|Bureau of Epidemiology|
|Bureau of Epidemiology||January 2001||Utah Department of Health|
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 2000. This 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. The data are provisional and may change slightly as final reports and investigations are collected.
The number of Salmonellosis cases reported to the health department declined by 14% in 2000 from 566 total cases in 1999 to 487 cases in 2000. In 2000, 60% of all Salmonella isolates were typed Salmonella enteritidis (SE), the serotype commonly associated with undercooked eggs and poultry. Also of interest, the number of SE cases associated with outbreaks declined slightly from 21% to 16%. Undercooked eggs were the suspect food in several of the SE outbreaks in 2000. (Figure 1)
The number of Shigellosis cases increased 26% from 66 cases in 1999 to 82 confirmed cases in 2000. Giardiasis cases increased slightly from 256 1999 cases to 274 cases in 2000. Reported cases of E. coli 0157:H7 infections increased 39% from 36 to 50 cases in 2000. The Council of State and Territorial Epidemiologists has recommended that Non-0157 types of E. coli join the list of reportable diseases as other strains of E. coli have been found to cause serious illness and discomfort. We have started surveillance and investigation of Non-0157 E. coli cases and have found an increase in reported cases from 23 cases in 1999 to 35 cases in 2000.
Campylobacteriosis cases increased 30% from 188 to 246 cases in 2000. Of the 246 confirmed cases, 37 or 15% were associated with a single source outbreak of Campylobacter jejuni involving a high school football team attending a summer camp. County officials conducted an investigation including food histories and found that the common source of exposure was most likely an irrigation tap that the participants used for drinking water. Water samples were obtained and tested positive for Campylobacter jejuni. There were 56 additional epidemiologically linked cases who were symptomatic but lacked laboratory confirmation.
Acute hepatitis A cases increased 9% from 64 cases in 1999 to 71 cases in 2000. Of the total number of hepatitis A cases reported during 2000, five (7.1%) were among food handlers. Only two (2.8%) were identified as being associated with daycare centers.
Acute hepatitis B cases decreased slightly from 38 1999 cases to 37 in 2000. Of this years cases, 30 (83%) were male and 47% were between the ages of 20 and 39. There were 21 perinatal hepatitis B cases reported in 2000, a decrease from 26 in 1999.
There was only one case of hepatitis C reported that contained sufficient criteria to meet the CDC case definition of an acute case. The Bureau of Epidemiology continues to maintain a database of newly reported patients with positive hepatitis C antibody tests. These test results do not differentiate between acute and chronic infections. The majority of hepatitis C reports were either ruled out by confirmatory tests or lacked the additional information necessary to determine the status of the case.
According to the Bureau of HIV/AIDS, Tuberculosis and Refugee Health, through the end of 2000, 143 AIDS cases were documented in Utah, representing a 2.7% decrease from 1999. Sixty-five percent of all reported AIDS cases through 2000 were diagnosed among men who have sex with men, while injecting drug use has accounted for 18% of the cases. Thirty-five AIDS-related deaths were documented in 2000, a 20% decrease from 44 deaths in 1999.
Sixty-six positive HIV antibody test results were reported to the bureau during 2000, representing an 12% 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.
Reported cases of tuberculosis increased from 40 in 1999 to 49 in 2000, an increase of 23%. During 2000, the majority of persons with TB in Utah were male (34 of 49 or 69%). Forty-seven percent (23 of 49) of persons with TB were White, non-Hispanic; 10% (5 of 49) were Black, non-Hispanic; 14% (7 of 49) were Asian/Pacific Islander; and 29% (14 of 49) were of Hispanic ethnicity. There were no Native American cases with TB in 2000. A slight majority (26 of 49 or 53%) of persons with TB were born outside of the United States. Most people with TB (45 of 49 or 92%) resided in one of the four densely populated counties along the Wasatch Front (i.e., Davis, Salt Lake, Utah and Weber counties). Six percent (3 of 49) were co-infected with the human immunodeficiency virus (HIV). The diagnosis of the majority of TB cases (43 of 49 or 88%) was confirmed with a positive laboratory culture. Drug sensitivity testing was performed on 100% (43 of 43) of available isolates. Of the isolates, 28% (12 of 43) were resistant to one or more antituberculosis medications. Most of the persons with TB (44 of 48 or 92%) who were eligible to receive medications were provided directly observed therapy (DOT). One person with TB was diagnosed at the time of their death.
Surveillance for the 1999-2000 influenza season began the week of October 18, 1999 and continued weekly through March 11, 2000. Surveillance participants included physicians offices, clinics, and university health centers. Various school districts throughout the state also reported the number of students absent per week during the surveillance period. There were 96 culture confirmed cases for the 1999-2000 surveillance season, a 14% increase over the previous seasons 84 culture confirmed cases. Influenza activity peaked the week ending January 1, 2000. Of the 96 cultures, 95 were type A with 47 subtype H3N2.
