Monthly Epidemiology Reports: 1997
Erie County Health Department (ECHD)
(Provided with the permission of the ECHD)
The Center for Disease Control issued an alert in the latter part of December 1996 warning that certain lots of Influenza vaccine supplied by Parke-Davis had decreased potency that might result in the patient being underprotected against influenza. A check with the agencies who provided influenza immunizations within Erie County revealed that only approximately 75 persons may have received this vaccine. Persons were directed to contact their physicians to see if they may have received this vaccine, and whether or not they were to be revaccinated. Influenza activity within Erie County during January is well below the expected level for this time of year.
During January there were 19 reports of food related illness. Eleven were referred to ECHD Environmental Health for field investigations. One additional report was referred to the New York State Department of Agriculture and Markets for further investigation. One of the reports involved a school lunch program in a City of Buffalo school where 45 children reportedly became ill with vomiting within 45 minutes to one hour following the suspect meal. A thorough investigation is underway. Many of the food items served at the meal have been sent to laboratories for analysis.
It was noted that there was a sizeable drop in the number of reported illnesses during the month of February. Later in the month it was found that part of this drop was due to the hold placed on the U.S. Mail pending payment of postage.
The New York State Health Department is actively monitoring the occurrence of Invasive Group A Strep Infections (GAS). This illness was made reportable in December 1994. Erie County had 11 cases in 1995; 19 cases in 1996; and 3 cases in 1997 through 2/28/97. Physicians as well as laboratories are minded that GAS is a reportable disease.
During February, there were 14 reports of food related illness. Eight were referred to ECHD Environmental health for field investigations. One additional report was referred to the New York State Department of Agriculture and Markets for further investigation. One school outbreak in January and one school outbreak in February involved hamburger patties manufactured at the same facility with the same lot number. As a result of these two clusters of illness, the NYS Department of Education Food Lunch Program put a voluntary embargo on hamburgers from the suspect lot number. Further analysis of the product is ongoing.
During the month of March 1997, there was a sizable increase in the number of reported cases of Invasive Group A Strep (N-6). The New York State Health Department is still keeping close watch on the number of reported cases of this illness. Currently there is a supplemental form that accompanies each report denoting further information about the patient. The individual health care providers are requested to complete these forms in addition to the confidential case report.
There has been a sizable increase in the number of reported cases of Hepatits A. (N-9). The ECHD has been able to establish a linkage among five of the cases and attributed the index case to exposure in South America. Four family members traveled to Bolivia but did not receive HAVRIX or IG prior to departure. There is still a national shortage of Imune Globulin. If you as a health care provider require IG for post exposure to household members, a limited supply is available through the ECHD. Contact Mr. Schwartz at 858-7698.
During March there were 16 reports of food related illness . Seven were referred to ECHD Environmental Health for further investigation. Two additional reports were referred to NYS Agriculture and Markets.
On April 18, 1997 the Morbidity Mortality Weekly Report (MMWR) contained an article reviewing the influenza pattern that occurred during the 96-7 Influenza Season. It was interesting that Influenza A predominated in the fall and the early weeks of 1997 and that it was gradually and almost exclusively replaced by Influenza B through week 14. (Fig.#1) In addition, the MMWR Supplement Vol 46, No. RR-9 dated 4/25/97 contains the ACIP recommendations for the Prevention and Control of Influenza. The 97-8 Influenza vaccine will contain A/Wuhan/359/95-like (H3N2); A/Bayern/07/95-like (H1N1) and B/ Beijing/184/93-like. The optimal timing for organized influenza vaccination programs will be October through Mid-November.
The rabies activity within Erie County is starting to increase as the weather modifies. During April 1997 there were 4 wildlife confirmed as having rabies. In the same time period there were 13 sets of Post Exposure Rabies Series recommended and approved.
During April there were 24 reports of food related illness. Five were referred to New York State Agriculture and Markets. An additional ten were referred to ECHD Environmental Health for field investigations.
