A weekly publication by the Bureau of Epidemiology
July 27, 2001
"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.
Steven T. Wiersma, MD, MPH—Acting Bureau Chief and State Epidemiologist
Don Ward, Surveillance Section Administrator, Epi Update Managing Editor
Bureau of Epidemiology Frequent Contributors:
|
Kathryn Snavely, MPH Reportable Disease Manager |
Jodi Baldy, MPH, Biological Scientist IV |
|
Ursula E. Bauer, PhD, Chronic Disease Epidemiologist |
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 |
Zuber Mulla, MSPH, Central Florida Carina Blackmore, MS Vet. Med., PhD, |
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 (SunCom 205-4401 or 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.usFor information on diseases and conditions of public health importance go to
MyFlorida.com, click on Health and Human Services, then Consumers--Diseases and Conditions.In this issue:
1. Outbreak of Norwalk-Like Illness in a Boy Scout Camp
Dolly Katz, PhD, MPH, Regional Epidemiologist, S.E. Florida
A camp for Boy Scouts on Summerland Key in Monroe County has voluntarily closed to interrupt an outbreak of gastroenteritis caused by Norwalk-like virus. The outbreak began in mid-June with illnesses among the staff and continued until the camp's closure on July 17.
The camp opened June 1 to provide both organized recreational activities and primitive camping for scout troops from all over the U.S. Scouts stayed in air conditioned bunkhouses on Summerland Key and at primitive campsites on Munson Island, an uninhabited island 2 miles from Summerland Key. The camp accommodated a total of 225 persons at both sites, with scout troops arriving daily for one-week stays. An average of 27 troops a week cycled through the camp; some stayed on Summerland Key and some went out to Munson Island after a night's stay at the base camp.
The county and state health departments were notified of the outbreak on July 3 when a scoutmaster from Minnesota called to report gastrointestinal illnesses in his troop members during their stay at the camp. A Florida scoutmaster called 3 days later with a similar history of illnesses in his troop while at the camp. Both troops had stayed on Munson Island.
For the investigation, illness was defined as vomiting or diarrhea in a camper or staff member while at the camp or within 48 hours after returning home. The camp director provided a list of staff members who had become ill and a roster of the names and telephone numbers of all scoutmasters whose troops had visited the primitive campsites. Scoutmasters were contacted by telephone and asked about illnesses among troop members and their family members. Stool samples were collected from ill persons at the camp and sent for testing to the state's Tampa Branch Laboratory.
Of 37 staff members at the camp, 20 (54%) 20 reported vomiting and/or diarrhea, with onsets ranging from June 13 to July 4. The Bureau of Epidemiology contacted 36 (52%) of 68 scoutmasters whose troops had been scheduled to visit the camp from June 2 through July 3. No illnesses were reported among scouts who arrived at the camp before June 16. The scoutmasters reported illnesses among 132 (44%) of 298 children and adults who had arrived at the camp from June 16 through July 3. The illnesses consisted of vomiting and diarrhea lasting for a mean of 24 hours. The ill scouts were from 13 states: Florida, Minnesota, North Carolina, Illinois, Indiana, Pennsylvania, Virginia, Texas, Kentucky, Ohio, Tennessee, West Virginia, and Colorado.
The pattern of illness onsets (see attached epi curve) suggested person-to-person transmission. Each troop that went out to Munson Island had food supplied by the camp in ice chests and water containers filled at the Summerland Key base camp from local tap water.
Scoutmasters also reported similar illnesses among two scouts' family members after their return home. A Minnesota scoutmaster reported that his son became ill on July 2, two days after his return home, and went to basketball practice the evening of July 2. On July 4, the coach and 5 members of the basketball team became ill with vomiting and diarrhea.
Of three stool samples from ill campers that were tested by the Tampa Branch Laboratory, two were positive for Norwalk-like virus.
Initial attempts to control the outbreak at the camp by emphasis on handwashing and hygiene and separate quarters for ill campers were not successful. Closure of the camp began on July 12, and the last campers were gone by July 17. The camp was scheduled to remain closed for at least a week, after which it would be inspected by the Department of Health and a decision made about reopening.
