Cysticercosis Los Angeles Countypublichealth.lacounty.gov/acd/presentations/Parasites/... ·...
Transcript of Cysticercosis Los Angeles Countypublichealth.lacounty.gov/acd/presentations/Parasites/... ·...
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CysticercosisLos Angeles County
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Public Health Problem Identified
• LAC Cysticercosis hospitalizations – 10-15 cases in 1970’s– 80 by early 1980’s
(F. Richards et. al. 1985, JAMA)
• Severe Disease– 56% Seizures, 21% hydrocephalus (N=238) among
hospitalized cases (D. Scharf 1988, Arch Neurol)
• Cysticercosis is Preventable !
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How to Prevent Cysticercosis
Review of Life Cycle
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Public Health OpportunityIn 1988 LAC Public Health identified an
opportunity for disease prevention:
• Add cysticercosis to the list of reportable diseases for LAC
• Public health nursing to screen close contacts of reported Cysticercosis cases for Taeniasis
• Refer Taeniasis cases for treatment
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Public Health Results
• This intervention method has been successful in identifying cases
– Taeniasis cases were identified in 7% (5/72) of households tested (1988-1991).F. Sorvillo et. al. 1992. Am. J. Trop. Med. Hyg
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What’s Happening With Cysticercosis in LAC Today ?• Review available data sources:
– Reported cases
– Death Certificates
– Hospital Discharge Data
– Published Studies
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Reported Cases LAC
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Reported Cases, LACFigure 1 Cysticercosis Incidence Rates per
100,000, Los Angeles County
y = -0.0366x + 0.7763R2 = 0.8124
0.0
0.1
0.2
0.3
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1.0
1988 1990 1992 1994 1996 1998 2000 2002 2004
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Reported Cases, LAC 1993-2006 (N=411)
47%192Female
53%216Male
Gender
12Unknown
1%2Pacific Islander
1%3African American
2%6Asian
4%17Caucasian
93%371Latino
Race/ Ethnicity%n
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Trends in Reported Cases, LACEarly vs. Later Cases
Health Department Cases
91%84%
61%
33%
6%
87%80%
60%
48%
7%
0%
20%
40%
60%
80%
100%
Latino Immigrant Born inMexico
U.SResident>10 yrs
Mortality
1988-1990 Study (N=138)2003-2006 Study (N=60)
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0
10
20
30
40
50
MeanAge
Year
s
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Reported Cases by Health District LAC, 2004-09 (n=59)
3%15Other Health Districts (2 or fewer cases)5%3CENTRAL HD/ Central HC (9)5%3BELLFLOWER HD/Bellflower HC (6)5%3WEST VALLEY HD (86) 5%3SOUTHEAST HD/Humphrey HC (72)5%3SOUTH HD/ South HC (69)5%3SAN FERNANDO HD/ Pacoima HC (62)7%4EAST VALLEY HD/ North Hollywood HC (19)7%4POMONA HD/ Pomona HC (54)7%4ANTELOPE VALLEY HD/Antelope Valley HC (5)10%6SAN ANTONIO HD/ Compton HC (58)14%8EL MONTE HD/ Pomona HC (23)%nHEALTH DISTRICT IMPACTED
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Mortality
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Cysticercosis Mortality• National Mortality
• 221 Deaths 1990-2002 (17 per year)• 60% occurred in CA• 32% occurred in LAC
F. Sorvillo et. al. 2004, EID
• LAC Mortality– Slight decrease over time– Demographics
• 96% Latino • Mean age 41.2 years• 62% male
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Hospitalizations
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Hospitalizations
Hospitalizations 1991-2008 (18 years)
• 7,169 Cysticercisis hospitalizations (398 per year)
• 3,937 NC* Hospitalization (218 per year)
• 1,488 NC* Hospitalization with primary Dx cysticercosis (82 per year)
*NC=neurocysticercosis
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Hospitalization DemographicsLAC, 1991-2008 (n=3937)
• 91.6 % Latino
• Male: Female = 1.1:1
• Mean age 38.4 years• 31.3 years in 1991• 43.1 years in 2008
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Hospitalizations • Economic Burden over 18 years
– $136.2 million total hospitalization charges• Averaging $7.9 million per year
– Average charge per patient was $37.6 thousand – Most common payment method
• Medicaid (43.9%)• Private insurance (24.5%)
• The average length of stay was 7.2 days.
