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The Epi-Log Newsletter
Volume 45, No. 7 - July 2005
The Medical Monitoring Project (MMP)
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MMP is a CDC-sponsored expanded HIV/AIDS surveillance project that will be starting in
King
County
and
Washington
State
later this summer. MMP will examine HIV-related presentation and outcomes. MMP has a three stage random selection process starting with selection of states (
Washington
was included among the 20 states selected), followed by medical providers, and then patients. This process is designed to ensure that a scientifically representative, population-based cohort of patients is selected.
Data will be collected by medical record review and patient interview. Medical record review data include HIV-related treatments, diagnoses, and laboratory values. The interview asks patients about their health-care seeking and other behaviors impacting HIV care, such as adherence to HAART. Some of the goals of MMP are to:
- help health and prevention planners estimate how many people are receiving care for HIV
- determine barriers to care
- examine morbidity still experienced by HIV-infected persons in the HAART-era
- measure adherence to, acceptance of, and adverse effects of therapy
If you are a provider and your site is selected for MMP, we encourage you to participate. It is essential that all selected providers participate as providers will be selected to represent many other providers that have similar characteristics.
If you would like more information about this project please contact Elizabeth Barash with the HIV/AIDS Program at (206) 296-2907.
2003 Nationwide Hepatitis A Incidence at a 40-Year Low
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A recent article by Wasley, et al in the Journal of the American Medical Association1 described the changing incidence and epidemiology of hepatitis A in the
United States
from the pre-vaccination era (1990-1997) to 2003.
Since surveillance began approximately 40 years ago, hepatitis A incidence in the
US
has followed a cyclical pattern, with peaks and nadirs typically occurring every ten years; the use of hepatitis A vaccination may have interrupted this cyclical pattern. Between the pre-vaccination baseline period (1990-1997) and 2003, the incidence of hepatitis A, 10.7 per 100,000 and 2.6 per 100,000 respectively, decreased 76 percent. In addition, the 2003 incidence rate was the lowest recorded in 40 years of surveillance, and was significantly lower than rates during the two previous nadirs of 9.2 /100,000 in 1983, and 9.1/100,000 in 1992. The provisional hepatitis A incidence rate for 2004 is even lower, at 1.9/100,000.
In order to evaluate the role that hepatitis A immunization may have played in these trends, Wasley, et al, compared the incidence of hepatitis A in states that had instituted recommendations to vaccinate, or to consider vaccinating children with hepatitis A vaccine, to states that did not. During the pre-vaccination baseline period (1990 to 1997), the hepatitis A incidence rate in the “vaccinating” states was four times higher than the rate in the “non-vaccinating” states. By 2003, however, there was no significant difference in the rates between vaccinating and non-vaccinating states.
Hepatitis A Trends in
King
County
The same declining trend in national hepatitis A incidence rates has also occurred in
King
County
. During the pre-vaccination baseline period (1990 to 1997), the average incidence of hepatitis A was 20.9 per 100,000; in 2003 the rate was 1.68 per 100,000 and in 2004 the rate was 0.8 per 100,000.
The hepatitis A vaccine was licensed in 1995. Beginning in 1997, the vaccine was recommended for high-risk children age two through eighteen years residing in
King
County
. In 2000, hepatitis A vaccination was recommended for all children age two through eighteen years.
In the
US
, Hepatitis A vaccine is currently recommended for:
- All children 2 through 18 years of age.
- Gay and bisexual men.
- Illicit drug users (injecting and non-injecting).
- International travelers to areas where hepatitis A is common:
- includes all areas of the world except
Canada
, Western Europe,
Scandinavia
,
Japan
,
New Zealand
, and
Australia
.
- Persons with chronic liver disease, including chronic hepatitis B and hepatitis C.
- Persons with clotting factor disorders, such as hemophiliacs.
- Anyone else who wants protection against hepatitis A.
1Wasley A, Samandari T, Bell B. Incidence of hepatitis a in the
United States
in the era of vaccination. JAMA 2005;294:194-201.
Campylobacteriosis Outbreak Associated with a Camping Trip to a Farm
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In June 2005, a King County health care professional (HCP) reported to Public Health that a child presenting with diarrhea, abdominal pain, and fever had been on a camping trip with his/her school prior to becoming ill. The family also reported that several other persons on the trip had been ill with similar symptoms following the trip. A stool specimen was collected for culture and Campylobacter was isolated. The same week, two more case of campylobacteriosis were reported in persons who had been on the same camping trip, held at a private farm. An outbreak investigation was initiated.
Of the 28 persons attending the camping trip (5 adults and 23 students), 14 (50%) reported having had symptoms consistent with campylobacteriosis following the trip. A total of four laboratory confirmed cases of campylobacteriosis were eventually reported in trip participants.
