Georgia Epidemiology Report The Georgia Epidemiology Report is a publication of the Epidemiology Section of the Epidemiology and Prevention Branch, Division of Public Health, Department of Human Resources May 1996 Volume 12 Number 5 Division Of Public Health Patrick J. Meehan, M.D. - Director Epidemiology and Prevention Branch State Epidemiologist Kathleen E. Toomey, M.D., M.P.H.- Director Epidemiology Section Paul A. Blake, M.D., M.P.H.-Director Surveillance Jeffrey D. Berschling, M.P.H.; Karen R. Horvat, M.P.H.; Jane E. Koehler, D.V.M, M.P.H.; Patrick L. Osewe, M.D., M.P.H.; Preeti Pathela, M.P.H.; Russell C. Sexton Jr., M.H.S.; Sabrina Walton, M.S.P.H. Chronic Disease Nancy E. Stroup, Ph.D.-Director Patricia M. Fox, M.P.H.; David M. Homa, Ph.D., M.P.H.; Thomas W. McKinley, M.P.H.; Edward E. Pledger, M.P.A.; D. Lee Warner, M.P.H. Tuberculosis Bharat K. Pattni, M.B.B.S., M.P.H. HIV\AIDS Awal D. Khan, Ph.D., M.A. Sexually Transmitted Diseases Quimby E. McCaskill, M.P.H.; Dhelia Williamson, M.S. Office of Perinatal Epidemiology Roger W. Rochat, M.D. - Director Mary D. Brantley, M.P.H.; Raymond E. Gangarosa, M.D., M.P.H.; Rebekah Hudgins, M.P.H.; Mary P. Mathis, Ph.D., M.P.H.; Florina Serbanescu, M.D.; Edward F. Tierney, M.P.H. Preventive Medicine Residents Lorenzo D. Botto, M.D.; Isabella A. Danel, M.D., M.S.; Hector S. Izurieta, M.D., M.P.H.;Michael M. McNeal, M.D., M.P.H.; Peter Strebel, M.D.;Sherrilyn Wainwright, D.V.M., M.P.H.; EIS Officers Luis G. Castellanos, M.D., Ph.D; Patricia M. Dietz, Dr.P.H. Georgia Epidemiology Report Editorial Board Editorial Executive Committee Patrick L. Osewe, M.D. - Editor Kathleen E. Toomey, M.D., M.P.H. Mary D. Brantley, M.P.H. Jeffrey D. Berschling, M.P.H. Mailing List Edward E. Pledger, M.P.A. 1996 Centennial Summer Olympic Games: Public Health Issues Every day public health officials work behind the scenes to monitor communicable diseases across Georgia, identifying any outbreaks or unusual disease patterns and initiating rapid intervention and preventive measures. This year, the summer Olympics will create a challenge for those working in public health. With the number of Olympic visitors expected to exceed 4 million in Georgia, early detection of communicable disease outbreaks, heat related illnesses, injuries and other preventable health conditions will be particularly important. Georgia's Olympic Public Health Surveillance System To protect the health of all Georgians and our Olympic visitors this summer, the Epidemiology and Prevention Branch (EPB) will be coordinating public health surveillance and intervention "outside the Olympic fence". This system is designed to rapidly detect any emerging disease outbreaks or unusual disease or injury patterns that may require immediate intervention, and to monitor the health services utilization during the time period around the Olympic Games. This system is designed to interface with the "inside the fence" medical events surveillance for Olympic athletes, developed by the Centers for Disease Control and Prevention (CDC) in conjunction with the Atlanta Committee for the Olympic Games (ACOG). Data from these surveillance systems will be used to describe statewide disease trends and patterns of health encounters immediately before, during and after the 1996 Olympic Games in Atlanta. To help monitor health trends during the Olympics, state public health officials have developed a surveillance system with three components: provider-based surveillance; laboratory surveillance; and health encounter surveillance at eight sentinel hospitals (Figure 1). This sentinel system will complement the enhanced surveillance system we already have in place statewide. Many public health officials and infection control providers across the state have completed special training in infectious disease recognition and management to ensure that the most up-to-date information is disseminated to hospitals and other medical providers. Come