Bureau of Epidemiology
Bureau of Epidemiology February 1998 Utah Department of Health
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Improved Treatment for STDs Critical to Health of Women and Children
Asthma Hospitalization Rates Among Children in Utah
Selected Nationally Notifiable Diseases
Disease Reporting: Should we go Electronic?
Monthly Morbidity Summary

 

Improved Treatment for STDs Critical to Health of Women and Children: New CDC Guidelines Address Urgent Health Need

The majority of severe illnesses and deaths associated with sexually transmitted diseases (STDs) could be prevented with improved diagnosis and treatment, according to the Centers for Disease Control and Prevention (CDC).

To address this urgent health need, the CDC issued updated national guidelines designed to improve the prevention, detection, and treatment of STDs, especially among women and infants—the two groups that suffer the most severe consequences.

The 1998 Guidelines for Treatment of Sexually Transmitted Diseases outline the most effective treatments for STDs and include recent advances that may greatly improve the health of women and infants and slow the spread of HIV.

According to Helene D. Gayle, M.D., M.P.H., Director of CDC’s National Center for HIV, STD, and TB Prevention (NCHSTP), perhaps the greatest challenge will be raising physician’s awareness of both the new guidelines and the critical need to screen for and treat STDs.

CDC will be widely disseminating the new guidelines and continuing efforts to improve provider training in the proper detection and treatment of STDs.

With early and correct treatment, most common STDs can be cured. Without treatment, common diseases like chlamydia and gonorrhea can have lifelong consequences, including infertility, potentially fatal tubal pregnancy, and debilitating illnesses in infants.

According to CDC, highly effective single-dose oral therapies are now available for almost all curable STDs. Public health practitioners are hopeful that these simpler treatments will not only improve the reproductive health of women, but may ultimately help prevent the heterosexual spread of HIV.

"Chlamydia and gonorrhea clearly increase a person’s risk of both giving and getting HIV," said Judith N. Wasserheit, M.D., M.P.H., Director of CDC’s Division of STD Prevention, "Treatment for these common STDs is now easier than ever before, and if initiated early enough, can protect a woman from severe reproductive consequences and reduce her chances of becoming infected with HIV."

Significant advances have also been made in the treatment of STDs during pregnancy. New treatments for chlamydia can be given less frequently and produce fewer side effects. And new recommendations stressing the need for screening and treatment of bacterial vaginosis among high-risk pregnant women (those with a previous pre-term birth) will likely reduce the number of infants born prematurely as a result of this disease. Screening for and treating these and other STDs during pregnancy could significantly improve infant health.

"Thousands of infants die or suffer birth defects each year because of STDs transmitted during pregnancy and childbirth. To reduce this toll, both physicians and pregnant women must recognize the critical need for appropriate screening and treatment," stressed Dr. Gayle. Gayle advises that if doctors don’t offer their pregnant patients screening for STDs, women should raise the issue.

The CDC guidelines stress the critical need to focus on preventing the further spread of STDs through multiple strategies. These include efforts to reduce risk behaviors; wider use of vaccines for sexually transmitted forms of hepatitis; and early detection and treatment of STDs to stop further transmission.

"Ideally, we want to prevent infection from ever occurring. But as individuals and as a society, we also have a responsibility to detect and treat the millions of STDs that currently go unrecognized and untreated every year," said Wasserheit, "STD treatment helps break the chain of transmission."

Even for the incurable STDs, such as human papilloma virus (HPV) and herpes, there are now easier treatments that can alleviate symptoms, prevent further health damage, and may decrease transmission.

The CDC treatment guidelines were developed in consultation with representatives from public and private health care settings, including managed care organizations, where an increasing proportion of STDs are treated.

Health care providers can access the guidelines through the Internet, http://www.cdc.gov/nchstp/dstd/dstdp.html or call 1-888-232-3228 (prompts, 2-5-1) to order copies. For more information on how to protect yourself from STDs or on STD screening and treatment, people can call the CDC STD hotline at 1-800-227-8922, or the Bureau of Epidemiology, STD Control Program (801) 538-6191.

Source: January 28, 1998 News Release from the CDC, National Center for HIV, STD, and TB Prevention Office of Health Communication.

