The Waco‐McLennan County Public Health District (WMCPHD) received 45 reports of com‐

municable disease from September 1st through November 30th of 2013. Reported diseases 

for this time period are listed in Table 1. Fifty one reports of communicable disease were 

reported in previous quarter (June‐August 2013).  Ten animal rabies cases were identified 

from McLennan County this quarter by the Department of State Health Services ‐ Zoonosis 

Control Department. The majority of reports consisted of gastrointestinal illnesses with 3 

parasitic and 28 bacterial as causative agents. There were 5 vaccine preventable diseases 

that were reported during this quarter, all of which were Varicella (Chicken Pox). 

Waco-McLennan County Public Health District

225 West Waco Drive, Waco, Texas 76707 P: 254-750-5450

Quarterly Report: Epidemiology & Public Health Preparedness

September-October-November 2013

Waco-McLennan County Public Health District

Table 1: Diseases  Sep‐Nov 2013  Rates  Jun‐Aug 2013  Rates  Mar‐May 2013  Rates 

Aseptic Meningitis          1  0.4 

Campylobacter  5  2.1  14  6.0  2  0.9 

Chagas (Chronic)      1  0.4     

Cryptosporidiosis  3  1.3  2  0.9  1  0.4 

Hepatitis A (Acute)      2  0.9  2  0.9 

Hepatitis B (Acute)      2  0.9     

Legionellosis*  1  0.4         

Lyme  1  0.4      1  0.4 

Pertussis  3  1.3  2  0.9  2  0.9 

Salmonellosis  15  6.4  18  7.7  5  2.1 

Shiga Toxin Producing Ecoli  1  0.4  1  0.4  1  0.4 

Shigellosis  7  3.0  3  1.3  1  0.4 

Streptococcus A      1  0.4     

Streptococcus B          1  0.4 

Tuberculosis  4  1.7      1  0.4 

Varicella  5  2.1  5  2.1  12  5.1 

Vibrio Parahemolyticus          1  0.4 

TOTAL  45  19.2  51  21.7  31  13.2 

Rates per 100,000 McLennan County population. (McLennan County 2010 Census population =234,906) 

* Legionellosis case was ruled out as "not a case". 

2012‐2013 Flu Vaccine 

         There are several flu vaccine options 

for the 2013‐2014 flu season. Traditional 

flu vaccines made to protect against 

three different flu viruses (called 

“trivalent” vaccines) are available. In ad‐

dition, this season, flu vaccines made to 

protect against four different flu viruses 

(called “quadrivalent” vaccines) also are 

available. The trivalent flu vaccine pro‐

tects against two influenza A viruses and 

an influenza B virus.  

The following trivalent flu vaccines are 

available: 

Standard dose trivalent shots that 

are manufactured using virus grown in 

eggs. These are approved for people ages 

6 months and older. There are different 

brands of this type of vaccine, and each is 

approved for different ages. However, 

there is a brand that is approved for chil‐

dren as young as 6 months old and up. 

A standard dose trivalent shot con‐

taining virus grown in cell culture, which 

is approved for people 18 and older. 

20122012--2013 F2013 FLULU S SEASONEASON Page 2

McLennan County Weekly Flu Activity, 2013

0

10

20

30

40

50

60

8/3

8/10

8/17

8/24

8/31 9/

79/14

9/21

9/28

10/5

10/12

10/19

10/26

11/2

11/9

11/16

11/23

11/30

12/7

Week Ending

Co

un

t

ILI Rapid flu A Rapid flu B Rapid flu ND*

Flu Activity 

         Statewide influenza‐like illness 

(ILI) activity continues to increase and 

is above baseline levels. Influenza ac‐

tivity is increasing steadily. All Texas 

Regions have reported laboratory con‐

firmed influenza, and the percentage 

of specimens positive for influenza is 

now over 10%. This is one threshold 

used by CDC to indicate the start of the 

flu season.          

          WMCPHD performs year around 

flu surveillance. Weekly flu activity in 

McLennan County is shown in the pic‐

ture below.  

A standard dose trivalent shot that is 

egg‐free, is approved for people 18 

through 49 years of age. 

