Bureau of Epidemiology
Bureau of Epidemiology January 1998 Utah Department of Health
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1997:  The Year in Review
Address Change!
Influenza A Subtype H5N1 in Hong Kong and a Surveillance Plan for Utah
Monthly Morbidity Summary
 
1997:  The Year in Review

Enteric Diseases

Based on preliminary data, 1997 saw a decrease in almost all of the enteric diseases reported to the Bureau of Epidemiology.  The only exception was E. coli O157:H7 where the number of reported cases increased from 30 cases in 1996 to 58 cases in 1997.  The number of cases of shigellosis continued to decrease from 307 cases in 1996 to 103 in 1997.  Reported cases of campylobacteriosis decreased 8.3% from 243 cases in 1996 to 223 cases in 1997.  The number of giardiasis cases decreased for the first time in many years to 299 cases in 1997.  The number of cases of salmonellosis decreased by 47% (279) in 1997.   Just over 42% of the salmonella isolates were Salmonella enteritidis (118) compared to 56% (297) in 1996.

Viral Hepatitis

In 1997, 556 cases of hepatitis A were reported, which was a 48% reduction from the year before.  Salt Lake county (304 cases) accounted for over 54 percent of the cases in Utah.  Along with Salt Lake County, Davis County (60) and Weber County (121) accounted for 87 percent of the total cases in Utah.

Of the total number of hepatitis A cases identified during 1997, 27 (4.8%) were found to be foodhandlers and, 114 (20.3%) were associated with day care centers.

Reports of hepatitis B cases decreased from 129 in 1996, to 93 in 1997.   Of the reported cases, 64.5% were male and 54.8% were 20-39 years old.

During 1997, 52 perinatal hepatitis B carriers were identified statewide.   A total of 144 household and sexual contacts were identified and evaluated.

Confirmed reports of hepatitis C decreased in 1997 to five cases.   One case each of hepatitis D and E were reported in 1997.  Once again we would urge health care providers to test individuals presenting with hepatitis rather than relying on a clinical diagnosis.

HIV/AIDS

According to the Bureau of HIV/AIDS, Tuberculosis and Refugee Health, 151 AIDS cases and 83 new HIV positive individuals were reported during 1997.  The 151 reported AIDS cases represent a 19.7% decrease from the 188 reported in 1996.

Meningitis

Meningococcal disease remained essentially unchanged at 17 cases in 1997.   Cases were evenly distributed throughout the year with no major outbreaks identified.  Isolates identified in cases from 1997, were Neisseria meningitidis serogroup B (6), serogroup C (3), serogroup Y (3), and serogroup unknown (5).  The ages of the 1997 cases ranged from 2 months to 73 years.  The mean age of cases was 22.5 years.  These infections resulted in one death.  Other causes of bacterial meningitis included Streptococcus pneumoniae (12) and other Streptococcus (3).

Viral meningitis increased from 32 cases during 1996 to 94 cases during 1997.  For most cases, the etiology was not established.  An enterovirus was isolated from only three of the cases.  Over 40% of the cases occurred in Washington County.

Sexually Transmitted Diseases

A total of 278 gonorrhea cases were reported for 1997, almost identical to the 277 cases reported in 1996.  Of the 278 cases, there were three cases of Penicillinase-Producing Neisseria gonorrhea (PPNG) reported, compared to ten cases reported during 1996.  All three PPNG cases were from Salt Lake County.  There were four cases of gonococcal related Pelvic Inflammatory Disease (PID) reported in 1997.  Reported cases among the 15-24 year olds (108 out of 278) represented 39% of Utah's gonorrhea morbidity in 1997.   Uncomplicated cases of chlamydia increased in 1997 with 1760 compared to 1583 in 1996.  This is in large part due to increases screening of females and the use of the more sensitive LCR test.  Chlamydia associated PID increased this year with 21 cases identified as compared to 15 cases reported in 1996.   Seventy-six percent of chlamydia cases reported were among females, and 73% occurred among 15-24 year olds.  There were five cases of early syphilis reported in 1997 (2 primary), compared with the three cases reported in 1996.

Tuberculosis

Reported cases of tuberculosis decreased from 58 cases in 1996 to 36 cases in 1997, a decrease of 38%.  The majority of cases were male (58%) although somewhat less than in 1996 (69%).  No single age group or race/ethnic group was responsible for the majority of cases.

Vaccine-Preventable Diseases

In 1997, one case of measles (rubeola) was reported in Utah.  This case actually occurred in 1996 and was an imported case from Germany.  No cases of rubella were reported in 1997.   Cases of pertussis decreased from 16 confirmed cases in 1996 to 14 in 1997.  There were three reported cases of Haemophilus influenzae disease in 1997, down from 8 in 1996.  No cases of polio were reported in 1997.

Zoonotic and Vectorborne Diseases

The number of cases of bat rabies in 1997 increased by one with a total of six bats testing positive.  There were no other animals found to be positive for rabies.  No cases of Hantavirus Pulmonary Syndrome (HPS) were reported in 1997.  Cases of Colorado tick fever increased from four cases in 1996 to five cases in 1997.  One case of lyme disease, one case of relapsing fever and four cases of tularemia were reported in 1997.  A total of three cases of imported malaria were reported in 1997.

Other reportable diseases

Three cases of Toxic Shock Syndrome (TSS) were reported in 1997.  Reports of Kawasaki disease increased slightly from 10 cases in 1996 to 12 cases in 1997.  Once again in 1997, there were two reports of infant botulism.  The number of cases of legionellosis increased to 19 in 1997, an increase of 58%.

