VOLUME 5
Feeling a Little Crabby?
Could your Valentine’s Day date be taking you out for more than seafood? …3 Flesh Eating Fish How a fish based pedicure could leave you with permanent scars …4
ISSUE 1 Feburary 2013
Meals on the Go
Tips for making sure your mail order meals are safe for you and your family…5
Bug bytes
A publication of Navy Environmental and Preventive Medicine Unit TWO
W
elcome to the latest edition of Bug Bytes.
As spring approaches, we look forward to the season of love and warmer weather. However, with a new year also comes new risks, new disease headlines, and new challenges in public health.
Helping You Promote Public Health This latest installment addresses important topics to keep you updated on the latest public health trends. W hether you have started a new diet, plan on getting a pedicure, or need general public health information, we hope that the articles within help you with your mission. As always, NEPMU-2 is ready to provide subject matter experts for your force health protection, anytime and anywhere. A.F. Vaughn CAPT, MC, USN OIC NEPMU-2
Can You Hear Me Now??? LTJG Victor Camaya installs a noise surveillance meter while TAD to Djibouti, Africa. LTJG Camaya, as well as other members of NMCPHC and NEPMU-2 , completed a OEHSA of the camp in November.
Product Recalls: What Consumers Should Know LCDR Elena Mathis, IHO Before you buy a used vehicle or other secondhand product, check to be sure it hasn't been recalled for safety reasons. Some recalls ban the sale of an item, while others ask consumers to return the item for replacement or repair. Sometimes, a seller provides a part that reduces the danger of using the product. If you're buying a product for a child, be especially vigilant. Each year, there are about 400 recalls of children's products such as toys, clothing, and jewelry. These references will help you obtain information on the latest safety recalls. You can also sign up for free email notifications.
References For Recalls Recalls.gov lists government-initiated recalls that are gathered from federal agencies. The National Highway Traffic Safety Administration lists recalls and safety information on vehicles and equipment. The Food Safety and Inspection Service lists recalls that involve meat, poultry, or processed egg products. The Food and Drug Administration lists recalls that involve food, medicines, medical devices, cosmetics, biologics, and pet food. Report incidents and safety concerns with consumer products at Saferproducts.gov
Did you know? Humans have the ability to distinguish 4,000 to 10, 000 smells. The strongest muscles of the human body are masseters, which are present on either side of the mouth. There are 2.5 trillion (give or take) red blood cells in your body at any moment. To maintain this number, about two and a half million new ones need to be produced every second by your bone marrow. That's like a new population of the city of Toronto every second. The surface area of a human lung is equal to that of a tennis court. Beards are the fastest growing hairs on the human body. If the average man never trimmed his beard, it would grow to nearly 30 feet long in his lifetime. Every time you lick a stamp, you're consuming 1/10 of a calorie. Every 2 weeks, the human stomach produces a new layer of mucous lining, otherwise the stomach will digest itself.
Doctor’s Orders: No Love For This Valentine... Linda Dunn Smith, DO, MPH, MPH&TM Q: There are rumors in the field that there is a strain of drug resistant gonorrhea. Is this true? If so, how do I treat it? Neisseria gonorrhea, also known as gonococcus (GC), is the second most commonly reported medical event in all military services for the past 15 years. It is second to Chlamydia trachomatis and is commonly transmitted as a co-infection with GC. Males usually present with a purulent discharge from their urethra and dysuria (painful urination) within 2-7 days after transmission. Females are often asymptomatic, have mucopurulent cervicitis, and some will have vaginal discharge or bleeding after intercourse. Females are at greatest risk for long-term and serious complications. Approximately 20% will have uterine invasion, putting them at risk for pelvic inflammatory disease (PID), infertility and ectopic pregnancies. GC can also infect the rectum, oral mucosa and the eyes. Diagnosis: Nucleic Acid Amplification Test (NAAT) is one of the most sensitive tests to diagnose GC and requires a urine sample; however, it does not provide information on antibiotic sensitivity or resistance. If initial treatment for GC is not effective, the Centers for Disease Control and Prevention (CDC) guidelines recommend performing culture and antibiotic susceptibility testing. Treatment: Due to antibiotic resistance in GC the treatment recommendations of GC have been changed. In August 2012, the CDC provided an update to their 2010 Sexually Transmitted Diseases Treatment Guidelines. The recommended treatment for uncomplicated GC is ceftriaxone 250 mg intramuscularly plus either a single dose of azithromycin 1 g orally or doxycy-cline 100 mg orally twice daily for 7 days. For diagnosis and treatment regimens refer to the CDC’s updated treatment guideline at http://www.cdc.gov/std/gonorrhea/arg/default.htm. GC is a required reportable disease. See BUMED INSTRUCTION 6220.12C, Medical Surveillance and Medical Event for reporting requirements and BUMED INSTRUCTION 6222.10C for the Prevention and Management of Sexually Transmitted Diseases.
