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EPI UPDATE
A weekly publication by the Bureau of Epidemiology
For May 10, 2000
"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.
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:
|
Steven Wiersma, MD, MPH,
Deputy State Epidemiologist |
William J. Bigler, PhD, MS,
Senior Epidemiologist |
Jodi Baldy, MPH,
Biological Scientist IV |
|
Ursula E. Bauer, PhD,
Chronic Disease Epidemiologist |
John Werth, MA,
Bureau Education Coordinator |
Lisa Conti, DVM, MPH,
State Public Health Veterinarian |
Regional Epidemiologists:
|
Dolly Katz, PhD, MPH,
SE Florida |
Roger Sanderson, RN, MA,
SW Florida |
Carina Blackmore, MS Vet. Med., PhD,
NE Florida Carina Blackmore, MS Vet. Med., PhD, |
Zuber Mulla, MSPH,
Central Florida Carina Blackmore, MS Vet. Med., PhD, |
Gérard Krause, MD, DTMH,
NW Florida |
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.
In this issue:
- Reasons Given for Utilization of Services from an Unlicensed Dentist
- Risk Factors for Lead Poisoning in Recently Arrived Immigrant Children Seen at Miami-Dade County Refugee Health Assessment Center
- Statewide Networking for the 2000 Arbovirus Season
- Eosinophilic Meningitis, CDC Confirmed – USA (Chicago)
- CDC Publishes Update on Influenza Activity
- CDC Website Teaches How to Investigate Disease Outbreaks
- Florida Past – The State Board of Health Service Emblem
- Weekly Disease Table: Week 18
1. Reasons Given for Utilization of Services from an Unlicensed Dentist
Bassart, L., Pandya-Smith, I., Weisbord, J., Trepka, M.J.
(The following article appeared in the Epi Monthly Report (Vol. 1, No. 4, April 2000) published by the Office of Epidemiology and Control, Miami-Dade County Health Department.)
Background: In December of 1998, the State of Florida initiated an Unlicensed Activity Office to investigate unlicensed practitioners. Since its inception, approximately 40 unlicensed practitioners have been arrested on a variety of charges throughout the state of Florida. In March of 2000, the office arrested a man who was practicing dentistry in Miami-Dade County without a license. The officials documented very poor infection control practices.
Objective: To determine possible reasons for use of services of an unlicensed dentist and to examine if there had been any potential transmission of hepatitis B, C, or HIV between clients who received services from the unlicensed dental practitioner.
Methods: Client contact information was obtained from a confiscated record book belonging to the practitioner. Miami-Dade County Health Department (MDCHD) personnel attempted to contact the listed clients so they could be advised to undergo screening for blood borne pathogens, namely hepatitis B, hepatitis C, and HIV. In addition, a hotline was made available to the public. This hotline was advertised on several local television, radio, and newspaper releases. Clients who desired to come in for testing were tested at the MDCHD Sexually Transmitted Diseases (STD) Clinic. A standardized questionnaire containing both closed and open-ended questions was used to obtain demographic information as well as information related to the use of this practitioner and what services were received. A certified HIV counselor, who was also trained about viral hepatitis, interviewed clients face-to-face. Serologic samples were drawn following the interview and pre–test-counseling session. Data were analyzed using Epi-Info.
Results: Approximately three hundred and forty-five clients were identified from the record book, and 125 (36%) clients were contacted. Of the 125, 85 (68%) reported receiving no services, 33 (26%) agreed to receive testing, and 5 (4%) admitted to services, but were reluctant to be tested, and 3 (2%) refused to give information. A total of forty-one clients were interviewed and tested in MDCHD including the 33 contacted clients and 8 additional clients who either get information from the hotline or other clients.
All 41 clients were of Hispanic ethnicity, the majority of whom were of Honduran (29.3%), Cuban (24.4%), and Guatemalan (17.1%) origin. Approximately forty-four percent reported living in the United States for less than twelve years. The average age was 44.5 years. Ages ranged from 20 to 83 years. Of the 41 clients tested, 30 (73%) used the practitioner for financial reasons alone, 8 (19.2%) clients used these services because of convenience (e.g. he was able to see them at home on a Sunday or after work), 3 (7.2%) were referred by a friend, and 2 (4.8%) could not obtain an appointment at their usual clinic. Four (9.8%) clients reported having dental insurance at the time of services. Only six clients (14.6%) reported that they knew he was unlicensed.
