Region 6 Quarterly Communicable Disease Report · Meningitis. Meningitis – Aseptic . Meningitis...

Region 6 Quarterly Communicable Disease Report

Fourth Quarter, 2008

Generated for Ottawa County Health Department

Contents: Outbreak Updates………………………….….………………… 3 CD Updates ……………………………………………………… 5

Region 6 Summaries of Reportable Diseases in MDSS Disease Group Summaries ……….………………..…... 5

Disease Specific Summaries …………………………... 11 Administrative Statistics…....................................................... 15

OCHD EDSSS Alerts Summaries ..……………………………. 18

Report Generated by Diana Brown Region 6 Epidemiologist – MDCH

1/26/2009

Region 6 Local Health Jurisdictions: Central Michigan District Health Department Clare County Isabella County Osceola County District Health Department 10 Lake County Mason County Mecosta County

Newaygo County Oceana County

Ionia County Health Department Kent County Health Department Mid-Michigan District Health Department Montcalm County Muskegon County Health Department Ottawa County Health Department

8

6

51 2n

2s

2

7

2

OUTBREAK SUMMARIES Shigella illness outbreak:

Public Health – Muskegon County (PHMC) continues to investigate an ongoing outbreak of Shigella illness. As of January 22nd, PHMC reported 93 confirmed cases of Shigellosis associated with the outbreak, with most of the cases being in children under the age of 10 years old.

As a means of stopping the spread of illness, daycare centers and elementary schools throughout Muskegon County are being educated on proper hygienic practices. PHMC has enlisted the aid of the American Red Cross, Access Health, and Volunteer Muskegon, through the Medical Reserve Corps, in addition to their own public health educators to help with the education efforts.

Shigella Sept

2008 Oct

2008 Nov 2008

Dec 2008

Jan 2008*

Outbreak Total

Confirmed Cases 1 7 26 48 11 93

* As of January 22, 2009 (Source: http://www.muskegonhealth.net/advisories/public_advisories.htm ) Please note, given this current Shigellosis outbreak, the 2008 fourth quarter Foodborne Illness counts for Region 6 are higher than in any fourth quarter in the previous five years (see graph in Region 6 Summaries of Reportable Diseases in MDSS section below). E. coli Outbreak:

An investigation of an Escherichia coli 0157:H7 outbreak at Michigan State University (MSU), which was later confirmed to be of the same genetic footprint to a concurrent outbreak at a Lenawee County jail, started with cases reported into MDSS in September 2008. In the end, several other counties reported to Michigan Department of Community Health (MDCH) confirmed cases with the same genetic footprint, bringing the total to 38 Michigan cases with 21 hospitalizations, and one hemolytic uremic syndrome (HUS). Additionally, nine individuals in Illinois and three from the Province of Ontario were identified to be ill with the same genetic strain of E. coli 0157. No deaths are known to be associated with this outbreak.

Through collaborative efforts between local health jurisdictions, university officials, Michigan Department of Agriculture (MDA) and MDCH, the epidemiological investigation pointed towards iceberg lettuce as the source of the illness outbreak. Independent case control studies performed in Michigan and in Illinois both identified iceberg lettuce as the common source of illness. MDA product traceback investigation identified Fresh Pak/Aunt Mid’s as the common processor of the lettuce supplied to the outbreak locations at MSU, Lenawee County Jail, and in Illinois as well as other foodservice locations identified by ill individuals.

Product samples from the time of the outbreak were not available for testing, thus only samples from the time of testing were tested for E. coli. These samples along with environmental samples from Aunt Mid’s processing plant tested negative for E. coli. MDA continues to work with food safety partners at

3

the California Department of Public Health – Food & Drug Branch, who are investigating the origin and handling of the lettuce in that state. (Source: http://www.michigan.gov/documents/mdch/e_coli_253032_7.pdf and MDCH epidemiologists) Norovirus activity for 2008:

Out of 138 Norovirus outbreaks reported to MDCH, 27 were in Region 6. Of these 27 outbreaks, 17 were “healthcare” related, 4 “other”, 3 “restaurants” and 3 “schools/camps”. Of the 27 outbreaks, 15 outbreaks were not tested, 11 were laboratory confirmed (1 GI, 10 GII) and 1 outbreak tested negative.

