Notifiable disease surveillance, Georgia, 1995-1996 / Epidemiology and Prevention Branch, Division of Public Health, Georgia Department of Human Resources

Table of Contents

I

~------------

INTRODUCTION

5

Purpose of Report

Source of Data

Interpretation of Data

Acknowledgments

OVERVIEW OF NOTIFIABLE DISEASES

6

Table 1 - Official List of Notifiable Diseases, Georgia, 1996

6

Revisions to the List of Notifiable Diseases

7

Listing of the District Health Offices

l0

Counties by Health District

11

State Map indicating Health Districts

12

Map - Georgia Immunization Levels

13

Table 2 - Number of Confirmed Cases of Notifiable Diseases Reported to

Georgia Division of Public Health, 1994-1996

14

AIDSIHIV

15

Figure - Reported AIDS Cases by Year of Report, 1984-1996

Figure - Reported AIDS Cases by Year of Diagnosis, 1984-1996

Botulism

18

Campylobacteriosis

19

Figure - Reported Cases ofCampylobacteriosis, 1987-1996

Figure - Rate of Campylobacteriosis, 1987-1996

Map - Rate ofCampylobacteriosis by County, 1995

Map - Rate of Campylobacteriosis by County, 1996

Chlamydia trachomatis, Genital Infections

23

Cholera

24

Cryptosporidiosis

25

Diphtheria

26

E. coli 0157:H7

27

Figure - Reported Cases of E. coli 0157:H7, 1993-1996

Giardiasis

29

Figure - Reported Cases of Giardiasis, 1993-1996

Map - Rate of Giardiasis by County, 1995

Map - Rate of Giardiasis by County, 1996

Gonorrhea

32

Haemophilus injluenzae, invasive

33

Figure - Reported Cases ofInvasive H injluenzae, 1987 - 1996

Figure - Rate of Reported Cases of Invasive H injluenzae, 1987 - 1996

Figure - Reported Cases by Age ofInvasive H injluenzae, 1995

Figure - Reported Cases by Age ofInvasive H injluenzae, 1996

Map - Rate of H injluenzae by County, 1995

Map - Rate of H injluenzae by County, 1996

Hantavirus Pulmonary Syndrome

38

1

' - - - - - - - - - - - - - Table of Contents (continued)

I

Viral Hepatitis

39

Hepatitis A

40

Figure - Reported Cases of Acute Hepatitis A, 1987-1996

Figure - Rate of Acute Hepatitis A, 1987-1996

Map - Rate of Acute Hepatitis A by County, 1995

Map - Rate of Acute Hepatitis A by County, 1996

Hepatitis B

43

Figure - Reported Cases of Acute Hepatitis B, 1987-1996

Figure - Rate of Acute Hepatitis B, 1987-1996

Figure - Reported Cases of Acute Hepatitis B by Age, 1995

Figure - Reported Cases of Acute Hepatitis B by Age, 1996

Map - Rate of Acute Hepatitis B by County, 1995

Map - Rate of Acute Hepatitis B by County, 1996

Hepatitis C/Non-A Non-B Hepatitis

.47

Figure - Reported Cases of Acute Hepatitis C/non-A non-B Hepatitis, 1987-1996

Figure - Rate of Acute Hepatitis C/non-A non-B Hepatitis, 1987-1996

Lead Poisoning

48

Figure - Number of Children Receiving Blood Lead Screening by Year

Figure - Confirmed Lead Poisoning Cases in Children, 1995 & 1996

Map - Confirmed Lead Poisoning Cases in Children by County, 1995-1996

Legionellosis

51

Figure - Reported Cases of Legionellosis, 1987-1996

Figure - Rate of Legionellosis, 1987-1996

Map - Rate of Legionellosis by County, 1995

Map - Rate of Legionellosis by County, 1996

Listeriosis

55

Lyme Disease

56

Figure - Reported Cases of Lyme Disease, 1987-1996

Map - Rate of Lyme Disease by County, 1995

Map - Rate of Lyme Disease by County, 1996

Lymphogranuloma Venereum Infection

60

Malaria

61

Figure - Reported Cases of Malaria, 1987-1996

Map - Rate of Malaria by County, 1995

Map - Rate of Malaria by County, 1996

Measles

65

Figure - Reported Cases of Measles, 1987 - 1996

Figure - Rate of Measles, 1987- 1996

2

_------ - - - - - - _......... Table of Contents (continued)

I

Meningococcal Disease

67

Figure - Reported Cases of Meningococcal Disease, 1987-1996

Figure - Rate of Meningococcal Disease, 1987-1996

Figure - Reported Cases of Meningococcal Disease by Age, 1995

Figure - Reported Cases of Meningococcal Disease by Age, 1996

Map - Rate of Meningococcal Disease by County, 1995

Map - Rate of Meningococcal Disease by County, 1996

Aseptic (Viral) Meningitis

71

Figure - Reported Cases of Viral Meningitis, 1987-1996

Figure - Rate of Viral Meningitis, 1987-1996

Mumps

73

Figure - Reported Cases of Mumps, 1987 - 1996

Figure - Rate of Mumps, 1987 - 1996

Pertussis

75

Figure - Reported Cases of Pertussis, 1987 - 1996

Figure - Rate of Pertussis, 1987 - 1996

Figure - Reported Cases of Pertussis by Age, 1995

Figure - Reported Cases of Pertussis by Age, 1996

Map - Rate of Pertussis by County, 1995

Map - Rate of Pertussis by County, 1996

Poliomyelitis

80

Rabies, Animal

81

Figure - Reported Cases of Animal Rabies, 1988-1996

Figure - Animal Rabies by Species, 1995-1996

Figure - Table of Animal Rabies by Species, 1993-1996

Map - Confirmed Animal Rabies by County, 1995

Map - Confirmed Animal Rabies by County, 1996

Rabies, Human

85

Rocky Mountain Spotted Fever

86

Figure - Reported Cases of Rocky Mountain Spotted Fever, 1987-1996

Map - Rocky Mountain Spotted Fever by County, 1995

Map - Rocky Mountain Spotted Fever by County, 1996

Rubella

90

Figure - Reported Cases of Rubella, 1987 - 1996

Salmonellosis

92

Figure - Reported Cases of Salmonellosis, 1987-1996

Figure - Rate of Salmonellosis, 1987-1996

Map - Rate of Salmonellosis by County, 1995

Map - Rate of Salmonellosis by County, 1996

3

- - - - - - - - - - - - - Table of Contents (continued)

I

Shigellosis

96

Figure - Reported Cases of Shigellosis, 1987-1996

Figure - Rate of Shigellosis, 1987-1996

Figure - Reported Cases of Shigellosis by Age, 1995

Figure - Reported Cases of Shigellosis by Age, 1996

Map - Rate of Shigellosis by County, 1995

Map - Rate of Shigellosis by County, 1996

Streptococcus pneumoniae, Drug-Resistant Invasive Disease

100

Syphilis

101

Figure - Reported Cases of Total Early Syphilis (TES), 1992-1996

Figure - Reported Cases ofTES by Age Group, 1995

Figure - Reported Cases of TES by Age Group, 1996

Adult Syphilis

103

Congenital Syphilis

:

106

Tetanus

108

Figure - Reported Cases of Tetanus, 1987 - 1996

Tuberculosis

109

Figure - Reported Cases of Tuberculosis, 1987-1996

MORBIDITY BY HEALTH DISTRICT/COUNTY, 1995

Rates (per 100,000 population) of Selected Notifiable Diseases by County

112

Number of Reported Cases of Selected Notifiable Diseases by County

121

MORBIDITY BY HEALTH DISTRICT/COUNTY, 1996

Rates (per 100,000 population) of Selected Notifiable Diseases by County

127

Number of Reported Cases of Selected Notifiable Diseases by County and District 136

4

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1

The Georgia Department of Human Resources, under the legal authority of OCGA 3112-2 and with the approval of the Board of Human R~sources, has designated certain diseases and conditions to be notifiable (Table 1). The purpose of notifiable disease reporting is to: 1) identify in a timely way any diseases or conditions that may require immediate public health intervention and follow-up; 2) monitor trends or patterns in disease occurrence; 3) identify areas or communities that require special public health response as a result of changes in disease patterns; and, 4) evaluate control and prevention interventions.
In Georgia, public health surveillance is conducted for more than 40 diseases and conditions. These 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.
Purpose of Report: The purpose of this report is to document information on reportable diseases in Georgia for health care providers, public health workers, and policy makers. This information is essential to determine the disease burden in Georgia, who is affected, and the public health actions needed to control and prevent disease.
Sources ofData: Cases of disease are reported to the Epidemiology and Prevention Branch in the Division of Public Health by county health departments, District health offices, hospitals, clinical laboratories, physicians, and public and private clinics. The reports are made by telephone, letter, fax or by mailing reporting forms provided by the Department. Population data used to calculate rates are based on population estimates generated by the Center for Health Information in the Division of Public Health.
Interpretation ofData: The information in this summary should be interpreted with caution because disease reporting is usually incomplete. Diseases that cause severe clinical illness and are associated with serious consequences (e.g., rabies, botulism) are probably reported more accurately than are diseases that are usually clinically mild and infrequently associated with serious consequences. (e.g., salmonellosis, mumps). The proportion of cases reported may also be influenced by the availability of diagnostic tests and testing facilities, provider compliance with reporting laws and the interests and priorities of state and local officials responsible for disease control and surveillance. Despite these limitations, the data in this report are useful in estimating the magnitude of the disease burden in Georgia and trends over time.
Acknowledgments: We would like to thank all physicians, nurses, laboratorians, and health department staff who actively contributed to our program and strongly encourage others to participate by reporting notifiable disease conditions.

This document is available on the web at: www.ph.dhr.state.ga.uslepVepistart.htm Also, please visit the Division of Public Health web site at: www.ph.dhr.state.ga.us

5

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Table 1: State of Georgia Official List of Notifiable Diseases, 1996

State Law OCGA 31-12-2: The department is empowered to declare certain diseases and injuries to be diseases requiring notice and to require the reporting thereof to the county board of health and the department in a manner and at such times as may be prescribed. The department shall require that such data be supplied as are deemed necessary and appropriate for the prevention of certain diseases and accidents as are determined by the department. All such reports and data shall be deemed confidential and shall not be open to inspection by the public; provided, however, the department may release such reports and data in statistical form or for valid research purposes.
All Georgia physicians, laboratories and other health care providers are required by law to report patients with the following conditions to their County Public Health Department or District Public Health office. Cases may also be reported to the Notifiable Disease Unit of the Epidemiology and Prevention Branch. Both lab-confirmed and clinical diagnoses are reportable within the time interval specified below. Reporting enables appropriate public health followup for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia. For the latest information from the Division of Public Health, visit our web site at www.ph.dhr.state.ga.us. To go directly to the Epidemiology and Prevention Branch page go to: www.ph.dhr.state.ga.us/epi/epistart.htm.

Immediately
any cluster of illnesses animal bites anthrax botulism cholera diphtheria E. coli 0157:H7 encephalitis (arboviral) *Haemophilus injluenzae (invasive) hepatitis A (acute) hantavirus hemolytic uremic syndrome measles (rubeola) meningitis (specify agent) *meningococcal disease (invasive) pertussis poliomyelitis rabies (human and animal) syphilis (congenital & adult) tuberculosis

Within 7 days

AIDS aseptic meningitis brucellosis campylobacteriosis cancer treated as an outpatient chancroid Chlamydia trachomatis (genital infection) cryptosporidiosis giardiasis gonorrhea tIDV hepatitis B & C (acute) ** HBsAg+ pregnant women ** newly identified HBsAg + carriers lead blood level> lOug/dl legionellosis leptospirosis *listeriosis (invasive)

lymphogranuloma venereum Lyme disease malaria mumps psittacosis Rocky Mountain spotted fever rubella (including congenital) salmonellosis shigellosis *streptococcal disease,
Group A or B (invasive) *Streptococcus pneumoniae,
drug resistant (invasive) tetanus toxic shock syndrome typhoid Vibrio infections

= * Invasive bacteria isolated from blood, bone, cerebral spinal fluid (CSF), joint, pericardial fluid,
peritoneal fluid, or pleural fluid.
t mv is reportable without personal identifiers
** Hepatitis B surface antigen positive
Infant mortality is reportable to Vital Records

Mail a completed form in an envelope marked CONFIDENTIAL to your County Public Health Department or District Public Health office OR to the Notifiable Disease Unit, Suite 6-325 (for AIDS, 6-407), 2 Peachtree St. NW, Atlanta, GA 30303-3142.

