Cleveland Department of Public Health. Allison LeBorgne, Epidemiology Intern. Chenai Milton, Epidemiologist

Transcription

1 2015 Cleveland Department of Public Health Allison LeBorgne, Epidemiology Intern Chenai Milton, Epidemiologist ANNUAL SUMMARY OF INFECTIOUS DISEASES FOR THE CITY OF CLEVELAND, 2015 Campylobacteriosis: Centers for Disease Control and Prevention (left); Hepatitis C: Centers for Disease Control and Prevention (top right); Shigella: Centers for Disease Control and Prevention (bottom right)

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3 Published 2017 Complied and Prepared by: Allison LeBorgne, Epidemiology Intern Office of Communicable Disease and Surveillance and Epidemiology Cleveland Department of Public Health 75 Erieview Plaza Cleveland, OH Chenai Milton, Epidemiologist Office of Communicable Disease and Surveillance and Epidemiology Cleveland Department of Public Health 75 Erieview Plaza Cleveland, OH

4 Table of Contents Definitions Introduction 2 Cleveland Demographics...3 Reportable Diseases for the State of Ohio...4 Reportable Diseases...6 Campylobacteriosis 9 Hepatitis C Influenza...13 Legionellosis.15 Salmonellosis 17 Outbreak Highlights Methods Limitations 23 Appendix... 24

5 Definitions Acute: a condition or disease with a sudden onset of symptoms Case: an accounted for instance of a health disorder or disease in a population Chronic: condition or disease with a slow onset of symptoms Communicable disease: infectious disease transmitted from someone infected (person, animal or reservoir) to a susceptible host through direct or indirect contact Food-borne Illness: also known as food poisoning and results from consuming an item that has been contaminated with a bacteria, virus or parasite Epidemiology: the study of the distribution and determinants of health and illness in a population Epidemiologist: people who monitor health trends and statistics to identify groups of people who are affected by various diseases. They investigate cases of disease to determine source, mode of transmission and risk factors for disease and use information collected to implement control measures to prevent the spread of disease Incidence: rate of new cases of a specific disease over a defined period of time Outbreak: occurrence of more cases of a disease than expected in a given area or among a specific group of people over a period of time Recall bias: a systematic error caused by differences in the accuracy or completeness of the information retrieved, or recalled, by study participants regarding information from the past Surveillance: the systematic collection, recording, analysis, interpretation and distribution of data reflecting the current health status of a population

6 Introduction The Cleveland Department of Public Health (CDPH) is the local public health agency for the City of Cleveland residents. Started in 1910, the department improves the quality of life in the city of Cleveland by promoting healthy behavior, protecting the environment, preventing disease, and making the city a healthy place to live. The CDPH has a range of programs providing clinical, environmental, health promotion, and population-based services. CDPH ensures a high quality of resources and services through various partnerships in the community. The Cleveland Department of Public Health have initiated and maintained working relationships with Case Western Reserve University, Metro Health Medical Center, Veterans Affairs Medical Center, Cuyahoga County Board of Health, Lakewood and Shaker Health Departments, the Center for Community Solutions and various others. These partnerships provide successful preventive public health services to meet the needs of the residents for the city of Cleveland communities. The Office of Communicable Disease Surveillance and Epidemiology (OCDSE) is charged with investigating and tracking the spread of communicable and chronic diseases, conduct surveillance and data analysis on public health issues for the city of Cleveland. With the use of the Ohio Disease Reporting System (ODRS) through the Ohio Department of Health (ODH), the epidemiologists are able to report, track and update information of cases reported by healthcare professionals of the city. The state of Ohio has developed a list of infectious diseases based on spread, severity and infectivity have to be reported in certain ways by certain times and are divided into classes A, B and C (see page 3-4).