Region 6 Outbreak Locations2008*

Norovirus Outbreak Locations, 2008

15%

11%63%

11% Restaurant

Healthcare

Schools/Camps

Other

N = 27

* Data as of 1/8/2009

Michigan Outbreak Locations2008*

Norovirus Outbreak Locations, 2008

17%

19%

46%

18%Restaurant

Healthcare

Schools/Camps

Other

N = 138

* Data as of 1/8/2009

Outbreaks Reported to MDCH2002-2008*

50

25

4834

147

120138

0

20

40

60

80

100

120

140

160

Cou

nt

2002 2003 2004 2005 2006 2007 2008

*Data as of 1/8/2009

Outbreaks Reported per Month 2008*

0

5

10

15

20

25

30

35

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

* Data as of 1/8/2009

Outbreaks Per Region 2008*

19

30

15

11

26 27

5 5

0

5

10

15

20

25

30

35

1 2N 2S 3 5 6 7 8

* Data as of 1/8/2009

Outbreaks Per Region, 2008*Laboratory Testing Status

0

5

10

15

20

25

30

35

1 2N 2S 3 5 6 7 8

PendingNegativeNot TestedConfirmed

* Data as of 1/15/2009 (Source: MDCH epidemiologists)

4

http://www.michigan.gov/documents/mdch/e_coli_253032_7.pdf

CD UPDATES Updated Norovirus Guidelines: The Norovirus Guidelines for Environmental Cleaning and Disinfection have been updated. Updates include: Norovirus-specific Food Code language, deletion of alternative disinfectants (gluts and iodine), addition of a bleach dilution table, deletion of contact time recommendation, addition of "pour or pump" bottles, corrected EPA language, and additional references. The updated Guidelines can be found on the web at: http://www.michigan.gov/documents/Guidelines_for_Environmental_Cleaning_125846_7.pdf .

REGION 6 SUMMARIES OF REPORTABLE DISEASES IN MDSS Reportable Conditions* in MDSS Disease Groups: Foodborne

Amebiasis Botulism – Foodborne Campylobacter Cryptosporidiosis Escherichia coli O157:H7 Giardiasis Listeriosis Salmonellosis Shiga toxin, E. Coli, Non O157:H7 Shiga toxin, E. Coli, Unsp Shigellosis Typhoid Fever Yersinia enteritis

VPD

Chickenpox (Varicella) Diphtheria H. influenzae Disease – Inv Measles Mumps Pertussis Polio Rubella Tetanus

Meningitis Meningitis – Aseptic Meningitis – Bacterial Other Meningococcal Disease Streptococcus pneumoniae, Inv

Vectorborne

Dengue Fever Ehrlichiosis Ehrlichiosis, human granulocytic Erhlichiosis, human monocytic Erhlichiosis, human, other, unsp Encephalitis, California Encephalitis, Eastern Equine Encephalitis, Powassa Encephalitis, St. Louis Encephalitis, Western Equine Lyme Disease Malaria Plague Rocky Mountain Spotted Fever Tularemia Typhus West Nile Virus

*NOTE: Not every condition listed has been reported in MDSS within the time periods analyzed in this report. Instead the lists represent conditions categorized within the MDSS disease groups summarized in this report.

5

Region 6 Reported Foodborne Illnesses in MDSS, Q1 2004 – Q4 2008:

0

20

40

60

80

100

120

140

160

180

200

220

Cas

es

Q1 Q2 Q3 Q4Quarter

Region 6 Reported Foodborne Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

0

20

40

60

80

100

120

140

160

180

200

220

Cas

es

2004 2005 2006 2007 2008Year

Region 6 Reported Foodborne Illnesses by Year and Quarter, 2004 - 2008

Q1Q2Q3Q4

6

Region 6 Reported Meningitis Illnesses in MDSS, Q1 2004 – Q4 2008:

0

10

20

30

40

50

60

70

80

90

Cas

es

Q1 Q2 Q3 Q4Quarter

Region 6 Reported Meningitis Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

