Berrien County Communicable Disease Review

Transcription

1 Berrien County Communicable Disease Review Guy Miller, MPH Berrien County Health Department 09/01/ P a g e

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3 Tabel of Contents: SURVEILLANCE... 1 HIV/AIDS... 2 Berrien County HIV/AIDS Characteristics... 3 HIV Prevalence Map... 1 FOODBORNE DISEASES AND CONDITIONS... 2 FOODBORNE... 4 Campylobacteriosis... 4 Cryptosporidiosis... 5 Giardiasis... 6 Salmonellosis... 7 Shigellosis... 8 E. coli infection... 9 VACCINE PREVENTABLE DISEASES Chicken pox (Varicella) Pertussis Haemophilus influenzae Hepatitis A Hepatitis B Influenza and Influenza-Like Illness Pneumococcal Disease (Invasive) SEXUALLY TRANSMITTED INFECTIONS Chlamydia (Genital) Gonorrhea VECTOR-BORNE DISEASES Lyme Disease West Nile Virus OTHER DISEASES/CONDITIONS Aseptic Meningitis Hepatitis C, Acute and Chronic Legionellosis, (Legionnaires' disease and Pontiac fever) Bacterial Meningitis Cryptococcosis Histoplasmosis Streptococcal Disease, Invasive Group A Acknowledgements P a g e

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5 SURVEILLANCE In the effort to prevent disease, protect health and promote an optimal quality of life for all, the Berrien County Health Department monitors for disease through public health surveillance. Public health surveillance (also referred to as epidemiologic surveillance) is the continuous systematic collection, analysis, and interpretation of specific health data that is essential to the planning, implementation, and evaluation of public health practice. For the purpose of this annual report the surveillance areas include Berrien County, Region 5 (Berrien, Van Buren, Cass, Allegan, Barry, Kalamazoo, Calhoun, Branch, and St. Joseph counties) and the state of Michigan. In order to accurately draw conclusion between these areas rates per 100,000 persons will be used to portray disease incidence. In Berrien County (and throughout country) the majority of surveillance efforts are through the monitoring of reportable conditions. Reportable conditions are health conditions that are capable impacting the health of the public on a significant level. State law mandates that healthcare providers or laboratories that suspect or diagnose any of the reportable conditions report them to the local health department. The daily reporting of reportable disease provides accurate and up to date information for surveillance organizations such as a local health departments and the Michigan Department of Health and Human Services (MDHHS) to quickly respond to any potential public health threat posed by these conditions. As a secure web-based disease reporting system, the Michigan Disease Surveillance System (MDSS) provides an aggregate of data from around the state to authorized users so that data is made available for public health officials to review and analyze. At the Berrien County Health Department reportable diseases are analyzed by the epidemiologist, medical director, and public health nursing staff. Often comparisons within the State of Michigan are helpful for determining whether or not a disease is common or rare. Comparing incidence rates of diseases between different populations helps provide context for the data and determine trends. This report will include comparisons among Berrien County, Region 5 (includes the following counties: Berrien, Van Buren, Cass, Allegan, Barry, Kalamazoo, Calhoun, Branch, and St. Joseph) and the State of Michigan. A list of reportable conditions and copies of communicable disease rules can be obtained at 1 P a g e

6 HIV/AIDS HIV (human immunodeficiency virus) continues to be a public health threat in Berrien County. According to MDHHS there is an estimated prevalence rate of 300 HIV positive individuals residing in Berrien County. The rate of HIV among Berrien County (163) residents is the third highest in the State behind Ingham County (175) and Wayne County (425).49% of all of the cases in Michigan have been associated through Male-Male sex. 16% of the cases have been associated with injection drug use. 59% of the HIV positive cases identified themselves as black and 32% identified as white. The highest prevalence among age groups is those who are between years of age (35%). Health Care Provider Guidelines for Conducting: Persons at high risk for HIV infection should be screened for HIV at least annually. HIV Screenings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. In Michigan, as required by MCL , all HIV tests to diagnose HIV infection must be preceded by written, informed consent, executed or signed by the test subject. A separate consent form is not, however, required. Consent for HIV testing can be incorporated into existing consent forms. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. Special Screening Guidance for Pregnant Women: HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women. 2 P a g e

