active; and
• are taking PrEP for HIV prevention.

Please use the links below for access to additional resources:

Syphilis pocket guide link: https://www.cdc.gov/std/syphilis/Syphilis-Pocket-Guide-FINAL-508.pdf

2021 STI treatment guidelines: https://www.cdc.gov/std/treatment-guidelines/default.htm

Since May 2022, CDC has been urging healthcare providers in the United States to be on alert for patients who have rash illnesses consistent with monkeypox. Distinguishing features of the rash include papules, vesicles, pustules, or scabs that are deep-seated, firm or rubbery, and have well-defined round borders. Vesicular or pustular stages of the lesions are often umbilicated (i.e., have a dent in the middle of them). They may be painful, painless, or itchy. People with monkeypox may develop symptoms including fever, headache, muscle aches, exhaustion or swollen lymph nodes during the prodromal period preceding the rash or with the rash. As of 8/1/2022, Clark County has no cases of Monkeypox.

Epidemiologic Criteria/Risk Factors:

Within 21 days of illness onset:

• Reports having contact with a person or people with a similar appearing rash or who received a diagnosis of confirmed or probable monkeypox OR
• Had close or intimate in-person contact with individuals in a social network experiencing monkeypox activity, this includes men who have sex with men (MSM) who meet partners through an online website, digital application (“app”), or social event (e.g., a bar or party) OR
• Traveled outside the US to a country with confirmed cases of monkeypox or where Monkeypox virus is endemic OR
• Had contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.)

If the individual does not meet the epidemiological criteria but the Healthcare Provider thinks there is a high clinical suspicion for Monkeypox, testing can still be performed.

Monkeypox can be found in any individual regardless of sexual orientation.

If there are no identified epidemiologic risk criteria for monkeypox infection, other possible causes of rash in adults should be considered, including secondary syphilis, herpes, and varicella zoster. In children without identified epidemiologic risk criteria for monkeypox, varicella zoster and molluscum contagiosum (MC) should be considered in the differential diagnosis. MC is an infection caused by a poxvirus (molluscum contagiosum virus) that is diagnosed more often in children than in adults. MC infection is usually a benign, mild skin disease characterized by lesions that may appear anywhere on the body.

For testing guidance, please see the Health Alert: Monkeypox Virus (MPX): Testing Guidance.

West Nile Virus (WNV) has been detected in mosquitos throughout Clark County. Awareness of WNV present in the community triggers an urgent need for the public health system throughout the county to work together in surveillance and early detection of any human cases of the virus among Clark County residents. Additionally, it is vital for all partners to stress the importance of taking precautions to prevent Mosquito-borne Diseases.

West Nile Virus (WNV), an arthropod-borne virus (arbovirus) most commonly spread by the bite of infected mosquitoes. 

Symptoms:  Most people who become infected with WNV do not have any symptoms. About one in five people who become infected develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea, or rash. WNV can lead to severe fever, encephalitis or meningitis.

Clinical Criteria: A clinically compatible case of arboviral disease is defined as follows:

• Neuroinvasive disease:
  • Meningitis, encephalitis, acute flaccid paralysis or other acute signs of central or peripheral neurologic dysfunction, as documented by a physician, and
  • Absence of a more likely clinical explanation. Other clinically compatible symptoms of arbovirus disease include: headache, myalgia, rash, arthralgia, vertigo, vomiting, paresis and/or nuchal rigidity.
• Non-neuroinvasive disease:
  • Fever (chills) as reported by the patient or a healthcare provider, and
  • Absence of neuroinvasive disease, and
  • Absence of a more likely clinical explanation. Other clinically compatible symptoms of arbovirus disease include: headache, myalgia, rash, arthralgia, vertigo, vomiting, paresis and/or nuchal rigidity.

Period of Communicability:  Humans are dead-end hosts for the virus (i.e., they do not circulate sufficient numbers of the virus in the blood stream to infect a mosquito). The disease cannot be spread from person to person.

For more guidance, please see the Health Alert: Mosquitos Test Positive for West Nile Virus.