 

Asthma Hospitalization Rates Among Children in Utah

Asthma is a lung disease characterized by: 1) airway obstruction that is reversible (but not completely in some patients), either spontaneously or with treatment, 2) airway inflammation, and 3) increased airway responsiveness to a variety of stimuli. Asthma can vary in severity from mild to severe symptoms or "crisis attack" that may require a physician’s care or admission to a hospital. In the U.S., asthma has been increasing over several decades. Between 1965 and 1984, the hospitalization incidence rates for children due to asthma increased over 200 percent. Between 1971 and 1980, the prevalence of asthma in six to 11 year old children in the U.S. increased from five to eight percent. Among all children in the United States, the prevalence of asthma is seven percent.

Recently, the Environmental Epidemiology Program conducted an assessment of the regional distribution of hospitalization rates of children (ages 0-14 years) in Utah due to asthma as the first diagnosis during the period 1992-1995. The overall state hospitalization rate for children in that age group due to asthma as the primary diagnosis was 12.3 cases per 10,000 children for the four year period. When hospitalization rates by county of residence are compared to state rates, Carbon, Duchesne, Garfield, Grand, and Salt Lake Counties were found to have significantly elevated rates of children hospitalized due to asthma for the period 1992 through 1995. Box Elder, Davis, Iron, Kane, Millard, Summit, Utah, Wasatch, and Washington Counties were found to have significantly lower childhood hospitalization rates due to asthma compared to the rest of the state for the combined 1992 through 1995 period. The hospitalization rate of a county was considered to be significantly different from the state rate when the 95% confidence interval did not include one and the statistical power to detect a true difference (Type II error) was greater than 80%.

Analysis of the distribution of the childhood asthma hospitalization rates at the zip code geographic level was conducted for Weber, Davis, Salt Lake, and Utah Counties. The western half of Salt Lake County, North Salt Lake in Davis County, and Spanish Fork in Utah County were found to have significantly higher rates of children hospitalized due to asthma during 1992 through 1995. Ogden and North Ogden zip code areas in Weber County; Bountiful, Syracuse and Layton zip code areas in Davis County; and Provo, Orem, and Pleasant Grove in Utah County were found to have significantly lower hospitalization rates.

The reasons for these differences are unknown. Risk factors associated with childhood asthma include poverty, maternal smoking during pregnancy, exposure to dirt mites and cockroaches, and genetic predisposition to airway hyper-reactivity. Additional research will be conducted to examine the spatial and temporal variances of childhood asthma in Utah in relation to various environmental factors including: ambient air pollution levels, proximity to hazardous waste sites, industrial pollution emissions, and pesticide use, as well as socioeconomic and demographic factors. These studies will help state and local public health and medical services implement effective intervention to reduce morbidity and mortality from childhood asthma.

 

Selected Nationally Notifiable Diseases,
Incidence Rates per 100,000 Population, U.S. and Utah, 1997

Disease

Reported U.S.

Cases **

U.S. Rate

(per 100,000)

Reported Utah

Cases

Utah Rate

(per 100,000)

AIDS

53,031*

19.7

150

7.3

Chlamydia

458,353

170.4

1,760

85.9

Gonorrhea

284,427

105.8

278

13.6

Hepatitis A

27,595

10.3

553

27.0

Hepatitis B

8,656

3.2

93

4.5

Legionellosis

1,033

.4

18

.9

Measles

133

.05

1

.05

Meningococcal Disease

3,078

1.1

17

.8

Pertussis

5,461

2.0

15

.7

Rubella

160

.06

0

0

Syphilis

7,787

2.9

7

.3

Toxic Shock

133

.05

3

.1

Tuberculosis

16,905

6.3

36

1.8

* Last update November 25, 1997
** Provisional data, MMWR Vol. 46/No. 52 & 53
Estimated U.S. population for January 1, 1998: 268,922,000 from Bureau of Census

 

Disease Reporting: Should we go Electronic?

Results from the 1997 Utah Department of Health’s Laboratory Practices Survey

The Bureau of Epidemiology was recently awarded a grant to improve our ability to rapidly identify and respond to emerging (and existing) infectious diseases. One part of this large project is to develop and implement an electronic reporting system for reportable diseases. Such a system would allow laboratories and physicians’ offices to send in reports of patients with reportable diseases electronically (e.g., via e-mail, through a modem or over the Internet). This could save time that is currently spent waiting for Morbidity Report Cards to arrive through the mail, eliminate the time currently spent reentering report forms once they are received, and, most important, reduce the time interval between the moment when a patient is diagnosed with a reportable disease and when this information can be analyzed by local and state health departments to identify possible outbreaks.