7 Berrien County HIV/AIDS Characteristics January 1, 2013 Risk Transmission Categories Definitions Blood Recipients: Hemophiliacs, blood transfusion recipients and organ recipients who receive blood products prior to 1985 & persons documented to have ever received and infected organ or unit of blood. Heterosexual Contact (HC): Heterosexual Contact with female Risk (HCFR): Males whose female sexual partners are known to be HIV-infected or at high risk for HIV. These partners meet one of the following criteria: IDU, hemophiliac, HIV infected transfusion recipient, or other HIV infected person of unknown risk. Heterosexual contact with Male (HCM): Females who have had sex with a male regardless of what is known about the male s HIV status or behavior. Injection Drug Users (IDU): Persons with a history of injection drug use. MSM/IDU: MSM (men who have sex with men) who also have a history of injection drug use. Perinatal: HIV transmission from mother to child during birth or through breastfeeding. Undetermined: Males and females with no identified risk. 3 P a g e

8 HIV Prevalence Map The map of Michigan provided by MDHHS (below) shows HIV prevalence rates by color and the actual number of HIV reported cases in As evidenced by the pattern of darker colors on the map, HIV tends to be more prevalent in more densely populated parts of the state and along major interstate highways such as I-94 and I P a g e

9 FOODBORNE DISEASES AND CONDITIONS Surveillance and monitoring of foodborne and gastrointestinal illnesses allows public health officials at the county, state, or national level to detect clusters of illness more quickly. The rapid identification of a potential foodborne illness outbreak is vital to reducing transmission and limiting the scope of an outbreak. This operation takes place on three distinct level; local, state and national. Locally, the Berrien County Health Department works across several departments to investigate all reported foodborne illnesses in its jurisdiction. This investigation includes obtaining a food history, identification of the source potentially contaminated foods and other high risk food types. At least weekly, the epidemiologist reviews this information looking for commonalities between cases. If potential relationships are found between two or more cases among individuals living in separate households, further investigation ensues. At the state level, the Michigan Department of Health and Human Services will test specimens from individuals with bacterial foodborne illness using a technique called Pulse-Field Gel Electrophoresis (PFGE). This technique identifies the DNA finger print of bacteria and can determine whether or not multiple cases of a disease have a common source. PFGE allows public health officials to identify disease outbreaks quickly and with a broad range of surveillance. Laboratories at state health departments, local health departments, and other federal agencies (CDC, USDA/FSIS, FDA) across the country conduct similar testing and report all results through PulseNet. Nationally, a system called PulseNet aggregates data on public health and food regulatory agency laboratories coordinated by the United States Department of Health and Human Resources and the Centers for Disease Control and Prevention (CDC). Laboratories within the network submit DNA fingerprints of organisms from stool samples submitted by residents within their jurisdiction. The CDC manages a greater database of pathogen genomic structures. Once a unique structure is detected among several samples, active surveillance begins for additional cases. Therefore, public health officials are able to detect the occurrence of an outbreak through DNA Fingerprints even if the cases are widely distributed geographically. It also allows for outbreak detection within a matter of hours rather than days, which is important in this age of a global food system. 2 P a g e

10 Rate per 100,000 Residents Jan-13 Mar-13 May-13 Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Number of Reported Cases The graph to the right identifies general seasonal trends in food related illness by month. The months of May through August are often associated with warm weather, picnics and cook outs. During this time people in Michigan are much more active with the environment as well as water and animals. Higher incidents are also seen around other popular times for mass gatherings and feasting such as Thanksgiving in November and New Year s carrying over into January. The most common food related illness noted in the past several years has been Reported Foodborne Illness Cases by Month (Berrien County, ) Campylobacter with a rate of 26 people per 100,000 in Berrien County (2015). Campylobacter is often associated with food contaminated with animal feces, raw poultry exposure, The graph below compares the rate of foodborne illness in Berrien County, Region 5 and the State of Michigan from 2010 to Compared to the State of Michigan, both Region 5 and Berrien County have had higher rates of foodborne illnesses. In 2012 Berrien County saw its highest foodborne illness rate (70 persons per 100,000) in the 6 year period. Since 2012 Berrien s rates have declined to 42 and have been very similar to the rate of disease at the state level All Reported Foodborn Ilnesses by Year ( ) Berrien Region 5 Michigan 3 P a g e

