The Year in Review
Based on preliminary data, the
big story in 1998 was an outbreak of pertussis that resulted
in 289 confirmed and probable cases. The outbreak occurred in two
locations, Salt Lake and Washington Counties, among a religious
fundamentalist group. Both adults and children were affected. A
low immunization rate in a relatively closed community may have
contributed to the outbreak.
Two cases of rubella were
reported in 1998. There were six reported cases of Haemophilus
influenzae disease in 1998, an increase from three in 1997.
No cases of measles or polio were reported in 1998.
The number of enteric diseases reported
to the health department increased slightly in 1998. Cases of
E. coli 0157:H7 increased from 58 cases in 1997
to 76 cases in 1998. Cases of shigellosis continued to
decrease from 103 cases in 1997 to 48 in 1998. Reported cases
of campylobacteriosis decreased 6.7% from 222 cases in
1997 to 208 cases in 1998. The number of giardiasis cases
remained nearly the same at 290. Cases of salmonellosis
increased by 31.4% (356) in 1998 from 271 a year ago. Just over
55% of the salmonella isolates were Salmonella enteritidis
(196) compared to 42% (115) in 1997.
In 1998, 195 cases of hepatitis A were reported, a 64.5%
reduction from the year before. Salt Lake County accounted for
only 32 percent (62) of the cases in Utah. Of the total
number of hepatitis A cases identified during 1998, 11 (5.6%)
were found to be food handlers. An even greater number, 24 (12.3%)
were associated with day care centers.
Reports of hepatitis B cases decreased
from 93 in 1997, to 66 in 1998. Of the reported cases 63.6% were
male and 68.2% were 20-39 years old. During 1998, 23 perinatal
hepatitis B carriers were identified statewide. A total of
51 household and sexual contacts were identified and evaluated.
Reports of hepatitis C increased from
five cases in 1997 to 22 cases in 1998. No cases of hepatitis
D or E were reported in 1998. Once again we would urge
health care providers to test individuals presenting with hepatitis
rather then relying on a clinical diagnosis.
According to the
Bureau of HIV/AIDS, Tuberculosis and Refugee Health, 143 AIDS
cases and 52 new HIV positive individuals were reported during
1998. The 143 reported AIDS cases represent a 4.0% decrease from
1997. The 52 HIV positive individuals reported during 1998 is
28% decrease from the 72 HIV infections reported in1997.
AIDS deaths documented in 1998 were 59% fewer
than in 1997. This downward trend in the number of AIDS deaths
in Utah follows national trends.
disease remained essentially unchanged at 15 cases in 1998. Cases
were evenly distributed throughout the year with no major outbreaks
identified. Isolates identified in cases from 1998, were Neisseria
meningitidis serogroup B (6), serogroup C (1), serogroup W135
(1), serogroup Y (3), and unknown (4). The ages of the 1998 cases
ranged from one month to 77 years. The mean age of cases was 16.0
years. These infections resulted in two deaths. Other causes of
bacterial meningitis included Streptococcus pneumoniae
(21), and other Streptococcus sp. (4), Cryptococcus
sp. (1), Staphylcoccus aureus (1), gram + cocci
The number of cases of viral meningitis
continued to increase from 94 cases during 1997 to 147 cases during
1998. For most cases, the etiology was not established. An enterovirus
was isolated from 16 of the cases with two cases being caused
by an echovirus and one caused by a Coxsackie B. In 1997, over
80% of the cases occurred in Salt Lake and Washington counties.
In 1998, 66% of the cases occurred in those counties.
Sexually Transmitted Diseases
A total of 235 gonorrhea
cases were reported for 1998, a 13% decrease compared to the
271 cases reported in 1997. Of the 235 cases, there were no reported
cases of Penicillinase-Producing Neisseria gonorrhea
(PPNG). There were four cases of gonococcal related Pelvic
Inflammatory Disease (PID) reported in 1998. Reported cases
among the 20-24 year olds (105) represented 45% of Utah's gonorrhea
morbidity in 1998. Chlamydia increased by 22% in 1998 with
2216 in 1998 compared to 1739 in 1997. The increased use of the
more sensitive amplification testing methods both in the public
and private sector may explain the increase in identified morbidity.
