Local health sleuths investigate contagious disease
By Paula J. McGarvey for The Montana Standard - 10/18/2005
It might lack the Hollywood stars, high tech equipment and nail biting suspense of the popular television series CSI, but the Butte Silver Bow Health Department does its share of solving mysteries with the goal of stopping the spread of disease in Southwest Montana.
"Our purpose at the health department is to prevent the spread of disease from one person to the next by rapidly identifying those diseases and preventing the spread of infection to other people," said Terri Hocking, a registered nurse and director of public health nursing services at the Butte Silver Bow Health Department.
Hocking said the list of diseases deemed reportable to the health department includes whooping cough, meningitis, encephalitis, tuberculosis, salmonella, E. coli, hepatitis A, hepatitis B, hepatitis C and sexually transmitted diseases, including syphilis, gonorrhea and chlamydia.
With a variety of different symptoms, incubation periods, and routes of infection, keeping track of reportable diseases is an awesome task. Hocking said that the health department receives between 200 and 300 cases annually to investigate.
"We take a very systematic approach to these investigations," said Hocking.
Part of the tracking system includes aggressive monitoring of local health care providers by health department staff, said Hocking.
"We have a system set up now for active surveillance," explained Hocking, describing how health department staff makes weekly calls to physicians, laboratories, emergency rooms and walk-in clinics to obtain updates on the status of reportable diseases. Once a diagnosis is reported, the process begins.
"The first thing I need to do is to verify that diagnosis," said Hocking, who typically contacts the patient's healthcare provider to find out if the person has been notified and treated. Once the diagnosis is confirmed, Hocking said that the source of the original infection needs to be determined.
Investigation plans depend on the disease being tracked. In the case of the whooping cough bacteria, health department investigators will often interview household members and family contacts, expanding their circle of coverage to include work or school associates as they track the path of a disease causing organism. In some cases, those exposed to a disease are given antibiotics to prevent them from becoming ill and decrease the risk of them spreading the disease to others.
"It's a little different with sexually transmitted diseases," said Hocking. With STDs, those exposed to a particular infective agent might receive a call from the health department alerting them about their contact, while keeping the name of the infection-source anonymous.
Although most of the time, the cases seen by the health department lack the glamour of TV labs in crime shows, occasionally, things get a little more exciting. In the 1990s, Hocking said that the health department was called in when Butte had an outbreak of food poisoning.
"This was the same kind of infection they called the Jack-in-the-Box outbreak in Washington," said Hocking. The infection was serious, as children in Washington state were dying from kidney failure after becoming infected with the bacteria.
"I got a call from the state that we had 6 cases of e. coli 0157. We had to do interviews and food histories on all these people." said Hocking, looking for some common thread in their recent diet.
When a common restaurant was found in all the case histories, Hocking said the source was ultimately traced to a local meat supplier. Once the restaurant changed suppliers, there were no more cases, said Hocking.
Hocking gave an example of another life threatening infection dealt with by health departments in the state. Although it didn't happen in Silver Bow County, this case gave Montana the distinction of having the only reported case in the nation of a tetanus infection in a newborn infant. According to Hocking, a family of Jamaican descent was living in Missoula and recently had welcomed a new baby into the family.
"The mother had never been immunized for tetanus. It was a cultural practice for them to pack the cord with mud to help it dry up and fall off," explained Hocking. The mud, which contained spores of tetanus causing bacteria, infected the baby.
"The baby survived because it (the disease) was recognized quickly," said Hocking.
Other times, cases get hairy. This past summer, Hocking said the department had to deal with a rabies scare. "We had a kid that was bitten by a bear cub," said Hocking, who had to determine if the animal was considered high risk and find out if a rabies treatment was warranted. Unlike domesticated animals, that can be held in quarantine and watched for symptoms, wild animals present more of a challenge.
"You don't know if the animal that's captured is the one, who causes the bite," said Hocking, who said in this case, it was decided to treat the child with the rabies series.
"The mortality rate for rabies is extremely high," she said.
Hocking said that sometimes, infectious disease cases can be confusing and the health department does see its share of false alarms.
"I had a call one Monday morning. Three patients were admitted over the weekend with symptoms of meningitis," recalled Hocking. After an extensive investigation, it was found that although the patient's symptoms initially resembled a meningitis outbreak, in fact, each patient ended up with a different diagnosis explaining their similar symptoms, said Hocking.
Hocking said that the health department does its part to get information out about the transmission and prevention of communicable disease.
"We play a very big role in public education," she said.
"If we can identify where infections come from and who they're infecting, then we can prevent it in other people and stop it in it's tracks," added Hocking.
