infectious disease

Ebola: Message from STEVEN GABBE, MD and ANDREW THOMAS, MD

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October 16, 2014

Dear Students and Colleagues:

In light of the news that a Dallas nurse who has tested positive for Ebola was in Ohio from October 10-13, we want to share some information with the university community about this situation.

We can assure you that you are at no risk of contracting Ebola if you have not had direct contact with a person with active symptoms of the disease. Direct contact would include exposure to an infected person’s body fluids or providing care to an individual with active symptoms. Simply shaking hands with an individual is considered a very low risk contact. Being in the near vicinity of another individual or passing an individual in the street is considered of no risk.

The Ohio State University Wexner Medical Center and Student Life’s Student Health Center continue to be at a high level of preparedness for any potential case of Ebola Viral Disease (EVD). We continue to be in close contact with Columbus Public Health, the Ohio Department of Health, the U.S. Centers for Disease Control and Prevention (CDC) and other hospitals across the state to aggressively monitor all developments in this situation. We are focused on reducing the risk of exposure as well as rapidly implementing protocols for providing care in our medical facilities or responding to public health concerns across campus. We are confident that we are prepared to care for a potential Ebola patient and plan to do so in the safest environment possible.

The CDC’s recommendation is to seek medical care immediately:

If you have traveled to the West African countries of Guinea, Liberia or Sierra Leone or if you have been in direct contact with a person with active EVD,

AND, if you develop a fever (temperature of 100.4 degrees F/38.0 degrees C or higher) and any of the other following symptoms: diarrhea, vomiting, stomach pain, headache, muscle pain, or unexplained bruising or bleeding.

If you meet these criteria for both known exposure AND symptoms, you should limit your contact with other people until you seek medical treatment. Do not travel anywhere besides a healthcare facility.

We will share additional information about the university’s preparedness procedures and additional resources. Until then, more information about Ebola can be found at the CDC website: http://www.cdc.gov/.

As always, the health and safety of all of our students, faculty, staff, patients, visitors and the community is our priority.
Steven G. Gabbe, MD
Senior Vice President for Health Sciences, The Ohio State University
CEO, The Ohio State University Wexner Medical Center

Andrew Thomas, MD
Senior Associate Vice President for Health Sciences, The Ohio State University
Chief Medical Officer, The Ohio State University Wexner Medical Center

Condoms are a beautiful thing!

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Condoms are a beautiful thing!

Condoms are a beautiful thing.  They are effective at preventing both pregnancy and sexually transmitted diseases.  They are inexpensive and easily obtained.  They are small and compact and easily kept in a wallet or purse.

However, they are only beautiful when they are used correctly.

WebMD reports the most commonly reported condom use errors are:

  • Not using condoms throughout sexual intercourse
  • Not leaving space at the tip
  • Not squeezing air from the tip
  • Putting the condom on inside out
  • Not using only water-based lubricants
  • Incorrect withdrawal

These types of errors reduce the effectiveness of condoms to about 85%. To get the maximum protection from your condom, follow these guidelines:

  • Use a NEW condom every time you have sex, be it vaginal or oral and make sure the condom is in place before there is any genital contact.
  • Make sure there is at least a ½ inch space at the tip of the condom for semen collection.  Some condoms have a built in reservoir tip for this purpose.  If yours does not, then just pinch the end while placing the condom to allow for this extra space.
  • After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw. Then gently pull the condom off the penis, making sure that semen doesn’t spill out.
  • Wrap the condom in a tissue and throw it in the trash where others won’t handle it.
  • If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken condom, and put on a new condom.
  • Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants. Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used because they can weaken latex, causing breakage.

If you’re interesting in learning more about condoms or in obtaining a few of these beautiful things for your own protection, check out the Condom Club at the Student Wellness Center.

Submitted by Tina Comston, M.Ed.

Hand, Foot, and Mouth – what is that?

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Foot and mouth.  Normally when I hear those words, I think of those embarrassing situations where something is said that shouldn’t have been, you know, ‘Open mouth, insert foot’.  But at Student Health, when foot and mouth is mentioned, it’s more likely to be due to Hand, Foot, and Mouth disease.  And lately, we’ve it’s been mentioned a few times.

Rash/blisters on hands and feet

Rash/blisters on hands and feet

Hand, Foot, and Mouth disease is a viral illness that’s typically associated with young children, but can occur in adults.  The disease starts gradually with a fever, sore throat, poor appetite, and just not feeling well.  After a couple of days painful sores develop in the mouth.  A skin rash may also develop on the palms or soles of the feet.  In some cases fingernail or toenail loss may occur.  (These do regrow without requiring medical treatment.)