Once again we wish to express our gratitude to the people in the laboratories, physicians' offices, local health departments, schools and nursing homes throughout Utah, whose reports are the basis for this summary.  Please keep up the good work.

 

Address Change

The Bureau of Epidemiology has a new post office box and zip code.

For sending mail use the post office box number.   The new address is:

Utah Department of Health
Bureau of Epidemiology
Program/Person name
P.O. Box 142104
Salt Lake City, Utah  84114-2104

The street address is as follows:

Utah Department of Health
Bureau of Epidemiology
288 North 1460 West
Salt Lake City, Utah 84116

Please make necessary changes to correspondence and notify concerned staff.  If you have any questions, please contact Connie Dean or Naomi Gibson at (801)538-6191.

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Influenza A subtype H5N1 in Hong Kong and a Surveillance Plan for Utah


The Hong Kong Department of Health, in collaboration with the Centers for Disease Control and Prevention and the World Health Organization, is currently investigating an outbreak of avian influenza A subtype H5N1.  This outbreak is significant in that this avian strain of influenza has not previously been known to infect humans.  Surveillance among poultry indicates that since March 1997, outbreaks of influenza A (H5N1) have occurred in poultry farms in Hong Kong and among chickens imported into Hong Kong from southern China.  The exact source of infection and the mode of transmission for human cases of H5N1 remain uncertain at this time, although preliminary evidence suggests that most case-patients were infected through exposure to birds.

As of January 15, 19 cases of influenza A (H5N1) have been identified in Hong Kong, including 18 laboratory-confirmed cases and one suspected case for which laboratory tests are not yet complete.  Six of the 18 laboratory-confirmed case-patients have died (case fatality rate of 33%) and two laboratory-confirmed case-patients remain critically ill.  With the exception of one case diagnosed in May 1997, all cases have occurred in November and December 1997.   The most recent case had onset of illness on December 28.  No human case of H5N1 influenza has been identified outside of Hong Kong.

The isolate from the May 1997 case was sensitive to amantadine and rimantidine.  The November/December isolates are being evaluated for sensitivity to these medications.  This strain of influenza A is not included in the 1997-1998 influenza vaccine.  Under normal circumstances, it can take as long as 6 months to develop and manufacture a vaccine against a new strain of influenza.  Although preliminary efforts to develop a vaccine against H5N1 are underway, a decision to begin commercial production of an H5N1 vaccine has not yet been made by the World Health Organization and the Centers for Disease Control and Prevention.

The investigators in Hong Kong are trying to determine if there is evidence of disease beyond these 19 cases, and whether illness results from person-to-person, as well as bird-to-person, transmission.  In the absence of evidence that this viral strain is easily transmitted from person-to-person, the risk of a pandemic at the present time is felt to be low.  For an influenza pandemic to occur, a novel influenza strain to which most of the population is susceptible would have to be capable of sustained  person-to-person transmission.   However, if the H5N1 virus develops the ability to be more efficiently transmitted from person-to-person, the virus could spread worldwide very rapidly.

If a human host is infected with two different influenza viruses, reassortment of RNA segments between the two influenza viruses can occur.  Genetic analysis of the viral isolates from seven H5N1 human cases from Hong Kong indicates that genetic reassortment between avian and human influenza viruses has not yet happened.  If sporadic H5N1 infections continue to occur in Hong Kong as the normal human influenza season begins, it is possible that the H5N1 virus may reassort to produce a strain that would have the potential to cause a pandemic.  As of January 15, there has been only normal seasonal influenza activity in Hong Kong; the influenza season in Hong Kong has two annual peaks, in March and in July.

We request that the medical community remain vigilant for patients who are hospitalized with severe influenza illnesses after traveling to either Hong Kong or southern China.  Since the influenza season in Hong Kong peaks in both March and July we request that the following surveillance protocol be continued until at least September 1998:

A.  Viral cultures should be obtained from patients who meet ALL of the following criteria:

     1 - Age > 1 year and < 60 years;

     2 - Initial presentation of an influenza-like illness (temperature greater than 100 F and symptoms of cough or sore throat);

     3 - hospitalization with unexplained pneumonia or Adult Respiratory Distress Syndrome (ARDS); and

     4 - symptom onset within 10 days of having been in Hong Kong or southern China.

B.  Immediately contact the Bureau of Epidemiology at 801-538-6191 to report any suspect case that meets the criteria listed above.

C.  Obtain a nasopharyngeal or throat swab for viral culture.1   Dacron swabs with a plastic or wire shaft should be used to collect specimens, which must then be immediately placed in viral transport media.  All specimens must be kept refrigerated (but not frozen) after collection and during transport to a virology laboratory.

Please mark the requisition slip as follows:  "Influenza-like illness with recent travel to Hong Kong or southern China."

Please contact the virology laboratory at (801)534-8400 to establish a procedure for prompt transport and processing of the specimen.  Same-day delivery of specimens is urged; if this is not possible then overnight storage and next-day shipment at 4 C is acceptable.  Longer delay may result in loss of the virus, which could reduce the chances of viral detection.

If the culture is positive for influenza A, the Utah Department of Health, Bureau of Epidemiology at (801)538-6191 will assist in arranging for transport to a laboratory with the capacity for influenza subtyping.
                                                                                                                                

1While you may also wish to obtain a rapid antigen test for influenza A, the low sensitivity of this test and the need for subtyping to identify H5N1 viruses, require that the rapid antigen test not be performed in place of viral cultures for these patients.

 

Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary - January 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
P.O. Box 142104
Salt Lake City, Utah 84114-2104
ir 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