Georgia Epidemiology Report The Georgia Epidemiology Report is a publication of the Epidemiology Section of the Epidemiology and Prevention Branch, Division of Public Health, Department of Human Resources June 1996 Volume 12 Number 6 Division Of Public Health Patrick J. Meehan, M.D. - Director 1996 Centennial Summer Olympic Games: Epidemiology and Prevention Branch State Epidemiologist Kathleen E. Toomey, M.D., M.P.H.- Director Epidemiology Section Paul A. Blake, M.D., M.P.H.-Director Surveillance Jeffrey D. Berschling, M.P.H.; Karen R. Horvat, M.P.H.; Jane E. Koehler, D.V.M, M.P.H.; Patrick L. Osewe, M.D., M.P.H.; Preeti Pathela, M.P.H.; Russell C. Sexton Jr., M.H.S.; Sabrina Walton, M.S.P.H. Chronic Disease Nancy E. Stroup, Ph.D.-Director Patricia M. Fox, M.P.H.; David M. Homa, Ph.D., M.P.H.; Thomas W. McKinley, M.P.H.; Edward E. Pledger, M.P.A.; D. Lee Warner, M.P.H. Tuberculosis Bharat K. Pattni, M.B.B.S., M.P.H. HIV\AIDS Awal D. Khan, Ph.D., M.A. Sexually Transmitted Diseases Quimby E. McCaskill, M.P.H.; Dhelia Williamson, M.S. Office of Perinatal Epidemiology Roger W. Rochat, M.D. - Director Mary D. Brantley, M.P.H.; Raymond E. Gangarosa, M.D., M.P.H.; Rebekah Hudgins, M.P.H.; Mary P. Mathis, Ph.D., M.P.H.; Florina Serbanescu, M.D.; Edward F. Tierney, M.P.H. Preventive Medicine Residents Lorenzo D. Botto, M.D.; Isabella A. Danel, M.D., M.S.; Hector S. Izurieta, M.D., M.P.H.;Michael M. McNeal, M.D., M.P.H.; Peter Strebel, M.D.;Sherrilyn Wainwright, D.V.M., M.P.H..; EIS Officers Luis G. Castellanos, M.D., Ph.D; Patricia M. Dietz, Dr.P.H. Georgia Epidemiology Report Editorial Board Editorial Executive Committee Patrick L. Osewe, M.D. - Editor Kathleen E. Toomey, M.D., M.P.H. Mary D. Brantley, M.P.H. Jeffrey D. Berschling, M.P.H. Mailing List Edward E. Pledger, M.P.A. Heat-Related Illness The 1996 Centennial Olympic Games and Paralympic Games will take place in the summer. In the 1988 Los Angeles Olympic Games, heat-related illness represented the single largest increase in morbidity recorded by their surveillance system. In Los Angeles, the Olympic venue sites were spread out and located along California's coast line. In Atlanta, it is estimated that over eighty percent of persons attending the Games will be walking within a 3 mile diameter around downtown Atlanta, the Centennial Olympic Ring, representing the most pedestrian concentrated Summer Olympic Games ever. Peak numbers of pedestrians are expected to be in the Ring (Atlanta) from July 22 through July 29. The peak pedestrian movements during the daytime will be from 8:30 am to 10:30 pm. Summer temperatures in Atlanta are usually 90 F and above, with high humidity--the heat index (calculated using both temperature and humidity) is expected to be higher for Atlanta than for any prior Games. On May 18, 1996, people who attended the Georgia Grand Prix, held in the New Olympic Stadium, were exposed to a heat index of at least 112o F. This exposure to a non-capacity crowd in the Stadium resulted in a number of heat-related illnesses among volunteers and spectators. Those who experienced heat-related illnesses that weekend at the stadium were not yet acclimated to the heat and humidity. Since it takes 10 to 14 days for acclimatization, many visitors to the Games this summer also will not be acclimated and will be at higher risk for heat-related illnesses. Heat-related illness can be minimized if simple and effective prevention steps are taken by each individual, and access is provided to these prevention measures. The responsible state, city, county, and the Olympic and Paralympic agencies and Sponsors are collaborating to enhance access to water and shaded and air-conditioned resting areas for our residents and visitors during the Olympic and Paralympic Games. This article describes heat-related illnesses, identifies high risk groups, presents simple and effective heat-related illness prevention measures, and illustrates activities the Division of Public Health has put into place with the Epidemiology Section, Epidemiology & Prevention Branch, Two Peachtree St., N.W., Atlanta, GA 30303-3186 Phone: (404) 657-2588 FAX: (404) 657-2586 collaboration of Fulton, DeKalb and other county public health departments, City of Atlanta, the Centers for Disease Control and Prevention, Atlanta Committee for Olympic Games, Atlanta Paralympic Games and other federal, state, county, city, and not-for-profit organizations. The following heat-related illnesses are expected to occur: Heat Stroke Extreme medical emergency! The body becomes unable to control its temperature: often rising rapidly to 106 F (41.1 C) or higher within 10-15 minutes. Rapid external cooling is essential while waiting for emergency medical services. Heat Edema Minor swelling of hands and feet. Move to cooler environment, raise