6

Revisions to the Official List of Notifiable Diseases
On January 1, 1996, the Official List of Notifiable Diseases was revised.
I. Diseases added to list:
Chancroid - Chancroid is an ulcerating sexually transmitted disease caused by infection with Haemophilus ducreyi.
Common in many countries worldwide, chancroid has been shown to be a significant cofactor for mv
transmission. Outbreaks of chancroid have been identified recently in many cities in the United States. Culture techniques to identify H. ducreyi have become more widely available, improving the diagnosis of chancroid in the United States. Reporting to public health, followed by timely sex-partner follow-up, will contain any
potential for outbreak of this bacterial STD associated with mv infection.
Chlamydia trachomatis, genital infection - C. traclwmatis genital infection is the most common bacterial STD in the United States. Previously only C. traclwmatis genital infection in females was a notifiable condition in Georgia. New developments in non-culture diagnostic techniques to identify chlamydial genital infections in men as well as women are now widely available, making the routine reporting of all chlamydia genital infection practical. Screening projects -- as well as a single dose treatment with azithromycin -- are part of a statewide effort to lower the high rates of this bacterial preventable STD. Reported statistical information will be crucial in order to focus disease prevention efforts; high rates of disease and costly complications justify the expansion of reporting to all cases.
Cholera - Cholera was formerly thought to have been eradicated from the United States. However, we now know that the organism is persisting in the Texas and Louisiana coastal environment. Cases of cholera occur periodically not only in those states, but wherever shellfish from those states is eaten. Georgia has had at least one such case. Furthermore, cholera invaded Latin America in 1991 for the first time in this century, and it has persisted there in endemic and epidemic form. The United States has had numerous imported cases of cholera, particularly in residents of Latin American origin (of which Georgia has a large and increasing number) who were infected when they visited their relatives in Latin America.
Cryptosporidiosis - This parasitic infection causes watery diarrhea and cramping abdominal pain. Outbreaks occur in child care centers, and waterborne outbreaks have occurred. Georgia has experienced 2 large waterborne outbreaks, including one associated with attendance at a large water park. Cryptosporidiosis was added to the National Notifiable Disease List (NNDL) by the Centers for Disease Control and Prevention (CDC) in conjunction with the Council of State and Territorial Epidemiologists (CSTE) in 1995.
Escherichia coli 0157:H7/HUS - E. coli 0157:H7, although not discovered until 1982, is now the third or fourth most common bacterial enteric pathogen. It causes severe bloody diarrhea for which there is no specific treatment, so prevention is critical. Commonly foodborne, E coli 0157:H7, is particularly associated with products of bovine origin, such as ground beef, but can easily spread person-to-person, as in child care facilities. Georgia has had an increasing number of cases detected and reported (15 in 1993,26 in 1994, and 29 in 1995), including an outbreak at a local restaurant chain. The infection was added to the NNDL in 1993. About 5-10% of persons with bloody diarrhea from E. coli 0157:H7 develop hemolytic uremic syndrome (HUS).
HUS is characterized by hemolytic anemia, kidney impairment, and low platelet count. Most cases of HUS in the U.S. are a consequence of E. coli 0157:H7 infections. HUS is a severe illness; almost all cases are hospitalized, and about half will require dialysis. The potential for prevention is high. HUS is a sentinel event which should provoke a search for E. coli 0157:H7 infections and public health intervention to prevent more, cases. HUS has been added to the NNDL.
Giardiasis - This is a protozoan infection which may cause a variety of intestinal symptoms. It can spread in child care centers and is the most common cause of waterborne disease outbreaks in the United States.
7

Revisions to the Official List of Notifiable Diseases
I: Diseases added to list: (cont'd)
Hantavirus - Hantavirus pulmonary syndrome (lIPS), commonly referred to as Hantavirus disease, is a recently recognized viral zoonosis characterized by a febrile prodrome, rapidly progressive respiratory insufficiency, and high mortality. Although the disease is identified most frequently in the Southwest of the U.S., cases have been identified in North Carolina, Horida, Virginia, Wisconsin and Louisiana. This newly identified disease is incompletely understood, and is probably not diagnosed correctly in many instances, particularly in areas where it has not been identified previously. It is on the NNDL.
Listeriosis, invasive - Listeriosis is a foodborne bacterial disease usually manifested as meningoencephalitis and/or septicemia. Pregnant women, neonates, elderly persons, and immunosuppressed persons are at greatest risk. The fatality rate for newborn infants is 30%. A number of common-source outbreaks have been traced to specific foods, so it is important to rapidly identify and investigate clusters of listeriosis to identify and control the source of infection.
Lymphogranuloma venereum (LGV) - LGV is an ulcerating sexually transmitted disease that is rare in the United States, but common in some parts of the world. Prevention of LGV in nonendemic areas like the U.S. is predicated on identification and treatment of sexual contacts of proved or suspected cases. Reporting is recommended for public health to ensure adequate treatment and partner follow-up to prevent the severe sequelae.
Meningitis (specify agent) - Meningitis is an important public health problem that often requires public health intervention. Meningococcal meningitis, pneumococcal meningitis, and Haemophilus influenzae meningitis have different implications for control and prevention efforts, so it is important to determine the etiologic agent.
Streptococcal disease, invasive, Group A - Severe group A streptococcal (GAS) infections have emerged as a public health problem since the mid-1980s. Recent changes in the U.S. have included outbreaks of rheumatic fever, the emergence of a streptococcal toxic shock syndrome, and an increase in the rate of invasive disease. These changes have also been noted in other countries, suggesting that there is a worldwide shift in the pattern of GAS disease. Surveillance will facilitate identification of clusters leading to investigation and preventive intervention; determine the rate and severity of invasive GAS disease locally and statewide to provide guidance for physicians; and monitor trends. GAS disease is on the NNDL.
Streptococcus pneumoniae, invasive drug-resistant (DRSP) - Streptococcus pneumoniae is the most frequent cause of bacterial pneumonia in persons of all ages, the most common cause of bacteremia and acute otitis media in children, and a leading cause of meningitis in the United States. Reports of DRSP have been increasing in the United States since the 1980s. The prevalence of drug-resistant strains varies widely from one community to another. Surveillance is needed to define and monitor the prevalence and geographic distribution of DRSP and rapidly recognize the emergence of new patterns of resistance. It was added to the NNDL in 1995.
8

Revisions to the Official List of Notifiable Diseases
II. Diseases removed from list: Amebiasis - This disease no longer causes significant morbidity and mortality in Georgia, and the few reports
that are made do not result in public health action. In 1995 the Council of State and Territorial Epidemiologists (CSTE) deleted it from the Nationally Notifiable Diseases List (NNDL). Guillain-Barre Syndrome - This syndrome was of great interest when it was suspected and then proved to be a complication of the swine flu vaccine. Now, however, cases are of little public health interest, and it is not on theNNDL. Histoplasmosis - Most infections are asymptomatic, and diagnosis of individual mild cases is difficult. A few outbreaks occur in association with exposure to bird or bat droppings, or to recently disturbed soil, but clusters of any disease should be reported whether or not the disease is notifiable. Hepatitis, unspecified - The laboratory diagnosis of hepatitis has now progressed to a level that permits specific diagnosis of most cases of hepatitis. Herpes, Type II - Herpes simplex virus, type 2 usually produces genital herpes. No curative antiviral therapy is available currently, and public health intervention is not carried out for cases or sex partners. Diagnosis is often made on clinical grounds, rather than using laboratory tests, although many cases are asymptomatic or only mildly symptomatic. This infection is not on the NNDL. Infant Mortality (including SillS) - Reporting of infant mortality through routine surveillance has proved to be less complete and less useful than the use of other sources of data on infant mortality. It has been of no practical value, and the data are not currently used. Reye's Syndrome - This syndrome, involving the central nervous system and liver, is a rare complication in children who have ingested salicylates and had influenza; it has also followed varicella. It was of particular interest when the association with salicylate ingestion was suspected, but that issue has been resolved. Reye's Syndrome is not on the NNDL. Silicosis - The epidemiology of silicosis has not been of practical value in understanding or controlling the disease in recent decades. It is not on the NNDL. Toxoplasmosis - Most infections are asymptomatic, but persons who are immunosuppressed are highly susceptible. Infection during pregnancy can lead to infection of and damage to the fetus. Measures necessary to control the disease are well understood, and reporting of the disease is of minimal usefulness in disease control. Reporting is not generally required in other states, and it is not on the NNDL. Tularemia - Reporting is considered useful only in selected endemic areas. It was deleted from the NNDL in 1995.
9

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Rome District District 1, Unit 1
Nw Georgia Regional Hospital
Bldg. 614
1305 Redmond Circle
Rome, GA 30165 Phone (706) 295-6656 FAX (706) 295-6015

Dalton District District 1, Unit 2 100 West Walnut Ave. Suite 92 Dalton, GA 30720 Phone (706) 272-2342 FAX (706) 272-2221

Gainesville District District 2 1131 Vine Street P. O. Box 1295 Gainesville, GA 30501 Phone (770) 535-5743 FAX (770) 535-5958

Marietta District District 3, Unit 1 1650 County Farm Road Room 249 Marietta, GA 30060 Phone (770) 514-2468 FAX (770) 514-2320 Lawrenceville District District 3, Unit 4 Office of Infectious Diseases P.O. Box 897 Lawrenceville, GA 30046 Phone (770) 339-4260 FAX (770) 339-4265
Dublin District District 5, Unit 1 2121-B Bellevue Road Dublin, GA 31021 Phone (912) 275-6568 FAX (912) 275-6575

Fulton District District 3, Unit 2 99 Butler Street SE Atlanta, GA 30303 Phone (404) 730-1391 FAX (404) 730-1499
Dekalb District District 3, Unit 5 445Winn Way Decatur, GA 30030 Phone (404) 508-7851 FAX (404) 294-3883
Macon District District 5, Unit 2 811 Hemlock Street ATIN: Epidemiology Macon, GA 31201-2198 Phone (912) 751-6214 FAX (912) 751-6099

Clayton District District 3, Unit 3 Administrative Office 675 Forest Pkwy. Forest Park, GA 30050 Phone (404) 363-6780 FAX (404) 366-2271 LaGrange District District 4 122 Gordon Commercial Drive Suite A LaGrange, GA 30240 Phone (706) 845-4035 FAX (706) 845-4038
Augusta District District 6 1916 North Leg Rd. Augusta, GA 30909 Phone (706) 667-4296 FAX (706) 667-4365

Columbus District District 7 District Clinical Services Box 2299 2100 Comer Ave. Columbus, GA 31902-2299 Phone (706) 321-6411 FAX (706) 321-6409
Savannah District District 9, Unit 1 2011 Eisenhower Dr P.O. Box 14257 Savannah, GA 31416-1257 Phone (912) 353-3125 FAX (912) 353-5195

Valdosta District District 8, Unit 1 312 North Patterson Street Valdosta, GA 31601 Phone (912) 333-5290 FAX (912) 333-7822
Waycross District District 9, Unit 2 1101 Church Street Waycross, GA 31501 Phone (912) 285-6002 FAX (912) 285-6004

Albany District District 8, Unit 2 1109 N. Jackson St. Albany, GA 31701-2022 Phone (912) 430-5138 FAX (912) 430-2920
Brunswick District District 9, Unit 3 1716 Ellis St. Brunswick, GA 31520 Phone (912) 264-3236 FAX (912) 262-1721

Athens District District 10 468 N. Milledge Ave. Athens, GA 30601 Phone (706) 542-9027 FAX (706) 542-9663

Notifiable Disease Unit Epidemiology and Prevention Branch Division of Public Health 2 Peachtree Street, N.W. Suite 6-325 Atlanta, GA 30303-3168 Phone (404) 657-2588 FAX (404) 657-2586

10

Counties by Health District

I

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County
APPLING ATKINSON BACON BAKER BALDWIN BANKS BARROW BARTOW BEN HILL BERRIEN BIBB BLECKLEY BRANTLEY BROOKS BRYAN BULLOCH BURKE BUTTS CALHOUN CAMDEN CANDLER CARROLL CATOOSA CHARLTON CHATHAM CHATTAHOOCHEE CHATTOOGA CHEROKEE CLARKE CLAY CLAYTON CUNCH COBB COFFEE COLQUITT COLUMBIA COOK COWETA CRAWFORD CRISP DADE DAWSON DECATUR DEKALB DODGE DOOLY DOUGHERTY DOUGLAS EARLY ECHOLS EFFINGHAM ELBERT EMANUEL

District 9-2 9-2 9-2 8-2 5-2 2-0 10-0 1-1 8-1 8-1 5-2 5-1 9-2 8-1 9-3 9-2
6-0
4-0 8-2 9-3 9-2 4-0 1-1 9-2 9-1 7-0 1-1 1-2 10-0 7-0 3-3 9-2 3-1 9-2 8-2
6-0
8-1
4-Q
5-2 7-0 1-1 2-0 8-2 3-5 5-1 7-0 8-2 3-1 8-2 8-1 9-1 10-0
6-0

County
EVANS FANNIN FAYETTE FLOYD FORSYTH FRANKLIN FULTON GILMER GLASCOCK GLYNN GORDON GRADY GREENE GWINNETI HABERSHAM HALL HANCOCK HARALSON HARRIS HART HEARD HENRY HOUSTON IRWIN JACKSON JASPER JEFF DAVIS JEFFERSON JENKINS JOHNSON JONES LAMAR LANIER LAURENS LEE LIBERTY LINCOLN LONG LOWNDES LUMPKIN MACON, MADISON MARION MCDUFFIE MCINTOSH MERIWETHER MILLER MITCHELL MONROE MONTGOMERY MORGAN MURRAY MUSCOGEE

District 9-2 1-2 4-0 1-1 2-0 2-0 3-2 1-2 6-0 93 1-1 8-2 10-0 3-4 20 2-0 5-2 1-1 7-0 2-0 4-0 4-0 5-2 8-1 10-0 52 92 6-0 6-0 5-1 5-2 4-0 8-1 5-1 8-2 9-3 6-0 93 8-1 2-0 7-0 10-0 7-0 6-0 9-3 4-0 82 8-2 5-2 5-1 10-0 12 70

County
NEWTON OCONEE OGLETHORPE PAULDING PEACH PICKENS PIERCE PIKE POLK PULASKI PUTNAM QUITMAN RABUN RANDOLPH RICHMOND ROCKDALE SCHLEY SCREVEN SEMINOLE SPALDING STEPHENS STEWART SUMTER TALBOT TALIAFERRO TATTNALL TAYLOR TELFAIR TERRELL THOMAS TIFT TOOMBS TOWNS TREUTLEN TROUP TURNER TWIGGS UNION UPSON WALKER WALTON WARE WARREN WASHINGTON WAYNE WEBSTER WHEELER WHITE WHITFIELD WILCOX WILKES WILKINSON WORTH

