Surveillance for the 1998-1999 Season
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. Influenza
is the category used in Utahs morbidity reporting system
to record cases of laboratory confirmed influenza. Influenza-like
illness is the category used to report similar upper respiratory
illnesses based on a physicians clinical impression. Viral
respiratory diseases dominate this category, with illness due
to influenza, parainfluenza, respiratory syncytial virus and
adenoviruses comprising the majority of morbidity. 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 patients age and previous immunity. Surveillance
for the 1998-99 influenza season began the week of October 18,
1998, and continued weekly through April 3, 1999 . Surveillance
participants included physicians offices, clinics, and
university health centers. Various schools throughout the state
also reported the number of students absent per week during
the surveillance period. We wish to thank all who participated
in the influenza surveillance program.
There were 84 culture confirmed cases for the
1998-99 surveillance season which is an increase over last seasons
50 culture confirmed cases. 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 50 were type A. Weekly rates of absenteeism among
participating schools were calculated using student enrollment
numbers and number of school days per week. Expected increases
in absenteeism rates were seen during the Thanksgiving and Christmas
holidays and there were no reports during the weeks of Christmas
and Spring Break. Otherwise, absenteeism remained fairly consistent
throughout the rest of the surveillance period. Unlike years
past, absenteeism did not have the same increases that were
seen in influenza-like illness reported by physicians.
The most effective measure for reducing the
impact of influenza is vaccination of persons at high risk each
year before the influenza season. Influenza vaccine is strongly
recommended for any person > six months of age who, because
of age or an underlying medical condition is at increased risk
for complications of influenza. Health-care workers and others
in close contact with persons in high-risk groups should also
be vaccinated. In addition, influenza vaccine may be administered
to any person who wishes to reduce the chance of becoming infected
with influenza. However, those with a known anaphylactic hypersensitivity
to eggs or to other components of the vaccine should not receive
the influenza vaccine.
influenza vaccine contains virus strains representing the influenza
viruses that are likely to circulate in the upcoming winter.
U.S. manufacturers will use the antigenically equivalent strains
of influenza vaccines because of their growth properties. Although
the current influenza vaccine can contain one or more of the
antigens administered in the previous year, annual vaccination
with the current vaccine is necessary because immunity declines
in the year following vaccination and because the current vaccine
differs slightly from that of the previous year. As a result,
supplies of 1998-99 vaccine should not be administered to provide
protection for the 1999-00 influenza.
The trivalent influenza vaccine prepared for
the upcoming season will include the following strains: A/Beijing/262/95-like
(H1N1), A/Sydney/5/97-like (H3N2), and B/Beijing/184/93-like
hemagglutinin antigens. For the B/Beijing/184/93-like antigen,
U.S. manufacturers will use the antigenically equivalent B/Yamanashi/166/98
virus because of its growth properties and because it is representative
of currently circulating B viruses. Beginning in October, when
vaccine for the upcoming influenza season becomes available,
health care providers who see high-risk patients, as part of
routine care or in the hospital, should offer influenza vaccination.
Opportunities such as these to provide vaccination should not
be missed. Organized vaccination campaigns should optimally
begin around mid-October to mid-November. Vaccine should not
be administered too far in advance of the influenza season in
such facilities as long-term care centers, because antibody
levels may begin to decline within a few months of vaccination
For health care providers interested in submitting
specimens for influenza testing, a standard throat swab or throat
washing is acceptable. Specimens should be collected within
three days of clinical onset, kept cold during transport, and
received by a laboratory within 24 hours.
If you are not currently part of our surveillance
program and would like to participate, please call the Communicable
Disease Control Program, Bureau of Epidemiology, at 538-6191.
Department of Health state laboratory has begun using a different
medium to test for a broader spectrum of Campylobacter
agents. The Bureau of Epidemiology has, therefore, expected
to see a moderate increase in Campylobacter disease reported.
A variety of serotypes occur and their identification may be
beneficial for epidemiologic purposes. Campylobacter jejuni
and, less commonly, C. coli cause gastroenteritis, while
other organisms, such as C. fetus and C. laridis,
have also been associated with diarrhea in humans.
Campylobacter is a bacterial diarrheal
illness that may cause malaise, fever, nausea, vomiting, and
abdominal pain. Abdominal pain can mimic that produced by appendicitis,
while fever may cause convulsions to develop in some young children.
Most cases recover from the acute illness within two to five
days, whereas a rare number of cases experience symptoms for
more than 10 days. Transmission occurs most commonly by ingestion
of the infectious agents in undercooked poultry and pork, contaminated
water and food, and raw milk. Transmission of the organism may
also occur by contact with infected infants, pets, or farm animals;
however, person-to-person transmission of C. jejuni is
The disease generally incubates for two to
five days, with a range of 1-10 days, depending on dose ingested.