0

20

40

60

80

100

Cas

es

2004 2005 2006 2007 2008Year

Region 6 Reported Meningitis Illnesses by Year and Quarter, 2004 - 2008

Q1Q2Q3Q4

7

Region 6 Reported Vectorborne Illnesses in MDSS, Q1 2004 – Q4 2008:

0

5

10

15

20

25

Cas

es

Q1 Q2 Q3 Q4Quarter

Region 6 Reported Vectorborne Illnessesby Quarter and Year, 2004 - 2008

20042005200620072008

0

5

10

15

20

25

Cas

es

2004 2005 2006 2007 2008Year

Region 6 Reported Vectorborne Illnesses by Year and Quarter, 2004 - 2008

Q1Q2Q3Q4

8

Region 6 Reported Acute Viral Hepatitis Infections in MDSS, Q1 2004 – Q4 2008:

0

2

4

6

8

10

12

14

16

18

20

Cas

es

Q1 Q2 Q3 Q4Quarter

Region 6 Reported Acute Viral Hepatitis (A, B, C, D, E) Infections by Quarter and Year, 2004 - 2008

20042005200620072008

0

2

4

6

8

10

12

14

16

18

20

Cas

es

2004 2005 2006 2007 2008Year

Region 6 Reported Acute Viral Hepatitis (A, B, C, D, E) Infections by Year and Quarter, 2004 - 2008

Q1Q2Q3Q4

9

Region 6 Reported Vaccine Preventable Diseases in MDSS, Q1 2004 – Q4 2008:

0

50

100

150

200

250

300

350

400

450

Cas

es

Q1 Q2 Q3 Q4Quarter

Region 6 Reported Vaccine Preventable Diseases by Quarter and Year, 2004 - 2008

20042005200620072008

0

50

100

150

200

250

300

350

400

450

Cas

es

2004 2005 2006 2007 2008Year

Region 6 Reported Vaccine Preventable Diseases by Year and Quarter, 2004 - 2008

Q1Q2Q3Q4

10

Disease Specific Summaries:

0

10

20

30

40

50

60

70

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Campylobacter Illnessesby Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Campylobacter Illnessesby Month, 2004 - 2008

0

5

10

15

20

25

30

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

1

2

3

4

5

6

7

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported E. coli O157:H7 Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported E. coli O157:H7 Illnessesby Month, 2004 - 2008

0

1

2

3

4

5

6

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

10

20

30

40

50

60

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Salmonellosis by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Salmonellosisby Month, 2004 - 2008

0

5

10

15

20

25

30

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

11

0

10

20

30

40

50

60

70

80

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Giardiasis by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Giardiasisby Month, 2004 - 2008

0

5

10

15

20

25

30

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

5

10

15

20

25

30

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Shigellosis by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Shigellosisby Month, 2004 - 2008

0

10

20

30

40

50

60

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

5

10

15

20

25

30

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Cryptosporidium Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Cryptosporidium Illnessesby Month, 2004 - 2008

0

2

4

6

8

10

12

14

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

12

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Flu Like Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Flu Like Illnessesby Month, 2004 - 2008

0

5,000

10,000

15,000

20,000

25,000

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

2

4

6

8

10

12

14

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Histoplasmosis Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Histoplasmosis Illnessesby Month, 2004 - 2008

0

1

2

3

4

5

6

7

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

50

100

150

200

250

300

350

400

450

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Chickenpox (Varicella) Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Chickenpox (Varicella) Illnessesby Month, 2004 - 2008

0

20

40

60

80

100

120

140

160

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

13

0

5

10

15

20

25

30

35

40

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Pertussis Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Pertussis Illnessesby Month, 2004 - 2008

0

5

10

15

20

25

30

35

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

0

1

2

3

4

5

6

7

8

9

10

11

Cas

es

Q1 Q2 Q3 Q4

Quarter

Region 6 Reported Hepatitis A Illnesses by Quarter and Year, 2004 - 2008

20042005200620072008

Region 6 Reported Hepatitis A Illnessesby Month, 2004 - 2008

0

1

2

3

4

5

6

Jan-0

4

Apr-04

Jul-0

4

Oct-04

Jan-0

5

Apr-05

Jul-0

5

Oct-05

Jan-0

6

Apr-06

Jul-0

6

Oct-06

Jan-0

7

Apr-07

Jul-0

7

Oct-07

Jan-0

8

Apr-08

Jul-0

8

Oct-08

Month-Year

Cas

es

Notes to Consider:

• Only cases with case status classified as “Confirmed” or “Probable” and with investigation status classified as “New,” “Active” or “Completed” were included in the summaries.