District 3-4 10-0 10-0 11 5-2 1-2 9-2 4-0 1-1 5-1 5-2 7-0 2-0 7-0
6-0
3-4 7-0 6-0 82 4-0 2-0 7-0 7-0 7-0
6-Q
9-2 7-0 5-1 8-2 82 8-1 9-2 2-0 51 4-0 8-1 5-2 2-0 4-0 1-1 10-0 9-2 6-0 5-2 9-2 7-0 5-1 2-0 1-2 51 6-0 5-2 8-2

11

STATE OF GEORGIA HEALTH DISTRICTS AND COUNTIES
12

Adequate Immunization Levels Public Health Clinics, Children 21 to 23 months of age
Georgia, 1996
Percent Adequate
D 89.5% to 100%
79.50/0 to 89.40/0
l1li 69.5% to 79.4%
59.5% to 69.4%
.....
w
This information is obtained from immunization records in county health departments and may not reflect the population-based immunization rate

Overview of Notifiable Diseases

Table 2: Number of Confirmed Cases of Notifiable Diseases Reported to Georgia . Division of Public Health by year, 1994-1996

Disease
AIDS Vaccine - Preventabe Diseases
Diphtheria Haemophilus influenzae, invasive Measles MUIq>s Pertussis Poliomyelitis Rubella Tetanus
Hepatitis

1994
2380
a
. 67 5 18 37
a
7 1

-1996

2271

2424

a

a

37

52

4

4

11

9

30

35

a

a

a

a

1

a

Hepatitis A Hepatitis B Hepatitis C
Meningitis

43

84

414

555

103

61

220

25

a

Meningococcal Disease
Aseptic Meningitis
Enteric Diseases

82

106

148

80

100

40

Carq>ylobacterios is Sahmnellosis Shigellosis Giardiasis E. coli 0157:H7
TlCkbome Diseases

1080

1049

793

1584

1661

1467

1887

1358

1125

463

572

820

26

29

39

LyIm Disease
Rocky Mountain Spotted Fever
Sexually Transmitted Diseases

127

14

1

62

59

65

Adult Syphilis (all stages) Adult Early Syphilis Congenital Syphilis Chlamydia trachormtis

3558

3752

2955

2695

2593

1986

54

57

35

n/a

1145

13584

Gonnorrhea
Tuberculosis Other Reportabe Diseases
Botulism Brucellosis Encephalitis (arboviral) Elevated blood Lead Legionnaires' Disease Malaria Psittacosis Rabies/Anirml

n/a

21449

19919

740

746

790

a

a

a

3

1

a

2

3

a

n/a

604

774

118

19

3

43

41

38

a

5

a

367

294

303

Qoup B Streptococcal Disease, invasive, Drug resistant

211

236

150

Typhoid

2

5

2

14

_ _ _ _ _ _ AIDS _ _ _ _..-1,
Clinical description: Infection with HIV results in a chronic infection that over time results in a broad spectrum of diseases. AIDS represents the most severe or late end of the clinical spectrum. The manifestations of HIV infection include generalized lymphadenopathy, oral candidiasis, recurrent diarrhea, wasting, central nervous system manifestations, recurrent bacterial infections, specified malignancies and a variety of opportunistic infections (Pneumocystis carinii pneumonia, disseminated toxoplasma infection, etc.).
Clinical case definition: Adults and children over 18 months ofage: Positive EIA test followed by a confirmatory Western blot positive test. Infants less than 18 months ofage: Because of the presence of maternal antibodies in all infants of HIV positive mothers at birth and because only about a quarter of such infants are truly infected, diagnosis by the routine adult criteria is only reliable after the infant has passed 18 months of age. Tests that detect the actual presence of the virus such as viral culture or the newly developed PCR test are available at HIV/AIDS referral centers and can detect true HIV infection in the first 6 months of life.
Surveillance case classification: The Centers for Disease Control and Prevention (CDC) has established the AIDS surveillance case definitions and extensively modified them over time. The latest definition went into effect in January 1993. This definition defines a case as anyone who has a confirmed HIV test and a CD4 cell count less than 200. In addition, anyone having any of the clinical diagnoses included in this and previous case definitions are considered cases. Further details can be obtained from the HIV/STD Epidemiology Unit.
15

- - - - - - AIDS- - - - -I
Current epidemiologic status of AIDS in Georgia: Georgia, the tenth most populated state in the United States, ranks eighth in both cumulative AIDS cases and in reported case rates per 100,000 population. As of 1995, a total of 14,481 AIDS cases were reported in Georgia since reporting began in 1980; of these 8,225 (57%) have died. The majority of cases were reported from the 8-county metropolitan area of Atlanta, but the proportion of AIDS cases reported to be living outside of the Atlanta area in smaller towns and rural areas is increasing. While a decline in the proportion of AIDS cases among men who have sex with men has occurred from 57% in 1990 to 41 % in 1995; increases are reported among inj ecting drug users and heterosexuals. As heterosexual transmission of HIV in Georgia has increased, the ratio of male to female AIDS cases has predictively declined from 26: 1 in 1984 to 4:1 in 1995. African-Americans, who make up only 29% of Georgia's population, continue to be disproportionately affected by the AIDS epidemic and accounted for 66% of cases diagnosed in 1995. For more information on AIDS in Georgia, contact the HIV/STD Epidemiology Unit for the Annual HIV/AIDS Report.
Reported AIDS Cases by Year of Report Georgia, 1984 - 1996
3500 ,----~~~~--~~-~~~~~~~~~-- 3000 .1993 Defmition
"'0
~o 2500 IllI Pre - 1993 Defmition
0..
& 2000 +---'=============='--~~---
1500 +--~-~~--~~-~-
84 85 86 87 88 89 90 91 92 93 94 95 96 Year
Georgia anticipated the addition of severe immunosuppression to the AIDS case definition, and began having these cases reported in late 1991. However, these cases were not officially added to the Georgia case count until 1993.
16

- - - - - - -~D-S - - - - _.....I
Reported AIDS Cases by Year of Diagnosis Georgia, 1984 -1996
3500,------------------------3000 + - - - - - - - - - - - - - - - - - - - - - - - 2500 1993 Definition 2000 .. Pre - 1993 Definition 1500 + - - - - - - - - - - - -
1~~~ t .., o _~+II+ + ..+..-...1..1
84 85 86 87 88 89 90 91 92 93 94 95 96 Year
If cases are distributed by year of diagnosis, many cases diagnosed in 1994 and 1995 will not be reported until 1996 or later.
17

_ _ _ _ _ Bo_ tulis_ m _ _ _ _1
Clinical description: Ingestion of botulinal toxin can result in an illness of variable severity. Common symptoms include diplopia, blurred vision, and bulbar weakness. Symmetric descending paralysis may progress rapidly. Laboratory criteria for diagnosis:
Detection of botulinal toxin in serum, stool, or patient's food, or Isolation of Clostridium botulinum from stool Surveillance case classification: Confirmed: A clinically compatible illness that is laboratory confirmed or that
occurs among persons who ate the same food as persons with laboratory confirmed botulism
Botulism occurs worldwide; sporadic cases and outbreaks occur where food products are prepared or preserved by methods that do not destroy spores of C. botulinum and permit toxin formation. In October of 1993, the Satilla Regional Medical Center in Waycross, Georgia notified the Ware County Board of Health and the Division of Public Health of four possible cases of botulism. All patients developed symptoms within a few days after eating from a restaurant. A subsequent epidemiologic investigation identified eight confirmed cases and implicated the cheese sauce component of the barbecued stuffed potatoes as the source of type A botulinal toxin. The process by which the cheese sauce was contaminated was unclear.
18

~ - - - -C-a- m p-y l- o b- a c-t e r i o s i s

I~

Clinical description: Infection that may result in diarrheal illness of variable severity; invasive disease may occur in immunocompromised persons.

Laboratory criteria for diagnosis: Isolation of Campylobacter jejuni, C. coli or C. fetus from any clinical specimen

Surveillance case classification: Probable: A clinically compatible illness that is epidemiologically linked to a
conftrmed case Conftrmed: A case that is laboratory conftrmed

2000
.'", 1500
e..'.".
.0.,. 1000
~
Z=' 500

Reported Cases of Campylobacteriosis Georgia, 1987 1996
1402 1445 1382

0

87

88

89

90

91

92

93

94

95

96

Year

Rate 0 f Cam py10 ba c te rio s is Ge 0 rg ia, 19 87 . 1996
25

20
<:> <:> <:>
o 15
-<:> ~ ~ 10
~
<':>":: 5

0

87

88

89

90

91

92

93

94

95

96

Year

19

Campylobacteriosis
Campylobacter was not known to be a common cause of diarrheal disease in humans until 1977, when a practical method for isolating the organism from stool was described. The fIrst confIrmed human cases in Georgia were detected in 1977, and in 1981 a cluster of cases in Atlanta was associated with drinking commercially distributed raw milk. Subsequently, Campylobacter infections in students at the University of Georgia were associated with eating chicken and contact with a cat. Following the introduction and rapid expansion of laboratory testing specifIc for the disease, the number of reported cases of campylobacteriosis grew rapidly over time. However, during the last few years, interest in reporting the disease has declined since the illness is usually mild and often improves without treatment. No simple, reliable subtyping system exists for Campylobacter as there is for Salmonella. The number of cases reported in Georgia reached its peak in 1989.
20

Rate of Campylobacteriosis by County

Georgia, 1995

Rates per 100,000

65.00 to 84.00

50.00 to 64.99

35.00 to 49.99
~



0.01 to 34.99

D 0.00

I..V..

Rate of Campylobacteriosis by County Georgia, 1996
Rates per 100,000
15.67 to 50.67 11.01 to 15.66
7.46 to 11.00 0.01 to 7.45
D~ 0.00
IV IV

ChlsnJydis IrschonJsliS/Genital Infections
Clinical description: Infection with sexually transmitted Chlamydia trachomatis may result in urethritis, epididymitis, cervicitis and acute salpingitis, but is often asymptomatic in women and men. Perinatal infections may result in inclusion conjunctivitis and pneumonia among newborns. Laboratory criteria for diagnosis: Isolation of C. trachomatis by culture, or Demonstration of C. trachomatis in a clinical specimen by detection of antigen or
nucleic acids Surveillance case classification: Presumptive: Non-gonococcal urethritis in a male, or N. gonorrhea culture negative
urethritis in a male Confirmed: A case that is laboratory confirmed
23

- - - - - - - - - Cholera - - - - - ,
Clinical description: An illness characterized by diarrhea and/or vomiting with variable severity. Laboratory criteria for diagnosis: Isolation of toxigenic (i.e., cholera toxin-producing) Vibrio cholerae 01 or 0139 from stool
or vomitus, or Significant increase in vibriocidal or antitoxic antibodies between acute- and early
convalescent-phase sera, or Significant decrease in vibriocidal antibodies between early and late convalescent-phase
sera among persons not recently vaccinated Surveillance case classification: Confirmed: A clinically compatible illness that is laboratory confirmed Comment: When other cases are known to be occurring, a less than fourfold increase in titer between acuteand convalescent-phase serum may be considered significant. Likewise, a less than fourfold decrease in titer between early and late convalescent-phase sera may be important in these circumstances. Illnesses caused by strains of V. cholerae other than toxigenic V. cholerae 01 or 0139 should not be reported as cases of cholera but as cases Vibrio infections. The etiologic agent of a case of cholera should be reported as either V. cholerae 01 or V. cholerae 0139.
24

- - - - - - - _..... Cryptosporidiosis

I

Clinical description: An illness caused by the protozoan Cryptosporidium parvum and characterized by diarrhea, abdominal cramps, loss of appetite, low-grade 'fever, nausea, and vomiting. Infected persons may be asymptomatic. The disease can be prolonged and lifethreatening in severely immunocompromised persons.
Laboratory criteria for diagnosis: Demonstration of Cryptosporidium oocysts in stool, or Demonstration of Cryptosporidium in intestinal fluid or small bowel biopsy
specimens, or Demonstration of Cryptosporidium antigen in stool by a specific immunodiagnostic
test such as enzyme-linked immunosorbent assay (ELISA)
Surveillance case classification: Confirmed, symptomatic: A laboratory-confirmed case associated with one or more of the symptoms described in the clinical description
Confirmed, asymptomatic: A laboratory-confrrmed case not associated with any of the clinical symptoms

25

Diphtheria
Clinical description: An upper respiratory tract illness characterized by sore throat, low grade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose without other apparent cause (as reported by a health professional). Laboratory criteria for diagnosis:
Isolation of Corynebacterium diphtheriae from a clinical specimen Surveillance case classification: Probable: Meets the clinical case definition, is not laboratory confirmed, and is
not epidemiologically linked to a laboratory confirmed case Confirmed: Meets the clinical case definition and is either laboratory confirmed
or epidemiologically linked to a laboratory confirmed case No cases of diphtheria were reported in Georgia in 1995 and 1996.
26

_ _ _ _ _ _ _ _ __._C_O_I._i_O_1_5_7_:_H_7

....~

Clinical description: An infection of variable severity characterized by diarrhea, often bloody, and abdominal cramps. Illness may be complicated by hemolytic uremic syndrome (HUS) or thrombocytopenic purpura (TPP). Asymptomatic infections can occur.

Laboratory criteria for diagnosis: Isolation of E. coli 0157:H7 from a clinical specimen, or Isolation of shiga-like toxin-producing E. coli 0157NM from a clinical specimen (strains of E. coli that have lost the flagella "H" antigen become nonmotile and are designated "NM")

Surveillance case classification:

Suspect:

A case of post-diarrheal HUS or TPP (see HUS case definition)

Probable:

(a) Isolation of E. coli 0157 from a clinical specimen, pending confirmation of Shiga-like toxin or

(b) Bloody diarrhea, HUS or TPP that is epidemiologically linked to a confirmed or probable case

Confirmed: A case that is laboratory confirmed

Reported Cases of E. coli 0157:H7

Georgia, 1993 . 1996

39

40

en 30
OJ
en
o:s U

'0

20

......

