sign in sign up
<<
Home , Shigellosis

State of Wyoming

Department of Health

Summary of Reportable Diseases 2015 Annual Report

Thomas O. Forslund Director

March 2015

Table of Contents

Executive Summary………………………………………………………………………………………………. 2 Methods……………………………………………………………………………………………………………….. 3 ……………………………………………………………………………………………….. 4 Cryptosporidiosis………………………………………………………………………………………………….. 5 Giardiasis……………………………………………………………………………………………………………... 6 influenza Disease……………………………………………………………...……………. 7 Invasive Pneumococcal Disease……………………………………………………………………………. 8 Norovirus Outbreaks…………………………………………………………………………………………….. 9 Pertussis……………………………………………………………………………………………………………….. 10 Rabies…………..………………………………………………………………………………………………………. 11 ……………………………………………………………………………………………………….. 12 -producing (STEC)……………………………………………………….. 13 Shigellosis…………………………………………………………………………………………………………….. 14 ……………………………………………………………………………………………………………… 15 West Nile Virus…………………………………………………………………………………………………….. 16 Case Count by County Table, 2015....……………………………………………………………………. 17 Diseases of Low Incidence, 2015.……………...…………………………………………………………. 19

State of Wyoming Department of Health

Summary of Reportable Diseases 2015 Annual Report

Summary of Infectious Diseases Annual Report is published by the Public Health Division Wendy E. Braund, MD, MPH, MSEd, FACPM State Health Officer and Senior Administrator

Additional information and copies may be obtained from: Clay VanHouten, MS Infectious Disease Epidemiology Unit Wyoming Department of Health 6101 Yellowstone Road, Suite 510 Cheyenne, WY 82002 307-777-5596 [email protected]

Executive Summary

The Wyoming Department of Health Infectious Disease Surveillance System is a collabora- tive effort among personnel in Wyoming Department of Health Infectious Disease Epidemi- ology Program, Wyoming Public Health Laboratory, local health departments, other state agencies, clinical laboratories, and healthcare providers in Wyoming and elsewhere. These groups work together to identify, investigate, and mitigate the effects of infectious diseases in the State of Wyoming.

Data presented in this report were collected by the Wyoming Department of Health Infec- tious Disease Epidemiology Program through the Reportable Diseases and Conditions sur- veillance system and through public health case follow-up. Disease surveillance databases contain information on reportable diseases and the public health investigations carried out on these disease occurrences. The databases contain information regarding the etiology, patient demographics, geographic location, clinical laboratory results, exposure histories, and public health control measures on each reported occurrence. Data were analyzed by state-level epidemiologists and other staff, and additional retrospective case review was performed to verify actual case counts.

This report provides an overview of descriptive epidemiology of certain reportable diseases and conditions from January 1, 2015 to December 31, 2015.

2

Methods

Definitions

 Crude incidence rate - Incidence is defined as the number of new cases diagnosed dur- ing a set time period in a defined population. Incidence is not a representation of risk. Therefore, a crude incidence rate is the number of new cases of a disease within the specified population. A crude incidence rate has not been adjusted for age or other con- founding variables. All crude incidence rates in this document are reported as the num- ber of cases per 100,000 population.

 Outbreak - An outbreak is defined as the occurrence of two or more cases of a disease with a common exposure.

 Age-adjusted incidence rate – Statewide age-adjusted rates reported in this document were standardized against the 2000 U.S population using specified age groups and are reported as the number of cases per 100,000 population. Age-adjustment allows rates to be compared over time and allows rates from one geographic area (e.g., state) to be compared with rates from another geographic area that may have differences in age distributions. Any observed differences in age-adjusted incidence rates are not due to differing age structures.

 Standardized incidence ratio –The standardized incidence ratio (SIR) is a summary ratio that allows a comparison of incidence rates from a defined population to a standard population. When comparing statewide incidence rates, the estimated 2014 US stand- ard population was used to calculate the SIR. It was not possible to calculate the state- level SIR for those diseases that are not nationally reportable due to lack of national summary data. A ratio of 1.00 indicates that the observed number of cases equals the expected number of cases. A ratio above 1.00 indicates that there were more cases ob- served than expected. Thus, a ratio of 1.25 means that there were 25 percent more ob- served cases than expected. A ratio below 1.00 indicates that there were fewer ob- served cases than expected. Therefore, a ratio of 0.85 is interpreted as 15 percent fewer observed cases occurring than expected. The confidence interval of a standardized inci- dence ratio is interpreted as follows:  If the lower number in the confidence interval is less than or equal to 1.00 and the upper number in the interval is greater than or equal to 1.00, there is no statistically significant difference between the number of observed cases and the number of expected cases.  If the lower number in the confidence interval is above 1.00, there is a 95 per- cent probability that a significantly higher number of cases were observed than expected.  If the upper number in the confidence interval is less than 1.00, there is a 95 percent probability that significantly fewer cases were observed than ex- pected.

