Monthly Epidemiology Reports: 1999
Erie County Health Department (ECHD)
(Provided with the permission of the ECHD)
There appears to be an increase in upper respiratory illness in Erie County during the month of January. Although we have confirmed cases of Influenza in this area, the majority of these cases are not the typical flu-like activity. The first influenza A isolate from December 1998 was confirmed as (H3N2) Sydney-like by ECMC Virology Laboratory. Children's Hospital Virology Laboratory also reported the first Influenza B isolate on 1/27/99 on a 16 Y.O. female from Amherst, NY. The Update on Influenza Activity from CDC for the period October 4,1998 through January 6, l999 indicates that overall influenza activity was low.
During January 1999, the US Department of Agriculture placed a voluntary recall on products produced at an Arkansas meat processing plant contaminated with Listeria Monocytogenes. Products from that plant were reportedly distributed in the Western New York area.
During January 1999, there were 9 reports of food related illness. Two were referred to the New York State Agriculture and Markets. Two others were referred to the ECHD Environmental Program for inspections.
There is a continuation of the occurrence of upper respiratory illness occurring within Erie County. The Children's Hospital Laboratory has reported a substantial increase in RSV, from 51 in January to 216 in February 1999. The flu-like activity continues as reported through the ECHD Active Surveillance Program. However, illness due to Influenza A and B are limited.
During February 1999, there were 19 reports of Pertussis confirmed by PCR through Children's Hospital Laboratory. The investigation of these cases failed to reveal any significant correlation other than a group of 3 cases that occurred in a BOCES Program in the Southern Tier.
During February 1999, there were 10 reports of food related illness. Three were referred to the ECHD Environmental Health Unit for field investigation.
The Pertussis Outbreak that started in Mid-February 1999 continued to escalate. During March there were an additional 203 cases with positive PCR and meeting case definition of 14 days or more of cough without other known cause. Many additional positive P CR reports were received from Children's Hospital Laboratory, but these are currently under investigation. The ECHD received assistance from the Centers for Diseases Control and Prevention, by them sending in an EIS Officer. He remained in Erie County for three weeks to help analyze this outbreak. Complete analysis of this outbreak including testing results, age group breakdown and epidemic curve by onset will be forthcoming in the next month's report.
The Pertussis Outbreak investigation took priority within the ECHD, therefore, investigation of other illness had to be delayed.
During March 1999, there were 9 reports of food related illness. Two were referred to the ECHD Environmental Health Unit for field investigation.
The Pertussis Outbreak of February through April 1999 in Erie County is coming to an end. As of 5/13/99 there were 354 cases, 275 ruled out as not meeting case definition and 26 still pending further investigation. Of the 275 that were ruled out 270 had p ositive PCR's. The ECHD is still awaiting results from the Dual Testing program through Wadsworth Laboratories and the Centers for Disease Control.
The Age Group Tabulation for the Pertussis Outbreak was as follows:
|1 - 2||43||12.1%|
|3 - 7||58||16.4%|
|8 - 12||49||13.8%|
|13 - 19||48||13.6%|
Concern was raised by the Centers for Disease Control over the possible occurrence of Pyloric Stenosis as a result of the increased prophylactic treatment with Erythromycin during the most recent Pertussis Outbreak. This matter is currently being investig ated by a specialist at Children's Hospital of Buffalo.
During April 1999, there were 16 reports of food related illness. One was referred to NYS Agriculture and Markets. Four others were referred to the ECHD Environmental Health Unit for field investigation.
The NYSDOH Wadsworth Rabies Laboratories has confirmed 11 cases of positive rabid animals submitted by the ECHD. Of these one was a bat and all the others were raccoons. During May 1999, ECHD recorded that 11 persons received post- exposure rabies series. Some of these persons would not have to receive the vaccine, if they kept the bats for testing. Improper guidance is being given by the law enforcement agencies, in that they are telling the persons exposed to release the bats. If a bat is submitted resu lts can be obtained in 24 to 48 hours.
In addition, pet owners are remiss on keeping their animals current for rabies shots. We had a few occasions where pets had to be euthanized or confined for a six month period in approved cages.