7 Cleveland Demographics The estimated population for Cleveland, Ohio in 2015 is 390,584 Out of the estimated population, 51.6% of individuals are African Americans The median age of people living in Cleveland, Ohio is 35.9 years old The population of Cleveland has been steadily decreasing for the last 10 years KEY FINDINGS: Age # % < 5 years 29, to 19 years 85, to 64 years 255, years 51, Sex # % Male 189, Female 203, For the City of Cleveland, including sexually 0 transmitted diseases, there were 9,952 cases of reportable infectious diseases (1,585 disease cases excluding sexually transmitted diseases) Since the estimated population for Cleveland is majority African Americans, they are at the highest risk for infection in the community for most infectious diseases than any other race Mapping has allowed us to identify Ward 5 and Ward 7 as the areas with the most reported incidences of infectious disease (neighborhoods included but not limited to West Boulevard, Brooklyn Centre, Lee-Harvard, Stockyards, Mount Pleasant and Lee-Seville) Disease Incidence in Cleveland by Ward, , , , ,000 50,000 Census Estimated Population of Cleveland, Ohio by Race These populations are estimates from the United States Census Bureau and do not directly reflect the 390,584 total estimated Cleveland population 2 This information is not based on data including HIV/AIDS information

8 Reportable Diseases for the State of Ohio Class A: Diseases of major public health concern because of the severity of disease or potential spread- report immediately via telephone upon recognition that a case, a suspected case, or a positive for epidemic case laboratory result exists. Anthrax Plague Botulism, foodborne Rabies, human Cholera Rubella (not congenital) Diphtheria Severe Acute Respiratory Syndrome Influenza A- novel virus infection (SARS) Measles Smallpox Meningococcal disease Tularemia Middle East Respiratory Syndrome Yellow Fever (MERS) Viral Hemorrhagic fever (VHF), including Ebola Virus disease, Lassa fever, Marburg hemorrhagic fever, and Crimean-Congo hemorrhagic fever Class B: Disease of a public health concern needing timely response because of potential for epidemic spread- report by the end of the next business day after the existence of a case, a suspected case, or a positive laboratory result is known. Arboviral neuroinvasive and nonneuroinvasive disease Chikungunya virus infection Eastern equine encephalitis virus disease LaCrosse virus disease (other California serogroup virus disease) Powassan virus disease St. Louis encephalitis virus disease West Nile virus infection Western Equine encephalitis virus disease Other arthropod-borne diseases Amebiasis Babesiosis Botulism (infant/wound) Brucellosis Campylobacteriosis Chancroid Chlamydia trachomatis infections Coccidoidomycosis Creutzfeldt-Jakob disease Cryptosporidiosis Cyclosporiasis Dengue E. Coli O157:H7 and Shiga toxinproducing E. Coli Ehrlichiosis/Anaplasmosis Giardiasis Gonorrhea Haemophilus influenzae (invasive disease) Hantavirus

9 Reportable Diseases for the State of Ohio Hemolytic uremic syndrome Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Influenza-associated hospitalization Influenza-associated pediatric mortality Legionnaires disease Leprosy (Hansen disease) Leptospirosis Listeriosis Lyme disease Malaria Meningitis (Aseptic viral/bacterial) Mumps Pertussis Poliomyelitis (including vaccineassociated cases) Psittacosis Q fever Rubella (congenital) Salmonellosis Shigellosis Spotted fever rickettsiosis, including Rocky Mountain Spotted Fever Staphylococcus aureus, with resistance or intermediate resistance to vancomycin Streptococcal disease, group A, invasive Streptococcal disease, group B, in newborns Streptococcal pneumoniae, invasive disease Syphilis Tetanus Toxic shock syndrome Trichinellosis Tuberculosis, including multi-drug resistant tuberculosis Typhoid fever Varicella Vibriosis Yersiniosis Class C: Report an outbreak, unusual incident or epidemic of other diseases (e.g. histoplasmosis, pediculosis, scabies, staphylococcal infections) by the end of the next business day. Outbreaks: Community Foodborne Healthcare-associated Institutional Waterborne Zoonotic

