Licking County Health Department 212 INFECTIOUS DISEASE REPORT
Narrative The Licking County Health Department (LCHD) made several improvements in 212 related to surveillance, investigations, case reports, and evaluations of infectious diseases. The changes have allowed investigators to respond to infectious disease reports more efficiently and have made collaboration with partnering agencies much easier. Infectious Disease Manual: The LCHD Infectious Disease Manual was updated in 212. The following sections were revised or added to the document: Public Information and Press Release Laboratory Access After Action Reports and Evaluations Non compliance of Healthcare Provider for Communicable Disease Reporting and Template Foodborne Disease Outbreak Investigations Infectious Disease Evaluations: A new template was developed in 212 and is being used to assess the investigations of LCHD staff responding to infectious disease reports. Case Notes: Infectious disease investigators have developed a more descriptive and organized method to document case notes within the Ohio Disease Reporting System (ODRS). This approach provides more information than what is required in ODRS and allows other investigators to better comprehend each situation. Disease Thresholds: LCHD applied a new technique in 212 using historical data to set thresholds for diseases of questions and estimate if an outbreak was occurring to prompt an investigation. Epi Team: The LCHD Epi Team implemented a process to send email alerts to members when a significant infectious disease event was occurring. This provided members with information on the status of each investigation. The LCHD Epi Team also added a representative from Licking Memorial Hospital to discuss emerging issues at each meeting. STD Task Force: LCHD formed a task force to address the rising rates of Chlamydia and Gonorrhea in the county. A partner notification project was developed to help treat both individuals and prevent reinfection.
DISEASE FACT SHEET Table 1: Top 5 Reportable Diseases Reportable Diseases (212) Table 2: STD Rankings STDs (212) Disease (Rank) Licking Rate Ohio Rate Disease (Rank) Licking Rate Ohio Rate 1.) Hepatitis C chronic 58.6 33.2 1.) Chlamydia 371.9 441.2 2.) Campylobacteriosis 31.1 9.9 2.) Gonorrhea 52. 136.3 3.) Pertussis 25.7 7.7 3.) Syphilis secondary 1.2 2.5 4.) Salmonellosis 16.1 11. T4.) Syphilis late latent.6 3.5 5.) Varicella 13.8 7. T4.) Syphilis stage unknown.6.1 Table 3: Influenza Surveillance Influenza Table 4: Ohio Department of Health HIV Statistics ODH HIV (211) IRIS Licking Rate Licking Cases HIV Type Licking Rate Ohio Rate 211 Season 517.2 865 212 Season 1,12.9 1,694 Prevalence (# living with infection) 69.1 155.3 Initial Diagnosis (# of new cases) 3.6 9.6 Notes: Data from Tables 1 and 2 were collected from the Ohio Disease Reporting System (ODRS). All Influenza data were taken from the Licking County Health Department s Influenza Reporting Improvement System (IRIS), Table 3. The HIV data in Table 4 were taken from the Ohio Department of Health s HIV/AIDS Surveillance Program page. Calculated Rates = number of new cases per 1, except for Prevalence Rate in Table 4. Population information collected from the United States Census Bureau. 211 population estimate used for 212. 212 not yet available.
#1 Hepatitis C chronic Table 5: Licking County Hepatitis C chronic History (27 212) Central Region Figure 1: Central Region Hepatitis C chronic Rates Hepatitis C chronic Year Cases Rate Rate Change Population 27 51 32.5 N/A 156,985 28 72 45.7 4.6% 157,721 29 85 53.6 17.3% 158,488 21 92 55.3 3.2% 166,492 211 97 58. 4.9% 167,248 212 98 58.6 1.% 167,248 Figure 2: Licking County Hepatitis C chronic (27 212) Notes: Calculated Rates = number of new cases per 1, in Table 5 and Figures 1 and 2. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = Prison Population; = County Rate is below the Ohio Rate. 211 population estimate used for 212. 212 not yet available.