OJ

.0

S
::l

10

Z

0

93

94

95

96

Year

27

~----E. - col- i 01- 57:- H7 ----, ~
This category of diarrheagenic E. coli was recognized in 1982 when a multi-state epidemic of hemorrhagic colitis occurred in the United States and was shown to be due to the specific E. coli serotype, 0157:H7. The disease can also be the cause of hemolytic uremic syndrome. Cattle are believed to be the reservoir, although humans may also serve as a reservoir for transmission within custodial institutions or families. Transmission usually occurs through consumption of contaminated food, most often poorly cooked beef(especially ground beet) and raw milk. Sustained outbreaks in custodial institutions have been observed, suggesting that transmission by direct contact occurs in high-risk populations. In Georgia, surveillance for E. .coli began in 1993. The increase in the number of cases in 1994, compared to the previous year, may be due to increased laboratory testing for E. coli as awareness of the disease increases among health care professionals. During 1995, Georgia had its first recognized outbreak of E. coli 0157:H7 infections. Investigation by the Epidemiology and Prevention Branch and local health officials traced cases in northern Georgia and eastern Tennessee to eating at 3 outlets of a fast-food hamburger chain (one in Georgia and 2 in Tennessee). Reference: Georgia Epidemiology Report, January 1996, Vol. 12, No.1.
28

_ _ _ _G_ iard_ iasis_ _ _ _1~

Clinical description: An illness caused by the protozoan Giardia lamblia and characterized by diarrhea, abdominal cramps, bloating, weight loss, or malabsorption. Infected persons may be asymptomatic.
Laboratory criteria for diagnosis: Demonstration of G. lamblia cysts in stool, or Demonstration of G. lamblia trophozoites in stool, duodenal fluid, or small bowel biopsy, or Demonstration of G. lamblia antigen in stool by a specific immunodiagnostic test such as enzyme-linked immunosorbent assay (ELISA)
Surveillance case classification: Confirmed. symptomatic: A laboratory-confirmed case associated with one or more symptoms described above
Confirmed asymptomatic: A laboratory-confirmed case associated with none of the above symptoms

Reported Cases of Giardiasis

Georgia, 1993 1996

1000

820

800

en

Cl,)

en

<:<:S
.u.....

600

.0...
Cl,)

400

..0

8

z=' 200

0

93

94

95

96

Year

29

Rate of Giardiasis by County Georgia, 1995
Rates per 100,000 80.00 to 165.00
I I 50.00 to 79.99
20.00 to 49.99 0.01 to 19.99
D~ 0.00
ow

Rate of Giardiasis by County
Georgia, 1996
Rates per 100,000
40.00 to 68.00
I I 20.00 to 39.99
I>i\'-"""'M
10.00 to 19.99 0.01 to 9.99
Dk'%"1rf2d 0.00
.w....

Gonorrhea
Clinical description: A sexually transmitted infection commonly manifested by urethritis, cervicitis, or salpingitis. Infection may be asymptomatic. Laboratory criteria for diagnosis:
Isolation of Neisseria gonorrhoeae from a clinical specimen, or Observation of gram negative intracellular diplococci in a urethral smear
obtained from a man Surveillance case classification: Probable: Demonstration of Gram negative intracellular diplococci in an
endocervical smear obtained from a woman or a written morbidity report of gonorrhea submitted by a physician without laboratory test. Confirmed: A case that is laboratory confirmed; demonstration of positive Gram stain in males.
Reported cases of gonorrhea have been decreasing in Georgia, a trend that has also been reported nationwide. Since the majority of the reports came from public sector clinics, the numbers are likely to underestimate the true gonorrhea morbidity in Georgia. In 1993, the reporting of gonorrhea was disrupted to restructure and improve the overall reporting system. In 1994, several clinics were identified to serve as sentinel surveillance sites for universal screening. Combined with the traditional passive laboratory and provider reporting, the new system is more likely to reflect true gonorrhea morbidity in Georgia.
32

HaenJophilus inlluenzae, invasive
Clinical description: Invasive disease due to Haemophilus influenzae may produce any of several clinical syndromes, including meningitis, bacteremia, epiglottitis, or pneumonia.
Laboratory criteria for diagnosis: Isolation of H. influenzae from a normally sterile site
Surveillance case classification: Probable: A clinically compatible illness with detection of H. influenzae type b
antigen in cerebrospinal fluid
Confirmed: A clinically compatible illness that is culture confirmed
Reported Cases ofInvasive H. influenzae Georgia, 1987 1996
400 321 ~ 300 u'" '.0... 200
OJ
s.0 100 :::I
Z
0 87 88 89 90 91 92 93 94 95 96 Year

Rate of Invasive H. influenzae Georgia, 19871996

6,-------------------------

i +-------~---~-L..::_-----------------_-- d-g ~~----_a. 4 + - - - - - - -.- ........- - " " 0 , , : : - - - - - - - - - - - - - - - - - -

... ~~

2
............--------.1--..-
o + - - - - + - - - - j - - - - - 1 f - - - - + - - - - l - - - - - + - - + - - - +"_l " _ - - - 1

87 88 89 90 91 92 93 94 95 96

Year

33

Haernophilus influenzae, invasive
The number of reported cases of Haemophilus influenzae has been decreasing since 1989, probably reflecting increased use of Rib vaccines for Haemophilus influenzae type b disease. Although it is not known what proportion of the reported cases of H. influenzae were type b disease since typing is generally not done, a recent EmoryCDC H. influenzae disease study in the metropolitan Atlanta area found that type b disease is becoming increasingly rare.
In Georgia and in the United States as a whole, the majority of reported cases are among children <5 years of age, and adults over the age of 60.
Reported Cases of H. influenzae by Age Georgia, 1995

Reported Cases of H. influenzae by Age

Georgia, 1996

20

17

~ 15
~""
.o.... 10
S"" 5 :::l
Zo

V

-""'f .~ ,..,

-.t"
0

0'
.;,

-.t"
"0" ""

0'
.";", ""

0'
~
0
~

0\ -.t"
0
-.t"

.0,..\, .0,..,

<+:>
'0

::.:::
Z :=>

Age Group

34

' - - - - - - - - - - - - - HaemophlluS Influenzas, Invasive

I

Invasive H. intluenzae Disease in Children <= 5 Years of Age Georgia, 1987-1996

400 321
300

II Number of Cases Number of Deaths

200

100

11

9

0

0

0

87 88 89 90 91 92 93 94 95 96

Year

35

Rate of H. influenzae by County Georgia, 1995
Rates per 100,000 6.00 to 15.15 2.00 to 5.99
0.01 to 1.99
Dmiim 0.00
w
O'l

Rate of H. influenzae by County Georgia, 1996
Rates per 100,000
6.00 to 10.00
IS 2.00 to 5.99
l~i~li~li~i~li~1 0.01 to 1.99
D 0.00
W '-J

Hantavlrus Pulmonary Syndrome

I

~------------

Hantavirus pulmonary syndrome, commonly referred to as HPS, is a febrile illness simulating

adult respiratory distress syndrome (ARDS) characterized by bilateral interstitial pulmonary

infiltrates and respiratory compromise requiring supplemental oxygen. The typical prodrome

consists of fever, chills, myalgias, headaches, and gastrointestinal symptoms. Typical clinical

laboratory findings include hemoconcentration, left shift in the white blood cell count,

neutrophilic leucocytosis, thrombocytopenia, and circulating immunoblasts.

Clinical description: An illness characterized by one or more of the following clinical features:

A febrile illness (i.e., temperature>101F [38.30CD occurring in a previously healthy person characterized by a) unexplained adult respiratory distress syndrome or b) bilateral interstitial pulmonary infiltrates with respiratory compromise requiring supplemental oxygen, developing within 72 hours of hospitalization.
An unexplained respiratory illness resulting in death, with an autopsy examination demonstrating non-cardiogenic pulmonary edema without an identifiable cause.

Laboratory criteria for diagnosis: Detection of hantavirus-specific immunoglobulin M or rising titers of hantavirus-specific
immunoglobulin G, or Detection of hantavirus-specific ribonucleic acid sequence by polymerase chain reaction in
clinical specimens, or Detection of hantavirus antigen by immunohistochemistry

Surveillance case classification: Confirmed: A clinically-compatible case meeting laboratory criteria for diagnosis

Comment: In general, a predisposing medical condition (e.g., chronic pulmonary disease, malignancy, trauma, burn, and surgery) is a more likely cause of ARDS than hantavirus. Laboratory testing must be performed or confmned at a reference laboratory. Because the clinical illness is nonspecific and adult respiratory distress syndrome is common, a screening case definition should be used to determine which patients to test. Patients who have these underlying conditions and ARDS should not be tested for hantavirus.

38

Viral Hepatitis
Clinical description: An acute illness with a) discrete onset of symptoms and b) jaundice or elevated serum aminotransferase levels Laboratory criteria for diagnosis:
Hepatitis A: IgM anti-HAV positive
Hepatitis B: 1. IgM anti-HBc positive (if done) or HBsAg positive
and 2. IgM anti-HAY negative (if done)
Hepatitis C: 1. Serum aminotransferase levels greater than 2 1/2 times the upper limit of normal, and 2. IgM anti-HAV negative, and 3. IgM anti-HBc negative (if done) or HBsAg negative, and 4. Anti-HCV positive
Non-A, Non-B Hepatitis: 1. Serum aminotransferase levels greater than 2 1/2 times the upper limit of normal, and 2. IgM anti-HAY negative, and 3. IgM anti-HBc negative (if done) or HBsAg negative, and 4. Anti-HCV negative
Surveillance case classification: Confirmed: A case that meets the clinical case definition and is laboratory
confirmed
39

_ _ _ _ _ Hep_ atiti_ s A _ _ _ _1~

Reported Cases of Acute Hepatitis A Georgia, 1987 - 1996

700

631

600

'O"J 500

u'""" 400

'-

0....
OJ

300

.D

S
z::>

200

100

0 87 88 89 90 91 92 93 94 95 96

Year

15

<0

<0

<0

0
<0

10

....

OJ 0-

~

c'o":: 5

Rate of Acute Hepatitis A Georgia, 1987-1996

O+------l---+--+---r-.---+---t---'f------l-----1

87

88

89

90

91

92

93

94

95

96

Year

In Georgia, the number of reported cases of hepatitis A have decreased from a high in 1988, when epidemics of hepatitis A swept the nation. This trend was consistent with the overall decrease in the number of reported cases of hepatitis A in the United States during the 1990s. In 1996, reported cases of hepatitis A increased, largely because of a recognized outbreak of hepatitis A among men who have sex with men in the Atlanta area.

40

Rate of Hepatitis A by County Georgia, 1995
Rates per 100,000 15.00 to 23.50
III 10.00 to 14.99
0.01 to 9.99
D 0.00
-I:>
-"

Rate of Hepatitis A by County Georgia, 1996
Rates per 100,000
15.00 to 30.00
I I 10.00 to 14.99
o 0.01 to 9.99
Imfi
0.00
.I:> IV

_ _ _ _He_ patit_ is B _ _ _.-....11~

Reported Cases of Acute Hepatitis B

HID 893
900

800

'~" 700

a'" 600

......

0
.....

500

~
~

400

::l
Z

300

200

100

0

Georgia, 1987 - 1996

87 88 89 90 91 92 93 94 95 96

Year

Rate of Acute Hepatitis B Georgia, 1987-1996
20

15

g

-.....
c~..

10

~

-~ 5

0 87 88 89 90 91 92 93 94 95 96 Year

Hepatitis B (formerly known as serum hepatitis) is not an uncommon disease. The increase in the number of reported cases of hepatitis B from 1992 to 1993 may be due to the change in the case definition. In 1990 the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE) published a new case definition that was not uniformly adopted by all counties and local health departments in Georgia until 1993. The drop in cases in 1995 is due, at least in part, to more careful adherence to the surveillance case definition, requiring evidence for an acute case.

43

"-

Hepatitis B

1~

Reported Cases of Acute Hepatitis B by Age Georgia, 1995

40

35

30

'0" 30
a..'.". 25

.0.. 20

0
~::s 15
Z 10

50 0

1

- - 0 v ""i .0;.\,

-- -- 0"""

0\
I V')

~
~

~ I V')
N

0\ M
0
M

Age Group

40

35

'0" 30

a'"
....

25

.0.. 20

0

~::s
Z

15
10

5

0

Reported Cases of Acute Hepatitis B by Age Georgia, 1996

14 13

0 ooo

-v

- -- :o!