10 Reportable Diseases Infectious Diseases Annual Infectious Disease Report 2015 Cleveland Cases Cleveland Rate per 100,000 Ohio Cases 2014 Ohio Rate per 100,000 U.S. Cases 2014 U.S. Rate per 100,000 Amebiasis Anthrax Babesiosis , Botulism, Foodborne Botulism, Infant/Wound Brucellosis Campylobacteriosis N/A N/A Chancroid Chikungunya virus Chlamydia trachomatis 6,027 1, , ,441, infection Cholera Coccidioidomycosis , Creutzfeldt-Jakob Disease 0 0 N/A N/A N/A N/A Cryptosporidiosis , Cyclosporiasis Dengue Diptheria Eastern Equine encephalitis E. Coli, Shiga Toxin , Producing Ehrlichia , Chaffeensis/Anaplasmosis Giardiasis , Gonorrhea 2, , , Haemophilus Influenzae , (Invasive) Hantavirus Hemolytic Uremic Syndrome (HUS) Hepatitis A , Hepatitis B, Acute/Chronic ,

11 Reportable Diseases Infectious Diseases Cleveland Cases Cleveland Rate per 100,000 Ohio Cases 2014 Ohio Rate per 100,000 U.S. Cases 2014 U.S. Rate per 100,000 Hepatitis C, , , Acute/Chronic Hepatitis D 0 0 N/A N/A N/A N/A Hepatitis E N/A N/A Human , Immunodeficiency Virus Influenza A, Novel N/A N/A Human Virus Influenza-Associated N/A N/A N/A N/A Hospitalization Influenza-Associated Pediatric Mortality Invasive Pneumococcal , disease Lacrosse Virus Disease Legionellosis , Leprosy (Hansen Disease) Leptospirosis Listeriosis Lyme Disease , Malaria , Measles Meningitis, Aseptic N/A N/A N/A N/A Meningitis, Bacterial 4 1 N/A N/A N/A N/A Meningococcal Disease Middle East Respiratory N/A N/A Syndrome Mumps , Other Arthropod-borne 0 0 N/A N/A N/A N/A diseases Pertussis , , Plague Polioyelitis (including vaccine-associated cases) Powassan virus disease Psittacosis Q Fever Rabies, human Rubella (congenital)

12 Reportable Diseases Infectious Diseases Cleveland Cases Cleveland Rate per 100,000 Ohio Cases 2014 Ohio Rate per 100,000 U.S. Cases 2014 U.S. Rate per 100,000 Rubella (non-congenital) Salmonellosis , , Severe Acute Respiratory Syndrome (SARS) Shigellosis , Smallpox Spotted Fever , Rickettsiosis St. Louis encephalitis Staph Aureus, Vancomycin Intermediate Strep Disease (INV), N/A N/A N/A N/A Group A Strep Disease, Group B N/A N/A N/A N/A (Newborn) Strep Toxic Shock Syndrome (STSS) Strep Pneumo (INV), N/A N/A N/A N/A Drug Resistant Syphilis , , Tetanus Toxic Shock Syndrome (TSS) Trichinellosis Tuberculosis (including ,421 3 drug resistant) Tularemia Typhoid Fever Varicella , Vibriosis (Not Cholera) , Viral Hemorrhagic Fever West Nile Virus Disease , Western equine 0 0 N/A N/A N/A N/A encephalitis Yellow Fever Yersiniosis N/A N/A N/A N/A 1 N/A: Information for specified portions with this denotation do not have current data from the Centers for Disease Control and Prevention 2 The rates for Cleveland were calculated by using the 2010 census data population of 396,815 3 The rates for Ohio and the United States were calculated using the Centers for Disease Control and Prevention s 2014 report of infectious disease populations (rounded to the nearest thousandth placement) for Ohio: 11,856,000 and the United States: 11,594,000

13 Campylobacteriosis Agent: Caused by the bacteria Campylobacter; One of the most common causes of diarrheal illness in the US Symptoms: diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism for the most common symptoms Incubation/Duration: illness lasts on average one week; some individuals do not have any symptoms Transmission: found on raw meat and un-cleaned food surfaces; Highest rate of infection takes place in the summer months because bacteria grows rapidly in warm weathers Prevention: Food preparers should make sure foods are cooked to right temperatures before serving/consuming In 2015 here were 70 cases of Campylobacteriosis in the city of Cleveland. Ward 16 had the highest level of disease incidence than other wards which consists of the Collinwood- Nottingham and Glenville neighborhoods. The average age of individual infected was approximately 48 years old and women made up 57.7 percent of these individuals. Due to the commonality of symptoms and individuals not seeking medical attention when ill, Campylobacteriosis could be underreported. Campylobacteriosis in Cleveland by Month, Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

