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 2001. This report provides the
health care community, government and regulatory agencies and other concerned individuals
and groups with important data on Utah’s reportable diseases and conditions. The data
is provisional and may change slightly as final reports and investigations are collected.
ENTERIC DISEASES
Campylobacteriosis cases decreased 7.3% from 246 confirmed cases in
2000 to 228 confirmed cases in 2001. Eighty-six percent of reported cases were serotyped jejuni.
Giardiasis cases remained very close in number, from 281 cases in 2000 to 283 in
2001. E. coli O157:H7 infections decreased 36% from 50 cases in 2000 to 32
in 2001. Shigellosis cases decreased 21% from 82 cases in 2000 to 65 in 2001. Of
the 82 confirmed cases, 36% were serotyped flexneri and 46% were serotyped sonnei.
Salmonellosis has seen the biggest change in number this year.
The number of confirmed cases decreased a dramatic 53% in the year 2001, from 487 cases in
2000 to 230 in 2001. Of those confirmed cases, 24% of all Salmonella isolates were typed Salmonella
typhimiuium. Seventeen percent of isolates in the year 2001 were typed Salmonella
enteritidis, as opposed to 60% in the year 2000. There was one single source outbreak
of Salmonellosis in the year 2001 that was typed Salmonella virchow, a serotype
that is not common in Utah. Out of the eight cases of S. virchow reported,
four were associated with this outbreak.
VIRAL HEPATITIS
Acute hepatitis A cases decreased 7% from 71 cases in 2000 to 66 in
2001. During the month of July, eight cases of hepatitis A reported travel through or
residence in a Central Utah County, however, after an extensive investigation, no source
could be identified. Acute hepatitis B cases decreased from 37 cases in 2000 to 26
in 2001. Of this year’s cases, 19 (73%) were male and seven (27%) were female. There
were 21 perinatal hepatitis B cases in 2000 and 33 in 2001. Three acute hepatitis C
cases were reported that contained sufficient criteria to meet the CDC case definition of
an acute case. The Office 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 ruled out by confirmatory tests, or lacked the additional information necessary to
determine the status of the case.
HIV/AIDS
During 2001, 116 AIDS cases were documented in Utah and
represent a 19% decrease from the 143 cases reported in 2000. The 22 AIDS deaths reported
through December 2001 was 42% lower than the previous year. The decrease in deaths
continues to follow national trends and is primarily attributable to the efficacy of
antiretroviral medications. Forty-nine HIV positive individuals were reported
during 2001, a 9% decrease from 2000. 71% of HIV-positive individuals and 58% of AIDS
cases were in the age group 20-39. Of the 165 individuals reported with HIV/AIDS in 2001,
141 (85%) were male, 24 (15%) were female. Four teenagers (ages 13-19) and fifteen young
adults (ages 20-24) were reported with HIV/AIDS during 2001 and one pediatric HIV
infection from another country was reported. One Utah and two out-of-state HIV-positive
individuals were reported with pulmonary tuberculosis. The cumulative total of HIV/TB
cases is 77 (63 Utah and 14 out-of-state cases). Forty-two individuals have died, leaving
a total of 35 who have been diagnosed with both HIV and TB living in Utah. During 2001,
male-to-male sexual contact was the most common means of HIV/AIDS exposure reported among
men of all races. The racial breakdown of men with HIV/AIDS in 2001 shows 69% were White,
18% were Hispanic, 10% were Black, one percent were Asian/Pacific Islander, one percent
were American Indian, and one percent were not known. During 2001, 23 women were reported
with HIV/AIDS. Of these, injecting drug use or sex with an injecting drug user accounted
for 25% of cases. The racial breakdown for women show that 39% were White, 48% were Black,
9% were Hispanic and 4% were Asian/Pacific Islander. 92% were of childbearing age (15-44).
Six pregnant HIV-positive women delivered a live infant during 2001. All six of these
women knew they were HIV positive before pregnancy.
TUBERCULOSIS
Reported cases of tuberculosis decreased from 49 in 2000 to 35 in 2001,
a decrease of 29%. The majority of persons with TB in Utah were male (24 of 35 or 69%),
the same percentage as last year. Twenty-nine percent (ten of 35) of persons with TB were
White, non-Hispanic; 17% (six of 35) were Asian/Pacific Islander; 11% (four of 35) were
Black, non-Hispanic; 6% (two of 35) were Native American/Alaskan; and 37% (13 of 35) were
of Hispanic ethnicity. A majority (22 of 35 or 63%) of persons with TB were born outside
of the United States.
Most people with TB (33 of 35 or 94%) live in one of the four densely
populated counties along the Wasatch Front (i.e., Salt Lake, Weber, Davis, and Utah). Six
percent (two of 35) were co-infected with the human immunodeficiency virus (HIV), and 6%
(two of 35) were known injecting drug users. The diagnosis of 77% of TB cases (27 of 35)
was confirmed with a positive laboratory culture. Drug sensitivity testing was performed
on 100% (27 of 27) of available isolates; 30% (eight of 27) of the isolates were resistant
to one or more antituberculosis medications. Most of the persons with TB (30 of 35 or 86%)
who were eligible to receive medications were provided directly observed therapy (DOT).
