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The Health of Multnomah County: Communicable Diseases Communicable Diseases This summary provides data about several communicable diseases in Multnomah County. These conditions include infections transmitted through casual contact, ingestion of contaminated food or water, and intimate contact, such as sexual activity or other exposure to bodily fluids. This summary includes: • • • • Tuberculosis Hepatitis A, B, and C Selected vaccine-preventable diseases: pertussis (whooping cough), meningococcal disease Diarrheal diseases related to: Campylobacter, E. coli, Salmonella, Giardia For each disease, condition, or pathogen, we provide numbers of cases and rate per 100,000 Multnomah County residents over several years and compare these to the state-wide statistics. When data are available, we also present the incidence rate by racial, ethnic, and gender groupings. Each section begins with an overview of the organism(s) that cause the disease, how it is spread, and how it may be prevented and treated. Tuberculosis Infectious agent: bacteria in the Mycobacterium tuberculosis complex of species Transmission: airborne (inhalation of aerosolized saliva or mucus of infected person) Prevention: controlling risk factors such as overcrowding, poverty, smoking, and diabetes; immunization (not used in the U.S.) Treatment: combination therapy of multiple antibiotic drugs Figure 7.11 Tuberculosis Case Rates Multnomah County, Oregon and U.S. 8 Rate per 100,000 Population Figure 7.11 displays rates of tuberculosis per 100,000 residents for Multnomah County, Oregon, and the U.S. TB rates in Multnomah County generally declined from 2000-2010. Rates of TB were higher among foreign-born residents than among U.S.-born residents; more than two-thirds of Oregon TB cases were in people born outside the United States (data not shown). 7 Multnomah County 6.2 6 5 5.8 4.9 U.S. 3.6 4 3 2 3.5 Oregon 2.3 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 MULTNOMAH COUNTY HEALTH DEPARTMENT Updated, February 2014 1 The Health of Multnomah County: Communicable Diseases Hepatitis A, B, and C Hepatitis B Infectious agent: hepatitis B virus, a hepadnavirus Typical transmission: bloodborne (contact with contaminated medical equipment; vaginal or anal intercourse; mother-to-child during gestation or childbirth) Prevention: use of barrier methods (e.g., condoms) during sexual contact; use of sterile, single-use medical equipment; immunization Treatment: none from acute episode, disease management for chronic cases Multnomah Co. Oregon 5 Rate per 100,000 population In Multnomah County and statewide, the yearly case rate of hepatitis A has decreased since the early 2000s (Figure 7.12). In 2010, the hepatitis A rate was down to 0.4 per 100,000 residents. Figure 7.12 Hepatitis A Case Rates 4 3.1 3 2 1.1 1 0.4 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Figure 7.13 Acute Hepatitis B Case Rates 12 Rate per 100,000 population Hepatitis A Infectious agent: hepatitis A virus, a picornavirus Transmission: fecal-oral (ingestion of fecal matter of an infected person, usually through contaminated food or water) Prevention: sanitary infrastructure, food handling regulations, hand washing; immunization Treatment: none, condition generally resolves after acute episode 10 Multnomah County Oregon 8.7 8 6 4 4.8 2 1.1 0 2001 2002 2003 2004 County rates of hepatitis B declined from 2001 on, and were at 1.1 per 100,000 residents in 2010 (Figure 7.13). MULTNOMAH COUNTY HEALTH DEPARTMENT Updated, February 2014 2 2005 2006 2007 2008 2009 2010 The Health of Multnomah County: Communicable Diseases Figure 7.14 Acute Hepatitis C Case Rates Multnomah County 1.2 Rate per 100,000 population Hepatitis C Infectious agent: hepatitis C virus, a flavivirus Typical transmission: bloodborne (injection drug use; contact with contaminated medical equipment; vaginal or anal intercourse; mother-to-child during gestation or childbirth) Prevention: use of sterile, single-use medical equipment; use