Bureau of Epidemiology
Bureau of Epidemiology May 2001 Utah Department of Health
inside... Influenza Surveillance for the 2000-2001 Season
Salmonella virchow For the First Time In Utah
Exceptional Efforts
Important Information
Monthly Morbidity Summary
 
Influenza Surveillance for the 2000-2001 Season

To identify the virus type(s) associated with influenza morbidity and define the beginning and end of the influenza season, the Bureau of Epidemiology conducts surveillance each influenza season. “Confirmed influenza” is the category used in Utah’s morbidity reporting system to record cases of influenza that are laboratory confirmed by either a DFA test or culture. Reported cases of influenza identified by a rapid test in a physician’s office were recorded as probable influenza. Reported cases of upper respiratory illnesses that were not laboratory tested, were recorded separately as “influenza-like-illnesses”. Viral respiratory diseases generally dominate this category, with the majority of illness due to influenza, parainfluenza, respiratory syncytial virus and adenoviruses. Symptoms associated with influenza and “influenza-like illnesses” include fever of 101 degrees or greater, malaise, chills, sore throat, myalgia, cough and coryza. Severity of illness varies, depending on a patient’s age and previous immunity.

Surveillance for the 2000-2001 influenza season began the week of October 9, 2000, and continued weekly through April 30, 2001. Surveillance participants included physicians’ offices, clinics, and university health centers. Also, various schools and school districts throughout the state reported the number of students absent per week during the surveillance period.

There were 129 laboratory confirmed cases reported during the 2000-2001 surveillance season, which is an increase over last season’s 96 cases. The first case was reported on October 16, amid concerns over the influenza vaccine shipment delay. It was reported nearly a month earlier than the first reported case during the 1999-2000 season. Influenza activity peaked the week ending January 27, 2001 nearly a month later than the peak last season. Cases continued to be reported through mid-April. Of the 129 cases, 93 were type B and 36 were type A. Five type A cases were further sub-typed by the Utah Public Health Laboratory and four were the H3N2 strain and one was the H1N1 strain. The Utah cases differed from the national trend of predominantly type A, H1N1 strain. Eighty-five of the reported confirmed cases in Utah were under 18 years of age, and only 4 were over 50 years of age. There were two influenza related deaths reported this year, both were pediatric patients with underlying health conditions.

Weekly rates of absenteeism among participating schools were calculated using student enrollment numbers and number of school days per week. A slight increase in absenteeism was seen during the week of the Thanksgiving holiday but the rates remained fairly consistent throughout the rest of the surveillance period. Similar to last season, absenteeism did not have the same increases that were seen in “influenza-like illnesses” reported by physicians.

Surveillance was enhanced this season by a partnership between the Bureau of Epidemiology and graduate students in the Department of Family and Preventive Medicine at the University of Utah. The students used a statistical package called statistical process control limits to analyze data on daily patient loads of clinics located throughout the state. They also provided supplies and arranged for couriers for participating clinics to collect clinical specimens on their patients. In the past, one of the biggest barriers for physicians in testing their patients has been the inability to transport specimens to the Utah Public Health Laboratory. Through the University’s project, even rural surveillance sites successfully submitted specimens. For more information on the University’s project, please contact the Department of Family and Preventive Medicine at (801) 581-7234.

We wish to thank the following participants in the influenza surveillance project:

Drs. Barton Avery and Gary Harris (Summit Clinic)
Utah State University Student Health Center
Dr. Von S. Pratt
Bountiful Instacare
Weecare Pediatrics
Health South Medical Clinic
Medical Mall Instacare
Mountain View Pediatrics
Rose Park Instacare
Hurricane Family Practice
University of Utah Health Network (Park City)
Brigham Young University Student Health Center
Mountainlands Community Health Center
Logan High School
Box Elder Junior High School
South Sanpete School District
Windridge Elementary School
J. A. Taylor Elementary School
West Point Elementary School
Academy Park Elementary School
Lone Peak Elementary School
Viewmont Elementary School
Backman Elementary School
Carbon School District
Washington School District
South Summit Elementary
Provo School District
Wasatch Middle School
Midland Elementary School

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Exceptional Efforts in Public Health

We would like to thank Kim Christensen and Tim Lane from the Utah Department of Health and staff at Salt Lake Valley Health Department for their key roles in identifying a cluster of Salmonella virchow. Our first alert of the possible outbreak came from Kim Christensen, a Microbiologist at the Utah Department of Health Laboratory. She noticed two cases of S. virchow, a strain of Salmonella not previously identified in Utah, within a two week period and immediately informed the Bureau of Epidemiology of the possible outbreak. We would like to thank Kim for her assistance in early identification of these cases.

Tim Lane is the Food Safety Program Manager for the Utah Department of Health. We would like to thank Tim for working closely with Salt Lake Valley Health Department in this investigation. Tim encouraged the collection of stool specimens from food handlers at the restaurant associated with the cases even though the onset dates of most cases were nearly a month past. Through this effort, another case of S. virchow was identified in a food handler. The food handler was properly treated and excluded from work until negative tests were obtained.