There were several animals at the farm (and an adjacent farm), including chickens, cows, turkeys, and goats. Environmental specimens were collected from animal areas and drinking water; all tested negative for bacterial pathogens, including E. coli O157:H7, Salmonella, and Campylobacter. One of three water samples collected was positive for fecal coliforms, though this was not the usual source of water for the campers. Possible sources of infection were discussed with the farm owners and the school, and education was provided on measures to prevent infections associated with animals, including E. coli O157:H7, Salmonella, and Campylobacter.
Although no single source for the illnesses was identified by the investigation, several high-risk activities and food items that have been previously associated with Campylobacter infection were identified, including consumption of unpasteurized dairy products, and direct and indirect contact with farm animals, and animal manure. Inadequate handwashing facilities and inadequate handwashing supervision likely exacerbated these risks.
During spring and summer, when visits to farms, petting zoos, and local fairs are on the increase, HCPs should inquire about recent direct or indirect contact with animals, or animal manure among patients (especially children) who present with acute gastroenteritis so that testing for bacterial infections (and other types of infection, including parasitic), can be initiated. Report suspect or confirmed infections with E. coli O157:H7 or Salmonella immediately, and confirmed cases of campylobacteriosis within three days to Public Health. Report suspected clusters of illness to Public Health immediately.
Special thanks to David Ramaley, ND, DC, for initially reporting this cluster of illness to Public Health.
Spokane Woman Tests Negative for West Nile Virus
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On July 18th, the Washington State Department of Health announced that a
Spokane
woman, who had initially tested positive for West Nile Virus, has tested negative after additional tests. There have still been no cases of West Nile virus infections identified in horses, bird or humans this year in
Washington
State
. One human case was reported in a
Washington
state resident in 2004, but that person was traveling in areas where West Nile Virus infection was occurring during his/her exposure period.
Communicable Disease and Epidemiology contact information
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> Disease reporting
| AIDS |
(206) 296-4645 |
| Sexually Transmitted Diseases |
(206) 744-3954 |
| Tuberculosis |
(206) 744-4579 |
| Other Communicable Diseases |
(206) 296-4774 |
| Automated 24-hour reporting line for conditions not immediately notifiable |
(206) 296-4782 |
> Hotlines
| Communicable Disease Hotline |
(206) 296-4949 |
| HIV/STD Hotline |
(206) 205-7837 |
> For health providers:
- Health Provider homepage
Resources to fact sheets, updated news, vaccine information, health educational materials and external links.
www.metrokc.gov/health/providers
Reported Cases of Selected Diseases in Seattle and King County
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Cases reported
in June
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Cases reported through June
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2005
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2004
|
2005
|
2004
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| Campylobacteriosis |
36
|
31
|
147
|
121
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| Cryptosporidiosis |
7
|
1
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47
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12
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| Chlamydial infections |
580
|
616
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2,912
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2,671
|
Enterohemorrhagic
E. coli (non-O157) |
0
|
0
|
4
|
0
|
| E. coli O157: H7 |
3
|
2
|
11
|
11
|
| Giardiasis |
17
|
14
|
60
|
65
|
| Gonorrhea |
169
|
111
|
830
|
583
|
| Hæmophilus influenzæ (cases <6 years of age) |
1
|
0
|
2
|
2
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| Hepatitis A |
4
|
2
|
12
|
5
|
| Hepatitis B (acute) |
2
|
0
|
13
|
14
|
| Hepatitis B (chronic) |
55
|
41
|
314
|
313
|
| Hepatitis C (acute) |
0
|
0
|
4
|
5
|
| Hepatitis C (chronic, confirmed/probable) |
104
|
56
|
644
|
620
|
| Hepatitis C (chronic, possible) |
37
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25
|
230
|
176
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| Herpes, genital (primary) |
157
|
82
|
409
|
376
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| HIV and AIDS (includes only AIDS cases not previously reported as HIV) |
36
|
33
|
245
|
213
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| Measles |
0
|
0
|
0
|
6
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| Meningococcal Disease |
1
|
0
|
11
|
9
|
| Mumps |
0
|
0
|
1
|
0
|
| Pertussis |
32
|
16
|
134
|
116
|
| Rubella |
0
|
0
|
1
|
0
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| Rubella, congenital |
0
|
0
|
0
|
0
|
| Salmonellosis |
24
|
27
|
110
|
104
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| Shigellosis |
4
|
1
|
30
|
31
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| Syphilis |
4
|
14
|
70
|
53
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| Syphilis, congenital |
0
|
0
|
0
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0
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| Syphilis, late |
7
|
4
|
41
|
35
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| Tuberculosis |
15
|
19
|
57
|
67
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