Infectious Disease Prevention Is So Much More than COVID-19

Surveillance, testing and guidance on everything from salmonella to syphilis

FRANKFORT The Infectious Disease Branch in the Division of Epidemiology and Vital Statistics at the Kentucky Department for Public Health was a busy place before the pandemic. This group of public health workers were the ones putting together surveillance, coordinating testing and providing guidance to healthcare providers on everything from salmonella to syphilis. Then COVID-19 brought unprecedented new challenges. The Kentucky Department for Public Health ramped up personnel and activities to bring their knowledge and experience to combat a previously unknown disease that has affected every facet of how we work and live in Kentucky for the past two years. The staff that typically worked on viral hepatitis, sexually transmitted diseases, insect vector illness, tuberculosis, and much more have been serving the COVID-19 response while trying to maintain the programs addressing those other ongoing health threats. Now that the case numbers of COVID-19 are receding in the population, these experts are returning more of their attention to areas of work that are vital for the continued health and safety of the Commonwealth.

The following is a briefing from Kentucky public health leaders regarding the current state of affairs for important infectious diseases being tracked and addressed by Kentucky’s public health infrastructure.

Viral Hepatitis:

Prior to COVID-19, an estimated 78,000 Kentuckians were living with hepatitis C (HCV). Given the stress of the pandemic on individuals and on harm reduction services, we anticipate rates of substance use disorder (SUD)-related infectious diseases have increased in the past two years, and that the previous hepatitis C estimate is now low. Already, we know Kentucky saw increases in overdose deaths and instances of HIV clusters during the pandemic. In a state with a high burden of new HCV infections, it would follow that prevalence of HCV has also increased. Because public health staff, at local and state levels, have been necessarily focused on COVID-19, it will take time to demonstrate how HCV rates have changed the past two years.

In 2021, the AIDS Institute estimated curing HCV to cost, on average, $19,051; the average cost of caring for someone who develops chronic hepatitis C is $205,760. More importantly, HCV devastates individuals, families, and communities as chronic infection impacts quality and length of life. Disease transmission modeling shows why these individuals should be prioritized for treatment. It is a real-time intervention into drug-user networks and an opportunity to reduce transmission. While HCV remains grossly underfunded at all levels, Kentucky is positioned to make identifying and treating HCV a priority and a winnable battle.
— Amanda Wilburn, MPH, Viral Hepatitis Program Manager

Sexually Transmitted Diseases (STDs):

In the STD Prevention and Control Program, the primary goal is to ensure the citizens of the Commonwealth are protected from common STDs. The national trend of increasing rates of STDs for the past seven years has been very discouraging, especially for syphilis. Treatment for syphilis is very simple, yet since 2015, there has been a 70% increase in syphilis in the United States. Although not as high as the national average, Kentucky has experienced a 12 percent increase in reported syphilis since 2015, with an infectious rate of 5.5 cases per 100,000.

Syphilis surveillance efforts have been expanded to ensure we are monitoring, analyzing and evaluating all incoming morbidities and properly investigate all infectious syphilis cases within 48 hours. The goal of the Kentucky STD Prevention and Control Program is to be proactive and ensure any emerging disease trends are met with timely intervention and thorough investigation.
— KY STD Prevention and Control Program

Tuberculosis:

Tuberculosis (TB) programs around the world faced significant challenges during the COVID-19 pandemic. With staffing capacities being stretched to the limit, reporting of other infectious conditions suffered, particularly with respiratory conditions such as TB.

COVID-19 and TB can have similar clinical presentations, so differentiating these diagnoses was sometimes challenging. In fact, several TB cases in Kentucky counted in late 2020 and 2021 had significant reporting and testing delays as they were suspected to have COVID-19 and active TB was not initially considered. It will be interesting to learn more about the long-term effects from COVID-19 on TB patient clinical outcomes and staffing shortages towards TB prevention and control.

As we are beginning to, hopefully, see the light at the end of the COVID-19 pandemic tunnel, we encourage Kentucky medical providers, community partners, and LHDs to “think TB” once again. Timely identification and reporting benefit the patient and also help significantly control the spread of TB within our communities.
— Emily Anderson, BSN, RN, KY TB Program Controller/Manager

— Charles Rhea, MPH, TB Program Epidemiologist

Tickborne Diseases:

As spring and summer are just around the corner, there is another waiting for the warm weather. You may have guessed it already: it is our little arthropod, the tick. They are known to be blood-sucking, opportunistic parasites that attach to the skin of a variety of hosts. Interaction between humans and ticks have been most commonly observed during the spring and summer months when outdoor activities are increased in wooded areas.

The most common ticks we can find in Kentucky are the lone star tick (Amblyomma americanum), American dog tick (Dermacentor variabilis), blacklegged tick (Ixodes scapularis), and the brown dog tick (Rhipicephalus sanguineus). These tick species can be important vectors of disease that can be extremely harmful to humans. At times, when a tick feeds on a host it will pass along pathogens that can cause disease such as bacteria, viruses, or protozoa. In Kentucky the most common tick-borne diseases we see here are spotted fever rickettsiosis (commonly referred to Rocky-Mountain spotted fever), lyme disease, and ehrlichiosis. It is important to note that not all tick species can serve as a vector for every pathogen, and not every tick bite will result in disease. However, monitoring and giving guidance to prevent or treat tick-borne diseases will be increasingly important as more people get outside to enjoy the spring weather together.
— Morgan Taylor, MPH, Vector-borne Epidemiologist

Enteric Diseases:

Heading into warmer weather, it’s important to remember that foodborne illness can have a significant impact on outdoor gatherings. Warmer temperatures encourage growth of foodborne pathogens, so remember to follow these steps this grilling season: separate meat (including poultry and seafood) items from other items to help avoid cross-contamination; chill proteins until you are ready to grill them; wash your hands and work surfaces thoroughly before and after preparing and cooking raw meat; don’t cross-contaminate food items with marinades or utensils that have touched raw meat juices; use clean utensils and plates to remove items from the grill; use a food thermometer to ensure proteins are cooked hot enough to kill pathogens; hold hot food items at 140°F or warmer until serving; and refrigerate leftovers within two hours (sooner if above 90°F outside) of cooking. Following the above steps should help ensure that your gathering does not become memorable for the wrong reasons.
—Jennifer Khoury, MPH, Foodborne/Waterborne Diseases Epidemiologist

For more information, contact Bethany Hodge, MD, MPH; Infectious Disease Branch Manager; Division of Epidemiology and Health Planning; Kentucky Department for Public Health; Mobile: 502.382.8959; Bethany.hodge@ky.gov