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Hospitalizations 1991-2008
• 3,937 neurocysticercosis hospitalizations identified– 72.8% seizure or convulsion (2,866)– 30.9% hydrocephalus (1,217)– 6.2% cerebral cyst (244)– 2.2% cerebral edema (866)– 2.0% death (77)
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Figure 1. Neurocysticercosis Hospitalizations and Hospital Charge by Year
Los Angeles County 1991-2008
Neurocysticercosis Hospitalizationsy = -0.26x + 221.09 (R2 = 0.01)
Hospital Charge for Neurocysticercosis y = 0.63x + 1.89 (R2 = 0.74)
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25
50
75
100
125
150
175
200
225
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275
300
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08
Year
Hosp
italiz
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4
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16
20
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28
32
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Cha
rge
($ M
illio
ns)
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31.9%1256MRI or CT Scan of Brain0.6%23Craniotomy3.3%131Brain Excision 3.9%155Ventriculostomy5.5%217Shunt Removal / Replace14.3%564Any Ventricular Shunt21.4%842Brain Procedure12.0%472Lumbar Puncture32.3%1273CNS Procedure
percentnProcedure
Los Angeles County 1991-2008 (N=3937)Hospitalizations Procedures
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Cysticercosis Trends
1993-2006 (16 years)
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Cysticercosis in Los Angeles County Early Cases (1993-1999) vs. Later Cases (2000-2006)
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115
0
100
200
300
Reported Cases Deaths Hospitalization NCHospitalization
NCHospitalization(Primary Dx)
1993-1999
2000-2006
Reported cases down 49%
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Cysticercosis in Los Angeles County Early Cases (1993-1999) vs. Later Cases (2000-2006)
227
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115
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0
100
200
300
ReportedCases
Hospitalization NCHospitalization(Primary Dx)
1993-19992000-2006
Reported cases down 49%Mortality down 37%
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Cysticercosis in Los Angeles County Early Cases (1993-1999) vs. Later Cases (2000-2006)
22724
2755
115 15
2883
0200400600800
100012001400160018002000220024002600280030003200
Reported Cases Deaths Hospitalization NCHospitalization
NCHospitalization(Primary Dx)
1991-1999
2000-2006
Reported cases down 49%Mortality down 37%Hospitalizations up 5%
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Cysticercosis in Los Angeles County Early Cases (1993-1999) vs. Later Cases (2000-2006)
22724
2755
1534
0115 15
2883
1611
00
200400600800
100012001400160018002000220024002600280030003200
ReportedCases
Deaths Hospitalization NCHospitalization
NCHospitalization(Primary Dx)
1991-1999
2000-2006Reported cases down 49%Mortality down 37%Hospitalizations up 5%
NC hospitalizations up 5%
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Cysticercosis in Los Angeles County Early Cases (1993-1999) vs. Later Cases (2000-2006)
22724
2755
1534
1039
115 15
2883
1611
909
0200400600800
100012001400160018002000220024002600280030003200
Reported Cases Deaths Hospitalization NCHospitalization
NCHospitalization(Primary Dx)
1993-1999
2000-2006
Reported case down 49%Mortality down 37%Hospitalizations up 5%NC hospitalizations up 5% NC hospitalizations (primary Dx) down 12%
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Cysticercosis in LAC
Early Cases vs. Later Cases
49% decrease in reported case
37% decrease in mortality
5% increase in hospitalizations
5% increase in NC hospitalizations
12% decrease in NC hospitalizations (primary diagnosis)
NC= neurocysticercosis
Cysticercosis in Los Angeles County Early Cases (1993-1999) vs. Later Cases (2000-2006)
22724
2755
1534
1039
115 15
2883
1611
909
0200400600800
100012001400160018002000220024002600280030003200
ReportedCases
Deaths Hospitalization NCHospitalization
NCHospitalization(Primary Dx)
1993-19992000-2006
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Other Published Studies
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Cysticercosis and Taeniasisis are Still Prevalent In and Around LAC
The sero-prevalence in a mostly Hispanic immigrant population in Ventura County approximates the prevalence in some endemic areas of Latin America. (DeGiorgio C, et al, Acta Neurol Scand. 2005)
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DeGiorgio C, et al 2005METHOD
– Obtain finger pick blood samples from 1) Select persons living in a federally funded, predominantly Hispanic residential community 2) and in two migrant farm worker camps in rural Ventura County, Californiia
– Test serum immunoblots for both cysticercosis and taeniasis.
