Georgia epidemiology report, Vol. 13, no. 6 (June 1997)

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

June 1997

Volume 13 Number 6
Yersinia enterocolitica Screening in Georgia Laboratories

http://www.ph.dhr.state.ga.us
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.-Chief
Notifiable Diseases
Jeffrey D. Berschling, M.P.H.; Karen R. Horvat, M.P.H. ; Amri B. Johnson, M.P.H.; Jane E. Koehler, D.V.M, M.P.H.; Katherine GibbsMcCombs, M.P.H.; Preeti Pathela, M.P.H.; Sabrina Walton, M.S.P.H.
Chronic Disease
Nancy E. Stroup, Ph.D.-Program Manager Patricia M. Fox, M.P.H.; A. Rana Bayakly, M.P.H.; Edward E. Pledger, M.P.A.
Tuberculosis
Naomi Bock, M.D., M.S.
HIV/AIDS/Sexually Transmitted Diseases
Kim Cook, M.D., M.S.P.H.-Program Manager Stephanie Bock, M.P.H.; Mary Lynn Gaffield, M.P.H.; Andrew Margolis, M.P.H.
Perinatal Epidemiology
Mary D. Brantley, M.P.H.; Paul C. Gangarosa, M.P.H.; Raymond E. Gangarosa, M.D., M.P.H.; Leslie E. Lipscomb, M.P.H.; Mary P. Mathis, Ph.D., M.P.H.
Preventive Medicine Resident
Hussain R. Yusuf, M.B.B.S., M.P.H.
EIS Officer
Michael S. Friedman, M.D.
Georgia Epidemiology Report Editorial Board
Editorial Executive Committee Paul A. Blake, M.D., M.P.H.- 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.

The epidemiology of Yersinia enterocolitica infections in the United States is poorly understood. Yersiniosis, characterized by a febrile diarrheal illness, primarily affects young children. Surveillance data show that cases typically peak during the winter months, and that many of these cases occur among African American children. An investigation conducted in the Atlanta area has shown a strong association between household preparation of chitterlings or "chitlins" (pork intestines) and Y. enterocolitica (YE) infection among infants. Chitterlings are a traditional food prepared in some Southern homes during the winter holiday season.
Methods
A telephone survey of laboratories throughout the state was conducted to determine the extent to which stools submitted for culture are screened for YE. All 217 licensed laboratories with bacteriology sections were contacted and asked if they accept stools for primary culture. Those that did were questioned about their policy regarding screening for Y. enterocolitica. Labs which sent their primary stool cultures to reference labs were asked for the name of the reference lab, and the reference lab was called to determine their procedures for YE testing.
Results
Of the 204 (94%) laboratories accepting stools for primary culture, 112 (55%) perform the stool cultures in-house and 92 (45%) send them to a reference lab. Of the 112 labs that perform stool cultures in-house, 72 (64%) screen for YE only under certain circumstances (e.g. a doctor's specific request); only 40 labs (36%) routinely screen all stools for YE. The 92 labs that sent specimens out for culture used a total of 30 reference labs; 19 (66%) of these reference labs did not screen for YE, and 11 (33%) routinely screened for YE.

Epidemiology Section, Epidemiology & Prevention Branch, Two Peachtree St., N.W., Atlanta, GA 30303-3186

Phone: (404) 657-2588

FAX: (404) 657-2586

We also examined variations in screening by geographic location, contrasting laboratories located in Macon or above with those located in the southern part of the state. Of the 82 laboratories located in north Georgia that perform stool cultures, only 33% included routine screening for YE compared with 43% for laboratories in south Georgia. More north Georgia laboratories screen only under special circumstances (67% versus 57%), while more laboratories in south Georgia (55% vs. 40%) refer specimens to reference laboratories. South Georgia laboratories were more likely to use a reference laboratory that screens routinely for YE (42% vs. 30%).
Conclusion
This brief survey indicates that most laboratories in Georgia are not screening for Y. enterocolitica infection. A total of 132 (65%) of labs statewide either do not culture stools routinely for YE or send them to a reference lab that does not routinely screen for YE. Only 32 (35%) labs sending stools to a reference lab

use one that routinely screens for YE. Failure to culture for YE probably allows many cases of YE to remain undetected, causing the burden of illness from this infection to be greatly underestimated.
Recommendation
The Division of Public Health encourages laboratories to add screening for Yersinia to their routine stool culturing protocol. Recent active surveillance activities nationwide have shown that YE infections are up to four times more common in Georgia than in other regions of the country. Use of cefsulodinirgasan-novobiocin (CIN) agar, which will selectively isolate YE, is likely to be cost effective in this area, especially during the winter holiday season when most cases occur. As more cases are discovered, the epidemiology of this emerging infection can be more clearly understood, aiding the development of effective preventive measures.
This report was contributed by Amri Johnson, Michael McNeil and Jane Koehler, Epidemiology and Prevention Branch; and Marsha Ray, Georgia State Public Health Laboratory.