All of the clients tested negative for HIV, hepatitis B surface antigen (HbsAg), and hepatitis C antibody test (HCV EIA). Two clients tested positive for hepatitis B core antibody total (anti-HBc) and hepatitis B surface antibody (HbsAb), indicating previous infection with hepatitis B. The unlicensed practitioner saw both clients on the same day. However, only one of the clients received an invasive procedure.
Conclusions: The use of the unlicensed dentist appears to be associated with both real and potential barriers to dental services in Miami-Dade County. There is a need for consumer education regarding dental agencies, services, and resources available in the community. It is important to educate the community and raise awareness regarding the potential health risks of using unlicensed health care practitioners. Transmission between the two clients who tested anti-HBc and HbsAb positive seems unlikely based on current information. However, this investigation is ongoing.
2. Risk Factors for Lead Poisoning in Recently Arrived Immigrant Children Seen at the Miami-Dade County Health Department Refugee Health Assessment Center
Gilbert V.R., Trepka M.J., Hustace T, Santana J.C., and Miami-Dade County Health Department Refugee Health Assessment Center, Miami, FL.
(The following article appeared in the Epi Monthly Report (Vol. 1, No. 4, April 2000) published by the Office of Epidemiology and Control, Miami-Dade County Health Department.)
Background: Since July 1999, the Miami-Dade County Health Department (MDCHD) has had a Childhood Lead Poisoning Prevention (CLPP) Program. As part of the new program, lead screening of children began on October 18, 1999 at the MDCHD Refugee Health Assessment Center, which screens recently arrived refugees primarily from Cuba.
Methods: All refugee children between the ages of 6 months and 6 years of age who attend the clinic are screened. If any have a blood lead level (BLL) of 10 micrograms/dL or greater, they are interviewed by a CLPP Program case manager using a standard questionnaire to assess risk factors for all children identified with elevated BLLs in Miami-Dade County. If the level is 10 -15 micrograms/dL, they are interviewed on the telephone. Children with blood lead levels higher than 15 micrograms/dL receive a home visit from the case manager and the environmental inspector. Risk factors were analyzed using Epi-Info version 6.0.
Results: Of the 467 children screened at the Refugee Center, 95 (20%) had elevated lead levels. Of the 95 children with elevated BLLs, questionnaires were administered to the families of 91 (96%) children. Eighty-eight (97%) of those questioned recently arrived from Cuba, two from El Salvador (2%), and one child from Mexico (1%). Anemia was present in 23 (25%) children. Over half of the children (52%) were described as hyperactive by parents, and 27 (30%) children reportedly exhibited pica. Due to their recent arrival in this country, the sources of exposure were assumed to have been in their countries of origin. Therefore, questions about potential exposures referred to their previous home environment. Currently, the CLPP Program is conducting open-ended interviews with refugee families to develop a more precise risk assessment tool appropriate to the environments of their countries of origin. Sixty-six percent of the children lived in a home with peeling paint, and 62% percent of the children played on porches or near windows with peeling paint. Approximately 73% of the children lived in a home during renovations, and 69% of children lived in a house built before 1980. Other risk factors included living near an industrial source potentially involving lead (57%) and/or near heavily traveled road or highway (74%). The proportion of children with parents who had an occupation or hobby involving lead was 34% and 27%, respectively. In addition, 10% of children lived in homes where batteries were recharged or rebuilt for home electricity. Making or handling lead pellets used in rifles was associated with the highest levels.
Conclusions: The prevalence (20%) of lead poisoning among children attending the refugee center is much higher than that seen among children in the United States (4.4%). Although it is difficult to prevent exposure in their country of origin, identification of these children benefits them for several reasons. They receive needed medical care, parents are educated about nutrition and avoiding exposure in their new home, and CLPP staff ensure that the children do not enter a home with lead hazards which could add to their lead burden.