A high‐dose trivalent shot, approved 

for people 65 and older. 

A standard dose intradermal triva‐

lent shot, which is injected into the skin 

instead of the muscle and uses a much 

smaller needle than the regular flu shot, 

is approved for people 18 through 64 

years of age. 

The quadrivalent flu vaccine protects 

against two influenza A viruses and two 

influenza B viruses. The following 

quadrivalent flu vaccines are available: 

A standard dose quadrivalent shot 

A standard dose quadrivalent flu 

vaccine, given as a nasal spray, is ap‐

proved for healthy people 2 through 49 

years of age 

For more information visit: 

http://www.cdc.gov/flu/about/season/

flu‐season‐2013‐2014.htm 

Visit http://flushot.healthmap.org/ to 

find vaccine in your area. 

Influenza-like illness activity (ILI): ILI is defined as fever over 100F and cough and/or sore throat in the absence of another diagnosis.

This report , disease reporting and flu reporting forms are also available on http://www.waco-texas.com/cms-healthdepartment

When winter temperatures drop 

significantly below normal, stay‐

ing warm and safe can become a 

challenge.  Extremely  cold  tem‐

peratures  often  accompany  a 

winter  storm,  so  you may  have 

to cope with power failures and 

icy  roads.  Although  staying  in‐

doors  as much  as  possible  can 

help  reduce  the  risk  of  car 

crashes and falls on the  ice, you 

may  also  face  indoor  hazards. 

Many homes will be  too  cold—

either due  to a power  failure or 

because the heating system isn’t 

adequate for the weather.  

wood stove, or kerosene 

heater,  install a smoke detec‐

tor  and  a  battery‐operated 

carbon  monoxide  detector 

near  the  area  to  be  heated. 

Test  them  monthly,  and  re‐

place batteries twice yearly.     

     Your  ability  to  feel  a 

change  in  temperature  de‐

creases  with  age,  and  older 

people  are  more  susceptible 

to health problems caused by 

cold.  If you are over 65 years 

old,  place  an  easy‐to‐read 

thermometer in an indoor 

Although  periods  of  extreme 

cold  cannot  always  be  pre‐

dicted far in advance, weather 

forecasts  can  sometimes  pro‐

vide  you  with  several  days’ 

notice. Listen to weather 

forecasts  regularly, and  check 

your emergency supplies 

whenever a period of extreme 

cold is predicted.  

   If you plan to use a fireplace 

or wood  stove  for emergency 

heating, have your chimney or 

flue inspected each year. Also, 

if  you’ll  be  using  a  fireplace, 

location where you will  see 

it  frequently, and check the 

temperature  of  your  home 

often  during  the  winter 

months.  

   Insulate  any  water  lines 

that run along exterior walls 

so your water supply will be 

less  likely  to  freeze.  To  the 

extent  possible, weatherproof  your  home  by  adding 

weatherstripping,  insulation,  insulated  doors  and 

storm windows, or thermal‐pane windows. 

   If you have pets, bring  them  indoors.  If you  cannot 

bring  them  inside,  provide  adequate  shelter  to  keep 

them warm. 

person) in case your water pipes freeze and rupture. • Medicines that any family member may need. If your area is prone to long periods of cold tempera-tures, or if your home is iso-lated, stock additional amounts of food, water, and medicine.

Keep several days’ supply of these items: • Food that needs no cook-ing or refrigeration, such as bread, crackers, cereal, canned foods, and dried fruits. Remember baby food and formula if you have young children. • Water stored in clean con- tainers, or purchased bottled water (5 gallons per

Plan Ahead Cold Weather SafetyCold Weather Safety

Prepare Your Home for Winter 

Page 3

Prepare for extremely cold weather every winter—it’s always a possibility.

When  people  must  use  space 

heaters  and  fireplaces  to  stay 

warm, the risk of household fires 

increases,  as  well  as  the  risk  of 

carbon  monoxide  poisoning.  Ex‐

posure  to  cold  temperatures, 

whether  indoors  or  outside,  can 

cause  other  serious  or  life‐

threatening  health  problems. 

