Download 2010 Infectious Disease Report

Health Care Network Update Supplemental Report
2010 Washington County
Infectious Disease Report
Department of Public Health and Environment
Disease Prevention and Control Team
Prepared July 2011
Washington County Department of Public Health and Environment
2010 Disease Report
2010 Reportable Diseases
This is the annual summary of the number of cases of selected reportable diseases for Washington County,
Minnesota for 2010. The Washington County data for this report was obtained from the reportable disease
surveillance data collected by the Minnesota Department of Health (MDH) and Washington County
Department of Public Health and Environment (WCPHE). The intent of this report is to describe specific
communicable disease trends for your consideration within your practice and health care setting.
Assessment of the population’s health for specific communicable diseases is a core public health function.
Disease surveillance, investigation, and prioritization and evaluation of control measures are components of
assessment.
Your prompt reporting of communicable diseases allows for early recognition of disease outbreaks when
control measures are most effective in preventing additional disease. Minnesota Rules Governing
Communicable Diseases which directs health care providers to report specific communicable disease can
be found at MDH Infectious Disease Reporting Site. As you know, the Health Insurance Portability and
Accountability Act (HIPAA) allows for routine disease reporting without patient authorization.
Incidence rates in this report were calculated using disease-specific numerator data and a standardized set
of denominator data derived from the U.S. Census data.
Resources
Washington County Public Health and Environment, http://www.co.washington.mn.us/info_for_residents/public_health/
MDH Infectious Disease Reporting, http://www.health.state.mn.us/divs/idepc/dtopics/reportable/index.html
MDH Disease Control Newsletter, http://www.health.state.mn.us/divs/idepc/newsletters/dcn/index.html
2
Washington County Department of Public Health and Environment
2010 Disease Report
Tick Borne Diseases
Lyme Disease ▪ Human Anaplasmosis ▪ Babesiosis
In Minnesota, tick borne diseases are carried by the blacklegged (or 2010 Washington County Cases
deer) tick. Once a tick is attached, it must remain on the host for a
minimum of 12 hours in order to transmit any disease. Incidence peaks Lyme Disease: 69
during the early summer months, although disease can be acquired Human Anaplasmosis: 11
any time that ticks are active — generally spring thaw through the first
hard freeze. All of Washington County is considered a high risk area. Babesiosis: 1
The number of blacklegged ticks, as well as incidence of tick borne
disease, is increasing locally and throughout the region. For this reason, a short course of antibiotics
following a blacklegged tick attachment of at least 24 hours may prevent Lyme disease. Prophylaxis is most
effective when started within 72 hours of finding the attached tick.
Lyme Disease
3 – 30 days after tick bite, patient usually develops flu-like symptoms
―Bulls-eye‖ rash appears in 60 – 80% of those infected
Symptoms include fever, stiff neck, fatigue, muscle and joint pain
Human Anaplasmosis
First recognized in Minnesota and Western Wisconsin in 1993
Symptoms begin 1 – 3 weeks after tick bite and are flu-like, including fever
Can be fatal, especially in compromised individuals
Cases per 100,000
population
Comparison of Lyme Disease Rates,
Washington County and Minnesota, 2000-2010
45
40
35
30
25
20
15
10
5
0
Wash Co
MN
*2008 and 2009 data for Lyme Disease included probable case count.
2010 data includes only confirmed cases of Lyme Disease.
Resources
MDH Tick-Transmitted Diseases Site, http://www.health.state.mn.us/divs/idepc/dtopics/tickborne/index.html
WCPHE Tick Borne Disease PDF, http://www.co.washington.mn.us/client_files/documents/phe/DPC/DPC-Ticks.pdf
3
Washington County Department of Public Health and Environment
2010 Disease Report
Sexually Transmitted Diseases
Chlamydia ▪ Gonorrhea ▪ Syphilis ▪ HIV/AIDS ▪ HBV
2010 Washington County Diagnosed Cases
Chlamydia: 383
Syphilis: 6
Female: 282
Primary: 2
Male: 102
Secondary: 1
Females: 1
Gonorrhea: 30
Males: 5
Female: 20
Early and Late Latent: 3
Male: 10
Hepatitis B: 1
HIV/AIDS: 21
HIV: 13
AIDS: 8
Hepatitis B Infant
Perinatal: 1
Number of Cases
Rates per 100,000
Sexually transmitted infections (STIs) reportable under state law include Chlamydia, Gonorrhea, Syphilis,
HIV/AIDS, Hepatitis B virus and Hepatitis C virus. STIs, especially Chlamydia represent the heaviest burden
of infectious diseases for Washington County
Chlamydia Cases and Rates
residents. In 2010, STIs represented 59% of overall
Washington County, 2000 - 2010
infectious disease cases in Washington County.
