Clark County Combined Health District 2018 Annual Communicable Disease Report

Transcription

1 Clark County Combined Health District 2018 Annual Communicable Disease Report Communicable Disease Summary 2018 In 2018, Clark County experienced a 24.2% increase in the number of communicable disease cases from 2017 to 2018 (1725 cases and 2143 cases, respectively) (Figure 1). The most frequently reported illnesses were chlamydia infection (875 cases), gonococcal infection (385 cases), and influenza-associated hospitalizations (312 cases) (Table 1). Figure 1: Annual Communicable Disease Totals, Clark County, Case counts include confirmed, probable, and suspect disease case classifications. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/2019. Reportable Conditions not Reported in Clark County in 2018: Amebiasis Anthrax Arboviral neuroinvasive and nonneuroinvasive disease Babesiosis Botulism, foodborne Botulism, infant Botulism, wound Brucellosis Chancroid Chikungunya Cholera Creutzfeldt-Jakob disease (CJD) Cyclosporiasis Dengue Diptheria Eastern equine encephalitis virus disease Ehrlichiosis/Anaplasmosis Hantavirus Hemolytic uremic syndrome (HUS) Hepatitis B (Perinatal) Hepatitis D Hepatitis E Influenza A novel virus Influenza-associated pediatric mortality LaCrosse virus disease (other California serogroup virus disease) Leprosy (Hansen disease) Leptospirosis Listeriosis Malaria Measles Meningococcal disease MERS Other arthropod-borne diseases Plague Poliomyelitis (including vaccineassociated cases) Powassan virus disease Psittacosis Q Fever Rabies, human Rubella (congenital) Rubella (not congenital) Severe acute respiratory syndrome (SARS) Smallpox St. Louis encephalitis virus disease Staphylococcus aureus, with resistance or intermediate resistance to vancomycin (VRSA, VISA) Streptococcal toxic shock syndrome (STSS) Tetanus Toxic shock syndrome Trichinellosis Tularemia Typhoid fever Varicella Vibrosis Viral hemorrhagic fever (VHF) Western equine encephalitis virus disease Yellow fever Zika virus infection 1 of 9

2 Clark County Combined Health District 2018 Annual Communicable Disease Report 1/11/2019 Table 1: Reportable Conditions Reported in Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/ Reportable Condition Quarter 1 Quarter 2 Quarter 3 Quarter 4 Grand Total Confirmed Total Confirmed Total Confirmed Total Confirmed Total Confirmed Total Enteric Diseases Campylobacteriosis Cryptosporidiosis E. coli, Shiga Toxin-Producing (O157:H7, Not O157, Unknown Serotype) Giardiasis Hepatitis A Salmonellosis Shigellosis Yersiniosis Hepatitis B & C Hepatitis B (including delta) - acute Hepatitis B (including delta) - chronic Hepatitis C - acute Hepatitis C - chronic Hepatitis C - Perinatal Infection Sexually Transmitted Infections HIV* Chlamydia infection Gonococcal infection Syphilis - congenital* Syphilis - early* Syphilis - primary* Syphilis - secondary* Syphilis - stage Unknown* Syphilis - unknown duration or late* Vaccine-Preventable Diseases Haemophilus influenzae (invasive disease) Influenza-associated hospitalization Meningitis - aseptic/viral Meningitis - bacterial (Not N. meningitidis) Mumps Pertussis Streptococcus pneumoniae - invasive antibiotic resistance unknown or non-resistant Streptococcus pneumoniae - invasive antibiotic resistant/intermediate of 9

3 Clark County Combined Health District 2018 Annual Communicable Disease Report 1/11/ Reportable Condition, continued Quarter 1 Quarter 2 Quarter 3 Quarter 4 Grand Total Confirmed Total Confirmed Total Confirmed Total Confirmed Total Confirmed Total Varicella Vector-borne and Zoonotic Diseases Lyme Disease Spotted Fever Rickettsiosis,including Rocky Mountain spotted fever (RMSF) West Nile virus disease (also current infection) Other Reportable Infectious Diseases Coccidioidomycosis CP-CRE Immigrant Investigation Influenza - ODH Lab Results Legionellosis - Legionnaires' Disease Streptococcal - Group A -invasive Streptococcal - Group B - in newborn Tuberculosis Total *HIV and Syphilis totals include Confirmed, Probable, Suspect, and Contact Investigations. HIV data were collected from ODRS and not from ODH HIV Surveillance. 3 of 9

