|Bureau of Epidemiology|
|Bureau of Epidemiology||January 2000||Utah Department of Health|
The Year in Review
Purpose of this Report
The Bureau of Epidemiology conducts surveillance to track the incidence of infectious diseases in Utah. Surveillance is crucial to understanding the health status of a population, planning effective prevention programs, and reducing morbidity and mortality. This report includes a brief overview of specific reportable infectious diseases of considerable public health significance in the state during 1999. The report provides the health care community, government and regulatory agencies, and other concerned individuals and groups, with important data on Utahs reportable diseases and conditions.
Enteric DiseasesThe number of salmonellosis cases had the most profound effect on the increased enteric disease rates. The number of cases increased 60% (568 total cases) in 1999 from the 356 cases reported in 1998, a year that saw a 31% increase in the number of cases over the previous year. Fifty-nine percent of the Salmonella isolates (336) were typed Salmonella enteritidis (SE) which is commonly found in undercooked poultry and raw eggs. In fact, 21% of SE cases (70) were associated with outbreaks involving the consumption of homemade ice cream prepared with shelled eggs.
Like Salmonella, the number of shigellosis cases also increased during 1999. The reported cases climbed 38%, from 48 cases in 1998, to 66 last year. However, reported cases of E. coli O157:H7, campylobacteriosis, and giardiasis, decreased during 1999. E. coli O157:H7 cases decreased from 75 in 1998 to 37 cases in 1999, a reduction of 51%; likewise, giardiasis cases decreased from 291 in 1998 to 255 in 1999, a drop of 12%; meanwhile, campylobacteriosis cases decreased slightly (10%) from 209 cases in 1998 to 188 in 1999.
Utah has continued its notable decline in hepatitis A cases reported. Disease rates peaked in 1996 with 1073 cases reported and have steadily declined since. In 1999, only 64 cases were reported, resulting in a 67% reduction compared to 1998, a year that also experienced a substantial decrease (65%) in reported cases compared to the previous year.
Of the total number of hepatitis A cases identified during 1999, five (7.8%) were among food handlers. Four of the five foodhandlers were employed in Washington County. No hepatitis A outbreaks were associated with daycare centers during the year. In fact, only three (4.7%) of the reported hepatitis A cases were associated with daycare centers, an 88% reduction compared to the 24 cases reported in 1998.
Like hepatitis A, numbers of reported hepatitis B cases also decreased. Hepatitis B cases dropped to 38, a 42% reduction from 1998 numbers. Of these cases, 58% were male and 63% were between the ages of 20 and 39.
During 1999, 26 perinatal hepatitis B carriers were identified statewide. A total of 54 household and sexual contacts were identified and evaluated.
The number of hepatitis C cases also dropped substantially (73%), from 22 cases reported in 1998, to 6 in 1999. One case of hepatitis D and two of hepatitis E were reported during the year. We continue to urge health care providers to test individuals presenting with hepatitis rather than relying on a clinical diagnosis.
HIV/AIDSAccording to the Bureau of HIV/AIDS, Tuberculosis and Refugee Health, through the end of 1999, 147 AIDS cases were documented in Utah, representing a 3% increase from 1998. Sixty-five percent of all reported AIDS cases through 1999 were diagnosed among men who have sex with men, while injecting drug use has accounted for 18% of the cases. Thirty-eight AIDS-related deaths were documented in 1999, representing a 36% increase over those in 1998, a trend that is consistent with what is seen nationally.
Fifty-nine positive HIV antibody test results were reported to the bureau during 1999, a number that represents a 13% increase in positive tests reported during the preceding year. These numbers represent persons who first tested HIV-positive during the year of the report, but whose date of acquiring HIV infection cannot be determined.
TuberculosisReported tuberculosis (TB) cases decreased from 52 in 1998 to 40 in 1999, a change of 23%. However, the number of TB-associated deaths increased from none in 1998 to five in 1999. Males and foreign-borne individuals continue to be disproportionately at an increased risk for the disease with half of the cases (50%) being refugees, immigrants, and migrants who were born outside of the United States, and 63% being male. Additionally, during 1999, there were 17 TB cases (43%) whose site of the disease included extra pulmonary sites as compared to 33% of the 1998 reported cases.
Surveillance for the 1998-99 influenza season began the week of October 18, 1998, and continued weekly through April 3, 1999. There were 84 culture confirmed cases for the surveillance season which was an increase over the 50 culture confirmed cases reported during the 1997-98 surveillance season. Of the 84 cultures, 67 were type A and 17 were type B. One of the cultures was sub typed as type A H3N2. Of the 50 culture confirmed cases seen during the 1997-98 season, all were type A.