I am Safe From the Flu: Could another illness be lingering in the background?
LT Robert Hontz
The winter months of November through March are the perfect time for bacteria and viruses to thrive. Maker of the runny nose, congested head, and persistent cough, flu viruses are having a field day right now- making more people sick than at any time in recent memory.
Click here for full class schedule Food Safety Managers (B-322-2101):
25-26 Feb, 25-26 Mar, 29-30 Apr Lab Identification of Malaria (B-322-2210):
27 Mar, 22 May 2013 Shipboard Pest Management (B-322-1075):
5-6 Mar, 14-15 May 2013 Shipboard Sanitation Certificate (B-322-1100):
19 Feb, 14 May 2013 For further info contact Jeff Bolden: NEPMU2NorfolkEducationandTraining@med.navy.mil
Newsletter Editors LT Sarah Goodman
However, bacterial infections also thrive during this cooler time of year. In particular, Group A Streptococcus infections (more commonly referred to as ‘strep throat’) tend to peak in the winter months. Often contracted through touching liquid droplets from an infected person, strep infections can also arise through sharing dining instruments or touching the sores of someone infected. The Centers for Disease Control and Prevention (CDC) lists ten signs and symptoms of common strep infections. They include: quick onset sore throat, pain when swallowing, fever, swollen tonsils with white pustules, red spots on the roof of the mouth, headache, nausea, swollen lymph nodes, general body aches, and rash. Your physician will swab the back of your throat to collect bacteria in order to make any accurate diagnosis. In the case of a bacterial infection like strep throat, antibiotics will clear it up and prevent its spread to others. But always remember, especially during this time of the season, to always maintain good hygienic practices. Wash your hands regularly, avoid others who you know are sick or appear to be sick, and remind yourself and others to cover their mouths with an elbow or cloth/towel when coughing or sneezing. Let’s all do our best to stay healthy this season, not only from a cornucopia of viruses, but also from those pesky bacteria!
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
2
Fitness Tips For The New Year
HM1 Ferrell Jenkins
It takes approximately 10 weeks to create a new habit. If your New Years resolution was to get fit, here are a few tips to keep you focused on your goals: Consider your fitness goals- Are you starting a fitness program to help lose weight? Or do you have another motivation, such as preparing for a marathon? Having clear goals can help you gauge your progress. Create a balanced routine- Most people should aim for at least 150 minutes of moderate-intensity aerobic activity — or 75 minutes of vigorous aerobic activity a week. You also need two or more days of strength training (weight lifting) a week incorporated in your plan. Within just 2-6 weeks of exercising, your body will complete significant anatomical changes that include wider blood vessels, higher blood volume, and more oxygen delivery. Go at your own pace- Since you're just beginning to exercise, start cautiously and progress slowly. If you have an injury or a medical condition, consult your doctor or a physical therapist for help designing a
fitness program that gradually improves your range of motion, strength and endurance.
Plan to alternate among activities that emphasize different parts of your body, such as walking, swimming and strength training.
Build activity into your daily routineFinding time to exercise can be a challenge. To make it easier, schedule time to exercise as you would any other appointment. Plan to watch your favorite show while walking on the treadmill, or read while riding a stationary bike. You may also try exercising in the morning to help avoid conflicting and busy day schedules.
Allow time for recovery- Many people start exercising with frenzied zeal — working out too long or too intensely — and give up when their muscles and joints become sore or injured. Plan ahead with designed time between sessions to allow for your body to rest and recover from your workouts.
Plan to include different activities- Different activities (cross-training) can keep exercise boredom at bay. Cross-training also reduces your chances of injuring or overusing one specific muscle or joint.
Put it on paper- A written plan may encourage you to stay on track. There are also many electronic tracking systems that can help you track physical fitness results and nutrition and diet intake trends.