Chlamydia associated PID decreased this year with seven
cases identified as compared to 21 cases reported in 1997. Seventy-three
percent of chlamydia cases reported were among females, and 74%
of the chlamydia cases reported occurred among 15-24 year olds.
There were seven cases of early syphilis reported in 1998
(1 primary, 3 secondary and 3 early latent), equal to the total
number of early syphilis cases reported during 1997 (2 primary,
3 secondary, and 2 early latent).
Reported cases of
tuberculosis increased from 36 cases in 1997 to 52 cases
in 1998, an increase of 44%. A slight majority of cases were male
(55%) which supports a growing trend in the decrease of the percentage
of males infected with the disease. As compared to the general
population, minorities were over represented with 19% Asian or
Pacific Islanders, 9.6% Native American and 5.8% Black. Of the
Whites, 40% were Hispanic. No single age group was responsible
for the majority of cases.
Zoonotic and Vector borne Diseases
In 1998, an epizootic
of bat rabies occurred in the state. The number of positive
tests increased from six in 1997 to 27 in 1998. There were no
other animals found to be positive for rabies.
1998 also saw the return of hantavirus pulmonary
syndrome (HPS) to the state. The last known case occurred
in October of 1996. Two cases of HPS were diagnosed during the
summer months. The cases were from Emery and Uintah Counties.
A case of Hantavirus Infection was diagnosed in a person
from Juab County. Hantavirus infection is a disease caused by
Sin Nombre Virus much like HPS, but without the classical respiratory
component found in HPS cases.
Only two cases of Colorado Tick Fever were
reported in 1998 down from the five cases reported in 1997. No
cases of Lyme disease were reported in 1998. One case of
relapsing fever and two cases of tularemia were
reported last year. Two cases of imported malaria were
reported in 1998. A case of Q Fever was reported
in 1998. Once again no cases of human plague were reported.
The last case of human plague was reported in 1994.
Other reportable diseases
Two cases of Toxic
Shock Syndrome (TSS) and one case of Streptococcus Toxic
Shock Syndrome (STSS) were reported in 1998. Eleven
cases of Kawasaki disease were reported in 1998.There was
one reported case of infant botulism. The number of cases
of legionellosis increased to 21 which is slightly higher
than the 19 cases reported in 1997.
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
And Adult Blood Lead Surveillance, Utah 1997
The Utah Blood Lead Registry (UBLR)
was established in 1990 by the Bureau of Epidemiology to investigate
the epidemiology of lead poisoning in the state of Utah. Prior
to 1996, only blood lead test results for adults with elevated
levels were collected. Since 1996, all blood lead test results
for both children and adults have been collected and entered into
the database. Clinical laboratories report blood lead results
to the Environmental Epidemiology Program monthly.
Childhood Blood Lead Epidemiology and Surveillance
The CBLES project
was established in July 1996 with support funds from CDC to investigate
the epidemiology of childhood blood lead poisoning in Utah and
to identify high risk populations within the state. Additionally,
the focus of the program is to develop and provide educational
materials to parents, health care workers and other interested
individuals concerning childhood blood lead poisoning.
Lead poisoning is particularly hazardous to children
because children more readily absorb lead than adults and the
developing nervous system of children is most susceptible to the
effects of lead. Lead can damage the childs brain and nervous
system causing decreased intelligence, learning disabilities,
attention deficit disorder, speech and language problems, behavior
problems, poor muscle coordination, decreased muscle and bone
growth and hearing damage. Lead can also cause kidney damage and
anemia. Lead poisoning often goes unnoticed because symptoms usually
do not develop until the condition becomes quite serious. Early
signs and symptoms of lead poisoning in children include persistent
tiredness or hyperactivity, irritability, loss of appetite, loss
of weight, reduced attention span, stomach aches, insomnia or
The CDC has recommended that intervention activities
begin with children whose blood lead level has been reported at
10 mcg/dL or higher. Intervention activities include education
of parents/child concerning lead poisoning, environmental assessments
of the home to locate "hot" spots of environmental lead
to which the child may have access, and public health nursing
assessments of the childs health. Most importantly, the
sources of lead must be identified, and eliminated from the childs
During 1997, 1825 blood tests on children ages
0 through 5 years of age were received. The geometric mean blood
lead level (BLL) was found to be 3.0 mcg/dL for that age group.