0\
.;.,

Age Group

44

Rate of Hepatitis B by County Georgia, 1995
.j:>. IJ1

Rate of Hepatitis B by County Georgia, 1996
Rates per 100,000 4.50 to 7.50
III 2.50 to 4.49
0.01 to 2.49
DtmIIIIIIIm 0.00
.j:>. 0'\

Hepatitis C/non-A non-B Hepatitis

Reported Cases of Hepatitis C/non-A non-B Hepatitis Georgia, 1987 - 1996

500

450

400 <Il
<l) <Il

u 300 CIl
l+-;

.0..
<l)

200

"S
Z

100

33

0

18

15

I-108
12

0

87 88 89 90 91 92 93 94 95 96

Year

Rate of Hepatitis C/non-A non-B Hepatitis
Georgia, 1987-1996
8-,----------------------------
o
86-+----------------F---"<--------
o~
o
":4-+---------------r----'l.------<l) 0.. <l)
J2 2
O+==::::::If:===!~=:-I~___I-__+-_+-_____+_--t:~'""_II
87 88 89 90 91 92 93 94 95 96
Year

Hepatitis C, formerly non-A, non-B hepatitis, is a recently identified bloodbome virus which is parenterally transmitted. Hepatitis C serological testing became available in 1991 and came into widespread use by blood banks in 1992. Earlier reported cases may reflect cases identified during the experimental development of the diagnostic test or reflect diagnosis of non-A, non-B hepatitis. The drop in cases in 1995 and 1996 is due at least in part to more careful adherence to the surveillance case definition. In particular, only acute cases of hepatitis C are included in the reported statistics. Laboratory tests indicating past and chronic infection are not included in these data.
47

~---Le- ad P- oiso- ning---.
Range of effects of lead: In general, children are more at risk for lead exposure than adults because children exhibit more hand-to-mouth activity and absorb more lead into their bodies. Lead affects virtually every body system. It is particularly harmful to the developing brain and nervous system of developing infants and young children. Very severe lead exposure (blood lead levels 80 ug/dL) in children can cause coma, convulsions, and even death. Lower levels can have adverse effects on the central nervous system, renal system, and hematopoietic system. Blood lead levels as low as 10 ug/dL, which do not cause distinctive symptoms, are associated with decreased intelligence and impaired neurobehavioral development, decreased stature or growth, decreased hearing acuity, and decreased ability to maintain a steady posture. Maternal and cord blood lead levels of 10 to 15 ug/dL appear to be associated with reduced gestational age and reduced birth weight.
Lead poisoning in Georgia: Virtual elimination of lead from gasoline, food cans, and residential paint in the last two decades has contributed to reductions in blood lead levels among children and adults in the U.S. population. Nevertheless, lead-based paint, lead-contaminated dusts and soils, and lead taken home by parents from a lead-related industry remain important sources of childhood lead exposure. Nationwide and in Georgia, the lead poisoning risk is disproportionately high for poor, minority children living in large metropolitan areas or living in older housing.
Surveillance case classification: Suspected: Capillary blood lead level >= 10 ug/dL
Confirmed: Venous blood lead level >= 10 ug/dL
Blood lead surveillance in Georgia began in 1994 when blood lead levels >= 10 ug/dL were made a notifiable condition. Since then, more than 1,000 children have been identified with a confirmed case oflead poisoning (a venous blood lead level >= 10 ug/dL). The true morbidity is likely much higher for the following reasons: 1) the health effects of elevated blood lead levels can be asymptomatic; for the most part, only those children who visit a health clinic for HealthCheck services under the Medicaid program are screened; 2) Georgia's case count does not include unconfirmed elevated capillary blood lead levels; and 3) reporting of elevated blood lead levels by laboratories and health-care providers is incomplete.
48

_ _ _ _Le_ ad P_ oiso_ ning_ _ _ _1~

Nmnber of Children Receiving Blood Lead Screening Georgia, 1995 - 1996

4<XXX)

c
;~g 3<XXX>

0

..'-
0

2<XXX)

II)

~ 1<XXX>

z:l

0

30994

30681

1995

1996

Year

HID
c
;g~ 800

0 600

..'0-
II) 400

~
:l

200

Z

0

Cont'intEd Lead Poisoning Cases in Children Georgia, 1995 - 1996
774 604

1995

1996

Year

For more information:
CDC's 1991 publication, Preventing Lead Poisoning in Young Children, and their proposed revised guidelines, Screening Young Children for Lead Poisoning: Guidelinesfor State and Local Public Health Officials, are available by searching CDC's Web site at http://www.cdc.gov.
Additional data on lead poisoning in Georgia are available on the Division of Public Health's Web site at http://www.ph.dhr.state.ga.us.

49

Confirmed Lead Poisoning Cases in Georgia as of December 31, 1996
Cases 350 to 506
II 100 to 349
1 to 99
DO miiIliiII
Uo1

_ _ _ _L_ egio_ nell_ osis_ _ _ _1
Clinical description: An illness with acute onset, commonly characterized by fever, cough, and pneumonia, that is confinned by chest radiograph. Encephalopathy and diarrhea may also be included. Laboratory criteria for diagnosis:
Isolation of Legionella from lung tissue, respiratory secretions, pleural fluid, blood, or other normally sterile sites, or
Demonstration of a fourfold or greater rise in the reciprocal immunofluoresence (IF) antibody titre to > 128 against Legionella pneumophila serogroup 1, or
Demostration of L. pneumophila serogroup 1 in lung tissue, respiratory secretions, or pleural fluid by direct fluorescence antibody testing, or
Demonstration of L. pneumophila serogroup 1 antigens in urine by radioimmunoassay
The urine antigen test is preferred over serology in the diagnosis of legionellosis.
Surveillance case classification: Probable: A clinically compatible illness with demonstration of a reciprocal
antibody titres > 256 from a single convalescent-phase serum specimen Confinned: A case that is laboratory confinned
51

~ - -Legionellosis

I~

Reported Cases of Legionellosis

Georgia, 1987 -1996

140
CiJ 120
<l,)
~ 100 ~ 80
o
~ 60
.0
S 40
:::l
Z 20
o

118 3

87 88 89 90 91 92 93 94 95 96

Year

Rate of Le gionellosis Ge0 rg ia, 1987 -19 96
2.0 , - - - - - - - - - - - - - - - - - - - - - - - - -
g 1.5 +----------------~~---
q oo
-: 1.0 +----------------+--~.--------
0.0 +----f-----j---+------+--t----+----+--+-------'\"
87 88 89 90 91 92 93 94 95 96 Year

52

Rate of Legionellosis by County Georgia, 1995
Rates per 100,000
4.00 to 9.55
III 1.00 to 3.99
0.01 to 0.99
DmmwJ 0.00
U1 W

Rate of Legionellosis by County Georgia, 1996
Rates per 100,000
6.01 to 12.00
III 3.01 to 6.00
0.01 to 3.00
-D 0.00
V1 .j:>.
I

_ _ _ _L_ ister_ iosis_ _ _ _1~
Clinical description: Infection caused by Listeria monocytogenes, which may produce any of several clinical syndromes, including stillbirths, listeriosis of the newborn, meningitis, bacteremia, or localized infections.
Laboratory criteria for diagnosis : Isolation of L. monocytogenes from a normally sterile site
Surveillance case classification:
Confirmed: A clinically compatible case that is laboratory confirmed

25

'<"U 20

u"'""
........

15

.0..
<U 10

.&:J

E

z:= 5

0

Reported Cases of Listeriosis Georgia, 1994-1996
22

94

95

96

Year

Rate of Listeriosis Georgia, 1994-1996
0.4

----------- --- 0
e0::-

OJ

o

0... 0.2

<U

0..

<U

~"" 0.1

0

94

95

96

Year

55

~--- Lym- e D- iseas_ e .-,
Lyme disease was first recognized in the United States in 1975 after a mysterious outbreak of arthritis among children in Lyme, Connecticut. Although the disease was initially thought to exist only in the northeastern United States, reports of Lyme Disease have increased dramatically in many areas of the country, making the disease an important public health problem. The first suspected cases in Georgia were identified in 1986, but were not laboratory confirmed. Routine testing for Lyme disease was initiated by the State Public Health Laboratory in 1988 but was discontinued in 1990 due to concerns about the questionable reliability of currently available laboratory tests, as well as budgetary constraints. This probably is the primary cause of the reduced number of cases reported after 1989. The laboratory data for cases reported after 1990 are from private laboratories.
Clinical description: A systemic, tick-borne disease with protean manifestations, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities. The best clinical marker for the disease is the initial skin lesion, erythema migrans, that occurs at the site of a tick bite among 60 - 80% of patients.
Clinical case definition: Erythema migrans, or At least one late manifestation, as defined below, and laboratory confirmation of infection.
Late manifestations: Late manifestations include any of the following when an alternate explanation is not found:
Musculoskeletal system: Recurrent, brief attacks (weeks or months) of objective joint swelling in one or a few joints, sometimes followed by chronic arthritis in one or a few joints. Manifestations not considered for diagnosis include chronic progressive arthritis not preceded by brief attacks and chronic symmetrical polyarthritis. Additionally, arthralgia, myalgia, or fibromyalgia syndromes alone are not criteria for musculoskeletal involvement.
Nervous system: Any of the following, alone or in combination: Lymphocytic meningitis, cranial neuritis, particularly facial palsy (may be bilateral); radiculoneuropathy; or rarely, encephalomyelitis. Encephalomyelitis must be confirmed by showing antibody production against B. burgdoiferi in the cerebrospinal fluid, demonstrated by a higher titer of antibody in CSF than in serum. Headache, fatigue, paraesthesia, or mild stiff neck alone are not criteria for neurologic involvement.
Cardiovascular system: Acute onset, high-grade (2 or 3) atrioventricular conduction defects that resolve in days to weeks and are sometimes associated with myocarditis. Palpitations, bradycardia, bundle branch block, or myocarditis alone are not criteria for cardiovascular involvement.
56

_ _ _ _ Lyme_ Dise_ ase _ _ _1
Laboratory criteria for diagnosis: Isolation of Borrelia burgdoiferi from clinical specimen, or Demonstration of diagnostic levels of IgM and IgG antibodies to the spirochete in serum or CSF, or Significant change in IgM or IgO antibody response to B. burgdoiferi in paired acute and convalescent phase serum samples
Surveillance case classification: Confirmed: A case that meets one of the clinical case definitions above

Reported Cases of Lyme Disease Georgia, 1987 1996

800

700

595

..''.."",.
u

600 500

'..0-..., 400

.&> 300
S
z= 200

100

14

0

87 88 89 90 91 92 93 94 95 96

Year

57

Rate of Lyme Disease by County Georgia, 1995
Rates per 100,000
4.00 to 6.23
III 2.00 to 3.99
0.01 to 1.99
D~ 0.00
V1 00

o
L[) ('i)
..o...
59

Lymphogranuloma Venereum Infection
, Clinical description: Infection with Ll, L2, or, L3 immunotypes of Chlamydia trachomatis may result in a disease characterized by genital lesions, suppurative regional lymphadenopathy, or hemorrhagic proctitis. The infection is usually sexually transmitted. Laboratory criteria for diagnosis: Isolation of C. trachomatis, immunotypes Ll, L2, or L3, from a clinical specimen, or Demonstration of inclusion bodies by immunofluorescence in leukocytes of an inguinal lymph node (bubo) aspirate, or Positive microimmunofluorescent serologic test for a lymphogranuloma venereum strain of C. trachomatis in a clinically compatible case Surveillance case classification: Probable: A clinically compatible case with one or more tender fluctuant inguinal lymph nodes or characteristic proctogenitallesions with supportive laboratory findings of a single C. trachomatis complement fixation (CF) titer of greater than 64. Confirmed: A case that is laboratory confirmed
60

Malaria

Clinical description: Signs and symptoms are variable, but chills followea by fever and sweating constitute the classic malaria paroxysm. The diagnosis should be considered for any person who has been potentially exposed to infection. Complications such as cerebral malaria may occur in Plasmodium jalciparum infection. Asymptomatic parasitemia may occur among immune persons.
Laboratory criteria for diagnosis: Demonstration of malaria parasites in blood films
Surveillance case classification: Confirmed: A person's first attack of laboratory confIrmed malaria that occurs in
the United States, regardless of whether the person has experienced previous attacks of malaria while outside the country. A subsequent attack experienced by the same person but caused by a different Plasmodium species is counted as an additional case. A repeated attack experienced by the same person and caused by the same species in the United States is not considered an additional case.

50

'" 40
Cl>
u..'"..".". 30

.0...

Cl>

~
E

20

:::l
Z

10

Reported Cases of Malaria Georgia, 1987 1996

43 41

0 87 88 89 90 91 92 93 94 95 96
Year

61

_ _ _ _ Ma_ laria_ _ _......1
Endemic malaria no longer occurs in many temperate zone countries and in well developed areas of tropical countries, but is a major cause of ill health in many parts of the tropics and sub-tropics where socio-economic development is deficient. High transmission areas are also found in the fringes of forests in S. America (e.g. Brazil) and S.E. Asia (e.g. Indonesia). In Georgia, malaria cases have increased during the 1990s with the majority of cases reported from the metropolitan Atlanta area among persons from countries where malaria is endemic. The increase in the number of cases of malaria in metro-Atlanta may reflect the increased international stature of the city. One case in southern Georgia in 1995 may have been locally acquired.
62

Rate of Malaria by County Georgia, 1995
Rates per 100,000 2.00 to 3.11 1.00 to 1.99
0.01 to 0.99
D~ 0.00
mw

Rate of Malaria by County Georgia, 1996
Rates per 100,000 6.00 to 12.00 3.00 to 5.99
0.01 to 2.99
DmiIliIlIlI! 0.00
O'l .l::>

'-

Measles

1~

Clinical case definition: An illness characterized by all of the following clinical features:
A generalized rash lasting 3 or more days, and A temperature greater than or equal to 38.30 C (101 0 F), and Cough, coryza, or conjunctivitis

Laboratory criteria for diagnosis: Isolation of measles virus from a clinical specimen, or Significant rise in measles antibody level by any standard serologic assay, or Positive serologic test for measles IgM antibody

Surveillance case classification:

Suspect:

Any rash illness with fever

Probable:

Meets the clinical case definition, has no or noncontributory serologic or virologic testing, and is not epidemiologically linked to a probable or confirmed case

Confirmed:

A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a confirmed or probable case. A laboratory confirmed case does not need to meet the clinical case definition.

Reported Cases of Measles Georgia, 1987 - 1996

400

361

"0" "c:":s

300

U .......

