Georgia epidemiology report, Vol. 22, no. 02 (Feb. 2006)

February 2006

volume 22 number 02

Georgia Physicians and Disease Reporting

Georgia physicians, laboratories, and other health care providers are required by law to report the occurrence of certain diseases and conditions to public health. Health departments throughout the state use notifiable disease reports not only to monitor disease trends but also to initiate prevention and control measures locally. Georgia's notifiable disease reporting system links public health officials to clinicians, infection control professionals, and laboratorians who are often the first to become aware of public health threats. Disease reporting enables outbreak (epidemic) detection as well as characterization of the epidemiology of endemic diseases. Sometimes a single report is enough to warrant investigation. Thus, complete and timely reporting are vital to Georgia's surveillance of notifiable diseases.
To better understand how and when physicians report diseases, we conducted a survey on awareness of reporting requirements and reporting practices among physicians practicing in Georgia. We asked physicians to complete the anonymous survey while attending professional meetings sponsored by the Georgia Academy of Family Physicians, the Georgia Chapter of the American Association of Pediatrics, the Georgia Chapter of the American College of Emergency Physicians and the Medical Association of Georgia from June through October, 2005. We received 192 responses, which included 29 emergency physicians, 30 internists, 63 family physicians and 70 pediatricians. Two-thirds (66%) of physicians surveyed had reported diseases in the past.
The survey findings presented here are of particular interest to our integral partners in disease surveillance, Georgia's clinicians, infection control professionals, and laboratorians. The reader can compare his/her awareness of reporting requirements and reporting practices to those of survey respondents.
Did you know that the state health department has a list of notifiable
diseases? Almost all physicians (99%) did know about Georgia's list of notifiable diseases. A notifiable disease reporting poster, which can be downloaded at http://health.state.ga.us/pdfs/epi/notifiable/notifiableposter.05.pdf, includes the list of diseases and reporting requirements. You can also contact the Public Health Liaison in your district for this poster and additional notifiable disease reporting materials (see list of Health Districts and Liaisons below).
Did you know that some diseases require immediate reporting, within
24 hours? Many respondents (23%) did not know about the immediacy of reporting requirements for certain conditions, such as acute hepatitis A infection, meningitis, tuberculosis disease, and potential bioterrorism agents like botulism and Q fever. Diseases and conditions that require immediate intervention should be reported by telephone to your Health District or to 1-866PUB-HLTH. The notifiable disease reporting poster lists diseases and conditions for which reporting is required within 24 hours (or within 7 days). The poster also includes ways to report using a secure internet site (http:// sendss.state.ga.us), by mail, or by telephone.

Did you know that any cluster of illness is reportable? Respondents were frequently (59%) unaware that clusters of illness are reportable in Georgia. Suspected illness clusters should be reported immediately by phoning your Health District or 1-866-PUB-HLTH. An illness cluster is an unusual group of health events that occur with proximity in time and/or space or that occur within a demographic group. A cluster may signal a larger outbreak of disease.
Did you know that you can reach the health department anytime at
1-866-PUB-HLTH? Most respondents (85%) had not heard of Georgia's notifiable disease emergency reporting system. The telephone number 1-866-PUB-HLTH can be used to report public health emergencies, including suspected illness clusters and immediately notifiable diseases, 24 hours a day, 7 days a week. This reporting system is managed by the Georgia Poison Center and staffed by communications officers who will notify and/or put callers in contact with appropriate public health officials as needed.
When you do NOT report a notifiable disease to the health depart-
ment, what are the reasons why? The most common reason (55%) for not reporting the occurrence of a particular notifiable disease was the belief that other entities report (e.g., clinical or reference laboratories, infection control professionals). Physician respondents who indicated `others report' as a basis for not reporting frequently (64%) selected this rationale alone. Therefore, we encourage physicians who believe, but are not certain, that others are reporting on their behalf to verify periodically that timely case reports are indeed being submitted. We also emphasize that direct patient contact, particularly medical interview and clinical diagnosis, makes clinicians a unique and critical reporting source for many circumstances, especially in detecting clusters of illness.
Although not included as a survey topic, there have also been misconceptions about the implications of the Health Insurance Portability and Accountability Act (HIPAA) privacy rules for activities such as disease reporting, surveillance, and investigation, with some believing that HIPAA would restrict such activities. In fact, HIPAA contains an exception for public health activities, meaning covered entities must still fulfill their obligations under law, for example, to report notifiable diseases and provide patient information to public health in the context of an outbreak investigation. Fact sheets on HIPAA and many other resources for clinicians are available on the internet at http://health.state.ga.us/epi/ manuals/.
For support of the project, we thank Karen O'Connor, Norma De Santiago, and Eric Slora of the American Association of Pediatrics; Harry Keyserling and Michelle Tidwell of the Georgia Chapter of the American Association of Pediatrics; Susan Reichman of the Georgia Academy of Family Physicians; Tara Morrison of the Georgia Chapter of the American College of Emergency Physicians; and Bob Addleton of the Medical Association of Georgia. Tom Bombard, Susan Lance, and Colleen Spellen also provided key administrative support.