For the week ending January 22, 2000, surveillance for the 1999-2000 season has tracked 80 culture confirmed cases of influenza. All 80 cases are type A, including 45 sub typed as type A H3N2. One reported suspect case of influenza for the season is presumably type B. A greater number of cases were reported earlier in the 1999-2000 season than during the 1998-99 surveillance season and the number of cases peaked the week ending January 1, 2000. Nonetheless, the bureau has no indication that the 1999-2000 season is more severe than the 1998-99 season.
MeningitisMeningococcal disease rates in 1999 were comparable to previous years with 16 reported cases. These cases were evenly distributed throughout the year with no major outbreaks identified. Isolates identified in 1999 cases included Neisseria meningitidis serogroup B (5), serogroup Y (7), and serogroup unknown (4).
There were 36 additional confirmed cases of bacterial meningitis reported during 1999. Causes included Streptococcus pneumoniae (21), other Streptococcus sp. (8), E. coli (1), gram + cocci (1), and Salmonella (1).
The number of reported viral meningitis cases dropped from 147 cases in 1998 to only 26 in 1999, an 82% decrease. While an etiology was not established for most cases, an echovirus was isolated from two of them. Sixty-nine percent of the cases (22) occurred in Salt Lake County.
Sexually Transmitted Diseases
There were 2220 cases of chlamydia reported in 1999, representing little change from the 2216 reported cases of 1998. A total of 254 gonorrhea cases were reported for 1999, an 8.1% increase compared to the 235 cases reported in 1998. There were 16 cases of Pelvic Inflammatory Disease reported in 1999, nearly a 50% increase in the number of cases (11) reported in 1998. Seven early syphilis cases were reported during the year (two primary and five early latent) compared with three in 1998.
Vaccine-Preventable DiseasesThe big story of 1998 was a pertussis outbreak involving 289 confirmed and probable cases. The number of cases plunged to 58 during 1999, an 80% reduction from 1998 figures, but still four times the number of cases (14) reported in 1997. This is partly attributed to the several 1999 cases that were epidemiologically linked to the 1998 outbreak.
There were two reported cases of Haemophilus influenzae type B disease in 1999, compared to one in 1998. There were no cases of measles (rubeola) or polio reported during 1999, but there were four confirmed and probable cases of mumps. Additionally, there were two cases of rubella documented throughout the year, including one case of congenital rubella. The cases mother had tested positive for the disease during her first trimester.Zoonotic and Vectorborne Diseases
In 1999, 665 animals were submitted for rabies testing, including 106 bats. A total of eight bats (7.5% of those submitted) tested positive for the disease, a 70% decrease from the 27 which tested positive during the 1998 epizootic. Rabid bats were identified in Davis (12.5%), Salt Lake (12.5%), Utah (37.5%), Washington (25%), and Weber (12.5%) Counties. No other animals tested positive for the disease.
There were no reported cases of hantavirus pulmonary syndrome (HPS) during 1999. The last confirmed HPS cases occurred in June and July of 1998, respectively. The sin nombre virus, the hantavirus responsible for causing HPS, is predominately found in the deer mouse (Peromyscus maniculatus) in Utah. According to recent field surveys conducted in the state, approximately 25-30% of the species is seropositive for the virus.
Utah had its first documented case of the tick-borne disease, human ehrlichiosis, in 1999. Ehrlichiosis is an acute, febrile, bacterial illness that has a clinical presentation similar to Rocky Mountain spotted fever (RMSF). Cases of RMSF increased from none to five during 1999, while three cases of Colorado tick fever were reported in 1999, up from two reported during the previous year. Two cases of Lyme disease were reported, although, the disease was most likely contracted outside of the state.
A total of four cases of imported malaria and four cases of tularemia were reported in 1999, both double the number of cases reported in 1998. Additionally, while animal plague was documented during the year, no cases of human plague have been reported since 1994.
Other Reportable DiseasesThere were 18 reported cases of legionellosis during 1999, compared to 21 reported in 1998. Laboratory specimens obtained from one of the cases and from water samples within the cases residence yielded Legionella with an identical Pulse Field Gel Electrophoresis (PFGE) pattern. Six cases of listeria were reported in 1999, whereas none were reported in the prior year. Although a PFGE link was established between two of these cases, no epidemiological link was identified. There was one case of Toxic Shock Syndrome and one case of Streptococcal Toxic Shock Syndrome reported in 1999. There were also three cases of infant botulism and two cases of vibrio parahaemolyticus reported during year.
