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JoffreyBalletSchool

HealthandSafetyHandbook

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TableofContentsIntroduction.................................................................................................................................................3

Injuries.........................................................................................................................................................3

BloodandBodyFluidExposure...................................................................................................................4

CommunicableDisease................................................................................................................................5

InformationforReportingCommunicableDiseases:...............................................................................6

CrisisProcedures:........................................................................................................................................7

FireEmergencies.........................................................................................................................................7

FireSafetyTips:........................................................................................................................................8

ViolenceorCriminalBehavioronCampus..................................................................................................8

ProtectionTipswithinJBSandNYC:........................................................................................................8

ActofTerrorism...........................................................................................................................................9

Evacuation.................................................................................................................................................10

TransportingStudentstoDormitory.........................................................................................................10

ShelteringinPlaceatJBS...........................................................................................................................10

LockdownLocationsatJBS:.......................................................................................................................10

ChemicalThreat.........................................................................................................................................11

Gunman.....................................................................................................................................................11

BombThreats............................................................................................................................................12

CatastrophicEmergency............................................................................................................................14

EmotionalDistress.....................................................................................................................................15

GeneralProcedures:..............................................................................................................................15

PsychologicalEmergency.......................................................................................................................16

SexualAssault,Stalking,andDomesticViolence.......................................................................................17

SexualAssault........................................................................................................................................17

Stalking..................................................................................................................................................18

DomesticandIntimatePartnerViolence...............................................................................................18

Appendix1:MedicalResources.................................................................................................................21

Hospital:.................................................................................................................................................21

UrgentCare:..........................................................................................................................................21

DanceInjuries:.......................................................................................................................................21

Appendix2CommunicableDiseasesofconcern.......................................................................................23

Chickenpox(varicellazosterinfection)..................................................................................................23

Diptheria................................................................................................................................................25

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Impetigo.................................................................................................................................................28

Influenza(Flu)........................................................................................................................................29

Measles(Rubeola,hardmeasles,redmeasles).....................................................................................33

MeningococcalDisease.........................................................................................................................35

Methicillin-ResistantStaphylococcusAureus(MRSA)...........................................................................37

Mumps(InfectiousParotitis).................................................................................................................39

Ringworm(Tinea)..................................................................................................................................41

Rubella(GermanMeaslesorThree-DayMeasles)................................................................................42

Mononucleosis,Infectious(Mono,EBVmononucleosis)......................................................................44

Pertussis(WhoopingCough).................................................................................................................45

InfantsandChildren..........................................................................................................................47

Scabies...................................................................................................................................................48

Whenandforhowlongisapersonabletospreadscabies?.................................................................49

SARS(SevereAcuteRespiratorySyndrome)..........................................................................................49

HowlongisapersonwithSARSinfectioustoothers?..........................................................................50

SkinInfectionsinAthletes.....................................................................................................................52

SexuallyTransmittedDiseases(STDs)....................................................................................................56

Tuberculosis(TB)...................................................................................................................................58

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Introduction

ItisthepolicyofJoffreyBalletSchooltoprovideasafeandhealthyenvironmentforallstudents,staff,faculty,andvisitors.ThisHealthandSafetyHandbookdocumentsthevarioushealthandsafetyproceduresandprotocolsinplaceatJoffreyBalletSchoolforstaff,faculty,andstudents.Themanual’spurposeistoaidintheidentificationofvarioushazardoussituationsthatcouldbeencountered.Itisalsointendedtohelppromoteasafeandhealthyenvironmentforallwhovisit,attend,andareemployedbyJoffreyBalletSchool.Weallshareintheresponsibilityformaintainingasafeandhealthyworkplace,andthismanualprovidesaguidetohelpyouunderstandyourrole.

Theinformationinthismanualrepresentsonlygeneralstandards.Thisinformationdoesnotsubstituteforallspecificsituations.Instructionsfromlawenforcementoremergencyrespondersshouldalwaysbefollowedforyourprotection.

InjuriesInjuriesareanunfortunatepartofsomedancer’sexperienceduringrigoroustraining.Injuriescanrangegreatlyinappearanceandseverity.JBSisdedicatedtominimizinginjuriesthroughproperinstruction.However,sometimesinjuriesareanunavoidablepartoftraining.

Staff/FacultyPolicies:

• Weencourageallstudentstoseekmedicalattentionforinjuries,butitisultimatelythestudent’sdecision(orparentifstudentisaminor).

• Injuredstudentsaretofollowdoctor’sordersforrecovery.• JBSstaffmembersarenottodiagnoseinjuriesortreatmentunlesslicensedorcertified

todoso.JBSisnotresponsibleforanyinjuriesincurred.• Studentsarerequestedtoobtainhealthinsurance.Studentsarefinanciallyresponsible

forallmedicaltreatmentreceivedduringtrainingatJBS.• Studentsarerequestedtocompleteahealthscreeningfordancersoraphysical

examinationpriortobeginningtrainingatJBStoensurethestudentdoesnothaveanyconditionsthatcouldinterferewithtrainingoroverallhealthofthestudent.

StudentProcedure:

• IfastudentbecomesinjuredduringJBSclass,informyourinstructor.YourinstructorwillpermityoutogototheHealthandWellnessOfficeifyouareabletowalkwithoutexacerbatingtheinjury.Ifnot,theinstructorwillsendastudenttobringtheHealthandWellnessCoordinatortotheinjuredstudent.

• Staffshouldnotdiagnoseinjuriesortreatmentunlesslicensedorcertifiedtodoso.

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• TheHealthandWellnessCoordinatorwillhelpyouwithyourinsuranceifmedicalassistanceisneeded.Studentsshouldkeeptheirhealthinsurancecardsandtreatmentpaymentmethodwiththematalltimesduringtraining.

• Thedeterminationtoseekmedicaladviceisultimatelyuptostudents(orparents/guardianifstudentisaminor),solongasthestudentisconscious.StudentsarefinanciallyforallmedicaltreatmentreceivedduringtrainingatJBS.

• Intheeventofastudentexperiencingunexplainedlossofconsciousness,JBSstaffwillcall9-1-1formedicalassistance.

• Ifsomeonestopsbreathing,requesthelpfromtheneareststaffthatiscertifiedinCPRortheHealthandWellnessCoordinator.Staffmayaskyoutocall9-1-1.Pleasefollowstaffinstructionstoassistasneeded.TherearealsoCPRinstructionspostedineachstudioatJBS.

BloodandBodyFluidExposureAnyexposureofbloodorbodyfluidshouldbeavoidedwheneverpossible.Exposureisreferringtoeye,mouth,mucousmembrane,ornon-intactskincontactwithbloodorotherpotentiallyinfectiousmaterials.

Thepurposeofthispolicyistoprovideguidanceforactionstoprotectthoserespondingtoincidentsinvolvingcontactwithbloodandotherbodyfluids.

Staff/FacultyProcedures:

Ifexposed,immediately:

• Washneedlesticksandcutswithsoapandwater.• Flushsplashestothenose,mouth,orskinwithwater.• Whencontactismadewiththeeyes,immediatelyflushtheeyeswithcleanwater,

saline,orsterileirrigants.• NotifytheHealthandWellnessCoordinator.• Seekmedicalattention,especiallyifthereiscontactwithbrokenskin,suchasacutor

anyopenwound.

Removal/Cleaning:

• Anyitemsthataresaturatedwithbloodaretobedoublebaggedwithsturdyplasticbags.Ifpossibledisposeofthematerialsinaredbag,whichshouldbelabeled‘BioHazard’.Asmallamountofblood(suchasatampon,pad,orband-aid)canbedisposedofinregularwaste.

• Discardshopobjects,suchasglassorneedles,inapuncture-resistant,leakproof,redorbiohazard-labeledcontainer.

• DONOTTOUCHCONTAMINATEDOBJECTSORMATERIALS.Usedisposableglovesorothertypesofprotectivebarrierstoprotectyourskinfromtouchingtheobject.

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• Contaminatedsurfacesmustbedecontaminatedwithanappropriatedisinfectantimmediatelyorassoonaspossible.

• AsktheHealthandWellnessCoordinatorforassistancewithdisposal.

StudentProcedures:

• Pleaseinformtheneareststaffmemberoftheincident.• Pleaseaskastaffmemberorstudenttoguardthehazardousmaterial,preventingany

furthercontact.Thepersonprotectingthehazardshouldnottouchitorputthemselvesindanger.

• ThestaffmemberwillsendsomeonetonotifytheHealthandWellnessCoordinator,whowillprovideassistance.

CommunicableDiseaseJoffreyBalletSchoolisdedicatedtoprotectingandenhancingthehealthandsafetyofallinourcommunity.Thissectioncontainsinformationaboutselectdiseasesthatmayhaveapotentialthreattothepublichealthofourcommunity.Learningthesignsandsymptomsofillnesswillalloweveryonetosharejointresponsibilityinpreventingorlimitingneworincreasednumbersofcommunicableillnessesontoourcampusandsurroundingcommunity.

IfanoutbreakofahighlycommunicablediseaseweretooccuratJBS,theindividual’sprivacywillbeprotectedtotheextentensuredbylawanddisclosuresofpersonalhealthinformationwillbemadeonlytoappropriatepersonsasmandatedbyNewYorkStatePublicHealthLaw.JoffreyBalletSchooldoesnothavethetoolsnecessarytoisolateindividualssuspectedofhavingacommunicablediseasethatrequiresisolation.Administrationwillassistineverypossiblewaywithhealthofficialsinplanningalternatearrangements.

Pleasenotethatitisimportanttobeinformedofsignsandsymptomsofillnessesthatmightposeathreattopublichealth.TheCentersforDiseaseControlandPrevention(www.cdc.gov)providesdetailedinformationonmanyillnesses.

StudentAbsencePolicy:

Ifyouareill,pleasestayhometoavoidinfectingothers.Werequestthatstudentsprovidedoctor’snotesfordaysabsentduetoillnesswheneverpossible.Doctor’snotesarerequiredininstancesof3ormoreconsecutivedaysabsentduetoillness.

StudentAbsenceProtocol:

Ifyouareill,pleaseemailyourprogram’sArtisticDirector,theHealthandWellnessCoordinator,andthedesignatedadministratorforyourprogramtoinformthemofthereasoningforyourabsence,alongwithyourexpectedreturndate.Ifyouneedhelpfindinga

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doctororworkingwithyourhealthinsurance,theHealthandWellnessCoordinatorisavailabletoassistyou.

Staff/FacultyAbsenceProtocol:

• Pleasecallyoursupervisor(ArtisticDirectorortheDirectorofOperations)toprovidenoticeassoonaspossible.

• Ifabsenceisplanned,pleasemaketherequestviaemailtoyoursupervisor(ArtisticDirectorortheDirectorofOperations)withasmuchadvancepossible,atleast2weekspriortothedateofabsence.

InformationforReportingCommunicableDiseases:NewYorkStateDepartmentofHealthRegionalEpidemiologyStaffNYSDepartmentofHealth,MetropolitanRegionalAreaOffice145HuguenotStreetNewRochelle,NewYork10801-5228Hours:8:30am-5pmPhone:914-654-7000#7Fax:914-654-7169NewYorkCityHealthDepartment125WorthStreet,Room315,CN-6NewYork,NewYork10013Hours:9am-5pmPhone:212-788-9830Fax:212-788-4268AfterHoursContact:PoisonControl212-764-7667Resources:NewYorkStateDepartmentofHealthwww.health.state.ny.usCentersforDiseaseControlandPreventionwww.cdc.govNewYorkCityDepartmentofHealthandMentalHygienewww.nyc.gov/html/doh

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CrisisProcedures:

TheentireJoffreyBalletSchoolcommunitysharestheconcernthatourfacilitiesremainsafeandsecure.Pleasebealerttosuspicioussituationsandpromptlyreportthreatening,violent,orcriminalbehaviortoyourArtisticDirectorortheneareststaffmember.Allthreatsagainstthesafetyofthestudentsandstaffaretobetakenseriously.JoffreyBalletSchooliscommittedtomaintainingthesafetyofourcommunity.Theseproceduresareinplacetokeepourstudents,staff,andfacultysafe.

Ifyouseeacriminalactorsomeoneactinginasuspiciousmanner,immediatelynotifythenearestArtisticDirector.Whenreportinganincident,pleaseincludethenatureandlocationoftheincident,alongwithdescriptionsofthepeopleandpropertyinvolved.

FireEmergenciesAllfirealarmsmustbetakenseriously.Survivalshouldbethetoppriorityinafiresituation.Buildingevacuationismandatoryuntilthesignalthatitissafetore-enterthebuildinghasbeenprovidedbythefiredepartment.

StudentProcedure:

• Staff/Facultywillprovideyouwithinstructionsforexitingthebuildingbyusingthenearestsafestairwell.ELEVATORSWILLNOTBEUSED.

• Thestairwellwillbeusedtoexitthebuildingforevacuationwhenpossible.Ifthestairwellisnotsafe,thefireescapeshouldbeused.Staffwillprovideinstruction.

• Whenthealarmissounded,alloccupantsshouldusethenearestsafeexit.• Thefirealarmisaloudbellorhornsignal.• Donotpanic,anddonotrun.Exitthebuildingquickly,butstaycalm.• FollowyourJBSstaffmember:AllJBSbuildingoccupantswillmeetatthestairsofthe

NYPublicLibrary,directlyacross6thAvenue.IftheNYPublicLibrarystairsareunsafe,pleaseproceedtothenearestsafezoneyourstaffmemberorfiremenleadyouto.Itisimportanttoremainwithyourgrouptoallowstaffmemberstoaccountforyoursafety.

• DoNOTre-enterthebuildinguntiltheFireDepartmenthasdeterminedthebuildingtobesafeforre-entry.

Ifyoususpectorseeafire,soundthealarm,andevacuatethebuildingbywayofthenearestsafestairwell.Closedoorsbehindyouifpossibletodososafely.DONOTUSETHEELEVATOR.

StaffProcedure:Allfacultymembersshouldimmediatelyevacuateallstudentsfromstudiouponactivationofthefirealarm.Staycalm.Youremotionswillleadyourstudents’responses.Itisimportanttonotehowmanystudentsyouhaveatthebeginningofeachclass,soyoucanaccountforallthroughouttheprocedure.Sendstudentstothesafespotinasingle-filelineviathenearestsafestairwell,andclosedoorsandwindowsbehindifyouareabletodososafely.Ifthemainstairwellisnotsafe,usethefireescape.DONOTALLOWANYONETOUSETHE

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ELEVATOR.Allemployeesmustevacuatethebuildingandgotothedesignatedsafemeetingareawiththeirgroup.Ifsafe,meetatthestairsoftheNYPublicLibrarydirectlyacross6thAve.Ifunsafe,continuedowntowntowardtheLibrary’scourtyardortothedesignatedspottheFiremenhavedeclaredtobethesafemeetingspot.DoNOTreenterthebuildinguntildeclaredsafe.

FireSafetyTips:• Checkdoorsandmetalknobsforheatbeforeopening.Ifthehandleordoorishot,do

notopenthedoor.• Ifyoumustmovethroughthicksmoke,staylowtothegroundandcrawlifpossibleto

avoidinhalingsmoke.Covermouth&nosewithascarforshirtifpossible.• Helppreventfires:followallrulesrelatingtofiresafety.

ViolenceorCriminalBehavioronCampusIfyouseeacriminalactorsomeoneactinginasuspiciousmanner,immediatelynotifythenearestArtisticDirector.Whenreportinganincident,pleaseincludethenatureandlocationoftheincident,alongwithdescriptionsofthepeopleandpropertyinvolved.

ProtectionTipswithinJBSandNYC:• Stayalertfortheunexpected,suspiciouspersons,ordangeroussituations,especially

whenwalkingalone.Walkwithsomeoneoringroupswheneverpossible.Sometimespick-pocketersusehelperstocreateadistraction.

• Useshadowsandstorewindowsormirrorstostayawareofyoursurroundings.• Keepyourbelongingswithyou.TheJBSlockerroomsarenotsupervised.Eitherbringa

locktouseaJBSlockerduringtheday(lockscannotbeleftovernightunlessyouareaKeystoneblendedmodelstudent)orbringyourbelongingswithyoutoyourstudio.Donotdisplaywallets,money,orjewelry.