#2 Campylobacteriosis Table 6: Licking County Campylobacteriosis History (27 212) Central Region Figure 3: Central Region Campylobacteriosis Rates Campylobacteriosis Year Cases Rate Rate Change Population 27 18 11.5 N/A 156,985 28 28 17.8 54.8% 157,721 29 17 1.7 39.9% 158,488 21 36 21.6 11.9% 166,492 211 67 4.1 85.6% 167,248 212 52 31.1 22.4% 167,248 Figure 4: Licking County Campylobacteriosis (27 212) Notes: Calculated Rates = number of new cases per 1, in Table 6 and Figures 3 and 4. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = County Rate is below Ohio Rate. 211 population estimate used for 212. 212 not yet available.
#3 Pertussis Table 7: Licking County Pertussis History (27 212) Central Region Figure 5: Central Region Pertussis Rates Pertussis Year Cases Rate Rate Change Population 27 23 14.7 N/A 156,985 28 2 12.7 13.6% 157,721 29 126 79.5 526.% 158,488 21 125 75.1 5.5% 166,492 211 13 7.8 89.6% 167,248 212 43 25.7 229.5% 167,248 Figure 6: Licking County Pertussis (27 212) Notes: Calculated Rates = number of new cases per 1, in Table 7 and Figures 5 and 6. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = County Rate is below Ohio Rate. 211 population estimate used for 212. 212 not yet available.
#4 Salmonellosis Table 8: Licking County Salmonellosis History (27 212) Central Region Figure 7: Central Region Salmonellosis Rates Salmonellosis Year Cases Rate Rate Change Population 27 12 7.6 N/A 156,985 28 25 15.9 19.2% 157,721 29 24 15.1 5.% 158,488 21 15 9. 4.4% 166,492 211 24 14.3 58.9% 167,248 212 27 16.1 12.6% 167,248 Figure 8: Licking County Salmonellosis Notes: Calculated Rates = number of new cases per 1, in Table 8 and Figures 7 and 8. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = County Rate is below Ohio Rate. 211 population estimate used for 212. 212 not yet available.
#5 Varicella Table 9: Licking County Varicella History (27 212) Central Region Figure 9: Central Region Varicella Rates Varicella Year Cases Rate Rate Change Population 27 63 4.1 N/A 156,985 28 24 15.2 62.1% 157,721 29 33 2.8 36.8% 158,488 21 21 12.6 39.4% 166,492 211 13 7.8 38.1% 167,248 212 23 13.8 76.9% 167,248 Figure 1: Licking County Varicella Notes: Calculated Rates = number of new cases per 1, in Table 9 and Figures 9 and 1. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = County Rate is below Ohio Rate. 211 population estimate used for 212. 212 not yet available.
STDs In 212, the rates for Chlamydia and Gonorrhea increased significantly compared to 211. Early projections estimated that Chlamydia was on the rise and as a result the Licking County Health Department decided to form an STD Task Force. The group addressed several issues and worked on a partner notification process to reduce rates. STD surveillance identified a large proportion of reinfections which prompted the targeting of partners for treatment. Figure 11: Chlamydia Figure 12: Gonorrhea In 212, the percentage of reinfection for Chlamydia was at 29.4% and 1.3% for Gonorrhea. This could imply that around 1 out of 3 people who have a positive test for Chlamydia will test positive again in Licking County. If an individual is diagnosed with an STD it s extremely important for the partner to be notified and tested. This needs to happen in order to prevent reinfection and lower STD rates in the county. The number of Gonorrhea cases for 212 was following a similar pattern to 211 until September when an increase was identified. Chlamydia was the primary focus of the STD Task Force but due to the late increase in Gonorrhea, both STDs will be addressed by the group. Syphilis information was made available in the Ohio Disease Reporting System in early 212 and will be tracked with the rest of the STDs. HIV/AIDS information is maintained by the Ohio Department of Health and the most current stats published were from 211.