During May there was a substantial increase in the number of reported cases of Giardiasis (N- 16). Ten of the reported cases were in recently arrived refugees. During the investigations it was found that there were multiple cases in the same households. Based on these findings it is recommended that the health care providers doing refugee assessments emphasize the importance of parasite testing on all recent arrivals.
There was a cluster of suspect and confirmed cases of Q Fever reported to the ECHD Bureau of Disease Control during may 1997. The NYSDOH became actively involved in the investigation at this institution. Some of their findings indicated that inadequate control measures were in place creating a risk situation for employees and researchers. A series of recommended corrective actions were submitted to the institution. At this time there are two confirmed and three suspect cases.
During May there were 17 reports of food related illness. Thirteen were referred to ECHD Environmental Health for field investigations.
During June 1997 there was a sizable increase in the number of reports of positive Hepatitis C Antibody results. The NYSDOH has developed a guideline for medical care providers to assist them in diagnosing an acute case of Hepatitis C. (Sheet Attached). The ECHD is still tasked with determining if these patient's with positive laboratory reports are : (Acute ; Chronic; or Asymptomatic).
On June 19, 1997, the NYSDOH issued a problem alert concerning cases of Cyclospora. Cyclosporidiosis is currently not a reportable disease. However, the NYSDOH is requesting that health care providers be made aware of its occurrence . As part of the O& P laboratory work up cyclospora should be considered. Four cases were confirmed following a luncheon served in Yonkers. In Erie County there were two confirmed cases of cyclospora during June.
The ECHD, Bureau of Disease Control and Environmental Health will be holding its Annual Pre Exposure Rabies Clinic for High Risk Persons during September and October of this year. High risk persons are : animal handlers, veterinarians and their staff, wildlife control persons, and animal control officers. Letters will be sent to persons who have been previous participants in this program during a July. Rabies titers will be drawn and tested at no charge. Pre exposure series and boosters will be made available on a pre-paid basis. If you have any questions or wish to participate in these clinics, please call 716- 858-6150 between 9:00 AM and 4:00 PM.
During the month of July there was a substantial increase in the number of reported cases of Campylobacteriosis (N-35)and Salmonellosis (N-15) when compared to the previous month of (N-17) and (N-4) respectively. The individual surveillance reports did not indicate any one single common source outbreak to account for this increase. This pattern of increased cases is similar to previous years during the summer months.
The ECHD, Bureau of Disease Control and Environmental Health has scheduled its Annual Pre Exposure Rabies Clinic for High Risk Persons starting on September 23rd at the SPCA (Esminger Road) and on September 24th at Erie Community College (South Campus). Those individuals who have not been contacted and are interested in taking advantage of this service may contact the ECHD Bureau of Disease Control at 858-6150. High risk persons are : animal handlers, veterinarians and their staff, wildlife control persons, and animal control officers.
During July there were 8 reports of food related illness. Seven were referred to ECHD Environmental Health offices for further investigation.
The number of enteric illnesses reported during the month of August is still above the expected norm. There were: Campylobacteriosis ( N-33), Giadiasis (N-10), and Salmonellosis (N-12), and E.Coli 0157 ( N-3). Further analysis of the surveillance reports indicated that two of the Campylobacter cases and two of the Giardia cases were imported from abroad. Two of the 12 Salmonella cases were related. During the investigation the ECHD encourages that other symptomatic individuals in the households consult their health care providers for testing .
During the month of August the Centers for Disease Control and Prevention and the New York State Health Department initiated four recalls of food items. The first was an alert regarding Hummus Products manufactured by Cedar Mediterranean Foods contaminated with Listeria. The second was a massive recall of potato salad produced by Orval Kent that was also contaminated with Listeria. The third involved escargot produced by Escargot International of Texas that was contaminated with Listeria. The final recall involved hamburger patties produced by Hudson Foods that were contaminated with E. Coli 0157. Health care providers aware of patients with diagnosed Listeriosis or E. Coli 0157 who became ill during August should contact the ECHD Disease Control Unit at 858-7698.
During August there were 13 reports of food related illness. Two were referred to NYS Agriculture and Markets for further investigations. Three additional cases were referred to ECHD, Environmental Health for field inspections.
