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February 17, 2017

NJLINCS Health Alert Network

Public Health Advisory

Distributed by the New Jersey Department of Health

Subject: Leptospirosis Cluster in the Concourse area of the Bronx

Date: 2/15/2017; 14:48:22

Message#: 103336-2-15-2017-PHAD

Contact Info: Kristin Garafalo, NJDOH - Infectious and Zoonotic Disease Program
Phone: 609-826-4872; Email:
Colin Campbell, NJDOH - Infectious and Zoonotic Disease Program
Phone: 609-826-4872; Email:

Attachments: Leptospirosis_in_the_Bronx_HAN_2_14_2017.pdf

On February 14, 2017, the New York City Department of Health and Mental Hygiene released a Health Alert (attached) regarding three recently reported Leptospirosis cases whose exposure occurred within a one block section of the Concourse area of the Bronx. Human leptospirosis cases are very rare in New York City: this is the first time a cluster of cases has been identified.

Leptospirosis is a zoonotic disease caused by bacteria belonging to the genus Leptospirosa. It is transmitted to humans through cuts and abrasions of the skin, or through mucous membranes contact with water or soil contaminated with the urine of infected animals. The New York City cluster is attributed to exposure to rats. Direct person-to-person transmission is rare but possible.

Symptoms of Leptospirosis can develop from 2 days to 4 weeks after exposure. The usual presentation is an acute febrile illness with fever, headache, myalgia, vomiting and jaundice. Left untreated, it can cause kidney damage, meningitis, liver failure, respiratory distress. Case fatality rate is 1 to 5%.

Diagnostic testing should be requested for patients where there is high suspicion for leptospirosis, based either on signs and symptoms, or on occupational, recreational, or vocational exposure to animals or environments contaminated with animal urine.

Although New Jersey does not mandate reporting of Leptospirosis at this time, voluntary reporting of suspected and confirmed cases is requested. These cases should be reported to the local health department where the patient resides. Information gathered from voluntary reporting of Leptospirosis cases within New Jersey will be used for surveillance and epidemiological purposes and to assist health care providers until leptospirosis is classified as a reportable disease through rule-making.

If you would like a copy of the above referenced attachment, please contact Aaron Allen at

January 31, 2017

NJLINCS Health Alert Network

Public Health Alert

Distributed by the New Jersey Department of Health

Subject: Confirmed Measles Case in Passaic County

Date: 1/31/2017; 13:05:39

Message#: 103323-1-31-2017-PHAL

Contact Info: Elizabeth F. Zaremski, NJDOH VPDP
Phone: 609-826-5964; Email:
Noelle Bessette, NJDOH VPDP
Phone: 609-826-5964; Email:

Attachments: None

The New Jersey Department of Health (NJDOH) is working with the City of Paterson, Division of Health to investigate a second laboratory-confirmed case of measles in New Jersey. This individual is a 7 month-old unvaccinated infant from Passaic County who developed a rash illness on January 21st and had recent international travel. This case is unrelated to the recently reported case of measles in a Hudson County adult male who was also exposed while traveling internationally.

The NJDOH is working with the local health department to identify and notify people who might have been exposed to this child during the time the child was infectious. To date, no associated cases have been identified. Persons exposed could develop symptoms as late as February 15th, 2017. For exposure details, please see the NJDOH press release issued yesterday ( or the NJDOH Measles Website (

Individuals who might have been exposed are urged to contact their healthcare providers to discuss their exposure and risk of developing illness. Anyone who develops symptoms consistent with measles is urged to call their healthcare provider BEFORE going to the medical office or emergency room so that special arrangements can be made to minimize exposure in the healthcare setting.

All healthcare personnel should have documented evidence of measles immunity on file at their work location. Having high levels of measles immunity among healthcare personnel and such documentation on file minimizes the work needed in response to measles exposures, which cannot be anticipated. Healthcare facilities should review their current policies regarding acceptable proof of immunization for healthcare personnel. Please view the MMWR for the ACIP/CDC current recommendations:

For more information and for Measles Exposure Guidance pertaining to clinical staff and the general public, please visit

The NJDOH continues to urge providers to remain vigilant for cases of measles (consider measles in persons who present with fever and rash) and would like to remind all healthcare and public health professionals about the importance of receiving up-to-date immunizations, especially prior to international travel.

