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Health Care Provider Information

Vector Bourne Illnesses

Rabies Information

Rabies is a disease caused by a virus that affects the nerve tissue of all warm-blooded animals, including humans.  Rabies is transmitted in the saliva of a rabid animal and causes death by paralysis.  Biting is the common route of transmission.  For more information about rabies on the CDC website follow this link


We recommend that you get your flu shot early in the fall. The best practice to protect yourself is to have your shot before the flu starts circulating in the community.  This is because it takes about two weeks for your body to create antibodies.  The CDC recommends that you get your flu vaccine by the end of October. However, a flu vaccine is beneficial throughout the flu season.


How do I protect myself against the flu?

  • Vaccinate everyone in your household who is 6 months old and older
  • Stay home when you get sick
  • Stay away from those who are sick
  • Wash your hands frequently
  • Cover your mouth and nose when sneezing or coughing
  • Avoid touching your eyes, nose, or mouth
  • Clean frequently touched objects
  • Get plenty of sleep
  • Be physically active
  • Manage stress
  • Drink plenty fluids
  • Eat a nutritious diet

To monitor flu virus activity for the 2018-2019 season, follow this link.

Legionella-Legionnaires’ Disease and Pontiac Fever

Legionella bacteria can cause a serious type of pneumonia (lung infection) called Legionnaires’ disease. The bacteria can also cause a less serious illness called Pontiac fever. This bacteria is most often introduced into the lungs via inhalation of contaminated water sources or soil.

Sources that Legionella may present in include:

  • hot tubs, decorative fountains and water features, plumbing systems of large buildings, cooling towers, showerheads or sink faucets, and from hot water tanks and heaters

Symptoms of Legionnaire's disease include:

  • Cough
  • Shortness of breath
  • Fever
  • Muscle aches
  • Headaches

Symptoms of Pontiac fever include:

  • Fever
  • Muscle Aches

People who get sick after being exposed to Legionella can develop two different illnesses: Legionnaires’ disease and Pontiac fever. If you have any of these symptoms please contact your primary care provider for evaluation.

For more information about Legionella infections click on this link.



Histoplasmosis  is an infection caused by a fungus called Histoplasma. The fungus lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. In the United States, Histoplasma mainly lives in the central and eastern states, especially areas around the Ohio and Mississippi River valleys. The fungus also lives in parts of Central and South America, Africa, Asia, and Australia.

  • People can get histoplasmosis after breathing in the microscopic fungal spores from the air. Although most people who breathe in the spores don’t get sick, those who do may have a fever, cough, and fatigue. Many people who get histoplasmosis will get better on their own without medication, but in some people, such as those who have weakened immune systems, the infection can become severe.

Most people only experience mild symptoms and seeking medical assistance is not necessary. However, some individuals will develop more severe symptoms that will require an assessment by a health-care provider. Symptoms typically start about 3-17 days after exposure.

Symptoms Include:

  • Fever 
  • Chills
  • Headache
  • Muscle Aches
  • Decreased Appetite
  • Cough
  • Chest Pain: Mid-Chest & Worse While Taking a Deep Breath

For more information, click this link

Vector-Borne Disease

Vector-borne diseases are diseases carried by infected fleas, ticks, or mosquitoes. The infected insect is called a vector, and the person who gets bitten by this vector has a vector-borne disease.  Some if these diseases are well known, such as; plague, West Nile Virus, malaria, Lyme disease, and Zika.  Other vector-borne diseases have been recently discovered, such as Heartland virus.  

During the 2018 summer, Nebraska had the most cases of West Nile Virus in the nation.  The highest concentration of West Nile cases in Nebraska are were located in the eastern portion of the state.  A variety of factors could be the cause of such a large number of cases during this season.  There has been an increased amount of precipitation over the summer, more standing water, cooler night-time temperatures, and a higher infection rate in the mosquitoes themselves. The state of Nebraska puts out a bi-weekly report about the activity of West Nile Virus, and the staff at Two Rivers create a quick one-page data sheet showing key information.  This information can be found on the West Nile and other Arboviruses page on the Two Rivers website.

To protect yourself against vector-borne diseases use the following tips:

  • Wear long pants, and long sleeved shirts when possible
  • Use insect repellent (here is a helpful tool from the EPA to find the best repellent for you)
  • Walk in the middle of paths (to avoid ticks)
  • When camping, hiking, or walking dogs, consistently check clothing for ticks and reapply insect repellents as needed