• Donotcarrymoremoneythannecessaryinyourbelongings.• Ifyoufeeluncomfortablewhileoutside,gointoapopulatedstoreorshoporfinda

policeofficer.• IfyoufeeluncomfortablewhileinsideJBS,alerttheneareststaffmember.• IfyoufindyourselfthevictimofacrimewhennotonJBSpremises,contactapolice

officer.Incaseofemergency,dial911.Otherwise,contact311(freefromanycitypayphone)andanofficerwillhelpyoumakeareport.311connectswithaliveoperator24hourseachday.

• Ifyouarebeingmugged,donotfightback.Yourlifeisworthmorethanwhatisinyourpocket!

• Donotpanic.Trytostaycoolandnoticeanydetailsyoucanaboutyourattacker.• Lookconfidentinwhereyouaregoing,howyouwalk,andwhatyouaredoing.• OnlyuseNYCyelloworcabs(ortheenvironmentallyfriendlygreenversions).NEVERuse

gypsycabs(typicallyblacktowncars)orcarservicesthatstopandoffertopickyouup.

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• Donotrunonsubwaystairsorwithinsubwaysystems.• Rideinthemiddlesubwaycar,whichiswheretheconductorislocated,orthefirstcar,

whichiswherethemotormanislocated.

Therearesometypicalwarningsignsofcriminalorviolentbehavior,butnoneofthebelowsignsaresufficientevidencetopredictresultingbehavior.Anoffendermayonlydemonstrateoneornoneofthefollowingsigns,aseachsituationisunique.Beawareofpotentiallyviolentwarningsignswhensomeone:

• Isuncooperativeordisrespectfultoauthorityfigures• Isusuallyargumentative,callsothersnames,curses,orusesabusivelanguage• Hasfewornoclosefriends• Ignoresthethoughtsandfeelingsorrightsofothers• Doesnotcooperatewithothers• Dwellsonperceivedrejectionsormistreatmentsfromothers• Hasbeenavictimofintimidationfromothers• Demonstrateschangesinbehavior,suchastardinessorabsenteeism• Hasahistoryofviolence• Frequentlyappearsdepressed• Hasbroughtaweapontoschoolorthreatenedtodoso

Allthreatsofviolenceshouldbetakenseriously.Mostattacksareplanned,andreportingtheissueorworrisomebehaviorcanbethekeytoaninterventionpreventingtheviolence.

Ifanemergencyoccursoncampus,pleasealertthenearestArtisticDirectororstaffmemberassoonaspossible.StaffwillimmediatelynotifyanArtisticDirector,whowillfollow-upwithstaffandpoliceasnecessary.

ActofTerrorism• Remaincalmandbepatient.Followtheadviceoflocalemergencyofficials.• Listentoyourradioortelevisionfornewsandinstructions.• Iftheeventoccursnearyou,checkforinjuries.Givefirstaidandgethelpforseriously

injuredpeople.EachJBSstudioandofficehasmedicalsuppliesavailable.• Donotlightmatchesorcandlesorturnonelectricalswitches.Checkforfires,fire

hazardsandotherhouseholdhazardsandimmediatelyalertofanyconcerns.Sniffforgasleaks,startingatthewaterheater.Ifyousmellgasorsuspectaleak,turnoffthemaingasvalve,openwindows,andgeteveryoneoutsidequickly.Shutoffanyotherdamagedutilities.Callyourfamilycontact—donotusethetelephoneagainunlessitisalife-threateningemergency.

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EvacuationIflocalauthoritiesaskyoutoleaveyourlocation,theyhaveagoodreasontomakethisrequest,andyoushouldheedtheadviceimmediately.ListentoyourradioortelevisionandfollowtheinstructionsoflocalemergencyofficialsandJBSstaff.Mostlikelytherewillbenophone,Internet,orpublictransportation.Ifpossible,wearlong-sleevedshirts,longpantsandsturdyshoes,soyoucanbeprotectedasmuchaspossible.

TransportingStudentstoDormitory• Staffbringabasicfirst-aidkit:Band-Aids,alcoholswabs,gauze,andmedicaltape.• Studentsandstaffleavebigbagsatschooltotravelfaster.Remembertobringyour

keys,ID/wallet,andhaveallphonesonsilent.• Usetravelroutesspecifiedbylocalauthorities—don'tuseshortcutsbecausecertain

areasmaybeimpassableordangerous.• Staffmovestudentsthroughneighborhoodsup11thAvetoWestEndAve.Stayaway

fromdownedpowerlines.Ifnecessary,safeplacesforstafftodirectthegrouptostopforcoverare:libraries,churches,postofficeetc.

ShelteringinPlaceatJBSClosetheschool.Followreverseevacuationprocedurestobringstudents,faculty,andstaffindoors.Iftherearevisitorsinthebuilding,providefortheirsafetybyaskingthemtostay–notleave.Whenauthoritiesprovidedirectionstoshelter-in-place,theywanteveryonetotakethosestepsnow,wheretheyare,andnotdriveorwalkoutdoors.

LockdownLocationsatJBS:3rdFloor:Costumecloset,stafflounge,3rdflooroffices4thFloor:Healthoffice,studio35ThFloor:5thflooroffices,Keystoneroom,&storagecloset

• Provideforansweringtelephoneinquiriesfromconcernedparentsbyhavingthe3rdfloorofficetelephoneavailable.Thisroomshouldalsobesealed.Staffphonesshouldbecloselymonitoredforupdates.Ifstudentshavecellphones,allowthemtousethemtocallaparentorguardiantoletthemknowthattheyhavebeenaskedtoremaininschooluntilfurthernoticeandthattheyaresafe.

• Staffshouldgatheressentialdisastersupplies,suchasnonperishablefood,bottledwater,battery-poweredradios,firstaidsupplies,flashlights,batteries,ducttape,plasticsheeting,andplasticgarbagebags.

• Bringeveryoneintothenearestlockdownroom.Shutandlockthedoor.• Writedownthenamesofeveryoneintheroom,andcallDirectorofOperationsto

reportwhoisintheroomwithyou.

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• Listenforanofficialannouncementfromschoolofficials,andstaywhereyouareuntilyouaretoldallissafeortoevacuate.Localofficialsmaycallforevacuationinspecificareasatgreatestriskinyourcommunity.

ChemicalThreatStaffuseducttapeandplasticsheeting(heavierthanfoodwrap)tosealallcracksaroundthedoor(s)andanyventsintotheroom.

Haveemployeesfamiliarwithbuilding’smechanicalsystemsturnoffallfans,heatingandairconditioningsystems.Somesystemsautomaticallyprovideforexchangeofinsideairwithoutsideair–thesesystems,inparticular,needtobeturnedoff,sealed,ordisabled.

GunmanAllthreatsagainstthesafetyofthestudentsandstaffaretobetakenseriously.JoffreyBalletSchooliscommittedtomaintainingthesafetyofourcommunity.Theseproceduresareinplacetokeepourstudents,staff,andfacultysafe.

Responsibilities:TheDirectorofOperationswillactastheactiveshootercoordinatorandwillberesponsibleformakingthedecisiontoevacuateabuilding.

StaffProcedure:

• ImmediatelyinformthenearestArtisticDirectorofathreator,ifastudent,informtheneareststaffmember.ArtisticDirectororstaffwillimmediatelyinformDirectorofOperations.

• IftheDirectorofOperationsmakesadecisiontoevacuate,thestaffwillleadtheevacuationfollowingtheevacuationproceduresoncethepoliceorDOOhavedeclaredthebuildingsafetoevacuate.

• Donotuseelevator,usestairsifpossibletoleadstudentstosafety.• Ifunabletosafelyevacuate,preparetolockdown.Immediatelylockelevatorifpossible.• Ifelevatorisoff:closeandlockhallwaydoorsoneachfloor,preventingentry.• Ifunabletolockelevator:staffshouldleadstudentstolockdownlocationsinfollowing

areas:

3rdFloor:Costumecloset,stafflounge,3rdflooroffices4thFloor:Healthoffice,Studio35ThFloor:5thflooroffices,Keystoneroom,&storagecloset

StudentProcedure:

• Studentsshouldremainquietduringlockdownandshouldnotopendoors.• Studentsshouldalwaysbewithastaffmember,andallphones/electronicsshouldbe

silenced.

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BombThreatsResponsibilities:TheDirectorofOperationswillactasthebombsearchcoordinatorandwillberesponsibleformakingthedecisiontoevacuateabuilding.

Staff/FacultyandStudentProcedure:

Ifreceivedbyphonecall:

• Trytokeepthecalleronthephone(mostcallswillbebrief).• FilloutBombThreatChecklistandfollowprotocol(followingpage)• Uponhangingup,immediatelyinformthenearestArtisticDirectoror,ifastudent,

informtheneareststaffmember.ArtisticDirectororstaffwillimmediatelyinformDirectorofOperations.

• Anyoneinthesearchareashouldnottouchunusualorsuspiciousobjects,useelevators,orcreateradioorcellphonetransmissions.

• IftheDirectorofOperationsmakesadecisiontoevacuate,thestaffwillleadtheevacuationfollowingthefireproceduresoncethepolicehavedeclaredthebuildingsafetoevacuate.DoorsandwindowsshouldNOTbeshut.Theyaretoremainopentohelpreduceshockwavesinthecaseofanexplosion.

Bombthreatbynoteorletter:

• Donothandletheletter,envelope,oranythinginthepackageorenvelope.Theitemsmaycontainimportantfingerprintsthatcouldleadtotheidentificationoftheresponsibleparty.Trynottofingerprintanyitems.

• ImmediatelynotifythenearestArtisticDirectororneareststaffmember.

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Source:FEMAhttp://emilms.fema.gov/is906/assets/ocso-bomb_threat_samepage-brochure.pdf

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CatastrophicEmergencyDesignatedstaff,onceinformed,willbeginthenotificationprocessintheeventofanaccident,illness,oractofviolenceresultingintheunexpecteddeathofaJoffreyBalletSchoolcommunitymember.TheDirectorofOperations,ArtisticDirector,andHealthandWellnesscoordinatorwillworktogethertoactivatetheprotocol.

ActsofViolenceincludebutarenotlimitedto:homicide,suicide,accidentleadingtodeath,sexualassault,assaultleadingtophysicalinjury,actofterrorism,fire,andnaturaldisaster.

ImmediateStaff/FacultyProcedures:

• Scenemanagement:DirectorofOperationswillcoordinateresponse.• DirectorofOperationswillarrangeinformingfamilyofthedeceasedorinjured.• DirectorofOperations,ArtisticDirector,andHealthandWellnessCoordinatorwillplan

supportserviceswhendeemedappropriate.

Staff/FacultyProcedures:

• DirectorofOperationswillplanandinstructArtisticDirectorsonappropriatemethodsofinformationreleasetomediaandwithintheJBScommunity.

• HealthandWellnessCoordinatorwillarrangeasymbolicactwithinonemonthoftheincident.

• DirectorofOperationswillarrangealiaisonwithexternalpolice.• TheDirectorofOperations,ArtisticDirectors,andHealthandWellnessCoordinatorwill

holdacrisiseventevaluationsession.

Resources:

ReadyNewYork:PreparingforEmergenciesinNewYorkCity

http://www.nyc.gov/html/oem/downloads/pdf/household_guide.pdf

NewYorkCityOfficeofEmergencyManagement

http://www.nyc.gov/html/oem/html/businesses/businesses.shtml

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EmotionalDistressTheHealthandWellnessCoordinatorisavailabletostudentsexperiencingemotionaldistress.Emotionaldistresscaninclude,butisnotlimitedto,thefollowing:loss,depression,eatingdisorderedbehavior,andbodyimageissues.

GeneralProcedures:SignssuggestingthatastudentshouldbereferredtotheHealthandWellnessCoordinator:

• Frequenttardinessorabsenteeism• Consistentdiscrepancybetweenpotentialandactualachievement• Uncharacteristicwork• Studentshiftsdiscussionfromadvisementontrainingtopersonalissues• Markedchangeinpersonalhygiene• Highlevelsofirritabilityand/orunruly,aggressivebehavior• DramaticWeightgainorloss• Drugand/oralcoholabuse• Behaviorthatregularlyinterfereswiththeclass• Dependencyonstaffmember• Traumaticexperiences,suchaslossordeath• Suddendistancingfromfacultyorotherstudents

EMERGENCYSITUATIONS:REQUESTHELPIMMEDIATLEY!

• Expressionofhomicidalorsuicidalthoughts• Severelossofemotionalcontrol• Grossimpairmentofthinkingability

HowtoMakeaReferralasaStaff/FacultyMember:

Ifyoubecomeawarethatastudentisdemonstratingworrisomebehavior(detailedabove)orishavingaproblem,itishelpfultoaskthestudent,“Areyoutalkingwithanyoneaboutthis?”Ifthestudenthasnotyetarrangedcounseling,itisbesttoencouragethestudenttoseekhelp.YoumayexpressyourconcernandremindthestudentthattheHealthandWellnessCoordinatorisavailabletohimorher.However,ifastudentisinneedofimmediatehelp,offertocalltheHealthandWellnessCoordinatorwiththestudentpresent.

IfyoucalltheHealthandWellnessCoordinatoronastudent’sbehalf,identifyyourselfandexplainthesituation.Provideabriefdescriptionofthebehaviorthatconcernsyouandthelevelofurgency,andthenallowthestudenttospeakdirectlytotheHealthandWellnessCoordinatortoarrangeanappointment.

Ifyouarenotcomfortablesuggestingareferral,orifthestudentisreluctanttoacceptone,feelfreetocalltheHealthandWellnessCoordinatortoshareyourconcerns.Yourinsightcanbe

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helpfulincreatingaplantoreachthestudenttodeterminehowseriousthingsmightbeforhim/her.

Youmayfollowupwiththestudenttodeterminewhetherheorshehasfolloweduponyourrecommendation,buttheHealthandWellnessCoordinatormustvaluestudentconfidentialitybykeepingmeetinginformationprivate.Checkinguponthestudentcanhelpshowyourcontinuedconcernandsupport.

HowtoMakeaReferralasaStudent:

Ifyouarecomfortable,suggesttothestudentthattheytalktosomeone,suchastheHealthandWellnessCoordinator.Ifyouarestillconcernedand/oryouworrythatthestudentwillnotseekhelp,scheduleameetingwiththeHealthandWellnessCoordinator,atwhichtimeyouwillbeabletodiscussyourconcernsconfidentially.Themostcaringthingyoucandoforafriendinneedistohelpthemtofindhelp.

Resources:

SuicidalCrisisHotline212-673-3000RapeCrisisHelpHotline

PsychologicalEmergencyTheentireJBScommunitysharesaresponsibilitytorespondtoapersoninapsychologicalemergencyandprotectthatindividualand/orthecommunity.

Pleasenotethefollowing:

AstudentisconsideredtoberesponsibleforhisorheractionsandbehavioratalltimesandissubjecttoJBSconsequencesorlegalaction.Ifthereissignificantdoubtaboutwhetherastudentiscapableofassumingresponsibilityforhisorherbehaviorornot,itisanemergencysituation.Staffshouldtakeimmediateactiontoinsurethesafetyofboththeindividualstudentandthecampuscommunity.

Ifyouencountersomeoneshowinganyofthefollowingsigns,itisanemergencysituation.Gethelpimmediatelyifsomeone:

• Expresseshomicidalorsuicidalthoughts• Demonstratesseverelossofemotionalcontrol• Demonstratesgrossimpairmentofthinkingability

StaffProtocol:Duringanemergencypsychologicalsituation,staffMembersshouldnevertransportastudentinapersonalvehicle,noraccompanythestudentinacab.Thestudentshouldbetransportedbyambulance,afamilymember,orpolice.

StaffmustNEVERsignthestudentintothehospital.

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Thestudentisresponsibleforanyandallcostsincurredformedicalvisit,treatment,ortransportation.JBSstaffmustnotsignthestudentintothehospital.