11 Rate per 100,000 Residents FOODBORNE Disease: Campylobacteriosis Etiologic Agent(s): Campylobacter bacterial species Incubation Period: Typically 2 to 5 days, with a range of 1 to 10 days Campylobacter Incidence ( ) Prevalence: An estimated 2.4 million Americans (0.8% of the US population) are infected annually. Approximately 12% of these cases are associated with international travel. Transmission: Ingestion of Campylobacter from contaminated food or water or infected animals. Ingestion from poultry or raw milk is particularly common, as is contact with puppies and kittens. Person-to-person transmission is rare Berrien Region 5 Michigan The incidence of Campylobacter cases in Berrien County and Region 5 have been slowly decreasing from Between the years 2013 and 2015 the rate of Campylobacter in Berrien County goes from 28 to 26 with an abnormally low rate of 17 cases per 100,000 residents in Prevention: Consume only fully cooked meat, poultry, and eggs and pasteurized dairy products. Wash hands before meal preparation, after contact with animals, and especially after contact with animal feces. Berrien County Residents with diagnosed Campylobacter Campylobacter Total Count Rate per 100, *** Male Gender Female Race Age White Black Asian/PI Other and older P a g e

12 Rate Per 100,000 Residents Disease: Cryptosporidiosis Etiologic Agent(s): Cryptosporidium parvum, Cryptosporidium hominis, (protozoan parasites) Incubation Period: 1 to 12 days with 7 days being the average. Prevalence: Approximately 1-4.5% of the population in developed countries is infected annually. Transmission: Fecal-oral route. This includes person-to-person, animal-to-person, waterborne and foodborne transmission. Asymptomatic infections are common and are in importance source of transmission Cryptosporidiosis Incidence ( ) Berrien Region 5 Michigan The rate of Cryptosporidiosis infections in both Region 5 and Berrien County have been fairly low relative to 2012 rates. Although these rates remain slightly above the rate of Cryptosporidiosis throughout the state of Michigan, the figures from 2014 and 2015 are much closer to the State s rate. Prevention: Hygiene habits that interrupt the fecal-oral transmission route (i.e. handwashing, appropriate sanitation of sewage, etc.) are effective in the reduction of transmission of Cryptosporidiosis. People should always avoid contact with animal feces and treat contaminated water contaminated water by boiling or filtering. Boiled waster must boil for at least one minute before drinking. Filtered water must pass through a reverse osmosis systems or filtered through a screen (with a pore size of 1 micron or less) for proper removal of Cryptosporidiosis. Chemical disinfectants will not kill the Cryptosporidium oocysts in drinking water. Berrien County Residents Laboratory Confirmed with Cryptosporidiosis Cryptosporidiosis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

13 Rate per 100,000 Residents Disease: Giardiasis Etiologic Agent(s): Giardia lamblia (protozoan parasite) 8 6 Giardia Incidence ( ) Incubation Period: Typically 3 to 25 days (or longer) with a median of 7 to 10 days. Prevalence: Giardiasis is relatively common worldwide with infections occurring mainly July through October. Many Berrien County cases are associated with international travel. Transmission: Fecal-oral route. Transmission in the US is most common in institutions and child-care facilities. Infection from contaminated water is more common that contaminated food. Any open water source that may be exposed to human or animal feces could become contaminated; chlorination is not fully effective at killing Giardia cysts Berrien Region 5 Michigan The rate of Giardiasis varies from year to year as represented from 2011 to In this time frame giardia outbreaks may be suspected in 2013 as an increase in both Region 5 and Berrien County were observe. Compared to Region 5 Berrien county has a lower incidence rate Prevention: Personal hygiene measures that disrupt the fecal-oral transmission route are important, especially in institutional settings. Avoid contact with water sources that may be exposed to human or animal feces; boil emergency water sources. Berrien County Residents with Laboratory Confirmed Giardiasis Giardiasis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

14 Rate per 100,000 Disease: Salmonellosis Etiologic Agent: Several Salmonella species causes human illness including: S. enteritidis, S. typhi, S. paratyphi, S. dublin, S. gallinarum and S. pullorum. Incubation Period: Usually 6 to 72 hours with 12 to 36 hours being the average. Prevalence: Approximately 40,000 cases are reported in the US annually, but many cases are mild enough that they go unreported. It is estimated that as few as 1% of cases are reported. Salmonella rates in the state of Michigan have remained consistent foe several years just under an incidence of 10 cases per 100,000 population. Transmission: Ingestion of Salmonella organisms in food from infected animals or food contaminated by feces, raw or undercooked eggs and poultry and unpasteurized milk products are some of the most common food sources. Household pets, specifically reptiles, are also potential sources of infection. Prevention: Thoroughly cook meat, poultry, and eggs to kill Salmonella and avoid unpasteurized milk products. Wash hands after any contact with animals or their feces Salmonellosis Incidence ( ) Berrien Region 5 Michigan Berrien County Residents with Laboratory Confirmed Salmonella Salmonella Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