3

Campylobacteriosis

2015 Summary In 2015, 154 (101 laboratory-confirmed and 53 Crude Incidence of Campylobacteriosis by Year, probable) cases of campylobacteriosis were re- Wyoming and the US, 2005-2015 ported (crude incidence rate: 26.36 cases per 100,000 per year). The incidence of campylo- WY Rate US Rate bacteriosis in Wyoming was greater than the 30 estimated U.S. incidence (14.5 cases per 25 100,000 per year) based on CDC MMWR surveil- 20 lance data (SIR: 1.80, 95% CI: 1.52-2.08). The 15 10 national health objective for campylobacteriosis 100,000) 5 is 8.5 per 100,000 persons per year. The median 0

age of cases of campylobacteriosis in Wyoming

Crude Incidence Rate (per

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 was 36 years (range: 0-84 years). Persons aged 2005 Year 40-64 years had the highest age-adjusted inci- dence rate (9.83 cases per 100,000 per year). Campylobacteriosis Cases by County of Residence Probable Exposure Reported by Cases 4 11 3 4 18 6 0 3 2 1 41 23 2 60 1 1 5 18 2

4 1 10 2 4 6 15 3 1 9 5 43

Campylobacteriosis Cases by Age Group and Sex

Female Male

60 Campylobacteriosis Outbreaks 50 40 Number of Multistate Outbreaks With 1 30 Wyoming Cases 20 10 Number of Wyoming Outbreaks Identified 3

Number of Cases 0

0-4

65+

5-15

15-24 25-39 40-64 Unknown Age Group in Years Updated March 2015 4

Cryptosporidiosis

2015 Summary

In 2015, 28 laboratory-confirmed cases of cryp- Crude Incidence of Cryptosporidiosis by Year, tosporidiosis were reported (crude incidence Wyoming and the US, 2005-2015 rate: 4.79 cases per 100,000 per year). The inci- dence of cryptosporidiosis in Wyoming was WY Rate US Rate greater than the estimated U.S. incidence (2.52 35 cases per 100,000 per year) based on CDC 30 MMWR surveillance data (SIR: 1.91 95% CI: 1.20 25 20

-2.62). The median age of cases of cryptosporid- 15 100,000) iosis was 31 years (range: 2-89 years). Persons 10 aged 25-39 years had the highest age-adjusted 5 0

incidence rate (1.54 per 100,000 persons). (per Rate Incidence Crude

2005 2006 2007 2008 2009 2010 2011 2012 2014 2015 2013 Year

Probable Exposure Reported by Cases Cryptosporidiosis Cases by County of Residence

0 1 0 1 14 2 1 2 9 1 1 0 0 0

1 1 2 0 2

1 2 10 1 0 0 1 0 2 0 0 1 Cryptosporidiosis Cases by Age Group and Sex

Female Male 10 Cryptosporidiosis Outbreaks 8 Number of Multistate Outbreaks With 6 0 Wyoming Cases 4 Number of Wyoming Outbreaks Identified 0

Number of Cases 2

0 0-4 5-14 15-24 25-39 40-64 65+ Age Group in Years

Updated March 2015 5

Giardiasis

2015 Summary In 2015, 35 laboratory-confirmed cases of giardi- Crude Incidence of Giardiasis by Year, Wyoming asis were reported (crude incidence rate: 6.03 and the US, 2005-2015 cases per 100,000 per year). The incidence of giardiasis in Wyoming was greater than the esti- WY Rate US Rate mated U.S. incidence (3.62 cases per 100,000 20 per year) based on CDC MMWR surveillance da- 15 ta (SIR: 1.67, 95% CI: 1.11-2.22). The median 10 age of cases of giardiasis was 27.5 years (range: 100,000) 5 1-81 years). Persons aged 25-39 years had the highest age-adjusted incidence rate (1.75 per Crude Incidence Rate (per 0

100,000 persons).