0
......

200

0

..0

S 100

::l
Z

10

0

0544

87 88 89 90 91 92 93 94 95 96

Year

65

_ _ _ _ Mea_ sles_ _ _-'1~

Rate of Measles

Georgia, 1987 . 1996

6

05

-q0
0

4

0

.... 3

0

0..2

/'"\
/\
/\

.0....
1 ~
~
o IlL

/
.-.. -"

\
"-- - -... - - -

87 88 89 90 91 92 93 94 95 96

Year

Measles is an acute, higWy contagious viral disease capable of producing epidemics. It is more common in winter and spring. Although measles is usually considered a childhood disease, it can be contracted at any age. In 1990, measles outbreaks occurred in Georgia in two areas: 1) in Athens among students at the University of Georgia; and 2) in Murray and Whitfield counties, among members of a religious sect who refused to be immunized.

66

--M- enin~ gococcal Disease

I

Clinical description: Meningococcal disease presents most commonly as meningitis and/or meningococcemia that may progress rapidly to purpura fulminans, shock, and death. However, other manifestations may be observed.

Laboratory criteria for diagnosis: Isolation of Neisseria meningitidis from a normally sterile site

Surveillance case classification: Probable: A positive antigen test in cerebrospinal fluid or clinical purpura
fulminans in the absence of a positive blood culture

Confirmed: A clinically compatible case that is culture confirmed

Reported Cases of Meningococcal Disease

Georgia, 1987 1996

Iff)

148

140
Q'") 120
8 100
'~- 80
~ 60
i 40
20
o

87 88 89 90 91 92 93 94 95 96

Year

Rate of Meningococcal Disease Georgia, 1987-1996
2.5

2.0
0 0 0
0 1.5
0

~ 1.0

0.>

~
c:::

0.5

0.0 87 88 89 90 91 92 93 94 95 96 Year

67

Meningococcal Disease

I

'---~----"""

Meningococcal meningitis is a severe bacterial infection of the blood stream and meninges. It is a relatively rare disease and usually occurs as a single, randomlyoccurring event. Clusters of cases or outbreaks are rare in the United States. Generally 70-100 sporadic cases of meningococcal disease occur in Georgia each year, and approximately 5%-10% are fatal. The number of reported cases has been increasing over the past several years. Special studies are planned to attempt to gain a better understanding of this disease and how it can be prevented.

Between November, 1992 and January, 1993, an unusual cluster of meningococcus Group C disease occurred in a small area around Carroll County. Seven cases were reported, which was seven times higher than the expected number for that county (one case every year based on five years of data).

Reported Cases of Meningococcal Disease by Age Georgia, 1995

40

30

~ 30
co
u
'"0 20
.....
Q.)
s..D 10
:::>
Z

0

-v

""T

0;-

-<:T

V")
6

0-
V")

-<:T

0-

6"""

<;'
V")

""" """

0-

0-

6"'"'

-<:T
6

"'"' -<:T

0-
V")
6
V")

=+
'-0

z::.0:

:=:>

Age Group

Reported Cases of Meningococcal Disease by Age Georgia, 1996
40

~ 30
'c"o

23

u

'"0 20

.....

Q.)

s..D 10 :::>
Z

0

v

""T

0;-

-<:T

0-

V")

=

'""7
V")

-<:T

0-

=<;'
"""

<;'
V")
"""

0-

0-

0-

6"'"'

-<:T
6

V")
6

"'"'

-<:T

V")

=+
'-0

::.0: Z

:=:>

Age Group

68

Rate of Meningococcal Disease by County Georgia, 1995
Rates per 100,000 20.00 to 29.36 10.00 to 19.99
4.00 to 9.99
I Immmi 0.01 to 3.99
D 0.00
O'l 1.0

Rate of Meningococcal Disease by County Georgia, 1996
Rates per 100,000
10.00 to 19.00 5.00 to 9.99
II 3.00 to 4.99
0.01 to 2.99 D 0.00
o.....

_ _ _ _A_s_ep_ti.c....(.v...i.r..a...l..)-..M.- eningitis

1~

Clinical description: A syndrome characterized by acute onset of meningeal symptoms, fever, and cerebrospinal fluid pleocytosis, with bacteriologically sterile cultures.
Laboratory criteria for diagnosis: No evidence of bacterial or fungal meningitis
Surveillance case classification: Confirmed: A clinically compatible illness diagnosed by a physician as aseptic
meningitis, with no laboratory evidence of bacterial or fungal meningitis

Reported Cases of Viral Meningitis

500

400 C/j
0

.d.'.".. 300

0....

0
~

200

:i 100

Georgia, 1987 - 1996
352 326

0 87 88 89 90 91 92 93 94 95 96

Year

Rate of Viral Meningitis Georgia, 1987 . 1996
6.------------------------
5-t----------J~:::::::~:___----------
=g4+---------J~-------''r_----------
<0
::3+-"'::::::O"'o;;;;::;;;'-----,~------""-'::>O~-------
<U
~2+-----=-----------~------
~1+------------------=:lI:::::::::::::~~~
0+---+--+----+---+------+---+-----1---+-----i
87 88 89 90 91 92 93 94 95 96
Year

71

Aseptic (viral) Meningitis
Viral meningitis is a relatively common, but rarely serious, clinical syndrome. It is caused by a wide variety of infectious agents, many of which are associated with other specific diseases. In epidemic periods, mumps may be responsible for over 25% of cases of established etiology. Active illness seldom exceeds 10 days and recovery is usually complete. The number of cases of viral meningitis has been decreasing in Georgia since 1991. The reason for this decline is not clear.
72

_ _ _ _ _M_ um_ ps_ _ _ _ _1~

Clinical case definition: An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting 2 or more days, and without other apparent cause (as reported by a health professional).

Laboratory criteria for diagnosis: Isolation of mumps virus from clinical specimen, or Significant rise in mumps antibody level by any standard serologic assay, or Positive serologic test for mumps IgM antibody

Surveillance case classification: Probable: A case that meets the clinical case definition, has no or noncontributory
serologic or virologic testing, and is not epidemiologically linked to a confirmed or probable case.

Confirmed:

A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a confirmed or probable case. A laboratory confirmed case does not need to meet the clinical case definition.

125

'"0,) 100

d'"
'+-<

75

0

I-<

t 50 0,)

~ 25

Reported Cases of MUfi1JS Georgia, 1987 -1996
96

0 87 88 89 90 91 92 93 94 95 96

Year

73

- - - - - M -um-ps- - - _.......,~

Rate of Mumps Ge0 rg ia, 1987-19 96
2.0

g

1.5

......

~ 1.0

...c(l).
(l)
~ 0.5

0.0 87 88 89 90 91 92 93 94 95 96

Year

Mumps is an acute viral disease that usually occurs in children. In 1995,9 of the 11 reported cases were in children under 10 years of age. The number of reported cases has been decreasing since 1989, with a sharp decrease after 1992. The decreasing trend in the number of cases may be due to increased vaccine coverage with measles, mumps, and rubella (MMR) vaccine following the 1990 measles outbreaks in Georgia.

74

_ _ _ _ Pe_ rtuss_ is _ _ _1~
Clinical case definition: , A cough illness lasting at least two weeks with one of the following: paroxysms of coughing,
inspiratory "whoop," or post-tussive vomiting and without other apparent cause (as reported by a health professional).
Laboratory criteria for diagnosis: Isolation of Bordetella pertussis from a clinical specimen
Surveillance case classification: Probable: Meets the clinical case definition, is not laboratory confirmed, and is
not epidemiologically linked to a laboratory confirmed case
Confirmed: A clinically compatible case that is laboratory confirmed or epidemiologically linked to a laboratory confirmed case

Reported Cases of Pertussis

Georgia, 1987 - 1996
80

70

'<"U 60

a'" 50

.......

0
l-<

40

<U

~ 30

Z=' 20

10

0

59

57

56

87 88 89 90 91 92 93 94 95 96

Year

75

- - - - - - - - Pertussis - - - - ,~
Rate of Pertussis Georgia, 1987-1996
1.0
g
.~ 0.5
Q.)
0..
Q.)
~
0.0 87 88 89 90 91 92 93 94 95 %
Year

Pertussis is a disease common to children everywhere regardless of race, climate, or geographic location. There has been a marked decline in incidence and mortality rates during the past four decades, mostly in communities fostering active immunization and areas where residents have access to good nutrition and medical care. In Georgia, the number of reported cases of pertussis has remained fairly stable over the last few years.

Reported Cases of Pertussis by Age

Georgia, 1995

30

<I'.l
a.... 25 21 Q.) <I'.l 20

0
~

15

Q.)

-a 10

::s
Z

5

000000 20

0

.-
V

".'-t

0\ I tr)

."<-t
0.-

.0-\ I
.tr-)

~
0
('-l

0\
('-l I
tr)
('-l

0\ M
0
M

~

0\
tr)
0
tr)

~

~
5

Age Category

76

Pertussis

Reported Cases of Pertussis by Age

Georgia, 1996

30 26
til
a 25 ~ til
..... 20
0
15 I-;
~
-S 10
::l
Z5

0 0 0 0 1 10 0 0

0

......
V

~
....I..

0\ I II')

.~ ..... I
.0.....

.0....\. I
I..I..'.).

~ I
0
C'l

~ I II')
C'l

0\
('f'l I
0
('f'l

~
~

0\
II') I
0
II')

~

~

Age Category

77

Rate of Pertussis by County Georgia, 1995
Rates per 100,000
4.00 to 10.60
III 1.00 to 3.99
0.01 to 0.99
-D 0.00
'-I 00

Rate of Pertussis by County Georgia, 1996
Rates per 100,000 4.00 to 10.60
II 1.00 to 3.99
0.01 to 0.99
DIiiiiml 0.00
-...J 1.0

~--- Po- liom- yelit- is -_.,

Clinical case definition: Acute onset of a flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss (as reported by a physician).

Surveillance case classification: Probable: A case that meets the clinical case definition

Confirmed:

A case that meets the clinical case definition and in which the patient has a neurologic deficit 60 days after onset of initial symptoms, has died, or has unknown follow up status.

Polio is a viral disease which may affect the nervous system. Since polio immunization became widespread, cases of polio have become rare. The last case of polio caused by wild poliovirus in the U.S. occurred in the 1970s. The last case of vaccine-related poliomyelitis was reported in Georgia in 1989 in a 22 year-old female resident of Sumter County. In 1985, the Pan American Health Organization (PAHO) established as a goal the elimination of poliomyelitis from the Western Hemisphere by 1990. The last confrrmed case of paralytic polio caused by wild poliovirus in the Western Hemisphere occurred in Peru in 1990.

80

~ - - Rabies, Animal

I~

Laboratory criteria for diagnosis: A positive direct fluorescent antibody test (preferably perfonued on central nervous system tissue) Isolation of rabies virus (in cell culture or in a laboratory animal) PCR detection of rabies virus in a clinical specimen.
Surveillance case classification: Continued: A case that is laboratory continued
The Georgia Public Health Laboratory tests all cases of suspected animal rabies involving a human or animal exposure. In 1996, 303 animals tested positive for rabies. Animal rabies was detected in 17 Health Districts and in 96 of the 159 counties. Only 7% of the positive animals were domestic species (cats 4%, dogs 2.5%, cows 0.5% and horses 1%). Among non-domesticated animals, raccoons (70%), skunks (9%), foxes (8%), bats (3%), and bobcats (2%) tested positive. Rabid bats, a particular concern, were found throughout the state.

Reported Cases of Animal Rabies

Georgia, 1988 1996
600

500

474

~ 400
~.''0."". 300 <U
S 200
:z::>:
100

0 88 89 90 91 92 93 94 95 96

Year

81

_ _ _R_ abie_ s, An_ imal_ _ _1~

Animal Rabies by Species Georgia, 1995 & 1996
80

60

-e<:
0

E-
'-

40

0

~

20

0

=0
0 OJ

=.....:
..:.:..::l

><
0 ~

OJ

en

e<:

~

.1995 .1996 1---

--...
<l.l
o

~
o
U

Confirmed Cases ofAnimal Rabies by Species, Georgia 19931996

Animal Type

1993 1994 1995 1996

Bat

6

7

11

9

Bobcat

8

4

8

6

Bovine

2

0

'0

1

Cat

10 13

10 12

Coyote

1

1

0

0

Dog

5

6

8

8

Fox

47

29

19 24

Goat

0

1

0

0

Horse

3

0

2

1

Otter

0

0

0

2

Raccoon

360 272 203 212

Skunk

0

0

0 28

82

Confirmed Animal Rabies by County Georgia, 1995
Cases
9 to 12
- 5 to 8 1 to 4
Do
0w0

..:r~ .::.s:.
0
0

.~ c

- .. tn
.-c(cI-a)

ceeonn
~

0::
ca

-ec-an

-rE-::

I-
0
(I)

C)

-c

(I)

.-.IE.--.
r::

0

0

f1) (I)

CD
~

ex:>

-q-

cf1u)
0

..0....

..0....

..0....