IfthestudentisaresidentinaJBSfacilityandisnotadmittedtothehospital,thestudentwillnotbeallowedtoreturntoJBSresidenceuntilheorshehascompletedanevaluationwithanoutsidepsychologist.TheDirectorofOperations,DirectorofResidence,andHealthandWellnessCoordinatorwillreviewtheevaluationresultsbeforedeterminingthesafetyofhisorherreturntoJBShousing.JBSreservestherighttorequirehimorhertocompleteasecondevaluationbyalicensedmentalhealthprofessionalbeforethedecisionregardingthestudentsreturntohousingmaybemade.

SuicideCrisisHotline:212-673-3000

SexualAssault,Stalking,andDomesticViolenceItisJBSpolicytoprovideanenvironmentthatissafeandfreefromviolence.JBSprohibitsanddoesnottolerateactsofviolencethatoccuronourownedorcontrolledpremisesoratschooleventsorprograms.Theviolentactsreferredtointhissectionincludesexualassault,domesticandintimatepartnerviolence,andstalkingagainstanymemberoftheJBScommunity.

Thispolicyisapplicabletoallstudents,staff,faculty,visitors,vendors,contractors,guests,andallthirdparties.ThoseinviolationaresubjecttocriminalprosecutionaswellasJBSdisciplinaryactionincludingbutnotlimitedtoexpulsion,terminationofemployment,andotherappropriatesanctions.

RapeCrisisHelpHotline212-577-7777914-345-9111

TheEmotionalDistresssectionishelpfulhere.

SexualAssault

Sexualviolenceisanysexualact,attempttoobtainasexualact,unwantedsexualcommentsoradvances,actstotraffic,orotheractivitiesdirectedagainstapersonusingcoercionbyanyperson,regardlessoftheirrelationshiptothevictim,inanysetting,includingbutnotlimitedtohomeandwork.Theabilitytogiveconsentisanimportantconsiderationinanysexualact.Apersonwhoisunabletounderstandthenatureorconditionoftheactinordertodeclineparticipation,ortocommunicateunwillingnesstoengageinthesexualact,e.g.,becauseofillness,disability,ageortheinfluenceofalcoholorotherdrugs,orduetointimidationorpressure,isunabletogiveconsent.

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Source:NewYorkStateDepartmentofHealthhttps://www.health.ny.gov/prevention/sexual_violence/what_to_do.htm#safe_program

Stalking

Insimplestterms,stalkingistheunwantedpursuitofanotherperson.Byitsnature,stalkingisnotaone-timeevent.Theindividual'sactionsmustbeconsideredinconnectionwithotheractionstodetermineifsomeoneisbeingstalked.Itincludesrepeatedharassingorthreateningbehaviortowardanotherperson,whetherthatpersonisatotalstranger,slightacquaintance,currentorformerintimatepartner,oranyoneelse.

Stalkingisalso:

• Aterrorizingcrimewithnorealidentifiedbeginningandseeminglynoend;• Acrimethatcancausetremendousfearwithouttheslightestphysicalinjury;• Abehaviorwithahighcorrelationtophysicalandsexualviolence1;• Acrimethatcanbelethal;and• Averyeffectivetacticofcontrolfordomesticviolenceabusers.

DomesticandIntimatePartnerViolenceDomesticviolenceiswhenonepersondoesavarietyofthingstocontrolanotherpersoninanintimaterelationship.Theshiftinpowercanhappenveryslowly,overaperiodoftime,sothattheotherpersoncannotevenrememberwhenithappened.Oritcanhappenveryquicklyafterthereissomesortofcommitmentorsomechangeinthelevelofintimacy.

PreventionofSexualAssaultandViolentAssaults:

Crimemaynotalwaysbeprevented,butactionsthatcanreducetheriskofbecomingavictimareimportantandinclude,butarenotlimitedto,thefollowing:

• Avoidwalkingalone,especiallyafterdark.• Alwayskeepyourapartment/roomlockedwhensleeping.• Followallresidencehallrules.Neverallowanyoneinthebuildingunlesstheyareyour

permittedguest.• Neverpropopenexteriordoors.• Callforhelpifyouseeanyoneinaresidencehallwhoappearssuspiciousordoesnot

belongthere.• Neverhideyourkeysoutsideyourapartment.• Clearlycommunicateyoursexualintentionsandlimits.• Trustyourself.Ifyouareuncomfortableorfeelthatsomethingiswrong,immediately

removeyourselffromthesituation.

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Policy:

IfaJBSstudentorstaffmembercommitssexualassaultonaJBSstudentorstaffmember,theassaulterwillfaceimmediateterminationorexpulsion.JBSwillreporttheincidenttolawenforcement.

Resource:

NewYorkStateDomesticViolenceHotline1-800-942-69061800-621-HOPE(4673)311TTY:1-866-604-5350

NewYorkStateResources

• AlphabeticalListingofNewYorkStateAgencieswithwebsites• EmpireJusticeCenter• NewYorkAsianWomen'sCenter• NewYorkCityGayandLesbianAnti-ViolenceProject• NewYorkCityMayor'sOfficetoCombatDomesticViolence• NewYorkStateCoalitionAgainstDomesticViolence• PaceWomen’sJusticeCenter

NationalOrganizationsandResources

• AmericanBarAssociationCommissiononDomesticViolence• BureauofJusticeStatisticsAboutCrimeandVictims• FuturesWithoutViolence(FormerlyTheFamilyViolencePreventionFund)• FeministMajorityFoundationDomesticViolenceInformationCenter• InstituteonDomesticViolenceintheAfricanAmericanCommunity• NationalCenterforVictimsofCrime• NationalCoalitionAgainstDomesticViolence• NationalCouncilofJuvenileandFamilyCourtJudges• TheNationalDomesticViolenceProBonoDirectory• NationalLatinoAlliancefortheEliminationofDomesticViolence• U.S.DepartmentofJusticeViolenceAgainstWomenOffice• ViolenceAgainstWomenOnlineResources• WomenofColorNetwork

GeneralInformationonDomesticViolence

• Feminist.comAnti-ViolenceResources• MINCAVA(MinnesotaCenterAgainstViolenceandAbuse):DomesticViolenceandViolence

AgainstWomen• NationalCenterforVictimsofCrime:

o StalkingResourceCenter

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o GetHelpSeries-DomesticViolence

DomesticViolenceandSpecificPopulations

• MINCAAResourceso DisabilitiesandViolenceo ElderAbuseo Same-sexdomesticviolencereferences

• TheRuralWomynZone:ViolenceAgainstRuralWomen• SurvivorProject:Transsexual,Transgender,andIntersexVictims

NewYorkStateDomesticViolenceResources

• NewYorkStateDomesticViolenceProgramsAcountybycountylistingofresidentialandnon-residentialdomesticviolenceprogramsinNewYorkState.

• NewYorkStateOrganizationsandHotlinesAlistofdomesticviolence-relatedstatewidehotlinesandresources.

SourceforSexualAssaultsectionofhandbook:OfficeforthePreventionofDomesticViolencehttp://opdv.ny.gov/whatisdv/about_dv/index.html

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Appendix1:MedicalResourcesEmergency:DIAL9-1-1

Hospital:BethIsraelMedicalCenter1stAvenueand16thSt.NewYork,NY10003-380Phone:212-420-2840Mt.SinaiHospital1005thAveNewYork,NY10011212-241-0043

UrgentCare:NewYorkDoctorsWalk-InUrgentCare65West13thSt.NewYork,NY10011Phone:212-414-2800Fax:212-414-2822LocatedinGreenwichVillageon13thSt.between5thand6thAvenearUnionSquare.http://www.nydoctorsurgentcare.com/ContactUs/tabid/19427/Default.aspxCityMDUrgentCare14W.14thSt.NewYork,NY10011Phone:212-390-0558Citymd.comUrgentMedicalCareUnionSquare110W.14thSt.NewYork,NY10011Phone:212-242-4333http://www.urgentmedicalcareunionsquare.com/urgent-care/

DanceInjuries:HarknessCenterforDanceInjuriesatNYUHospitalforJointDiseases6142ndAveSuiteGFloor2NewYork,NY10016Phone:(212)598-6022harkness@nyumc.orgSportsMedicinePhysician:

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Dr.DonaldRose,M.D.–specialtyindancers;DirectorofHarknessCenterHarknessMedicalCenter:DanceClinic240East18thSt.(at2ndave)NewYork,NY10003Phone:(212)598-6022http://www.donaldrosemd.com/Meet/

SportsMedicinePhysician,InternalMedicine,&Acupuncturist:Dr.JeffreyDelson,M.D.WashingtonSquareSportsMedicine7GaySt.NewYork,NY10014Phone:(212)206-0629EmailDr.Delson@yahoo.comPsychology:Dr.LindaHamiltonEmail:talk2me@wellness4performers.comPhone:(917)841-2169

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Appendix2CommunicableDiseasesofconcern

Thefollowingisnotacompletelistofallcommunicablediseasesofconcern,butinsteadinformationonthemoreprevalentorlikelydiseasesofconcernatJBS.

Chickenpox(varicellazosterinfection)

Whatischickenpox?

Chickenpoxisahighlycontagiousillnesscausedbythevaricella-zostervirus(VZV),atypeofherpesvirus.Itisoftenamildillness,characterizedbyanitchyrashontheface,scalpandtrunkwithpinkspotsandtinyfluid-filledblistersthatdryandbecomescabsfourtofivedayslater.Seriouscomplications,althoughrare,canoccurmainlyininfants,adolescents,adultsandpersonswithaweakenedimmunesystem.Thesecomplicationsincludebacterialinfectionsofskinblisters,pneumonia,andencephalitis(inflammationofthebrain).Intemperateclimates,suchastheNortheast,chickenpoxoccursmostfrequentlyinthelatewinterandearlyspring.

Whogetschickenpox?

Chickenpoxisacommonchildhoodillnesswith90percentofthecasesoccurringinchildrenyoungerthantenyearsofage.BeforetheavailabilityofthevaricellavaccineintheU.S.,almosteveryonedevelopedchickenpox.Mostpeoplewhoarevaccinatedwillnotgetchickenpox.Thosewhoarevaccinatedanddevelopchickenpoxusuallyhaveamildformoftheillness.Theyhavefewerspotsandrecoverfaster.

Howischickenpoxspread?

Chickenpoxistransmittedfrompersontopersonbydirectlytouchingtheblisters,salivaormucusofaninfectedperson.Theviruscanalsobetransmittedthroughtheairbycoughingandsneezing.Chickenpoxcanbespreadindirectlybytouchingcontaminateditemsfreshlysoiled,suchasclothing,fromaninfectedperson.Directcontactwiththeblistersofapersonwithshinglescancausechickenpoxinapersonwhohasneverhadchickenpoxandhasnotbeenvaccinated.Blistersthataredryandcrustedarenolongerabletospreadchickenpox.

Whatarethesymptomsofchickenpox?

Initialsymptomsincludesuddenonsetofslightfeverandfeelingtiredandweak.Thesearesoonfollowedbyanitchyblister-likerash.Theblisterseventuallydry,crustoverandformscabs.Theblisterstendtobemorecommononcoveredthanonexposedpartsofthebody.Theymayappearonthescalp,armpits,trunkandevenontheeyelidsandinthemouth.Mildor

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asymptomaticinfectionsoccasionallyoccurinchildren.Thediseaseisusuallymoreseriousinyounginfantsandadultsthaninchildren.

Howsoondosymptomsappear?

Symptomscommonlyappear14to16days(rangeoftento21days)afterexposuretosomeonewithchickenpoxorherpeszoster(shingles).

Whatarethecomplicationsassociatedwithchickenpox?

Newbornchildren(lessthanonemonthold)whosemothersarenotimmunemaysuffersevere,prolongedorfatalchickenpox.Anypersonwithaweakenedimmunesystem,includingthosewithcancer,humanimmunodeficiencyvirus(HIV)ortakingdrugsthatsuppresstheimmunesystem,mayhaveanincreasedriskofdevelopingasevereformofchickenpoxorshingles.

ReyeSyndromeisanunusualcomplicationofchickenpoxthatislinkedtochildrenwhotakeaspirinoraspirin-containingproductsduringtheillness.ReyeSyndromeisaseverediseaseaffectingallorgansystems,but,mostseriouslythebrainandliverandmaybefatal.TheexactcauseofReyeSyndromeisunknown.Aspirinoraspirin-containingproductsshouldneverbegiventochildrenunder18yearsofagewithchickenpox.

Whenandforhowlongisapersonabletospreadchickenpox?

Apersonismostabletotransmitchickenpoxfromonetotwodaysbeforetherashappearsuntilalltheblistersaredryandcrusted.Peoplewithaweakenedimmunesystemmaybecontagiousforalongerperiodoftime.

Isthereatreatmentforchickenpox?

Acyclovirisapprovedfortreatmentofchickenpox.However,becausechickenpoxtendstobemildinhealthychildren,mostphysiciansdonotfeelthatitisnecessarytoprescribeacyclovir.Acyclovircanbeconsideredforotherwisehealthypeoplewhoareatriskofmoderatetoseverevaricella.Itisimportanttoconsultwithyourphysicianforrecommendationsontheuseofacyclovir.

Doespastinfectionwithchickenpoxmakeapersonimmune?

Mostpeopledonotgetchickenpoxmorethanonce.However,sincevaricella-zostervirusremainsinthebodyafteraninitialinfection,infectioncanreturnyearslaterintheformofshinglesinsomeolderadultsandsometimesinchildren.

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Isthereavaccineforchickenpox?

Avaccinetoprotectchildrenagainstchickenpoxwasfirstlicensedin1995.Childrenwhohaveneverhadchickenpoxshouldroutinelybeadministeredtwodosesofvaricellavaccinewiththefirstdoseat12to15monthsandtheseconddoseatfourtosixyearsofage.Persons13yearsofageandolderwhohaveneverhadchickenpoxorhavenotreceivedthevaricellavaccineshouldgettwodosesofthevaricellavaccineatleast28daysapart.

Thevaricellavaccinemaybegivenalongwiththemeasles-mumps-rubella(MMR)vaccineinacombinationcalledmeasles-mumps-rubella-varicella(MMRV)thatisapprovedforuseinchildren12monthsthrough12yearsofage.

InNewYorkState,varicellavaccineisrequiredforchildrenenrolledinpre-kindergartenprogramsandschools.Vaccinationisrecommendedforhealthcarepersonnelandcollegestudentswhohaveneverhadchickenpox.

Whatcanbedonetopreventthespreadofchickenpox?

Maintaininghighlevelsofvaricellaimmunizationinthecommunityiscriticaltocontrollingthespreadofchickenpox.Topreventfurtherspreadofchickenpox,peopleinfectedwiththediseaseshouldremainhomeandavoidexposingotherswhoaresusceptible.Infectedpersonsshouldremainhomeuntiltheblistersbecomedryandcrusted.Itisveryimportanttoavoidexposingnon-immunenewbornsandpersonswithaweakenedimmunesystemtochickenpox.

Varicellavaccinationisrecommendedforoutbreakcontrol.Duringanoutbreak,personswhodonothaveadequateevidenceofimmunityshouldreceivetheirfirstorseconddoseasappropriate.

In2006,anewproductcalledVariZIG™becameavailabletoprotectpatientswithoutevidenceofimmunitytovaricellawhoareathighriskforseverediseaseandcomplicationsandhavebeenexposedtochickenpox.ThepatientgroupsrecommendedtoreceiveVariZIGincludethosewithaweakenedimmunesystem,pregnantwomen,newbornswhosemothershavesymptomsofvaricellaaroundthetimeofdelivery(fivedaysbeforetotwodaysafterdelivery)andcertainprematureinfantsexposedtochickenpoxasnewborns.

Diptheria

Whatisdiphtheria?

Diphtheriaisahighlycontagiousandpotentiallylife-threateningbacterialdiseasecausedbyCorynebacteriumdiphtheriae.Therearetwotypesofdiphtheria:respiratoryandcutaneous.Respiratorydiphtheriainvolvesthenose,throatandtonsils,andcutaneousdiphtheriainvolvestheskin.Cutaneousdiphtheriaisdiscussedbelow.