• In the Summaries of Reportable Diseases in MDSS, timelines were determined by

onset date or referral date if onset date was missing.

• Quarters are designated as follows: o Q1 January 1st – March 31st o Q2 April 1st – June 30th o Q3 July 1st – September 30th o Q4 October 1st – December 31st

14

MDSS ADMINISTRATIVE STATISTICS – REGIONALLY AND STATEWIDE

Foodborne Illnesses Time from Onset to Referral (Days) Total time Referral to Completion (Days)

Location N Average Median Maximum Location N Average Median Maximum1 63 11.13 9 42 1 96 19.17 13 84

2N 89 9.9 8 33 2N 124 17.4 15 68 2S 63 11.4 8 59 2S 126 31.77 28 76 3 34 8.26 6 23 3 50 16.24 12 100 5 46 12.41 11 46 5 68 14 8 52 6 159 9.01 7 44 6 184 16.43 11 92 7 41 9.68 9 30 7 50 10.7 7 82 8 10 13.5 11 29 8 14 12.86 9 38

Statewide 505 10.13 8 59 Statewide 712 18.96 14 100 Meningitis Illnesses

Time from Onset to Referral (Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum

1 85 5.48 5 17 1 100 9.03 6 43 2N 60 7.37 6 26 2N 120 5.88 4 43 2S 63 10.38 7 69 2S 121 24.89 23 76 3 40 4.65 4 18 3 68 6.47 4 28 5 61 6.92 5 62 5 80 12.01 6 69 6 75 8.91 7 36 6 84 12.24 8 35 7 18 4.28 4 11 7 22 8.95 7 29 8 6 17 13 47 8 7 17.14 14 52

Statewide 408 7.39 5 69 Statewide 602 12.24 7 76 Vectorborne Illnesses


1 0 0 0 0 1 7 28 24 80 2N 3 14.67 13 21 2N 23 21.65 17 80 2S 4 13.75 11 27 2S 16 38 37 70 3 1 43 43 43 3 5 19.8 8 57 5 2 9.5 10 17 5 6 31.33 30 78 6 2 20.5 21 21 6 5 15.6 19 26 7 0 0 0 0 7 3 17 4 43 8 4 15.5 11 38 8 10 29 30 52

Statewide 16 16.5 13 43 Statewide 94 22.67 18 80

15

Acute Viral Hepatitis (A, B, C, D, E) Infections

Time from Onset to Referral

(Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum

1 7 9 9 20 1 15 17.6 9 75 2N 4 23.5 28 36 2N 28 9.86 9 31 2S 4 21.5 13 58 2S 63 18.48 7 75 3 11 4.91 4 10 3 26 10.42 7 43 5 2 8.5 9 9 5 17 10.06 4 47 6 1 12 12 12 6 4 16.25 16 34 7 3 1.67 2 3 7 4 21.75 15 54 8 1 13 13 13 8 5 18.2 15 35

Statewide 33 10.42 7 58 Statewide 163 14.66 8 75 Vaccine Preventable Diseases


1 84 7.73 5 48 1 128 12.26 8 48 2N 97 10.18 8 40 2N 221 7.72 5 43 2S 48 15.35 10 44 2S 68 15.34 10 84 3 87 7.16 6 27 3 148 8.37 6 43 5 88 13.39 10 67 5 115 9.71 5 93 6 112 13.12 6 73 6 169 8.57 2 68 7 22 8.59 7 32 7 35 12.83 10 44 8 36 11.19 10 48 8 58 10.21 6 34

Statewide 574 10.86 7 73 Statewide 942 9.73 5 93 MDSS Administrative Statistics Interpretation Guide: Dates: Onset Date = the first day the case experienced symptoms. This date is a user-generated value and may not be available for all cases. Referral Date = theoretically the date the case was referred to the Health Department and therefore entered into the MDSS. This date is automatically generated by the system as the date the case was entered into the MDSS but can be changed manually if desired, but must be no more than 90 before the system generated date. This value is available for all cases. Completion Date = the date the case was marked as “completed.” This date is a system-generated value, is only available for cases marked as “completed” in the investigation status field, but can be changed if the case is re-opened and then re-closed (see below).