15 Rate per 100,000 Disease: Shigellosis Etiologic Agents: Several species of Shigella bacteria. The two most common are S. sonnei and S. dysenteriae. Incubation Period: Typically 1 to 3 days; sometimes up to 1 week. Prevalence: Approximately 14,000 cases are reported in the US annually Shigellosis Incidence ( ) Berrien Region 5 Michigan Transmission: Person-to-person transmission from the fecal-oral route. Infected food handlers with poor hand hygiene commonly spread Shigella. Recreational water supplies contaminated with feces can be a source of infection. The above graph shows two significant spikes in the rate of Shigellosis cases in Berrien County (2012) and Region 5 (2014). These increases are likely related to outbreaks in the region. Overall the prevalence of Shigellosis seems to remain relatively steady throughout the State of Michigan. Prevention: Proper personal hygiene and handwashing following trips to the bathroom are imperative. Proper sanitation and separation of sewage is also important. Berrien County Residents with Laboratory Confirmed Shigellosis Shigellosis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

16 Pate per 100,000 Disease: E. coli infection Etiologic Agent(s): Escherichia coli, specifically O157:H7 and other shiga toxin producing strains. Incubation Period: 2 to 10 days with a median of 3 to 4 days Shiga Toxin Producing E. coli Incidence ( ) Prevalence: Common in most developed countries. Transmission: Consuming meat that is contaminated with ruminant feces (this contamination usually happens during slaughter) or direct contact with animals or their environment. Person-to-person transmission through the fecal oral route also occurs Berrien Region 5 Michigan The rate of STEC is relatively low in the 6 year period with no rate over 3.5 cases per 100,000. Because these rates are so low, the smallest change can make trends appear more drastic then they actually are. These trends are more obvious when looking at case counts in 2013 (1 case) and 2014 (2 cases).with only one more case of STEC, the rate appears to be largely effected due to the small scale of this figure. Prevention: Properly clean and sanitize fruits, vegetables and other foods before consuming by scrubbing with a detergent or cooking to a core temperature of 160 o F for at least 15 seconds. Practice proper hand hygiene and use separate utensils when preparing raw foods (especially meats). Berrien County Residents with Laboratory Confirmed Shiga Toxin-producing E. Coli (STEC) STEC Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

17 VACCINE PREVENTABLE DISEASES The best way to protect our population from life threatening diseases is prevention through vaccination. Although vaccines are not available for every infectious disease, a large number of vaccines are available to protect health. Vaccine preventable diseases (VPD) are diseases in which an effective vaccine has been derived, testes and approved by the Food and Drug Administration (FDA) for distribution to the general public. The goal of providing vaccinations to the public is to generate herd immunity (a protective population that is able to preserve the most vulnerable populations in our communities). To effectively achieve this goal vaccinations are available for children aged 0-6 years old and adolescents aged 7-18 years. In the United States these vaccinations are widely available and recommended to all who have healthy immune systems. However, because some of the population remains unprotected from VPD it is important to monitor Berrien County vaccination rates to quickly identify subsets of the population that might be at increased risk due to low herd immunity levels. Recommended Immunization Schedule for Persons Aged 7 Through 18 years United States, 2012 For those who fall behind or start late, see the catch-up schedule 10 P a g e

18 Vaccine Age Group Dose US Michigan Berrien County Health People 2020 Goal Varicella months 1 dose 91.2% 91% 84.6% 90% Haemophilus months 3 doses 93.7% 53% 51.3% 90% influenza Hepatitis A months 2 doses 54.7% % N/A Hepatitis B months 3 doses 90.8% 82.5% 86.1% 90% Meningococcal months 1 dose data not available N/A Pneumococcal months 4 does 82% 84.7% 83.1% 90% Diphtheria, Tetanus, Pertussis Measles, Mumps, 65 years 1 dose 68.5% 37.5% 66.8% 90% months 4 doses 83.1% 79.6% 73.89% 90% months 1 dose 91.9% 89.2% 85.6% 90% Rubella Polio months 3 doses 92.7% 90.8% 84.4% 90% 1 National Immunization Survey Michigcan Care Improvement Registry, Data Accessed October % Vaccine Preventable Illness by Specific Disease Berrien County Vaccine Preventable Illness by Specific Disease State of Michigan % 19.7% 59.2% Chickenpox (Varicella) H. influenzae Disease - Inv. Mumps 27.2% Chickenpox (Varicella) H. influenzae Disease - Inv. Mumps Pertussis 39.3% Pertussis 2.8% 5.6% Shingles 4.6% 1.0% Shingles These graphs show the percent of vaccine preventable disease in Berrien County (on the left) and the State of Michigan (on the right) for As shown, Varicella or Chickenpox (59.2%) was the most reported vaccine preventable disease in Berrien County and Pertussis (39.3%) was the most reported vaccine preventable disease in the State. 11 P a g e