4 Disease Trends Chlamydia Infection Chlamydia infection has been the most frequently reported condition in Clark County since 2011, and has increased by 18.6% over the last year (Figure 2). In the state of Ohio, Chlamydia cases have also been steadily increasing. Gonococcal Infection The number of cases of gonococcal infection in Champaign County has been slowly increasing over time (19.2% increase in 2018) (Figure 2). This disease trend has been seen in the state of Ohio as well. Figure 2: Chlamydia Infection and Gonococcal Infection cases in Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/2019. Influenza-associated Hospitalizations In 2018, the total number of influenza-associated hospitalizations increased by 121.6% from 2017 (Figure 3). This number has been increasing since Figure 3: Influenza-associated Hospitalizations, Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/ of 9

5 Hepatitis C Chronic Infection The total number of Hepatitis C Chronic cases in Clark County has been slowly increasing over time. This is partially due to a change in 2016, which broadened the case definition for Hepatitis C Chronic infection, resulting in more cases being classified as Probable and fewer cases being classified as Confirmed. This is evidenced by the increase in total number of cases and a decrease in confirmed cases (Figure 4). Figure 4: Hepatitis C - Chronic cases by case classification status, Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/2019. Total Syphilis Total syphilis includes syphilis, congenital; syphilis, early; syphilis, late latent (>1 year) asymptomatic; syphilis, primary; syphilis, secondary; syphilis, stage unknown; syphilis, unknown duration or late. Total syphilis in Clark County has been decreasing since 2016 (Figure 5). Figure 5: Total syphilis cases by case classification status, Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/2019. *Total includes Probable, Suspect, and Contact Investigations. 5 of 9

6 Hepatitis A There was a dramatic increase (85.6%) in the number of hepatitis A cases reported to the Clark County Combined Health District (CCCHD) in 2018 (Figure 6). In 2018, there were 36 total cases of hepatitis A reported in Clark County (30 confirmed, 6 suspect) (Table 2). Prior to 2018, the most recent confirmed case of hepatitis A occurred in 2011 (Table 2). Figure 6: Hepatitis A, Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/10/2019. Table 2: Hepatitis A in Clark County, Ohio, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/10/2019. Case Classification Status Year Confirmed Suspected The Ohio Department of Health (ODH) has declared a statewide community outbreak of hepatitis A after observing an increase in cases linked to certain risk factors since the beginning of Clark County has 17 cases associated with the statewide community outbreak. For further case statistics relating to Clark County s statewide community outbreak cases, please see attached Hepatitis A Report Clark County Outbreaks Clark County Combined Health District investigated 21 outbreaks in 2018 (Table 3). Six investigations involved a long-term care facility and 11 involved a school or day care facility. 6 of 9

7 Table 3: Outbreak Investigations in Clark County, Outbreak Agent Outbreak Type Date Investigation Date Investigation Reported Completed 1 Influenza virus Healthcare-Associated 1/5/2018 1/19/ Clostridium perfringens Healthcare-Associated 1/9/2018 5/4/ Pink eye Community 1/19/2018 1/30/ Influenza virus Institutional 1/26/2018 4/9/ Streptococcus Community 2/2/2018 3/2/ Norovirus Institutional 2/6/2018 3/2/ Influenza virus Healthcare-Associated 2/6/2018 3/22/ Influenza virus Institutional 2/9/2018 2/26/ Cryptosporidium & Campylobacter Zoonotic 2/15/2018 5/24/ Influenza virus Healthcare-Associated 3/6/2018 3/30/ Fifth disease Community 4/17/2018 6/8/ Rotavirus Community 4/30/2018 6/12/ Hand, foot, mouth disease Community 6/11/2018 6/26/ Hand, foot, mouth disease Institutional 9/11/ /10/ Hand, foot, mouth disease Institutional 9/12/ /11/ Hand, foot, mouth disease Community 10/2/ /21/ Hand, foot, mouth disease Institutional 10/15/ /11/ Impetigo Institutional 10/29/ /11/ Norovirus Unusual Incidence 10/30/ /27/ Hand, foot, mouth disease Community 11/14/ /21/ Campylobacter Cluster 12/10/2018 Report outstanding (90-day window not closed) 7 of 9