swollen limbs above level of the heart. Sunburn Can occur quickly; the skin's protective barrier is damaged; the physiological processes are diverted to heal the burn. Hydration and electrolytes are altered in severe cases. Prickly Heat A rash found commonly over areas of the skin covered by clothing. Heat Exhaustion Victim exhibits a lack of energy, loss of appetite, throbbing headache, and a confused, dizzy and weak feeling. Move to cooler environment, restore fluid volume orally if victim can drink voluntarily. If the victim cannot drink on their own or if no relief is seen in 10-15 minutes, call for emergency medical service immediately! Heat exhaustion may lead to heatstroke. Chronic Illnesses Hot and humid weather will physiologically exacerbate some underlying chronic illnesses including cardiovascular, cerebrovascular, and respiratory illnesses, and illnesses of the liver and kidney. Move to a cooler environment and loosen clothing. Prevention Measures Each individual can use well documented and effective prevention measures for personal protection from heat-related illness. The following steps will help beat the heat: q Drink plenty of fluids even if you don't feel thirsty. Drink at least 8 to 10 glasses of cool water daily. In addition to drinking water, sports beverages can add electrolytes that are lost during sweating, but must not be the sole source of fluid intake. Water is essential. Carry a personal water bottle. Limit consumption of alcohol since alcohol contributes to dehydration. Cooling and appropriately hydrating the victim is essential. Physician evaluation may be necessary for appropriate treatment. Medications Use of antihypertensives, antihistamines, diuretics, antidepressants, and other medications may diminish the physiological responses of the body to increasing body temperature. Consideration of medications the victim is taking is essential for appropriate treatment. Heat Syncope (fainting) Usually seen with a recent history of vigorous exercise. Move to cooler environment, lie down face up, rehydrate with oral fluids if able to drink voluntarily. q Don't become overheated. The sun's rays are usually most intense and damaging between 10 AM and 4 PM. Minimize time in direct sunlight during these hours. Slow down, do not exercise or overexert, especially during these hours. Placing a cool, wet cloth around your neck or under your armpits will help dissipate some of the heat. Use a car sunvisor to minimize the direct radiant heat produced by the sun to the inside of a parked car. q Dress for heat. Wear loose-fitting, lightweight, light-colored clothing ("breathable fabrics that will wick moisture away, such as cotton"). Wear a wide-brimmed hat and sunglasses. Protect your legs from a hot outdoor seats by carrying something to sit on. Heat Cramps Brief intermittent cramps and pain usually involving thighs and shoulders. Move to a cooler environment, rest, and replace fluids orally. If not relieved by treatment, consider emergency medical service transport. Heat Tetany Spasms of the wrist or foot caused by rapid body temperature changes. Move to a cooler environment. q ALWAYS apply sunscreen, with a minimum sun protection factor (SPF) of 15. The sunscreen should protect against both UVA and UVB rays. Sunburn may be severe and can occur quickly. Small children are especially vulnerable due to their high body surface/body mass ratio. Keep children out of direct sun as much as possible. q Never leave children or pets in a closed parked car!! Life-threatening overheating can occur within 10-15 minutes. - 2 - Except for heatstroke, most heat-related illnesses, if identified early, will respond to cooling the victim and rehydration with cool water and sports beverages. q Produced a public health brochure to encourage personal protection and safety during the Olympic Games; If the victim's illness is "life-threatening".... Call 911. q Planned to locate public health staff along pedestrian corridors to offer information on heat-related illnesses and injuries. Groups at high risk for heat-related illness include: q infants, children (especially up to four years of age) and pets q people 65 years of age or older q people with underlying chronic illnesses (heart and circulatory disorders, pulmonary disorders, diabetes, other chronic illnesses) q people who are on certain medications q people who cannot remove themselves easily from a hot environment due to physical, physiological, or mental handicaps q people who overexert during work or exercise q people who are overweight (due to insulation effect of body fat). The Georgia Division of Public Health (DPH) is planning heat-prevention interventions during the Olympics for residents and visitors, especially for those at high risk. These interventions will be