19 Rate per 100,000 Disease: Chicken pox (Varicella) Etiologic Agent: Varicella-zoster virus Incubation Period: 10 to 21 days. Length of Infectious Period: Approximately 5 to 7 days. Infectious period starts 1 to 2 days prior to rash onset and lasts until all lesions have crusted. Transmission: Droplet and airborne particles from respiratory secretions Chickenpox (Varicella) Incidence ( ) Berrien Region 5 Michigan Despite Berrien County having a much higher rate in 2010, the rates of Varicella have since decreased and leveled out around 10 cases per 100,000 in Berrien County Residents diagnosed with Chickenpox Chickenpox (Varicella) Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

20 Rate per 100,000 Disease: Pertussis Etiologic Agent: Bordetella pertussis 20 Pertussis Incidence ( ) Incubation Period: Approximately 6 to 20 days with an average of 9 to 10 days. Length of Infectious Period: Approximately 3 weeks or 5 days after initiation of effective antibiotic therapy. Transmission: Respiratory droplet transmission. Prevention: Vaccination of infants and children according to the recommended schedule; vaccination of adults who have contact with infants who have not completed the first three vaccines in the series Berrien Region 5 Michigan Over the past 6 years Berrien County has had a lower rate of Pertussis incidence compared to the rest of the state and Region 5. Note: Pertussis rates and the number of cases are significantly influenced by testing practices of patients at any given time. Berrien County Residents with Probable & Confirmed Pertussis Pertussis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

21 Disease: Haemophilus influenzae Etiologic Agent: Haemophilus influenzae serotype b. (Bacterium) Incubation Period: Estimated to be 2 to 4 days. Length of Infectious Period: As long as organisms are present; 24 to 48 hours after initiation of effective antibiotic therapy. Transmission: Respiratory droplet transmission Berrien County has had four reported cases of H. influenzae during the three-year period covered in this report. Two cases presented in 2013, one in 2014 and one in P a g e

22 Rate per 100,000 Disease: Hepatitis A Etiologic Agent: Hepatitis A virus 6 Hepatitis A Incidence ( ) Incubation Period: 15 to 50 days with 28 to 30 days being the average Length of Infectious Period: Varies. Maximum infectivity occurs during the last half of the incubation period through the first week of jaundice. Transmission: Person-to-person through the fecal-oral route Berrien Region 5 Michigan The rate of Hepatitis A in the State of Michigan has decreased from a fairly higher prevalence in A similar is also noted for Region 5. There has been little change in the rates of Hepatitis in Berrien County from Prevention: Vaccination of individuals at high risk of Hepatitis A. These include: individuals with chronic liver disease or clotting disorders, men who have sex with men, injection drug users, susceptible persons traveling to areas where Hepatitis A virus is endemic, and children in communities with consistently elevated rates of Hepatitis A. Additionally, excluding ill food service workers can prevent transmission if the worker is infected with Hepatitis A. Berrien County Residents with Probable & Confirmed Hepatitis A Hepatitis A Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

23 Rate per 100,000 Disease: Hepatitis B Etiologic Agent: Hepatitis B virus. 20 Chronic Hepatitis Incidence ( ) Incubation Period: 45 to 180 days with days as the average. Length of Infectious Period: Varies. Infectivity can begin weeks before symptom onset and last through the acute clinical course of disease. The infectivity of chronically infected individuals varies depending on viral and antibody titers. Transmission: Through direct contact with infected bodily fluids or contact with inanimate objects that have had contact with infected bodily fluids (Hepatitis B virus can survive up to one week on surfaces). Perinatal transmission is also possible Berrien Region 5 Michigan Berrien County continues to have low rates of Hepatitis B incidence compared to the rest of the state and Region 5 with one of the lowest Hepatitis B rates 5 per 100,000) in Prevention: Vaccination and avoiding contact with others bodily fluids. Berrien County Residents with confirmed Hepatitis B Hepatitis B Chronic Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