3. Statewide Networking for the 2000 Arbovirus Season
Dr. Lisa Conti, State Public Health Veterinarian
Florida has a long history of identifying and controlling mosquito-borne diseases such as St. Louis Encephalitis (SLE), Eastern Equine Encephalitis (EEE) and dengue. Critical local, state and federal partnerships have allowed for intensified arbovirus surveillance and enhancement of mosquito control measures in response to evidence of increased viral transmission. Different agencies become involved at various times during routine surveillance. Therefore, a crucial part of the state's arbovirus epidemiology program is the dissemination of information to the proper agencies and persons, and the coordination of appropriate prevention and control measures. In addition to Department of Health local and state activities, partnerships include:
Florida Mosquito Control Association/56 Mosquito Control Agencies - Activities include: Conducting appropriate mosquito and arbovirus surveillance as feasible; providing larvicide and adulticide applications as appropriate and feasible; providing adequate avian serosurveillance of most likely sites of SLE activity; and disseminating data (website: www.floridamosquito.org) and training. Creation of mosquito control districts and state aid for arthropod control are legislatively mandated.
Department of Agriculture and Consumer Services (DACS) Bureau of Entomology and Pest Control/Coordination Council on Mosquito Control (CCMC) - Activities include: Coordinating with the Bureau of Epidemiology and with county health departments before releasing vector data to the media or to the public; providing mosquito control technical support and other services as needed to local mosquito control programs and CHDs; and facilitating the sharing of mosquito control personnel and equipment between districts, as allowed for in Florida Statutes 388.231 and 388.351. The interagency CCMC meets quarterly to discuss pertinent issues including arbovirus control and prevention and acts as an advisory body. Its membership is legislatively mandated.
DACS Division of Animal Industry and Bureau of Diagnostic Laboratory - Activities include: Directing statewide surveillance for arthropod-borne diseases in animals; conducting appropriate tests for detection of arthropod-borne diseases in animals; and sharing findings with the DOH Bureau of Epidemiology on a regular basis.
Florida Universities - Activities include: Providing leadership in arthropod-borne disease research at the Florida Medical Entomological Laboratory (FMEL) and College of Veterinary Medicine, University of Florida and the John A. Mulrennan, Sr., Public Health Entomology Research and Education Center (PHEREC), Florida A&M University; distributing research findings; and providing consultation and technical assistance to disease and arthropod control agencies.
Florida Fish and Wildlife Conservation Commission (FWCC) - Activities include: Notifying the department of wild bird mortality. The FWCC has state and regional biologists who provide consultation and technical assistance to the state and county health departments.
Department of Environmental Protection - Activities include: Coordinating efforts for intensified mosquito spraying in protected wetlands as needed during health alerts; and providing consultation and technical assistance as requested.
Florida Tourism Marketing Corporation (Visit Florida USA) - Activities include: Providing timely and accurate arboviral prevention information to attractions, hotels/motels and travel agencies; and maintaining public confidence and credibility with appropriate health information for people wishing to visit the state.
4. Eosinophilic Meningitis, CDC Confirmed - USA (Chicago)
The Division of Parasitic Diseases, National Center for Infectious Diseases, CDC, has been assisting the Chicago Department of Public Health, Arizona health officials, the Caribbean Epidemiology Centre (CAREC), and the Ministry of Health, Jamaica, in the investigation of an outbreak of eosinophilic meningitis thought to be due to Angiostrongylus cantonensis.
A group of 23 tourists from Chicago and other cities in the United States traveled to Jamaica from 2-9 April 2000. Ten (43.5%) of the 23 tourists have developed symptoms and signs of meningitis a median of 10 days after leaving Jamaica (range, 5-20 days). Eight of the tourists have been hospitalized; seven had eosinophils in their cerebrospinal fluid (range 3-48%). Chief complaints from patients have included headache, neckache, backache, nausea, visual disturbances, nuchal rigidity, paresthesias, and hyperesthesias. One patient has required steroids to treat severe headaches. No patient has died.
Other findings typical of eosinophilic meningitis caused by A. cantonensis include abdominal discomfort, altered consciousness, generalized weakness, flaccid paralysis of the extremities, diplopia, reduced visual fields, optic atrophy, periorbital edema, and unilateral facial paralysis; pulmonary findings have occurred in severe cases. The incubation period for A. cantonensis infection averages 2 weeks, but can range from several days to a month or more. Autochthonous infection in humans has been rarely reported in Louisiana, Hawaii, the Bahamas, Jamaica, Puerto Rico, and Cuba.
Diagnosis is supported by a history of travel to or residence in an A. cantonensis-endemic area, consumption of undercooked food potentially containing infective larvae, compatible clinical and CSF findings, including eosinophils, and a positive serologic test. Rarely, a definitive diagnosis can be made by finding worm larvae in the CSF or ocular chamber.