14 Incidences of Campylobacteriosis by Neighborhood in Cleveland, 2015 Incidences of Campylobacteriosis by Ward in Cleveland, 2015

15 Hepatitis C Agent: blood-borne pathogen that can be transmitted from person-to-person through blood or other body fluid contact Symptoms: fever, fatigue, dark urine, clay-colored stool and abdominal pain, loss of appetite, nausea, vomiting, joint pain and jaundice Incubation: could be from 2 weeks to 6 mouths with most common span of 3 to 9 weeks Transmission: since this is a blood-borne pathogen, people are at risk of contracting the infection if the come onto contact with an infected persons blood or bodily fluids Prevention: do not share needles when participating in intravenous drug use, ask about cleanliness of tattoo and piercing equipment before use, where gloves when you might come into contact with blood and also practice safe sex All except 3 of the 672 cases in Cleveland in 2015 are chronic cases of Hepatitis C. Most chronic cases belong to individuals on average 48 years old and 61.5 percent of the cases are males. African Americans make up 36.3 percent of the individuals infected Americans and 37.9 percent of infected individuals Caucasian. Ward 12 has the highest amount of individuals that have Hepatitis C with 65 cases which consists of the Brooklyn Centre, Kinsman, Buckeye-Shaker Square and Tremont neighborhoods. Hepatitis C in Cleveland by Race, Hepatitis C for Cleveland by Sex in 2015 Female Male

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17 Influenza Hospitalizations Agent: contagious respiratory illness that spreads easily through communities Symptoms: fever, cough, sore throat, runny nose, muscle or body aches, headache, fatigue and sometimes vomiting and diarrhea which is more common in children Incubation/Duration: infection takes about1 to 4 days to show symptoms in the body and the infection lasts on average for the same amount of time Transmission: most people are infected from coming into contact with someone who is already infected. Hospitalized-acquired influenza cases are individuals who go into the hospital with another complication and due to their immunocompromised state, they contracted influenza. The biggest chance of infection is when the climate switches from cold to hot and bacteria replicates. Reported Influenza for Cleveland by Ward, Ward Number Prevention: wash hands regularly especially during times of the year where virus spread is high; help improve surveillance and overall understanding of disease by seeking medical attention when possibly infected to avoid underreporting While there is a flu season, there was no significant correlation with time of year to amount of diagnosed cases. There were 187 reported incidences of influenza in Cleveland for 2015 and almost 67 percent of cases belonged to African Americans.1 The Cleveland ward with the highest incidence was Ward 7 which consist of the the Stockyards, Lee-Seville and Mount Pleasant neighborhoods. 1 These incidences are only hospitalized patients with influenza. This does not include patients tested by primary care doctors, emergency rooms, urgent cares, patients sent home to recover, etc.

18 Incidences of Influenza by Neighborhood in Cleveland, 2015

19 Legionellosis Agent: Legionella or Legionnaries disease is a bacterium that s naturally found in freshwater environments Symptoms: fever, cough, chills and muscle aches Incubation: may take 2 to 10 days after exposure before you experience symptoms Transmission: the bacteria can grow in man-made water systems like showers, faucets, air-conditioning units, hot tubs, public swimming areas, fountains, hot water tanks, etc. Prevention: to reduce disease spread, regularly clean and disinfect any water systems that you, your family or members of your community may come into contact with Most healthy people exposed to the bacteria will not become ill but smokers, individuals 50 years or older, people with chronic lung disease, with weak immune systems or are immunocompromised have a greater risk of having complications The average age of diagnosis in 2015 was about 58 years old and African Americans make up 74 percent of individuals who had the infection. Ward 7 had the highest amount of cases, which consist of the Stockyards, Lee-Seville and Mount Pleasant neighborhoods. This could be due to an issue with public water supply in these areas during that time or that the population is older and at a greater risk of contracting the illness. Legionellosis in Cleveland by Sex, 2015 Legionellosis in Cleveland by Month, Female Male Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