This article was written by Ben Silk, M.P.H., Jim Buehler, M.D., Ruth Berkelman, M.D., and Cherie Drenzek, D.V.M, M.S.
The Georgia Epidemiology Report Via E-Mail
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PUBLIC HEALTH LIAISONS IN GEORGIA'S HEALTH DISTRICTS (AS OF DECEMBER 2005)*

Athens Area (District 10) Julia Presuel Cell: 706-765-0041 Pager: 706-208-2645 Fax: 706-369-5877 jppresuel@gdph.state.ga.us
Augusta Area (District 6) Sarah Walker, MPH Office: 706-729-2192 Cell: 770-378-9652 Pager: 706-732-2369 Fax: 706-667-4792 sewalker6@gdph.state.ga.us

DeKalb County (District 3-5) Quyen Phan, RN, MSN Office: 404-294-3892 Cell: 678-449-5023 Fax: 404-294-3842 FAX qtphan@gdph.state.ga.us
Dublin Area (District 5-1) Jennifer Edwards Office: 478-275-6545 ext. 6559 Fax: 478-275-6575 jpedwards@gdph.state.ga.us

Macon Area (District 5-2) Christine A. Elder, MPH Office: 478-751-6036 Cell: 478-214-5754 Fax: 478-751-6074 caelder@gdph.state.ga.us
Rome Area (District 1-1) Scott Henson Jr. Office: 706-295-6790 Cell: 706-298-4323 Fax: 706-802- 5342 srhenson@gdph.state.ga.us

Clayton County (District 3-3) Beverly Lester Office: 770-960-9056 ext. 183 or 770-471-8635 Cell: 770-355-5899 or 678-794-1259 blester@gdph.state.ga.us

Fulton County (District 3-2) Jacqueline Evans, MA Office: 404-730-1009 Cell: 770-550-2275 Fax: 404-730-1283 jeevans@dhr.state.ga.us

Savannah Area / Coastal Health District (District 9-1) Annette Neu, RN BSN CIC Brunswick Office: 912-262-3092 Savannah Office: 912-644-5234 Cell: 912-266-3343 Fax: 912-261-1964 alneu@gdph.state.ga.us

Cobb and Douglas Counties (District 3-1) Kimberly D. King, MPH Office: 770-514-2331 Cell: 678-249-4084 Fax: 678-784-1075 kimking@gdph.state.ga.us

Gainesville Area (District 2-0) Donna Sue Campbell, LCSW Office: 770-535-6989 Fax: 770-535-5958 dscampbell@gdph.state.ga.us

Valdosta Area (District 8-1) Courtney D. Sheeley Office: 229-245-6436 Cell: 877-536-1359 Fax: 229-259-5003 cdsheeley@gdph.state.ga.us