Measles Overview
Measles is a highly contagious disease that is transmitted by respiratory droplets and airborne spread. The disease can result in severe complications, including pneumonia and encephalitis. The incubation period for measles ranges from 7 to 21 days. Individuals are infectious 4 days before and after rash onset. The diagnosis of measles should be considered in any person with a generalized maculopapular rash, fever, and cough, coryza, or conjunctivitis. Immunocompromised patients and patients who are not fully immune may have an atypical presentation.

Healthcare providers should maintain vigilance for measles importations and have a high index of suspicion for measles in persons with a clinically compatible illness who have traveled abroad or who have been in contact with travelers. Measles is endemic in many countries, including popular travel destinations. Providers should assure that persons who are traveling outside the U.S. have appropriate documented immunity to measles.

Before any international travel:
- Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days)
- Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days
- Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days

Suspected measles cases should be reported immediately to the local health department, and serologic and virologic specimens (throat/nasopharyngeal swabs and urine) should be obtained for measles virus detection and genotyping. A viral specimen is preferable to serology in vaccinated individuals. Laboratory testing should be conducted in the most expeditious manner possible. More information regarding measles testing is available at

Preventing Transmission in Health Care Settings
To prevent transmission of measles in health care settings, airborne infection control precautions (available at should be followed stringently. Suspected measles patients (i.e., persons with febrile rash illness) should be removed from emergency department and clinic waiting areas as soon as they are identified, placed in a private room with the door closed, and asked to wear a surgical mask, if tolerated. In hospital settings, patients with suspected measles should be placed immediately in an airborne infection (negative-pressure) isolation room if one is available and, if possible, should not be sent to other parts of the hospital for examination or testing purposes.

All healthcare personnel should have documented evidence of measles immunity on file at their work location. Having high levels of measles immunity among healthcare personnel and such documentation on file minimizes the work needed in response to measles exposures, which cannot be anticipated.

As an added precaution, hospital Emergency Departments are encouraged to provide signage which directs staff and/or patients to identify anyone presenting with fever and rash.

In Summary
1) When obtaining the medical history of a patient with a febrile rash illness consistent with measles, please inquire as to whether the person traveled to an area visited by this confirmed case of measles.
2) Report all suspect measles cases (febrile illness accompanied by generalized maculopapular rash) immediately (DO NOT WAIT FOR LABORATORY CONFIRMATION) to the local health department. If unable to reach the local health department, notify the NJDOH during regular business hours at (609) 826-5964. After business hours, or on the weekend, call NJDOH at (609) 392-2020.
3) Place all patients with suspected measles in airborne isolation immediately.
4) Obtain clinical specimens for diagnostic testing from blood (for both IgM and IgG to measles), urine, nasopharyngeal aspirates/throat swabs.
5) Determine the immune status of contacts. Offer measles vaccine or immune globulin to susceptible exposed contacts as appropriate. Quarantine contacts who cannot produce documentation of immunity from day 5 through day 21 following exposure.
6) Assure that all those eligible for MMR vaccine receive appropriate and timely vaccination.

Additional information is available:

NJDOH website at:

Centers for Disease Control and Prevention website at:

January 20, 2016

From: Donald Allegra MD, ID Consultant

Re: Zika Virus

CDC on Friday 1/15 took the unusual step of issuing a new travel alert at 7PM at night because of concern that the situation was so serious, it could not wait until Monday 1/18.

Zika is a mosquito-borne viral infection related to Dengue. It is spread by Aedes mosquitoes which also can spread Dengue and Chikungunya viruses. It was first described in humans in 1968 and typically occurs in Africa and Southeast Asia. The current outbreak in the Americas was first identified in May 2015 (only 8 months ago). It now involves 14 countries or territories including Brazil, Columbia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico.

Infection with Zika virus is usually mild and only 1 in 5 even develop symptoms and hospitalization and fatalities are rare. The most common symptoms are nonspecific and include fever, rash, joint pain, pinkeye, headache, muscle pain, and vomiting and last several days to a week. Incubation period is 3-12 days.

CDC is now advising pregnant women in any trimester to consider postponing travel to the 14 endemic areas because of a growing link between microcephaly (a congenital condition associated with incomplete brain development) and Zika virus infection. Microcephaly can be associated with seizures, developmental delays, intellectual and motor disabilities, and hearing loss. It is a rare congenital disease but in Brazil alone, 3500 cases of microcephaly have occurred from October 2015 to January 2016. This is far above the expected number and Zika virus has been identified in some of the fetal tissues of affected babies. There is no specific treatment for Zika infection and no commercially available test. Testing is only available through the NJ State Lab and CDC.