Humans become infected with A. cantonensis by accidentally ingesting infected mollusks--either by eating improperly cooked intermediate hosts (snails and slugs), or by eating raw paratenic (transport) hosts such as freshwater shrimp. Infection may also be acquired by eating vegetation (e.g., salad greens) contaminated by snails or slugs.
Disease is usually self-limited; most patients recover fully. However, some cases cause severe illness with lasting neurologic sequelae or even death. Symptoms typically persist for 2-4 weeks; treatment is mainly symptomatic.
Headache generally subsides dramatically following lumbar puncture. Corticosteroids may be given to reduce cerebral edema but are not thought to benefit those with mild symptoms. A. cantonensis is susceptible to mebendazole and other antihelminthics, however, The Medical Letter cautions that using antiparasitic drugs can provoke neurologic symptoms. Surgical removal of larvae is recommended for patients with ocular involvement.
If you are aware of a case of eosinophilic meningitis, we ask that you report it to your state health department. If you would like additional information, please contact Ms. Sue Partridge (Tel: 770-488-7775 or or Dr. Tom Navin (Tel: 770-488-7760 or at the Division of Parasitic Diseases/NCID/CDC.
5. CDC Publishes Update on Influenza Activity
(The following article appears in IAC Express (serial online), Issue Number 161, May 8,2000)
May 5, 2000
CDC PUBLISHES UPDATE ON INFLUENZA ACTIVITY, 1999-2000
The Centers for Disease Control and Prevention (CDC) published an article titled "Update: Influenza Activity--United States and Worldwide, 1999-2000 Season, and Composition of the 2000-01 Influenza Vaccine" in the May 5, 2000, issue of the MMWR. This article summarizes worldwide surveillance for influenza during the 1999-2000 season, describes the 2000-01 influenza vaccine, and highlights
changes in recommendations for the prevention and control of influenza.
1. SUMMARY OF WORLDWIDE INFLUENZA ACTIVITY, 1999-2000
SEASON
The introduction to this MMWR article reads in part: "Influenza A (H3N2) viruses were the predominant viruses isolated in the United States and worldwide during 1999-2000. This was the third consecutive year that influenza A/Sydney/05/97-like (H3N2) viruses were the most prevalent viruses isolated in the United States. Influenza activity in the United States was similar to the previous two seasons, although mortality measurements attributed to pneumonia and influenza (P&I) were unusually high. Overall, the 1999-2000 influenza vaccine was well matched to circulating influenza viruses."
The body of the article notes that in the United States, "Influenza activity began to increase in mid-December 1999 and peaked during the weeks ending December 25, 1999 (week 51), and January 15, 2000 (week 2)." The article also notes that "moderate to severe influenza outbreaks were reported in the Americas, Asia, and Europe" from October 3, 1999, through April 28, 2000.
2. COMPOSITION OF THE 2000-01 INFLUENZA VACCINE
The section of this MMWR article titled "Composition of the 2000-01 Influenza Vaccine" reads in part: "The Food and Drug Administration's Vaccines and Related Biologic Products Advisory Committee (VRBPAC) recommended A/New
Caledonia/20/99-like (H1N1), A/Panama/2007/99-like (H3N2), and /Yamanashi/166/98-like viruses for the 2000-01 U.S. trivalent influenza vaccine. This recommendation was based on antigenic and molecular analyses of recently isolated influenza viruses, epidemiologic data, and postvaccination serologic studies in humans."
6. CDC Website Teaches How to Investigate Disease Outbreaks
7. Florida Past - The State Board of Health Service Emblem
William J. Bigler, PhD
The following information was penned by E. Charlton Prather, MD, MPH, who twice served as State Health Officer (1974-79 and 1986-87).
The design of the State Board of Health emblem presented for years of dedicated service was made by combining the seal of the State of Florida with the wand and serpent of Aesculapius. The symbols appearing in the seal are the sun (glory, splendor and absolute authority), the highlands (tropical south), the steamboat (commerce and progress), the flowers (hope and joy), the Cocoa tree (victory, justice and royal honor), the Indian (the influence of native Americans over the state). Inscribed around the seal were the words, "Twenty years of Service" or " Thirty years of Service".