This is a contagious disease that is spread through close person-to-person contact, saliva, fluid from blisters, stool, and respiratory droplets in the air after a cough or sneeze.  Pretty much the same way as most viruses.

The best way to avoid getting Hand, Foot, and Mouth is to wash your hands often with soap and water, disinfect frequently touched surfaces, and avoid close contact with someone who is infected.

If you do become ill with the disease, treatment includes:

  • Rest
  • Plenty of fluids
  • Over the counter medications to relieve fever and pain
  • Mouthwashes or sprays that numb the mouth

To aid with the discomfort of mouth sores:

  • Suck on popsicles or ice chips
  • Drink cold beverages
  • Avoid acidic foods and beverages such as citrus, fruit drink, and soda
  • Avoid salty and spicy foods
  • Rinse your mouth with warm water after meals

If your symptoms worsen or just don’t seem to get better after a couple days, seek medical treatment.

Submitted by Tina Comston, M.Ed.

Reviewed by Mary Lynn Kiacz, M.D.

Ebola – Why is it a problem in West Africa?

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If Ebola is rare why is it a problem in West Africa?  It can all be boiled down to one word – LACK.

LACK of understanding:  People do not understand how Ebola is transmitted.  Some believe that just saying the word aloud will make the disease appear while others blame physicians for the spread of the virus.  They have hidden family members rather than sending them to facilities to avoid quarantine.

LACK of medical supplies:  Medical supplies, such as gloves and needles are reused.  If not properly disinfected,

Reuse of medical supplies contributes to the spread of Ebola.

Reuse of medical supplies contributes to the spread of Ebola.

Ebola can be transferred  to a patient who was not previously infected.

LACK of health care workers:  In this area of the world there is approximately 1 doctor for every 10,000 people.    Health care workers from other countries, dressed in hazmat suits, are often not trusted and end up going home.

LACK of proper burial techniques:  Traditional funeral practices include washing the body by hand and touching the body at the funeral.     Both the body and objects which could have been contaminated should be cleaned and disinfected.  However, burial teams have literally been chased out of town when attempting to implement these practices.

Perhaps one day, when the above obstacles are overcome, the word LACK will be used to indicate the presence of Ebola in the world.

Submitted by JoHanna D’Epiro, P.A.

Edited by Tina Comston, M.Ed.

Reviewed by Gladys Gibbs, M.D.

Ebola: Should I be worried?

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Worried – no.  Informed – yes.

Ebola is rare.  It is not an airborne illness and is not easily spread –

West African countries affected by Ebola.

West African countries affected by Ebola.

so disregard any thoughts of The Last Ship (www.tstdrama.com/TheLastShip) scenario playing out any time in the near future.

Presently the Ebola outbreak is concentrated in West Africa, specifically Guinea, Sierra Leone, Liberia, and Nigeria.  That’s approximately 5,000 miles away from The Ohio State University.  That being said, with the ease of travel these days, someone could be in West Africa today and on campus tomorrow, so it’s good to be informed.

Here’s what you need to know:

Ebola is spread through direct contact with bodily secretions (stool, urine, saliva, or sweat).  This could be through:

  • Coming in contact with a secretion, perhaps while caring for someone, and then touching your eyes, nose,  mouth, or an open wound
  • Touching an object that has been contaminated and then touching your eyes, nose, mouth, or an open wound
  • Eating/handling infected animals (bats, monkeys, rodents, pigs)

The incubation period, that is, the time from contact with the virus until symptoms occur, is usually 5 to 7 days but can last as long as  21 days.  Individuals with no symptoms are not contagious.

Symptoms of Ebola include:

  • High fever, > 101.5
  • Severe headache
  • Muscle pain
  • Sore throat
  • Vomiting
  • Diarrhea
  • Abdominal pain

If you have been in direct personal contact with anyone who is from or has traveled to one of the West Africa countries listed above or have handled an animal from one of these countries and you experience these symptoms, seek care at the Wexner Medical Center.

If you will be traveling to Africa, the CDC recommends the following:

  • Careful attention to hygiene. Avoid direct contact with blood and body fluids.
  • Do not handle items that may have contacted infected person’s blood or body fluids.
  • Avoid contact with animals or raw meat.
  • Avoid foreign hospitals where Ebola patients are being treated.  The US Embassy or consulate can provide information on facilities that are suitable for your needs.
  • Monitor health for 21 days if you were in an area with an Ebola outbreak .