Crab Lice: Parasites Looking for Love in All the Wrong Places LCDR Kathryn Barbara
Phthirus pubis, the pubic or crab louse, is an insect of the order Psocodea and is an ectoparasite who only inhabit human hosts. Often called crab lice because of their appearance, pubic lice are found primarily in the pubic or genital area of humans but have been found infesting coarse body hair, such as hair on the legs, armpits, mustache, beard, eyebrows, or eyelashes. Pubic lice have three life stages: egg (nit), nymph, and adult. Nits can be difficult to see and are usually found attached to the hair shaft. They are yellow to white in color and oval in shape. Pubic lice nits take about 6-10 days to hatch and adult females can lay approximately 30 eggs during their life span. The adult lice are 1.5-2.0 mm long, tan to grayish-white in color, and females are usually larger than males. Adult lice must feed on human blood and will die 1-2 days after falling off a human host. Pubic lice are transmitted from person to person most often by sexual contact although bedding and clothing may play a small role in their transmission. Pubic lice most commonly are spread directly from person to person by sexual contact. According to the Center for Disease Control and Prevention the following steps should be taken to prevent the spread of pubic lice: Sexual contacts of an infested person should be examined. Sexual contact between the infested person and their sexual partner should be avoided until all have been examined, treated, and reevaluated. To prevent possible spread by bedding and clothing, machine wash and dry in hot water (at least 130°F) and high heat drying cycle. Clothing and items that are not washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks. Additionally, do not share clothing, bedding, and towels used by an infested person. Persons with pubic lice should be examined and treated for any other sexually transmitted diseases that may be present. Pubic lice are most often treated with a lice killing 1% permethrin lotion that can be purchased over-the-counter. These medications are safe and effective when all label instructions are followed properly. Other chemical treatments for crab lice are not recommended due to increased risk or lack of U.S. Food and Drug Administration approval. A non-chemical approach to ridding one’s body of pubic lice is shaving or waxing the affected area. In fact, several recent reports have stated there appears to be a decline of pubic lice most likely due to the current popularity of Brazilian bikini waxes and male grooming. So if you start itching in the hair down ’there’ see a medical provider because it could be crab lice looking for love.
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
3
April 2 & 3- (SHARP) Sexual Health and Responsibility training for STI Prevention Counseling, Promoting Sexual Health in the Military Population, and Sexual Partner Counseling and Referral Training will be offered. To register for Sexual Health Training, contact SHARP at sharp@nehc.mar.med.navy.mil or call 757-953-0974. For additional information, please contact NEPMU-2 Health Promotion at NEPMU2Norfolk-HRA@med.navy.mil or call 757.953-6585.
FISHY FOOT FETISHS Ichthys Pedicures Could Cause an Icky Infection LT Sarah Goodman
GET YOUR ANSWERS HERE EMAIL NEPMU-2 click on the links below
As we approach the spring season, many of us are busy doing our yearly cleaning, planting flowers, and ah yes… using up all those holiday gift cards. For all those ladies and gents that are looking to relax or “just feel pretty” after a busy holiday season, you may choose to seek out a soothing pedicure.
Fleet/FMF -Entomology
Many of us are aware of the traditional risks of getting a pedicure. Most health professionals do a conscious check of the facility and their techniques before sitting in the massage chair. However, an old Middle Eastern pedicure tradition is making its way into the United States, and could cause serious medical issues if not monitored properly.
-Environmental Health -Industrial Health -Health Promotions
“A fish pedicure, also known as a fish spa, involves patrons dipping their feet in a tub of water filled with small fish called Garra rufa. Garra rufa are sometimes referred to as ‘doctor fish’ because they eat away dead skin found on peoples’ feet, leaving newer skin exposed.” (CDC 2012)
Training Threat Assessment Deployable Platforms Department
While this may seem like a cool alternative to the traditional spa day, there are associated risks. Many states have banned the practice due to at least one of the following reasons:
Senior Enlisted Leader
In April 2011, there was a large bacterial outbreak in Great Britain related to fish pedicures. In addition, inspectors have discovered the fish themselves can carry Vibro vulnificus, Vibro cholerae, and S. agalatiae. In the United States, “there have been no published reports to date regarding illness from fish pedicures,” the CDC said in June 2011. “However, fish-free foot-baths in nail salons have been implicated in several outbreaks of nontuberculous mycobacterial infections, including the species Mycobacterium abscessus and M. fortuitum," which have left customers with boils and scars.”