In summary, the following recommendations have been made:

  1. All pregnant women should be advised to postpone travel to the 14 areas where Zika virus has been identified.
  2. If a pregnant woman travels to an area with Zika virus, she should be advised to strictly follow steps to avoid mosquito bites.
  3. If a pregnant woman returns from a Zika-infected area and develops 2 or more symptoms (fever, rash, joint pain, or pinkeye) within 2 weeks of travel or has ultrasound evidence of microcephaly or intracranial calcification, she should be tested for Zika virus.

From: Donald T. Allegra, MD, ID Consultant

Re: Lassa Fever

May 29, 2015

On May 25th, the New Jersey Department of Health reported a death from Lassa Fever in a traveler who had come to the US from Liberia. He was asymptomatic when screened at JFK Airport on May 18th and then the next day had sore throat, fever, and fatigue. He presented to an emergency department in New Jersey and was apparently asked about travel and denied it, but then returned to the hospital 3 days later, much sicker, and eventually died. The New Jersey case is the 6th case of Lassa reported in the US in returning travelers since 1969.

Lassa Fever is in the viral family of hemorrhagic fevers like Ebola, but much less serious. It was first discovered in 1969 and the name comes from the town in Nigeria where the first cases occurred. It has a mortality rate of only about 1% compared to as high as 70% with Ebola. It is most common in West Africa in Liberia, Sierra Leone, Guinea, and Nigeria, but other countries in the area also have reported cases. There are estimated to be 100,000 to 300,000 cases a year in West Africa with about 5000 deaths.

The virus is transmitted by the multimammate rat, which is very common in both rural and urban areas of West Africa. It often inhabits homes and scavenges for human food left unprotected. The virus is transmitted by direct contact with urine or droppings of these infected rodents or by aerosols of tiny particles contaminated with infected rodent droppings. The incubation period is 1-3 weeks and 80% of patients present with mild non-specific symptoms such as fever, malaise, weakness, and headache. Symptoms are varied and non-specific which makes a clinical diagnosis difficult. 20% of patients can develop more serious illness including bleeding, respiratory distress, nausea/vomiting, and encephalitis or inflammation of the brain. Death usually comes from multi-organ system failure. The most common complication is deafness which can occur even in mild cases and is often permanent. The anti-viral drug, Ribavirin, has been used successfully in treatment and is most efficacious when used early in the illness. There is no vaccine available at this time.

Person to person transmission has never been documented in the US and does not occur with casual contact. It is felt that direct contact with blood or body fluids through skin cuts, mucous membranes, or sexual contact is necessary to spread the virus.

There is no expectation that Lassa will present a risk to the US population or result in secondary cases such as happened with Ebola. However, the lessons to take away from this recent incident is that we live in a very interconnected world where citizens of any country are within a 24 hour reach of our 3 major airports. Liberia has been declared free of Ebola but Sierra Leone and Guinea still are having cases and we have to maintain our vigilance for Ebola and other infectious diseases.

From: Donald T. Allegra, MD, ID Consultant

Re: Chikungunya (CHIKV) Virus Alert

September 12, 2014

With all the headline news about the deadly Ebola virus in West Africa, there has been very little press about a virus called Chikungunya (CHIKV) which is currently causing epidemics in many Caribbean countries. The virus first appeared in the French area of St. Martin in December 2013. Since then, there have been over 500,000 suspected or confirmed cases including 221 cases in Puerto Rico and the US Virgin Islands and even locally transmitted cases in Florida. 95% of the cases have been reported from the Dominican Republic, Haiti, Martinique, Guadeloupe and St. Martin but the outbreak has yet to peak in the Dominican Republic, Haiti, El Salvador, Venezuela, and Puerto Rico. The virus is spread by the mosquitoes Aedes aegypti and Aedes albopictus (the Asian tiger mosquito), which are also present in the USA and bite during daytime hours in urban areas. The reporting of CHIKV is encouraged but not mandatory and despite this, the number of cases in the US confirmed and reported to the CDC has gone from 138 cases as of 7/14/2014 to 635 cases as of 8/25/14.

Chikungunya is derived from an African word "kungunyala" which translates literally as "that which bends up", an indication of the severe joint pains which characterize this disease. Symptom appear after a period of 3-7 days (range 1-12), there is a sudden onset of high fever to >102 F with muscle aches and multiple joint involvement but most common in the hands and feet. It is sometimes associated with headache, rash, nausea, and vomiting. Initial symptoms last 7-10 days but joint pains can persist for months with relapses possible and some patients can have joint pains for years. There is no specific vaccine or treatment but the disease is rarely fatal.