The illness may remain communicable throughout the entire course
of infection which may last from several days to several weeks.
However, those not treated with antibiotics may shed the organism
for up to seven weeks. When given early in the course of infection,
erythromycin shortens the duration of illness and prevents relapse.
Treatment with the antibiotic usually eradicates the organism
from stool within two to three days. Ciprofloxacin is an alternative
agent that is effective, but is not approved by the Food and
Drug Administration for persons younger than 18 years.
contamination can be prevented by thoroughly cooking all animal-derived
foodstuffs, especially those from poultry. Cross-contamination
can be avoided by handwashing after handling animals or raw
poultry and thoroughly washing cutting boards and utensils with
soap after contact with the food. Pasteurization of milk and
chlorination of water supplies are also important in hampering
infection. Infected food handlers and hospital employees who
are asymptomatic pose no known hazard for disease transmission
and need not be excluded from work if proper personal hygiene
measures are maintained. Outbreaks are uncommon in child care
centers, however, infants and children in diapers with symptomatic
C. jejuni infection should be excluded from child care
or cared for in a separate protected area until diarrhea has
Definition for Public Health Surveillance
Clinical description: A bacterial
infection that may result in diarrheal illness of
Laboratory criteria for diagnosis: Isolation
of Campylobacter from any clinical specimen.
Case classification: Probable: a clinically
compatible case that is epidemiologically linked to
a confirmed case. Confirmed: a case that is
MMWR/May 2, 1997/Vol. 46/RR-10
Prevention Through the Community Planning Committee Process
Community Planning Committee is looking for volunteers. Dedicated
volunteers are needed to develop an HIV prevention plan for
Utah. We need representatives from all backgrounds who care
about preventing HIV. The committee meets twice each month to
discuss issues and make recommendations to the health department.
Help with child care and out-of-town travel costs is available.
If you want to nominate a friend or volunteer yourself, CALL
538-6096 or 800-537-1046, or visit http://188.8.131.52/els/hivaids/eduprogram.html
for a nomination form and criteria. Please respond as soon as
possible before September 24.
In March 1993, a Federal legislation project
known as the Comprehensive HIV Prevention Act was
presented to the United States Congress. This project mandated
the creation of HIV prevention programs through local planning
By November, the Centers for Disease Control
and Prevention (CDC) introduced the project nationwide. In 1994,
the Bureau of HIV/AIDS, at the Utah Department of Health, initiated
the process in Utah.
With the help of representatives throughout
the state, a structure was developed for the future Community
Planning Committee (CPC) including nomination requirements for
It was determined that Utah would have one
statewide planning committee. The majority of CPC members are
from areas of the state most heavily impacted, but rural areas
are also represented. The CPC is comprised of 26 members with
WHAT IS COMMUNITY
local health agencies.
impacted by the epidemic present and future.
based service and religious organizations.
in behavioral science, epidemiology, evaluation and research.
HIV prevention community planning is a dynamic
collaborative process through which health departments work
in partnership with community planning group(s) to design local
prevention plans that best represent the needs of the various
communities at risk for, or infected with, HIV.
major goals of HIV prevention community planning are
to improve the effectiveness of HIV prevention programs
Participation by individuals
infected with and affected by HIV
Application of sound
scientific methods that will halt the spread
of HIV disease.
THE WORK OF THE COMMITTEE IS BASED
ON THE PRINCIPLES OF:
Parity: that all members are provided
opportunities for orientation and skills building, have an
equal voice in voting and other decision-making activities.
Inclusion: the assurance that the
views, perspectives, and needs of all affected communities
are included and involved in a meaningful manner in the community
Representation: the assurance that
those who are representing a specific community truly reflect
that communitys values, norms and behaviors.
THE NINE STEPS OF COMMUNITY PLANNING
Develop an Epidemiologic
Conduct a Needs Assessment.
Assemble a Resource Inventory.
Conduct a Gap Analysis.
Identify Potential Strategies
Prioritize Target Populations
Develop a Plan.
Evaluate the Planning Process.
Update the Plan.
WHAT DO CPCs DO?
The simple answer is: they plan! The
main product that CPC members create is a comprehensive HIV
Make a commitment to the
process and its results.
Participate in all decision-making
Serve on committees or in
work groups and complete identified tasks.
Gather data and information,
Make a commitment to serve
for two years.
Health Department Staff:
HIV PREVENTION RESOURCES
Provide leadership, guidance
Furnish necessary data and
Develop a work plan with completion
Manage the logistics of the
CPC meeting and dissemination of materials to members.
of Health, Bureau of Epidemiology
Monthly Morbidity Summary - August
1999 - Provisional Data
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
Craig R Nichols, MPA, Editor, State Epidemiologist, Director
Bureau of Epidemiology
Cristie Chesler, BA, Managing Editor