Columbus Area (District 7) Johnny L. Miller Office: 706-321-6157 Cell: 404-473-4338 Pager: 888-517-8583 Fax: 706-321-6326 camiller6@gdph.state.ga.us

Gwinnett County (District 3-4) Alana Sulka, MPH Office: 678-442-6918 Cell: 678-300-0016 Fax: 770-339-5971 asulka@dhr.state.ga.us

Waycross Area (District 9-2) Shelby Lee Freeman, MPH Office: 912-764-0759 Fax: 912-871-1901 snlee@gdph.state.ga.us

* A listing of Georgia counties and corresponding Public Health Districts is at http://health.state.ga.us/regional/index.asp.

2005 Georgia Cancer Highlights,

CANCER
Cancer is the second leading cause od death in Georgia. However, 30 to 35 percent of

cancer deaths can be prevented by eating a healthy diet and being pyhsically active.

Cancer Incidence

From 1999-2002, an annual average of 32,574 cancer cases

were diagnosed in Georgia.

Breast, lung and bronchus, and colon and rectum cancers

account for 56% of all new cancer cases among females in

Georgia.

Breast cancer is the leading cause of cancer incidence among

females in Georgia.

Prostate, lung and bronchus, and colon and rectum cancers

account for 58% of all new cancer cases among males in

Georgia.

Prostate cancer is the leading cause of cancer incidence

among males in Georgia.

Leading causes of Death in Georgia, 1998 - 2002

Diabetes 2%
P neumonia and Inf luenza 3%

Hear t Dis eas e 28%

Lung and Br onchus 30%
Colon and Rectum 9%

The burden of cancer can be significantly reduced by appropriate use of mammography, colorectal screening, and other early detection examinations and by preventing or stopping tobacco use, improving diet, and increasing physical activity.
Who is at risk for developing cancer? Everyone. Since the occurrence of cancer increases as
individual's age, most cases affect adults who are middle-aged or older.
2005 Estimates: In 2005, at least 38,000 new cancer cases will be diagnosed
among Georgians: about 104 cases per day. More than 16,400 Georgians will die of cancer each year.
Age-adjusted Cancer Incidence Rates, All Sites, by County, Georgia, 1999-2002

Chr onic Res pir ator y Dis eas e 5%
Unintentional Injur y 5%
Str oke 7%

Cancer 21%

Br eas t 8%
P r os tate 6%
Other Cancer s 47%

Rate significantly higher than the state average
No significant difference from the state average
Rate significantly lower than the state average

Other 29%
Cancer is the second leading cause of death in Georgia. Nearly two-thirds of cancer deaths can be linked to modifi-
able risk factors such as tobacco use, diet, obesity, and lack of physical activity.
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Age-adjusted Cancer Incidence Rates, by Race and Sex, Georgia (19992002), and the United States (1998-2002)

Geo rg ia Unit ed Stat es

Rate per 100,000

70 0

663 642

600

50 0

400

300

200

10 0

0 M b lack

551 554 M white

362 385

402 423

Fb lack

F whit e

Males are 46% more likely to be diagnosed with cancer than females.
Black males in Georgia are 20% more likely to be diagnosed with cancer than white males.
White females are 11% more likely to be diagnosed with cancer than black females.

In the U.S, males have a 1 in 2 lifetime risk of developing cancer. Females have a 1 in 3 lifetime risk.
Age-adjusted Cancer Incidence Rates, Females, Georgia (1999-2002) vs United States (1998-2002)
B reas t
Lung and Bro nchus Co lo rect al
Ut erine Co rp us

Leading Causes of Cancer Incidence in Georgia

No n-Ho d g kin Ovary

Georgia United States

Age-adjusted Cancer Incidence Rates, Males, Georgia (1999-2002) vs United States (1998-2002)