24 Reported ILI cases Disease: Influenza and Influenza-Like Illness Etiologic Agent: Influenza A and B viruses Incubation Period: 1 to 4 days Length of Infectious Period: Usually the first 3 to 5 days of illness. Transmission: Respiratory droplets, direct contact with (surfaces contaminated by) respiratory secretions. Prevention: Annual influenza vaccines and proper hand hygiene. Influenza surveillance is different than the surveillance of many other reportable conditions because the majority of people with influenza will not seek healthcare because their symptoms are mild. Therefore, only pediatric deaths associated with influenza or the individuals infected with novel strains of influenza are required to be reported to the Berrien County Health Department. During the pandemic influenza season, all individuals admitted to the intensive care unit with influenza (or influenza like illness) were required to be reported. Laboratory-confirmed cases of influenza are reported by healthcare providers to the Berrien County Health Department as an aggregate count (not individual cases). Schools and daycare facilities also report the aggregate number of students/attendees that reportedly have an influenza-like illness on a weekly basis. The graph below shows influenza-like illness trends based on data reported by schools and daycare facilities. Due to the source of the data, the actual number of cases may be inaccurate but these metrics are very accurate in the evaluation of monthly and seasonal trends Berrien County Influenza Like Illnessess Flu Season ( ) Flu Season Flu Season Flu Season Flu Season Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. 17 P a g e

25 Rate per 100,000 Disease: Pneumococcal Disease (Invasive) 15 Strep. pneumoniae, invasive Indicence ( ) Etiologic Agent: Streptococcus pneumoniae 10 Incubation Period: Not well established; infection likely results from previously asymptomatic colonization. Length of Infectious Period: Infectious until 24 hours after the initiation of effective antibiotic therapy. Colonization without infection occurs. Prevalence: Pneumococcal pneumonia is fairly common and remains an important cause of mortality in children and the elderly worldwide Berrien Region 5 Michigan The State of Michgian and Berrien County consistently have similar rates over this time period. Region 5 has had the highest prevelence of disease and Berrien has remained with rates comparable to the State. Transmission: Infectious respiratory droplets. Exposures to infected individuals often do not result in infection. Prevention: Vaccination of children and the elderly. Berrien County Residents with Invasive Pneumococcal Disease Streptococcus pneumoniae, inv Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

26 SEXUALLY TRANSMITTED INFECTIONS Surveillance of infectious diseases also includes sexually transmitted infections. As Chlamydia and Gonorrhea are the two most common reportable infectious diseases in the county (and state), monitoring the rates and distribution of these illnesses is important for slowing transmission. The prevention and control of STIs is based on the following five major concepts: o Education and counseling of persons at risk on ways to adopt safer sexual behavior. Primary prevention of STIs begins with changing the sexual behaviors that place persons at risk for infection. o Identification of asymptomatic infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services. o Effective diagnosis and treatment of infected persons. o Evaluation, treatment, and counseling of sex partners of persons who are infected with an STI; and o Pre-exposure vaccination of persons at risk for vaccine-preventable STIs (i.e. HPV). 19 P a g e

27 Rate per 100,000 Disease: Chlamydia (Genital) Etiologic Agent: Chlamydia trachomatis. Prevalence: According to the CDC, Michigan ranks 24 th out of 50 States in the United States, with a rate of persons per 100,000 population; just under the national average rate of Transmission: Sexual intercourse or neonatal infection from exposure to the mother s cervix Chlamydia Incidence ( ) Berrien Region 5 Michigan Prevention: Reproductive health education and emphasis on condom use during sexual intercourse. Additionally, routine screening coupled with effective treatment among sexually active males and females is important as many Chlamydia cases are asymptomatic. Berrien has had significantly higher rates of Chlamydia reported in 2011 (672 cases per 100,000 people) compared to the State (495) and Region 5 (473).Current rates are equal to Region 5 and trending similarly to the State of Michigan s rate; although slightly higher. Berrien County Residents with Laboratory Confirmed Chlamydia Chlamydia Total Count Rate per 100, *** Gender Male Female White Race Black Asian/PI Other Age and older P a g e

28 Rate per 100,000 Disease: Gonorrhea Etiologic Agent: Neisseria gonorrhoeae 200 Gonorrhea Indicence ( ) Prevalence: Disease affects both males and females epically sexually active adolescents and young adults. Antibiotics are often used to clear infection with some antibiotic resistant strains developing. Transmission: Contact with mucous membranes of infected individuals, almost exclusively through sexually activity. Perinatal transmission also occurs. Prevention: Reproductive health education and emphasis on condom use during sexual intercourse Berrien Region 5 Michigan The rate of Gonorrhea in Berrien County has been on the decline from 2010 to rates appear to have increased but remain consistent with the rest of the state and Region 5. Berrien County Residents with Laboratory Confirmed Gonorrhea Gonorrhea Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