visit our new Web site ! ! http://www.ph.dhr.state.ga.us for updated information about outbreaks or other public health issues related to the Olympic Games Epidemiology Section, Epidemiology & Prevention Branch, Two Peachtree St., N.W., Atlanta, GA 30303-3186 Phone: (404) 657-2588 FAX: (404) 657-2586 Figure 1. Olympic Public Health Surveillance Public Health Command Center Outbreak or Unusual Health Event (Daily as needed) Notifiable Diseases Reports from Infection Control Practitioners, Physicians & Other Providers Statewide State Epidemiologist Notifiable Diseases (Daily) State Public Health Laboratory Statewide Selected Health Encounters (Daily) 8 Sentinel Hospital Emergency Rooms The Georgia Public Health Laboratory and several major private laboratories in Georgia will report cultures and other test results that may require immediate follow-up on a daily basis to DHR. The medical encounter active surveillance will involve 8 sentinel hospital emergency rooms across the state. These 8 hospitals (Table 1) were selected because of their proximity to Olympic venues, their wide scope of services and their willingness to participate. Table 1. Olympic Sentinel Hospital Surveillance Metro-Atlanta Venues q Dekalb Medical Center q Grady Health System q Piedmont Hospital q Southern Regional Medical Center q Georgia Baptist Medical Center * q Rockdale Hospital * q South Fulton Medical Center * Other Georgia Venues q Athens Regional Hospital q Columbus Medical Center q Medical Center of Central Georgia q Savannah Memorial Hospital q Northeast Georgia Medical Center * * Alternate sites These systems, working together, will ensure that information about infectious diseases and other important health outcomes are identified rapidly for prompt intervention. Although importation of deadly infectious diseases is unlikely, it is possible, and health authorities need to be alert to the possibility (Tables 2 and 3). Unusual diseases are reported in Georgia every year. Several cases of dengue fever were reported last summer among Georgia residents who visited the Caribbean. Vaccine preventable diseases--particularly diphtheria--have reached epidemic proportions in several countries, especially the former Soviet Republics. The best protection against these vaccine preventable diseases is for parents to be sure that all children who reside in Georgia are up-to-date with their childhood immunizations. For foodborne diseases that are commonly seen in Georgia, rapid identification will ensure that the source is detected and controlled early. Table 4 lists some toxic exposures that may present in the summer months. Table 2. Communicable Disease Outbreaks Worldwide Africa: Cerebrospinal Meningitis - Over 38,000 cases and over 5,000 deaths have been reported in 11 countries in Africa since the beginning of the year. Most of the cases have been associated with outbreaks in Burkina Faso, Chad, Mali, Niger, and Nigeria. Ebola - The latest reported outbreak of Ebola hemorrhagic fever occurred in February, 1996, in Gabon. Of the 20 confirmed cases, 12 had direct contact with blood of a dead chimpanzee. The epidemic has been controlled and no other cases have been reported since February. Plague - Reported in many African countries including Angola, Botswana, Kenya, Libya, Madagascar, Malawi, Mozambique, Namibia, South Africa, Tanzania, Uganda, Zimbawe, and Zaire. Asia: Plague - Endemic in China, Indonesia, Mongolia, Myanmar (Burma), India and especially in Vietnam. Central America, South America and the Caribbean: Dengue - Approximately 140,000 cases of dengue fever were reported from Mexico, Central America, South America, and the Caribbean in 1995. This year, 429 have been reported from one district in Brazil. Leptospirosis - More than 200 cases and over 16 deaths occurred in Nicaragua in October, 1995. Rabies - More than 14 human rabies deaths have been reported from Ecuador this year. Ecuador has the highest rabies death rate