Confirmed elevated blood lead reports were received for 36 children.
An elevated blood test is considered confirmed when the analysis
was performed on a venous blood sample or two consecutive elevated
capillary blood draws are reported. Another 35 children were reported
with elevated blood lead levels (EBLL) that are pending confirmation.
The prevalence of EBLL in children in this age group was found
to be between 1.9% for confirmed cases, and 3.8% when both confirmed
and unconfirmed results were combined. The prevalence of EBLL
dropped slightly between 1996 (4.0%) and 1997(3.8%).
During 1997, only 0.78% of the children in Utah
ages 0 through 5 years old were screened for elevated blood lead
levels. From these data it is apparent that there is a need for
a more concerted effort to increase the number of blood lead screens
performed so that those children at risk of elevated blood lead
levels may be identified and measures taken to reduce these levels.
Nationally, it has been noted that the highest risk for lead poisoning
occurs in areas of lower income and older housing. However, this
is not always true as older homes are at times renovated by those
with higher incomes. Renovation of older homes painted with lead
based paint increases the risk of exposure as walls which were
painted with lead based paint are sanded and repaired.
The risk factors noted from survey responses
from the parents of lead poisoned children indicated children
placing their fingers into their mouths after exposure to lead
dust was the number one risk factor. Other factors noted include:
chewing on crayons, toys furniture, crib, or window sills, the
home of the child was built before 1960, the home has peeling
paint, child has been observed eating dirt, the child uses crayons
manufactured outside of the U.S., and the adults in the childs
family work in a high risk occupation for lead.
Adult Blood Lead Epidemiology and Surveillance
During 1997, blood
lead levels on 201 adults with BLLs > 15 mcg/dL were reported
to the UBLR. Blood lead test reports were received on 837 Utah
adults > 18 years of age during 1997. The range of all blood
lead levels reported in 1997 was 0.0 to 90 mcg/dL with a geometric
mean of 4.6 mcg/dL. The prevalence for blood lead poisoning in
1997 was found to be 5.3 persons per 100,000 for blood lead levels
> 25 mcg/dL and 1.2 persons per 100,000 for blood lead levels
> 40 mcg/dL. Corresponding values for 1996 were 5.7 and 1.1
persons per 100,000 respectively. The Bureau of Epidemiology conducted
telephone surveys of cases with BLLs > 25 mcg/dL to collect
epidemiological data. Participants were asked to report about
personal activities and hobbies performed at home and about work
habits and protective occupational measure. The most significant
personal risk factor identified through surveillance was participating
in target practice, house and auto painting, and refinishing furniture.
These risk factors are consistent with what has been found in
previous years. It is worth noting that there has been at least
one identified case where a child was poisoned by lead brought
home by an adult working in a lead related industry. The adult
was also identified as having an elevated blood lead level. Other
risk factors for adult exposure to lead include making jewelry
and using lead solder. The high risk industries noted in Utah
for exposure to lead include: auto repair, painting, mining, scrap
and waste, industrial inorganic chemical, printing, electronics
and ceramics, ammunition and arms, and rubber and plastic hose
In adults, lead can damage the brain, kidney,
and reproductive system. Lead can also cause anemia, fatigue,
increased blood pressure, short-term memory loss, reproductive
problems such as decreased sex drive and sperm count in men, difficulty
in becoming pregnant and miscarriages in women, slower reflexes,
poor muscle coordination and nerve damage.
The ABLES project continues to be an effective
and important program in identifying cases of elevated blood lead
levels and in providing information to assist those cases in reducing
their blood lead levels. The data collected indicates that occupational
lead poisoning prevention program and industrial control measures
being used are contributing to lowering both the magnitude and
prevalence of adult lead poisoning. Additional efforts need to
be made to identify the smaller industries previously not contacted
to insure that all employees who work in high risk occupations
are being tested.
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