Submitted by JoHanna D’Epiro, P.A.

Edited by Tina Comston, M.Ed.

Reviewed by Mary Lynn Kiacz, M.D., Gladys Gibbs, M.D.

Help! I found a tick on me! Am I going to get Lyme Disease?

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deer tick versus dog tick

I have an indoor-outdoor dog. Well, he seems to think he’s an indoor dog who should have full run of the house and that the couch is his own personal domain. We beg to differ on that point…. Anyway, when taking him for walks he likes to put his nose to the ground and check out everything which means he is often walking through tall grass. And yes, along the way he is likely to pick up a tick or two. We’ve found a couple on both him and unfortunately also in the house. My husband, who also thinks the cough is his own personal domain, has found a couple of ticks on himself. (Now, he’s trying to sit in my tick-free chair – but that’s not going to happen!)

Anyway, that got me to wondering about Lyme disease. What should you do if you’ve been bit by a tick?

The Centers for Disease Control and Prevention (CDC) states that Lyme disease is spread through the bite of infected ticks. In Ohio, this is through the blacklegged tick more commonly known as a deer tick. Deer ticks are tiny. An adult tick is about the size of a sesame seed, while an immature tick is closer to a poppy seed and very difficult to see. These immature ticks are the ones most likely to transmit the disease as they are difficult to see. Dog ticks, the ones we’ve had in our house, do not transmit Lyme disease (In the image on the right, the top row shows a deer tick from nymph stage to one that is engorged, while the bottom row shows a dog tick.)
Ticks can attach to any part of the body, but are often found in hard-to-see areas such as the groin, armpits, and scalp. A tick must be attached for 36-48 hours or more before the disease is transmitted.

If you find a tick on yourself, after you have finished panicking, get a pair of tweezers. Grasp the tick as close the skin’s surface as possible. Pull upward with steady, even pressure until you have removed the tick. Thoroughly clean the bite area and your hands with rubbing alcohol, iodine, or soap and water.

Early symptoms of Lyme disease include:

  • Red, expanding rash called erythema migrams (EM), kind of looks like a bulls-eye
  • Fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes

If you had a tick bite, live in an area known for Lyme Disease, or have recently travelled to such an area and you experience any of these symptoms, seek medical attention! Make sure you tell your doctor that you have had a recent tick bite. Your doctor will prescribe antibiotics which should allow you to recover rapidly and completely.

Submitted by Tina Comston, M.Ed.

Mumps, Mumps, and More Mumps!

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Sick with mumps?  Sick of hearing about mumps?   Sick of school but still have to finish? (sorry, can’t help you there) Unfortunately, mumps is still with us.  As of April 15, 2014, the number of cases of mumps in central Ohio has topped 200.  If you want detailed information about the illness, here it is.  

Submitted by JoHanna D’Epiro, P.A.

And if you feel like reading, here is list of references used to develop the presentation:

  1. Rubin, S., Link, M. Sauder, C.,  Zhang, C. Ngo, L. Rima, B. Duprex, W. 2012. Recent Mumps Outbreaks in Vaccinated Populations: No Evidence of Immune Escape. Journal of Virology 86:615-620.
  2. Public Health England. The Green Book, Immunisation Against Infectious Disease. Mumps (2013) 
  3. Center for Disease Control and Prevention (CDC) Mumps Epidemic — Iowa, 2006.  MMWR Morb Mortal Wkly Rep. 2006;55(13);366-368.  
  4. Center for Disease Control and Prevention (CDC) BAM! Body and Mind. 2010. Immune Platoon Disease Database (Mumps) 
  5. Dayan, G., Quinlisk, M. ,Parker, A.,et al. Recent Resurgence of Mumps in the United States. The New England Journal of Medicine. 2008; 358:1580-1589.
  6. Center for Disease Control and Prevention (CDC). Measles, Mumps and Rubella – Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps:  Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports. 1998; 47.  
  7. Center for Disease Control and Prevention (CDC) The Pink Book: Course Textbook. Epidemiology and Prevention of Vaccine-Preventable Diseases. Slide Set Mumps. 2012. 
  8. US Department of Health and Human Services. Healthy people 2010: understanding and improving health. Washington, DC: Department of Health and Human Services; 2000.  
  9. Center for Disease Control and Prevention (CDC) Mumps Epidemic — United Kingdom, 2004-2005. MMWR Morb Mortal Wkly Rep. 2006;55(07); 173-175
  10. WBNS Ten TV, Columbus Ohio. 
  11. Center for Disease Control (CDC) The Pink Book: Course Textbook. Epidemiology and Prevention of Vaccine-Preventable Diseases: Chapter 14 Mumps. May 2012  
  12. Conniff, R.  A Forgotten Pioneer of Vaccines. The New York Times May 2013. Retrieved from: http://www.nytimes.com/2013/05/07/health/maurice-hilleman-mmr-vaccines-forgotten-hero.html?_r=0
  13. Merrsch, J. Mumps 2012 Medicinenet.  Retrieved from: http://www.medicinenet.com/mumps/article.htm
  14. College of Physicians of Philadelphia: The History of Vaccines.  Mumps. Retrieved from: http://www.historyofvaccines.org/content/articles/mumps
  15. Anis, E., Grotto, I, Moerman, L., Warshavsy, B., Slater, E. Lev. B. Mumps outbreak in Israel’s highly vaccinated society: are two doses enough? Epidemiology Infectious. 2012;140:439-446.
  16. Center for Disease Control and Prevention (CDC). Research: Epidemic of Mumps among Vaccinated Persons, the Netherlands. 2009-2012. 2014; 20(4)
  17. Albrecht, M. Mumps. In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA 2014.
  18. Defendi, G. Mumps. Medscape  Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  
  19. Gupta, R., Best, J.,  McMahon, E.  Mumps and the UK epidemic 2005. British Medical Journal. 2005;330:1132
  20. Roush, S. (Editor) Center for Disease Control (CDC). Manual for the Surveillance of Vaccine Preventable Disease. Mumps, Chap. 9. August 2012 Mumps Chap. 9.
  21. Ogbuanu, I., Kutty, P., Hudson, J. et al. Impact of a Third Dose of Measles-Mumps-Rubella Vaccine on a Mumps Outbreak. Pediatrics. 2012; 130: pp. e1567 -e1574.  
  22. Stokes, J..U.S. Army Medical Department Office of Medical History. Chapter 6 – Mumps.

You Got What!?! Mumps!?!

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Stay home for 5 days after symptoms.

Columbus Public Health is currently working closely with the medical staff at Ohio State’s Office of Student Life to investigate a mumps outbreak among students.

Mumps is a viral illness that can cause fever, body aches, headaches, fatigue, swelling of the salivary glands or pain with chewing or swallowing. About a third of people who contract the mumps virus do not develop any symptoms.

How does the mumps virus spread?

Mumps is most commonly spread when an infected person coughs or sneezes, and a non-infected person inhales respiratory droplets that contain the virus.

How soon after infection do symptoms occur?

Symptoms usually occur 14 to 18 days after infection. The time between infection and illness can be as short as 12 days or as long as 25 days.

When can mumps be spread?

People with mumps are usually contagious from two days before to five days after they develop symptoms. A person is most contagious just before symptoms appear.

How can a person with mumps avoid spreading it to others?

  • Stay at home for five days after symptoms (salivary gland swelling) begin (required by Ohio law OAC 3701-3-13, (P)); avoid school, work, social gatherings, and other public settings.
  • Cover your mouth and nose with a tissue when you cough or sneeze.
  • Wash your hands frequently with soap and water or an alcohol-based hand cleaner.
  • Do not share eating utensils, cups, straws, or tissues.

Is there a vaccine to prevent?

Yes, the mumps vaccine is given on or after a child’s first birthday. In the United States, it is usually combined with measles and rubella vaccines, together known as MMR (measles, mumps and rubella). A second dose of mumps vaccine is recommended before children enter school (when they are four to six years old.) People who receive two doses of mumps vaccine are much less likely to develop mumps than those who have one dose or none.

Can people who have been vaccinated still get mumps?

Yes, for every 100 people vaccinated, 80 to 90 of them will be fully protected, but 10 to 20 are at risk for the disease. Though mumps vaccination cannot protect everyone, the vaccine greatly lowers the number of people who get sick when exposed to the virus. If a community maintains a high vaccination rate, the risk of exposure declines too. And while vaccination cannot protect everyone from developing mumps, people who get mumps following vaccination are at lower risk of problems.

What should I do if I attend The Ohio State University and think I was exposed to mumps?