In conclusion, this outbreak was caused by Nowalk-like virus that was transmitted person-to-person among staff and campers. The outbreak was sustained over several incubation periods by continuous introduction of new susceptibles, as new scout troops arrived at the camp.
Steven Wiersma, MD, MPH, Acting Chief, Bureau of Epidemiology, State Epidemiologist
FOR IMMEDIATE RELEASE July 27, 2001
***WEST NILE VIRUS UPDATE***
Florida’s First Human West Nile Virus Case Confirmed
TALLAHASSEE—The Florida Department of Health (DOH) announced today that the first human West Nile Virus infection in Florida, previously reported as presumptive, was confirmed by the Centers for Disease Control and Prevention (CDC). The patient is a 73 year-old male resident of Madison County. His condition is currently listed as serious. A medical alert for West Nile (WN) virus and Eastern equine encephalitis (EEE) is still in effect for a 14 county area of north Florida including the following counties: Holmes, Washington, Jackson, Bay, Calhoun, Gulf, Franklin, Liberty, Gadsden, Wakulla, Leon, Jefferson, Madison and Taylor.
The Department of Health urges all Floridians to take precautions against mosquito bites.
"Even though the risk of contracting West Nile virus and other mosquito-borne viruses by humans is low, people need to use protective measures to reduce their risk of getting the disease," said DOH Secretary Robert G. Brooks, MD. He added, "It is important to take measures to guard against mosquito bites." Brooks recommends the following:
DOH continues to conduct statewide surveillance for arboviruses, including WN, EEE and SLE. The latest WN surveillance indicates a total of 27 WN-positive dead birds, one WN-positive sentinel chicken and three WN-positive horses as indicated below:
The Department of Health laboratories provide testing services for patients with clinical signs of arboviral encephalitis. These signs may include headache, fever, fatigue, dizziness, weakness and confusion. Physicians should submit serum and/or cerebrospinal fluid samples to either the Tampa or Jacksonville Department of Health branch laboratories. People over the age of 50 are at the greatest risk of contracting WN virus.
For more information on West Nile virus, visit the DOH Bureau of Epidemiology’s West Nile website at MyFlorida.com (click on Health and Human Services, then Consumers – Diseases and Conditions, then West Nile Virus).
Lisa Conti, DVM, MPH, State Public Health Veterinarian
We have quickly managed to distribute all of the 10,000 " What You Should Know about Human Arboviral Encephalitis" brochures to the county health departments and interagency partners. Attached is the material in a format for you to download and photocopy. This file will also be posted on the DOH website under Arbovirus Encephalitis and Under West Nile virus.
4. West Nile Virus Surveillance and Merlin
Kathryn Snavely, MPH, Reportable Disease Manager
With the identification of the first presumptive human case of West Nile virus and increased activity of Eastern Equine Encephalitis (EEE), surveillance for arboviral encephalitis has become increasingly important. The medical alert that was issued last month has now been extended to include many of the counties in the panhandle.
The ICD9 code for Encephalitis, West Nile Virus has been added to the Merlin system to allow reporting of WNV as a specific condition. Other arboviral encephalitides including St. Louis and Western Equine are also reportable.
Please review the case definitions for arboviral diseases. An electronic copy of the case definitions can be found on the Bureau of Epidemiology website. If you have any reporting or Merlin questions please contact the Merlin Helpdesk by email, through the global address book.
5. Meningococcal Outbreak Update
Marc Traeger, MD, Epidemiology Intelligence Officer
"NEWS RELEASE Contact: Jeff Goldhagen MD, Director
630-3220
VACCINE CAMPAIGN FOR MENINGOCOCCAL DISEASE PLANNED FOR UNIVERSITY OF NORTH FLORIDA SUMMER STUDENTS
Jacksonville – State and county health and University of North Florida officials have announced a plan to vaccinate summer term B and C students aged 17-25 at the University of North Florida (UNF) in Jacksonville for an infection caused by a bacterium called Neisseria meningitides, which has been confirmed in three UNF students. Free vaccinations will be provided on campus on July 31 and August 1 for students between 17-25 years of age attending summer terms B and C.
