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Epidemiology Annual Report 2018 Epidemiology Annual Report 535 South Loop 288 Denton, TX 76205-4502 www.DentonCounty.gov/Health Denton County Public Health Director Matt Richardson, DrPH, MPH Epidemiology Division Chief Epidemiologist Juan Rodriguez, MPH Epidemiologist Lily Metzler, MPH Epidemiologist Taylor Keplin, MPH Epidemiologist Abby Hoffman, M.S. Acknowledgments This report was prepared by the Epidemiology Division staff. We wish to acknowledge the contribution of our health care providers for reporting notifiable conditions and their cooperation in diseases investigations. In addition, we wish to thank Denton County Public Health staff and Medical Reserve Corp for their assistance in disease surveillance and investigations along with our colleagues at the Texas Department of State Health Services for providing data used in this report. Methodology The total population estimates used in this report were collected from the Texas Demographic Center1 and represent the population estimates for Denton County as of July 1, 2018. Population estimates may vary from previous Epidemiology Annual Reports due to changes of these estimates and are not directly associated to population estimates produced by the U.S. Census Bureau. The Sexually Transmitted Disease (STD) and Human Immunodeficiency Virus (HIV) case numbers and rates for Denton County were obtained from the Texas Department of State Health Services STD Surveillance Program Dashboard2. STD and HIV rates were calculated by the Texas Department of State Health Services based on population projections from the U.S. Census Bureau3. Data for Denton County notifiable conditions was collected from the Texas Department of State Health Services National Electronic Disease Surveillance System (NEDSS)4. This system delivers public health data to both state and local agencies, allowing data sharing and the ability to conduct disease surveillance. Notifiable condition yearly case counts may fluctuate due to changes in case criteria such as the broadening of case definitions and acceptable testing methods. In addition, some notifiable conditions became newly reportable within this report’s specified 5-year time frame, which may appear as a sudden increase of cases. 1. https://demographics.texas.gov/Data/TPEPP/Estimates/ 2. http://healthdata.dshs.texas.gov/InfectiousDisease/STD 3. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html 4. https://www.dshs.texas.gov/nedss/default.shtml Table of Contents Summary of Notifiable Diseases 2014-2018.........................................................................................................1 Sexually Transmitted Diseases.......................................................................................................2 Chlamydia...................................................................................................................................................2 Gonorrhea..................................................................................................................................................5 HIV..............................................................................................................................................................8 Syphilis......................................................................................................................................................11 Vaccine Preventable Diseases.......................................................................................................14 Pertussis...................................................................................................................................................14 Varicella....................................................................................................................................................17 Gastrointestinal Diseases....................................................................................................................................20 Campylobacteriosis..................................................................................................................................20 Cryptosporidiosis......................................................................................................................................23 Cyclosporiasis...........................................................................................................................................26 Salmonellosis............................................................................................................................................29 Shiga toxin-producing Escherichia coli (STEC)..........................................................................................32 