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year

Probable Exposure Reported by Cases

Giardiasis Cases by County of Residence

2 3 1 0 7 11 0 0 5 1 1 0 0 1

0 6 3 2 1 0 9 6 0

0 2 0 1 0 Giardiasis Cases by Age Group and Sex 4 1 3

Female Male

12 Giardiasis Outbreaks 10 8 Number of Multistate Outbreaks With 0 6 Wyoming Cases 4

2 Number of Wyoming Outbreaks Identified 0 Number of Cases of Number 0 0-4 5-14 15-24 25-39 40-64 65+ Age Group in Years

Updated March 2015 6

Haemophilus influenzae Disease

2015 Summary In 2015, five invasive cases of Haemophilus in- Crude Incidence of Haemophilus influenza Disease fluenzae Disease were reported. The cases in- by Year, Wyoming and the US, 2007-2015 clude all serotypes. Most of the cases presented WY US Rate with bacteremia with another clinical manifesta- 2 tion (, , and meningitis). The status was known for all of the cas- es, and only one individual was immunized. The median age of cases was 60 years (range: 0 to 93 1 years) and 60% of cases were female.

Vaccine Status of H. flu Cases

100,000) (per RateIncidence Crude 0

Un-vaccinated

2008 2009 2011 2012 2013 2015 2010 2014 Vaccinated Unknown 2007 Year

? H. flu Cases by County of Residence 1 4 0 0 0 0 0 0 0 Serotypes of H. flu Cases 0 0 0 0

Serotype B 1 0 0 3 0 Unknown Serotype 4 0

0 0 2 0 H. flu Cases by Age Group and Sex 0 0 0 0

Female Male

3 H. flu Cases by Clinical Manifestation

2 Bacteremia 2

Numberof Cases Bacteremia + cellulitis 1 1 Bacteremia + meningitis 1 Bacteremia + pneumonia 1 0 0-4 5-14 15-24 25-39 40-64 65+ Age Group in Years

Updated March 2015 7

Invasive Pneumococcal Disease

2015 Summary In 2015, 19 cases of invasive pneumococcal dis- Annual IPD Crude Incidence by year for Wyoming ease (IPD) were reported. Drug-resistant Strep- and the US (2005-2015)* tococcus pneumonia isolates were the cause of 4 of the 19 IPD cases. Most of the cases present- WY Rate U.S. Rate ed with bacteremia with or without clinical 7 pneumonia. Vaccination status was known for 6 5 just over half of the cases, and only five individu- 4 als were immunized. The median age of cases 3 2 was 59 years (range: 2 to 86 years) and 42% of 100,000) 1

cases were female. 0

Crude Incidence Rate (per Rate Incidence Crude

2006 2011 2007 2008 2009 2010 2012 2013 2014 2015 2005 Year

*Data not available prior to 2010 Status of IPD Cases

IPD Cases by County of Residence Vaccinated Un-vaccinated Unknown

1 0 0 0 4 ? 1 1 1 0 5 5 9 0

0 0 1 1 0

IPD Cases by Age Group and Sex 1 1 0 1 1 0 0 5 Male Female 8 7 6 IPD Cases by Clinical Manifestation 5 4 Bacteremia 16 3 Bacteremia + pneumonia 13 2 Number of Casesof Number Pleural Effusion 2 1 Meningitis 1 0 0-4 5-14 15-24 25-39 40-64 65+ Cellulitis 1 Age Group in Years Empyema 1

Updated March 2015 8

Norovirus Outbreaks

2015 Summary In 2015, 8 outbreaks of norovirus were reported. The number of outbreaks reported slightly decreased from the previous year.

Outbreak Location Norovirus Outbreaks by County

1 0 0 0 0 1 0 0 0 0 5 2 0 0 2 1 0

0 0 1 0 0 0 0 2 0 1

Norovirus Outbreaks 2011—2015

Updated March 2015 9

Pertussis

2015 Summary In 2015, 29 (26 confirmed and 3 probable) con- Crude Incidence of Pertussis by Year, Wyoming firmed cases of pertussis were reported (crude and the US, 2007-2015 incidence rate: 4.95 cases per 100,000 per year). The crude incidence rate of pertussis in Wyo- WY US Rate ming was lower than the estimated U.S. inci- 20 dence (5.65 cases per 100,000 per year) based 15 on the CDC 2015 Final Pertussis Surveillance Re- 10 port. The median age of cases of pertussis was 100,000) 5 13 years (range: 0-56 years).