During May there was a sizable increase in the number of reported cases of Giardiasis (N-15). The average for the past four month period was 5.5. Some of these cases may have been due to the improper cleaning of fresh fruits and vegetables. The current re commendation is that food items that are not peeled should be scrubbed with a vegetable brush and running water.
During May 1999, there were 4 reports of food related illness. None were referred for further investigation.
The Centers for Disease Control has issued a travel advisory for persons going to the Yukon Territory, Alaska and for persons taking cruises to those areas, because of the outbreak of Influenza Type A. Persons less than 65 who have underlying chronic medi cal conditions (e.g. pulmonary or cardiac disease) should consult their health care providers before traveling to this area regardless of their vaccination status. Persons 65 or more who did not receive the current Influenza Vaccine should consult their h ealth care provider for information on Influenza and for anti-viral medication (Amantadine or Rimantadine) to be used within 48 hours of onset of symptoms. (Reference MMWR dated 7/2/99)
The number of reported cases of enteric illness are down from previous years. Usually the summer months have a substantial increase in numbers. It is strongly advised that persons engaging in picnics or outings take precautions to insure that hazardous fo ods are kept at proper temperatures (below 40 degrees or above 140 degrees).
The ECHD, Bureau of Disease Control now has a FAX Machine (858-7964). This should enhance the reporting of communicable diseases.
During summertime activities and camping sessions the ECHD Environmental Health Unit is reminding families to leave the wildlife alone, especially the raccoons, to avoid any unnecessary post-exposure rabies treatment.
During June 1999, there were 15 reports of food related illness. Three were referred for further investigation.
On July 16, 1999 the New York State Department of Health issued a medical advisory concerning Rotavirus Vaccine and Hepatitis B Vaccine containing Thimerosal.
CDC and the American Academy of Pediatrics have recommended that health providers suspend the use of Rotavirus Vaccine until further information is available. This advisory is due to potential increased risk of intussusception (a type of bowel obstruction ) in children during the first several weeks after receiving Rotavirus Vaccine.
The American Academy of Pediatrics and the U.S. Public Health Service issued a statement requesting drug manufacturers to reduce or eliminate Thimerosal, a mercury-containing preservative, in vaccines. Unless a Thimerosal-free product can be used, infants born to mothers who are not infected with Hepatitis B should wait to start Hepatitis B vaccination series until 6 months of age, rather than getting their first Hepatitis B shot between birth and 2 months as previously recommended.
The New York State Department of Health in conjunction with The Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) have jointly issued a warning on July 16, 1999, suspending the use of Rotavirus Vaccine until further studies ca n be completed.
In addition, the AAP and the United State Public Health Service issued the following statement concerning the use of Hepatitis B Vaccine with thimerosal: "Unless a thimerosal-free product can be used, infants born to mothers who are not infected with hepa titis B should wait to start the Hepatitis B vaccination series until six months of age, rather than getting their first hepatitis B shot between birth and two months as previously was recommended." The availability of the Thimerosal-free vaccine is expec ted in this area by September 1999.
During July 1999, NYSDOH sent out an updated reporting protocol to all Permitted Laboratories and Blood Banks in New York State. This document clarifies which pathogens must be reported immediately to the local health unit.
During July 1999, there were 10 reports of food related illness. Five were referred to the ECHD Environmental Health unit for further investigation.
The Erie County Health Department, Bureau of Disease Control investigated a cluster of Salmonellosis Group D cases that appeared to have a common source of exposure at a local restaurant. The ongoing investigation resulted in 16 confirmed cases of Salmone llosis and another 11 suspect cases. Six of the confirmed cases were foodhandlers at the restaurant.
The New York State Department of Health has issued an alert on August 25th concerning the confirmation of a Malaria Case at the Baiting Hollow Boy Scout Camp in Suffolk County. There was one confirmed case of Plasmodium Vivax.
The NYSDOH also issued an alert concerning the outbreak of E.Coli 0157 at a County Fair in Washington County. Health Care Providers across the state are cautioned to be on the look out for diarrheal illness with unknown agent. All health care facilities, day care centers, and schools within Erie County have been alerted.
