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EPI UPDATE
A weekly publication by the Bureau of
Epidemiology
"The reason for
collecting, analyzing and disseminating information on a disease is to control that
disease. Collection and analysis should not be allowed to consume resources if action does
not follow."
--Foege WH et al. Int. J of Epidemiology 1976; 5:29-37.
For August 27, 1999
Richard S. Hopkins, MD, MSPH,
Bureau Chief, State Epidemiologist
Don Ward, Surveillance Section Administrator, Epi Update Managing Editor
Jill H. Parker, MSP, Epi Update Editor
Bureau of Epidemiology Frequent Contributors:
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Steven Wiersma,
MD, MPH,
Deputy State Epidemiologist
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William J. Bigler, PhD, MS,
Senior Epidemiologist
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Jodi Baldy, MPH,
Biological Scientist IV
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Ursula E. Bauer, PhD,
Chronic Disease Epidemiologist
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John Werth, MA,
Bureau Education Coordinator
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Lisa Conti, DVM, MPH,
State Public Health Veterinarian
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Regional Epidemiologists:
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Dolly Katz, PhD, MPH,
SE Florida
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Roger Sanderson, RN, MA,
SW Florida
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Carina Blackmore, MS Vet. Med., PhD,
NE Florida
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Zuber Mulla, MSPH,
Central Florida
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Gérard Krause, MD, DTMH,
NW Florida
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Please print out this
material and share with epidemiology staff, county health department directors,
administrators, medical directors, nursing directors, environmental health directors and
others with an interest in information of this type. Thank you.
The Bureau of Epidemiology is available 24 hours a day, 7
days a week for consultation at our main number (850/245-4401) PLEASE NOTE:
Consultation after 5 p.m. & on weekends is intended for emergencies.
The Department of Health has a home on the
World Wide Web at --- http://www.doh.state.fl.us
In this issue:
1. Reporting Procedures for HbsAg Positive Pregnant Women
2. Rabies Alert Map: January through August 20, 1999
3. Environmental Control of Asthma - Two Day Seminar
4. Childhood Lead Poisoning - Teleconference Announcement
5. Upcoming Events
6. Florida Past: Preservation of "Good Order and Health" in the
Florida Provinces
7. Weekly Disease Table: Week 33
1. Reporting Procedure for HbsAg
Positive Pregnant Women
Don Ward, Surveillance Section Administrator
With the changes in Chapter 64D-3.013, Florida Administrative Code, all
hepatitis B surface antigen (HbsAg) positive pregnant women and all HbsAg-positive
children less than 25 months of age are reportable regardless of the presence of illness.
A positive hepatitis B surface antigen test (HBsAg) does not, in itself, confirm the
presence of disease. Further testing is necessary to identify the infection as acute or
chronic disease or asymptomatic seroconversion. The purpose of reporting HBsAg positive
pregnant women is to ensure the protection of their infants against infection with
hepatitis B. In the 1997 Red Book of the American Academy of Pediatrics, the authors state
that, "Transmission of perinatal HBV infection can be prevented in approximately 95%
of infants born to HBsAg-positive mothers by early active and passive immunoprophylaxis of
the infants, i.e., vaccination and HBIG administration."
While assuring that HBsAg positive pregnant women receive appropriate follow-up; and
that their infants receive immunoprophylaxis is the responsibility of the county health
departments with coordination by the Bureau of Immunization, reporting of these women to
the Bureau of Epidemiology is important for at least two reasons:
- One of the important components of the upcoming statewide viral hepatitis prevention
initiative will be a hepatitis registry, which will contain information about patients
infected with viral hepatitis and others at risk (such as contacts). For search and
analysis purposes, it will be important to include HBsAg-positive women in the registry.
- Reporting to the Bureau of Epidemiology maintains consistency of reporting and provides
the capacity for epidemiologic analysis as is possible with all other hepatitis
infections.
Procedure (also see diagram at end of article):
- County health departments will report all HBsAg-positive pregnant women and
HbsAg-positive children <25 months of age to the Bureau of Epidemiology on a 2016
morbidity report form. When the morbidity is recorded in the Bureau of Epidemiology, the
2016 report will be forwarded to the Bureau of Immunization for matching against the
"Perinatal Hepatitis B Case and Contact Reports." The ICD code for reporting on
the 2016 to be used for HBsAg positive pregnant women will be 07039. The ICD code to be
used for reporting cases of children less than 25 months of age with HbsAg positive
surface antigen is 07744.
- County health departments will also report (within 10 days) extended data for
HBsAg-positive pregnant women directly to the Bureau of Immunization on the DH1876 (1/92),
"Perinatal Hepatitis B Case and Contact Report" according to CHD Internal
Operating Policy: Immun 7, and TA Immun 7. CHDs will continue to case manage the
HbsAg-positive pregnant woman, her infant and contacts according to CHD Guidebook Internal
Operating Policies: Immun 7 and STD 10 and Technical Assistance: Immun 7 and STD 16.