Crude Incidence Rate (per 0

2008 2009 2010 2011 2012 2013 2014 2015 2007 Vaccine Status among Cases Year

Vaccinated Vaccinated Vaccinated up-to-date Complete series Not up-to-date Pertussis Cases by County of Residence

0 5 0 0 1 6 0 0 10 0 0 1 0 Un-vaccinated Unknown 0 0 2 4 0

? 1 0 11 11 0 1 0 0 2 3 Pertussis Cases by Age Group and Sex

Female Male 14 Pertussis Outbreaks 12 10 Number of Multistate Outbreaks With 2 8 Wyoming Cases 6 4 Number of Wyoming Outbreaks Identified 0 Number of Cases of Number 2 0 < 1 yr 1-4 5-10 11-18 19-64 65+ Age Group in Years

Updated March 2015 10

Rabies

2015 Summary Rabies Positive Percent of Animals Tested, In 2015, 15 rabies positive animals were report- Wyoming, 2000-2015 ed: 9 bats and 6 skunks. A total of 522 animals 10% captured or located in Wyoming were tested for rabies at the Wyoming State Veterinary Labora- 8% tory, with approximately 3% of animals testing 6% positive. As a result of contact with animals that 4% either tested positive or were suspected of hav- 2% ing rabies, a total of 38 people received rabies PercentPositive

post-exposure prophylaxis (PEP). 0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2014 2015 The first documented human case of rabies in 2013 Year Wyoming was reported in 2015. In September an elderly woman was admitted to a local hospi- tal with a 5-day history of progressive weakness, Animal Rabies Cases by County of Capture ataxia, dysarthria, and dysphagia. Due to respira- tory failure, she was subsequently transferred to 6 2 0 0 a referral hospital in Utah. The patient’s family 0 0 informed clinicians that in August the patient 0 0 0 0 awoke with a bat on her neck but had not sought medical care. Tests at CDC confirmed infection 0 0 1 0 0 with a rabies virus variant enzootic to the silver- haired bat. The patient died on October 3, 2015. 2 0 0 0 0 1 2 1 Animal Cases by Species

Number of Humans who Received PEP

Contact with a BAT suspected rabid 15

9 0 Contact with a CAT suspected rabid 6

Contact with a DOG suspected rabid 8

Contact with some OTHER animal (includes skunk, cow, raccoon, coyote, 8 0 6 prairie dog, and pack rat) suspected rabid

Updated March 2015 11

Salmonellosis

2015 Summary In 2015, 99 (92 laboratory-confirmed and 7 Crude Incidence of Salmonellosis by Year, Wyo- probable) cases of salmonellosis were reported ming and the US, 2005-2015 (crude incidence rate: 16.95 cases per 100,000 WY Rate US Rate per year). The incidence of salmonellosis in Wy- 25 oming was equal to the estimated U.S. incidence 20 (15.56 cases per 100,000 per year) based on 15 CDC MMWR data (SIR: 1.10 95% CI: 0.88-1.31). 100,000) 10 The national health objective for salmonellaosis 5 is 11.4 per 100,000 persons per year. The medi- Crude Incidence Rate (per 0

an age of cases of salmonellosis was 30 years

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 (range: 0-85 years). Persons aged 40-64 years 2005 had the highest age-adjusted incidence rate Year (5.44 per 100,000 persons).

Salmonellosis Cases by County of Residence

Probable Exposure Reported by Cases 9 6 3 0 12 6 5 0 1 0

11 30 12 43 1 2 13 12 1

3 0 0 0 2 5 1 0 2 0 5 13

Salmonellosis Cases by Age Group and Sex

Female Male Salmonellosis Outbreaks 35 30 Number of Multistate Outbreaks With 25 9 20 Wyoming Cases 15 Number of Wyoming Outbreaks Identified 3 10

Number of Cases 5 0 0-4 5-14 15-24 25-39 40-64 65+ Age Group in Years

Updated March 2015 12

Shiga toxin-producing Escherichia coli (STEC)

2015 Summary In 2015, 38 (27 laboratory-confirmed and 11 Crude Incidence of STEC by Year, Wyoming and the probable) cases of shiga toxin-producing Esche- richia coli (STEC) were reported (crude incidence WY Rate US Rate rate: 6.51 cases per 100,000 per year). The inci- 8 7 dence of STEC in Wyoming was greater than the 6 5 estimated U.S. incidence (1.78 cases per 4

100,000 per year) based on CDC MMWR data 100,000) 3 2 (SIR: 3.57, 95% CI: 2.43-4.70). In Wyoming, inci- 1 dence of Non-O157:H7 STEC was higher com- Crude Incidence Rate (per 0

pared to incidence of O157:H7 STEC (3.42 vs.