8 Timeliness of Disease Reporting Timely reporting of infectious diseases is important in identifying potential outbreaks and reducing disease burden. Public health relies on health care providers and laboratories for identification and prompt reporting of these communicable diseases. The Ohio Administrative Code identifies two quality indicators related to completeness and timeliness for nine reportable diseases (OAC (B) (2)): Meeting the median number of days between date of diagnosis and report to the health department in ODRS. Increasing the percent completeness for reportable infectious diseases in ODRS by age, race, ethnicity, and sex. The following reportable diseases were identified by the advisory committee as having the most value and opportunity to impact public health related to improved timeliness and completeness of reporting: Camplyobacteriosis, Cryptosporidiosis, E. Coli O157:H7 and Shiga toxin-producing E. Coli (STEC), Giardiasis, Influenza-associated hospitalization, Legionnaires disease, Pertussis, Salmonella, and Shigellosis. The reporting lag is the difference in days between the date of diagnosis and the date the case was reported to Champaign Health District (CHD). Weekends were removed in the median lag calculation and only confirmed and probable cases were included in the analysis. All diseases included are Class B reportable diseases with an expectation that they be reported to ODH by the next business day. Given this established standard, an appropriate proxy that should also be monitored to see continuous improvement is the percentage of reports (locally and aggregated at the state level) that meet or exceed the established standard (Ohio Department of Health, 2018). Table 4: Percent Completeness of Report and Median Days Reporting Lag for Selected Diseases* in Clark County, All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/9/2019. Reportable Condition Age Sex Race Ethnicity Percent Completed Percent Completed Percent Completed Percent Completed Reported Within 1 Business Day Percent Reported Reporting Lag** Median Days Total Number of Cases Reported Campylobacteriosis 100% 100% 50% 100% 60.7% 1 28 Cryptosporidiosis 100% 100% 92% 92% 66.7% 1 12 Giardiasis 100% 100% 100% 100% 66.7% 0 3 Influenza-associated hospitalization 100% 100% 98% 99% 61.4% Legionellosis - Legionnaires' Disease 100% 100% 100% 100% 100% 0 13 Pertussis 100% 100% 100% 100% 100% 0 4 Salmonellosis 100% 100% 100% 100% 41.7% 2 12 Shigellosis 100% 100% 100% 100% 100% 1 1 * Diseases included confirmed and probable cases of: Campylobacteriosis, Cryptosporidiosis, E. coli O157:H7 and Shiga toxin-producing E. coli (STEC), Giardiasis, Influenza-associated hospitalization, Legionnaires; disease, Pertussis, Salmonellosis and Shigellosis. ** Reporting Lag is the difference in business days between the date of diagnosis and the date of report. If blank, date of diagnosis defaulted to lab specimen collection date, then date of illness onset. 8 of 9

9 Notes Reportable Disease Changes in Ohio in 2018 The following changes took effect on March 21, 2018: Additions: Carbapenemase producing (CP) carbapenem resistant Enterobacteriaceae (CRE); Hepatitis C, Perinatal Infection References Ohio Department of Health. (2018). Public Health Quality Indicators: Annual Report, July Report-2018.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9 DDDDM3000-d19078a bb4-94f5-32d92d700f7d-mqNAxBh 9 of 9