During August 1999 there were 6 reports of food related illness. One was referred to NYS Agriculture and Markets. Two others were referred to ECHD Environmental Health for inspection.
On 9/3/99, a public health alert was issued regarding the cluster of encephalitis cases in New York City area. Initially this outbreak was thought to be attributed to St. Louis Encephalitis (SLE). Subsequent updates on this matter indicated that this outb reak was due to West Nile-Like Viral Encephalitis. Further evidence of this virus was found in avain species including crows. The NYSDOH has issued an alert to be on the look out for crows that are dying. The ECHD should be contacted to make arrangements for testing of these animals.
The Erie County Health Department, Bureau of Disease Control received notification from NYSDOH on September 5th, regarding the Outbreak of E. Coli 0157:H7 at the Washington County Fair. In turn all medical providers, day care centers, and school superinte ndents in Erie County were alerted to monitor for additional cases of illness. Fortunately, there were no reports of E. Coli 0157:H7 during September.
The State of New York has recently amended the School Immunization Law (Public Health Law 2164) to require Hepatitis B Vaccine for all children enrolled in the seventh grade in any Intermediate or Middle School on or after September 1, 2000. Considering t hat Hepatitis B is a 3 shot series normally given over a 6 month period, these children will have to have their immunization records reviewed, and those lacking Hepatitis B will have to be started as soon as possible to be completed by September.
During September 1999 there were 17 reports of food related illness. Eleven were referred to ECHD Environmental Health for inspection. One of the larger outbreaks involving 240 persons was probably due to a Norwalk-like Virus.
On 11/1/99, the New York State Department of Health issued an alert concerning Influenza Activity. Influenza outbreaks were confirmed in one long term care facility inMonroe County, and two long term care facilities in New York City. All three were Influ enza A. Two were A Sydney-like (H3N2) and the third is pending. Locally, Children's Hospital Virology Laboratory identified the first Influenza A isolate on 10/15/99 in a 2 month old female from Buffalo. This was done by Rapid Antigen Testing. Unfortunate ly, the culture did not grow, so further identification was impossible.
The State of New York has recently amended the School Immunization Law (Public Health Law 2164) to require Hepatitis B Vaccine for all children enrolled in the seventh grade in any Intermediate or Middle School on or after September 1, 2000. Considering t hat Hepatitis B is a 3 shot series normally given over a 6 month period, these children will have to have their immunization records reviewed, and those lacking Hepatitis B will have to be started as soon as possible to be completed by September 2000.
During October 1999 there were 12 reports of food related illness. Two were referred to NYS Agriculture & Markets. Five others were referred to ECHD Environmental Health for further investigation.
The Bureau of Disease Control has been investigating a cluster of Pertussis cases that have been occurring since September 1999: ( September N-14, October N-28, and November N-27 ) . The total number of reported Pertussis cases through 11/30/99 is 430. Th ese cases are occurring throughout Erie County.
The ECHD Active Surveillence is monitoring influenza activity. So far this year flu-like activity has been quite low . A recent publication in the MMWR Vol48/RR14 dated 12/17/99 addresses the use of Neuraminidase Inhibitors forTreatment of Influenza A and B Infections.
During November 1999 there were 17 reports of food related illness. Eleven were referred to ECHD Environmental Health for further investigation.
The reporting of communicable diseases for the month of December 1999 is attached. The year end totals are provisional at this time.
The number of reported cases of Pertussis is still remaining quite high for December. The delay in reporting is due to the requirement that there must be 14 days or more of documented cough. The health care providers in this area are rapidly identifying t he cases and placing them on antibiotic treatment along with the family members.
During the third week of December there was an upsurge of Flu-like activity within Erie County. Numerous isolates of Influenza A have been reported by the Virology Laboratory at Children's Hospital. In addition, there were four cluster of cases that have been identified in long term care facilities within Erie County. Starting about 12/24/99, the hospital emergency rooms were inundated with patients presenting with respiratory flu-like illness.
The New York State Department of Health has set up a Public Web Site:
This home page has a link directly to the weekly influenza activity throughout the state.
During December 1999 there were 18 reports of food related illness. Eight were referred to ECHD Environmental Health for field investigation. One additional report was referred to NYS Agriculture and Markets.