16

Please consider:

To be included in the analysis, a case must have an onset date during the specified time period (if onset date is missing, then referral date is used). If a case is not “completed,” the number of days from referral to completion is not available and it will not be included in the Referral to Completion analysis. If the onset date is missing, the number of days from onset to referral is not available for that case and will not be included in the Onset to Referral analysis. If a case is re-opened and the investigation status is marked as “completed” a second time, the case completion date will be changed to the most recent date. For example, if a case is completed on Jan 1st, 2005 and then re-opened and completed again on March 1st, the completion date used in the calculation will be March 1st. Theoretically, referral date is the date that the case is received by the local health department and therefore entered into the MDSS, however, this is not always the case and the referral date is changeable by the LHD.

Statistics: N = number of cases used to determine the Average and Maximum values Average = the average (also called the mean) number of days between the Onset Date the Referral Date (or between the Referral Date and the Completion Date). Additionally, the mean can be influenced by outlying values. Median = the middle number in a given sequence of numbers Maximum = the largest number of days between Onset and Referral (or Referral and Completion)

Additional points to consider when interpreting this report: It is important to keep in mind that administrative report results can vary widely. Factors affecting the administrative report results include:

1) The date on which the report is run. The specific cases included in the analysis can change as cases are entered, investigated and closed. 2) The number of cases / characteristics of cases included in the analysis. Small sample sizes (N) are subject to outlying data. For example, if your jurisdiction only has a couple of VPDs during a certain time frame and it takes an unusually long time to investigate one of them or a lab report was delayed, the time between Onset and Referral and Referral and Completion may be artificially elevated. Additionally, remember that the mean is more likely to be influenced by outlying values than the median.

17

EMERGENCY DEPARTMENT SYNDROMIC SURVEILLANCE SYSTEM ALERT SUMMARIES: Syndromic Surveillance Categories:

Category

Example Complaint

Gastrointestinal

Abdominal pain or cramping, nausea, vomiting, diarrhea

Constitutional Fever, chills, body ache, flu symptoms, weakness, fatigue, anorexia, malaise

Respiratory

Nose, throat or lung problems, sinusitis, cold symptoms, bronchitis, cough, asthma, COPD, sore throat

Rash

Any rash

Hemorrhagic

Bleeding from any site

Botulinic

Ocular abnormalities, difficulty speaking or swallowing

Neurological

Non-psychiatric complaints. Headache, facial pain, numbness, seizure, tremor, convulsion, dizziness

Other “Pain or process in a system not being monitored”. Lacerations, contusions, muscle aches, non-respiratory chest pain.

Default

All complaints that could not otherwise be classified, i.e. no word in the complaint matched any searchable keywords.

NOTE: This list of example complaints is not comprehensive.

18

Ottawa County Date Range: 10/1/08-12/31/08

Syndrome Date County Observed Threshold Comments

Constitutional 12/29/2008 Ottawa 10.61453 8.19101

19/179 visits. Female: 57.9%. Average age: 29.6yo; median age: 18yo; age range: 1yo-84yo; predominant age group: 0yo-10yo (42.1%). Predominant complaints: fever (68.4%); weakness (31.6%). This is the second constitutional alert in two days. Fluctuations are still within 3 month historical range. Total visits for all registrations are elevated coming out of the holiday. Nothing remarkable in MDSS. OTC sales for "anti-fever pediatric" are slightly elevated over the holiday. Will continue to monitor. DB Fluctuations returned to pre-alert levels one day after alert. DB


16/168 visits. Female: 43.8%. Average age: 27.8yo; median age: 13yo; age range: 0yo-73yo; predominant age group: less than 6yo (50%). Predominant complaints: fever (68.8%). Despite a spike in normalized value- absolute value is within 3 month historical range. Nothing remarkable in MDSS or OTC sales. DB