of any Latin American country. Venezuelan Equine Encephalitis - An extensive outbreak of Venezuelan equine encephalitis has been reported from Venezuela in recent months. Plague - Foci in northeastern Brazil, Peru and Bolivia. Europe: Diphtheria - During the past several months more than 50,000 cases of diphtheria have been reported in Russia and the Ukraine. In the first two months of this year alone, Russia has reported more than 3,300 new cases. United States: Rubella - During the past few months, North Carolina has reported a multi-county rubella outbreak. The outbreak was first recognized among Hispanic workers in several industries in two counties but has subsequently spread. Worldwide: Tuberculosis - Among infectious diseases, tuberculosis is the leading killer of adults in the world today. The World Health Organization (WHO) estimates that at least one third of the world's entire population is now infected. The risk of encountering one or more cases of active tuberculosis among Olympic visitors is probably lower than the risk of encountering a case in a local resident. For public health questions or public health emergencies, such as botulism or diphtheria call: The Epidemiology & Prevention Branch (24 hours) (404) 657-2588 After 5:00 pm, you will be referred to an answering service that will contact an on-call epidemiologist. For information related to rabies or possible rabies exposures call the Georgia Poison Center (see next page). - 2 - World Region Country Africa Algeria Angola Benin Botswanna Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Cote D'Lvorie Djibouti Egypt Equatorial Guinea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Libya Madagascar Malawi Mali Mauritania Mauritius Morocco Mozambique Namibia Niger Table 3. Participating Countries: 1996 Summer Olympics World Region Country World Region Country World Region Country World Region Country Nigeria Rwanda Sao Tome & Principe Senegal Seychelles Sierra Leone Somalia South Africa Sudan Swaziland Tanzania Togo Tunisia Uganda Zaire Zambia Zimbabwe Americas (Central) Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama Americas (North) Canada Mexico United States Americas (South) Argentina Bolivia Brazil Chile Columbia Ecuador Guyana Paraguay Peru Suriname Uruguay Venezuela Asia Afghanistan Bahrain Bangladesh Bhutan Brunei Darussalam Cambodia China Chinese Taipei Hong Kong India Indonesia Iran Iraq Israel Japan Jordan Kazakhstan Kuwait Kyrgyzstan Laos Lebanon Malaysia Maldives Mongolia Myanmar Nepal North Korea Oman Pakistan Palestine Philippines Qatar Saudi Arabia Singapore South Korea Sri Lanka Syria Tajikistan Thailand Turkmenistan United Arab Emirates Uzbekisan Vietnam Yemen Caribbean Antigua & Barbuda Aruba Bahamas Barbados Bermuda British Virgin Islands Cayman Islands Cuba Dominica Dominican Republic Grenada Haiti Jamaica Netherlands Antilles Puerto Rico St. Kitts and Nevis St. Lucia St. Vincent and The Grenadines Trinidad & Tobago US Virgin Islands Europe Albania Andorra Armenia Austria Azerbaijan Belarus Belgium BosniaHerzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Great Britian Greece Hungary Iceland Ireland Italy Latvia Liechtenstein Lithuania World Region Country Luxembourge Malta Moldova Monaco Norway Poland Portugal Republic of Macedonia Romania Russia San Marino Slovakia Slovenia Spain Sweden Switzerland The Netherlands Turkey Ukraine Yugoslavia Oceana American Samoa Australia Cook Islands Fiji Guam Nauru New Zealand Papua New Guinea Solomon Islands Tonga Vanuatu Western Samoa Table 4. Selected Accidental Poisonings Cigatoxin Clinical syndrome in persons who have eaten a type of fish associated with ciguatera fish poisoning (snapper, grouper). Incubation usually 2-8 hours, but may be as long as 48 hours. Gastrointestinal symptoms are followed by neurologic manifestations including paresthesia of lips, tongue, throat or extremities and reversal of hot and cold sensations. Puffer fish (tetrodotoxin) Incubation period 10 minutes to 3 hours, but usually less than an hour. Symptoms include paresthesia of lips, tongue, face or extremities often followed by numbness, loss of proprioception or floating sensation. Scombrotoxin Clinical syndrome in persons known to have eaten a fish previously associated with scombroid poisoning (eg Mahi-Mahi). Incubation period is 1 minute to 3 hours, usually less than 1 hour. Symptoms include flushing, headache, dizziness, burning of mouth and throat, upper and lower gastrointestinal symptoms, urticaria and generalized pruritus. Monosodium glutamate (MSG) History of eating foods with large amounts of MSG. Incubation period 3 minutes to 2 hours (usually less than 1 hour). Symptoms include burning sensation in chest, neck, abdomen or extremities; sensations of lightness and pressure over face or a heavy feeling in chest. Mushroom poisoning Incubation period is usually less than 24 hours. Symp- toms include upper and lower gastrointestinal symptoms. Depending on mushroom type also may include confusion, delirium, visual disturbances. Organophosphate poisoning Insecticides that include parathion, carbophenothion, malathion. Some of the compounds in this group are among the most toxic chemicals known, while others are minimally toxic when used appropriately. Incubation period few minutes to 8 hours. Symptoms include nausea, vomiting, abdominal cramps, diarrhea, excessive salivation, headache, blurred vision, weakness, chest pains, tearing, cyanosis, confusion, muscle twitching, convulsions, coma loss of reflexes. For questions or emergencies related to any ingestion or possible poisoning, or information related to rabies exposures call: The Georgia Poison Center (24-hours) In Atlanta (404) 616-9000 Toll free in Georgia (800) 282-5846 TDD (404) 616-9287 For incidents involving unusual circumstances (such as those involving possible international medicines and/or cultural remedies), Mercer University maintains a drug information database for doctors, available 8:00 am to 4:00 pm Monday through Friday. Mercer Drug Information Center (404) 986-3440 This report was contributed by Kathleen Toomey, Patrick Osewe, Tom McKinley and Mary Brantley, EPB, Ga DPH. - 3 - The Georgia Epidemiology Report Epidemiology and Prevention Branch Two Peachtree St., NW Atlanta, GA 30303-3186 May 1996 Volume 12 Number 5 Reported Cases of Selected Notifiable Diseases in Georgia Profile for February 1996 Selected Notifiable Diseases Campylobacteriosis Giardiasis H. influenzae B Meningococcal Disease Rubella Salmonellosis Shigellosis Viral Meningitis Tuberculosis Congenital Syphilis Early Syphilis Other Syphilis Cryptosporidiosis E. coli O157:H7 Legionnaires' Disease Lyme Disease Mumps Pertussis Total Reported forFebruary 1996 41 45 13 15 0 72 43 2 47 9 167 59 3 1 0 0 0 0 Previous 3 Months Total Ending inFebruary 1996 1995 1994 135 218 97 121 91 84 43 14 22 53 38 27 0 0 0 305 278 217 100 463 130 24 13 13 192 242 215 20 10 12 547 638 716 207 239 192 11 7 2 3 2 1 1 14 25 0 6 19 2 2 5 5 5 10 Previous 12 Months Total Ending inFebruary 1996 1995 1994 1009 1115 682 591 473 408 97 58 76 130 94 87 0 7 0 1709 1571 1270 1192 2012 537 101 79 160 764 763 793 62 52 92 2505 2578 3674 1069 854 962 113 23 9 30 27 15 10 102 49 14 108 63 9 16 19 28 33 55 The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office; and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia. AIDS Profile Update Report Period Total Cases Reported * Percent Female MSM Risk Group Distribution (%) Race Distribution (%) IDU MSM&IDU HS Blood Unknown White Black Other Last 12 Mos 05/95 to 04/96 5 Yrs Ago 05/90 to 04/91 Cumulative 01/80 to 04/96 2385 1307 15404 18.4 9.8 13.7 46.5 17.7 4.2 62.7 16.6 6.3 53.1 19 6 15.3 1.4 15 35.7 61 3.2 7.8 2.5 4.2 48.8 50 1.1 10.2 2.1 9.6 41.9 56.2 1.9 MSM - Men having sex with men IDU - Injection drug users * Case totals are accumulated by date of report to the Epidemiology Section HS - Heterosexual -4-