M elano ma Ut erine Cervix

Pro s t at e

Lung and Bro nchus

Co lo rectal

Blad d er

M elano ma No n-Ho d g kin
Oral Cavity

Geo rg ia United St ates

Kid ney

Leukemias

P a nc re a s

0

50

10 0

15 0

200

The annual age-adjusted cancer incidence rate for males in Georgia is 570 per 100,000.
Prostate cancer is the leading cause of cancer incidence among Georgia males and accounts for 29% of all cancer incidence among males each year.
Prostate and lung and bronchus cancer incidence rates are higher among Georgia males than among U.S males.
Colorectal and bladder cancer incidence rates are lower among Georgia males than the U.S males.

Pancreas

Thyro id

0

50

10 0

15 0

200

The annual age-adjusted cancer incidence rate for females in Georgia is 391 per 100,000.
Breast cancer is the leading cause of cancer incidence among Georgia females and accounts for 32% of all new cancer cases among females each year.
Breast, lung and bronchus, lung, and uterine cancer incidence rates are lower among Georgia females than U.S females.

Estimated Costs In Georgia, annual cancer costs are approximately $4.6 bil-
lion: $1.7 billion for direct medical costs, $406 million for indirect morbidity costs, and $2.5 billion for indirect mortality costs.

Data source: GCCR (1999-2002) Date updated: December 2005 Publication number: DPH05.116H For more information on Cancer Data, please contact GCCR at (404) 463-8918 or visit http://health.state.ga.us/programs/gccr/ index.asp

Division of Public Health http://health.state.ga.us
Stuart T. Brown, M.D. Director
State Health Officer

Epidemiology Branch http://health.state.ga.us/epi
Susan Lance, D.V.M., Ph.D. Director
State Epidemiologist

Georgia Epidemiology Report
Editorial Board Carol A. Hoban, M.S., M.P.H. Editor
Kathryn E. Arnold, M.D. Cherie Drenzek, D.V.M., M.S. Susan Lance, D.V.M., Ph.D.
Stuart T. Brown, M.D. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer
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Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588
Fax: (404) 657-7517

Georgia Department of Human Resources
Division of Public Health

Please send comments to: Gaepinfo@dhr.state.ga.us

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

February 2006

Volume 22 Number 02

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for November 2005

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 November 2005
2005
38 2468
15 1 26 1023 4 3 6 5 0 2 0 3 0 152 83 1 4 4 21 0 48

Previous 3 Months Total

Ending in November

2003

2004 2005

114

152

130

8919

8246

7959

33

60

50

5

7

10

239

260

162

4406

4062

3812

20

17

16

350

61

24

163

108

25

9

6

13

0

0

1

7

5

2

1

2

0

5

8

10

0

0

0

722

608

731

217

167

295

34

24

9

123

106

45

156

72

27

233

216

126

0

1

0

128

121

138

Previous 12 Months Total

Ending in November

2003

2004

2005

633

589

596

36067

34354

32653

115

187

142

30

23

31

856

899

652

17855

16019

15361

76

118

107

779

340

124

611

473

188

35

41

37

10

12

6

33

20

18

3

2

1

32

31

50

0

1

0

2016

1965

1999

1314

662

663

128

121

98

456

480

403

745

412

273

891

831

796

11

6

2

520

525

525

* 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
Latest 12 Months: 02/05-01/06 Five Years Ago: 02/01-01/02 Cumulative: 07/81-01/06

Total Cases Reported* <13yrs >=13yrs Total

3

1,836 1,839

2

1,619 1,621

226

29,567 29,793

Percent Female

AIDS Profile Update
Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood Unknown

25.8

32.4

5.6

2.0

9.0

1.3

49.7

26.9

33.6

9.1

2.8

18.7

2.0

33.8

19.6

45.1

15.6

4.9

14.1

1.9

18.5

Race Distribution (%) White Black Other

24.4 73.6

2.0

18.6 77.1

4.3

31.7 65.8

2.5

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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