10 Clark County Combined Health District Hepatitis A Report 1/10/ Hepatitis A Update The Ohio Department of Health (ODH) has declared a statewide community outbreak of hepatitis A after observing an increase in cases linked to certain risk factors since the beginning of Outbreaks of hepatitis A are occurring in several states across the U.S., including neighboring states of Indiana, Kentucky, Michigan and West Virginia. Hepatitis A is a vaccine-preventable liver disease that usually spreads when a person ingests fecal matter - even in microscopic amounts - from contact with objects, food or drinks contaminated by the stool of an infected person. Hepatitis A can also be spread from close personal contact with an infected person, such as through sex. People at increased risk for hepatitis A in this outbreak include: People with direct contact with individuals infected with the virus Men who have sex with men People who use street drugs whether they are injected or not People who are incarcerated People experiencing homelessness People who have traveled to other areas of the U.S. currently experiencing outbreaks Symptoms of hepatitis A include fatigue, low appetite, stomach pain, nausea, clay-colored stools and jaundice. People with hepatitis A can experience mild illness lasting a few weeks to severe illness lasting several months. As of January 7, 2019, ODH reported 1,370 outbreak cases of Hepatitis A across 66 (75%) counties in Ohio (Table 1). Table 1: Hepatitis A Statewide Community Outbreak Case Statistics, Ohio, Data obtained from ODH, last updated 1/7/2019. Hepatitis A Statewide Community Outbreak, Ohio Case Statistics Number of cases 1370 Illness onset range 1/5/ /29/2018 Number of hospitalizations 856 (63%) Age range 2-81 years Sex 59% male Number of deaths 4 Number of counties with cases 66 (75%) Hepatitis A in Clark County There was a dramatic increase (85.6%) in the number of hepatitis A cases reported to the Clark County Combined Health District (CCCHD) in 2018 (Figure 1). In 2018, there were 36 total cases of hepatitis A reported in Clark County (30 confirmed, 6 suspect) (Table 2). Prior to 2018, the most recent confirmed case of hepatitis A occurred in 2011 (Table 2). Table 2: Hepatitis A in Clark County, Ohio, Data queried from Ohio Disease Reporting System (ODRS) Data Extract on 1/10/2019. Case Classification Status Year Confirmed Suspected Contact apetroff@ccchd.com with questions 1

11 Clark County Combined Health District Hepatitis A Report 1/10/2019 Figure 1: Annual hepatitis A cases in Clark County, Data queried from Ohio Disease Reporting System (ODRS) Data Extract on 1/10/2019. Hepatitis A Statewide Community Outbreak Case Statistics for Clark County Clark County has 17 cases associated with the statewide community outbreak. Of these cases, 70.6% are male, 94.1% are white, and 88.2% are non-hispanic (Table 3). Ages are distributed evenly, ranging from years with an average age of 38.4 and a median age of 37 (Table 3). Approximately 59% of cases are years old (Figure 2). The hospitalization rate of outbreak-related hepatitis A cases in Clark County is 47% (Table 3). While this rate is lower than the state hospitalization rate (63%), it is still higher than expected. The majority of Clark County cases were reported in November and December 2018, but there was an initial peak in May 2018 (Figure 3). Table 3:Hepatitis A Statewide Community Outbreak Case Statistics, Clark County, Data queried from Ohio Disease Reporting System (ODRS) Data Extract on 1/10/2019. Hepatitis A Statewide Community Outbreak, Clark County Case Statistics Number of cases 17 Illness onset range 5/13/ /19/2018 Number of hospitalizations 8 (47%) Age range years Average age 38.4 Median age 37 Sex 70.6% Male Race 94.1% White Ethnicity 88.2% Non-Hispanic Contact apetroff@ccchd.com with questions 2

12 Clark County Combined Health District Hepatitis A Report 1/10/2019 Figure 2: Hepatitis A statewide community outbreak cases by age group, Clark County, Data queried from Ohio Disease Reporting System (ODRS) Data Extract on 1/10/2019. Figure 3: Hepatitis A statewide community outbreak cases by month, Clark County, Data queried from Ohio Disease Reporting System (ODRS) Data Extract on 1/10/2019. Community Response Community response includes: Ongoing surveillance Case investigation Post-exposure prophylaxis for contacts of hepatitis A cases Vaccine outreach to high risk populations Education and awareness to high risk populations Contact apetroff@ccchd.com with questions 3