July 2002 volume 18 number 07 Division of Public Health http://health.state.ga.us Kathleen E. Toomey, M.D., M.P.H. Director State Health Officer Epidemiology Branch http://health.state.ga.us/epi Paul A. Blake, M.D., M.P.H. Director State Epidemiologist Mel Ralston Public Health Advisor Georgia Epidemiology Report Editorial Board Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H. Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer Georgia Department of Human Resources Division of Public Health Epidemiology Branch Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-7517 Please send comments to: Gaepinfo@dhr.state.ga.us The Georgia Epidemiology Report is a publication of the Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources Notifiable Disease Reporting Introduction The Georgia Department of Human Resources, under the legal authority of OCGA 31-12-2 and with the approval of the Board of Human Resources, has designated certain diseases and conditions notifiable. The purpose of the reportable disease surveillance is to: 1. Identify in a timely way any diseases or conditions that may require immediate public health intervention and follow up (e.g., outbreak of E. coli 0157 infections); 2. Detect changing trends or patterns in disease occurrence (e.g., recent increase in shigellosis); 3. Identify areas or communities that require special public health response as a result of changes in disease patterns (e.g., "hot spots" for hepatitis A); and 4. Assess and evaluate control and prevention interventions (e.g., decrease in a disease after a vaccine is introduced). In Georgia, more than 60 diseases and conditions are under public health surveillance. The data are collected by local and state health agencies who are responsible for analyzing, interpreting and disseminating the information to "those who need to know" for administrative, program planning, and decision making purposes. All Georgia physicians, laboratories and other health care providers are required by law to report patients with the conditions listed on page 3 to their County Health Department or District Health Office. Cases may also be reported to the Notifiable Disease Section of the Epidemiology Branch of the State Division of Public Health. Both lab-confirmed and clinical diagnoses are reportable within the time interval specified. Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia. How to Report Cases may be reported electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us, by completing a Notifiable Disease Report Form and mailing in an envelope marked CONFIDENTIAL, or by calling your County Health Department or District Health Office. If your District Health Office cannot be reached, call the Georgia Division of Public Health at 404-657-2588, or after business hours at 770-578-4104. A statewide toll free reporting hotline is being established and will be available in the near future. To obtain Notifiable Disease Reporting cards or a copy of the latest laminated Disease Reporting poster, please contact the Notifiable Disease Section at 404-657-2588, or via email at Gaepinfo@dhr.state.ga.us. What to Report The disease or condition, patient's name (except for HIV), address, phone, and date of birth; physician's name and phone; name, institution and phone of person reporting; and pregnancy status. Please report unsual or unexplained cases and any cluster of cases immediately. This is our most important way of detecting diseases that require immediate public health action (e.g., bioterrorism agents). Influenza Surveillance Expands in Georgia Although influenza activity typically peaks during the winter months, influenza viruses circulate year-round and remain a threat to persons who are very young or old or who have chronic medical conditions. The emergence of a novel influenza strain capable of causing a pandemic is also a possibility, and surveillance improves public health's ability to rapidly identify new strains of influenza for possible inclusion in the influenza vaccine. For these reasons, Georgia is one of several states participating in a pilot program to conduct influenza surveillance throughout the year, rather than just during the winter months. Summer influenza surveillance is possible thanks to the continued efforts of several volunteer sentinel health-care providers throughout the state. You may learn more about flu surveillance at http://health.state.ga.us/epi/ flu, or call 404-657-2588 if you are a clinician interested in volunteering to assist in Georgia's influenza sentinel surveillance network. Summary of Trends in Number of Cases of Selected Diseases Reported, by Year, 1995-2001, and Five Year Mean/Median for 1997-2001 Disease AIDS - Diagnosed Aseptic Meningitis Campylobacteriosis Chlamydia genital infection Cryptosporidiosis Cyclosporiasis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Listeriosis (invasive) Lyme Disease Malaria Meningococcal Disease (invasive) Mumps Pertussis Rabies - Animal S. pneumoniae Invasive DRSP Salmonellosis Shigellosis Streptococcal Disease - Group A (invasive) Streptococcal Disease - Group B (invasive) Syphilis - Total* Tuberculosis Yersiniosis 1995 2193 100 1050 110 29 577 37 84 103 19 14 14 42 113 12 30 294 1674 1426 51 188 721 1996 2052 47 795 93 39 50 414 61 3 10 1 37 146 9 20 303 236 1462 1126 