Neurological 12/24/2008 Ottawa 8.90411 8.09063 13/146 visits. Within 3m hx limits. CCs diverse with no unusual clustering. Age range 19-96yrs. Headache/migraine in younger cases; tia/cva/syncope/seizure in older cases. Unremarkable. SS

Gastrointestinal 12/17/2008 Ottawa 20.83333 20.7149

30/144 visits. Female: 70%. Average age: 24.4yo; median age: 21.5yo; age range: 1yo-59yo; predominant age group: 18yo-44yo (53.3%). Despite a spike in normalized value- absolute value is within 3 month historical range. Total registrations for all visits are slightly below moving average. There are two Salmonellosis cases reported in MDSS in previous 2 weeks. Nothing remarkable in OTC sales or by geography. DB

Hemorrhagic 12/17/2008 Ottawa 6.08696 5.22542 7/115 visits. Female: 85.7%. Average age: 40.7yo; median age: 31yo; age range: 2yo-90yo. Predominant complaints: GI bleed (4/7); vag bleeding (2/7). Fluctuations are within 3 month historical range. Nothing remarkable in MDSS or by geography. DB

Rash 12/16/2008 Ottawa 6.31579 5.68023

12/190 visits. Female: 50%. Average age: 28.2yo; median age: 24.5yo; age range: 1yo-67yo. Predominant complaints: Rash (7/12); scabies (4/12). Despite a spike compared to recent values- values are within 3 month historical range. Nothing remarkable in MDSS- OTC sales or by geography. DB


2/108 visits. Female: 68.2%. Average age: 36.1yo; median age: 29yo; age range: 0yo-89yo; predominant age group: 18yo-44yo (40.9%). Predominant complaints: abd pain (59.1%); vomiting (31.8%); diarrhea (22.7%). Fluctuations are within 3 month historical range. Total registrations for all visits for one particular facility (HH) are below moving average (~25%). Nothing remarkable in MDSS- OTC sales or by geography. DB

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Hemorrhagic 12/2/2008 Ottawa 6.875 6.58656

11/160 visits. Female: 81.8%. Average age: 43.4yo; median age: 46yo; age range: 0yo-77yo. Predominant complaints: rectal bleeding (5/11); nose bleed (2/11). Despite a spike in values- values are within 3 month historical range. Nothing remarkable in MDSS or by geography. DB


18/114 visits. Female: 72.2%. Average age: 36.4yo; median age: 34yo; age range: 1yo-83yo. Predominant complaints: abd pain (9/18); nasea/vomiting (4/18). Despite a slight spike in normalized value- both values are within recent historical range. Alert was generated when total GI visits (absolute value) was below moving average due to a decrease in total registrations for all visits ~50% below moving average. Will follow-up regarding this decrease (likely due to delays data submission). DB Total registrations for all visits have since returned to norm one day after generation of alert. DB

Respiratory 11/30/2008 Ottawa 27.43902 26.08228

45/164 visits. Female: 62.2%. Average age: 33.6yo; median age: 30yo; age range: 0yo-91yo. Predominant complaints (alone or with other complaints): cough (42.2%); sore throat (17.8%); sob (15.6%). Both normalized and absolute values are 3 month historical range. Nothing remarkable in MDSS- OTC sales or by geography. Will continue to monitor. DB Values dropped to pre-alert values one day after alert. DB


21/103 visits. Female: 76.2%. Average age: 31.2yo; median age: 28yo; age range: 2yo-75yo. Predominant complaints (alone or with other complaints): abd pain (10/21); vomiting (8/21); diarrhea (4/21). Despite a spike in normalized value- absolute value is slightly above moving average. Total registrations for all visits are below moving average due to delays is data submissions from a particular facility (HH). One orovirus outbreak has been confirmed within the two weeks prior to the generation of the alert. The alert was likely generated from a spike in normalized value above threshold due to delays in data submission from a reporting facility. Nothing remarkable by geography or by OTC sales. DB