The first step in developing a successful electronic reporting system is the evaluation of the mechanisms used to transfer information that are currently being used by reporting agencies in the state of Utah. We conducted a survey in October, November and December of 1997 to obtain information for this evaluation.

"Most labs surveyed were interested in the possibility of electronic reporting to the health departments...."

Methods: Laboratories in Utah that met the requirements of the Clinical Laboratory Improvement Amendments (CLIA) were contacted by phone (n=176). A contact from each laboratory was interviewed using a standard questionnaire. The questionnaire included questions about the following areas, (1) how did these labs receive and/or send out results; (2) how did these labs report to the health departments; (3) did these labs currently use computer systems to manage their lab data; and, (4) would these labs be interested in electronic reporting if available?

Results: The survey was completed by 173 of 176 laboratories for a 98% response rate. Forty of these 173 laboratories were either reference laboratories or laboratories associated with a hospital, and 125 were affiliated with physicians’ offices. Eight did not fall into either category, and were excluded from further analysis. The results will be presented in two categories: one for reference/hospital labs (n=40) and one for physicians’ office labs (n=125).

When laboratories refer tests out that are not performed in their facility, many reference/hospital labs (31 of 40 or 78%) and nearly half of physicians’ office labs (60 of 125 or 48%) receive at least some results electronically. When it comes to sending the results back to the health care provider who ordered the test, however, electronic transfer is less common - 11 of 40 reference/hospital labs (28%) and six of 125 physicians’ office labs (5%) report that they have this capability.

When asked if they relay information to the health departments (local and/or state) about individuals diagnosed with reportable diseases, 30 of 40 reference/hospital labs (75%) and 74 of 125 physicians’ office labs (59%) say they do report. The remaining 10 reference/hospital labs (25%) and 51 physicians’ office labs (41%) report their results only to the health care provider who ordered the test. When reportable diseases are reported to the health departments, these come in over the phone or by hard copy (either in the mail or by facsimile).

Computer systems designed to manage lab data are commonly used in reference/hospital labs (30 of 40 or 75% have such a system), but much less frequently in physicians’ office labs (23 of 125 or 18%). A variety of software packages were mentioned by those labs with computer systems.

Most labs surveyed were interested in the possibility of electronic reporting to the health departments (34 of 40 reference/hospital labs or 85% and 70 of 125 physicians’ office labs or 56%). The most frequent comment noted when labs either weren’t interested or weren’t sure if they were interested in electronic reporting was that diagnosing a reportable disease at their facility was such a rare event that they were uncertain it would be worth their effort to learn how to use the system.

Discussion: When electronic reporting is available, this will speed up the collection of reportable disease reports. While the system itself is still in the planning stage, we were very pleased to learn of the interest in electronic reporting, both in reference and hospital labs and in physicians’ office labs. The results from this survey will be useful as we develop the system. For example, we learned that many of the reference and hospital labs are already managing their lab results electronically and direct transfer of their data to the health departments might be feasible. On the other hand, most physicians’ office labs do not have that capability but may want to take advantage of electronic reporting that uses the Internet as an avenue to transfer data.

The one disappointing finding from our survey was that current reporting to the health departments is inconsistent. A situation mentioned repeatedly was the case where a physician’s office believed that the lab they were receiving results from was reporting, and a reference/hospital lab believed that the health care provider who ordered the test was reporting. If both the health care provider and lab believe that the other one is reporting, no report gets made! If no report is made, no investigation will be conducted and the opportunity to prevent further illness will be lost.

Does the advent of electronic reporting mean that we do not want to hear from those who cannot take advantage of the latest technology? Of course not! The Bureau of Epidemiology will always be glad to accept your reports over the phone, through the mail, by a facsimile, or via any other method you prefer. We just want to hear from you.

Acknowledgment: The Bureau would like to recognize and thank Rachel Sedrick, a student at the University of Utah, for her excellent work developing and administering the questionnaire.

 

Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary
- February 1998 - 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
Cristie Chesler, BA Managing Editor