"By offering vaccinations to those most at-risk for this disease, we hope to prevent other people from getting sick," said Duval County Health Department Director Jeff Goldhagen, M.D.
Three cases were reported in a 19-year-old male, a 21-year-old male and a 21-year-old female. These cases occurred from May through July of this year.
Meningococcal disease results in either meningitis, which refers to an infection in the lining of the spinal cord and brain (sometimes referred to as spinal meningitis), or sepsis, an infection in the bloodstream. The transmission of meningococcal disease requires close, personal contact with an infected individual over an extended period of time. The Department of Health is targeting those at highest risk for vaccination--students aged 17-25, currently attending summer sessions B and C at UNF. Vaccination is not recommended for UNF staff, visitors, special groups such as children in summer day camps or daycare on campus, older students, and other local residents, since they do not fall within the high-risk category.
Neisseria meningitides is a bacterium carried in the upper respiratory tract of up to 5-10% of persons with no symptoms. Rarely, persons who become colonized with the bacteria will develop invasive disease. Disease is often characterized by a typical rash, and may result in serious illness such as meningitis or sepsis and progress to shock or death. Milder forms of the disease also occur. The disease is treated with antibiotics, but in severe cases the death rate remains high despite prompt antibacterial treatment.
A vaccine can prevent further cases from developing and is used to control outbreaks caused by four N. meningitides strains. It has been shown to be effective in over 85% of those who receive it. "There is no chance of contracting meningitis from this vaccine and side effects are uncommon, usually limited to discomfort or redness at the injection site," said Goldhagen.
The Department of Health continues to recommend that college students throughout the state consider being vaccinated against meningococcal disease in accordance with current national guidelines. College freshmen, particularly those living in dormitories or residence halls, are at modestly increased risk for meningococcal disease compared with persons the same age who are not attending college. College students desiring vaccine that are not included in this campaign should contact their medical care provider.
The Department of Health has established a hotline for additional information on meningococcal disease. The automated hotline can be reached at 1-904-620-1406. Information can also be obtained from the Department of Health’s web site at MyFlorida.com (click on Health and Human Services, then Consumers – Diseases and Conditions, then Meningitis or Meningococcal Disease)."
6. Meningococcal Outbreak, University of North Florida campus, Jacksonville/Duval County
Marc Traeger, MD, Epidemiology Intelligence Officer
The outbreak announced in the press release above was confirmed by Duval County Health Department. The steps in the evaluation and management of suspected outbreaks of serogroup C meningococcal disease (SCMD) (1), and how they were completed in the current outbreak, are as follows:
Three cases of Neisseria meningitidis serogroup C were confirmed with onset of illness dates May 1 – July 1. The Duval CHD investigated and confirmed illnesses consistent with the disease. The case patients included a 19-year-old male, a 21-year-old male and a 21-year-old female. The final isolate was received by the state lab in Jacksonville on July 24 and was confirmed and reported on July 27. All case-patients were students attending the University of North Florida.
Local health facilities were contacted to enhance surveillance. All isolates were sent to the DOH lab and confirmed as serogroup C. Incidence rates for meningococcal disease in Duval County averaged 1.0 per 100,000 over the past 10 years.
Pulsed-field gel electrophoresis of enzyme-restricted DNA fragments was performed at the DOH laboratory. The PFGE patterns did not match.
The only common affiliation among the 3 case-patients is enrollment at University of North Florida. Therefore, this is an organization-based outbreak.
The case-patients were undergraduates with age ranges 19-21. The identified population at risk was
Since 3 cases occurred in this organization-based outbreak in less than or equal to 3 months, the attack
rate was calculated.Attack rate per 100,000 = [(number of SCMD cases in 3 month period)/(number of population at risk)] x
100,000.Attack rate = (3/4000) X 100,000 = 75.