#1 Chlamydia Table 1: Licking County Chlamydia History (27 212) Central Region Figure 13: Central Region Chlamydia Rates Chlamydia Year Cases Rate Rate Change Population 27 134 85.4 N/A 156,985 28 226 143.3 67.8% 157,721 29 381 24.4 67.8% 158,488 21 381 228.8 4.8% 166,492 211 52 3.2 31.2% 167,248 212 623 372.5 24.1% 167,248 Figure 14: Licking County Chlamydia Notes: Calculated Rates = number of new cases per 1, in Table 1 and Figures 13 and 14. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = Prison Population; = County Rate is above the Ohio Rate. 211 population estimate used for 212. 212 N/A.
#2 Gonorrhea Table 11: Licking County Gonorrhea History (27 212) Central Region Figure 15: Central Region Gonorrhea Rates Gonorrhea Year Cases Rate Rate Change Population 27 28 17.8 N/A 156,985 28 76 48.2 17.8% 157,721 29 84 53. 1.% 158,488 21 51 3.6 42.3% 166,492 211 44 26.3 14.1% 167,248 212 87 52. 97.7% 167,248 Figure 16: Licking County Gonorrhea Notes: Calculated Rates = number of new cases per 1, in Table 11 and Figures 15 and 16. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = Prison Population; = County Rate is above the Ohio Rate. 211 population estimate used for 212. 212 N/A.
#3 Syphilis Table 12: Licking County Syphilis History (27 212) Central Region Figure 17: Central Region Syphilis Rates Syphilis Year Cases Rate Rate Change Population 27 2 1.3 N/A 156,985 28 3 1.9 46.2% 157,721 29 5 3.2 68.4% 158,488 21 6 3.6 12.5% 166,492 211 8 4.8 33.3% 167,248 212 4 2.4 5.% 167,248 Figure 18: Licking County Syphilis Notes: Calculated Rates = number of new cases per 1, in Table 12 and Figures 17 and 18. All data were collected from the Ohio Disease Reporting System (ODRS). Population information collected from the United States Census Bureau. Symbols of significance: = Prison Population; = County Rate is above the Ohio Rate. 211 population estimate used for 212. 212 N/A.
Table 13: Amebiasis E.coli 157:H7 REPORTABLE DISEASE JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD Amebiasis Anaplasmosis Anaplasma phagocytophilum Anthrax Botulism foodborne Botulism infant 1 1 Botulism wound Brucellosis Campylobacteriosis 6 1 6 4 7 4 5 2 8 2 7 52 Chancroid Chlamydia 4 55 54 58 64 51 48 57 46 66 49 35 623 Cholera Coccidioidomycosis 1 1 Creutzfeldt Jakob Disease Creutzfeldt Jakob Disease variant (vcjd) Cryptosporidiosis 1 1 1 1 4 Cyclosporiasis Cytomegalovirus congenital (CMV) Dengue Dengue Hemorrhagic Fever Diphtheria E.coli Not O157:H7 1 1 1 1 1 1 6 E.coli O157:H7 1 1 Notes:
Table 14: E.coli Unknown serotype Hepatitis B (including delta) acute/chronic REPORTABLE DISEASE JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD E.coli Unknown serotype Eastern equine encephalitis virus disease Ehrlichiosis/Anaplasmosis Undetermined Ehrlichiosis Ehrlichia chaffeensis Ehrlichiosis Ehrlichia ewingii Encephalitis post chickenpox Encephalitis post mumps Encephalitis post other infection Encephalitis primary viral Giardiasis 1 1 1 3 Gonorrhea 3 9 3 6 5 7 6 7 1 16 4 11 87 Granuloma inguinale Haemophilus influenzae (invasive disease) 1 3 2 1 1 8 Hantavirus infection Hantavirus pulmonary syndrome Hemolytic uremic syndrome (HUS) Hepatitis acute viral undetermined etiology Hepatitis A 1 1 2 1 5 Hepatitis B Investigation Hepatitis B Perinatal Infection 1 1 2 Hepatitis B (including delta) acute 1 1 1 3 Hepatitis B (including delta) acute/chronic Notes:
Table 15: Hepatitis B (including delta) chronic Measles indigenous to Ohio REPORTABLE DISEASE JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD Hepatitis B (including delta) chronic 3 2 1 2 3 1 1 3 16 Hepatitis C acute Hepatitis C acute/chronic Hepatitis C chronic 11 3 8 12 6 6 5 1 9 9 8 11 98 Hepatitis E Herpes congenital Immigrant Investigation Influenza A novel virus infection 2 2 Influenza associated hospitalization 1 7 35 43 Influenza associated pediatric mortality Influenza Seasonal (IRIS) 6 5 13 13 11 7 6 41 1188 165 Kawasaki disease LaCrosse virus disease 1 1 Legionellosis Legionnaires Disease 1 1 Leprosy (Hansen Disease) Leptospirosis Listeriosis Lyme Disease 1 1 2 Lymphogranuloma venereum (LGV) Malaria Measles imported from outside Ohio Measles indigenous to Ohio Notes:
Notes: REPORTABLE DISEASE JAN MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD FEB Measles indigenous/imported Meningitis aseptic/viral 2 1 7 1 3 Meningitis bacterial (Not N. meningitidis) 1 1 Meningococcal disease Neisseria meningitidis 1 1 Mumps Mycobacterial disease other than tuberculosis 2 4 1 1 1 2 13 2 2 2 Pertussis 2 1 1 5 4 14 43 1 3 3 1 6 Plague Poliomyelitis non paralytic Poliomyelitis paralytic Poliomyelitis paralytic/non paralytic Powassan virus disease Psittacosis Q fever, acute Q fever, chronic Rabies animal Reye syndrome Rheumatic fever Rocky Mountain spotted fever (RMSF) 1 1 2 Rubella congenital Rubella not congenital 2 Salmonellosis 1 7 3 1 1 8 27 1 1 2 Table 16: Measles indigenous/imported Salmonellosis
Table 17: Severe Acute Respiratory Syndrome (SARS) Toxoplasmosis congenital REPORTABLE DISEASE JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD Severe Acute Respiratory Syndrome (SARS) Shigellosis 1 2 1 2 6 Smallpox St. Louis encephalitis virus disease Staphylococcal aureus (VISA) Staphylococcal aureus (VRSA) Streptococcal Group A invasive 2 2 Streptococcal Group B in newborn 1 1 2 Streptococcal toxic shock syndrome (STSS) Strep. Pneumo antibiotic resistance unknown 1 5 1 1 1 2 1 1 3 2 1 19 Strep. Pneumo antibiotic resistance/intermed. 2 1 1 2 1 7 Syphilis congenital Syphilis early latent (<1year) asymptomatic 1 1 Syphilis late with symptoms (no neurosyphilis) Syphilis neurosyphilis Syphilis primary Syphilis secondary 1 1 2 Syphilis stage Unknown 1 1 Syphilis unknown latent Tetanus Toxic shock syndrome (TSS) Toxoplasmosis congenital Notes:
Notes: REPORTABLE DISEASE JAN MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD FEB Trichinosis Tuberculosis Tuberculosis multi drug resistant (MDR TB) Tularemia Typhoid fever Typhus fever 5 Varicella 2 2 1 3 1 23 2 2 1 2 2 Vibrio parahaemolyticus infection Vibrio vulnificus infection Vibriosis other (not cholera) Viral Hemorrhagic Fever (VHF) West Nile virus disease (also current infection) Western equine encephalitis virus disease Yellow fever Yersiniosis Table 18: Trichinosis Yersiniosis
Outbreaks Licking County Health Department : INFECTIOUS DISEASE REPORT Table 19: Licking County 212 Outbreaks Type # of Outbreaks Hand, Foot and Mouth 1 H3N2v (Influenza) 1 Norovirus 5 Pertussis 1 Salmonellosis 1 Unknown 2 TOTAL 11 Figure 19: Licking County 212 Outbreaks Breakdown Summary Hand, Foot and Mouth: A single Hand, Foot and Mouth outbreak was reported to the health department with a few individuals experiencing symptoms. A couple of unofficial reports of HFM were suspected in the county but could not be confirmed. H3N2v: Four confirmed cases of H3N2v were detected in Licking County. The Licking County Health Department prepared and collaborated with local partners to limit the spread of H3N2v which affected areas across the state. Norovirus: A total of five Norovirus outbreaks were identified throughout Licking County in 212. The virus caused illness in all ages and in different settings. The positive lab specimens from each outbreak contained the strain Norovirus GII.4_New Orleans. Pertussis: Several cases of Pertussis were reported in a timeframe which exceeded the health departments threshold and indicated the possibility of an outbreak. During the investigation, a number of cases were epidemiologically linked to one another which confirmed the existence of an outbreak. Salmonellosis: The laboratory results on a Licking County Salmonella case matched a multistate outbreak being tracked by the CDC. The strain responsible for the outbreak has been linked to hedgehogs. Unknown: There were two outbreaks where the causative agent could not be identified because lab specimens were unable to be collected. Notes:
Conclusion 211 1.) Hepatitis C chronic 2.) Campylobacteriosis 3.) Meningitis aseptic/viral 4.) Salmonellosis 5.) Mycobacterial disease Table 2: Top 5 Reportable Disease Comparison (211 212) Licking Rate 58. 4.1 14.9 14.3 11.3 Rate Change 1.% 22.4% See Below 12.6% See Below 212 1.) Hepatitis C chronic 2.) Campylobacteriosis 3.) Pertussis 4.) Salmonellosis 5.) Varicella Licking Rate 58.6 31.1 25.7 16.1 13.8 Table 21: Top 5 Reportable Disease Ranking Change Comparison (211 212) Reportable Disease Licking Rate 211 212 Rate Change Pertussis 7.8 25.7 229.5% Meningitis aseptic/viral 14.9 4.2 71.8% Varicella 7.8 13.8 76.9% Mycobacterial disease 11.3 7.8 31.% Three of the top 5 reportable diseases in Licking County from 211 were again in the same positions for 212. Hepatitis C chronic was the leading infectious disease reported in the county and in Ohio for 212 (not including STDs). Campylobacteriosis was again the second leading reportable infectious disease in Licking County and in 212 the rate decreased by 22.4%. An important consideration for Campylobacteriosis would be the status of the case classification and the type of test used to detect the bacteria. 75% of the cases reported in Licking County for 212 were classified as suspected due to the use of an antigen test. Studies have been conducted to evaluate the effectiveness of antigen tests to truly detect Campylobacter and the results have shown a high number of false positives. If Licking County just used the number of confirmed Campylobacter cases for 212 then the county rate would be at 7.8 and in the middle tier for the region. Discussion will take place to see if the antigen test can be used as a screening tool followed up by a culture to confirm the presence of Campylobacter in Licking County. A Pertussis outbreak contributed to an increased rate in 212 and placed third on the list for the leading reportable diseases in the county. Salmonellosis ranked fourth on the list with a 12.6% increase from 211. Varicella replaced Mycobacterial disease from 211 for the fifth place spot.
Conclusion Due to the increased rates of Chlamydia and Gonorrhea, STD Task Force members are working on new ideas to help educate and treat the people of Licking County. The group is still focusing on partner notification and treatment to bring rates down in 213. Influenza is no longer a reportable disease but LCHD staff are committed to tracking the number of cases in the county to provide information to the public. The Influenza Reporting Improvement System (IRIS) and participation by area providers makes this all possible. A weekly influenza report is published on LCHD s website which started in late 212. The IRIS report contains all of the data collected for the week and compares it to past years. Several outbreaks were reported in 212 and LCHD staff were able to respond to these events to limit their spread. Education was also provided to staff members where these outbreaks took place to assist with early detection and control measures for the future. Norovirus was an issue for the entire state in 212 and Licking County had 5 confirmed outbreaks. All of these outbreaks were controlled once the reporting location notified LCHD and provided recommendations. The Licking County Health Department will continue to conduct disease surveillance to help protect the people of Licking County.