113 155 2479 779 1997 1581 55 769 74 46 41 765 224 6 26 9 57 107 11 18 323 255 1377 1206 80 165 2562 681 1998 1500 428 769 25243 152 85 1215 20700 69 879 213 8 32 5 43 102 2 38 310 324 1839 1137 91 259 2118 623 1999 1365 180 729 30788 165 10 42 1357 21476 80 482 232 5 30 32 72 4 52 247 556 1977 284 113 354 1900 662 52 2000 1259 205 607 29220 190 11 45 1201 19253 86 376 353 10 20 48 53 2 52 357 581 1688 339 150 363 1678 683 48 Five Year (1997-2001) 2001 Mean 1145 1370.0 272 228.0 640 702.8 32687 162 148.6 29 45 52.6 961 18349 109 77.0 930 686.4 435 291.4 12 8.2 16 24.8 7.0 49 45.8 57 78.2 9 5.6 23 36.6 402 327.8 435 430.2 1721 752 188 1720.4 743.6 124.4 408 309.8 1905 562 49 2032.6 642.2 Five Year (1997-2001) Median 1365 205 729 162 45 80 765 232 8 26 7 48 72 4 38 323 435 1721 752 113 354 1905 662 * Total includes Primary, Secondary, Early Latent, Other, Congenital The article was written by Carol A. Hoban, M.S., M.P.H. and Elizabeth Poole. Birth Defects Will Soon Be Reportable Conditions Statewide Birth defects are the leading causes of infant mortality and morbidity in the United States. In Georgia, few statewide data exist, making improvements in public health programs difficult. In response to this, birth defects were made reportable under State Laws Official Georgia Code Annotated (OGCA)31-12-2 and 31-3-3.2 which mandate the reporting of notifiable diseases, conditions and injuries, and newborn hearing screening, and Chapters 290-5-3-.02 and 290-5-24 of the Rules of Department of Human Resources, which regulate the reporting of notifiable diseases and metabolic disorders. To date, the authority granted by these laws and regulations with regard to birth defects has only been activated within the 5-county metropolitan Atlanta area. Mandatory reporting will be activated throughout the state in 2002. The following conditions will be reportable: congenital anomalies, Fetal Alcohol Syndrome, genetic and metabolic conditions and Cerebral Palsy. The Georgia Birth Defects Reporting and Information System (GBDRIS) is a passive surveillance system designed to provide information on incidence, prevalence, trends and epidemiology of birth defects. The GBDRIS collects information on children from birth to six years of age. The mission is to develop and maintain a birth defects reporting and information system for Georgia that supports the early and accurate identification of children with birth defects to facilitate prevention, planning and evaluation programs and to facilitate improved access to health care services. The system relies on existing data as well as hospital, laboratory and provider reporting through a web based system. Until system development has been completed, data from the following Department of Human Resources sources will be linked to provide information to the system: electronic birth certificates, fetal death certificates, death certificates, hospital discharge database, Medicaid data, Newborn Metabolic and Sickle Cell Screening Program, Newborn Hearing Screening Program and WIC data. Security procedures have been established to protect the privacy of all families, infants, physicians, and hospitals. All data within the GBDRIS are maintained in a secure environment. All identifying information is kept strictly confidential, and is published or presented only in a manner that ensures that no individual or institution can be identified. Counts of fewer than five cases a year will not be published. However, these cases will still be included in summary data. The system is maintained by the Maternal and Child Health Epidemiology Section of the Epidemiology Branch, Division of Public Health, Department of Human Resources (DHR). This article was written by Debra Helfrick, M.P.H -2 - -3 - The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186 PRESORTED STANDARD U.S. POSTAGE PAID ATLANTA, GA PERMIT NO. 4528 July 2002 Volume 18 Number 07 Reported Cases of Selected Notifiable Diseases in Georgia Profile* for February 2002 Selected Notifiable Diseases Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis Total Reported for Apr 2002 2002 35 2356 6 3 70 1319 5 43 14 2 0 5 2 0 0 79 79 3 16 17 8 0 20 Previous 3 Months Total Ending in April 2000 2001 2002 129 141 113 6883 7562 7926 42 27 22 3 4 7 272 211 168 4055 3999 4019 23 31 23 69 197 146 62 87 84 3 2 3 0 0 1 16 20 10 1 5 2 12 7 4 0 0 0 222 183 212 84 68 231 40 21 16 76 77 47 160 167 94 177 242 100 9 5 0 144 131 100 Previous 12 Months Total Ending in April 2000 2001 2002 646 631 612 28698 30616 33028 147 173 154 44 44 51 1369 1142 889 19912 19261 18400 87 94 100 376 545 866 255 401 416 9 10 12 0 0 1 70 55 42 6 7 4 61 38 20 0 1 0 1920 1672 1723 287 326 995 147 111 87 288 281 257 586 554 583 721 801 670 19 21 14 667 680 518 * 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. AIDS Profile Update Report Period Latest 12 Months: 06/01-05/02 Five Years Ago: 06/97-05/98 Cumulative: 07/81-05/02 Total Cases Reported* <13yrs >=13yrs Total 1 1839 1840 4 1435 1439 210 24856 25066 Percent Female 24.5 19.5 17.4 MSM 38.6 42.7 47.8 IDU 7.5 19.0 17.5 Risk Group Distribution (%) MSM&IDU HS Blood 2.5 13.6 2.1 5.1 18.0 1.2 5.5 13.4 1.9 Unknown 35.7 13.9 13.9 Race Distribution (%) White Black Other 19.4 75.9 4.7 22.9 74.5 2.6 34.3 63.3 2.4 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 -