Since the attack rate exceeds 10 SCMD cases per 100,000 persons, the vaccination target group
should be determined. In this case, the target group is the same as the population at risk: currently enrolled students at the
University of North Florida, ages 17-25 (population approximately 4000). In some settings, the target
group will be smaller or larger than the population at risk.
References
1. CDC. Control and Prevention of Serogroup C Meningococcal Disease: Evaluation and Management of Suspected Outbreaks: Recommendations of the Advisorly Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-5);13-21.
7. Bureau of Epidemiology Bioterrorism Preparedness Activities
Don Ward, Surveillance Section Administrator
The Bureau of Epidemiology has recently received notification from CDC of renewal of its bioterrorism preparedness grant. Resources from this grant are used to support program activities in two categories, (1) enhancement of ongoing surveillance and epidemiology programs and (2) the development of new strategies for bioterrorism surveillance and epidemiology. Related work includes surveillance systems development, implementation of specialized surveillance programs, public and private sector training and information dissemination. In the coming year, the bureau will be actively involved in the following approaches:
8. Distance Learning Teleconference: The Emergence of Resistant Pathogens
Jody Baldy, MPH, Biological Scientist IV
In case you missed this upcoming program announced in the department’s Distance Learning Schedule, we want to remind you of an important satellite teleconference coming on August 1, 2001, entitled "The Emergence of Resistant Pathogens: A Call for Interventional Collaboration." The program will originate from the University of South Florida, College of Public Health and air from 6:30-8:30 p.m. Eastern Time.
Details concerning goals, speakers, registration, continuing education credit, and satellite information are contained in the attached documents. Please share this information with other public health colleagues throughout Florida who may be interested in participating in the program. It is expected that approximately 28 countries in Latin America and the Caribbean nations and about 35 states within the U.S. to participate in this program.
Since the teleconference is being broadcast after routine operating hours, you may want to have your staff make a videotape copy for viewing at a later time.
9. Final Notice Before Presentation--- Risk Factors for Hepatitis C (HCV) Among STD Clinic Clientele: Miami, Florida
Weisbord JS1, Trepka MJ2, Zhang G2, Pandya-Smith I2, Whisenhunt S2, Brewer T3.
1
CDC Prevention Fellow assigned to the Miami-Dade County Health Department11:00 AM – 12:00 PM EST
Dial-in by 11:10 AM at (850) 487-8587 or SunCom 277-8587
Abstract
Background: Hepatitis C virus (HCV) is the most common blood borne infection in the United States. Injection drug use and history of blood transfusions prior to July 1992 are well-known risk factors for hepatitis C. Several studies have shown that HCV is transmitted through sex and through non-IV drug use. However, the extent to which HCV is spread through these routes is debated. The rate of HCV among the general population is 1.8%. Among persons reporting a history of an STD, the prevalence is 6%. We hypothesized that the prevalence of hepatitis infection among patients at the Miami-Dade County Health Department (MDCHC) STD clinic would be higher than the estimated 6%. Therefore, we undertook a study to assess the prevalence of, and risk factors for HCV among this population. We also sought to determine the sensitivity, specificity and positive predictive value (PPV) of screening criteria in this STD clinic clientele.
Methods: Study participants were recruited from the downtown STD clinic of the MDCHD. Any client 18 years or older who presented to the STD clinic for a new problem, was eligible to participate in the study. If interested in being tested for HCV as part of the study, the participant gave informed consent, received education and counseling on HCV, and was interviewed using the questionnaire. The instrument assessed CDC screening criteria, as well as uncertain risk factors such as tattooing, body piercing, snorting drugs, and exchanging sex for money, number of lifetime sex partners and history of an STD.