20 Incidences of Legionnaires disease by Neighborhood in Cleveland, 2015

21 Salmonellosis Agent: Salmonella bacteria is found by testing a blood or stool sample Symptoms: diarrhea, fever and abdominal pain Incubation: within 12 to 72 hours of coming in contact with the bacteria you may experience the symptoms Transmission: found in raw food products especially poultry; many cases of infection can come from having poultry as backyard or inside pets or coming into contact or eating the food Prevention: thoroughly cooking meats especially poultry will dramatically reduce the chances of becoming ill as well as keeping common food surfaces clean There were 45 cases of Salmonellosis with an average age of 38 years old. From looking at the information provided, there was no correlation of gender or time of infection occurring that would seem to affect risk of infection. Most of these cases took place in Ward 1 which is comprised mostly of the Riverside neighborhood Salmonellosis in Cleveland by Ward, Ward Number

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23 Outbreak Highlights Gastrointestinal Illness The outbreak in question took place at a high school sport s banquet in Cleveland, Ohio and occurred in the beginning of January and was the biggest reported outbreak in 2015 for the city. It s expected based on the latency period of symptom onset and symptoms experienced that the infection was norovirus. There were 158 individuals interviewed about the banquet and they were able to give details on what types of foods they consumed. The case was defined as any symptomatic, self-reported gastrointestinal illness that were reported through phone interview questionnaires conducted from February 2 nd to May 20, 2015 regarding the sports banquet that took place of January 7, The Ohio Infectious Disease A, B, C class list defines this as a community outbreak. There were a total of 58 symptomatic individuals in the outbreak time period of January 6, 2015 through January 10, If symptoms were reported before January 7 th or after January 9 th they were considered unrelated events to the outbreak. The different foods that were looked at did have results that were statistically significant but since there was no laboratory investigation, there was no specific food source to be identified as the main source of exposure. There was an environmental investigation conducted by a registered sanitarian from the Cleveland Department of Public Health and found no critical health violations. A major limitation of this study was recall bias and absence of lab confirmation of the infection. Not only was the Cleveland Department of Public Health not able to determine the virus or bacteria responsible, they also could not narrow the scope of which foods were the source of infection. We learned from this outbreak that our society could stand to be better educated on hand hygiene, environmental cleaning (banquet centers) and food catering standards.

24 Outbreak Highlights Shigella On January 20, 2015, the Ohio Disease Reporting System (ODRS) notified the Office of Communicable Disease Surveillance and Epidemiology (OCDSE) of 9 cases of Shigella at a daycare center in Cleveland, Ohio. The 9 cases spanned 2 families, 5 being siblings from one family and 3 children and their mother from another. Interviews of the cases were completed and then they were subsequently provided with control measures, educational materials, fact sheets and stool test kits. There were 22 people total that experienced symptoms that were interviewed and had stool samples collected. The daycare center did a thorough job of excluding individuals who did not have positive bacterial presence while still ill during the time period. Some individuals with this strain of infection could not use the normal antibiotic treatment to get rid of the infection and alternate antibiotics had to be used. In preventing this kind of outbreak from spreading in the future, individuals infected must submit 2 negative stool samples to their local health department before they are allowed to return to direct patient care, childcare or handle food per the Ohio revised code. Disinfecting all bathroom facilities daily and educating people who work with children on the proper cleaning techniques for all surfaces in the location. 1Shigella bacteria, Centers for Disease Control and Prevention

25 Outbreak Highlights Scabies Scabies are caused by an infestation of the skin by a human itch mite that burrows into the upper layer of the skin where they live and lay eggs. It occurs worldwide and effects all types of individuals especially people living in close proximity of each other such as in prisons, extended-care facilities and nursing homes. The most common symptoms are intense itching and a pimple-like skin rash that usually spreads through skin-to-skin contact for prolonged periods of time. In May of 2015, a report was received from a treatment services location that was experiencing an outbreak of scabies with 9 cases in total. Itching and rash were the most reported symptoms for all individuals infested. Treatment recommendations and education material were provided to the staff of the location. The treatment services center started using control methods after the outbreak was reported to control the situation. All infected individuals were women with an average age of 30. In some cases if an individual is experiencing an infestation first time, symptoms may not show up for months but are able to transmit the infestation the entire time they are infested. The best way to prevent scabies is by avoiding skin-to-skin contact with someone who is already infested and cleaning, dry-cleaning or storing infested items in plastic bags for up to a week to get rid of the mites. 1Scabies mite, Centers for Disease control and Prevention

