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2017 Summary KENT COUNTY HEALTH DEPARTMENT EPI FOCUS 2017 Communicable Disease Summary Contents Introduction What are reportable diseases? ................................................................................................................................................... 2 Michigan Disease Surveillance System (MDSS) ........................................................................................................................... 2 Gastrointestinal illnesses Campylobacter ............................................................................................................................................................................ 4 Shigellosis ....................................................................................................................................................................................5 Giardiasis .....................................................................................................................................................................................5 Salmonellosis .............................................................................................................................................................................. 6 Sexually Transmitted Infections HIV/AIDS .................................................................................................................................................................................... 7 Chlamydia .................................................................................................................................................................................... 7 Gonorrhea .................................................................................................................................................................................... 7 Vaccine Preventable Diseases Pertussis ...................................................................................................................................................................................... 8 Lyme disease ............................................................................................................................................................................... 9 Tuberculosis ................................................................................................................................................................................ 9 Influenza ........................................................................................................................................................................................ 10 Stay Up to Date on Local Data ...................................................................................................................................................... 10 INTRODUCTION HEPATITIS A Prevention and control of communicable disease is a necessary and critical During 2017, there were 633 aspect of assuring community health and is an affirmative duty of local public cases of Hepatitis A health departments. To this end, the Kent County Health Department diagnosed in Michigan as part (KCHD) monitors the occurrence of over 80 communicable diseases on a of a state-wide outbreak, community-wide basis. Health care providers in Kent County are a critical component of our surveillance system. As such, it is important that KCHD primarily located in Oakland, provide feedback on disease trends in our community. Monroe, and Wayne Counties in Southeast Michigan. 509 of This edition of Epi Focus provides surveillance data on the following these cases were hospitalized diseases: campylobacter, shigellosis, giardiasis, salmonellosis, HIV/AIDS, and there were 20 deaths. chlamydia, gonorrhea, pertussis, Lyme disease, tuberculosis and influenza. Please take a moment to review these data and contact us at 616-632-7228 KENT COUNTY should you have any questions or comments. In 2017, Kent County had 1 What are reportable diseases? Hepatitis A case linked to the A reportable disease is any disease, condition, infection or suspect outbreak. There are typically occurrence of disease that is required under Michigan State Law (Section 1-2 cases of Hepatitis A per 5111 of Act. No. 368 of the Public Acts of 1978, as amended, being 333.511 of year in Kent County. the Michigan Compiled laws) to be reported by physicians, laboratories, schools, daycare centers, and camps to the local health department. HIGH-RISK POPULATIONS The list of reportable diseases, along with details on how to report to the local Hepatitis A can be transferred health department, can be found in the Health Care Professionals Guide to by eating contaminated food, Disease Reporting in Michigan. during sex, or living with someone with Hep A. High- MICHIGAN DISEASE SURVEILLANCE SYSTEM (MDSS) risk populations include: The Michigan Disease Surveillance System (MDSS) is a web-based people who are homeless, communicable disease reporting system that facilitates coordination among incarcerated or formerly local, state and federal public health agencies during follow-up investigations incarcerated, drug users, and of communicable disease events. Along with the Michigan Sydromic Surveillance System (MSSS), these tools provide real-time access for data men who have sex with men. entry and analysis to improve the timeliness of public health interventions. These populations are encouraged to seek out the All data presented in this report were obtained from the MDSS and MSSS. If Hep A vaccine. you would like to learn more about these systems or are interested in becoming a user, additional information can be found using the following links: MDSS, MSSS. GASTROINTESTINAL ILLNESSES A variety of infectious agents can cause gastrointestinal illnesses, and testing does not always identify the cause. Once a report of gastrointestinal illness is received by KCHD, Communicable Disease and Epidemiology (CD/Epi) Unit staff initiate an investigation into potential exposures that may have caused the patient’s illness. Patients are asked for travel history, water exposures (swimming and drinking water), animal contacts, exposure to other ill individuals and food history. The goal of these investigations it to identify community risks that threaten the public’s health. These threats can be localized, such as Cryptosporidium contaminated water at a park or widespread, such as food products contaminated with Salmonella at a processing facility. Whatever the source of infection once identified, KCHD works with other public health partners at the local, state and federal level to prevent further spread. Due to the length of time between a patient’s onset of symptoms and completion of an epidemiologic interview with KCHD CD/Epi staff, recall of exposures is often difficult. In the case of salmonellosis, patients are asked to provide a seven-day food history. Health care providers can assist in identifying potential sources of illness by obtaining a meal and travel history from patients who present with gastrointestinal symptoms. Obtaining this information early in the disease process limits recall bias and provides valuable information to the investigation initiated by KCHD. In 2017, several local laboratories began implementing Culture-Independent Diagnostic Testing (CIDT) for gastrointestinal pathogens. Surveillance case definitions from the Centers for Disease Control and Prevention (CDC) require that a positive culture be reported to public health departments for a case of GI illness to be considered confirmed. For several gastrointestinal pathogens (Campylobacter, Salmonella, Shigella, Cryptosporidiosis and Escherichia coli), a positive CIDT constitutes a probable case based on the surveillance case definition. Previous versions of this report only included data on confirmed cases, but because of the shift to CIDT among local laboratories, data presented here for all gastrointestinal infections save for giardiasis include both confirmed and probable cases. http://www.cdc.gov/salmonella/resources/timeline-for-reporting-of-cases.pdf Gastrointestinal Illnesses of Greatest Frequency, Kent County, Five-Year Averages (2013-2017) 15.4 Campylobacter 12.0 Giardiasis 10.0 Salmonellosis Shigellosis Rate per 100,000per Rate Cryptosporidiosis 4.9 Shiga toxin-producing Escherichia coli --(STEC) 3.3 2.3 Average Campylobacter Campylobacter is an infectious bacterium typically acquired from eating undercooked poultry or contaminated dairy or produce. It is one of the most common causes of diarrheal illness in the United States. In 2017, 121 cases of Campylobacter were reported to KCHD, well above the five-year average of 88 cases per year from 2012-2016. It is possible that the increase in the number of cases is due to the growth of culture-independent diagnostic testing (CIDT) and the move to including both confirmed and probable cases in the annual count. Nearly half (48%) of the cases were reported in individuals 40 years of age and older, with those 70 and older accounting for 13% of all cases. Twenty-eight (28) of the cases had out of state or international travel in the month before getting sick. The CDC recognizes that international travel is a cause of about 1 in 5 cases of Campylobacter infection. Campylobacter 25 20 15 10 Rate perRate 100,000 5 0 2013 2014 2015 2016 2017 Kent Michigan Shigellosis Shigellosis is an infectious bacterial disease which causes diarrhea, and usually resolves itself in 5 to 7 days. It can be acquired by swimming in water contaminated with the bacteria, contact
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