The wand and serpent of Aesculapius have been the symbols of healing since ancient times. Aesculapius is known as the Father of Medicine since ancient times and was probably first recognized as the god of healing arts by the Greeks about 430 BC. Apparently in 1200 BC when treating a patient in his tent, a serpent conferred great wisdom upon him by coiling about his staff. At that time serpents were considered to be a symbol of wisdom, power and health. Also Aesculapius had a daughter named Hygiea from whom we get the word "hygiene", the science with which public health is concerned. The statues of Hygiea frequently display a serpent in her hands drinking milk from a saucer. She is said to have emerged from her temple in times of epidemic and by deftly waving her serpents she would dispel the outbreaks.
The wand and staff of Aesculapius is considerably different than the Caduceus which is used on the uniforms of Army Medical and US Public Health Service Officers. This device is a winged rod entwined by two serpents. In Greek mythology the Caduceus represents Hermes (or Apollo, AKA Mercury to Romans) the god of fertility and thieves who had many duties including "conducting souls to Medes" and acting as messenger of the gods. It was decided that the single minded devotion to health duties required of State Board of Health and County Health Department employees would not be properly symbolized by a character having such a diversity of task. The wand and serpent of Aesculapius was therefore thought to be a more appropriate symbol for the State Board of Health.
Editorial note: A computerized version of the original State Board of Health emblem that was created by Ms. Georgia Murphy in the DOH Office of Communications and Program Marketing is now being used as the logo for the Bureau of Epidemiology. See our Web page for an illustration at www.doh.state.fl.us (choose epidemiology as subject)
8. Weekly Disease Table: Week 18
County-Confirmed Cases, Sorted Alphabetically by Disease
(NR represents years that the disease lacked status as a reportable condition)
|
DISEASE |
1997 TO DATE |
1998 TO DATE |
1999 TO DATE |
3 YEAR AVERAGE
TO DATE |
1999 TOTAL CASES |
2000 TO DATE |
|
Amebiasis |
15 |
15 |
13 |
14.3 |
66 |
2 |
|
Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
|
Botulism |
0 |
0 |
0 |
0 |
4 |
0 |
|
Brucellosis |
0 |
1 |
0 |
0.3 |
3 |
1 |
|
Campylobacteriosis |
247 |
202 |
242 |
230.3 |
987 |
242 |
|
Ciguatera |
2 |
0 |
1 |
1 |
2 |
0 |
|
Cryptosporidiosis |
26 |
28 |
28 |
27.3 |
179 |
13 |
|
Cyclosporiasis |
24 |
2 |
0 |
8.7 |
5 |
1 |
|
Dengue |
0 |
1 |
1 |
0.7 |
3 |
1 |
|
Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
|
E. coli O157:H7 |
15 |
4 |
11 |
10 |
54 |
12 |
|
E. coli , other (known serotype) |
2 |
2 |
7 |
3.7 |
16 |
4 |
|
Ehrlichiosis, Human |
0 |
0 |
0 |
0 |
2 |
1 |
|
Encephalitis, Eastern Equine |
0 |
0 |
0 |
0 |
2 |
0 |
|
Encephalitis, St. Louis |
0 |
0 |
0 |
0 |
5 |
0 |
|
Encephalitis, other (known organism) |
6 |
3 |
2 |
3.7 |
5 |
3 |
|
Encephalitis, post-infectious1 |
3 |
1 |
2 |
2 |
14 |
1 |
|
Giardiasis (acute) |
417 |
330 |
259 |
335.3 |
1320 |
283 |
|
Haemophilus influenzae , invasive1 |
6 |
16 |
16 |
12.7 |
53 |
18 |
|
Hansen’s Disease (Leprosy) |
0 |
3 |
0 |
1 |
3 |
0 |
|
Hantavirus Infection |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hemolytic Uremic Syndrome |