Infants  and  the  elderly  are  par‐

ticularly  at  risk,  but  anyone  can 

be affected. To keep yourself and 

your  family  safe,  you  should 

know  how  to  prevent  cold‐

related  health  problems  and 

what  to  do  if  a  cold‐weather 

health emergency arises.  

Emergency Supplies List:

• an alternate way to heat your home during a power failure: - dry firewood for a fireplace or wood stove, or - kerosene for a kerosene heater • furnace fuel (coal, propane, or oil) • electric space heater with automatic shut-off switch and non-glowing elements • blankets • matches • multipurpose, dry-chemical fire extinguisher • first aid kit and instruction manual • flashlight or battery-powered lantern • battery-powered radio • battery-powered clock or watch • extra batteries • non-electric can opener • snow shovel • rock salt • special needs items (diapers, hearing aid batteries, medications, etc.)

Heat your home safely. Keep space heat‐

ers away from things that can catch fire, 

such as drapes, furniture or bedding, and 

do not place them on furniture. Never 

leave children unattended around space 

heaters and avoid running cords where 

they may be tripping hazards. 

Do not use charcoal or gas grills or genera‐

tors indoors. Fumes can be deadly. 

Conserve heat by closing doors to rooms 

that are not being used. Roll towels and 

place under doors. Cover windows with 

drapes or blankets. 

Protect your pipes. Leave a slow drip and 

open cabinets with pipes.  

Recognizing Hypothermia Adults: • shivering, exhaustion • confusion, fumbling

hands memory loss, slurred

speech drowsiness Infants: • bright red, cold skin very low energy If a person’s tempera-ture gets below 95° seek medical attention imme-diately.

Source: “Extreme Cold: A Prevention Guide to Promote Your Health and Safety” http://www.bt.cdc.gov/disasters/winter/pdf/extreme-cold-guide.pdf

DDDISEASEISEASEISEASE R R REPORTINGEPORTINGEPORTING

The Waco-McLennan County Public Health District has a 24-hour a day/ 7 days a week number that can be utilized to report any cases of disease.

The 24/7 disease reporting number is (254) 750-5411

On a daily basis the epidemiology department reviews, investigates, and reports all cases of communicable disease recognized 

as Notifiable Diseases in Texas.  This allows for monitoring of disease trends and detection of outbreaks. Reporting may also 

be done directly to Epidemiology at (254) 750‐5493 or fax reports to (254) 750‐5405. 

Visit us at http://www.waco‐texas.com/cms‐healthdepartment/

E59-11364 (Rev. 01/13) DSHS, Visit www.mclennanpublichealth.org to download disease reporting forms. This document was modified to be used in McLennan County on 2/2013.

Report confirmed and suspected cases. Unless noted by *, report to Waco-McLennan County Public Health District using number above or Epidemiology

Department at 254-750-5493 or FAX 254-750-5405.

A – I When to Report L – Y When to Report

*Acquired immune deficiency syndrome (AIDS)1, 2 Within 1 week *Lead, child blood, any level & adult blood, any level6 Call/Fax Immediately

Amebiasis3 Within 1 week Legionellosis3 Within 1 week

Amebic meningitis and encephalitis3 Within 1 week Leishmaniasis3 Within 1 week

Anaplasmosis3 Within 1 week Listeriosis3, 4 Within 1 week

Anthrax3, 4 Call Immediately Lyme disease3 Within 1 week

Arbovirus infection3, 5 Within 1 week Malaria3 Within 1 week

*Asbestosis6 Within 1 week Measles (rubeola)3 Call Immediately

Babesiosis3 Within 1 week Meningococcal infections, invasive3, 4 Call Immediately

Botulism (adult and infant)3, 4 Call Immediately Mumps3 Within 1 week

Brucellosis3, 4 Within 1 work day Pertussis3 Within 1 work day

Campylobacteriosis3 Within 1 week *Pesticide poisoning, acute occupational6 Within 1 week