As we enter into the high season for Caribbean tourism, some things to remember:

  1. High fever and joint aches in returning travelers from the Caribbean should trigger concern for both CHIKV and Dengue since both diseases are carried by the same mosquitoes and have similar symptoms.
  2. Those at highest risk for disease complications are the elderly, those with underlying medical conditions, and women in the late stages of pregnancy. These groups should be cautioned about travel to high risk areas and all travelers should be advised to use insect repellent in these areas.
  3. Testing for CHIKV can be done through commercial labs or at CDC.
  4. Treatment is supportive and symptomatic but would avoid aspirin and ibuprofen until Dengue is ruled out, since these drugs can increase the risk of bleeding in patients with Dengue.

Although Ebola is certainly a much deadlier disease, we are far more likely for Americans to develop CHIKV in the coming months, and US travelers should be aware of the high risk of CHIKV in vacationing in the Caribbean Basin.

From: Donald T. Allegra, MD, ID Consultant

Re: Severe Respiratory Disease Associated With Enterovirus D68

September 12, 2014

You are probably all aware from news reports that a respiratory illness originating in the Midwest is now spreading rapidly and causing many hospital admissions in children and teenagers. This started on August 19, 2014 when CDC was notified of an increase in respiratory illness in Children's Mercy Hospital in Kansas City, Missouri. On August 23, 2014, the University of Chicago Children's Hospital also notified CDC of a similar problem in their institution. An investigation was begun and a relatively rarely isolated organism, Enterovirus EV-D68 was identified. Subsequently, this virus has now spread to more than 12 states from Utah to Delaware.

Enteroviral infections are associated with many illnesses from meningitis to rash. EV-D68 appears to cause primarily a respiratory disease. The patients admitted to hospitals have been from 6 weeks to 16 years old with a median age of 4-5 years. About 10% of patients presenting to Midwest hospitals have been admitted, so for many patients this disease appears to be just a "summer cold" with little consequences. However, the 10% who have been admitted often have a history of asthma (70%), all had difficulty breathing, and several patients required a ventilator. There have been no deaths so far. There is no available vaccine nor is there any specific treatment for this disease. It appears to spread through airborne droplets and contact with environmental objects contaminated with the virus.

Given the wide geographic spread of the virus in the last month, we have to assume that cases will appear in New Jersey very soon or are already here and not detected. All parents should consider EV-D68 as a possible cause of acute unexplained severe respiratory illness in children. If their children start with cold symptoms and then develop wheezing or trouble breathing, they should bring their children to the closest emergency room as soon as possible.

October 15, 2012- Centers for Disease Control and Prevention (CDC) with state and local health departments and the Food and Drug Administration (FDA) are investigating a multistate meningitis outbreak of fungal infections among patients who have received a steroid injection of a potentially contaminated product into the spinal area. Several patients suffered strokes that are believed to have resulted from their infection. The investigation also includes fungal infections associated with injections in a peripheral joint space, such as a knee, shoulder or ankle. CDC and public health officials are referring any patients who have symptoms that suggest possible meningitis or a possible peripheral joint infection to their physicians who can evaluate them further. Those patients injected in peripheral joints only are not believed to be at risk for fungal meningitis but could be at risk for joint infection. This form of meningitis is not contagious. To view current counts of deaths and illnesses by state, please click here.

For additional information on this outbreak, click here.


October 14, 2012- Consumers should not eat any products associated with Sunland and should discard them immediately, FDA officials warned. That is especially important for children, the elderly and those with compromised immune systems, who are most vulnerable to dangerous salmonella infections.

The number of products associated with the company's recall over Salmonella has continued to expand over recent weeks, climbing to more than 240. The number of products associated with the company's recall has continued to expand over recent weeks, climbing to more than 240. A full list of recalled products can be found here.


September 28, 2012– Dale and Thomas Popcorn is voluntarily recalling a limited number of ready-to-eat bags of select flavors of Popcorn, Indiana-brand popcorn products because of possible contamination by Listeria monocytogenes.

Products involved in the recall should not be consumed and may be returned to the point of purchase for a full refund or replacement.