450
180
Chlamydia, which is caused by the bacterium,
400
160
Chlamydia trachomatis, is most notably associated
350
140
with its ability to permanently damage a woman's
300
120
250
100
reproductive organs and often presents without any
200
80
symptoms. The highest percentage of cases for
150
60
Washington County is consistently in the 15-19 and
100
40
20-24 age groups.
50
20
0
0
The Minnesota Chlamydia Strategy:
Cases
Rates
Chlamydia Rates, Females Age 15-24,
Washington County, 2000-2010
Rate per 100,000
Action Plan to Reduce and Prevent Chlamydia in
Minnesota was created in 2011 to help understand
the impact of Chlamydia in Minnesota. Chlamydia
was the highest disease burden statewide in
Minnesota in 2010 with 4,327 males and 10,065
females affected. Washington County Public Health
and Environment is aware of the significance of this
disease burden and is working towards interventions
to reduce and prevent transmission of sexually
transmitted infections.
1400
1200
1000
800
600
Resources
MDH STD Statistics and Reports, http://www.health.state.mn.us/divs/idepc/dtopics/stds/stdstatistics.html
CDC Treatment Guidelines, http://www.cdc.gov/std/treatment/default.htm
MDH Expedited Partner Therapy Site, http://www.health.state.mn.us/ept
4
Washington County Department of Public Health and Environment
2010 Disease Report
Pertussis
Pertussis, or whooping cough, is a bacterial infection
involving the respiratory system. Symptoms include a cough
lasting more than 7 days, often accompanied by post-tussive
vomiting and/or a ―whooping‖ sound with inhalation.
This distinctive sound is more prevalent in pediatric patients.
Given the highly contagious nature and
transmission route of this bacterium, confirmed
and suspect cases should be excluded from close
-contact settings, including school and daycare,
for 5 days following the start of treatment. To
further reduce spread, prophylactic antibiotics
should be offered to household members and
extended household contacts. WCPHE conducts
follow-up investigation of all reported pertussis
cases to assess the burden of disease in the
community and recommend targeted control
measures to prevent additional disease. Often,
individual and group contacts are identified and
informed of the exposure.
2010 Washington County Cases
Pertussis: 52
*provisional data
80
60
40
20
0
35
30
25
20
15
10
5
0
Pertussis
Rates per 100,000
Number of Cases
Pertussis Cases and Rates,
Washington County 2000-2010
Pertussis Rate
Although pertussis is often considered a childhood illness, a large number of cases occur in adolescents
and adults. Older adolescents and adults are the primary reservoir of the etiologic agent. Infants and very
young children typically experience more severe morbidity and are often sentinel cases denoting an
increase of disease activity within a community.
Pertussis numbers have been increasing across the country since the mid 1970’s. Factors behind this rise
include under-vaccination of children, waning immunity from childhood vaccinations, and under-recognition
of mild cases of the disease in older adolescents and adults.
Due to the recognition of waning immunity, the CDC recommends the following pertussis-containing vaccine
(Tdap) schedule for children older than 7 years and adults:
Adolescents at 11-12 years.
Adolescents 13-18 years who did not receive a dose at 11-12 years.
Adults 19-64 years should receive a single dose of Tdap instead of Td, especially those who are
caregivers of or in close contact with infants less than 12 months, including health care workers.
Pregnant women due for vaccination should receive it in the immediate postpartum period.
ACIP has recommended off-label use of Tdap products in order to expand Tdap vaccination and reduce
pertussis disease:
Children 7-10 years who have not completed their DTaP primary series.
Adults 65 years and older, especially those who are caregivers of or in close contact with infants
less than 12 months.
Resources
MDH Pertussis Information for Health Professionals,
http://www.health.state.mn.us/divs/idepc/diseases/pertussis/hcp/index.html
5
Washington County Department of Public Health and Environment
2010 Disease Report
Gastrointestinal Illness Report
A myriad of gastrointestinal illness (including an observed increase
of gastroenteritis) are designated as reportable under state law to
the health department.
In general, patients presenting with
gastrointestinal tract illness will exhibit symptoms of vomiting and/or
diarrhea, abdominal pain, and possibly fever. Food or water borne
outbreaks are defined as incidents in which two or more unrelated
persons experience a similar illness after a common exposure or
are linked by common etiologic agent.