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Whatisrespiratorydiphtheria?

Respiratorydiphtheriapresentsasasorethroatwithlow-gradefeverandamembraneattachedtothetonsils,pharynx,ornose.Neckswellingisusuallypresentinseveredisease.Respiratorydiphtheriacanleadtoseverebreathingproblems,heartfailure,blooddisorders,paralysis,comaandevendeath.

Whogetsrespiratorydiphtheria?

RespiratorydiphtheriaisextremelyrareintheUnitedStatesbecauseofwidespreadimmunization.MostoftheinfrequentcasesofdiphtheriaintheU.S.areamongunvaccinatedorinadequatelyvaccinatedpersons,particularlythosewhotraveltoareaswherediphtheriaiscommonandthosewhocomeintoclosecontactwithtravelersfromsuchareas.

Howisdiphtheriaspread?

Diphtheriaistransmittedfrompersontopersonthroughclosecontactwiththedischargefromaninfectedperson'seyes,nose,throatorskin.

Whatarethesymptomsofrespiratorydiphtheria?

Symptomsincludesorethroat,low-gradefever,muscleweakness,lossofappetiteandenlargedlymphnodeslocatedintheneck.Agrayishcoloredmembranemayformoverthenose,throatandtonsilsblockingtheairwayandmakingitdifficulttoswallow.Personsmaydevelopabarkingcoughandhoarsenesswithextensiveinvolvementofthethroat.

Howsoondosymptomsappear?

Symptomsusuallyappeartwotofivedaysafterinfection,witharangeofonetotendays.

Whatarethecomplicationsofuntreatedrespiratorydiphtheria?

Deathoccursinapproximatelyfivetotenpercentofallrespiratorycaseswithhigherdeathrates(ofupto20percent)amongpersonsyoungerthanfiveandolderthan40yearsofage.

Whatisthetreatmentforrespiratorydiphtheria?

Diphtheriademandsimmediatemedicalattention;anydelayintreatmentcanresultindeath.Apersonwithdiphtheriashouldbehospitalized,isolatedandtreatedwithdiphtheriaantitoxinandantibiotics,suchaspenicillinanderythromycin.

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Whenandforhowlongisapersonabletospreadrespiratorydiphtheria?

Untreatedpatientswhoareinfectedwiththediphtheriagermmaybecontagiousforuptofourweeks.Ifthepatientistreatedappropriately,thecontagiousperiodcanbelimitedtolessthanfourdays.

Doespastinfectionwithdiphtheriamakeapersonimmune?

Recoveryfromdiphtheriaisnotalwaysfollowedbylastingimmunity.

Isthereavaccinefordiphtheria?

DiphtheriavaccineforchildreniscombinedwithtetanusandacellularpertussistoformatriplevaccineknownasDTaP(diphtheria,tetanus,acellularpertussis).In2005,anewvaccinewasapprovedasasingleboostervaccinationforadolescentsandadultscalledTdap(tetanus,diphtheriaandacellularpertussis).Td(tetanusanddiphtheria)isalsoavaccineusedasaboostervaccinationinadolescentsandadults,however,itdoesnotcontainthepertussisvaccine.

DTaPshouldbegivenattwo,four,six,15to18monthsofage,andbetweenfourandsixyearsofage.

ThepreferredageforTdapvaccinationis11to12years.However,alladolescentsaged11to18yearsshouldreceiveasingledoseofTdapinsteadoftheTdforboosterimmunizationiftheyhavecompletedtherecommendedchildhoodDTaPvaccinationseriesandhavenotreceivedTdorTdap.AnintervaloffiveyearsbetweenTdandTdapisencouraged;howeveranintervaloflessthanfiveyearsbetweenTdandTdapadministrationcanbeused.Thereafter,Tdshouldbegiveneverytenyearstomaintainimmunity.

Adultsaged19to64yearsshouldreceiveasingledoseofTdaptoreplaceasingledoseofTdforactiveboostervaccinationiftheyreceivedtheirlastdoseofTdgreaterthantenyearsearlier.Thereafter,Tdshouldbegiveneverytenyearstomaintainimmunity.

InNewYorkState,diphtheriavaccineisrequiredforallchildreninpre-kindergartenprogramsandschools.

Whatcanbedonetopreventdiphtheria?

Thesinglemosteffectivecontrolmeasureismaintainingthehighestpossiblelevelofimmunizationinthecommunity.Othermethodsofcontrolincludeprompttreatmentofcasesandacommunitysurveillanceprogram.

Whatiscutaneous(skin)diphtheria?

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IntheUnitedStates,cutaneousdiphtheria,althoughrare,ismostoftenseenamongpersonswithpoorhygienewholiveincrowdedconditions.Skininfectionswithdiphtheriaarestillcommonintropicalcountriesandareevenmorecontagiousthanrespiratorydiphtheria.Skinwoundsarecharacterizedbyascalingrash,soresorbyblisterswhichcanoccuranywhereonthebody.Skinwoundsmaybepainful,swollenandreddened.Theskininfectionistreatedbythoroughcleansingwithsoapandwaterandappropriateantibiotics.

Impetigo

Whatisimpetigo?

ImpetigoisacommonbacterialskininfectioncausedbyGroupAStreptococcus(GAS)or"strep."

WhatisGroupAStreptococcus(GAS)?

GroupAStreptococcus(GAS)or"strep"isacommonbacterium(bacteriumisthesingularformoftheplural,bacteria)thatisfoundontheskinorinthethroat("strepthroat").PeoplecancarryGASandhavenosymptomsofillnessortheymaydeveloprelativelymildskininfections,includingimpetigo.

Howdoesimpetigospread?

GroupAStreptococcus(GAS)or"strep"canbetransmittedthroughdirectperson-to-personcontactwithsomeonewhohastheinfection.GAScanalsobepickedupindirectlythroughcontactwithanitem(suchasawrestlingmat,gear,towel,razor,orcellphone)thatiscontaminatedwiththebacterium.

Whatarethesymptomsofimpetigo?

• Symptomsusuallybegan1-3daysafterinfection.• Sores(lesions)beginassmallredspots,usuallyontheface(especiallyaroundthenose

andmouth),butcanappearanywhereonthebody.• Thesoresareoftenitchy,butusuallynotpainful.• Thesoresdevelopintoblistersthatbreakopenandoozefluid--thisfluidcontains

infectiousbacteriathatcaninfectothersiftheyhavecontactwithit.• Afterafewdays,therupturedblistersformaflat,thick,honey-colored(yellowish-

brown)crustthateventuallydisappears,leavingredmarksthathealwithoutscarring.• Theremaybeswollenglands(enlargedlymphnodes),butusuallynofever.

ClickheretoviewaphotographofimpetigoonthefacefromDermAtlas.

Whatshouldathletesdoiftheythinktheyhaveimpetigo?

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Whilemildcasesofimpetigomaybetreatedwithoutseeingahealthcareprovider,athletesarerecommendedtohaveamedicalprofessionaldeterminewhattypeofinfectiontheyhave,howtotreatit,andifitiscontagious.Iftheinfectioniscontagious,athletesshouldnotpracticeorcompeteuntiltheirmedicalproviderclearsthemtoreturn.

Influenza(Flu)

Whatistheflu?

Thefluisacontagiousrespiratoryillnesscausedbyinfluenzaviruses.Itcancausemildtosevereillness,andattimescanleadtodeath.Somepeople,suchasolderpeople,youngchildren,andpeoplewithcertainhealthconditions,areathighriskforseriousflucomplications.

EveryyearintheUnitedStates:

• Onaveragemorethan200,000peoplearehospitalizedfromflucomplications,and;• Morethan23,600peoplediefromflu(witharangeof3,349-48,614people);about90%ofsuch

deathsoccurinpersonsaged65yearsandolder.

Thebestwaytopreventthisillnessisbygettingafluvaccination.

Whatarethesymptomsoftheflu?

Thefluusuallystartssuddenlyandmayincludethesesymptoms:

• Fever*orfeelingfeverish/chills• Cough• Sorethroat• Runnyorstuffynose• Muscleorbodyaches• Headaches• Fatigue(tiredness)• Somepeoplemayhavevomitinganddiarrhea,thoughthisismorecommoninchildrenthan

adults

*It'simportanttonotethatnoteveryonewithfluwillhaveafever.

Whatarethecomplicationsassociatedwiththeflu?

Someofthecomplicationscausedbyfluincludepneumonia,earinfections,sinusinfections,dehydration,andworseningofchronicmedicalconditions,suchasheartorlungdisease,asthmaordiabetes.

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Howisthefluspread?

Thefluisspreadindropletsreleasedbycoughingandsneezing.Itusuallyspreadsfrompersontoperson,thoughoccasionallypeoplemaybeinfectedbytouchingsomethingwithvirusonitandthentouchingtheireyes,nose,ormouth.

Whenandforhowlongisapersonabletospreadtheflu?

Youmaybeabletopassontheflutosomeoneelsebeforeyouknowyouaresick,aswellaswhileyouaresick.Mostadultsmaybeabletoinfectothersbeginning1daybeforesymptomsdevelopandupto5to7daysafterbecomingsick.Somepeople,especiallyyoungchildrenandpeoplewithweakenedimmunesystems,mightbeabletoinfectothersforanevenlongertime.

ColdVersusFlu

Whatisthedifferencebetweenacoldandtheflu?

Thefluandthecommoncoldarebothrespiratoryillnessesbuttheyarecausedbydifferentviruses.Becausecoldsandflusharemanysymptoms,itcanbedifficult(orevenimpossible)totellthedifferencebetweenthembasedonsymptomsalone.Mostpeoplewhohaveflusymptomswillnotbetested,anddonotneedtobetested,becausetestresultsusuallydonotchangehowapatientistreated.Treatment,ifdecideduponbythehealthcareprovider,willusuallybebasedonseverityofsymptomsandhowlikelyapersonistohavecomplicationsofflu–notonthebasisofatestresult.Whatarethesymptomsofthefluversusthesymptomsofacold?

• Theflutendstostartverysuddenly,whilecoldstendtodevelopgradually.• Thefluisworsethanthecommoncold,andsymptomssuchasfever,bodyaches,extreme

tirednessanddrycougharemorecommonandintense.• Peoplewithcoldsaremorelikelytohavearunnyorstuffynose.• Coldsgenerallydonotresultinserioushealthproblems,suchaspneumonia,bacterial

infections,orhospitalizations.

PreventingtheFlu

Whatisthebestwaytoprotectmyselfagainsttheflu?

Thesinglebestwaytopreventthefluistogetafluvaccinationeachfall.Therearetwotypesofvaccines:

• The"flushot"isaninactivatedvaccine(containingkilledvirus)thatisgivenwithaneedle.Itcanbegiveninthemuscleorjustundertheskin.Theflushotthatisgiveninthemuscleisapprovedforuseinpeopleolderthan6months,includinghealthypeopleandpeoplewithchronicmedicalconditions.Theflushotthatisgivenbelowtheskinisforthose18-64yearsofage.

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• Thenasal-sprayfluvaccineisavaccine(sometimescalledLAIVfor"LiveAttenuatedInfluenzaVaccine")madewithlive,weakenedfluvirusesthatdonotcausetheflu.LAIVisapprovedforuseinhealthypeople2yearsto49yearsofagewhoarenotpregnant.

Talktoyourprovidertofindoutwhichvaccineisrightforyouandyourfamily.

Abouttwoweeksaftervaccination,antibodiesdevelopthatprotectagainstfluvirusinfectionfortheentireseason.Fluvaccineswillnotprotectagainstillnessescausedbyotherviruses,suchasthecommoncold.

Whoshouldgetthefluvaccine?

Everyone6monthsofageandoldershouldgetvaccinatedagainsttheflu.Vaccinationshouldbeginassoonasthevaccineisavailable.

Vaccinationtopreventfluisparticularlyimportantforpersonswhoareatincreasedriskforseverecomplicationsfromfluorathigherriskforflu-relatedoutpatient,emergencydepartment,orhospitalvisits.Thelistbelowincludesthegroupsofpeoplemorelikelytogetflu-relatedcomplicationsiftheygetsickfrominfluenza:

• Childrenyoungerthan5,butespeciallychildrenyoungerthan2yearsofage• Adults50yearsofageandolder,butespeciallythose65yearsofageandolder• Womenwhoareorwillbepregnantduringfluseason• AmericanIndiansandAlaskanNatives• Residentsofnursinghomesandotherchroniccarefacilities• Peoplewhohavethefollowingmedicalconditions:

o Neurologicalandneurodevelopmentalconditions[includingdisordersofthebrain,spinalcord,peripheralnerve,andmusclesuchascerebralpalsy,epilepsy(seizuredisorders),stroke,intellectualdisability(mentalretardation),moderatetoseveredevelopmentaldelay,musculardystrophy,orspinalcordinjury].

o Chroniclungdisease(suchaschronicobstructivepulmonarydisease[COPD]andcysticfibrosis)andAsthma

o Heartdisease(suchascongenitalheartdisease,congestiveheartfailureandcoronaryarterydisease)

o Blooddisorders(suchassicklecelldisease)o Endocrinedisorders(suchasdiabetesmellitus)o Kidneydisorderso Liverdisorderso Metabolicdisorders(suchasinheritedmetabolicdisordersandmitochondrialdisorders)o Weakenedimmunesystemduetodiseaseormedication(suchaspeoplewithHIVor

AIDS,orcancer,orthoseonchronicsteroids)o Peopleyoungerthan19yearsofagewhoarereceivinglong-termaspirintherapyo Peoplewhoaremorbidlyobese(BodyMassIndex,orBMI,of40orgreater)

Vaccinationeffortsshouldalsofocusondeliveringvaccinetothefollowingpersons:

• Healthcarepersonnel;

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• Householdcontactsandcaregiversofchildrenyoungerthan5yearsandadultsaged50yearsorolder,withparticularemphasisonvaccinatingcontactsofchildrenyoungerthan6months

Doesmychildneedtoreceivemorethanonedoseoffluvaccinethisseason?

Somechildrenaged6monthsthrough8yearsrequiretwodosesoffluvaccine(givenaminimumoffourweeksapart).Childreninthisagegroupwhoaregettingvaccinatedforthefirsttimewillneedtwodoses.Ifthisisnotthefirstseasonthatyourchildisreceivingfluvaccine,talkwithyourchild'sprovidertodeterminehowmanydosesyourchildneedstoprotectthemfromthefluthisyear.

WhoshouldNOTbevaccinated?

Therearesomepeoplewhoshouldnotbevaccinated.Theyinclude:

• Peoplewhohavehadaseverereactiontoafluvaccination;• Childrenlessthan6monthsofage.

Somepeopleshouldwaittogetvaccinateduntiltheytalkwiththeirprovider.Theyinclude:

• Peoplewhohaveasevereallergytochickeneggs;• Peoplewhoaresickwithafever.(Thesepeoplecangetvaccinatedoncetheirsymptomslessen.

Peoplewithamildillnesscanusuallygetthevaccine.)• PeoplewhodevelopedGuillain-Barresyndrome(GBS)withinsixweeksofgettingfluvaccine.

Whatothermethodscanhelppreventtheflu?

Althoughthesinglebestwaytopreventseasonalfluistogetvaccinatedeachyear,goodhealthhabitsoftencanhelpstopthespreadofgermsandpreventrespiratoryillnessesliketheflu.

• Avoidclosecontactwithpeoplewhoaresick.Whenyouaresick,keepyourdistancefromotherstoprotectthemfromgettingsicktoo.

• Stayhomewhenyouaresick.Ifpossible,stayhomefromwork,school,anderrandswhenyouaresick.Youwillhelppreventothersfromcatchingyourillness.

• Coveryourmouthandnose.Coveryourmouthandnosewithatissuewhencoughingorsneezing.Ifnotissueisavailable,coughorsneezeintothebendofyourarm.Itmaypreventthosearoundyoufromgettingsick.

• Cleanyourhands.Washingyourhandsoftenwillhelpprotectyoufromgerms.Ifsoapandwaterarenotavailable,useanalcohol-basedhandsanitizerthatcontainsatleast60%alcoholtocleanyourhands.