One person with TB was diagnosed at the time of his death.
INFLUENZA
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 130 laboratory confirmed cases reported during the 2000-2001
surveillance season, which is an increase over last seasons 96 cases. The first case was
reported on October 16, amid concerns over the influenza vaccine shipment delay. The first
case 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 130
cases, 93 were type B and 37 were type A. Four of the five type A cases that were further
sub-typed by the Utah Public Health Laboratory 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 four 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. Similar to last
season, absenteeism did not have the same increases that were seen in “influenza-like
illnesses” reported by physicians.
MENINGITIS
Meningococcal disease rates stayed the same from 2000 to 2001.
There were eight cases reported in 2000 and eight cases reported in 2001. Identified
isolates included serogroup B (1), serogroup Y (3).
Bacterial Meningitis numbers remained very close from 2000 to
2001. There were 34 confirmed cases in 2000 and 40 in 2001. 42.5% of isolates (17 cases)
were serotyped strep pneumo, while Group A Strep accounted for eight cases and
Group B Strep for five.
Viral Meningitis increased 65% from 46 cases in 2000 to 76 cases
in 2001. An etiology was not established for most cases. Sixty-two percent of the cases
were Salt Lake County residents and 23% were Utah County residents.
SEXUALLY TRANSMITTED DISEASES
Case numbers for 2001 are still provisional at this point. It is
estimated that there will be approximately 2300 cases of chlamydia for 2001. This
represents a larger increase over the previous year than was seen in 2000. An estimated
240 cases of gonorrhea were reported in Utah in 2001, also representing an increase
over the number of gonorrhea cases seen in 2000. The STD Control Program was awarded
monies from the CDC to implement a high-risk adolescent female screening program at
several locations along the Wasatch Front. This program commenced in August of 2001 and
has been successful in identifying several cases of chlamydia and pregnancy in high-risk
adolescent females.
VACCINE PREVENTABLE DISEASES
Pertussis cases increased greatly in the year 2001. During 2000, 18
confirmed cases of Pertussis were reported and 78 cases were reported in 2001.
Haemophilus influenzae decreased slightly in 2001 with two type B, three type A,
three type F and one that was not typed. There was only one case of mumps reported
in 2001 compared to seven cases reported in 2000.
ZOONOTIC AND VECTORBORNE DISEASES
The year 2001 only had one case of hantavirus pulmonary syndrome
(HPS). The case was a Salt Lake County resident and unfortunately, was fatal. This brings
Utah’s total number of hantavirus cases to 18.
In 2001, there were 15 bats that tested positive for rabies.
Counties reporting rabid bats include Cache (27%), Salt Lake (13%), Utah (13%), and Box
Elder, Davis, Duchesne, Tooele, Uintah, Washington, and Weber each with one positive bat.
No other animals tested positive for the disease.
The number of Rocky Mountain Spotted Fever cases increased from
two in 2000 to three in 2001. There were four cases of tularemia in 2001 as opposed
to two cases in 2000. Imported malaria cases decreased slightly from six cases in
2000 to four in 2001.
OTHER REPORTABLE DISEASES
The number of legionellosis decreased from 12 cases in 2000 to
seven cases in 2001. Four cases of listeriosis were reported during 2000 while only
two were reported in 2001. Infant botulism was reduced by half, with eight reported
in 2000 and four in 2001. There was only one case of Brucellosis melitensis in 2001
as opposed to two in 2000, and the same for leptosporosis, with two reported in
2000 and one in 2001.
In July 2001, the Office of Epidemiology and the Centers for Disease
Control and Prevention worked with TriCounty Health Department to investigate an outbreak
of coccidioidomycosis among workers at an archeological site at Dinosaur National
Monument (DNM). A case was defined as an illness with onset of at least two selected
symptoms (i.e. self-reported fever, difficulty breathing and cough) after June 18, in a
person working at DNM. Ten persons met the case definition, including eight student
volunteers and two DNM archeologists. Illness onset occurred during June 28-July 1. The
most common symptoms included difficulty breathing, fever, cough, fatigue, shortness of
breath, myalgia and generalized skin rash. Using serum specimens concentrated 3-5 fold in
an assay that detects IgM antibodies (immunodiffusion tube precipitin), nine of the ten
acute serum specimens from patients contained IgM antibodies to Coccidioides immitis,
confirming acute coccidioidomycosis. Ground disturbing activities such as construction or
archeology digs may increase risk for infection. Dinosaur National Monument is located
approximately 200 miles north of the area of Utah where C. immitis is endemic. The
outbreak in this location indicates that endemic areas may extend farther north than
previously documented. Health care providers should be alert for coccidioidomycosis cases
in persons who reside in or have traveled to these areas and who may have been exposed to
dust from disturbed soil.
The Bureau of Epidemiology expresses gratitude to laboratory personnel,
physician’s 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.