26 Methods All data used in this summary report was reported to the Cleveland Department of Public Health which was later reported to the Ohio Department of Health as well as the Centers for Disease Control and Prevention. The populations that were used to calculate rates for Cleveland (396,815) Ohio (11,594,000) and the United States (318,856,000) were referred to earlier and were used for the calculations. For each disease from each location, the following calculation was performed: = Incidence Rate Amount of incidence in specific disease Total population being observed 100,000 = Rate per 100,000 With these values we can see, for example, that there was a rate of per 100,000 people in the city of Cleveland in 2015 that had a reported case of Gonorrhea. This means that for every 100,000 people in the population, approximately 573 people mostly likely had Gonorrhea at some point during the year. were shown throughout this report, were mapped and analyzed with the use of GIS (Geographic Information Systems) software to help identify areas in the city that specific disease showed to be more problematic than others. There are 17 wards for Cleveland and 34 neighborhoods, respectively. Since it can be difficult to determine from looking at one map, each of the higher incidence diseases that were discussed previously in the report have two maps to see the differences between ward and neighborhood. Any data that was provided and the case had an address from outside of the city of Cleveland was removed. While sexually transmitted diseases are shown to have the most significant results in this study, they are not discussed in depth in this report because they are annually reported separately, but are included because they are reportable infectious diseases. Data for HIV/AIDS for 2015 is limited and is not reflected in any ward or neighborhood information. All data collected was analyzed in SPSS statistical software. The maps that

27 Limitations While the data provided seems complete, there is some missing data and underreporting that needs to be handled for this data to be absolutely accurate. With the use of GIS, some cases were removed from analysis because they were not able to be plotted due to incomplete address information. There is also an issue of misclassification. For example, time of infection that s reported by the patient could be inaccurate and can be recorded differently for each disease. Some disease incidence cases reported in ODRS have the event date as the first day of symptom onset while other diseases and/or cases go by the date of positive result from a lab from the patient s sample. This means that the information of date and/or month of event could be skewed per disease. Underreporting continues to be an issue all over the country due to public health and healthcare professionals not fully understanding protocols. Since each state has different policies and still has to follow the national protocols, reports slip through the cracks. This is also an issue with diseases who have similar, common symptoms where individuals would not seek out medical assistance in diagnoses.

28 Appendix References: 1. Centers for Disease Control and Prevention. (2014, June 3). Campylobacter. In CDC, from 2. Centers for Disease Control and Prevention. (2017, January 27). Hepatitis C FAQs for Health Professionals. In CDC, from 3. Centers for disease Control and Prevention. (2017, March 24). Influenza (Flu). In CDC, from 4. Centers for Disease Control and Prevention. (2016, July 7). Legionella (Legionnaires Disease and Pontiac Fever). In CDC, fromhttps:// 5. Centers for Disease Control and Prevention. (2015, January 1) Nationally Notifiable Infectious Diseases (Historical). In CDC, from 6. Centers for Disease Control and Prevention. (2016, December 30). Salmonella. In CDC, from 7. Centers for Disease Control and Prevention. (2010, November 2). Parasites Scabies. In CDC, from 8. Centers for Disease Control and Prevention. (2016, October 14). Summary of Notifiable Infectious Diseases and Conditions United States, In CDC, from 9. Cleveland Department of Public Health. (2017). About the Cleveland Department of Public Health. In Cleveland Health, from Sexually Transmitted Disease Surveillance Program of the Ohio Department of Health. (2017, January 11). Sexually Transmitted Diseases and Data Statistics. In Ohio, from United States Census Bureau. (2015). Cleveland Sex by Age Population Estimate for In American Fact Finder, from YR_B01001B&prodType=table 12. United States Census Bureau. (2015). U.S. Department of Commerce: Tables for Cleveland, Ohio. In Census, from