Q') LO ~ 0
D

...........'\...1.!.-

84

_ _ _ _ Rab_ ies, _ Hum_ an _ _ _1~
Clinical description: Rabies is an acute encephalomyelitis that almost always progresses to coma and death within 10 days of the first symptom. Laboratory criteria for diagnosis:
Detection by direct fluorescent antibody of viral antigens in a clinical specimen (preferably the brain or the nerves surrounding hair follicles in the nape of the neck), or
Isolation (in cell culture or in a laboratory animal) of rabies virus from saliva, cerebrospinal fluid (CSF), or central nervous system tissue, or
Identification of a rabies neutralizing antibody titer greater than or equal to 5 (complete neutralization) in the serum or CSF of an unvaccinated person, or
Identification of rabies virus by PCR Surveillance case classification: Confirmed: A clinically compatible illness that is laboratory confirmed Rabies is primarily a disease of animals. The disease is uncommon in humans in developed countries. The last case of human rabies in Georgia was reported in 1991. Most human cases of rabies in recent years have been caused by the variant of rabies virus harbored by bats.
85

- - - - - - - - _ , Rocky Mountain Spotted Fever ........
Clinical description: An illness most commonly characterized by acute onset of fever, usually accompanied by myalgia, headache, and petechial rash (on the palms and soles in two thirds of the cases).
Laboratory criteria for diagnosis: Fourfold or greater rise in antibody titer to the spotted fever group antigen by immunofluorescent antibody (lFA), complement fixation (CF), latex agglutination (LA), microagglutination (MA), or indirect hemagglutination (IRA) test, or a single titer greater than or equal to 64 by IFA or greater than or equal to 16 by CF, or
Demonstration of positive immunofluorescence of skin lesion (biopsy) or organ tissue (autopsy), or
Isolation of Rickettsia rickettsii from clinical specimen
Surveillance case classification: Probable: A clinically compatible case with supportive serology (fourfold rise in
titer or a single titer greater than or equal to 320 by Proteus OX 19 or OX 2, or a single titer greater than or equal to 128 by LA, IRA, or MA test)
Confirmed: A case that is laboratory confirmed

Reported Cases of Rocky Mountain Spotted Fever Georgia, 19871996

80

70

66

.'"., 60
u~ 50 ~.... 40 ~ 30
8
Z 20

10
o

87 88 89 90 91 92 93 94 95 96

Year

86

_ _Ro_ cky_ Mo_ unt_ ain_ Spo_ tted_Fe_ ver_........1~
Rocky Mountain spotted fever occurs throughout the United States during spring, summer and fall. In the western part of the United States, adult males are infected more frequently, while in the east, the incidence is higher in children. The difference is related to conditions of exposure to infected ticks. In Georgia, cases of the disease are not concentrated in any particular area and have been reported from all parts of the state.
87

Confirmed Rocky Mountain Spotted Fever by County Georgia, 1995
.2Number of Cases 1
~
D
00 00

Confirmed Rocky Mountain Spotted Fever by County Georgia, 1996
.3Number of Cases
.1l1li 2
Do
00
~

_ _ _ _Ru_ bell_ a _ _ _1~

Clinical case definition: An illness with all of the following characteristics:
Acute onset of generalized maculopapular rash, and Temperature greater than 37.2 C (greater than 99 F), if measured, and Arthralgia/arthritis, lymphadenopathy, or conjunctivitis

Cases meeting the measles case definition are excluded. Also excluded are cases with serology compatible with recent measles virus infection.

Laboratory criteria for diagnosis: Isolation of rubella virus, or Significant rise in rubella antibody level by any standard serologic assay, or Positive serologic test for rubella IgM antibody

Surveillance case classification: Probable: A case that meets the clinical case definition, has no or noncontributory
serologic or virologic testing, and is not epidemiologically linked to a laboratory-confirmed case

Confirmed:

A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a laboratory confirmed case

Reported Cases of Rubella

Ge orgia, 1987-1996
10 9

.'.",
u'"""

8 7 6

7

7

4-<

0......,. 5

4 .&>

3 E
::I

Z2

I

0 00

00

0

87 88 89 90 91 92 93 94 95 96

Year

90

Rubella
In unvaccinated populations, rubella is primarily a childhood disease. In areas where children are well vaccinated, adolescent and adult infections become more frequent. Rubella can be a particular problem during pregnancy or it may result in congenital rubella syndrome (CRS). CRS occurs in up to 90% of infants born to women who acquired confirmed rubella during the first trimester of pregnancy; the risk of a single congenital defect falls to approximately 10%-20% by the 16th week, and defects are rare when the maternal infection occurs after the 20th week of gestation. If they are not already immune, all women of reproductive age should be vaccinated for rubella prior to pregnancy. No confirmed cases of rubella were reported in Georgia during 1995 and 1996. In 1994, however, 7 confirmed cases were reported: 3 from Clarke County, 2 from Hall County, 1 from DeKalb County,. and 1 from Fulton County.
91

'-

Salmonellosis

---.11~

Clinical description: An illness of variable severity commonly manifested by diarrhea, abdominal pain, nausea, and sometimes vomiting. Asymptomatic infections may occur, and the organism may cause extraintestinal infections.
Laboratory criteria for diagnosis: Isolation of Salmonella from a clinical specimen
Surveillance case classification: Probable: A clinically compatible illness that is epidemiologically linked to a
confIrmed case
ConfIrmed: A case that is laboratory confIrmed

Reported Cases of SabnoneUosis Georgia, 1987 - 1996
2400

200:>

1846

~ '"
d'" 1600
.."0"' 1200
~
Z~= 800

400

0 87 88 89 90 91 92 93 94 95 96 Year

92

, - - - - - - Salmonellosis - _........~

Rate of Salmonellosis Georgia,1987-1996
30,-----------------------

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87

88

89

90

91

92

93

94

95

96

Year

Salmonellosis is one of the more common causes of gastroenteritis in Georgia. Most cases occur in the summer months and are seen as single cases, clusters or outbreaks. The number of reported cases of salmonellosis has remained fairly constant over the years. Since reported cases only represent those confirmed by stool culture, these numbers represent a small fraction of the true morbidity. Despite underreporting, salmonellosis remains one of the most frequently reported communicable diseases in Georgia. The most commonly reported serotypes are Typhimurium and Newport.

93

Rate of Salmonellosis by County Georgia, 1995
Rates per 100,000
80.00 to 131.30 50.00 to 79.99
20.00 to 49.99 0.01 to 19.99
D~ 0.00
1.s.:0:.

Rate of Salmonellosis by County Georgia, 1996
Rates per 100,000 80.00 to 131.30 50.00 to 79.99
20.00 to 49.99 0.01 to 19.99
D~ 0.00
1.0 V1

I

Shigellosis

~

Clinical description: An illness of variable severity characterized by diarrhea, fever, nausea, cramps, and tenesmus. Asymptomatic infections occur.
Laboratory criteria for diagnosis: Isolation of Shigella from a clinical specimen
Surveillance case classification: Probable: A clinically compatible illness that is epidemiologically linked to a
conftrmed case
Conftrmed: A case that is laboratory conftrmed

Reported Cases of Shigellosis
Georgia, 1987 1996
2400 1887
'" 2000
3<1.> 1600 ~.... 1200
<1.>
~s 800
::s
Z 400
o
87 88 89 90 91 92 93 94 95 96
Year

=31
~ 20

Rate of Shigellosis Georgia, 1987 1996
L

Rate of Shigellosis by County

Georgia, 1995

'\

Rates per 100,000
90.00 to 144.00 40.00 to 89.99
20.00 to 39.99 0.01 to 19.99
D~ 0.00

~
00

Rate of Shigellosis by County Georgia, 1996
Rates per 100,000
90.00 to 144.00
l1li 40.00 to 89.99
20.00 to 39.99
~IIII 0.01 to 19.99
D 0.00
1.0 1.0

Streptococcus pneumonlae, Drug-resistant Invasive Disease
. Clinical Description: Pneumococcus may cause many clinical syndromes depending on the site of infection (e.g. otitis media, pneumonia, bacteremia, or meningitis). "Invasive" pneumococcal disease usually refers to bacteremia and/or meningitis, although S. pneumoniae infections involving other normally sterile sites such as joint, pleural, or peritoneal fluid are sometimes seen. Laboratory Criteria for Diagnosis: Isolation of S. pneumoniae from blood, cerebrospinal fluid, or other sterile site, and Intermediate and high level resistance (defined by National Committee for Clinical Laboratory Standards [NCCLS] approved methods and interpretive minimum inhibitory concentration [MIC] breakpoints) of the S. pneumoniae isolate to at least one antimicrobial
agent currently approved for use in treating pneumococcal infection.*
Surveillance case classification: Probable: A clinically compatible case caused by laboratory-confirmed culture of S. pneumoniae identified as "non-susceptible" (i.e., an oxacillin zone size of <20mm) when oxacillin screening is the only method of antimicrobial susceptibility testing performed. Confirmed: A clinically compatible case caused by laboratory-confIrmed S. pneumoniae identified as "non-susceptible" according to MIC interpretive breakpoints as outlined in NCCLS guidelines for susceptibility testing to any antimicrobial agent currently approved for
use in treating pneumococcal infection. *
Comment: NCCLS recommends that all invasive S. pneumoniae isolates that are found to be "possibly resistant" to beta-Iactams (i.e., an oxacillin zone size of <20mm) by oxacillin screening should undergo further susceptibility testing using a quantitative MIC method acceptable for penicillin, extended spectrum cephalosporins, and other drugs as clinically indicated.
* Minimum Inhibitory Concentration (MIC) Interpretive Standard (ug/ml) for S. pneumoniae;
NCCLS Guidelines 1994.
100

- - - - - - - - Syphilis - - - _.....,~

Syphilis is a complex sexually transmitted disease with a highly variable clinical course. Classification by a clinician with expertise in syphilis may take precedence over the following case definitions developed for surveillance purposes.
During the latter half of the 1980s, an epidemic of syphilis occurred in Georgia peaking in 1990, when 8,224 cases of syphilis were reported. The epidemic, which also occurred in the neighboring southern states, was associated with the use of crack cocaine and cocaine.

6(0)

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3(0)

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2(0)

1(0)

0

Reported Cases of Total Early Syphilis Georgia, 1992 - 1996
5199

92

93

94

95

96

Year

Reported Cases of Total Early Syphilis by Age

Georgia, 1995

1200 1004
1(0)

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101

- - - - - - - - - - Syphilis - - - - - ,~

1200

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Reported Cases of Total Early Syphilis by Age Georgia, 1996
739

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34

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102

~ - - - -Sy- phi- lis - - - - , ~
Primary Syphilis:
Clinical description: The characteristic lesion of primary syphilis is the chancre, but atypical primary lesions may occur. Laboratory criteria for diagnosis:
Demonstration of Treponema pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods
Surveillance case classification: Probable: A clinically compatible case with one or more ulcers (chancres)
consistent with primary syphilis and a reactive serologic test Confirmed: A clinically compatible case that is laboratory confirmed
Secondary Syphilis:
Clinical description: A stage of infection due to Treponema pallidum, characterized by localized or diffuse mucocutaneous lesions and generalized lymphadenopathy. Constitutional symptoms are common, and clinical manifestations are protean. The primary chancre may still be present. Laboratory criteria for diagnosis:
Demonstration of T. pallidum in clinical specimens by darkfield, fluorescent antibody, or equivalent microscopic methods
Surveillance case classification: Probable: A clinically compatible case with a reactive nontreponemal (VDRL,
RPR) test titer of greater than or equal to 4 Confirmed: A clinically compatible case that is laboratory confirmed
103

~---- Syph- ilis --_.
Early Latent Syphilis:
Clinical description: A subcategory of latent syphilis. When initial infection has occurred within the previous 12 months, latent syphilis is classified as early. Surveillance case classification: Presumptive: Latent syphilis (see above) of a person who has evidence of having
acquired the infection within the previous 12 months based on one or more of the following criteria: A nonreactive serologic test for syphilis or a nontreponemal titer that has dropped fourfold within the past 12 months A history of symptoms consistent with primary or secondary syphilis without a history of subsequent treatment in the past 12 months A history of sexual exposure to a partner with conflfmed or presumptive primary or secondary syphilis, or presumptive early latent syphilis, and no history of treatment in the past 12 months Reactive nontreponemal and treponemal tests from an individual whose only possible exposure occurred within the preceding 12 months
Late Latent Syphilis:
Clinical description: A subcategory of latent syphilis. When initial infection occurred more than one year earlier, latent syphilis is classified as late. Surveillance case classification: Presumptive: Latent syphilis (see above) of a patient who shows no evidence of
having acquired the disease within the past 12 months (see Early Latent Syphilis) and whose age and titer do not meet the criteria specified for unknown latent syphilis
104

"-

Syphilis

1~

Unknown Latent Syphilis:
Clinical description: A subcategory of latent syphilis. When the date of initial infection cannot be established as occurring within the previous year, and the patient's age and titer meet criteria described below, latent syphilis is classified as unknown latent.
Surveillance case classification: Presumptive: Latent syphilis (see above) that does not meet the criteria for early
latent syphilis, and the patient is 13 - 35 years of age with a nontreponemal test serologic titer of greater than or equal to 32
Neurosyphilis:
Clinical description: Evidence of central nervous system (CNS) infection with Treponema pallidum
Laboratory criteria for diagnosis: A reactive serologic test for syphilis and reactive VDRL in cerebrospinal fluid (CSF)
Surveillance case classification: Presumptive: Syphilis of any stage, a negative VDRL in CSF, and both of the
following: Elevated CSF protein or leukocyte count without other known causes of
these abnormalities Clinical symptoms or signs consistent with neurosyphilis without other
known causes for these clinical abnormalities
Confirmed: Syphilis, of any stage, that meets the laboratory criteria for neurosyphilis

105

'-

Congenital Sy..p..h.-i.l-is

1~

For reporting purposes, congenital syphilis includes cases of congenitally acquired syphilis in infants and children, as well as syphilitic stillbirths.