• Avoidtouchingyoureyes,nose,ormouth.Germsareoftenspreadwhenapersontouchessomethingthatiscontaminatedwithgermsandthentoucheshisorhereyes,nose,ormouth.

• Practiceothergoodhealthhabits.Cleananddisinfectfrequentlytouchedsurfacesathome,workorschool,especiallywhensomeoneisill.Getplentyofsleep,bephysicallyactive,manageyourstress,drinkplentyoffluids,andeatnutritiousfood.

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Cantheflubetreated?

Incertaincircumstances,yourdoctororhealthcareprovidermightprescribeantiviraldrugstohelpreducetheseverityanddurationofyourillness.Antiviraldrugsarenotsoldover-the-counterandaredifferentfromantibiotics.Youcangetthemonlyifyouhaveaprescriptionfromyourdoctororhealthcareprovider.Yourhealthcareprovidercanhelpdecidewhetheryoushouldtakeanantiviraldrug,and,ifso,whichoneyoushouldtake.

Antiviraldrugsareasecondlineofdefensetotreatthefluifyougetsick.NYSDOHrecommendsfluvaccinationasthefirstandbestwaytopreventinfluenza.

Measles(Rubeola,hardmeasles,redmeasles)

Whatismeasles?

Measlesisahighlycontagiousviraldiseasethatcanbeveryseriousorevenfatal.Itbeginswithafeverthatlastsforacoupleofdays,followedbyacough,runnynose,andconjunctivitis(pinkeye).Arashstartsonthefaceandupperneck,spreadsdownthebackandtrunk,thenextendstothearmsandhands,aswellasthelegsandfeet.Afteraboutfivedays,therashfadesinthesameorderitappeared.Seriouscomplicationsofmeaslesincludepneumoniaandencephalitis(inflammationofthebrain).

Whogetsmeasles?

Asaresultofwidespreadimmunization,themeaslesvirusdoesnotcirculateintheUnitedStates.AllreportedcasesofmeaslesintheUnitedStateshavebeenbroughtinfromothercountries,usuallyEuropeandAsia.TravelersleavingtheUnitedStatesshouldbeimmunetomeasles.Althoughmeaslesisusuallyconsideredachildhooddisease,itcanbecontractedatanyagebyapersonwhoneverhadthediseaseorbeenvaccinated.Unvaccinatedindividualsare22timesmorelikelytogetmeaslesthanarewhothosewhohavetwomeaslesvaccines,usuallygivenasmeasles,mumpsandrubellavaccine(MMR).

Howismeaslesspread?

Measlesishighlycontagious.Themeaslesviruslivesinthemucusinthenoseandthroatofinfectedpeople.Whentheysneeze,coughortalk,dropletssprayintotheairandthedropletsremainactiveandcontagiousoninfectedsurfacesforuptotwohours.

Whatarethesymptomsofmeasles?

Measlessymptomsgenerallyappearintwostages.Inthefirststage,whichlasttwotofourdays,theindividualmayhavearunnynose,coughandaslightfever.Theeyesmaybecome

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reddenedandsensitivetolightwhilethefevergraduallyriseseachday,oftenpeakingashighas103°to105°F.Koplikspots(smallbluishwhitespotssurroundedbyareddisharea)mayalsoappearonthegumsandinsideofthecheeks.Thesecondstagebeginsonthethirdtoseventhdayandconsistsofaredblotchyrashlastingfivetosixdays.Therashusuallybeginsonthefaceandthenspreadsdownwardandoutward,reachingthehandsandfeet.Therashfadesinthesameorderthatitappeared,fromheadtoextremities.Othersymptomsincludeweightloss,diarrheaandenlargedlymphglandsthroughoutthebody.

Howsoondosymptomsappear?

Symptomsusuallyappearintento12days,althoughtheymayoccurasearlyassevenoraslateas18daysafterexposure.

Whenandforhowlongisapersonabletospreadmeasles?

Anindividualisabletotransmitmeaslesfromfourdayspriortoandfourdaysafterrashonset.

Whatarethecomplicationsassociatedwithmeasles?

Complicationsoccurinupto30percentofallcasesandaremorecommoninthoseyoungerthanfiveandolderthan20yearsofage.Pneumoniaoccursinuptosixpercentofreportedcases.Encephalitis(inflammationofthebrain)mayalsooccur.Othercomplicationsincludemiddleearinfection,diarrheaandseizures.Infectionofthemotherduringpregnancyhasbeenassociatedwithanincreaseinlow-birthweightinfants,prematurelabor,miscarriageandbirthdefects.

Whatisthetreatmentformeasles?

Thereisnospecifictreatmentformeasles.

Doespastinfectionmakeapersonimmune?

Yes.Immunityacquiredaftercontractingthediseaseisusuallypermanent.

Isthereavaccineformeasles?

Measles-containingvaccineisrecommendedforanyonebornonorafterJanuary1,1957,whodoesnothaveahistoryofphysician-diagnosedmeaslesorabloodtestconfirmingmeaslesimmunity.Individualsshouldreceive2dosesofMMR(measles,mumps,rubella)vaccineformaximumprotection.Thefirstdoseshouldbegivenat12to15monthsofage.Theseconddoseshouldbegivenatfourtosixyearsofage(ageofschoolentry)atthesametimeastheDTaPandpolioboosterdoses.MMRvaccineisrecommendedforallmeaslesvaccinedosesto

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provideincreasedprotectionagainstallthreevaccine-preventablediseases:measles,mumpsandrubella.Unprotectedpersonscangetthevaccineatanyage.

InNewYorkState,measlesimmunizationsarerequiredofallchildrenenrolledinpre-kindergartenprogramsandschools.Healthcarepersonnelandcollegestudentsarealsorequiredtodemonstrateimmunityagainstmeasles.

DoestheMMRvaccinecauseautism?

Thereisnoevidencetosupportthatmeasles-mumps-rubellavaccine(MMR)causeautism.

Whatcanbedonetopreventthespreadofmeasles?

Maintaininghighlevelsofmeaslesimmunizationinthecommunityiscriticaltocontrollingthespreadofmeasles.Infectedindividualsshouldbeexcludedfromworkorschoolduringtheirinfectiousperiod.Measles-containingvaccineshouldbeprovidedtosusceptiblecontactswithin72hoursofexposure.ImmuneGlobulin(IG)canbegiventosusceptiblepersonswithinsixdaysofexposure.

MeningococcalDisease

Whatismeningococcaldisease?

Meningococcaldiseaseisaseverebacterialinfectionofthebloodstreamormeninges(athinliningcoveringthebrainandspinalcord)causedbythemeningococcusgerm.

Whogetsmeningococcaldisease?

Anyonecangetmeningococcaldisease,butitismorecommonininfantsandchildren.Forsomeadolescents,suchasfirst-yearcollegestudentslivingindormitories,thereisanincreasedriskofmeningococcaldisease.EveryyearintheUnitedStatesapproximately2,500peopleareinfectedand300diefromthedisease.Otherpersonsatincreasedriskincludehouseholdcontactsofapersonknowntohavehadthisdisease,immunocompromisedpeople,andpeopletravelingtopartsoftheworldwheremeningococcalmeningitisisprevalent.

Howisthemeningococcusgermspread?

Themeningococcusgermisspreadbydirectclosecontactwithnoseorthroatdischargesofaninfectedperson.

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Whatarethesymptoms?

Highfever,headache,vomiting,stiffneckandarasharesymptomsofmeningococcaldisease.Thesymptomsmayappeartwoto10daysafterexposure,butusuallywithinfivedays.Amongpeoplewhodevelopmeningococcaldisease,10to15percentdie,inspiteoftreatmentwithantibiotics.Ofthosewholive,permanentbraindamage,hearingloss,kidneyfailure,lossofarmsorlegs,orchronicnervoussystemproblemscanoccur.

Whatisthetreatmentformeningococcaldisease?

Antibiotics,suchaspenicillinGorceftriaxone,canbeusedtotreatpeoplewithmeningococcaldisease.

Shouldpeoplewhohavebeenincontactwithadiagnosedcaseofmeningococcalmeningitisbetreated?

Onlypeoplewhohavebeeninclosecontact(householdmembers,intimatecontacts,healthcarepersonnelperformingmouth-to-mouthresuscitation,daycarecenterplaymates,etc.)needtobeconsideredforpreventivetreatment.Suchpeopleareusuallyadvisedtoobtainaprescriptionforaspecialantibiotic(eitherrifampin,ciprofloxacinorceftriaxone)fromtheirphysician.Casualcontact,asmightoccurinaregularclassroom,officeorfactorysetting,isnotusuallysignificantenoughtocauseconcern.

Isthereavaccinetopreventmeningococcalmeningitis?

Therearethreevaccinesavailableforthepreventionofmeningitis.Thepreferredvaccineforpeopleages2-55yearsisMeningococcalconjugatevaccine(MCV4).ThisvaccineislicensedasMenactra(sanofipasteur)andMenveo(Novartis).Meningococcalpolysaccharidevaccine(MPSV4;Menomune[sanofipasteur]),shouldbeusedforadultsages56andolder.Thevaccinesare85to100percenteffectiveinpreventingthefourkindsofmeningococcusgerm(typesA,C,Y,W-135).Thesefourtypescauseabout70percentofthediseaseintheUnitedStates.BecausethevaccinesdonotincludetypeB,whichaccountsforaboutone-thirdofcasesinadolescents,theydonotpreventallcasesofmeningococcaldisease.

Isthevaccinesafe?Arethereadversesideeffectstothevaccine?

Thethreevaccinesavailabletopreventmeningococcalmeningitisaresafeandeffective.However,thevaccinesmaycausemildandinfrequentsideeffects,suchasrednessandpainattheinjectionsitelastinguptotwodays.

Whoshouldgetthemeningococcalvaccine?

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Thevaccineisroutinelyrecommendedforalladolescentsages11-12years,allunvaccinatedadolescents13-18years,andpersons19-21yearswhoareenrollingincollege.Thevaccineisalsorecommendedforpeopleages2yearsandolderwhohavehadtheirspleenremovedorhaveotherchronicillnesses,aswellassomelaboratoryworkersandtravelerstoendemicareasoftheworld.

Whoneedsaboosterdoseofmeningococcalvaccine?

CDCrecommendsthatchildrenage11or12yearsberoutinelyvaccinatedwithMenactraorMenveoandreceiveaboosterdoseatage16years.Adolescentswhoreceivethefirstdoseatage13-15yearsshouldreceiveaone-timeboosterdose,preferablyatages16-18years.Teenswhoreceivetheirfirstdoseofmeningococcalconjugatevaccineatorafterage16yearsdonotneedaboosterdose,aslongastheyhavenoriskfactors.

Allpeoplewhoremainathighestriskformeningococcalinfectionshouldreceiveadditionalboosterdoses.Ifthepersonisage56yearsorolder,theyshouldreceiveMenomune.

HowdoIgetmoreinformationaboutmeningococcaldiseaseandvaccination?

Contactyourphysicianoryourstudenthealthservice.AdditionalinformationisalsoavailableonthewebsitesoftheNewYorkStateDepartmentofHealth,http://www.health.state.ny.us/;theCentersforDiseaseControlandPrevention,http://www.cdc.gov/DiseasesConditions/;andtheAmericanCollegeHealthAssociation,http://www.acha.org.au/info/general/Home/get/0/0/.

Methicillin-ResistantStaphylococcusAureus(MRSA)

WhatisStaphylococcusaureus?

Staphylococcusaureus("staph")isabacteriumthatiscarriedontheskinorinthenoseofapproximately25%to30%ofhealthypeoplewithoutcausinginfection--thisiscalledcolonization.StaphbacteriaareoneofthemostcommoncausesofskininfectionsintheU.S.Mostoftheseskininfectionsareminor(suchaspimplesandboils),arenotspreadtoothers(notinfectious),andusuallycanbetreatedwithoutantibiotics.However,somestaphbacteriaareresistanttocertainantibiotics--onetypeiscalledMRSA.

WhatisMRSA?

MRSAstandsformethicillin-resistantStaphylococcusaureus.MRSAisastaphbacteriumthatcertainantibioticsinthepenicillinfamilyshouldbeabletotreat,butcannot.Whentheinfectionisresistanttothemedication,itiscalledresistance.However,othernon-penicillinantibioticscaneffectivelytreatmostMRSAinfections.

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Whatcausesantibioticresistance?

Mostresistancetoantibioticsdevelopsfromtakingthemimproperly.Examplesare:

• Incompleteuse:Notfinishingtheentireantibioticprescription(oftenbecausepeoplestarttofeelbetterandstoptakingthemedication).

• Inappropriateuse:Takingantibioticsforaviralinfection(antibioticsdoNOTtreatviralinfectionssuchascoldsortheflu).

• Unnecessaryuse:Takingantibiotics"justincase"(forexample,takingthempriortoavacationorspecialeventtotrytopreventillness).

Itisimportanttotakeprescriptionmedicationonlywhenprescribedforyoubyahealthprofessionalandtotakeallthemedicineevenifyoufeelbetterbeforeyouhavecompletedtheprescription.

HowseriousisMRSA?

AlthoughhealthcareproviderscantreatmostMRSAskininfectionsintheiroffices,MRSAcanbeveryseriousandevencausedeath.MRSAcancausepneumoniaorsevereinfectionsoftheblood,bones,surgicalwounds,heartvalves,andlungs.MRSAcanbefatalifnotidentifiedandtreatedwitheffectiveantibiotics.

HowdoessomeonegetMRSAinfection?

Mostoften,MRSAistransmittedbydirectskin-to-skincontactwithsomeonewhohastheinfection.

MRSAcanbespreadbyindirectcontacttoo(forexamplecontactwithamatthathasinfecteddrainageonitorbysharingatowelorcellphonewithsomeonewhohasMRSA).Becauseofthis,neversharepersonalhygieneandhealthitems.

WhereontheskindoesMRSAappearandwhatarethesymptoms?

MRSAinfectionscommonlyoccurwherethereisabreakintheskin(forexample,acutorwound),especiallyinareascoveredbyhair(forexample,thebeardarea,backoftheneck,armpit,groin,legs,orbuttocks)

MRSAmaylooklikeabumpontheskinthatmaybered,swollen,warmtothetouch,painful,filledwithpus,ordraining.Thepusordrainagecontainstheinfectiousbacteriathatcanbespreadtoothers.PeoplewithMRSAmayhaveafever.

HowisMRSAdiagnosedandtreated?

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Dependingonyoursymptoms,yourhealthcareprovidermaysendanasalswaborskintissuespecimentoalaboratorytoidentifytheinfectionorconfirmthatyouhaveMRSA.

Yourhealthcareprovidermaydrainthepusfromthelesion--donotdothisyourself.

Ifyouareprescribedanantibiotic,takeitexactlyasdirectedandtakeallofthemedicineeveniftheinfectionimprovesorgoesawaybeforeyouhavefinishedtheentireprescription.Iftheinfectiondoesnotbegintoimprovewithinafewdays,contactyourhealthcareprovider.

Mumps(InfectiousParotitis)

Whatismumps?

Mumpsisaviraldiseasecharacterizedbyfever,headache,muscleweakness,stiffneck,lossofappetite,swellingandtendernessofoneormoreofthesalivaryglandssituatedalongtheangleofthejawandinsidethemouth,includingtheparotidglandlocatedwithinthecheeksjustbelowthefrontoftheear.

Whogetsmumps?

ThenumberofcasesofmumpsdecreaseddramaticallyintheUnitedStatesfollowingtheintroductionofthemumpsvaccinein1967,fromanestimated100,000-200,000tofewerthan300casesannually.IntheUnitedStates,since2001,anaverageof265mumpscaseshasbeenreportedeachyear.

Recently,therehasbeenanincreaseinthenumberofmumpscasesreported.In2006,over6,000casesofmumpswerereportedacrossthenation.

Howismumpsspread?

Mumpsistransmittedbydirectcontactwithsalivaproducedinthemouthanddischargesfromthenoseandthroatofinfectedindividuals.

Whatarethesymptomsofmumps?

