Monthly Epidemiology Reports: 1998
Erie County Health Department (ECHD)
(Provided with the permission of the ECHD)
The number of reported cases of Pertussis (N-15) during January is above the expected monthly total . According to the NYSDOH other counties across the state are experiencing an increase in number of reported cases of Pertussis. The Enhanced Pertussis Surveillance Program has altered their criteria to require Pertussis immunization data on confirmed and suspect cases only.
Influenza activity in Erie County is on the increase. As of the end of January 1998, there have been multiple isolates of Influenza A Nanchang-like. The NYSDOH Regional Office has been monitoring health related facilities for influenza - like activity. As of 2/3/98, there were 18 facilities within Erie County identified with influenza-like illness.
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. ECMC Virology Laboratory has reagents for testing for the Avium Influenza and Sydney Influenza Strains.
During January there were 11 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 Pertussis (N-19) during February is above the expected monthly total when compared to 1997. The ECHD Bureau of Disease Control is encouraging physicians to be watching for suspect cases and ordering PCR tests to confirm the diagnosis. Diagnosed cases should be placed on the appropriate antibiotic and not returned to their programs until they have been treated for five days.
Throughout February, reports of influenza-like illness were reported by the Active Surveillance System. On 2/17/98, the ECMC Virology Laboratory cross-tested the 1997-8 Influenza isolates against the A-Sydney reagent. Twenty-six of the isolates were found to be strongly positive for A-Sydney.
The ECHD has issued a News Release concerning the changes in Required School Immunizations for Fall 1998. The focus is on the addition of 3 Hepatitis B immunizations required for the Pre-kindergarten (born after 1/1/95); and Kindergarten Enterers (born after 1/1/93). If these children are to be in compliance at the start of school in Fall 1998, they must start the Hepatitis B Immunizations as soon as possible.
During February 1998, there were 20 reports of food-related illness. Twelve were referred to the ECHD Environmental Health Unit for further investigation.
There were twelve additional cases of Pertussis reported during March, bringing the first quarter total of 1998 to 46. During 1997 the first quarter total was only 3. The increased number of cases is partially due to the awareness of Pertussis on the part of the health care providers. Pertussis immunizations are required for enrollment in a licensed Day Care Center according to the NYS Department of Social Services.
Influenza activity throughout March 1998 was very slight in Erie County. Officially the Influenza Season lasts through mid May. The experts at CDC are predicting that there may be a resurgence of a strain of influenza similar to that of the 1918 Pandemic in the near future. Heightened awareness and diagnosis and the rapid production of influenza vaccines will minimize the effects if such a strain were to appear.
During March 1998, there were 13 reports of food related illness. One was referred to the Pennsylvania State Health Department. Seven others were referred to ECHD Environmental Health for field inspections.
During April 1998 the reported cases of Pertussis dropped to 2. A further review of the cases during the first four months of this year showed a total of 48. The age group breakdown as follows:
- 1 YR.: 19
- 1 - 5: 11
- 6-19: 14
- 20-39: 1
- 40+: 3
The Influenza 1997-8 Season will be officially ending in Mid May. The MMWR Influenza Guidelines for the Influenza 98-9 Season was published by the Center for Disease Control and Prevention on May 1, 1998. The influenza vaccine for the 1998-9 Influenza Season will contain A/Beijing/262/95-like (H1N1); A/Sydney/5/97-like; and B/Beijing/184/93-like. U.S. produced vaccine will contain B/Harbin/07/94 instead of B/Beijing/184/93-like which is antigenetically equivalent.
During April 1998, there were 16 reports of food related illness. One was referred to NYS Agriculture and Markets. Two others were referred to the NYSDOH since they involved Caribbean Cruise Ships. Three others were referred to ECHD Environmental Health for field investigations
The Centers for Disease Control and the New York State Health Department are monitoring all isolates of Salmonellosis. In NYS all salmonella isolates from the laboratories are to be forwarded to Wadsworth Labs for grouping verification and sub typing. The preliminary data indicates that there have been changing patterns of groupings throughout the state. In addition, some rare groups and sub types have been found.
During May, twelve persons were reported as having received post exposure rabies treatment, bringing the year to date total to 30. As the weather gets warmer the outdoor activities will increase and likewise the potential for exposure to domestic and wild animals. To try to eliminate the unnecessary use of post exposure rabies vaccine it is essential that the proper information be given to those exposed regarding the capture, observation or examination of the biting animal. If medical questions arise concerning post exposure rabies treatment, call Mr. Schwartz at 858-7698 or after-hours 898-4225 (MERS).