The recalled products were distributed to various retailers, vendors, distribution centers, and consumers through the Internet on or after August 8th, 2012 with Best By dates of February 4th, 2013 through March 12th, 2013. All recalled products were packaged in red bags of various sizes. Consumers can identify if they have purchased an impacted product by looking at the Best By date located in the front, top right corner of the package and the Bag UPC (Code) located in the nutritional panel found on the back, bottom left corner of the package.

All other Popcorn, Indiana-brand products are safe to consume.

The potential for contamination was noted after testing by the company revealed the presence of Listeria monocytogenes in some ready-to-eat bags of Popcorn, Indiana-brand products.

Consumers with recalled product(s) should contact Dale and Thomas’ dedicated recall hotline (866) 940-7936 Monday through Friday 9:00 a.m. to 4:30 p.m. Eastern Time, or email the company at: for additional information.


August 24, 2012- The maker of Trader Joe’s peanut butter tied to a multi-state salmonella outbreak has pulled dozens of additional peanut and almond products because of possible contamination.

Sunland Inc. of Portales, N.M., has voluntarily recalled 76 different products, including three brands of Trader Joe’s peanut butter, according to a press release issued Monday.

U.S. health officials on Saturday warned consumers not to eat Trader Joe’s Valencia Creamy Salted Peanut Butter after the product was linked to 29 infections in 18 states linked to the rare salmonella Bredeney.

The other two Trader Joe’s brands that have been recalled include Trader Joe’s Valencia Peanut Butter with Roasted Flaxseeds, Crunchy and Salted and Trader Joe’s Almond Butter with Roasted Flaxseeds, Crunchy and Salted.

In addition, Sunland is recalling peanut and almond products sold under popular brands including Archer’s, Earth Balance, Fresh & Easy Heinen’s, Natural Value, Naturally More, Open Nature, Serious Food, Silly Prices and Sprouts, among others. The recall applied to products with best-by dates between May 1, 2013 and Sept. 24, 2013.


September 10, 2012- Forever Cheese inc. is recalling all Ricotta Salata Frescolina brand, Forever Cheese lot # T9425 and/or production code 441202, from one specific production date due to possible Listeria Monocytogenes contamination, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

The cheese was sold to distributors for retailers and restaurants in CA, CO, D.C., FL, GA, IL, IN, MA, MD, ME, MT, NJ, NM, NY, OH, OR, PA, VA, WA between June 20 and August 9, 2012. Products were sold to supermarkets, restaurants and wholesale distributors.

The cheese in question is Ricotta Salata brand Frescolina from one production date coded 441202 on the original wheel. There have been 14 reported illnesses in 11 states which may be related to this.


August 26, 2012 - Fresh Express Incorporated is voluntarily recalling a limited quantity of expired 10 oz. Hearts of Romaine salad with the expired Use-by Date of August 23, 2012 and a Product Code beginning with "G222" as a precaution due to a possible health risk from Listeria monocytogenes.

No illnesses are reported in association with the recall. No other Fresh Express products are being recalled.

In an unlikely event that consumers may still have this expired product in their refrigerators, it should not be consumed, but discarded instead. Consumers with questions may call the Fresh Express Consumer Response Center at (800) 242-5472 during the hours of 8 a.m. to 7 p.m. Eastern Daylight Time.

Fresh Express Hearts of Romaine 10 oz Bag 7127926102 AL, AR, FL, GA, IL, IN, KY, LA, MD, MO, MS, NC, OH, PA, SC, TN, TX, VA, WV


August 22, 2012 – Spence & Co Ltd, Brockton MA, a smoked salmon company is recalling Wellsley Farms brand 16oz Nova Lot: 6704701 and Spence & Co brand 8oz Smoked Trim Lot: 6704701 due to an abundance of caution because of possible contamination by Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant woman.

The recalled product is identified and distributed as follows:

BJ’S Wholesale Club, Wellsley Farms brand 16oz Nova in Florida, N. Carolina, Georgia,
Delaware, Pennsylvania, Maryland, New Jersey, New York & Ohio on 6.13.12.

Spence & Co Ltd brand 8oz Smoked Salmon Trim distributed to Krogers and King Soopers in Ohio, Kentucky, Indiana, Colorado, Wyoming & Utah between 6.22.12 and 6.29.12.

No illnesses have been reported. The bacterium was discovered during routine sampling.

Consumers who have purchased either product should get in touch with the place of purchase for a full refund or contact the consumer number:508-427-5577, Monday thru Friday between 9am and 5pm EST.

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