Symptomsofmumpsincludealow-gradefever,headache,muscleaches,stiffneck,tirednessandlossofappetitefollowedbyswellingandtendernessofoneormoreofthesalivaryglands,includingtheparotidgland.Approximatelyone-thirdofinfectedpeopledonothavenoticeablesalivaryglandswelling.Upto50%ofmumpsinfectionsarenotspecifictoanysymptomsand15-20%ofallcasespresentwithoutanysymptoms.

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Howsoonafterinfectiondosymptomsoccur?

Theincubationperiodisusually16to18days,althoughitmayvaryfrom12to25days.

Whatcomplicationshavebeenassociatedwithmumps?

Severecomplicationsarerare.However,mumpscancauseinflammationofthebrainand/ortissuecoveringthebrainandspinalcord(encephalitis/meningitis),inflammationofthetesticles(orchitis),inflammationoftheovaries(oophoritis)and/orbreasts(mastitis),inflammationofthepancreas(pancreatitis),spontaneousabortionanddeafness,whichisusuallypermanent.

Whatisthetreatmentformumps?

Thereisnospecifictreatmentformumps.

Whenandforhowlongisapersonabletospreadmumps?

Mumpsiscontagiousthreedaysbeforeuntil5daysaftertheonsetofparotitis(inflammationoftheparotidgland).

Doespastinfectionwithmumpsmakeapersonimmune?

Immunityacquiredaftercontractingthediseaseisusuallylongterm.

Isthereavaccineformumps?

Yes.Themumpsvaccine,whichiscontainedintheMMR(measles,mumps,andrubella)vaccine,canpreventthisdisease.Mumps-containingvaccineisrecommendedforanyonebornonorafterJanuary1,1957,whodoesnothaveahistoryofphysician-diagnosedmumpsorabloodtestconfirmingmumpsimmunity.Evidenceofimmunitythroughdocumentationofadequatevaccinationisnowdefinedas1doseofalivemumpsvirusvaccineforpreschool-agedchildrenandadultsnotathighriskand2dosesforschool-agedchildren(i.e.,gradesK—12,)andforadultsathighrisk(i.e.,healthcarepersonnel,internationaltravelers,andstudentsatpost-high-schooleducationalinstitutions).ThefirstdoseofMMRisgivenat12to15monthsofageandtheseconddoseisgivenbetween4to6yearsofage.Ifyoudonotknowifyouhavebeenvaccinatedorhadmumpsdiseasediagnosedbyaphysician,vaccinationisrecommended.

InNewYorkState,mumpsimmunizationisrequiredofallchildrenenrolledinpre-kindergartenprogramsandschool.Collegestudentsarealsorequiredtodemonstrateimmunityagainstmumps.Itisrecommendedthathealthcarepersonneldemonstrateimmunityagainstmumps.

Whatcanbedonetopreventthespreadofmumps?

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ThesinglemosteffectivecontrolmeasureistobevaccinatedwithtwoMMRvaccinesunlessthereisevidenceofpriorimmunitytomumps.Personsdiagnosedwithmumpsshouldremainathomeduringtheirinfectiousperiod(untilafter5daysofsymptomonset).

Ringworm(Tinea)

Whatisringworm?

Ringwormisacommon,contagiousskininfection.RingwormisNOTcausedbyaworm.Atypeoffunguscalledadermatophytecausesit.Dermatophytesalsocauseothercommonskin,hair,andnailinfections,includingathlete'sfootandjockitch.

Howdoesringwormspread?

Thedermatophytethatcausesringwormcanbepassedfrompersontopersonbydirectskin-to-skincontactorbycontactwithcontaminateditemssuchascombs,unwashedclothing,andshowersurfaces.Somepets(includingcatsanddogs)andlivestock(suchascows,goats,horses,andpigs)cancarrythefungusandtransmitittopeople.Becausedermatophytesthriveinwarm,moistareas,athletesareatriskforringwormbecausetheyarelikelytosweatandbearoundotherswhoaresweating.Thisiswhypreventionissoimportant.

Whatarethesymptomsofringworm?

• Itchy,red,raised,scalypatchesthatmayblisterandooze.• Sharply-definededgesintheshapeofacircleoraring.• Oftenredderaroundtheoutsidewithnormalskintoneinthecenter.• Skinmayappearunusuallydarkorlight.• Baldpatchesonscalp.• Fingerandtoenailsthatarediscolored,thick,orcrumble.

Howisringwormdiagnosed?

Medicalprofessionalshaveseveralwaystodetermineifyouhaveringworm.Theycan:

• Diagnoseitbasedonhowtherashoraffectedarealooks.• Examineyourskininadarkroomwithaspecialbluelight(calledaWood'slamp)that

usesultravioletlighttolookforchangesinyourskincolor.• Scrapesomeoftheaffectedareafromyourskinandexaminethecellsundera

microscope.

Howisringwormtreated?

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Athleteswithrashesshouldcontacttheirdoctor.Ifadoctordiagnosestherashasringworm,theymayprescribeafungicidalmaterialtoswallowastabletsorpowdersthatcanbeapplieddirectlytotheaffectedareas.

Rubella(GermanMeaslesorThree-DayMeasles)

Whatisrubella?

Rubellaisahighlycontagiousviraldiseasecharacterizedbyslightfever,mildrashandswollenglands.Althoughmostcasesaremild,ifrubellaiscontractedearlyinpregnancy,itcanspreadfromthemothertoherdevelopingbabythroughthebloodstreamandresultinbirthdefectsand/orfetaldeath.Asaresultofwidespreadimmunization,rubelladoesnotcirculateintheUnitedStates,butcanbecontractedthroughforeigntravel.

Whogetsrubella?

ThenumberofcasesofrubelladecreaseddramaticallyintheUnitedStatesfollowingtheintroductionoftherubellavaccinein1969.Thedecreasewasgreatestamongchildren.AdultsaccountforanincreasingproportionofthefewcasesthatstilloccurinUnitedStates.Theseareoftenindividualswhoremainunvaccinatedforreligiousreasonsorareforeign-bornimmigrantswhocomefromareaswhererubellavaccineisnotroutinelyused.RubellastillremainsacommondiseaseinmanypartsoftheworldandtheriskofexposuretorubellaoutsideoftheUnitedStatesishigh.Travelerstocountrieswhererubellacasesstilloccurshouldbeimmunetorubella.

Howisrubellaspread?

Rubellaisspreadbydirectcontactwithnasalorthroatsecretionsofinfectedindividuals.Rubellacanalsobetransmittedbybreathingindropletsthataresprayedintotheairwhenaninfectedpersonsneezes,coughsortalks.

Whatarethesymptomsofrubella?

Rubellaisamildillnesswhichmaypresentfewornosymptoms.Symptomsmayincludearash,slightfever,jointaches,headache,discomfort,runnynose,sorethroatandreddenedeyes.Thelymphnodesjustbehindtheearsandatthebackoftheneckmayswell,causingsomesorenessand/orpain.Therash,whichmaybeitchy,firstappearsonthefaceandprogressesfromheadtofoot,lastingaboutthreedays.Asmanyashalfofallrubellacasesoccurwithoutarash.Howsoondosymptomsappear?

Theusualincubationperiodforrubellais14days;witharangeof12to23days.

Whatarethecomplicationsassociatedwithrubella?

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Complicationsoccurmorefrequentlyinadultwomen,whomayexperiencearthritisorarthralgia,oftenaffectingthefingers,wristsandknees.Thesejointsymptomsrarelylastformorethanamonthafterappearanceoftherash.

Upto85percentofinfantsinfectedwithrubellainthefirsttrimesterofpregnancywillsufferbirthdefectsand/orneurologicabnormalities(CongenitalRubellaSyndrome,CRS).

Whatisthetreatmentforrubella?

Thereisnospecifictreatmentforrubella.

Whenandforhowlongisapersonabletospreadrubella?

Rubellamaybetransmittedfromsevendaysbeforetosevendaysaftertherashappears.

Doespastinfectionwithrubellamakeapersonimmune?

Yes.Immunityacquiredaftercontractingthediseaseisusuallypermanent.

Whatisthevaccineforrubella?

Rubellavaccineisgivenincombinationmeasles,mumps,rubella(MMR)vaccineandisrecommendedforanyonebornonorafterJanuary1,1957whodoesnothavelaboratoryevidenceofrubellaimmunity.Birthbefore1957isnotacceptableevidenceofrubellaimmunityforwomenwhocouldbecomepregnant;womenofchildbearingageshouldhavetheirimmunitycheckedandreceiverubellavaccineifneeded.

Althoughonlyonedoseofrubella-containingvaccineisrequiredasacceptableevidenceofimmunitytorubella,childrenshouldreceivetwodosesofMMRvaccine.Rubellavaccineisfirstgivenonorafterachild'sfirstbirthdayasMMRvaccine.Childrenusuallyreceivethefirstdosebetween12and15monthsofageandtheseconddosepriortoschoolentryatfourtosixyearsofage.

InNewYorkState,rubellavaccineisrequiredofallchildrenenrolledinallpre-kindergartenprogramsandschools.Healthcarepersonnelandcollegestudentsarealsorequiredtodemonstrateimmunityagainstrubella.

Whatisthedangerofnotbeingimmunizedagainstrubella?

Rubellainfectionisdangerousbecauseofitsabilitytodamageanunbornbaby.Ifrubellaimmunizationwasdiscontinued,immunitytorubellawoulddeclineandrubelladiseasewouldreturn.Thedangerwouldbetopregnantwomenwho,ifinfected,couldpassthediseasetotheirinfants(fetuses)causingCRS.

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Whatcanbedonetopreventthespreadofrubella?

Maintaininghighlevelsofrubellaimmunizationinthecommunityiscriticaltocontrollingthespread.ControlofthespreadofrubellaisneededprimarilytopreventthebirthdefectscausedbyCRS.Therefore,womenofchildbearingageshouldhavetheirimmunitycheckedandreceiverubellavaccineifneeded.Infectedindividualsshouldbeexcludedfromworkorschoolduringtheirinfectiousperiod.

Whatiscongenitalrubellasyndrome(CRS)?

Congenitalrubellasyndromeoccursamongatleast25percentofinfantsborntowomenwhohadrubelladuringthefirstthreemonthsofpregnancy.Infectionofapregnantwomancanresultinamiscarriage,stillbirthorthebirthofaninfantwithabnormalitieswhichmayincludedeafness,blindness,cataracts,heartdefects,mentalretardation,liverandspleendamage.

Mononucleosis,Infectious(Mono,EBVmononucleosis)

Whatisinfectiousmononucleosis?

Infectiousmononucleosisisaviraldiseasethataffectscertainbloodcells.ItiscausedbytheEpstein-Barrvirus(EBV),whichisamemberoftheherpesvirusfamily.Mostcasesoccursporadically.Outbreaksarerare.

Whogetsinfectiousmononucleosis?

WhilemostpeopleareexposedtotheEpstein-Barrvirussometimeintheirlives,veryfewgoontodevelopthesymptomsofinfectiousmononucleosis.Inunderdevelopedcountries,peopleareexposedinearlychildhoodwheretheyareunlikelytodevelopnoticeablesymptoms.IndevelopedcountriessuchastheUnitedStates,theageoffirstexposuremaybedelayedtoolderchildhoodandyoungadultagewhensymptomsaremorelikelytoresult.Forthisreason,itisrecognizedmoreofteninhighschoolandcollegestudents.

Howisinfectiousmononucleosisspread?

Thevirusisspreadbyperson-to-personcontact,viasaliva(onhandsortoys,orbykissing).Inrareinstances,thevirushasbeentransmittedbybloodtransfusion.

Whatarethesymptomsofinfectiousmononucleosis?

Symptomsincludefever,sorethroat,swollenglandsandfeelingtired.Sometimes,theliverandspleenareaffected.Durationisfromonetoseveralweeks.Thediseaseisveryrarelyfatal.

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Howsoondosymptomsappear?

Symptomsappearfromfourtosixweeksafterexposure.

Whenandforhowlongisapersonabletospreadinfectiousmononucleosis?

Thevirusisshedinthethroatduringtheillnessandforuptoayearafterinfection.Aftertheinitialinfection,thevirustendstobecomedormantforaprolongedperiodandcanlaterreactivateandbeshedfromthethroatagain.

Whatisthetreatmentforinfectiousmononucleosis?

Notreatmentotherthanrestisneededinthevastmajorityofcases.

Whatcanapersondotominimizethespreadofinfectiousmononucleosis?

Avoidactivitiesinvolvingthetransferofbodyfluids(commonlysaliva)withsomeonewhoiscurrentlyorrecentlyinfectedwiththedisease.Atpresent,thereisnovaccineavailabletopreventinfectiousmononucleosis.

Pertussis(WhoopingCough)

Whatispertussis?

Pertussis,orwhoopingcough,isahighlycontagiousbacterialinfectionthatcausesanuncontrollable,violentcoughlastingseveralweeksorevenmonths.Itiscausedbyabacteriumthatisfoundinthemouth,noseandthroatofaninfectedperson.Pertussismaybeginwithcold-likesymptomsoradrycoughthatprogresstoepisodesofseverecoughing.Whogetspertussis?

Pertussiscanoccuratanyage.Childrenwhoaretooyoungtobefullyvaccinatedandthosewhohavenotyetcompletedtheprimaryvaccinationseriesareathighestriskforsevereillness.Sincethe1980s,thenumberofreportedpertussiscaseshasgraduallyincreasedintheUnitedStates.In2005,over25,000casesofpertussiscaseswerereportedintheUnitedStates,thehighestnumberofreportedcasessince1959.Approximately60percentofthecaseswereinadolescentsandadultsandmaybearesultofdecreasingimmunityinthispopulation.

Howispertussisspread?

Pertussisisprimarilyspreadfrompersontopersonbydirectcontactwithmucusordropletsfromthenoseandthroatofinfectedindividuals.Frequently,oldersiblingswhomaybeharboringthebacteriaintheirnoseandthroatcanbringthediseasehomeandinfectaninfantinthehousehold.

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Whatarethesymptomsofpertussis?

Pertussisbeginsasamildupperrespiratoryinfection.Initially,symptomsresemblethoseofacommoncold,includingsneezing,runnynose,low-gradefeverandamildcough.Withintwoweeks,thecoughbecomesmoresevereandischaracterizedbyepisodesofnumerousrapidcoughsfollowedbyacrowingorhighpitchedwhoop.Athick,clearmucousmaybedischargedfromthenose.Theseepisodesmayrecurforonetotwomonths,andaremorefrequentatnight.Olderpeopleorpartiallyimmunizedchildrengenerallyhavemildersymptoms.

Howsoonafterinfectiondosymptomsappear?

Theincubationperiodisusuallyseventotendayswitharangeoffourto21daysandrarelymaybeaslongas42days.

Whenandforhowlongisapersonabletospreadpertussis?

Ifuntreated,apersoncantransmitpertussisfromonsetofsymptomstothreeweeksaftertheonsetofcoughingepisodes.Theperiodofcommunicabilityisreducedtofivedaysaftertreatmentwithantibiotics.

Whatarethecomplicationsassociatedwithpertussis?

Majorcomplicationsofpertussisaremorecommonamonginfantsandyoungchildrenandmayincludepneumonia,middleearinfection,lossofappetite,sleepdisturbance,syncope(temporarylossofconsciousness),dehydration,seizures,encephalopathy(adisorderofthebrain),apneicepisodes(briefdelayinbreathing)anddeath.

Whatisthetreatmentforpertussis?

Therecommendedantibioticsforthetreatmentandpostexposurepreventionofpertussisincludeazithromycin(Zithromax),erythromycinandclarithromycin(Biaxin).Alternately,trimethoprim-sulfamethoxazole(Bactrim)canbeused.

Doespastinfectionwithpertussismakeapersonimmune?

Neithervaccinationnornaturalinfectionwithpertussisguaranteeslifelongprotectiveimmunityagainstpertussis.Sinceimmunitydecreasesafterfivetotenyearsfromthelastpertussisvaccinedose,olderchildren,adolescentsandadultsareatriskofbecominginfectedwithpertussisandneedvaccination.

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Whatisthevaccineforpertussis?