of barrier methods (e.g., condoms) during sexual contact Treatment: antiretroviral drugs (lessen symptoms but rarely eliminate virus) Oregon 1.0 0.8 0.7 0.5 0.6 0.4 0.4 0.3 0.2 0.0 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2004 2005 2003 2006 2007 2008 2009 2010 In the early 2000s, rates of acute hepatitis C were similar for the state (.4 per 100,000) and Multnomah County (.5 per 100,000). By 2003-2005, however, the rates diverged. Until 2008, Multnomah County had higher rates of acute hepatitis C than the rest of the state, peaking with the 2004-2006 interval. After 2008, the county’s rate decreased to 0.3 per 100,000 residents, while the state rate remained at 0.7 per 100,000. Selected vaccine-preventable diseases Pertussis (whooping cough) Infectious agent: Bordetella pertussis bacteria Typical transmission: airborne Prevention: immunization Treatment: antibiotics to prevent spread to others Table 7.1 Selected Vaccine-preventable Diseases, Multnomah County Rate per 100,000 Population Pertussis From 2000 through 2007, 62% of the pertussis cases in Oregon were in people aged 10 years or older (data not shown). The rate of pertussis in the county has fluctuated since 2002, with peaking at12.9 per 100,000 in 2005 and dropping to 3.2 in 2007. There were 51 cases of pertussis reported in Multnomah County in 2010, with a rate of 6.9 cases per 100,000 (Table 7.1). Meningococcal Disease Year 2002 Rate 3.7 Cases 25 Rate 1.0 Cases 7 2003 8.8 60 1.3 9 2004 4.0 27 1.0 7 2005 12.9 87 1.3 9 2006 3.4 23 0.9 6 2007 3.2 22 0.7 5 2008 5.2 37 1.1 8 2009 6.7 49 1.1 8 2010 6.9 51 ** too few cases to report MULTNOMAH COUNTY HEALTH DEPARTMENT Updated, February 2014 3 ** The Health of Multnomah County: Communicable Diseases Meningococcal Disease Infectious agent: Neisseria meningitidis bacteria Typical transmission: contact with infected saliva Prevention: immunization Treatment: antibiotics For the past several years, rates of meningococcal disease in Multnomah County have hovered around one case for every 100,000 residents (Table 7.1). Diarrheal Diseases The most common causes of diarrheal diseases in Multnomah County include the organisms Campylobacter, E. coli, Salmonella, and Giardia. Rate per 100,000 population Rates of most of these diarrheal Figure 7.15 diseases have increased in recent Diarrheal Disease Rates, Multnomah County years (Figure 7.15). The 2010 30 Campylobacter E. Coli Giardia Salmonella rate of campylobacteriosis (27.2 per 100,000) did not achieve the 25 21.9 Healthy People 2020 standard of 8.5 cases per 100,000. 20 16.5 Salmonellosis, at 15.1 cases per 100,000 residents in 2010, also 15 12.1 failed to meet the Healthy 10 People 2020 threshold of 11.4. However, Multnomah County’s 5 rate of 0.4 cases of Shiga toxin1.7 producing E. coli (STEC) per 0 100,000 residents in 2010 met 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 the Healthy People 2020 standard of 0.6. The federal government does not set a standard for giardiasis, but Multnomah County (24.3 per 100,000) and Oregon (12.5) had higher rates than the national rate of 7.4 in 2008. Data Sources Data about case reports were obtained from the Oregon Health Authority’s Acute and Communicable Disease Prevention and Tuberculosis Programs. Population estimates were obtained from the National Center for Health Statistics. To stabilize rates and observe trends in situations with small numbers of cases, some rates were aggregated into rolling averages using three-year intervals instead of singleyear counts. In some instances, we are unable to present the rate or number of cases because reporting small numbers could compromise confidentiality and/or accuracy. We used statistical techniques to assess if those changes were significant, meaning that the differences were real and did not happen by chance alone. MULTNOMAH COUNTY HEALTH DEPARTMENT Updated, February 2014 4 27.2 24.3 15.1 0.4 2010 The Health of Multnomah County: Communicable Diseases MULTNOMAH COUNTY HEALTH DEPARTMENT Updated, February 2014 5