*Cancer7 See rules7 Plague (Yersinia pestis)3, 4 Call Immediately

Chagas’ disease3 Within 1 week Poliomyelitis, acute paralytic3 Call Immediately

*Chancroid1 Within 1 week Poliovirus infection, non-paralytic3 Within 1 work day

Chickenpox (varicella)8 Within 1 week Q fever3 Within 1 work day

*Chlamydia trachomatis infection1 Within 1 week Rabies, human3 Call Immediately

*Contaminated sharps injury9 Within 1 month Relapsing fever3 Within 1 week

*Controlled substance overdose10 Call Immediately Rubella (including congenital)3 Within 1 work day

Creutzfeldt-Jakob disease (CJD)3 Within 1 week Salmonellosis, including typhoid fever3 Within 1 week

Cryptosporidiosis3 Within 1 week Severe Acute Respiratory Syndrome (SARS)3 Call Immediately

Cyclosporiasis3 Within 1 week Shigellosis3 Within 1 week

Cysticercosis3 Within 1 week *Silicosis6 Within 1 week

*Cytogenetic results (fetus and infant only)11 See rules11 Smallpox3 Call Immediately

Dengue3 Within 1 week *Spinal cord injury12 Within 10 work days

Diphtheria3 Call Immediately Spotted fever group rickettsioses3 Within 1 week

*Drowning/near drowning12 Within 10 work days Staph. aureus, vancomycin-resistant (VISA and VRSA)3, 4 Call Immediately

Ehrlichiosis3 Within 1 week Streptococcal disease (group A, B, S. pneumo), invasive3 Within 1 week

Escherichia coli infection, Shiga toxin-producing3, 4 Within 1 week *Syphilis – primary and secondary stages1, 13 Within 1 work day

*Gonorrhea1 Within 1 week *Syphilis – all other stages1, 13 Within 1 week

Haemophilus influenzae type b infections, invasive3 Within 1 week Taenia solium and undifferentiated Taenia infection3 Within 1 week

Hansen’s disease (leprosy)3 Within 1 week Tetanus3 Within 1 week

Hantavirus infection3 Within 1 week *Traumatic brain injury12 Within 10 work days

Hemolytic Uremic Syndrome (HUS)3 Within 1 week Trichinosis3 Within 1 week

Hepatitis A (acute)3 Within 1 work day Tuberculosis (includes all M. tuberculosis complex)4, 14 Within 1 work day

Hepatitis B, C, and E (acute) 3 Within 1 week Tularemia3, 4 Call Immediately

Hepatitis B identified prenatally or at delivery (acute & chronic) 3 Within 1 week Typhus3 Within 1 week

Hepatitis B, perinatal (HBsAg+ < 24 months old) 3 Within 1 work day Vibrio infection, including cholera3, 4 Within 1 work day

*Human immunodeficiency virus (HIV) infection1, 2 Within 1 week Viral hemorrhagic fever, including Ebola3 Call Immediately

Influenza-associated pediatric mortality3 Within 1 work day Yellow fever3 Call Immediately

Influenza, Novel3 Call Immediately Yersiniosis3 Within 1 week

In addition to specified reportable conditions, any outbreak, exotic disease, or unusual group expression of disease that may be of public health concern should be reported by the most expeditious means available

* Call 254-750-5478 for HIV/STD and 254-750-5496 for Tuberculosis related questions and reporting 1 Please refer to specific rules and regulations for HIV/STD reporting and who to report to at: http://www.dshs.state.tx.us/hivstd/healthcare/reporting.shtm. 2 Labs conducting confirmatory HIV testing are requested to send remaining specimen to a CDC-designated laboratory. Please call 512-533-3132 for details. 3 Reporting forms are available at http://www.dshs.state.tx.us/idcu/investigation/forms/. Investigation forms at http://www.dshs.state.tx.us/idcu/investigation/

Call as indicated for immediately reportable conditions. 4 Lab isolate must be sent to DSHS lab. Call 512-776-7598 for specimen submission information. 5 Reportable Arbovirus infections include neuroinvasive and non-neuroinvasive California serogroup including Cache Valley, Eastern Equine (EEE), Dengue, Powassan,