The Bureau of Epidemiology expresses gratitude to laboratory personnel, physicians offices, local health departments, schools and nursing homes, whose reports are the basis of this summary. Reporting of notifiable diseases to the health department is the backbone of disease surveillance in Utah and nationally and becomes increasingly important as emerging infectious diseases are gaining greater public attention. In order to enhance surveillance efforts, the Communicable Disease Rule, R 386-702, was revised and put into effect October 1, 1999. The complete Utah Administrative Rules are available at http:/health.utah.gov/ or may be obtained from the Bureau of Epidemiology, 801-538-6191. Thank you and please keep up the good work.
Alert to Health Care Providers: Bicillin® C-R Is Not Recommended for the Treatment of Syphilis!
The Bureau of Epidemiology is aware of several recent instances where patients with syphilis have been treated with Bicillin® C-R. The package insert for Bicillin® C-R states that it is NOT to be used for the treatment of syphilis.
The recommended treatment for adults with primary, secondary or early latent syphilis (i.e., syphilis of less than one years duration) is 2.4 million units (MU) of benzathine penicillin G (BPG) administered intramuscularly in a single dose.* A dose of Bicillin® L-A contains the recommended dose.
A dose of Bicillin® C-R contains 1.2 MU of BPG and 1.2 MU of procaine penicillin G. Procaine penicillin G is NOT recommended for the treatment of syphilis because it has a shorter half-life in the body than BPG. The longer half-life of BPG is essential to ensure that all of the slow-growing bacteria that cause syphilis have been killed. The risk of using Bicillin® C-R to treat patients with syphilis is that they may remain infected after the treatment is complete.
*There are other treatment recommendations for patients who are allergic to penicillin; for those who have syphilis of greater than one years duration, neurosyphilis, or congenital syphilis; or, for children. Consult the following reference for further information: CDC. 1998 Guidelines for treatment of sexually transmitted diseases. MMWR 1998; 47 (No. RR-1). You may also call your local health department or the Bureau of Epidemiology at 801-538-6191.
The Bureau of Epidemiology started an internet web site a little more than two years ago. It is found at http://health.utah.gov/epi/. Initially, it was very brief and contained only broad program descriptions and contact points. Since then, it has developed to include a variety of links, publications, fact sheets and summary reports. The bureau has developed and published on the web more than 70 fact sheets on infectious diseases, from AIDS to Yersiniosis. Also available are the Annual Communicable Disease Reports starting with the 1991 report, and the Epidemiology Newsletter starting with the January 1997 issue. Linked to the bureau web page are web pages for the three programs within the bureau.
The Sexually Transmitted Disease (STD) Control Program web page contains five-year summaries of STDs in Utah as well as maps of rates for chlamydia and gonorrhea. In addition, a link to the CDC guidelines for investigating STDs can be found at this page.
The Environmental Epidemiology Program (EEP) web page contains links to the programs activities such as indoor air quality, cancer cluster investigations, work-related burn injuries and blood lead poisoning. As well as descriptions of these programs, publications developed by the EEP can be found at these sites. Popular publications include the Parents Guide to Childhood Lead Poisoning Prevention, the Your Lead Level pamphlet and the Occupational Lead Exposure: Information for the Health Care Worker pamphlet.
Several useful documents published by the bureau have also been posted at the Communicable Disease Control (CDC) Program site. Those documents include the Controlling Communicable Diseases: Information and Prevention Guidelines for Child Care Centers and Schools guide book, and the Resource for Infection Control in the Long-Term Facility guide book. The CDC program maintains, on a seasonal basis, a web page that reports the progress of the influenza season. Also posted are case and investigation report forms such as the Utah Confidential Morbidity Report Form, used to report cases of reportable diseases to the bureau and the newly revised Communicable Disease Rule (R386-702), which outlines the reporting procedures and specifies what diseases are reportable.
The use of the internet is an exciting, fast, convenient, and less expensive way of getting information out to health care providers, public health decision makers and the general public. As new information is developed, the bureau will continue to use the web as a method of distribution.
Utah Department of Health, Bureau of
The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.
Send comments to: The Bureau of Epidemiology, Box 142104, Salt Lake City, UT
84114-2104 or call (801) 538-6191
Rod Betit, Executive Director, Utah Department of Health