Active Laboratory-based Surveillance for Invasive Neisseria meningitidis

Active laboratory-based surveillance for meningococcal disease began in the metropolitan Atlanta area in 1988 and was expanded to include the rest of Georgia in January 1997. Public health officials hope to identify all cases of invasive meningococcal disease that occur in Georgia. This effort is part of Georgia's Emerging Infections Program, a collaboration between the Division of Public Health and Emory University, supported by a grant from the Centers for Disease Control and Prevention.

coccal isolates from sterile sites to the State Public Health Laboratory for serogrouping. Because few laboratories perform serogrouping and many isolates were not sent to the State laboratory in previous years, the pre-1997 data on serogroups are sparse.
Figure 1. Reported Neisseria meningitidis Cases, GA, Jan 1, 1995 to May 31, 1997

Number of Cases

During the first 5 months of 1997, 57 cases of invasive Neisseria meningitidis infection were identified in Georgia. These cases reflect reports of cultures from sterile sites only--commonly blood and cerebrospinal fluid. In the first five months of 1995, there were 54 cases of meningococcal disease. During the same time period in 1996, there were 86 cases. (Figure 1.)
Through this active surveillance effort, laboratories statewide are encouraged to submit all meningo-

Months

- 2 -

For the first 5 months of 1997, there have been 3 serogroup B isolates, 11 serogroup C isolates, 32 serogroup Y isolates, 1 C/W135 and 1 A/Y isolate, as well as 9 isolates of unknown serogroup. Although a small proportion of these isolates of unknown serogroup were not "typable", most of them were never submitted for serogrouping. This year the proportion of isolates with serogroup information has increased.
Invasive Neisseria meningitidis cases have been seen sporadically throughout the state; no outbreaks have been identified this year. Serogroup Y has been isolated from specimens throughout the state, and is increasing in prevalence. A higher incidence of cases throughout the winter and spring months is the typical seasonal pattern of this infection. Serogroup C, most often associated with outbreaks, occurs sporadically in the northwest area of the state (Figure 2).

Cases per 100,000 persons

Figure 2. Rate of Meningococcal Disease by Health District, Georgia 1995 and 1996
Health District Unit
This report was contributed by Katherine McCombs and Jane Koehler, Epidemiology and Prevention Branch.

Mark your Calendars!
Third Annual Georgia Nurses' Tuberculosis Conference
Tuesday - Wednesday November 18-19, 1997 Holiday Inn Select, Decatur, GA
Keynote Speaker:
Patricia Simone, MD
Chief, Field Services Branch, Division of Tuberculosis Elimination National Center for HIV, STD, and TB Prevention Centers for Disease Control and Prevention Atlanta, GA
Sponsors American Lung Association of Georgia, Division of Infectious Diseases Emory University School of Medicine, Georgia Department of Human Resources Epidemiology and Prevention
Branch, Georgia Nurses' Association, Georgia Infection Control Network, and Emory AIDS Training Network
Contact hours will be offered Call for information
TB Conference Hotline (404) 727-2931
- 3 -

The Georgia Epidemiology Report Epidemiology and Prevention Branch Two Peachtree St., NW Atlanta, GA 30303-3186

June 1997

Volume 13 Number 6

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for March 1997

Selected Notifiable Diseases Campylobacteriosis

Total Reported for March
1997 34

Previous 3 Months Total

Ending in March

1995

1996

1997

190

161

110

Previous 12 Months Total

Ending in March

1995

1996

1997

799

1019

742

Chlamydia genital infection Cryptosporidiosis

1121 2

2595 0

3257 13

3189 8

2595 0

12113 13

13527 88

E. coli O157:H7

1

2

4

14

4

31

49

Giardiasis Gonorrhea Haemophilis influenzae (invasive)

62 1486
3

119 4875
18

161 5376
21

210 4408
17

336 4875
27

614 21949
40

869 18969
48

Hepatitis A (acute)

34

38

55

102

46

101

461

Hepatitis B (acute)

4

Blood Lead Level > 10 g/dL (cap)

183

Blood Lead Level > 10 g/dL (ven)

73

Legionellosis

0

Lyme Disease

0

Meningococcal Disease (invasive)

15

51

8

22

555

573

489

116

135

208

10

1

0

5

0

1

40

58

36

82

60

75

555

2973

2901

116

623

690

18

10

2

7

9

2

53

129

125

Mumps

0

3

1

2

3

9

10

Pertussis Rubella

2

6

6

7

14

30

36

0

0

0

0

0

0

0

Salmonellosis

74

214

261

233

1113

1708

1440

Shigellosis Syphilis - Primary Syphilis - Secondary

73

407

132

242

1622

1083

1235

16

53

55

49

189

294

185

30

151

156

101

493

642

447

Syphilis - Early Latent

129

503

348

313

1625

1525

1285

Syphilis - Other** Syphilis - Congenital

122

257

233

347

736

1139

1049

2

10

16

8

33

65

28

Tuberculosis

65

143

219

173

742

813

743

* 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.

** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

Report Period

Total Cases Reported *

AIDS Profile Update

Percent

Risk Group Distribution (%)

Race Distribution (%)

Female

MSM IDU MSM&IDU HS Blood Unknown White Black Other

Last 12 Mos 06/96 to 05/97 5 Yrs Ago 06/91 to 05/92 Cumulative 01/80 to 05/97

2159 1951 17837

21.0

39.2 17.9

4.7

14.7

52.6 23.0

7.8

14.7

51.7 19.1

6.0

16.5 1.4

20.3

10.3 1.6

4.7

11.2 2.0

10.0

28.0 69.5 2.5 39.3 59.0 1.7 40.2 57.8 2.0

MSM - Men having sex with men IDU - Injection drug users HS - Heterosexual * Case totals are accumulated by date of report to the Epidemiology Section

- 4-