Results: A total of 710 hepatitis tests were performed as part of the study. The overall acceptance rate was 52%. We were unable to analyze twenty-one (3%) of the 710 tests performed due to an insufficient amount of blood. Analysis was performed on 689 completed questionnaires and corresponding laboratory results. The overall prevalence rate of hepatitis infection among our study population was 4.6%. In the multivariate analysis, four risk factors were significantly associated with being hepatitis infection, independent of confounding factors. These variables included IV drug use OR=29.1, 95% CI 7.7,106.5; a history of having spent at least one night in prison/jail OR=3.7, 95% CI 1.1,12.1; sexual contact with an HCV+ person OR=12.4, 95% CI 2.3,66.0, and older age OR=1.1, 95% CI 1.1, 1.2. The sensitivity of the CDC’s routine HCV screening criteria in this population was 69%, specificity 91% and PPV 28%. By adding a history of having spent at least one night in prison/jail to the CDC’s screening criteria, we increased the sensitivity from 69 to 91%, but decreased the specificity to 58%, and the PPV to 18%.
Conclusions: In our STD clinic population we found a prevalence of HCV similar to that found in other studies conducted in STD clinics. Having had a sexual contact with an HCV positive person was independently associated with HCV. We also found that a history of incarceration was independently associated with hepatitis C infection. This relationship should be further studied. CDC’s routine screening criteria were not sensitive in this STD population. Based on the study’s findings, we will consider including a history of incarceration, and sex with an HCV positive person to the routine screening criteria used it the STD clinic of the MDCHC.
Additional Information
Further details regarding the audio-conference call and PowerPoint files will be posted on the Bureau of Epidemiology Intranet web site. We will be providing lab CE’s and nursing CEU’s for this presentation so be sure and register online if you would like to participate in this program. Information about upcoming topics and presenters will also be posted in the Epi Update. If either of these access points is unavailable to you, please e-mail Melanie Black [Melanie_Black@doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448) to request presentation materials.
Important
While we realize you might not always be able to call in at 11:00 AM, it can be distracting to the speaker and others in the audience when participants dial-in throughout the hour. Please try to call in on time and remember to put your phones on mute so as not to disturb others. Thank you for your cooperation.
10. Future Grand Round Topics and Continuing Education
Melanie Black, MSW, Professional Training Coordinator
The Bureau of Epidemiology is proud to announce the following topics to be presented at our monthly Grand Rounds Program, which is held the last Tuesday of each month from 11:00 AM – 12:00 PM.
July 31, 2001
"Risk Factors for Hepatitis C (HCV) Among STD Clientele: Miami, Florida"
Presenter: Joanna Weisbord, MSW, MPH, CDC Prevention Fellow assigned to the Miami-Dade County Health Department
August 28, 2001
"Invasive Group A Streptococcal Infections in Florida: Risk Factors for Hospital Mortality"
Presenter: Zuber Mulla, MSPH, Regional Epidemiologist, Bureau of Epidemiology, Florida Department of Health
September 25, 2001
"Emerging Pathogens"
Presenter: Timothy Dolan, PhD, ABMM, Laboratory Coordinator, Manatee County Health Department
In addition to the nursing CEU’s and environmental Contact Hours, we are now providing CE’s for laboratory personnel. Environmental contact hours and Laboratory CE’s will be available only when the topic is deemed to be appropriate. Further details regarding the audio-conference call, PowerPoint files and continuing education are posted on the Bureau of Epidemiology Intranet web site.
