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BROOKVILLE Illnesses caused by ticks are being diagnosed across Indiana, including here, attendees of the July 11 Franklin County Health Department quarterly meeting learned.
A 45-year-old female in the Metamora-Peppertown area came down with Rocky Mountain spotted fever after finding a tick on her neck while driving, reported FCHD nurse Mary Ellen Buckler, R.N. She went to the Margaret Mary Health emergency room with neurological symptoms.
The patient "is really scared," according to the nurse. After severe neck pain, "she's getting better slowly ... She may have residual" health effects.
Health officer Dr. Michael Fain, Oxford, Ohio, who practices in Brookville, said, "I treated a presumptive (case of a tick-related illness) the other day." He found a tick in the ear of a child who had a fever and enlarged lymph nodes and treated the infection with antibiotics.
Another patient of Fain's "pulled hundreds" of ticks off his clothing and skin after turkey hunting in Tennessee. "We're working him up," suspecting Lyme disease.
Ironically, the Indiana State Department of Health reported the same day as this meeting, "The Centers for Disease Control and Prevention has confirmed two cases of Heartland virus infection in Indiana over the last two years. Both patients were residents of southern Indiana and survived their infections."
Tick bites can cause serious illness and even death, and the discovery of Heartland virus gives Hoosiers another important reason to take precautions, said state Health Commissioner Jerome Adams, M.D., M.P.H. If you become ill after spending time outdoors, visit your health care provider immediately especially if you found an attached tick. Prompt diagnosis of tick-borne illness helps prevent complications.
The news release continues, "Other tick-borne diseases found in Indiana include Lyme disease, ehrlichiosis and Rocky Mountain spotted fever. In 2016, Indiana reported more than 200 cases of tick-borne illness. (Please see box on how to avoid illnesses.)
Staff and board members discussed a problem they had never confronted before.
Sanitarian David Fehlinger met with customers of Hospitality House Bed-and-Breakfast, which faces the Whitewater Canal near the fire department in Metamora.
Customers showed him photos of "bedbugs, feces in sheets, we don't know what kind animal fur on furniture, mouse droppings ... It's pretty nasty. I wouldn't want to stay there."
Fehlinger said, "These people (B&B customers) are really angry." After viewing the room, they stayed elsewhere.
He sent a letter to the owner June 13 ordering the rooms be made habitable. After no response, on June 29 Fehlinger and Fain posted closure letters on Hospitality House rooms. Nevertheless, "they're still renting" rooms, according to the sanitarian.
Fain summarized, "They're ignoring the orders of the health department. We can't tolerate that." ISDH officials told Fain "we are allowed to shut things down, but we don't have arrest authority ... Let's find out about enforcement. If we take action and it's ignored, we have to go through the judicial system to get it done."
"The whole town of Metamora is complaining," concerned the town will get a bad reputation, Fehlinger noted.
Attorney Gene Stewart, who advises the department on legal issues, arrived and weighed in. "The health officer has the authority to shut down obvious violations, but that doesn't mean the individual you're shutting down is going to comply." The court can issue an injunction, and enforce sanctions if the person doesn't follow the order. Typically disobeying orders results in fines. A judge also could hold a violator in contempt.
He concluded, "If they keep operating, you're going to have to go to the court."
Fehlinger reported that health departments in larger counties with more staff have more rules about restaurants and bed-and-breakfasts that fail to meet ISDH standards and he wondered if Franklin County could create similar expectations.
Stewart and Fain told the sanitarian to check out Brown County or Madison rules for bed-and-breakfasts.
Supervisor Angie Ruther, R.N. reported," We have an issue with ... bedbugs. How do the board and Dr. Fain feel about Mary Ellen and myself making repeated scheduled visits to homes that have bedbugs? We don't want to do it."
When Buckler took one patient's blood pressure, "there are two bedbugs crawling on her." Ruther visits a man living with bedbugs every other week. She said, "I don't want to abandon them because they will not take their medicines correctly if we don't see them."
The health officer asked if patients had bedbug bites. Both did.
Fain said ISDH and CDC officials do not consider the bugs a vector for infectious disease. But he was concerned the nurses could carry bedbugs to other patients, the health department and their homes.
He advised, "If you feel unsafe for any reason, you're not obligated to sacrifice yourselves."
Board member Jennifer Profitt, Brookville, asked, "Is there anything we can do to help them eradicate" the bugs? The supervisor pointed out "It's an expense," one that many residents can't afford.
Fain suggested calling Adult Protective Services, which might find a funding source to treat houses and also arrange for respite care at long-term care facilities while houses are treated.
The health officer urged the nurses to wear hazmat suits or permethrin-treated clothing when visiting homes with bedbug problems.
Buckler had a simpler solution: Families will be asked bring medications and pill boxes to FCHD to be refilled, and Ruther agreed.
After Indiana Senate Bill 392, which allows a school or school corporation to fill a prescription for an emergency medication, was enacted, Franklin County High School asked the health officer to write the school a prescription for an EpiPen (epinephrine injection) for the emergency treatment of anaphylaxis, a life-threatening allergic reaction; albuterol, which eases breathing in people with asthma and other conditions; and naloxone for the emergency treatment of a known or suspected opioid overdose. St. Michael School also requested an EpiPen prescription. Fain said, "I'm going to go ahead and do this."
As the county health officer, he and attending physicians signed court forms committing two patients (one with schizophrenia, the other with dementia) to a psych unit in mid-July. Adult Protective Services employees will get evaluations and try to find family members to be guardians. Otherwise, a judge will appoint guardians.
Recovery Works has opened at 2060 State Road 1 N., Cambridge City, said Buckler. It offers detoxification, inpatient and outpatient services and can be reached at 765-478-5395.
Linda Vaughan asked that her contract as local public health coordinator not be renewed after the June 30 expiration date. She will remain as grant administrator through Dec. 31, when that contract expires, said Ruther. "We have hired someone new" for the public health coordinator position. Faye Hay, Cedar Grove, started July 1. "She's going to be wonderful. She was in the Army and helped with strategic planning," according to Ruther. ISDH employees will train Hay.
Two more board members are needed. FCHD officials are looking for county residents with law enforcement or agriculture backgrounds. Interested persons may contact Ruther at 765-647-4322.
Debbie Blank can be contacted at firstname.lastname@example.org or 812-934-4343, Ext. 113.
How to reduce the risk of tick bites
Avoid direct contact with ticks by staying away from wooded and brushy areas and walking in the center of trails.
Use EPA-registered insect repellents with active ingredients such as DEET, picaridin, IR3535 or oil of lemon eucalyptus.
Apply products containing 0.5 percent permethrin to clothing and gear, such as boots, pants, socks and tents.
After outdoor activities, people should conduct full-body tick checks using a hand-held or full-length mirror. Children should be assisted when performing tick checks. Showering or bathing can help remove any unattached ticks. Pets, coats and day packs should also be checked for unattached ticks. Tumbling dry clothes in a dryer on high heat for 20 minutes will kill unattached ticks on clothing.
Attached ticks may be safely removed by using tweezers to grasp the tick close to the skin and then pulling outward with steady and even pressure. After the tick is removed, the area should be washed thoroughly. The tick should be discarded by submerging in alcohol; placing in a sealed bag or container, wrapping it tightly in tape; or flushing down the toilet. Ticks should never be crushed with fingernails.
Indiana State Department of Health
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