For the week ending January 27, 2001, surveillance for the 2000-2001 season has tracked 52 laboratory confirmed influenza cases (39 type B, 13 type A). Two cases were sub typed H3N2. Active surveillance will continue throughout the season.
Meningococcal disease rates decreased 56% from 16 reported cases in 1999 to seven cases in 2000. Seventy-five percent of the cases occurred in the first four months of the year. Cases occurred in Salt Lake County (5) and Utah County (2). No major outbreaks were identified. Isolates included serogroup B (1), serogroup C (1), serogroup D (2), serogroup Y (2), and W135 (1).
There were 33 additional confirmed cases of bacterial meningitis reported in 2000. Causes included Streptococcus pneumoniae (18), other Streptococcus sp. (10), Staphylococcus (1), E coli 0157:H7 (1), and three of unknown origin.
The number of reported viral meningitis cases increased 61% from 26 cases in 1999 to 42 cases in 2000. An etiology was not established for most cases. Fifty-three percent of the cases are Salt Lake County residents.
Sexually Transmitted Diseases
There were 2191 chlamydia cases reported in 2000, representing a slight decrease from the 2220 reported cases in 1999. A total of 231 gonorrhea cases were reported in 2000, also a slight decrease from the 254 cases in 1999. There were 13 cases of Pelvic Inflammatory Disease, down from 16 reported cases in 1999. Twelve early syphillis cases were reported during 2000 (one primary, one secondary, and ten early latent) compared with seven cases in 1999.
Vaccine Preventable Diseases
Utah had three cases of measles (rubeola) in 2000, the first cases since 1996. Results of the case investigations indicated that the first case may have been exposed at an international snowboarding competition. Previously, there was a suspected case of measles in a member of the U.S. Snowboarding team at the same competition who became symptomatic while in Utah and was later lab confirmed in her own state. The other two Utah cases were employees of the health clinic where the first case was diagnosed. None of the cases have a documented history of receiving two doses of measles vaccine.
Pertussis cases decreased again from 58 confirmed cases in 1999 to 18 in 2000. The high numbers in 1999 were partly attributed to cases that were epidemiologically linked to a 1998 outbreak. There was one case of Haemophilus influenzae type B compared to two cases in 1999. Other types of Haemophilus influenzae in 2000 included type A (3), type F (1), and six cases that were not typed. There were seven confirmed cases of mumps, an increase from four cases in 1999. There were no cases of rubella in 2000 compared to one case in 1999.Zoonotic and Vectorborne Diseases
In 2000, a total of 638 animals were submitted for rabies testing, including 104 bats. A total of ten bats tested positive for the virus, a slight increase from the eight positive bats in 1999. Counties reporting rabid bats include Davis (40%), Summit (30%), Cache (10%), Utah (10%), and Weber (10%). No other animals tested positive for the disease.
The year 2000 brought the return of hantavirus pulmonary syndrome (HPS) after a HPS-free 1999. There were four cases of HPS this year. Of the four cases, two were Carbon County residents and two were Salt Lake County residents. One case was fatal. This brings Utahs total number of hantavirus cases to 17, with an average age of 36.6 and a 29.4% fatality rate.
Utah had its first human plague case since 1994. The patient was a 57-year old male from Washington County. It is probable that he contracted plague from the bite of an infected flea off a rodent at his rural property. Officials from the Bureau of Epidemiology and Centers for Disease Control and Prevention (CDC) conducted an environmental investigation of the property. Numerous rodent nests and droppings were plainly visible in his barn and shed and near woodpiles. The patient also reported seeing rodents in his house. In order to test for the presence of Yersenia pestis in the local rodent population, traps were set and rodents were tested for the bacteria. One deer mouse (Peromyscus maniculatus) and one dog, belonging to the neighbor across the road from the patient, tested positive for Y. pestis. Educational signs were posted at local parks and information was distributed to campers and local residents alerting people to the possible presence of plague in the area and advised against contact with sick or dead animals and recommended using insect repellents on clothing and skin.
The number of Rocky Mountain spotted fever cases decreased from five cases in 1999 to two in 2000. Colorado tick fever cases also decreased slightly from three cases in 1999 to two in 2000. There were two tularemia cases in 2000, down from four cases in 1999. Imported malaria cases increased slightly from four cases in 1999 to six cases in 2000.
Other Reportable Diseases
There were 12 reported cases of legionellosis during 2000, compared to 18 reported in 1999. Four cases of listeriosis were reported, down from six cases in 1999. There were two cases of Toxic Shock Syndrome in 2000, compared to one case in 1999. Infant botulism cases increased to eight cases from 1999's three cases. There were also two cases of Brucellosis melitensis in women who had recently moved to Utah from Mexico and two cases of leptosporosis.
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 as well as the United States and becomes increasingly important as emerging infectious diseases are gaining greater public attention.
Figure 1. Utah Salmonella Enteritidis 1999 & 2000
Utah Department of Health,
Bureau of Epidemiology
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
Approval 8000008: Appropriation 3705
Rod Betit, Executive Director, Utah Department of Health