St. Louis Encephalitis (SLE), West Nile, and Western Equine (WEE). 6 Please refer to specific rules and regulations http://www.dshs.state.tx.us/lead/Reporting-Laws-Administrative-Code.aspx. 7 Please refer to specific rules and regulations for cancer reporting and who to report to at http://www.dshs.state.tx.us/tcr/reporting.shtm. 8 Varicella reporting form at http://www.dshs.state.tx.us/idcu/health/vaccine_preventable_diseases/forms/NewVaricellaForm.pdf. Call local health dept for copy with their fax number. 9 Not applicable to private facilities. Initial reporting forms for Contaminated Sharps at http://www.dshs.state.tx.us/idcu/health/infection_control/bloodborne_pathogens/reporting/. 10 Contact local poison center at 1-800-222-1222. For instructions, forms, and fax numbers see http://www.dshs.state.tx.us/epidemiology/epipoison.shtm#rcso. 11 Report cytogenetic results including routine karyotype and cytogenetic microarray testing (fetus and infant only). Please refer to specific rules and regulations for birth defects

reporting and who to report to at http://www.dshs.state.tx.us/birthdefects/BD_LawRules.shtm. 12 Please refer to specific rules and regulations for injury reporting and who to report to at http://www.dshs.state.tx.us/injury/rules.shtm. 13 Laboratories should report syphilis test results within 3 work days of the testing outcome. 14 MTB complex includes M. tuberculosis, M. bovis, M. africanum, M. canettii, M. microti, M. caprae, and M. pinnipedii. Please see rules at http://www.dshs.state.tx.us/idcu/disease/tb/reporting/.

Texas Notifiable Conditions24/7 Number for Immediately Reportable– 254-750-5411

Above Information is CONFIDENTIAL. Please notify sender if received in error and return or destroy. EEPI-2 (HSR7 Rev. 8/08)

General Instructions This form may be used to report suspected cases and cases of notifiable conditions in Texas, listed with their reporting timeframes on the reverse side of this form or available at www.dshs.state.tx.us/idcu/investigation/forms/101A.pdf. In addition to specified reportable conditions, any outbreak, exotic disease, or unusual group expression of disease that may be of public health concern should be reported by the most expeditious means available. A health department epidemiologist may contact you to further investigate this Infectious Disease Report. Information needed to classify cases of infectious disease is outlined in the Epi Case Criteria Guide found at www.dshs.state.tx.us/idcu/investigation/forms/EpiCaseGuide.pdf.

Confirmed and suspected cases should be reported to your local or regional health department at the following address, phone or fax number:

Waco-McLennan County Public Health District 225 West Waco Drive, Waco, TX 76707

Phone: (254)750-5411 (24/7 reporting)

Fax: (254) 750-5405 As needed, cases may be reported to the Department of State Health Services at 1-800-252-8239, 512-458-7676, or after-hours at 512-458-7111

Disease or Condition Date: _________________ (Check type) Onset Specimen collection (Please fill in onset or closest known date) Absence Office visit

Physician Name Physician Address See Facility address below Physician Phone See Facility phone below ( ) -

Diagnostic Criteria (Diagnostic Lab Result and Specimen Source or Clinical Indicators)

Patient Name (Last) (First) (MI) Telephone ( ) -

Address (Street) City State Zip Code County

Date of Birth (mm/dd/yyyy) Age Sex Male

Female

Ethnicity Hispanic

Not Hispanic

Race White Black

Asian Other UnknownOccupation (if student also include school name and grade)

(if under 18) Guardian’s Name Occupation

Telephone (_____) ______ - ______

Was patient hospitalized? ___ Yes ____ No If yes, Name of Hospital: _____________________________________________________

Admission Date: ____/_____/_______ Discharge Date: _____/______/________ Discharge status: Recovering/Recovered Deceased Unknown

FOR HEPATITIS REPORTING: Liver Function Test Date: ALT: AST: Name of Reporting Facility Address

Name of Person Reporting Title Phone Number

( ) - extension

Date of Report (mm/dd/yyyy) E-mail

Notes, comments, or additional information such as other lab results/clinical info, pregnancy status, travel history, etc. PLEASE ATTACH LAB REPORT IF AVAILABLE.

Confirmed Probable Suspected Dropped Duplicate, with new information

Entered into Epi Tracker Entered into NEDSS (date): Case ID#

Initial Provider

Infectious Disease Report

This form expires on January 1, 2010.