29 VECTOR-BORNE DISEASES Vector-borne diseases are diseases that are transmitted from (non-human) living organisms to a human. Mosquitoes and ticks are the most common insect or arthropod disease vectors in Michigan and are responsible for transmission of many vector-borne diseases. With constant changes seasons and other environmental factors it is important to maintain an active surveillance of vectors as wells as vector-borne illnesses to monitor potential threat vector-borne disease may have on a population s health. Lyme disease is the most common vector-borne disease in Berrien County and has been spreading from the west coast of Michigan, East. 22 P a g e

30 Rate per 100,000 Disease: Lyme Disease Etiologic Agent: Borrelia burgdorferi Vector: Black-legged tick (Ixodes Scapularis) Transmission: A bite from a tick infected with B. burgdorferi Lyme Disease Incidence ( ) Prevention: Preventing tick bites and/or prompt removal of ticks is the best prevention for Lyme disease. Avoid entering tick habitats such as forested areas or areas with a lot of thick brush Berrien Region 5 Michigan Berrien continues to see a rise in rates of Lyme disease compared to the rest of the state and region. Tick repellent and clothing choices that prevent exposed skin are the best ways to prevent tick bites if you must enter their habitat. The risk of transmission is extremely low during the first 24 hours of tick attachment making daily tick checks and prompt removal of ticks important behaviors for preventing Lyme disease. Embedded ticks should be removed using fine-tipped tweezers and the area should be cleansed with an antiseptic. Berrien County Residents with Laboratory Confirmed Lyme Disease Lyme Disease Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

31 Disease: West Nile Fever, West Nile Meningitis, West Nile Encephalitis, and West Nile Poliomyelitis Etiologic Agent: West Nile Virus Vector: Mosquitoes, most commonly Culex and Aedes species Transmission: A bite from a mosquito infected with West Nile Virus is the primary mode of transmission. Potential alternate modes of transmission include organ transplantation, blood transfusions, breastfeeding, and mother-to-child in utero. Prevention: Prevention of mosquito bites is the only method for preventing West Nile Virus infection. Use mosquito repellent and wear protective clothing (long sleeves, long pants, and socks) when spending time outdoors. Additionally, reducing the number of mosquito breeding sites near the places people spend time outdoors can lower the risk of mosquito bites. This entails removing opportunities for standing water to accumulate outdoors. There have been no reported human cases of West Nile Virus infection in Berrien County since P a g e

32 OTHER DISEASES/CONDITIONS Berrien County constantly monitors nearly 100 reportable diseases, many of which have been previously discussed. There are some diseases or conditions that cannot be classified in any of the prior categories because their mode of transmission or pathogenesis. Although these diseases are grouped in a category called other, each disease or condition represents a potential impact on the public s health and is mandated to be reported by physicians, laboratories, and health care providers without delay. 25 P a g e

33 Rate per 100,000 Disease: Aseptic Meningitis Etiologic Agent: A wide variety of infectious agent can be implicated, mostly viruses. In approximately 50% of cases, no cause of disease is identified. Incubation Period: Varies depending on the organism causing illness. Length of Infectious Period: Varies depending on the organism causing illness. Transmission: Varies depending on the organism causing illness. Prevention: Varies depending on the organism causing illness Aseptic Meningitis Incidence ( ) Berrien Region 5 Michigan Aseptic meningitis rates have been fairly low compared to the rest of the state. In 2012 the rates of Aseptic meningitis decreased significantly to 3.2 per 100,000. Since then the rates have risen but are still below those seen in Region 5 and the state. Berrien County Residents with Aseptic Meningitis Aseptic Meningitis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

34 Rate per 100,000 Disease: Hepatitis C, Acute and Chronic 100 Chronic Hepatitis Incidence ( ) Etiologic Agent: Hepatitis C virus Incubation Period: 2 weeks to 6 months, common 6 to 9 weeks. 20%-30% are symptomatic and 75%-85% of acute infections become chronic. Transmission: Blood-borne. This includes receiving contaminated donated blood products, shared needles (for drug use, tattoos, or piercings), or inadequately sterilized instruments used in medical procedures Berrien Region 5 Michigan Hepatitis C rates in Berrien County and region 5 are fairly similar with a 6 year average of 52 and 57 per 100,000 respectively. The State of Michigan on the other hand has a 6 year average rate of 76. Berrien County Residents Chronic Hepatitis C Hepatitis C, Chronic Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