2 |
0 |
1 |
1 |
7 |
2 |
|
Hemorrhagic Fever |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hepatitis A |
135 |
187 |
203 |
175 |
797 |
171 |
|
Hepatitis B |
119 |
105 |
110 |
111.3 |
532 |
114 |
|
Hepatitis C2 |
NR |
NR |
13 |
NR |
56 |
12 |
|
Hepatitis Non-A, Non-B |
25 |
22 |
0 |
15.7 |
12 |
6 |
|
Hepatitis, perinatal B2 |
NR |
NR |
0 |
NR |
|
1 |
|
Hepatitis, unspecified |
2 |
1 |
6 |
0 |
16 |
4 |
|
Hepatitis, +HBsAg, pregnant woman2 |
NR |
NR |
1 |
NR |
243 |
91 |
|
Lead Poisoning |
424 |
496 |
486 |
468.7 |
1787 |
245 |
|
Legionellosis |
7 |
14 |
7 |
9.3 |
26 |
14 |
|
Leptospirosis |
0 |
0 |
0 |
0 |
1 |
0 |
|
Listeriosis2 |
NR |
NR |
5 |
NR |
34 |
9 |
|
Lyme Disease |
4 |
9 |
3 |
5.3 |
52 |
7 |
|
Malaria |
23 |
18 |
25 |
22 |
97 |
18 |
|
Measles |
1 |
1 |
1 |
1 |
2 |
0 |
|
Meningococcal Disease (N. meningitidis) |
64 |
46 |
42 |
50.7 |
125 |
39 |
|
Meningitis, Group B Streptococci |
5 |
6 |
5 |
5.3 |
14 |
5 |
|
Meningitis, Haemophilus influenzae1 |
4 |
5 |
7 |
5.3 |
13 |
1 |
|
Meningitis, Streptococcus pneumoniae |
38 |
43 |
49 |
43.3 |
99 |
41 |
|
Meningitis, Listeria monocytogenes |
0 |
3 |
2 |
1.7 |
13 |
1 |
|
Meningitis, other bacterial (including unspecified) |
16 |
17 |
17 |
16.7 |
60 |
30 |
|
Mercury Poisoning |
0 |
0 |
1 |
0.3 |
7 |
3 |
|
Mumps |
7 |
8 |
1 |
5.3 |
6 |
1 |
|
Neurotoxic Shellfish Poisoning2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Pertussis |
28 |
11 |
9 |
16 |
85 |
13 |
|
Pesticide Poisoning |
0 |
1 |
1 |
0.7 |
32 |
3 |
|
Plague |
0 |
0 |
0 |
0 |
0 |
0 |
|
Poliomyelitis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Psittacosis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Rabies, Animal |
105 |
77 |
59 |
80.3 |
176 |
46 |
|
Rocky Mountain Spotted Fever |
1 |
1 |
1 |
1 |
2 |
0 |
|
Rubella, including congenital |
0 |
1 |
0 |
0.3 |
1 |
1 |
|
Salmonellosis |
460 |
444 |
502 |
468.7 |
3066 |
435 |
|
Shigellosis |
320 |
438 |
434 |
397.3 |
1490 |
389 |
|
Smallpox2 |
NR |
NR |
0 |
NR |
0 |
0 |
|
Staphylococcus aureus, (GISA/VISA)2 |
NR |
NR |
0 |
NR |
0 |
0 |
|
Staphylococcus aureus, (GRSA/VRSA)2 |
NR |
NR |
0 |
NR |
0 |
0 |
|
Streptococcal Disease, invasive Group A |
13 |
23 |
18 |
18 |
93 |
55 |
|
Streptococcus pneumoniae , invasive disease |
72 |
190 |
199 |
153.7 |
684 |
358 |
|
Tetanus |
0 |
1 |
1 |
0.7 |
3 |
0 |
|
Toxic Shock Syndrome |
0 |
3 |
2 |
1.7 |
6 |
0 |
|
Toxoplasmosis |
2 |
4 |
4 |
3.3 |
17 |
2 |
|
Typhoid Fever |
3 |
7 |
19 |
9.7 |
23 |
1 |
|
Vibrio cholerae (serogrp O1) |
0 |
0 |
0 |
0 |
1 |
0 |
|
Vibrio cholerae (serogrp Non-O1) |
3 |
1 |
3 |
2.3 |
9 |
3 |
|
Vibrio vulnificus |
1 |
2 |
2 |
1.7 |
23 |
0 |
|
Vibrio other (including unspecified) |
10 |
5 |
11 |
8.7 |
48 |
7 |
|
Yellow Fever |
0 |
0 |
0 |
0 |
0 |
0 |
1 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."
2 The reportable disease rule was revised in July, 1999. Kawasaki Disease, Histoplasmosis, Reye Syndrome, and Typhus were deleted from the weekly disease table since cases are no longer reportable as of July 4, 1999. Hepatitis C; perinatal hepatitis B; hepatitis B +HbsAg, pregnant woman; listeriosis; smallpox, S. aureus (GISA/VISA) and S. aureus (GRSA/VRSA) were added to the reporting requirements as of July 4, 1999. Paralytic shellfish poisoning is now referred to as neurotoxic shellfish poisoning.
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