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DeGiorgio C, et al 2005RESULTS (N=449)
– 1.8% positive for T. solium cysticercosis
– 1.1%. Positive for T. solium taeniasis
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Conclusion• Cysticercosis remains a public health problem in
LAC
• The disease is severe and represents a significant economic burden to LAC
• The disease can be prevented through detection and treatment of taeniasis cases
• Implementing improved testing methods for taeniasiswill increase the likelihood of detection
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Questions ?
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References1. Lescano AG , Garcia HH , Gilman RH , Gavidia CM , Tsang VC ,Rodriguez S , Moulton LH , Villaran MV , Montano SM , GonzalezAE , 2009 . Taenia solium cysticercosis hotspots surroundingtapeworm carriers: clustering on human seroprevalence but noton seizures . PLoS Negl Trop Dis 3: e371 .2. Willingham AL 3rd , Harrison LJ , Fevre EM , Parkhouse ME , 2008 .Inaugural meeting of the Cysticercosis Working Group inEurope . Emerg Infect Dis 14: e2 .3. Morales J , Martinez JJ , Rosetti M , Fleury A , Maza V , Hernandez M ,Villalobos N , Fragoso G , de Aluja AS , Larralde C , Sciutto E ,2008. Spatial distribution of Taenia solium porcine cysticercosiswithin a rural area of Mexico . PLoS Negl Trop Dis 2: e284 .4. Lescano AG , Garcia HH , Gilman RH , Guezala MC , Tsang VC ,Gavidia CM , Rodriguez S , Moulton LH , Green JA , Gonzalez AE ,2007. Swine cysticercosis hotspots surrounding Taenia soliumtapeworm carriers . Am J Trop Med Hyg 76: 376 – 383 .5. Sorvillo FJ , DeGiorgio C , Waterman SH , 2007 . Deaths from cysticercosis,United States. Emerg Infect Dis 13: 230 – 235 .
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References6. DeGiorgio C , Pietsch-Escueta S , Tsang V , Corral-Leyva G , Ng L ,Medina MT , Astudillo S , Padilla N , Leyva P , Martinez L , Noh J ,Levine M , del Villasenor R , Sorvillo F , 2005 . Sero-prevalence ofTaenia solium cysticercosis and Taenia solium taeniasis inCalifornia, USA . Acta Neurol Scand 111: 84 – 88 .7. Richards FO Jr , Schantz PM , Ruiz-Tiben E , Sorvillo FJ , 1985 .Cysticercosis in Los Angeles County . JAMA 254: 3444 – 3448 .8. Sorvillo FJ , Waterman SH , Richards FO , Schantz PM , 1992 .Cysticercosis surveillance: locally acquired and travel-relatedinfections and detection of intestinal tapeworm carriers in LosAngeles County . Am J Trop Med Hyg 47: 365 – 371 .9. del la Garza Y , Graviss EA , Daver NG , Gambarin KJ , ShanderaWX , Schantz PM , White AC Jr , 2005 . Epidemiology of neurocysticercosisin Houston, Texas. Am J Trop Med Hyg 73:766 – 770 .10. Scharf D , 1988 . Neurocysticercosis. Two hundred thirty-eight casesfrom a California hospital. Arch Neurol 45: 777 – 780 .
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References11. Los Angeles County Department of Public Health. Office ofHealth Assessment and Epidemiology. Los Angeles CountyHealth Survey Data. Available at: http://www.lapublichealth.org/ha/HA_DATA_TRENDS.htm. Accessed February 2, 201012. Agency for Health Care Research and Quality , 2010 . U.S. Departmentof Health and Human Service/HCUPnet.s . Available at:http://hcupnet.ahrq.gov . Accessed February 2, 2010.13. DeFrances CJ , 2008 . National Health Statistics Reports . 2006National Hospital Discharge Survey. No 5 .14. Wilkins PP , 1999 . Development of a serologic assay to detectTaenia solium taeniasis . Am J Trop Med Hyg 60: 199 – 204 .15. Tsang VC , Brand JA , Boyer AE , 1989 . An enzyme-linked immunoelectrotransferblot assay and glycoprotein antigens for diagnosinghuman cysticercosis ( Taenia solium ) . J Infect Dis 159:50 – 59 .