provided in collaboration with the city and county agencies associated with Olympic and Paralympic venue sites, other state, city and county agencies, CDC and other federal agencies, and not-for-profit organizations (such as the Red Cross, and the Salvation Army), ACOG, and other non-governmental groups. Public Health along with the above collaborators has already taken several steps to aid in the prevention of heat-related illness and has established coordinated treatment protocols and emergency response efforts for people with heat-related illness as follows: q Organized and implemented a surveillance system involving sentinel hospital emergency rooms to monitor trends of heat-related illness and other injuries and infectious diseases that may require investigation and interventions; q Trained and continue training EMS personnel in the on-site treatment of heat-related illness to reduce the need for transporting patients to hospitals; q Improved communication procedures between EMS personnel and hospitals; q Negotiated with state, county, and city officials on the placement of tents in high pedestrian traffic areas. q Will staff eight donated prevention tents positioned along the heaviest pedestrian corridors in the Olympic Ring and support prevention efforts at other designated locations of increased risk, such as park-and-ride lots. q Will stock each tent with heat-related illness prevention brochures, hats, sunscreen, hand fans, and water as well as identify near-by shaded and air-conditioned areas. q Will provide prevention information to support churches which are opening their doors to give out water and provide a cooled environment. q Support prevention efforts to provide water and shade at park-and-ride lots as well as locations where spectators line up outside venues for transportation and entrance to events. An effective emergency medical response system can easily be overwhelmed by victims of heat-related illness. Simple and effective prevention measures can reduce the burden imposed on the emergency medical services and enhance enjoyment of the Games. These efforts must include widespread provision of basic services, early recognition of heat-related illness, and rapid and appropriate treatment on site, unless the illness is life-threatening. Working together we can help prevent heat-related illness, deal with symptoms early, and assist in interventions that will ensure a healthy visit to our state and the 1996 Olympic and Paralympic Games. Information Resources 1. CDC. Heat-Related deaths--Philadelphia and United States, 1993-1994. MMWR 1994:43:453-5. 2. Kilborne EM, Choi K, Jones TS, Thacker SB, and the Field Investigation Team. Risk factors for heatstroke: a case-control study. JAMA 1982;247:3332-6 3. Kilborne EM. Illness due to thermal extremes. In: Maxcy KF, Rsenau MJ, Last JM, eds. Maxcy-Rosenau-Last public health and preventive medicine. 13th ed. East Norwalk, Connecticut: Appleton and Lange, 1992:491-6. This report was contributed by Sherrilyn Wainwright, EPB, GA Division of Public Health. - 3 - The Georgia Epidemiology Report Epidemiology and Prevention Branch Two Peachtree St., NW Atlanta, GA 30303-3186 June 1996 Volume 12 Number 6 Reported Cases of Selected Notifiable Diseases in Georgia Profile for March 1996 Selected Notifiable Diseases Campylobacteriosis Giardiasis H. influenzae B Meningococcal Disease Rubella Salmonellosis Shigellosis Viral Meningitis Tuberculosis Congenital Syphilis Early Syphilis Other Syphilis Cryptosporidiosis E. coli O157:H7 Legionnaires' Disease Lyme Disease Mumps Pertussis Total Reported for March 1996 69 71 19 25 0 63 34 5 71 3 190 81 6 1 0 0 0 2 Previous 3 Months Total Ending inMarch 1996 1995 1994 157 190 142 160 119 101 56 22 28 62 42 26 0 0 0 253 214 224 121 407 212 13 11 11 202 144 141 16 9 11 554 691 759 213 250 233 13 5 2 3 2 1 0 10 43 0 5 32 1 3 7 5 6 10 Previous 12 Months Total Ending in March 1996 1995 1994 1015 1121 698 613 479 384 105 61 76 143 98 83 0 7 0 1698 1567 1283 1070 2077 594 102 80 150 804 743 797 64 52 87 2416 2616 3525 1086 866 939 118 23 10 30 27 16 9 83 67 9 100 75 9 14 17 29 33 56 The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office; and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia. Report Period Total Cases Reported * Percent Female AIDS Profile Update MSM Risk Group Distribution (%) IDU MSM&IDU HS Blood Unknown Race Distribution (%) White Black Other Last 12 Mos 06/95 to 05/96 5 Yrs Ago 06/90 to 05/91 Cumulative 01/80 to 05/96 2400 1309 15630 17.5 10.2 13.7 46.8 17.8 4.3 62.8 17.2 5.8 53.1 19.0 6.0 15.2 1.2 14.7 7.8 2.3 4.0 10.2 2.1 9.6 36.2 49.1 41.8 60.6 3.2 49.7 1.2 56.2 2.0 MSM - Men having sex with men IDU - Injection drug users * Case totals are accumulated by date of report to the Epidemiology Section HS - Heterosexual -4-