During May 1998, there were 16 reports of food related illness. One was referred to NYS Agriculture and Markets. Seven others were referred to ECHD Environmental Health for field investigations.
During June 1998, only two of the specimens submitted by Erie County to the NYS Rabies Lab were found to be positive for rabies. However, during the same period of time there were 21 post-exposure rabies series authorized. When handling inquires from patients who have been exposed to a potentially rabid animal, it is important that the person be instructed to obtain information on the pet's owner, the address, and the rabies shot status. If bitten by a wild animal, try to capture the animal so that it can be tested.
On June 16, 1998, a problem alert was issued by the NYSDOH concerning E.Coli 0157:H7. They are reviewing all cases that occurred during May and are trying to determine if there is any correlation to these cases. This alert has been issued for five states (Connecticut, Maine, Massachusetts, New Hampshire, and New York). The private physician should insure that all confirmed cases are reported in a timely manner so follow up can be started.
The Centers for Disease Control and Prevention issued an advisory on June 23, 1998 concerning Hand, Foot and Mouth Disease (HFMD). An outbreak in Taiwan has affected 30,000 children resulting in 50 deaths. The common cause of HFMD is infection with coxsackievirus A16(CA16) and with the less common Enterovirus 71 (EV71). EV71 meningitis or encephalitis may occasionally be fatal.
During June 1998, there were 22 reports of food related illness. Three were referred to NYS Agriculture and Markets. Two others were referred to NYSDOH. Six others were referred to ECHD Environmental Health for field investigations.
During July 1998, there was a substantial increase in the number of enteric illnesses. i.e. Campylobacteriosis N-21;and Salmonellosis N-15 . For the most part these are all sporadic cases. During the investigations it was found that many of the individuals in close contact with the index case are not being tested even when there is enteric illness present. Recommendation from the ECHD is that these individuals consult their health care provider for testing when symptoms are present.
The Centers for Disease Control and Prevention has released an Audio Tape Hepatitis C: Diagnosis, Clinical Management and Prevention for physicians (Side A - 42 min. Side B - 38 min.. This tape is available from ECHD Disease Control upon request. If interested call Jack Schwartz - 858 - 7698.
The NYSDOH has informed the local health units that Wyeth Ayerest is experiencing problems with the production of the Influenza Vaccine 98-99 and therefore is anticipating that it will be unable to supply orders for the vaccine that have been submitted. It is suggested that if you ordered vaccine from this vendor, you may try an alternate source such as Connaught.
During July 1998, there were 10 reports of food related illness. One was referred to NYS Agriculture and Markets. Another was referred to Niagara County Health Department. Five additional cases were referred to ECHD Environmental Health for field investigations.
The Erie County Health Department has been reviewing the numbers of enteric illnesses reported within Erie County over the past two years. There has been a significant drop in all reported enteric illnesses. During the investigations of the cases there have been others within the household or close contacts that were also ill, but not evaluated by a medical provider. The ECHD is still recommending that those with a similar illness be evaluated by a medical provider and have a stool specimen submitted. To offset the additional laboratory cost to the medical provider, the Erie County Public Health Laboratory has agreed to supply the testing materials and perform the stool specimen testing without charge. Providers interested in securing these testing materials may contact the ECHD Public Health Laboratory at 881-7272.
During August there has been a substantial increase in reports of Viral/Aseptic Meningitis. (N- 32), compared to the previous months average of five. A large portion of these have been identified as due to enterovirus. This increase is consistent with the seasonal increase that has occurred over the past few years.
The ECHD is investigating a cluster of six Hepatitis A cases that have occurred in Buffalo during July and August. In addition, there have been other sporadic cases. The national shortage of Immune Globulin is still in effect. The ECHD has a limited supply of IG. If you have patients who have been in close contact with a Hepatitis A case, call the ECHD Disease Control so that they may receive preventive immunization. The ECHD will be conducting its annual Pre-Exposure Rabies Clinic and titer testing for high risk individuals in Erie County, i.e. (Veterinarians, Animal handlers, Animal Control Officers, and Wildlife Rehabilitators). The clinics will be held the 19th and 20th of October. There will be a cost for the vaccinations, but the titers will be done at no charge. The1998-99 Influenza Vaccine Information Sheet is available. You may request a photo-ready copy by calling 858-7697. During August 1998, there were 13 reports of food related illness. Four cases were referred to ECHD Environmental Health for field investigations.