- In the event that a HBsAg-positive pregnant woman is determined to be infected with
acute hepatitis B, the county will report that acute infection separately (from the
surface antigen report) on a 2016 with the ICD code 07030. That 2016 report must be
accompanied by a CDC 53.1 "Viral Hepatitis Case Record." Both will be sent to
the Bureau of Epidemiology.
Immunization and Epidemiology policies that specify the perinatal hepatitis B and STD
follow-up in the county health department guidebook will be modified to reflect this
change in reporting practices.
Reporting Procedures for HbsAg Positive Pregnant Women
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IF
HbsAg+ pregnant woman or child <25 months of age
THEN
1. Complete 2016, send to Bureau of Epidemiology [ICD codes: 07039 (pregnant women)
or 07744 (children < 25 months of age)]
2. Complete "Perinatal Hepatitis B Case and Contact Report" form (DH 1876)
and send to Bureau of Immunization
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IF the woman is found to be a case of chronic hepatitis
B, or if she is determined to be a case of asymptomatic seroconversion
(neither a case of acute nor chronic hepatitis B):
THEN, no further reporting is required for these two cases.
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IF the woman is further diagnosed with acute hepatitis B:
THEN
1. Include the acute case on a separate 2016 report (ICD code=7030)
2. Complete the CDC 53.1 "Viral Hepatitis Case Record" form
3. send both documents to the Bureau of Epidemiology.
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2. Rabies Alert Map
Dr. Lisa Conti, DVM, MPH, State Public Health Veterinarian
Attached is the rabies alert map for January through August 20, 1999. The map
will also be posted on the Bureau of Epidemiology internet web page http://www.doh.state.fl.us.
Should you have trouble accessing the map, either from this attachment or from
the internet web page, please contact Jill Parker
to request that a copy be faxed or mailed to you.
Rabies Alert Map
3. Environmental Control of
Asthma is Topic of Two Day Seminar Hosted by the Bureau of Environmental Toxicology
The Florida Department of Health, Bureau of Environmental
Toxicology is co-sponsoring a two-day technical seminar on the environmental control of
asthma. The seminar will focus on the relationship between asthma, an important emerging
public health issue, and indoor allergens. Attendees will receive practical information
about identifying and controlling conditions that adversely affect the indoor environment
and human health. The seminar will be lead by nationally recognized presenters who will be
available before, during, and after the event for additional discussions and responses to
questions.
Two regional seminars have been planned. The first will be held at the Oceanfront
Auditorium in Miami on September 30 to October 1, 1999. The second is planned for November
18-19, 1999 at the Sheraton Safari Hotel in Orlando.
There will be a significantly reduced registration fee for Department of Health staff.
For additional information and to receive a brochure on these events, please call Radon
and Indoor Toxics Office at (850) 488-1525 or Suncom 278-1525.
4. Childhood Lead Poisoning -
Teleconference Announcement
Trina Thompson, Coordinator, Childhood Lead Poisoning Surveillance Program,
Bureau of Environmental Epidemiology
The Childhood Lead Poisoning Surveillance Program (Bureau of
Environmental Epidemiology), with funding from the Centers for Disease Control and
Prevention, is offering a teleconference on September 17, 1999, entitled "Childhood
Lead Poisoning: Research Practice and Prevention."
5.
Upcoming Events
- 2000 NACCHO Annual Conference July 19-22, 2000, Los Angeles, California
This conference will be held jointly with the Association of State and Territorial
Health Officials (ASTHO).
- National Association of Community Health Centers, Inc. 30th Annual Conference
September
26-29, 1999, Miami Beach, FL
For more information, visit NACHC's web page at
http://www.nachc.com.
- American Public Health Association 1999 Annual Meeting November 7-11, 1999 Chicago,
Illinois
For more information, see the APHA web site or contact Carroll Lewis at APHA.
- 1999 Maternal, Infant, and Child Health Epidemiology Workshop, December 8-9, 1999,
Atlanta, Georgia
For more information, visit MICHEP's website.
6. Florida Past: Preservation of "Good Order and Health" in
the Florida Provinces
William J. Bigler, PhD
Last week we printed a facsimile of Major General Jacksons ordinance for
creation of the Board of Health for St. Augustine. A similar ordinance was executed for
Pensacola.