The number of reported cases of Viral/Aseptic Meningitis cases continues to increase. The normal monthly total ranges from 1 to 4 cases. During August there were 17 and in September 30 cases. Ten of these cases have been further identified as Enterovirus. A similar pattern was seen during 1996 when there were 22 and 28 cases reported during August and September. Many questions arise from the programs where these cases attend. The ECHD recommends that the programs make use of the NYSDOH Fact Sheet on Viral/Aseptic Meningitis for contacts of these cases.
During the month of August there were 10 cases of Pertussis that were investigated and reported to the NYSDOH. A review of these cases showed that only one had an onset during September. The others had onsets of illness distributed throughout July and August but were late in having the surveillance completed.
During September there were 15 reports of food related illness. One was referred to NYS Agriculture and Markets for further investigations. Seven additional cases were referred to ECHD, Environmental Health for field inspections.
The number of reported cases of Viral/Aseptic Meningitis cases continues to be above the expected monthly total . During October there were 19 new cases reported. The majority of these cases is due to Enterovirus. These cases are termed sporadic since these has been no linkage established between the cases.
There appears to be an increased awareness of Pneumococcal Disease and Pneumovax as a preventive vaccine. The ECHD has answered multiple calls concerning programs where the vaccination is available. The NYSDOH supplies Pneumovax free of charge through the Vaccine for Children Program for use in patients up to age 19.
During October there were 14 reports of food related illness. One was referred to NYS Agriculture and Markets for further investigations. Five additional cases were referred to ECHD, Environmental Health for field inspections.
The number of reported cases of Viral/Aseptic Meningitis cases have started to decrease during the month of November, similar to the pattern of last year. A large portion of the reported cases have been due to Enterovirus.
The active surveillance program by ECHD Disease Control has noted that there has been only sporadic occurrences of Flu-like illness in the community. A similar pattern is occurring nationwide. There have not been any influenza isolates at CHOB or at ECMC laboratories so far this flu season.
During November there were 12 reports of food related illness. Two was referred to NYS Agriculture and Markets for further investigations. Two additional cases were referred to ECHD, Environmental Health for field inspections.
The reporting of communicable diseases for the month of December 1997 is attached. The totals for the year are provisional at this point.
There has been an increase in the number of reported cases of Pertussis during December (N-11), bringing the total for the year to 46. This is substantially less than what Erie County experienced during 1996 with a total of 260. The NYSDOH in conjunction with the Centers for Disease Control and Prevention is embarking on an Enhanced Pertussis Surveillance Program set to begin on 1/2/98. This new surveillance program will require collection of multiple data not just on the case but on each member of the immediate household, to include immunization history by date, dosage, manufacturer and administrator. .
On December 12, 1997, the ECHD, Bureau of Disease Control was notified by the NYSDOH that there were three outbreaks of Influenza A occurring in Manhattan, Brooklyn and Albany. Two of these were determined to be Influenza A/Wuhan-like (H3N2).
On December 16, 1997, Dr. Marie Talty, from Children's Hospital Virology Laboratory reported the first Influenza A isolate in Erie County. The specimen was collected from a one month old female living in the City of Buffalo. The isolate was sent to the ECMC Virology Laboratory and further identified as Influenza A Nanchang-like (H3N2). During the next week, there were two outbreaks of Influenza A documented in a Buffalo and an Alden health-related facility.
The NYSDOH is encouraging the use of rapid Antigen testing when an outbreak occurs to determine if it is due to Influenza A. This testing is available locally through Children's or ECMC's laboratories. The media has focused on a new strain of Avium Influenza (H5N1). Four deaths have been reported due to this strain. The WHO has confirmed cases of this type in Hong Kong only. However, there is concern of spread to other parts of the world. As a monitoring measure, the CDC has supplied ECMC Virology Laboratory with reagents for testing for this strain.
During December there were 13 reports of food related illness. One was referred to NYS Agriculture and Markets for further investigations. Six additional cases were referred to ECHD, Environmental Health for field inspections.