Again in September there has been a large number of reported Viral/Aseptic Meningitis (N-29). A large portion of these have been identified as due to enterovirus. The majority of these have been reported by only one hospital. There may be more cases occurring in the community that have not been reported.
The Centers for Disease Control and Prevention is predicting that this will be an early Influenza season. The well-documented outbreak of A-Sydney in Alaska and the smaller outbreaks in Tennessee may serve as a warning to those persons who have not already received their 1998-99 Influenza vaccine. The medical providers are also reminded to check if their patients are candidates for the Pneumococcal vaccine. These vaccines may be given simultaneously, but at different sites. The 1998-99 Influenza Vaccine and the Pneumococcal Vaccine Information Forms are available by calling (716) 858-7698.
The ECHD will be conducting its annual Pre-Exposure Rabies Clinic and titer testing for high risk individuals in Erie County, i.e.(Veterinarians, Animal handlers, Animal Control Officers, and Wildlife Rehabilitators). The clinics will be held October 19th at Erie Community College (South), 4051 Southwestern Blvd, Orchard Park, NY, and October 20th at the SPCA, Esminger Road, Tonawanda, NY.
During September 1998, there were 15 reports of food-related illness. Two were referred to the New York State Department of Agriculture and Markets. Seven others were referred to ECHD Environmental Health for field investigations.
The number of reported cases of Viral/Aseptic Meningitis Cases (N-18) has declined from the previous months. This seasonal trend is consistent with the previous two years. A large number of these cases have been determined to be caused by entero virus.
The Centers for Disease Control and Prevention is predicting that this will be an early Influenza season. There has been some sporadic influenza activity in downstate New York, but so far there have been no isolates in Western New York area. There are two viral laboratories in the area capable of testing for influenza. One is at Children's Hospital of Buffalo (878- 7084), and the other is at Erie County Medical Center (898-4211). You may contact these laboratories for directions on influenza specimen collection.
The ECHD conducted its annual Pre-Exposure Rabies Clinic and titer testing for high risk individuals in Erie County, i.e. (Veterinarians, Animal handlers, Animal Control Officers, and Wildlife Rehabilitators) on 10/19/98 and 10/20/98. Sixty-nine Pre-exposure series were started and 438 titers were drawn and forwarded to NYSDOH Rabies Laboratories.
During October 1998, there were 14 reports of food-related illness. One was referred to New York State Agriculture and Markets. Another was referred to Cattaraugus County. Nine others were referred to ECHD Environmental Health for field investigations.
The number of reported communicable diseases was substantially less during the month of November when compared to the previous months. A similar pattern occurred in the latter two months of 1997. At the same time the number of positive Hepatitis C antibody laboratory reports are increasing.
The Erie County Health Department was notified on December 3, l998, of the first isolate of Influenza A by Children's Hospital Virology Laboratory. The isolate was on a one month old from Derby, New York. Regional influenza activity has been reported in New York and Maryland. Outbreaks of Influenza A have been reported in three nursing homes in Bronx and Nassau counties. Locally, there have been reports of respiratory illness, but not the typical flu-like illness.
During November 1998, there were 8 reports of food related illness. One was referred to New York State Agriculture and Markets. Four others were referred to ECHD Environmental Health for field investigations.
The initial review of the year-end totals reflects that there has been approximately 1,300 more reportable conditions in 1998 when compared to 1997 year-end totals. This increase is mainly attributed to the number of reported positive Hepatitis C Antibody laboratory reports. The enteric illnesses, i.e. Salmonella, Shigella and Giardia have all shown a slight increase. At the same time other diseases have shown a slight decrease.
The review of the ECHD Active Surveillance System indicated that the 98-99 Influenza season has been very mild so far. The first isolate of Influenza Type A was reported on December 3, 1998. There have been no school closing thus far due to influenza. There has been minimal influenza activity in the health related and long term care facilities.
During December 1998, the NYSDOH in conjunction with the FDA issued a "Food Alert" concerning the voluntary recall of certain brands of Hot Dogs and Other Packaged Meats, because of potential contamination with Listeria bacteria. In effect this became a multistate outbreak involving 10 states, including New York.
During December 1998, there were 19 reports of food-related illness. One was referred to New York State Agriculture and Markets. Two others were referred to Niagara County and one more to St. Lawrence County. Four more were referred to the ECHD Environmental Program for inspection.