Since Governor Jackson had authority to appoint the Mayor and aldermen for both cities,
he also produced ordinances that outlined the duties and powers of the government as they
related to the preservation of "Good Order and Health" for the town. A facsimile
of the Ordinance for Pensacola follows:
"AN ORDINANCE
"By Major General Andrew Jackson, Governor of the provinces of the Floridas,
exercising the powers of the Captain General and of the Intendant of the Island of Cuba,
over the said provinces, and of the Governors of said provinces respectively:
"That with a view to the preservation of the good order and health of the town of
Pensacola I do ordain:
"Sect. 1. That there shall be appointed by the Governor annually, a Chief Officer
to be called the Mayor, and six subordinate officers to be called Aldermen, who shall form
a Council, and have and exercise all the powers necessary to the good government of the
said town.
"Sect. 2. That the said Mayor and Council shall have power by Ordinance or
otherwise, to impose fines and forfeitures for the infraction of their regulation, and
appoint such officers as they may deem necessary for the support of their town government.
"Sect. 3. As the Christian Sabbath is observed throughout the civilized world, it
is ordained, that in order to remove any doubts which might be entertained with respect to
the powers of the Mayor and Council on this subject, that the said Mayor and Council be
authorized to make any regulation for the due observance thereof which they may deem
proper.
"Sect. 4 In order to remove all doubts on the subject of the limits of the said
town of Pensacola and its dependencies, as well as to place under the immediate control of
the Mayor and Council, all the fountains or springs from which the inhabitants are
supplied with water, it is ordained, that the incorporated limits of said town shall be as
follows:
"Bounded to the south and east by the harbor, to the west by the Western Lagoon,
or Bayou Chico, and to the north by a line running due east from Galvez Spring to where
such line will intersect the eastern or Texar Lagoon.
"Sect. 5. That public gaming houses, as well as public gaming of every
description, (billiards alone excepted) shall be and the same is thereby interdicted and
prohibited, under the penalty of two hundred dollars for each conviction, and the
forfeiture of all the apparatus or machinery used towards the commission of such offences,
as well as all sums of money which may be seized by the public officer or other person;
one half to the use of the informer, and the other to the use of the town, and that each
and every person so convicted, shall be, and stand committed to prison until the whole of
said fine and costs are paid, and moreover, until he shall have good and sufficient surety
in the sum of five hundred dollars for his good behavior, for and during the term of one
year.
"Sect. 6. That the Mayor and Alderman, as is provided for in this Ordinance, shall
be known and called the City Council of Pensacola, and in that name may acquire and
dispose of property for public uses, and sue and be sued, and plead and be impleaded on
all subjects relating to, or connected with the said town and its dependencies.
"Sect. 7. That all inkeepers, grocers, and all other retailers of liquor, are, by
this Ordinance, expressly prohibited from furnishing or selling any liquor or ardent
spirits whatever, to any soldier in the service of the United States of America, under the
penalty of 19 dollars for each offence, and to stand committed to the common jail until
the said penalty with costs are paid.
Pensacola, July 18,1821
(signed) ANDREW JACKSON
By the Governor,
K. Call,
Acting Secretary of West Florida"
7. Weekly Disease Table - Week 33
County-Confirmed Cases, Sorted Alphabetically by
Disease
NR represents years that the disease lacked
status as a reportable condition
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DISEASE
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1996 TO DATE
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1997 TO DATE
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1998 TO DATE
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3 YEAR AVERAGE TO DATE
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1998 TOTAL CASES
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1999 TO DATE
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Amebiasis
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46
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35
|
41
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40.7
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91
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28
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Anthrax
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0
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0
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0
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0
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0
|
0
|
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Botulism
|
0
|
0
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0
|
0
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0
|
0
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Brucellosis
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5
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0
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2
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2.3
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3
|
1
|
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Campylobacteriosis
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711
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608
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445
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588
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975
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565
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Ciguatera
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8
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4
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7
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6.3
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7
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2
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Cryptosporidiosis
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92
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69
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78
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79.7
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203
|
75
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Cyclosporiasis
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174
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61
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6
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80.3
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6
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4
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Dengue