If you are exposed to mumps and have been vaccinated, you are less likely to develop the disease. If you did not get the vaccine or only got one dose, there is no treatment to prevent infection. However, we would recommend that you get a 2nd dose or begin the vaccine series as this may lessen the severity of illness or decrease the spread to others on campus. The vaccine is available through Student Life Student Health Services. Call 292-4321 to schedule an appointment.

If you develop symptoms of mumps, please stay home from work, school, sports and all public gatherings for five days after symptoms start. You should seek medical care to be properly diagnosed. You can schedule an appointment with Student Life’s Student Health Services by phone at 292-4321 or via their website, or after hours you can go to Ohio State’s urgent care center at the Martha Morehouse Medical Plaza, 2050 Kenny Road, Suite 2400.

Faculty and staff with mumps symptoms should contact their private health care providers.

Have mumps outbreaks occurred in vaccinated people before?

Yes, in 2006 there was an outbreak of mumps in the Midwestern United States. The outbreak was mainly among college students who had already been vaccinated. There was an outbreak of mumps in 2009-2010, mostly among school-aged children who had been vaccinated in New York City. Also, as recent as February of this year, Fordham University in New York experienced an outbreak amongst its student community.

What problems can mumps cause?

  • The vast majority of mumps cases do not lead to serious complications.
  • The mumps virus can cause inflammation of the central nervous system, but the resulting illness (viral meningitis) is usually not serious. Headache and stiff neck may occur in up to 15% of people with mumps.
  • Males who are past puberty may experience orchitis, or testicular inflammation. It causes pain, swelling, nausea, vomiting and fever. The affected area may remain tender for weeks. Approximately half of patients with orchitis experience some atrophy of the testicles, but they rarely lose the ability to produce sperm.
  • Some women may experience inflammation of the ovaries or breasts from mumps.
  • Deafness, in one or both ears, occurs in approximately one person out of 20,000 who develops mumps.

Where can I get more information about mumps and mumps vaccine?

Information provided courtesy of Ohio State Student Life Student Health Services, Columbus Public Health, Centers for Disease Control and Prevention and Fordham University.

Repost of

Doodie in the Pool!

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In this well-known scene from Caddy Shack, panic ensues when “doodie” is found in the pool.   While the movie is all in good fun, there’s actually some truth in there as well.  Crypto, AKA Cryptosporidium, is a microscopic parasite that can affect both humans and animals.  It lives in the intestines and is passed in the stool of an infected person or animal.  The most common means of transfer – water.  It is actually one of the most common causes of waterborne disease, both through recreational water such as swimming pools or lakes, and drinking water.  This parasite is very resilient and has a hard outer shell which allows it to survive outside the body for long periods of time and also makes it resistant to chlorine.

Those most at risk for contracting crypto are:

  • Children who attend day care centers
  • Child care workers
  • International travelers
  • Backpackers, hikers, and campers who drink unfiltered, untreated water
  • People, including swimmers, who swallow water from contaminated sources
  • People who handle infected cattle
  • People exposed to human feces through sexual contact

The most common symptom of crypto is watery diarrhea.  Other symptoms include:

  • Stomach cramps or pain
  • Dehydration
  • Nausea
  • Vomiting
  • Fever
  • Weight loss

If you become infected with crypto, you can expect the symptoms to appear in 2-10 days.  They will usually last about 1-2 weeks and may go in cycles where you seem to get better and then feel worse before the illness ends.  Most people with a healthy immune system recover without treatment.  An over the counter anti-diarrheal medicine can help and it’s important to drink plenty of fluids to prevent dehydration.

Crypto is very contagious. The following steps should be taken by those infected with Crypto to avoid spreading the disease to others:

  • Wash your hands frequently and thoroughly with soap and water, especially after changing diapers, using the toilet, and before eating or preparing food.
  • For at least 2 weeks after the diarrhea has stopped, do not swim in recreational water. You can contaminate water for several weeks after the symptoms have ended.
  • Avoid sexual practices, such as oral-anal contact, that bring you in contact with fecal matter.
  • Avoid contact with people who have a weakened immune system.
  • Do not put children who have Crypto in a child care setting until the diarrhea has ended.

If you suspect you have crypto, or your symptoms are not improving, schedule an appointment at Student Health Services or with your health care provider. 

In the meantime – if you see “doodie” in the pool, play out that scene in Caddy Shack and get out of the water ASAP!!

You can read more about Crypto at the CDC website:

Submitted by Tina Comston

Reviewed by Dr. Ryan Hanson