Bureau of Epidemiology
Bureau of Epidemiology January 1999 Utah Department of Health
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1998: The Year in Review
Child And Adult Blood Lead Surveillance, Utah 1997  
 
 
1998: The Year in Review

Vaccine-Preventable Diseases


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.

Enteric Diseases

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.

Viral Hepatitis

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.

HIV/AIDS

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.

Meningitis

Meningococcal 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 (1).

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).

Tuberculosis

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 work.

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Child 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 (CBLES)

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 child’s 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 constipation.

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 child’s health. Most importantly, the sources of lead must be identified, and eliminated from the child’s access.

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 child’s family work in a high risk occupation for lead.

Adult Blood Lead Epidemiology and Surveillance (ABLES)

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 & belting.

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 Services

Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology

Cristie Chesler, BA, Managing Editor

 

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