11. Weekly Disease Table (Week 29)
| DISEASE |
1999 TO |
2000 TO |
3-YEAR |
2000 |
2001 TO |
2001 |
|
Animal Rabies |
96 |
71 |
95 |
161 |
123 |
8 |
|
Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
|
Botulism, foodborne |
0 |
0 |
0 |
0 |
0 |
0 |
|
Botulism, infant |
0 |
0 |
0 |
0 |
0 |
0 |
|
Botulism, wound |
0 |
0 |
0 |
0 |
0 |
0 |
|
Botulism, other |
0 |
0 |
0 |
0 |
0 |
0 |
|
Brucellosis |
0 |
1 |
0.7 |
2 |
1 |
0 |
|
Campylobacteriosis |
482 |
506 |
459 |
1026 |
461 |
17 |
|
Ciguatera |
2 |
1 |
3 |
14 |
0 |
0 |
|
Cryptosporidiosis |
64 |
33 |
52.7 |
180 |
40 |
1 |
|
Cyclosporiasis |
2 |
3 |
3.3 |
9 |
25 |
0 |
|
Dengue Fever |
2 |
0 |
1 |
3 |
3 |
0 |
|
Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
|
Ehrlichiosis, human |
1 |
0 |
0.3 |
0 |
0 |
0 |
|
Encephalitis, chickenpox |
0 |
0 |
0 |
0 |
0 |
0 |
|
Encephalitis, Eastern Equine |
0 |
0 |
0 |
0 |
0 |
0 |
|
Encephalitis, herpes |
2 |
3 |
2.7 |
7 |
1 |
0 |
|
Encephalitis, influenza |
0 |
1 |
0.3 |
1 |
0 |
0 |
|
Encephalitis, measles |
0 |
0 |
0 |
0 |
0 |
0 |
|
Encephalitis, mumps |
0 |
0 |
0 |
0 |
0 |
0 |
|
Encephalitis, other |
3 |
5 |
4.3 |
8 |
2 |
0 |
|
Encephalitis, St. Louis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Encephalitis, Venezuelan |
0 |
0 |
0 |
0 |
0 |
0 |
|
Encephalitis, Western Equine |
0 |
0 |
0 |
0 |
0 |
0 |
|
Escherichia Coli 0157:H7 |
27 |
34 |
26 |
95 |
17 |
1 |
|
Escherichia Coli, other |
11 |
6 |
6.3 |
13 |
6 |
0 |
|
Giardiasis |
527 |
615 |
591.3 |
1466 |
518 |
31 |
|
H. Influenzae Cellulitis |
0 |
0 |
0.7 |
1 |
0 |
0 |
|
H. Influenzae Epiglottitis |
0 |
0 |
0 |
1 |
0 |
0 |
|
H. Influenzae Meningitis |
10 |
2 |
6.7 |
11 |
6 |
0 |
|
H. Influenzae Pneumonia |
3 |
2 |
2.7 |
7 |
12 |
0 |
|
H. Influenzae Prim.Bacteremia |
15 |
22 |
16 |
57 |
44 |
1 |
|
H. Influenzae Septic Arthritis |
0 |
0 |
0 |
1 |
0 |
0 |
|
Hantaviris Infection |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hemolytic Uremic Syndrome |
3 |
7 |
4.3 |
18 |
1 |
0 |
|
Hemorrhagic Fever |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hepatitis A |
342 |
252 |
290.3 |
589 |
293 |
18 |
|
Hepatitis B |
216 |
240 |
219.3 |
525 |
212 |
6 |
|
Hepatitis B (+HbsAg in pregnant women) |
22 |
212 |
78 |
493 |
216 |
10 |
|
Hepatitis, Perinatal Hep B |
1 |
1 |
0.7 |
1 |
4 |
0 |
|
Hepatitis C |
28 |
9 |
12.3 |
19 |
13 |
1 |
|
Hepatitis, Non-A, Non-B |
2 |
5 |
17.3 |
6 |
2 |
0 |
|
Hepatitis, Other, including unspecified |
9 |
6 |
6.7 |
7 |
4 |
0 |
|