2005 2006 2008 2009 2010 2011 2012 2013 2014 2015 2007 1.37 per 100,000 persons). The national health Year objective for STEC O157 is 0.6 per 100,000 per- * STEC not nationally notifiable until 2006 sons per year. The median age of cases of STEC was 12 years (range: 1-66 years). Persons aged 0-14 years had the highest age-adjusted inci- STEC Cases by County of Residence dence rate (1.71 per 100,000 persons). 8 Probable Exposure Reported by Cases 1 0 1 5 0 0 2 0 0

0 0 5 0 9 1 1 17 1

1 0 1 0 3 0 1 9 6 0 1 3

STEC Cases by Age Group and Sex Female Male STEC Outbreaks 12 10 Number of Multistate Outbreaks With 8 0 Wyoming Cases 6 4 Number of Wyoming Outbreaks Identified 2 2

Number of Cases 0

0-4

65+

5-14

15-24

25-39 40-64 Unknown Age Group in Years Updated March 2015 13

Shigellosis

2015 Summary In 2015, 10 (6 laboratory-confirmed and 4 prob- Crude Incidence of Shigellosis by Year, Wyoming able) cases of shigellosis were reported (crude and the US, 2005-2015 incidence rate: 1.71 cases per 100,000 per year). WY Rate US Rate The incidence of shigellosis in Wyoming was less 20 than the estimated U.S. incidence (6.56 cases per 100,000 per year) based on CDC MMWR da- 15

ta (SIR: 0.26, 95% CI: 0.10-0.42). The median 10 100,000) age of cases of shigellosis was 8.5 years (range: 5 2-70 years). Persons aged 5-14 years had the

Crude Incidence Rate (per 0

highest age-adjusted incidence rate (0.86 per

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 100,000 persons). 2005 Year

Shigellosis Cases by County of Residence

Probable Exposure Reported by Cases 1 9 0 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0

0 0 0 7 0 0 0 0 0 0 0 0 Shigellosis Cases by Age Group and Sex

Female Male 6 Shigellosis Outbreaks 5 4 Number of Multistate Outbreaks With 1 3 Wyoming Cases 2 Number of Wyoming Outbreaks Identified 0 Number of Cases 1 0 0-4 5-14 15-24 25-39 40-64 65+ Age Group in Years

Updated March 2015 14

Tularemia

2015 Summary In 2015, 21 (11 laboratory-confirmed and 10 Crude Incidence of Tularemia by Year, Wyoming probable) cases of tularemia were reported and the US, 2005-2015 (crude incidence rate: 3.59 cases per 100,000 per year). The incidence of tularemia in Wyo- WY Rate US Rate 4.0 ming was higher than the estimated U.S. inci- 3.5 dence (.07 cases per 100,000 per year) based on 3.0 2.5 CDC MMWR data (SIR: 51.89, 95% CI: 29.68- 2.0

100,000) 1.5 74.04). The median age of cases of tularemia 1.0 was 49 years (range: 6-81 years). Persons aged 0.5

Crude Incidence Rate (per 0.0

40-64 years had the highest age-adjusted inci-

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 dence rate (1.4 per 100,000 persons). 2005 Year

Probable Exposure Reported by Cases Tularemia Cases by County of Residence

1 0 1 3 2 3 3 2 0 0 0 8 0

0 0 0 1 1

1 0 12 0 1 1 0 0 0 0 2 Tularemia Cases by Age Group and Sex

Female Male Tularemia Clinical Manifestation 9 8 Glandular 5 7 6 Oropharyngeal 1 5 4 Pneumonic 4 3

Number of Cases 2 Typhoidal 6 1 0 Ulcerative 1 0-4 5-14 15-24 25-39 40-64 65+ Age Group in Years Ulceroglandular 4

Updated March 2015 15

West Nile Virus

2015 Summary

In 2015, five West Nile (WNF) and three Crude Incidence of WNND , Wyoming and the US, West Nile Neuroinvasive Disease (WNND) cases 2005-2015 were reported (crude incidence rate for WNND cases 0.5 per 100,000 per year). The incidence WY Rate US Rate of WNND in Wyoming was equal to the estimat- 5 ed U.S. incidence (0.41 cases per 100,000 per 4 year) based on CDC MMWR data (SIR: 1.27, 95% 3 CI: 2