InfantsandChildren

Thechildhoodvaccineforpertussisisusuallygivenincombinationwithdiphtheriaandtetanus.ImmunizationauthoritiesrecommendthatDTaP(diphtheria,tetanus,acellularpertussis)vaccinebegivenattwo,four,andsixand15to18monthsofageandbetweenfourandsixyearsofage.

Pre-teensandAdolescents

In2005,anewvaccinewasapprovedasasingleboostervaccinationforadolescentsandadultscalledTdap(tetanus,diphtheria,andacellularpertussis).

ThepreferredageforroutinevaccinationwithTdapis11or12yearsold.Adolescents,aged11through18shouldreceiveasingledoseofTdapinsteadofTd(tetanus,diphtheria)forboosterimmunizationagainsttetanus,diphtheria,andpertussisiftheyhavecompletedtherecommendedchildhoodDTP/DTaPvaccinationseries.

AsingledoseofTdapvaccineisalsorecommendedforchildrenaged7through10yearswhoarenotfullyvaccinatedagainstpertussis.

Adults

Alladultsover19yearsofagewhohaveorwhoanticipatehavingclosecontactwithaninfantshouldreceiveasingledoseofTdaptoprotectagainstpertussisandreducethelikelihoodoftransmission.Forotheradultsaged65yearsandolder,asingledoseofTdapvaccinemaybegiveninsteadofTdvaccineinpersonswhohavenotpreviouslyreceivedTdap.TdapcanbeadministeredregardlessofintervalsincethelastTdvaccine.

Healthcarepersonnel,regardlessofage,shouldreceiveasingledoseofTdapiftheyhavenotpreviouslyreceivedTdapandregardlessofthetimesincetheirmostrecentTdvaccination.

InNewYorkState,pertussisvaccineisrequiredofallchildrenbornafter1/1/2005whowillbeenrolledinpre-kindergartenprogramsandschools.Tdapvaccineisrequiredforchildrenbornonorafter1/1/1994andenrollinginthe6ththrough11thgrade.

Whatcanbedonetopreventthespreadofpertussis?

Thesinglemosteffectivecontrolmeasureismaintainingthehighestpossiblelevelofimmunizationinthecommunity.Treatmentwithappropriateantibiotics,suchasZithromax,willshortenthetimeapersoncanspreadpertussistofivedaysafterthebeginningoftreatment.Peoplewhohaveormayhavepertussisshouldstayawayfromyoungchildrenandinfantsuntilproperlytreated.Treatmentofpeoplewhoareclosecontactsofpertussiscasesisalsoanimportantpartofprevention.

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Whatisparapertussis?

Parapertussisisabacterialillnessthatissimilartopertussis(whoopingcough)butisnotascommonandgenerallycauseslessseveresymptoms.Upto40percentofallcasesofparapertussiswillpresentwithnosymptoms.Veryyounginfants(lessthansixmonthsofage)mayhaveamoreseverecourseofparapertussisthanolderpersons.Parapertussisisspreadthroughtheairindropletsproducedduringcoughingandsneezing.Apersoncanbeinfectedwithparapertussisandpertussisatthesametime.Parapertussiscanbedistinguishedfrompertussisbycertainlaboratorytests.Antibiotictreatmentshouldbestartedassoonasparapertussisissuspected.Allinfantslessthansixmonthsofageshouldreceiveantibioticsasapreventivemeasureiftheyhavebeenincontactwithapersonwhohasparapertussis.

Scabies

Whatisscabies?

Scabiesisafairlycommoninfectiousdiseaseoftheskincausedbyamite.Scabiesmitesburrowintotheskinproducingpimple-likeirritationsorburrows.

Whogetsscabies?

Scabiesinfestationscanaffectpeoplefromallsocioeconomiclevelswithoutregardtoage,sex,raceorstandardsofpersonalhygiene.Clustersofcasesoroutbreaksareoccasionallyseeninnursinghomes,institutionsandchildcarecenters.

Howisscabiesspread?

Scabiesmitesaretransferredbydirectskin-to-skincontact.Indirecttransferfromundergarmentsorbedclothescanoccuronlyifthesehavebeencontaminatedbyinfestedpeopleimmediatelybeforehand.Scabiescanalsobetransmittedduringsexualcontact.

Whatarethesymptomsofscabies?

Themostprominentsymptomofscabiesisintenseitchingparticularlyatnight.Theareasoftheskinmostaffectedbyscabiesincludethewebsandsidesofthefingers,aroundthewrists,elbowsandarmpits,waist,thighs,genitalia,nipples,breastsandlowerbuttocks.

Howsoondosymptomsappear?

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Symptomswillappearfromfourtosixweeksinpeoplewhohavenotpreviouslybeenexposedtoscabiesinfestations.Peoplewhohavehadapreviousboutwithscabiesmitesmayshowsymptomswithinonetofourdaysaftersubsequentre-exposures.

Whenandforhowlongisapersonabletospreadscabies?

Apersonisabletospreadscabiesuntilmitesandeggsaredestroyedbytreatment.

Whatisthetreatmentforscabies?

Skinlotionsorcreamscontainingscabicidesareavailablethroughaphysician'sprescriptionforthetreatmentofscabies.Thelotionsareappliedtothewholebodybelowthehead.Sometimes,itchingmaypersistbutshouldnotberegardedastreatmentfailureorreinfestation.Personswhohavehadskincontactwithaninfestedperson(includingfamilymembers,roommates,directcareprovidersandsexualcontacts)shouldalsobetreated.Whatcanbedonetopreventthespreadofscabies?

Avoidphysicalcontactwithinfestedindividualsandtheirbelongings,especiallyclothingandbedding.Healtheducationonthelifehistoryofscabies,propertreatmentandtheneedforearlydiagnosisandtreatmentofinfestedindividualsandcontactsisextremelyimportant.

SARS(SevereAcuteRespiratorySyndrome)WhatisSARS?

Severeacuterespiratorysyndrome(SARS)isaviralrespiratoryillnessthatwasfirstreportedinAsiainFebruary2003.Overthenextfewmonths,theillnessspreadtomorethantwodozencountriesinNorthAmerica,SouthAmerica,EuropeandAsia.BylateJuly2003,nonewcaseswerebeingreportedandtheoutbreakwasconsideredcontained.Duringthisoutbreak,8,098peopleworldwidebecamesickwithSARS,resultingin774deaths.ThemostrecentcasesofSARSwerereportedinChinainApril2004inanoutbreakresultingfromexposurestothevirusthatoccurredinalaboratory.

WhatarethesymptomsandsignsofSARS?

Theillnessusuallybeginswithahighfever(temperaturegreaterthan100.4degreesF).Thefeverissometimesassociatedwithchillsorothersymptoms,includingaheadache,ageneralfeelingofdiscomfortandbodyaches.Somepeoplealsoexperiencemildrespiratorysymptomsattheoutset.Approximately10-20percentofpatientshavediarrhea.Aftertwotosevendays,SARSpatientsmaydevelopadrycoughwithmostdevelopingpneumonia.

WhatisthecauseofSARS?

SARSiscausedbyacoronaviruscalledSARS-associatedcoronavirus.Coronavirusesareacommoncauseofmildtomoderateupperrespiratoryillnessinhumans.Thereisnotenoughinformationaboutthevirustodeterminethefullrangeofillnessthatitmightcause.

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Coronaviruseshaveoccasionallybeenlinkedtopneumoniainhumans,especiallypeoplewithweakenedimmunesystems.Thevirusesalsocancauseseverediseaseinanimals,includingcats,dogs,pigs,miceandbirds.

HowisSARSSpread?

SARSismainlyspreadbycloseperson-to-personcontact.ThevirusthatcausesSARSisthoughttobetransmittedmostreadilybybeingwithin3feetofrespiratorydropletsproducedwhenaninfectedpersonsneezesand/orbytouchingasurfaceorobjectcontaminatedwithinfectiousdroplets.ClosecontactisdefinedashavingcaredfororlivedwithapersonknowntohaveSARSorhavingdirectcontactwithsecretionsand/orbodyfluidsofapatientknowntohaveSARS.Examplesincludekissingorembracing,sharingeatingordrinkingutensils,closeconversation(withinthreefeet)orphysicalcontact.Closecontactdoesnotincludewalkingnearapersonorsittingacrossawaitingroomorofficeforabrieftime.

WhoisatriskforgettingSARS?

MostexposurestoSARSoccurinhealthcarefacilitiesandhouseholds.Communitytransmissionoutsideofthesesettingshasbeenreported,buttheseoccurredrarely.Personsatriskinhealthcarefacilitiesincludehealthcareworkers,patientsandvisitors.Inhouseholds,thegreatestriskistofamilymembersofSARSpatients.Transmissioncouldoccurinalaboratoryifpropersafetyproceduresarenotstrictlyfollowed.

Inaddition,itispossiblethatSARSvirusmightbespreadmorebroadlythroughtheairorbyotherwaysthatarenotyetknown.

IfIwereexposedtoSARS,howlongwouldittakeformetobecomesick?

Theincubationperiod(thetimebetweenexposuretotheSARSvirusandonsetofsymptoms)istypicallytwotosevendays,althoughinsomecasesitmaybeaslongas10days.

HowlongisapersonwithSARSinfectioustoothers?

InformationsuggeststhatpeoplewithSARSaremostlikelytobeinfectiousonlywhentheyhavesymptomssuchasfeverorcough.However,asaprecautionagainstspreadingthedisease,CDCrecommendsthatpeoplewithSARSlimittheirinteractionsoutsidethehome(stayhomefromworkandschool)until10daysaftertheirsymptomshavegoneaway.

DosomepeoplewhorecoverfromSARSbecomesickagainorrelapse?

CDCandotherscientistsaretryingtogainafullunderstandingofwhatfactorsmightinfluenceillnessprogressionandrecovery.Suchfactorscouldberelatedtothevirusitself,howthebody'simmunesystemreactstothevirusorhowinfectionwiththevirusistreated.HowwidespreadwastheSARSoutbreakintheUnitedStates?

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ThroughJuly2003,atotalof192SARScaseshadbeenreportedintheUnitedStates,including159suspectand33probablecases;ofthe33probablecasesonly8hadlaboratoryevidenceoftheSARSvirus.NoSARS-relateddeathsoccurredintheU.S.SARScasesreportedintheU.S.occurredprimarilyamongpeoplewhotraveledtoSARS-affectedareas;asmallnumberofpeoplebecameillafterbeinginclosecontactwith(havingcaredfororlivedwith)aSARSpatientwhileintheU.S.

WhatwasdonetocontaintheSARSoutbreakintheU.S.?

TominimizetheriskforSARSamongU.S.residents,thepublichealthsystemtookcarefulandthoroughprecautionstopreventthespreadofSARS.PeoplewhoweresuspectedofhavingSARSwereisolatedfromothersandreceivedcare.Peoplearrivingfromaffectedpartsoftheworld(whomighthavebeenexposedtoSARS)receivedinformationaboutSARSandinstructionsonwhattheyshoulddoiftheybecameill.SARSpatientsandtheircontactsweremonitoredtohelppreventspreadofthedisease.

WhatdidCDCdotocombattheSARSoutbreak?

CDCworkedcloselywiththeWorldHealthOrganization(WHO)andotherpartnersinaglobalefforttoaddresstheSARSoutbreak.Foritspart,CDCtookthefollowingactions:

• ActivateditsEmergencyOperationsCentertoprovideround-the-clockcoordinationandresponse.

• Committedmorethan900medicalexpertsandsupportstafftoworkonSARSresponse.

• Deployedmedicalofficers,epidemiologistsandotherspecialiststoassistwithon-siteinvestigationsaroundtheworld

• ProvidedassistancetostateandlocalhealthdepartmentstoinvestigatepossiblecasesofSARSintheUnitedStates.

• ConductedextensivelaboratorytestingofclinicalspecimensfromSARSpatientstoidentifythecauseofthedisease.

• InitiatedasystemfordistributinghealthalertnoticestotravelerswhohavebeenexposedtocasesofSARS.

Inaddition,CDCiscontinuingtoworkwithfederal,stateandlocalhealthdepartmentsandotherprofessionalorganizationstoplanforarapidrecognitionandresponseshouldSARSre-emerge.

WhatisNewYorkStatedoingtoprepareitscitizensforapossiblereappearanceofSARS?

NewYorkStateispreparingforthepossiblereappearanceofSARSby:

1. EducatinghealthcareworkersaboutSARSdiagnosisandreporting,

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2. DevelopingSARSsurveillancesystemstodetermineifandwhereSARShasre-emerged,

3. Developingguidelinesforpreventingtransmissionindifferentsettings,and

4. ImprovinglaboratorytestsforSARS.

IfthereisanotheroutbreakofSARS,howcanIprotectmyselfandmyfamily?

IfSARSweretoreemerge,therearesomecommonsenseprecautionsthatyoucantakethatapplytomanyinfectiousdiseases.Themostimportantisfrequenthandwashingwithsoapandwateroruseofalcohol-basedhandrubs.Youshouldavoidtouchingyoureyes,noseandmouthwithuncleanhandsandencouragepeoplearoundyoutocovertheirnoseandmouthwithatissuewhencoughingorsneezing.

IsitsafetotraveltoothercountriesoutsideoftheU.S.?

Atthistime,thereisnoevidenceofongoingtransmissionofSARSanywhereintheworld.IntheabsenceofSARStransmission,thereisnoneedforconcernabouttravelorotheractivities.

SkinInfectionsinAthletes

Howcanskininfectionsaffectathletes?

Skininfectionscantakeathletesoutoftheactionandputthemonthesidelines.Wrestlers,rugbyplayers,andotherswhoparticipateinsportswherethereisdirectskin-to-skincontacthaveanincreasedriskofgettingcontagiousskininfections.However,athletes,coaches,trainers,schoolathleticprograms,andathleticclubscantakestepstopreventthespreadofskininfections.

Howseriousareskininfections?

Mostcasesofskininfectionsinathletesaremildandtreatable.Butwithouttherighttreatment,certainskininfectionscanbeveryseriousandevenlifethreatening.

WhatshouldIdoifIhavearashorskincondition?

• Tellyourcoachandyourparentorguardianifyouareaminor(under18yearsofage).Becauseitcanbedifficulttotellskinconditionsapart,haveahealthcareproviderdeterminewhatkindofrash,condition,orinfectionyouhaveandhowtotreatit.

• Donotpracticeorcompeteuntilyouaretoldbyamedicalprofessionalthatyourrashorskininfectioncannotbetransmittedtoothers.

• Donotcovercontagiousskininfectionsandcontinuetopracticeorcompete--bandagescanfalloffandyoucouldunintentionallyspreadtheinfectiontoanotherathlete.

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• Ifahealthcareproviderdeterminesthatyourrashorconditionisnotcontagious(suchaspsoriasis,eczema,acne,orheatrash),youcancontinuetoparticipateinyoursport.However,covertheaffectedareascompletelyandsecurelytoprotectyourskinbeforeyoupractice,play,orcompete.

• Ifyourrashorskinconditionisnotcontagious,butispainfulduringpracticeorcompetition,waituntilyoufeelbetterbeforeresumingyoursport.

Whatisthemostimportantwaytopreventthespreadofskininfections?

Handwashing(handhygiene)isthemostimportantwaytopreventthespreadofskininfectionsinanysetting.

Towashyourhandsproperly:

• Wetyourhandswithcleanwaterandapplysoap.Usewarmwaterifitisavailable.

• Rubhandstogethertomakealatherandscruballsurfaces.

• Continuerubbinghandsfor20seconds(thetimeittakestosing"HappyBirthday"twice).

• Rinsehandswellwithcleanwater.

• Dryyourhandsusingapapertowelorairdryer.

• Ifpossible,useyourpapertoweltoturnoffthefaucet.

Ifsoapandwaterarenotavailableandyourhandsarenotvisiblydirty,useanalcohol-basedhandsanitizer(60%alcoholorgreater)ifpermittedbyyourschoolorathleticclub.Ifalcohol-basedhandsanitizersarenotallowedorareunavailable,handsanitizersthatdonotcontainalcoholmayalsobeuseful.