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0
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2
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2
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1.3
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5
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2
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Diphtheria
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0
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0
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0
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0
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0
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0
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E. coli O157:H7
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15
|
34
|
24
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24.3
|
57
|
31
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E. coli, other (known serotype)
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3
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5
|
3
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3.7
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12
|
12
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Ehrlichiosis, Human
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4
|
2
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0
|
2
|
1
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1
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Encephalitis, Eastern Equine
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0
|
2
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0
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0.7
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0
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0
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Encephalitis, St. Louis
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0
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0
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0
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0
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2
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0
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Encephalitis, other (known organism)
|
4
|
7
|
3
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4.7
|
7
|
3
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Encephalitis, post-infectious*
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12
|
5
|
7
|
8
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21
|
5
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Giardiasis (acute)
|
1036
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896
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777
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903
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1636
|
638
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Haemophilus influenzae*, invasive
|
14
|
16
|
29
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19.7
|
45
|
33
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Hansens Disease (Leprosy)
|
1
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0
|
3
|
1.3
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4
|
2
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Hantavirus Infection
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0
|
0
|
0
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0
|
0
|
0
|
|
Hemolytic Uremic Syndrome
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0
|
3
|
6
|
3
|
12
|
6
|
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Hemorrhagic Fever
|
0
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0
|
0
|
0
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0
|
0
|
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Hepatitis A
|
276
|
290
|
311
|
292.3
|
539
|
404
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Hepatitis B
|
321
|
236
|
249
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268.7
|
466
|
261
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Hepatitis Non-A, Non-B
|
53
|
57
|
56
|
55.3
|
95
|
4
|
|
Hepatitis, unspecified
|
2
|
5
|
6
|
4.3
|
26
|
10
|
|
Lead Poisoning
|
1196
|
841
|
1094
|
1043.7
|
1805
|
423
|
|
Legionellosis
|
20
|
16
|
22
|
19.3
|
48
|
17
|
|
Leptospirosis
|
0
|
0
|
1
|
0.3
|
2
|
0
|
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Lyme Disease
|
10
|
15
|
25
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16.7
|
71
|
19
|
|
Malaria
|
53
|
47
|
35
|
45
|
96
|
53
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Measles
|
1
|
3
|
2
|
2
|
2
|
2
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Meningococcal Disease (N. meningitidis)
|
129
|
103
|
89
|
107
|
133
|
74
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|
Meningitis, Group B Streptococci
|
17
|
11
|
11
|
13
|
22
|
10
|
|
Meningitis, Haemophilus influenzae
|
5
|
6
|
11
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7.3
|
12
|
11
|
|
Meningitis, Streptococcus pneumoniae
|
70
|
50
|
56
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58.7
|
96
|
75
|
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Meningitis, Listeria monocytogenes
|
4
|
2
|
4
|
3.3
|
13
|
6
|
|
Meningitis, other bacterial (including unspecified)
|
65
|
37
|
38
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46.7
|
75
|
46
|
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Mercury Poisoning
|
5
|
2
|
0
|
2.3
|
4
|
2
|
|
Mumps
|
6
|
8
|
9
|
7.7
|
11
|
3
|
|
Neurotoxic Shellfish Poisoning
|
3
|
0
|
0
|
1
|
0
|
0
|
|
Pertussis
|
65
|
47
|
25
|
45.7
|
39
|
54
|
|
Pesticide Poisoning
|
1
|
0
|
1
|
0.7
|
1
|
1
|
|
Plague
|
0
|
0
|
0
|
0
|
0
|
0
|
|
Poliomyelitis
|
0
|
0
|
0
|
0
|
0
|
0
|
|
Psittacosis
|
0
|
0
|
1
|
0.3
|
2
|
0
|
|
Rabies, Animal
|
144
|
191
|
131
|
155.3
|
215
|
123
|
|
Rocky Mountain Spotted Fever
|
1
|
2
|
1
|
1.3
|
2
|
3
|
|
Rubella, including congenital
|
10
|
1
|
3
|
4.7
|
4
|
0
|
|
Salmonellosis
|
1276
|
1096
|
1271
|
1214.3
|
3038
|
1371
|
|
Shigellosis
|
886
|
742
|
1297
|
975
|
2343
|
858
|
|
Streptococcal Disease, invasive Group A
|
2
|
24
|
31
|
19
|
57
|
59
|
|
Streptococcus pneumoniae, Drug Resistant
|
1
|
131
|
291
|
141
|
493
|
412
|
|
Tetanus
|
1
|
1
|
2
|
1.3
|
3
|
1
|
|
Toxic Shock Syndrome
|
0
|
1
|
3
|
1.3
|
4
|
3
|
|
Toxoplasmosis
|
6
|
4
|
7
|
5.7
|
15
|
9
|
|
Typhoid Fever
|
12
|
5
|
10
|
9
|
16
|
22
|
|
Vibrio cholerae (serogrp O1)
|
0
|
0
|
0
|
0
|
0
|
1
|
|
Vibrio cholerae (serogrp Non-O1)
|
1
|
6
|
6
|
4.3
|
11
|
7
|
|
Vibrio vulnificus
|
7
|
8
|
15
|
10
|
35
|
10
|
|
Vibrio other (including unspecified)
|
14
|
20
|
46
|
26.7
|
73
|
25
|
|
Yellow Fever
|
0
|
0
|
0
|
0
|
0
|
0
|
*Haemophilus influenzae can be the agent responsible
for disease under three of the reportable conditions listed-:
"Haemophilus influenzae, invasive" and under "Encephalitis, post
infectious." Cases of Haemophilus influenzae meningitis are reported under
"Meningitis, H. influenzae."
Editor's Note: Kawasaki Disease, Histoplasmosis, Reye Syndrome, and Typhus were
deleted from the weekly disease table since cases are no longer reportable.
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