Lead Poisoning |
904 |
594 |
799.7 |
1219 |
346 |
17 |
|
Legionellosis |
12 |
23 |
18.7 |
51 |
35 |
4 |
|
Leprosy |
2 |
1 |
2 |
4 |
0 |
0 |
|
Leptospirosis |
0 |
1 |
0.7 |
2 |
0 |
0 |
|
Listeriosis |
11 |
13 |
8 |
32 |
10 |
0 |
|
Lyme Disease |
10 |
11 |
13 |
54 |
11 |
0 |
|
Malaria |
44 |
43 |
39.3 |
90 |
28 |
2 |
|
Measles |
1 |
1 |
1.3 |
2 |
0 |
0 |
|
Meningitis, Group B Strep |
8 |
10 |
9.3 |
21 |
9 |
1 |
|
Meningitis, List Monocytogenes |
5 |
3 |
4 |
7 |
0 |
0 |
|
Meningitis, Meningococcal |
25 |
22 |
24.7 |
41 |
38 |
2 |
|
Meningitis, other |
32 |
52 |
39 |
110 |
46 |
4 |
|
Meningitis, Strep Pneumoniae |
65 |
60 |
59.7 |
112 |
37 |
0 |
|
Meningococcemia, disseminated |
39 |
43 |
44.3 |
80 |
41 |
2 |
|
Mercury Poisoning |
2 |
6 |
2.7 |
11 |
2 |
0 |
|
Mumps |
2 |
2 |
4.3 |
4 |
2 |
0 |
|
Neurotoxic Shellfish Poisoning |
0 |
0 |
0 |
0 |
0 |
0 |
|
Pertussis |
36 |
34 |
30.7 |
48 |
12 |
0 |
|
Plague, Bubonic |
0 |
0 |
0 |
0 |
0 |
0 |
|
Plague, Pneumonic |
0 |
0 |
0 |
0 |
0 |
0 |
|
Poliomyelitis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Psittacosis |
0 |
0 |
0.3 |
3 |
0 |
0 |
|
Q Fever |
0 |
0 |
0 |
0 |
0 |
0 |
|
Human Rabies |
0 |
0 |
0 |
0 |
0 |
0 |
|
Rocky Mountain Spotted Fever |
2 |
0 |
1 |
1 |
2 |
1 |
|
Rubella |
0 |
2 |
1.7 |
2 |
1 |
0 |
|
Rubella, Congenital |
0 |
1 |
0.3 |
1 |
0 |
0 |
|
Salmonellosis |
1116 |
1043 |
1041 |
2755 |
1100 |
78 |
|
Shigellosis |
754 |
696 |
827.3 |
1292 |
404 |
24 |
|
Smallpox |
0 |
0 |
0 |
0 |
0 |
0 |
|
Staphylococcus Aureus (GISA/VISA) |
0 |
0 |
0 |
0 |
0 |
0 |
|
Staphylococcus Aureus (GRSA/VRSA) |
0 |
0 |
0 |
0 |
0 |
0 |
|
Streptococcal Disease, Invasive Group A |
35 |
71 |
44.3 |
146 |
93 |
3 |
|
Streptococcus Pneumoniae, Invasive |
318 |
604 |
401 |
1147 |
553 |
6 |
|
Tetanus |
1 |
0 |
1 |
1 |
3 |
1 |
|
Toxoplasmosis |
7 |
6 |
6.3 |
12 |
13 |
2 |
|
Trichinosis |
0 |
0 |
0 |
1 |
0 |
0 |
|
Tularemia |
0 |
0 |
0 |
0 |
0 |
0 |
|
Typhoid Fever |
21 |
5 |
12 |
12 |
3 |
0 |
|
Vibrio Alginolyticus |
5 |
6 |
4.3 |
15 |
1 |
0 |
|
Vibrio Cholerae Type 01 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Vibrio Cholerae Non-01 |
5 |
4 |
5 |
4 |
3 |
0 |
|
Vibrio Fluvialis |
3 |
1 |
2.3 |
2 |
0 |
0 |
|
Vibrio Hollisae |
4 |
3 |
3 |
3 |
0 |
0 |
|
Vibrio Mimicus |
1 |
2 |
2 |
2 |
1 |
0 |
|
Vibrio, other |
1 |
0 |
0.7 |
2 |
0 |
0 |
|
Vibrio Parahaemolyticus |
8 |
5 |
14.7 |
16 |
5 |
0 |
|
Vibrio Vulnificus |
6 |
2 |
7 |
13 |
3 |
0 |
|
Yellow Fever |
0 |
0 |
0 |
0 |
0 |
0 |