-0.17-2.70). The median age of WNV cases was 100,000) 1 61.5 (range 14-81 years). Cases were evenly dis- 0

tributed among males and females. Most case Crude Incidence Rate (per

2005 2006 2007 2008 2010 2011 2012 2013 2014 2015 2009 patients were likely infected within the state of Year Wyoming. Numerous bird species, horses and mosquito pools also tested positive for West WNF and WNND Combined Cases by County of Nile Virus in 2015. Residence Other Species Infected 1 0 0 1 1 0 0 1 0 0

4 4 0 5 0 1 0 0

0 2 West Nile Virus (WNV) Human Cases in 0 0 0 Wyoming, 2015 0 0 1

WNF WNND Probable Location of Exposure 3

WNF WNND 2 In-state 4 1

1 Out-of-State 0 0 Multiple Exposures 0 1 0 Undetermined 1 1

Number of Human WNV Cases Human of Number

Jul 4

Aug 1 Aug 8

Jul 11 Jul 18 Jul 25

Jun 6

Jun 13 Jun 20 Jun 27

Aug 15 Aug 22 Aug 29 Week of Symptom Onset

Updated March 2015 16 Wyoming Morbidity Park Total Uinta Uinta Teton Crook Platte Platte Albany Lincoln Report 2015 Carbon Goshen Weston Weston Laramie Johnson Natrona Sublette Fremont Fremont Big Horn Niobrara Niobrara Sheridan Converse Converse Campbell Washakie Washakie Hot Springs Sweetwater

Aseptic meningitis 0 0 3 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 Botulism, infant 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 Campylobacteriosis 9 3 18 2 2 4 5 10 1 3 43 4 18 1 11 1 4 1 1 6 5 0 2 154 Coccidioidomycosis 1 0 0 0 0 0 1 0 0 0 3 1 3 0 0 1 0 0 3 1 0 0 0 14 Colorado Tick Fever 0 0 0 3 0 0 1 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0 7 Creutzfeldt-Jacob Disease 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 3 (CJD) Cryptosporidiosis 0 0 14 0 1 1 0 1 0 0 1 0 2 1 1 0 0 2 2 1 0 1 0 28 Giardiasis 4 0 5 0 2 3 6 0 1 0 3 2 3 0 0 0 2 0 1 1 1 1 0 35 Group A , 0 0 1 0 0 0 2 0 0 0 0 0 1 0 0 0 1 0 0 1 0 1 1 8 invasive Group B Streptococcus, 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 2 0 1 7 invasive , 0 0 0 0 0 0 0 0 0 0 0 2 3 0 0 0 0 0 0 0 0 0 0 5 invasive Hantavirus pulmonary 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 syndrome Hepatitis A, acute 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 3 Legionellosis 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 4 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 Malaria 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 , invasive (Mening. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 disease)

17 Wyoming Morbidity Park Total Uinta Uinta Teton Crook Platte Platte Albany Lincoln Report 2015 Continued Carbon Goshen Weston Weston Laramie Johnson Natrona Sublette Fremont Fremont Big Horn Niobrara Niobrara Sheridan Converse Converse Campbell Washakie Washakie Hot Springs Sweetwater

Pertussis 0 0 0 1 0 0 2 0 0 0 3 0 4 0 5 1 0 0 0 10 2 0 1 29 Rabies, animal 1 0 0 0 0 0 1 0 0 0 1 2 0 0 2 0 6 0 0 0 2 0 0 15 Rabies, human 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Salmonellosis 5 3 12 0 1 0 13 0 0 0 13 3 12 1 6 0 9 2 2 6 5 5 1 99 Shiga toxin-producing 0 0 5 0 0 1 0 1 0 2 9 1 5 0 1 0 8 1 3 0 1 0 0 38 Escherichia coli (STEC) Shigellosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 1 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 Strep, other, invasive, 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 3 0 1 0 1 1 0 8 beta-hem (non-A nonB) Streptococcal toxic-shock 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 syndrome Streptococcus pneumoniae, invasive 0 0 4 1 0 0 1 0 0 1 5 1 1 0 0 1 1 0 1 1 0 1 0 19 disease (IPD) Tularemia 0 1 2 0 1 3 0 1 0 0 2 0 1 0 0 1 1 0 0 0 0 0 8 21 Varicella (Chickenpox) 0 1 5 0 1 0 1 1 0 0 2 1 0 0 0 0 1 0 0 1 0 0 0 14 West Nile Virus 0 0 1 0 0 1 1 2 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 8 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 3