Touseanalcohol-basedhandsanitizer:

• Applyproducttothepalmofonehand.

• Rubhandstogether.

• Rubtheproductoverallsurfacesofhandsandfingersuntilhandsaredry.

Asanathlete,whatcanIdotopreventgettingorspreadingskininfections?

• Reportanyskinlesionsorsorestoyourcoachingstaffimmediately(andparentorguardianifyouareunder18yearsofage).

• Haverashesandsoresevaluatedbyamedicalproviderbeforeresumingpracticeorcompetition.

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• Washyourhandsfrequentlyoruseanalcohol-basedhandsanitizer(ifapprovedbyyourschoolorclub)intheabsenceofsoapandcleanwater.

• Washyourhandsafterusingsharedequipment(suchasbarbellsandfreeweights).

• Useacleantowelasabarrierbetweenyourbareskinandsharedsurfaces(forexample,exerciseequipment,saunabenches,orphysicaltherapytablesandequipment).

• Avoidcontactwithothers'lesionsandpossiblycontaminateditems(forexample,bandages,towels,orgear).

• Washyourhandsaftercontactwithothers'potentiallyinfectiouswounds,skin,orsoiledbandages.

• Useyourowncontainerofliquidsoap(donotshare!)andshowerbeforeandassoonaspossibleafterEVERYpractice,game,ortournament.

• Avoidtouchingyoureyes,nose,ormouthwithyourhandstohelppreventthespreadofinfections.

• Donotpickorsqueezeskinsores,whichcanworsenaninfectionandpossiblyspreadittoothers.

• Completelyandsecurelycoverskininfectionsthatarenotcontagious(suchaseczema)beforepractice,meets,orgames.

• Donotsharetowels,washcloths,soap,razors,toothbrushes,ortopicalpreparations(includingdeodorants,lotions,ointments,gels,orcreams).

• Washtowelsaftereachuse,usinghotwaterwithdetergent(andbleachifpossible)anddrycompletelyonhighheatsetting.

• Washanddisinfect,asindicated,personalandsharedathleticgearandequipment(includingwrestlingmats).

• Launderuniformsandotherclothingaftereveryuse.

• Showerwithsoap(preferablyliquid,notbar,soap)beforeusingwhirlpools,coldtubs,steamrooms,orsaunas.

• Donotusewhirlpools,coldtubs,steamrooms,orsaunasifsores,scratches,scrapes,orwoundsarepresentanywhereonyourbody.

• Donotsharecellphones,beveragecontainers(suchaswaterbottlesorsportsdrinks),cigarettes,oranythingelsethattouchesthelips,entersthemouth,orhascontactwithanaffectedskinarea.

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Whatshouldcoaches,trainers,orotherauthorizedpersonsdotoreducethespreadofskininfectionsinathletes?

• Examineathletesforskininfectionsbeforeeachpracticeorcompetition:

o Excludeathleteswhohavecontagiousskininfectionsfrompracticeorcompetitionuntilamedicalproviderdeterminesthattheinfectionisnolongerinfectious.

o Complywithyourdistrict'sorclub'sstandardclearanceprocessbeforeallowingathletestoreturntosportsorphysicaleducationclass.

• Knowandusehandhygieneandteachathleteshowtoproperlywashtheirhandswithsoapandcleanwateroruseanalcohol-basedhandsanitizer(ifapprovedbytheschoolorclubadministration).Inaddition:

o Knowtheschoolorclubpolicyontheuseofalcohol-basedhandsanitizer.Iftheyareapprovedforuse,provideappropriatestudentsupervision.Insituationswhereaccesstosinksislimited(e.g.,inagymnasium),provideindividualcontainersofalcohol-basedhandsanitizertoeachteammember.

o Usehandhygieneaftercontactwithplayers,especiallyafterchangingbandagesorprovidingwoundcare.Authorizedpersonswhoassistwiththeapplicationofcleandressingsshouldweardisposableglovesandwashtheirhandsandforearmsimmediatelyafterremovinggloves.

o Remindathletestouseacleantowelasabarrierbetweenbareskinandsharedsurfacessuchasexerciseequipmenttoreducetheneedforfrequentsanitizerapplication.

• Forathleteswithskinwounds:

o Ensurethatnon-contagiousskinwoundsorconditionsarecoveredcompletelyandsecurely(bandagedandcoveredwithaprotectivesleeve)duringpracticesandmeets.

o Makesureallwounds(e.g.,cuts,scrapes,abrasions)arecoveredwithabandageuntilhealed--especiallywhencontactwithshareditems(suchasphysicaltherapyorweightequipment)mayoccur.

o Excludeathleteswithdraininglesionsoropenwounds(regardlessiftheyarecovered)fromswimmingpools,whirlpools,icetubs,saunas,andhottubs.

• Provideenoughcleantowelstoyourteamsothatnoonehastoshare,andremindathletesnottosharetowels,eveninthegymduringpracticeorcompetition.

Whatshouldschoolsandclubsdotopreventthespreadofskininfections?

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• Environmentalsurfacesintheathleticsettingshouldbecleanedanddisinfected.Establisharegularcleaningscheduleforsharedenvironmentalsurfacessuchaswrestlingmatsorstrength-trainingequipment:

o Sanitizematsandotherhigh-useequipmentbeforeeachpracticeandseveraltimesadaythroughoutatournament.

o Sanitizeallskin-contactpointsofweightequipmentatleastonceaday.

o UseasanitizerorUSEnvironmentalProtectionAgency(EPA)registereddisinfectantforuseagainstMRSAonsurfacesoruseafreshlymixedsolutionofonepartbleachto100partswater(1tablespoonbleachto1quartofwater).

o Followthedirectionslistedonthelabelsofallcleaninganddisinfectingproducts.Payparticularattentiontothecontacttimesfortheseproducts.

• Repairordiscardequipmentwithdamagedsurfacesthatcannotbeadequatelycleaned(e.g.,equipmentwithexposedfoam).

• Covertreatmenttables.Discardorlaundercoveringsaftereachuse.

• Ifsoiledlinensandclothingarewashedonschoolpremises,washwithregularlaundrydetergentinhotwater(minimum160°F).Ifthewatertemperatureisnot160°Forhigher,addonecupofbleachtothewash.Dryinahotdryer.Considerwearinggloveswhenhandlingdirtylaundry.

SexuallyTransmittedDiseases(STDs)Thetermsexuallytransmitteddiseaseisusedtocoverthemorethan25-30infectiousorganismsthatarespreadthroughsexualactivity.STDsarealmostalwaysspreadfrompersontopersonbysexualactivity.Theseinfectionsaremosteasilyspreadbyvaginaloranalintercourse,andsometimesbyoralsex.SomeSTDscanalsobespreadthroughblood,particularlyamongintravenous(IV)druguserswhomaybesharingdrugequipment(needles,syringes,or"works").Inaddition,pregnantwomenwithSTDsmaypasstheirinfectiontoinfantsintheuterus(womb),duringbirth,orthroughbreast-feeding.

MostpeoplewithSTDshavenosymptoms.Withouttreatmentthesediseasescanleadtomajorhealthproblemssuchasnotbeingabletogetpregnant(infertility),permanentbraindamage,heartdisease,cancer,andevendeath.Ifyouthinkyouhavebeenexposedtoasexuallytransmitteddisease,youandyoursexpartner(s)shouldvisitahealthclinic,hospitalordoctorfortestingandtreatment.

WheretoGoforSTDScreeningandTreatment

ManylocalandcountyhealthdepartmentshaveclinicswhereyoucangettestedandtreatedforSTDs.Someclinicsarefree,atothers,youmayhavetopaytogetSTDtestingandtreatment.TheSTDClinicsinNewYorkStatepagecontainslinkstocontactinformationforSTDclinicsorganizedbycounty.YoualsocancalltheNationalSTDhotline(1-800-232-4636)tofindaclinicnearyou.Link:http://www.health.ny.gov/diseases/communicable/std/clinics/

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YourdoctororhealthcareprovidermayalsodoSTDtestingandtreatment.Seeyourdoctororhealthcareproviderrightawayifyouhavesymptoms.Ifyoudonothaveadoctororhealthcareproviderandneedtogettestedrightaway,gotoalocalUrgentCarecenter,walkinclinicorhospitalemergencyroom.

STDLinksInformationonSTDsMoreinformationonspecificSTDsandtheirprevention,symptomsandtreatmentInformationonPartnerServicesInformationonExpeditedPartnerTherapyInternetResourcesSexuallyTransmittedDiseases-CentersforDiseaseControlandPreventionDivisionofSTDPrevention,NationalCenterforHIV,STDandTBPrevention-CDCIwannaknow.org-InformationAboutTeenSexualHealthandSTDsAmericanSocialHealthAssociationHepatitisInformation(NYSDOH)HIV/AIDSInformation(NYSDOH)ProviderResourcesClinicianReportingProceduresProviderHIVReportingandPartnerServicesTreatmentandLaboratoryGuidelinesCDCSTDTreatmentGuidelines2010Update:TetracyclineandDoxycyclineShortageandImpactstoRecommendedSTDTherapy(CDC)Update:OralCephalosporinsNoLongeraRecommendedTreatmentforGonococcalInfectionsMorbidityandMortalityWeeklyReport(MMWR)(August10,2012)HealthAdvisory:OralCephalosporinsnolongerrecommendedfortreatmentofgonoccalinfectionsintheUnitedStates(September2012)(PDF,105KB,3pg.)CongenitalSyphilisSurveillanceinUpstateNewYork,1989-1992TheJournalofInfectiousDiseases1995;171:732-52002LaboratoryGuidelinesScreeningTestsToDetectChlamydiatrachomatisandNeisseriagonorrhoeaeInfectionsProtocolfortheAcuteCareoftheAdultPatientReportingSexualAssaultExpeditedPartnerTherapyExpeditedPartnerTherapyforChlamydiatrachomatisPartnerServicesforSTD/HIVPreventionInformationonPartnerServicesRecommendationsforPartnerServicesProgramsforHIVInfection,Syphilis,Gonorrhea,andChlamydialInfection-November2008MMWR(PDF,698KB,92pg.)IntegratedSTD,HIVandViralHepatitisRiskAssessmentQuestionnaireEnglish(PDF,182KB,1pg.)Español(PDF,788KB,1pg.)HaitianCreole(PDF,433KB,1pg.)RiskQuestionnaire-Instructionsforstaff(PDF,23KB,3pg.)AnswerGuideforRiskQuestionnaire(PDF,31KB,1pg.)TrainingandReferenceNationalNetworkofSTD/HIVPreventionTrainingCentersSTD101inaBox-ReadytoUsePresentations-CDCThePractitioner'sHandbookfortheManagementofSTDs-SeattleSTD/HIVPreventionTrainingCenterStatisticsSTDDataandStatisticsSTDMaterialsOrderForm

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STDeducationmaterialsorderform

Tuberculosis(TB)Whatistuberculosis?

Tuberculosisisabacterialdiseaseusuallyaffectingthelungs(pulmonaryTB).Otherpartsofthebodycanalsobeaffected,forexamplelymphnodes,kidneys,bones,joints,etc.(extrapulmonaryTB).Approximately1,300casesarereportedeachyearinNewYorkState.

Whogetstuberculosis?

Tuberculosiscanaffectanyoneofanyage.Peoplewithweakenedimmunesystemsareatincreasedrisk.

Howistuberculosisspread?

TuberculosisisspreadthroughtheairwhenapersonwithuntreatedpulmonaryTBcoughsorsneezes.ProlongedexposuretoapersonwithuntreatedTBusuallyisnecessaryforinfectiontooccur.

Whatisthedifferencebetweenlatenttuberculosisinfectionandtuberculosisdisease?

Latenttuberculosisinfection(LTBI)meansthepersonhastheTBgermintheirbody(usuallylungs),buthasyettodevelopobvioussymptoms.InlatentTB,thepersonhasasignificantreactiontotheMantouxskintestwithnosymptomsoftuberculosis,andnoTBorganismsfoundinthesputum.Tuberculosisdiseaseindicatesthepersonhassymptoms,asignificantreactiontoaMantouxskintestandorganismsfoundinthesputum.InordertospreadtheTBgerms,apersonmusthaveTBdisease.HavinglatentTBinfectionisnotenoughtospreadthegerm.Tuberculosismaylastforalifetimeasaninfection,neverdevelopingintodisease.

Whatarethesymptomsoftuberculosis?

ThesymptomsofTBincludealow-gradefever,nightsweats,fatigue,weightlossandapersistentcough.Somepeoplemaynothaveobvioussymptoms.

Howsoondosymptomsappear?

MostpeopleinfectedwiththegermthatcausesTBneverdevelopactiveTB.IfactiveTBdoesdevelop,itcanoccurtwotothreemonthsafterinfectionoryearslater.Theriskofactivediseaselessensastimepasses.

Whenandforhowlongisapersonabletospreadtuberculosis?

ApersonwithTBdiseasemayremaincontagiousuntilhe/shehasbeenonappropriatetreatmentforseveralweeks.However,apersonwithlatentTBinfection,butnotdisease,cannotspreadtheinfectiontoothers,sincetherearenoTBgermsinthesputum.

Whatisthetreatmentfortuberculosis?

PeoplewithlatentTBinfectionshouldbeevaluatedforacourseofpreventivetherapy,whichusuallyincludestakingantituberculosismedicationforseveralmonths.PeoplewithactiveTBdiseasemustcompleteacourseoftreatmentforsixmonthsormore.Initialtreatmentincludesatleastfouranti-TB

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drugs,andmedicationsmaybealteredbasedonlaboratorytestresults.Theexactmedicationplanmustbedeterminedbyaphysician.Directlyobservedtherapy(DOT)programsarerecommendedforallTBpatientstohelpthemcompletetheirtherapy.

Whatcanbetheeffectofnotbeingtreatedfortuberculosis?

Inadditiontospreadingthediseasetoothers,anuntreatedpersonmaybecomeseverelyillordie.

Whatcanbedonetopreventthespreadoftuberculosis?

ThemostimportantwaytostopthespreadoftuberculosisisforTBpatientstocoverthemouthandnosewhencoughing,andtotakealltheTBmedicineexactlyasprescribedbythephysician.

Whatismultidrug-resistanttuberculosis(MDR-TB)?

ThisreferstotheabilityofsomestrainsofTBtogrowandmultiplyeveninthepresenceofcertaindrugswhichwouldnormallykillthem.

Whatisextensivelydrug-resistanttuberculosis(XDR-TB)?

Extensivelydrug-resistantTB(XDR-TB)isasubsetofMDR-TBinwhichthestrainsofTBbacteriaareresistanttoseveralofthebestsecond-linedrugsforTB.Thesestrainsareverydifficulttotreat.XDR-TBcasesmakeupapproximately10percentofMDR-TBcases.

WhogetsMDR-TB?

TBpatientswithdrugsensitivediseasemaydevelopdrugresistanttuberculosisiftheyfailtotakeantituberculosismedicationsasprescribed,aswellasTBpatientswhohavebeenprescribedanineffectivetreatmentplan.TBcasesdiseasedwithMDR-TBcantransmitthedrugresistantinfectiontootherindividuals.

Whatisthetreatmentformultidrug-resistanttuberculosis?

Forpatientswithdiseaseduetodrugresistantorganisms,expertconsultationfromaspecialistintreatingdrugresistantTBshouldbeobtained.Patientswithdrugresistantdiseaseshouldbetreatedwithdrugstowhichtheirorganismsaresusceptible.TheeffectivenessoftreatmentforlatentinfectionwithMDR-TBisuncertain.

WhatcanbedonetopreventthespreadofMDR-TB?

EnsuringpeoplewithMDR-TBtakealltheirmedicationandteachingpatientstocovertheirmouthandnosewhencoughingandsneezingcanreducetheriskofspreadofMDR-TB.Inaddition,directlyobservedtherapyshouldbeusedtoensurepatientscompletetherecommendedcourseoftherapy.

AlloftheaboveCommunicableDiseaseFactSheetinformationisfromtheNewYorkStateDepartmentofHealth.Furtherinformationcanbefoundattheirwebsite:http://www.health.ny.gov/diseases/communicable/index.htm