RESOURCE LINKS
Instructions Navy Medicine Publications PrevMed Topic Page NMCPHC (NEHC) supported page of Preventive Medicine topics and resources
If you still want to get your toes “summer ready”, but want to reduce your risk for infection, these are a few tips you can use to protect yourself:
USAPHC U.S. Army Public Health Command
Make sure implements are cleaned between uses Look for “double dipping” or when a technician uses an implement to take product out of a container, puts it on the client, then sticks it back in the container. Ask if pedicure equipment and hydrotherapy tubs are self-sanitizing or find out how they are sanitized Bring in your own files and nail boards
WHO Fact Sheets World Health Organization publications and fact sheets AFPMB Armed Forces Pest Management Board online Bug Bytes Archive Back issues of the NEPMU -2 newsletter available online
1 1. Garra rufa are sometimes referred to as “doctor fish” because they eat away dead skin found on peoples’ feet, leaving newer skin exposed. However, fish pedicure tubs cannot be thoroughly cleaned between patrons and the fish themselves cannot be sanitized. 2. The Chinese Chin chin, another species of fish, is easily confused for the Garra rufa species. The Chin chin, unlike the Garra rufa, actually bites and can draw blood, increasing the risk of infection.
2
4
Mail Order… Food? The number one New Years resolution in America every year is to diet and/or lose weight. Now, more than before, we are bombarded with dozens of commercials advertising nutritional meal plans where you sign up and can have meals sent directly to your home. With more Americans working and being more timecrunched than ever, this appears to be the ultimate time saver and convenience. While the mail order industry enjoys a good safety record, ordering food through the mail may cause concerns about food safety, shelf life, and distribution. It's imperative to develop some mental checklists for how both food and packaging should look when perishable mail order foods arrive. This is especially true for meat, poultry, fish, and other perishable foods such as cheesecake, which must be carefully handled in a timely manner to prevent foodborne illness. The following food safety tips will help the recipient determine if their perishable foods have been handled properly: Make sure the company sends perishable items, like meat or poultry, cold or frozen and packed with a cold source. It should be packed in foam or heavy corrugated cardboard. The food should be delivered as quickly as possible — ideally, overnight. Make sure perishable items and the outer package are labeled "Keep Refrigerated" to alert the recipient. When you receive a food item marked "Keep Refrigerated," open it immediately and check its temperature.
Bravo Zulu!!! NEPMU-2 would like to congratulate HM1 Daniel Estigoy on his selection as Sailor of Year!
NEPMU-2 would like to congratulate HM2 Timothy Schuette on his selection as Junior Sailor of the Year
LCDR Elena Mathis, IHO
The food should arrive frozen or partially frozen (at least below 41 °F). Even if a product is smoked, cured, vacuum-packed, and/or fully cooked, it still is a perishable product and must be kept cold. If perishable food arrives warm (above 41 °F) notify the company. Do not consume the food. Do not even taste suspect food. If giving as a gift, tell the recipient if the company has promised a delivery date. Or alert the recipient that "a gift is in the mail" so someone can be there to receive it. Don't have perishable items delivered to an office unless you know it will arrive on a work day and there is refrigerator space available for keeping it cold. Americans also enjoy cooking foods that are family favorites and mailing these items to family and friends. The same rules that cover the mail order industry also apply to foods prepared and mailed from home. Make sure perishable foods are not held at temperatures between 41 and 135 °F for no longer than 2 hours.
Welcome Home! We are proud to welcome CDR Cynthia Sikorski back to NEPMU-2 after her recent deployment to Kabul, Afghanistan, in support of Operation Enduring Freedom. While deployed, she worked as a Preventive Medicine Mentor for NATO Training Mission-Afghanistan and helped build public health infrastructure and bio-surveillance capacities for the Afghanistan National Security Forces. She advised the Afghan National Army (ANA) Chief of Public Health on matters related to Force Health Protection, outbreak mitigation, and disease surveillance. She also helped to establish the first ever combined Infectious Disease and Preventive Medicine Residency for ANA physicians.
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 5 Website: http://www.med.navy.mil/sites/nepmu2