We would also like to thank the public health nurses and food safety staff at Salt Lake Valley Health Department for follow up and persistence in gathering food histories from patients and working closely with the implicated restaurant in ensuring safe practices. Thanks to all who assisted in this Public Health “exceptional effort.”

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Important Information

When Reporting a
Communicable Disease:

Call: (801) 538-6191
Or:
Fax: (801) 538-9923

The May 2001 Newsletter is the most current Newsletter online.

For Information on Fact Sheets for Diseases or
Annual Report Information, as well as The Epidemiology Newsletter, you can browse our website:

http://health.utah.gov/epi/

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Salmonella virchow For the First Time in Utah

Salmonella is an ongoing problem in food safety and public health. It is estimated that from 2 to 4 million cases of salmonellosis occur in the U.S. annually. Gastroenteritis caused by Salmonella is characterized by abdominal cramps, diarrhea, nausea, vomiting, fever and headache. Most of the time, the patient recovers in 1 to 2 days, however, it can cause more serious symptoms. Foodnet data from the Centers for Disease Control and Prevention (CDC) suggest that between 800,000 to 4,000,000 nontyphoidal Salmonella infections occur each year in the United States, resulting in an estimated 18,000 hospitalizations and 500 deaths.

In the past two years, the majority of outbreak associated Salmonella cases in Utah have been identified as Salmonella enteritidis (SE). In 1999, there were three separate outbreaks of SE associated with consumption of home made ice cream prepared with raw eggs. Several other outbreaks of SE were also linked to eggs. In addition to the SE outbreaks, Utah has also seen cases of Salmonella muenchen associated with alfalfa sprouts and Salmonella typhimurium associated with unpasteurized orange juice. There have been outbreaks throughout the country of various types of Salmonella including Salmonella kottbus associated with alfalfa sprouts, Salmonella saintpaul associated with mangoes and Salmonella poona associated with cantaloupe.

The month of February 2001 brought the discovery of a type of Salmonella never before seen in the state of Utah. The Bureau of Epidemiology was notified by the State Microbiology Lab of two cases of Salmonella virchow in a two week period. Since this type of Salmonella is new to Utah, the investigation began. Upon initial investigation, there did not appear to be a link since one case was from Salt Lake County and one was from Duchesne County. Upon further investigation, it was discovered that the Duchesne County resident had traveled to Salt Lake and had eaten at one of the same restaurants as the Salt Lake County case. County food inspectors conducted an investigation of the restaurant, which serves fast food including burgers, fries and shakes, and found no major food safety violations. Nearly a month later, a third case of S. virchow appeared on the scene and the same restaurant was reported in the food history.

At this point, county food safety staff returned to the restaurant to conduct further interviews with food handlers and to collect stool samples for testing. Of twenty-eight food handlers who were interviewed and submitted stool samples, one tested positive for S. virchow. Initially it was thought that this could be the source of the outbreak, but the onset date of the food handler was similar to the other cases and there was no history of travel. The food handler’s symptoms cleared within a few days so a physician was not seen. The positive culture was obtained on March 31, 2001, six weeks after the illness and no symptoms were reported at the time of the lab test. After the organism was identified, the food handler was excluded from work until two negative specimens were obtained. One more case of S. virchow has been identified, bringing the total cases in 2001 to five. The fifth case had an onset date of March 31, 2001. Despite persistent efforts by Salt Lake Valley Health Department, no common exposure with the outbreak cases was identified. (Figure 1)

According to FDA, S. virchow is commonly associated with a variety of sources, including tuna, catfish, shrimp, snake heads and frog legs. The Centers for Disease Control and Prevention has record of two outbreaks of S. virchow between 1973 and 1997. A 1973 outbreak in Maryland was associated with a restaurant exposure to beef or veal. Twenty-four illnesses were reported. Missouri reported an outbreak of S. virchow in 1998 involving exposure in a private home to several food sources including BBQ beef, shrimp and crab. Thirty-eight cases reported illness associated with the outbreak. As Salmonella outbreaks from varying sources continue to pose a public health problem, rapid identification and investigation of cases is the key to prevention.

For further information on food safety and prevention of Salmonella and other food borne diseases, FDA provides excellent information and resources on their website: www.cfsan.fda.gov.

Figure 1. 2001 Utah Salmonella virchow Cases

Case

Exposure

Onset

Meal

Lab Test Date

1

1/28/2001

2/1/2001

Cheeseburger and fries

2/7/2001

2

1/20/2001

1/29/2001

Hamburger with pastrami and fries

2/1/2001

3

2/9/2001

2/11/2001

Hamburger and fries

3/2/2001

4

Multiple

2/14/2001

Multiple

3/31/2001

5

Unknown

3/31/2001

Not Outbreak associated

4/3/2001

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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary - May 2001 - Provisional Data

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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
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Gerrie Dowdle, MSPH, Managing Editor
Connie Dean, Production Assistant

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