Gastrointestinal disease threats (including food and water borne
illness) are numerous and varied, involving biological and
nonbiological agents. These diseases can be caused by numerous
microorganisms and their toxins. Over the past several years, food
and water-borne outbreaks in the county have been linked to
lettuce (Campylobacter); undercooked vegetable omelets
(noroviruses); dissection of owl pellets (Salmonella); swimming
pools (Cryptosporidium); iced beverages (hepatitis A virus); and
backyard wading pools (Shigella).
2010 Washington County Cases
Camplyobacteriosis: 39
Salmonellosis: 26
Shiga Toxin Producing E.coli: 5
Shigellosis: 1
Cryptosporidiosis: 5
2010 Enteric Outbreaks
Clostridium perfringens: 1
Norovirus:
—Food-borne: 4
—Person-to-person: 2
In 2010, a confirmed Clostridium perfringens food-borne outbreak was associated with a Mother’s Day
buffet. Over 650 restaurant patrons attend the event. Based on univariate rate analysis of epidemiologic
data, environmental field investigation and illness histories of patients, prime rib was definitely implicated as
source of bacterial intoxication.
Outbreak Surveillance
Physicians and other health care professionals have a critical role in surveillance and prevention of potential
gastrointestinal disease outbreaks. Only a small proportion of individuals who experience gastrointestinal
illness seek medical care. A health care professional who encounters these individuals may be the only one
with the opportunity to make an early and expeditious diagnosis.
To capitalize on health care professional reports, WCPHE utilizes a unified outbreak investigative approach
with a core team of public health professionals (i.e., epidemiologist, medical consultant, environmental
health specialists and public health nurses.) The investigation is designed to assess the extent and severity
of disease, disrupt transmission and assure implementation of targeted control measures.
Resources
Diagnosis and Management of Foodborne Illnesses; A Primer for Physicians and Other Health Care Professionals
http://www.ama-assn.org/ama/pub/physician-resources/medical-science/food-borne-illnesses/diagnosismanagement foodborne.shtml
MDH Food-borne Illness Information for Healthcare Providers,
http://www.health.state.mn.us/divs/idepc/dtopics/foodborne/healthcare.html
6
Washington County Department of Public Health and Environment
2010 Disease Report
Total Disease Reports 2008-2010
Disease/Infection
2008
2009
2010*
AIDS
4
5
3
Amebiasis
1
4
1
Aseptic Meningitis
8
4
17
Babesiosis
0
0
1
Bacterial Meningitis—Other
0
0
0
Campylobacteriosis
26
38
39
Chlamydia
316
364
383
Chlamydia, Gonorrhea
8
10
7
Coccidiomycosis
0
0
0
Cryptosporidiosis
1
5
5
Cyclospora
0
1
0
Dengue Fever
1
1
0
Giardiasis
33
26
0
Gonorrhea
39
48
23
H. Influenzae, Invasive Dis.
0
4
5
Hemolytic Uremic Syndrome
0
1
0
Hepatitis A
0
3
0
Hepatitis B
1
2
1
Hepatitis B—Perinatal
11
17
1
Hepatitis C
0
1
0
HIV
2
7
12
Human Anaplasmosis
11
9
11
Human Monocytic
Ehrlichiosis
0
0
1
Kawasaki Disease
0
0
2
Lyme Disease
73
96
69
Malaria
0
0
1
*provisional data
7
Washington County Department of Public Health and Environment
2010 Disease Report
Total Disease Reports Cont.
Disease/Infection
2008
2009
2010*
Meningococcal Disease
0
1
0
Mumps
0
0
0
N. Meningitidis, Invas. Dis.
1
0
0
Pertussis
25
39
52
Polio, Paralytic
0
1
0
Rabies-Animal Positive
3
2
2
Rocky Mtn. Spotted Fever
1
1
0
S. Pneum., Drug-Res. Invas.
0
6
0
S. Pneum., Invas. Disease
3
2
21
Salmonellosis
30
30
26
Shiga Toxin Prod. E. Coli
9
17
5
Shigellosis
10
5
1
Strep Grp A Invas. Disease
11
5
6
Strep Grp B Invas. Disease
7
15
15
Syphilis Early Latent
1
3
1
Syphilis Late Latent
3
3
2
Syphilis Primary
2
0
2
Syphillis Secondary
1
1
1
Toxic Shock Syndrome
0
0
0
Tuberculosis
2
2
3
Tuberculosis Infection, Latent
12
20
0
Typhus Fever
(Fleaborne, Murine)
0
1
0
Vibriosis
1
0
0
West Nile Virus Non-Neuro
0
0
0
Yersiniosis
0
1
0
*provisional data
8