18 Diseases of low Incidence Disease 2015 2014 2013 2012 2011 Amoebiasis (Entamoeba histolytica ) 0 0 0 0 1 Anaplasma/ 0 0 0 0 1 Anthrax (Bacillus anthracis ) 0 0 0 0 0 Babesiosis (Babesia sp) 0 0 0 0 0 ( sp) 0 0 0 0 0 Botulism ( botulinum ) 1 0 0 2 0 (Brucella sp) 0 0 0 0 0 California Serogroup Virus (Jamestown Canyon, La Crosse, others) 1 0 0 0 0 ( ) 0 0 0 0 0 Coccidioidomycosis (Coccidioides immitis ) 14 2 5 7 3 Colorado Tick Fever 7 4 4 1 0 Creutzfeldt-Jacob Disease 3 0 1 0 0 Cyclosporiasis (Cyclospora cayetanensis ) 0 0 1 0 0 Dengue Fever 0 0 0 0 0 Diptheria ( diphtheriae ) 0 0 0 0 0 Eastern Equine Encephalitis Virus 0 0 0 0 0 ( ) 0 0 0 0 0 Haemophilus influenzae (sterile site) 5 6 6 2 2 Hantaviral Disease 1 1 0 1 1 Hemorrhagic Fever Viruses 0 0 0 0 0 Hemolytic Uremic Syndrome 0 0 1 0 1 Hepatitis A 3 1 0 1 2 Kawasaki Syndrome 0 2 2 0 1 Legionellosis (Legionella sp) 4 2 1 4 4 (Mycobacterium leprae ) 0 0 0 0 0 (Leptospira interrogans ) 0 0 0 0 0 (Listeria monocytogenes ) 0 0 0 0 6 Lyme Disease (Borrelia burgdorferi ) 1 3 3 4 2 Malaria (Plasmodium sp) 1 0 0 0 0 Measles 0 0 0 0 0 Meloidiosis (Burkholderia pseudomallei ) 0 0 0 0 0 (Neisseria meningitidis) 1 0 2 3 0

19 Disease 2015 2014 2013 2012 2011 Mumps 0 0 0 1 1 ( ) 0 0 0 0 0 Poliomyelitis/Poliovirus Infection 0 0 0 0 0 Powassan Virus (neuro- and non-neuro invasive) 0 0 0 0 0 Psittacosis (Chlamydophila psittaci ) 0 0 0 0 0 Q-Fever ( ) 0 0 1 1 1 Relapsing Fever (Borrelia sp) 0 0 0 0 0 Reyes Syndrome 0 0 0 0 0 Rocky Mountain Spotted Fever ( ) 1 0 2 2 10 Rubella 0 0 0 0 0 Severe Acute Respiratory Syndrome (SARS) 0 0 0 0 0 St. Louis Encephalitis Virus (neuro- and non-neuro invasive) 0 0 0 0 0 Smallpox 0 0 0 0 0 Group A Streptococcus, invasive 8 7 7 7 7 Group B Streptococcus, invasive 7 8 2 2 2 Strep pneumoniae, invasive 19 13 19 23 14 Strep, other, invasive, beta-hem (non-A, nonB) 8 5 2 0 0 Tetanus (Clostridium tetani ) 0 0 0 0 1 Toxic-Shock Syndrome (Streptococcal, Staphylococcal) 1 1 0 1 0 Trichinellosis (Trichinella sp) 0 0 0 0 0 Tularemia ( ) 21 1 2 1 1 (Salmonella typhi ) 0 0 0 0 0 (Rickettsia sp) 0 0 0 0 0 Vancomycin-Intermediate Staphylococcus aureus (VISA) 0 1 0 0 0 Vancomycin-Resistant Staphylococcus aureus (VRSA) 0 0 0 0 0 Varicella (chickenpox only) 14 11 9 19 13 Vibrio sp (including non-cholera) 0 1 0 0 1 Western Equine Encephalitis Virus 0 0 0 0 0 Yellow Fever 0 0 0 0 0 Yersiniosis (Y. enterocolitica, Y. pseudotuberculosis ) 3 1 1 1 0

20