Shigellosis.................................................................................................................................................35 Invasive Diseases.................................................................................................................................................38 Streptococcus, invasive Group A..............................................................................................................38 Streptococcus, invasive Group B..............................................................................................................41 Streptococcus pneumoniae, invasive.......................................................................................................44 Summary of Notifiable Conditions 2014-2018 Case counts refer to confirmed and probable cases Total Cases in Previous Years Notifiable Condition 2014 2015 2016 2017 2018 Acute Flaccid Myelitis (AFM) 0 0 0 2 0 Amebiasis 5 3 2 4 3 Anaplasma phagocytophilum 0 0 0 0 0 Brucellosis 1 0 3 0 0 Campylobacteriosis 46 84 57 65 59 Carbapenem-resistant Enterobacteriaceae 2 2 3 10 14 Chagas, chronic indeterminate 0 0 0 1 0 Chikungunya virus diseases 8 1 0 1 0 Creutzfeldt-Jakob Disease 0 0 3 1 1 Cryptosporidiosis 7 21 9 24 19 Cyclosporiasis 8 14 11 12 3 Cysticercosis 1 0 1 0 0 Dengue 2 2 1 3 0 Haemophilus influenzae, invasive a 0 1 9 12 10 Hemolytic uremic synd,postdiarrheal 0 1 0 1 0 Hepatitis A, acute 2 10 3 0 5 Hepatitis B, acute 2 6 6 5 7 Hepatitis C, acute 2 1 4 1 0 Hepatitis E, acute 1 1 1 0 1 Influenza-associated pediatric mortality 2 1 0 1 0 Legionellosis 8 5 5 8 11 Leishmaniasis 1 1 1 0 0 Listeriosis 2 0 1 1 0 Lyme disease 1 0 3 3 2 Malaria 1 2 7 2 3 Measles (Rubeola) 0 0 0 0 1 Multidrug-resistant organisms (MDRA) a 3 10 11 9 14 Mumps 0 1 8 12 2 Neisseria meningitidis, invasive (Mening. disease) 0 0 1 0 1 Pertussis 102 78 68 99 55 Q fever, Acute 0 0 0 0 0 Salmonellosis 118 175 142 118 152 Shiga toxin-producing Escherichia coli (STEC) 30 26 27 29 19 Shigellosis 93 58 77 23 29 Spotted Fever Rickettsiosis 1 0 4 0 1 Streptococcus pneumoniae, invasive disease (IPD) 34 38 49 47 53 Streptococcus, invasive Group A 14 13 14 19 22 Streptococcus, invasive Group B 24 26 39 37 40 Typhoid fever (Salmonella typhi) 0 2 1 1 3 Varicella (Chickenpox) 64 51 49 61 30 Vibrio vulnificus infection 0 0 0 0 1 Vibriosis, other or unspecified 1 3 1 1 2 West Nile Virus 4 10 20 12 2 Yersiniosis 0 1 0 0 1 Zikaa 0 0 9 2 0 Case counts reflective of MMWR year in Texas Department of State Health Services NEDSS database 1 a. Reporting requirements variations during represented time frame Chlamydia STDs Denton County 2014-2018 • Causative Agent: (bacterial) Chlamydia trachomatis • Signs/Symptoms: o Men: Most men do not exhibit symptoms. Symptoms – penile discharge, urethral itching, burning sensation when urinating, pain and swelling in one or both testicles. Complications – rarely infertility. o Women: Up to 70% of infected women do not exhibit symptoms. Symptoms – abnormal vaginal discharge, burning sensation when urinating. Infants born to infected women may develop eye or pneumonic infections. Complications – PID, chronic pelvic pain, infertility, ectopic pregnancy. o Rectal infection – rectal pain, discharge, bleeding. VPDs o Untreated chlamydia may increase the chance of acquiring or transmitting HIV. • Mode(s) of Transmission: Perinatally or sexually transmitted infection • Incubation Period: 7-14 days or longer • Period of Communicability: Infected individuals are assumed to be infectious. Figure 1. Chlamydia in Denton County and Texas 2500 600 2400 500 2300 400 GI Illness 2200 300 Cases 2100 200 Rate per 100,000 2000 100 1900 0 2014 2015 2016 2017 2018 Year Denton County Cases Denton County Rate Texas Rate Invasive Data Source: Texas Department of State Health Services 2 Figure 2. Chlamydia by Gender, Denton County 2014-2018 STDs 450 400 350 300 250 200 150 Rate per 100,000 per Rate 100 50 0 2014 2015 2016 2017 2018 VPDs Male Female Data Source: Texas Department of State Health Services Figure 3. Chlamydia by Race/Ethnicity, Denton County New Cases 2018 White 19.7% GI Illness Unknown Black 50.4% 16.6% Hispanic 10.9% Other 2.3% White Black Hispanic Other Unknown Data Source: Texas Department of State Health Services Invasive *In 2018, there was a large number of chlamydia and gonorrhea cases for the “unknown” race/ethnicity category. This was due to a delay in updating the race/ethnicity field in the surveillance data. Ongoing data quality improvement will address this for 2019 reporting.* 3 Figure 4. Chlamydia by Race/Ethnicity, Denton County 2014-2018 STDs 700 600 500 400 300 200 Rate per 100,000 per Rate 100 0 VPDs 2014 2015 2016 2017 2018 White Black Hispanic Other *Graph does not represent unknown or missing Race/Ethnicity Data Source:
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