Constitutional 11/19/2008 Ottawa 12 11.4978

12/100 visits. Female: 41.7%. Average age: 32yo; median age: 25.5yo; age range: 0yo-93yo. Predominant complaints: fever (7/12); dizzy (4/7). Despite a slight spike in normalized value- absolute value is slightly below moving average. Total registrations for all visits are ~30% below moving average likely contributing to the generation of the alert. Nothing remarkable in MDSS or by geography. DB

Rash 11/6/2008 Ottawa 7.05882 6.81903

12/170 visits. Female: 75%. Average age: 23yo; median age: 18yo; age range: 5yo-56yo. Predominant complaints: rash (11/12); hives (1/12). Despite a spike in normalized and absolute values- values are within 3 month historical range. Nothing remarkable in MDSS or by geography. DB

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39/136 visits. Female: 59.0%. Average age: 26.6yo; median age: 16yo; age range: 0yo-87yo; predominant age group: 5yo-17yo (33.3%). Predominant complaints: cough (51.3%); sob (25.6%); sore throat (12.8%). Despite a spike in normalized values- absolute values are only slightly above historical range. OTC sales data indicates a slight increase in cough/cold meds sales. Nothing remarkable in MDSS or by geography. DB


30/184 visits. Female: 77.7%. Average age: 37.5yo; median age: 35.5yo; age range: 3yo-78yo. Predominant complaints: abd pain (70.0%); vomiting (26.7%). Fluctuations are within 3 month historical range. There is a one confirmed E. coli O157:H7 and one Shigellosis case reported in MDSS in the 2 weeks before alert. There is nothing remarkable in OTC sales data or by geography. DB


34/137 visits. Female: 55.9%. Average age: 32.4yo; median age: 26yo; age range: 0yo-86yo; predominant age group: 18yo-39yo (35.3%). Predominant complaints: cough (47.1%); sore throat (26.5%); sob (14.8%). Despite a spike in normalized value- absolute value is within recent historical range. Nothing remarkable in MDSS- OTC sales or by geography. DB


5/41 visits. Nothing remarkable my demographics or complaints- except 5/5 females. Fluctuations are within recent historical range- in which absolute values are below moving average. Note: Total registrations for all visits (for all facilities) are below moving average (around 65%) - HH last submitted registration data on 10/17/08 (currently overdue) - likely contributing to generation of alert. DB


Alert summary for 10/18/08 and 10/19/08 alerts. 10/18/08 alert: 11/165 visits; 10/19/08 alert: 2/37 visits; combined alerts: 13/202 visits. Combined analysis: Female: 38.5%. Average age: 40.6yo; median age: 33yo; age range: 0yo-86yo. Predominant complaints: gi bleed/bloody stools (4/13); blood in urine (2/13). There is one confirmed E. coli 0157:H7 case reported in MDSS in the 2 weeks before generation of alerts. Despite an increase in normalized values- absolute values are below moving average. Total registrations for all visits (for all facilities) are below moving average (around 65%). Registration data from HH last submitted on 10/17/08 (currently overdue) - likely contributing to generation of the alert. Will continue to monitor and inquire about overdue submission from HH. DB HH has resumed submitting data- normalized and absolute values are still below moving average. DB


See 10/19/08 alert summary.

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Rash 10/15/2008 Ottawa 7.14286 6.95069

14/196 visits. Female: 57.1%. Average age: 9.1yo; median age: 5yo; age range: 1yo-25yo; predominant age group: 6yo or younger (64.3%). Predominant complaints: rash (13/14); scabies (1/14). Seven chickenpox cases have been reported in MDSS in the 2 weeks prior to alert. Though values are spiked- they are within recent historical range. Nothing remarkable in OTC sales or by geography. DB


33/207 visits. Female: 69.7%. Average age: 30.1yo; median age: 25yo; age range: 1yo-83yo; predominant age group: 18yo-39yo (48.5%). Predominant complaints: abd pain (66.7%); vomiting (15.2%); diarrhea (15.2%). Despite a spike in both normalized and absolute values- only the normalized value is higher (slightly) than the 3 month historical range. Total registrations for All Visits are below moving average- likely contributing to a higher normalized value and the generation of the alert. One case of Giardia has been reported in MDSS within last 2 weeks. DB

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Region 6 Quarterly Communicable Disease Report · Meningitis. Meningitis – Aseptic . Meningitis...

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