35 Rate per 100,000 Disease: Legionellosis, (Legionnaires' disease and Pontiac fever) Etiologic Agent: Legionella pneumophila Incubation Period: 2 to 10 days for Legionnaires disease and 5 to 72 hours for Pontiac fever. Prevalence: Cases occur throughout North America. Transmission: Small droplets of contaminated water inhaled via water vapor or mist. A Legionella bacterium grows best in warm ( o F) moist environments such as hot tubs, cooling towers, large plumbing systems and decorative fountains. Legionella is not typically spread by person to person transmission Legionellosis Incidence ( ) Berrien Region 5 Michigan The rate of Legionellosis varies year from year. While the rest of the state had an increase in incidence, Region 5 and Berrien saw a decrease. Berrien County Residents Legionellosis Legionellosis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

36 Rate per 100,000 Disease: Bacterial Meningitis Etiologic Agent: More than 75% of bacterial meningitis cases are caused by Neisseria meningitides, Streptococcus pneumoniae, or Haemophilus influenzae type B (Hib). Incubation Period: 1 to 10 days depending on the organism causing illness. Length of Infectious Period: As long as organisms are present or 24 to 48 hours after the initiation of effective antibiotic therapy. With a rate less than three persons per 100,000, there is little significance among the data being compared. Transmission: Direct contact and/or respiratory droplets. Prevention: Vaccination. Vaccines are available for the three bacteria species that most commonly cause bacterial meningitis. Antibiotics should be given as a prophylaxis to close contacts of an index case Bacterial Meningitis Incidence ( ) Berrien Region 5 Michigan Berrien County Residents with Bacterial Meningitis Bacterial Meningitis Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

37 Disease: Cryptococcosis Etiologic Agent: Cryptococcus neoformans (fungi) Prevalence: Occurs worldwide and the distribution tends to mimic that of AIDS. Cryptococcosis tends to be an opportunistic infection and advanced AIDS patients are most susceptible. Transmission: Inhalation of fungal spores. Not through person to person or animal to person. Berrien County Residents with Laboratory Confirmed Cryptococcus Cryptococcosis Total Count Rate per 100, *** 30 P a g e

38 Disease: Histoplasmosis Etiologic Agent: Histoplasma capsulatum (fungi). Clinical Manifestation: Varies. Infections can be asymptomatic, acute respiratory, acute disseminated, chronic disseminated or chronic respiratory symptoms. Prevalence: Occurs in foci in the Americas, Africa, eastern Asia, and Australia. Transmission: Inhalation of spores (conidia) from contaminated soil or animal feces. Berrien County Residents with Laboratory Confirmed Histoplasmosis Histoplasmosis Total Count Rate per 100, *** 31 P a g e

39 Rate per 100,000 Disease: Streptococcal Disease, Invasive Group A 6 Streptococcal Dis, Inv, Grp A Incidence ( ) Etiologic Agent: Streptococcus pyogenes, group A of over 130 serologically distinct types that vary by geographic and time distributions. Incubation Period: 1 to 3 days. Transmission: Respiratory droplets or direct contact. Milk or milk products have been the most commonly implicated food item during foodborne outbreaks of Streptococcus Berrien Region 5 Michigan Overall, the rate of Invasive group A strep has not changed much from 2011 to All of the geographic regions had low rates in 2010 which all increase by the year Prevention: Appropriate hand hygiene, patient completion of entire course of prescribed antibiotics, consuming only pasteurized milk, and exclude food handlers with skin lesions from work. Berrien County Residents with Invasive Streptococcal Disease (Group A) Streptococcal Disease, Invasive Group A Total Count Rate per 100, *** Gender Race Age Male Female White Black Asian/PI Other and older P a g e

40 Acknowledgements The data presented in the report was collected from the Michigan Disease Surveillance System in August of The Berrien County Health Department would like to acknowledge and thank all health care providers and laboratories who are in compliance with the communicable disease reporting rules and report illnesses in a timely manner. Without these partners, our surveillance efforts would be much less fruitful. Thank you for your dedication to protecting and promoting the health of our community. Notes Tables are cited based on case status at the time the annual communicable disease report was created. Rates are not calculated for less than 5 cases as too few cases negate any usefulness for comparative purposes. Rates generated for each disease are based on the 2010 Census. If you have any questions regarding the information provided in the county communicable disease report please contact the Berrien County Health Department Epidemiologist, Guy Miller, at (269) or gmiller@bchdmi.org. The epidemiologist is available to discuss the report and any limitations of the data that may exist. Contact information: Guy Miller, MPH Epidemiologist Berrien County Health Department gmiller@bchdmi.org 2149 East Napier Ave., P.O. BOX 706 Benton Harbor, Michigan P a g e