Surveillance case classification: Presumptive: Either of the following:
1) Any infant whose mother had untreated or inadequately treated syphilis at delivery, regardless of findings in the infant;

2) Any infant or child who has a reactive treponemal test for syphilis and anyone of the following: any evidence of congenital syphilis on physical examination any evidence of congenital syphilis on long-bone radiograph reactive cerebrospinal fluid (CSF) VDRL3 elevated CSF cell count or protein (without other cause) reactive test for FfA-ABS19S-IgM antibody

Confirmed:

Identification of Treponema pallidum by darkfield microscopy, fluorescent antibody, or other specific stains in specimens from lesions, placenta, umbilical cord, or autopsy material

A syphilitic stillbirth is defined as a fetal death in which the mother had untreated or inadequately treated syphilis at delivery of a fetus after a 20-week gestation or of a fetus weighing >500 grams. Inadequate treatment consists of any nonpenicillin therapy or penicillin given <30 days before delivery. Signs in an infant 2 years of age) may include hepatosplenomegaly, characteristic skin rash, condyloma lata, snuffles, jaundice (syphilitic hepatitis), pseudoparalysis, or edema (nephrotic syndrome). Stigmata in an older child may include: interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson's teeth, saddle nose, rhagades, or Clutton's joints.

106

_ _ _ Con.g..e.n.i.t.a-l _S.y.p-h..il-is

1~

It may be difficult to distinguish between congenital and acquired syphilis in a seropositive child after infancy. Signs may not be obvious and stigmata may not yet have developed. Abnormal values for CSF VDRL, cell count, and protein, as well as IgM antibodies, may be found in either congenital or acquired syphilis. Findings on long-bone radiographs may help, since these would indicate congenital syphilis. The decision may ultimately be based on maternal history and clinical judgment. The possibility of sexual abuse also needs to be considered. In 1989, a new, more sensitive surveillance case definition for congenital syphilis was introduced. The new case definition had greater sensitivity than the older definition. At around the same time, other areas greatly enhanced active case finding efforts for congenital syphilis. Consequently, the number of reported cases dramatically increased during 19891992. Although the change in case definition resulted in a period of transition when trends cannot be easily interpreted, by 1992 all reporting sources had implemented the new case definition and the reliability of trends has stabilized.

107

- - - - - - - Tetanus - - - ,k
Clinical case definition: Acute onset of hypertonia and/or painful muscular contractions (usually of the muscles of the jaw and neck) and generalized muscle spasms without other apparent medical cause (as reported by a health professional)
Surveillance case classification: Confirmed: A case that meets the clinical case definition

Reported Cases of Tetanus Georgia, 1987 - 1996
5

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87 88 89 90 91 92 93 94 95 96

Year

The occurrence of tetanus is sporadic and relatively uncommon in the United States, with only about 50 cases reported each year. In Georgia, three cases were reported between 1991 and 1995, all males 12 - 35 years of age.

108

- - - - - - - - Tuberculosis - - - ,
Tuberculosis (TB) is a disease caused by the organism Mycobacterium tuberculosis, sometimes referred to as the tubercle bacillus. TB is spread from person to person by airborne particles that contain M. tuberculosis. Diagnosis of TB can be made by clinical or laboratory criteria.
Clinical description: A chronic bacterial infection due to Mycobacterium tuberculosis characterized pathologically by formation of granulomas. The most common site of infection is the lung, but other organs may be involved.
Laboratory criteria for diagnosis: Isolation of M. tuberculosis bacilli from body secretions and/or tissues.
Surveillance case classification: Confirmed: A case which is laboratory confirmed, or in the absence of laboratory
confrrmation, a case that meets the clinical criteria

Reported Cases of Tuberculosis Georgia, 1987 1996

1000 889

en

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800

<:<$

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600

~
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400

z0 200

860

909 893

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87 88 89 90 91 92 93 94 95 96

Year

109

_ _ _ _T_ ube_ rcul_ osis_ _ _ _1~
TB case rates in Georgia steadily declined from mid-century until 1985, when case rates increased, rejecting a national increasing trend. This increase in TB cases in the U.S. has been attributed to decay of the public health infrastructure, the advent of HIV/AIDS, increased immigration, and transmission in congregate settings such as homeless shelters and correctional institutions. Since the yearly number of reported cases peaked in 1991 and 1992 for both Georgia and the nation, the number has gradually decreased. The decrease in TB cases is most likely due in large part to increased federal, state and local funding for TB prevention. With improved infrastructure for TB control programs, case rates are again declining nationally, despite the continued existence of the other factors. Georgia has consistently had case rates above the national average. In 1995, 746 cases were reported; 39% of the cases in 1995, were from the metropolitan Atlanta counties of Fulton and DeKalb. TB cases were predominantly male (66%), African American (66%) and native born (89%). In contrast to trends naturally showing a large proponent of TB cases, the foreign born remain a relatively small but increasing proportion of TB patients (11 % in 1995). At least 15% of TB cases were co-infected with HIV; the proportion is undoubtedly higher but HIV testing ofTB cases is incomplete.
110

State and County Totals 1995 to 1996
111

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995

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Baker

0.00 0.00 0.00 0.00

Baldwin

0.00 0.00 0.00 0.00

Banks

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Barrow

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Berrien

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Brantley

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Brooks

0.00 0.00 0.00 0.00

Bryan

0.00 0.00 0.00 0.00

Bulloch

0.00 0.00 0.00 0.00

Burke

0.00 0.00 0.00 0.00

Butts

0.00 0.00 0.00 0.00

Calhoun

0.00 0.00 0.00 0.00

Camden

0.00 0.00 0.00 0.00

Candler

0.00 0.00 0.00 0.00

Carroll

0.00 0.00 0.00 0.00

Catoosa

0.00 0.00 0.00 0.00

Charlton

0.00 0.00 0.00 0.00

Chatham

0.00 0.00 0.00 0.00

Chattahoochee 0.00 0.00 0.00 0.00

Chattooga

0.00 0.00 0.00 0.00

Cherokee

0.00 0.00 0.00 0.00

Clarke

0.00 0.00 0.00 0.00

Clay

0.00 0.00 0.00 0.00

Clayton

0.00 0.00 0.00 0.00

Clinch

0.00 0.00 0.00 0.00

Cobb

0.00 0.00 0.00 0.00 1

Coffee

0.00 0.00 0.00 0.00

Colquitt

0.00 0.00 0.00 0.00

Columbia

0.00 0.00 0.00 0.00

Cook

0.00 0.00 0.00 0.00

Coweta

0.00 0.00 0.00 0.00

Crawford

0.00 0.00 0.00 0.00

Crisp

0.00 0.00 0.00 0.00

Dade

0.00 0.00 0.00 0.00

Dawson

I 0.00 0.00 0.00 0.00

Decatur

0.00 0.00 0.00 0.00

Dekalb

0.00 0.00 0.00 0.17

Dodge

0.00 0.00 0.00 0.00

Dooly

0.00 0.00 0.00 0.00

Dougherty

0.00 0.00 0.00 0.00

Douglas

0.00 0.00 0.00 0.00

Early

0.00 0.00 0.00 0.00

Echols

0.00 0.00 0.00 0.00

Effingham

0.00 0.00 0.00 0.00

Elbert

0.00 0.00 0.00 0.00

Emanuel

0.00 0.00 0.00 0.00

Evans

0.00 0.00 0.00 0.00

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4.72 0.00

35.23 0.00

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44.04 0.00 0.00 0.00

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13.81 0.00 0.00 0.00

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164.80 0.00 0.00 0.00

4.81 0.00 0.00 0.00

37.36 0.00 0.00 0.00

0.00 0.00 0.00 0.00

60.96 0.00 0.00 0.00

37.60 0.00 0.00 0.00

85.12 0.00 0.00 0.00

53.60 0.00 0.00 0.00

111.54 0.00 0.00 0.00

147.30 0.00 0.00 0.00

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49.28 0.00 0.00 0.00

33.50 0.00 0.00 0.00

92.44 0.00 0.00 0.00

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124.85 0.00 0.00 0.00

32.85 0.00 0.00 0.00

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56.28 0.00 0.00 0.00

26.66 0.00 0.00 0.00

3.82 0.00 0.00 0.00

14.41 0.00 0.00 0.00

80.17 0.00 0.00 0.00

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112

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995

,

County Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee

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113

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995
,

County Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell . Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

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0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00

.l!:!
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<t:
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0.00 1.95 0.00 0.00 0.00 0.00 23.19 0.00 0.00 0.00 0.00 0.00 1.00 1.56 0.00 0.00 11.00 0.00 4.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.71 0.00 0.00 0.00 1.67 0.00 0.00 0.00 0.00 0.00 2.31 2.78 0.00 0.00 0.00 0.00 0.00 0.00 7.69 0.00 0.00 0.00 0.00

114

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995

.

I

I

W "5

U

~

LD

County Appling

:r2o
0.
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0.00

Atkinson

0.00

Bacon

0.00

Baker

27.59

Baldwin

2.43

Banks

0.00

Barrow

0.00

Bartow

0.00

Ben Hill

0.00

Berrien

0.00

Bibb

0.00

Bleckley

0.00

Brantley

0.00

Brooks

0.00

Bryan

0.00

Bulloch

0.00

Burke

0.00

Butts

0.00

Calhoun

0.00

Camden

0.00

Candler

0.00

Carroll

0.00

Catoosa

0.00

Charlton

0.00

Chatham

1.73

Chattahoochee 0.00

Chattooga

0.00

Cherokee

0.91

Clarke

2.10

Clay

0.00

Clayton

1.49

Clinch

0.00

Cobb

0.19

Coffee

0.00

Colquitt

2.67

Columbia

3.82

Cook

0.00

Coweta

0.00

Crawford

0.00

Crisp

0.00

Dade

0.00

Dawson

27.38

Decatur

0.00

Dekalb

3.94

Dodge

0.00

Dooly

9.98

Dougherty

1.03

Douglas

0.00

Early

16.91

Echols

0.00

Effingham

0.00

Elbert

0.00

Emanuel

0.00

Evans

0.00

2'
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0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

2.43 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

2.14 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

2.54 0.00

0.00 0.00

0.00 0.00

0.43 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.5710.38

0.00 0.00

0.00 0.00

0.00 2.55

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

1.37 0.00

0.00 0.00

0.00 0.00

0.00 2.06

1.23 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 4.71

0.00 0.00

I
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0.00 0.00 0.00 0.00 0.00 0.00 10.28

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 2.43

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 1.57 0.00 0.00 1.57 0.00 4.72

0.00 0.00 0.00 0.00 0.00 0.00 29.36

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 2.02 0.00 0.00 0.00 2.02

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 2.14

0.00 0.00 0.00 0.00 '0.00 0.00 0.00

0.00 0.00 6.23 0.00 0.00 0.00 6.23

0.00 20.45 0.00 0.00 0.00 0.00 0.00

0.00 2.77 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 1.27 0.00 5.08

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.87

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.91 0.00 0.91

0.00 0.00 0.00 0.00 0.00 0.00 1.05

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.50 0.00 0.00 1.49 0.00 1.49

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.57 0.19 0.00 0.95 0.00 1.33

0.00 0.00 0.00 0.00 0.00 0.00 9.38

0.00 0.00 0.001 0.00 2.67 0.00 8.00

0.00 0.00 1.27 0.00 0.00 0.00 1.27

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 1.64

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.34 0.00 1.37 0.00 0.51

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 3.08

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 3.25

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

4.81 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 25.07 0.00

0.00 1.27 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.43 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 4.48 0.00 0.00 0.00 0.00

0.00 0.91 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.99 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.57 0.00 0.00 0.19 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

1.64 1.64 0.00 0.00 0.00 0.00

0.00 10.56 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.34 0.51 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

4.71 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00

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0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.43 0.00

0.00 0.00

4.48 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.19 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

1.03 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

10.31 0.00

0.00 0.00

0.00 0.00

rn

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0
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(j)

30.44 12.18

16.68 33.35

20.55 10.28

27.59 0.00

41.34 0.00

0.00 0.00

5.87 20.54

3.15 0.00

41.10 46.97

6.91 48.35

49.15 11.45

9.13 0.00

15.40 0.00

43.83 12.52

5.54 5.54

14.98 17.12

9.62 14.43

18.68 6.23

20.45 20.45

13.85 2.77

0.00 0.00

12.70 16.51

0.00 4.29

0.00 11.15

22.96 28.59

0.00 0.00

4.48 4.48

10.87 12.68

49.37 88.23

0.00 0.00

15.92 22.38

98.54 82.12

21.79 22.36

34.39 59.40

18.66 5.33

21.66 11.47

50.44 100.88

18.00 32.72

0.00 0.00

14.37 4.79

0.00 0.00

9.13 9.13

22.96 3.83

23.28 20.54

5.65 0.00

0.00 0.00

46.26 19.53

9.85 24.62

25.37 16.91

0.00 0.00

9.74 3.25

20.61 5.15

4.71 9.43

0.00 22.12

115

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995

County Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee

:'
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co
~m
a.
Ql
I
5.91 0.00 0.00 1.90 0.00 2.05 0.00 0.00 0.00 0.00 4.76 8.12 0.68 3.40 2.78 0.00 0.00 0.00 9.49 0.00 2.79 0.00 0.00 3.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.69 0.00 0.00 2.45 0.00 7.42 0.00 0.00 4.63 0.00 0.00 0.00 4.84 0.00 0.00 0.00 3.34 1.06 2.00 0.00

2
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0.00 5.91

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.73 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.45 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

3.09 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

3.34 0.00

0.00 0.53

0.00 0.00

0.00 0.00

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0.00 0.00 0.00 0.00 0.00 0.00 1.21 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 1.20 0.00 0.00 0.00 0.00

0.00 1.90 0.00 0.00 0.00 0.00 0.00 0.00 1.90 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.44 0.44 0.00 1.46 0.00 2.78 0.00 1.03 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.81 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.90 0.45 0.45 0.23 0.23 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 4.21 0.00 4.21 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 2.79 0.00 5.57 0.00 1.39 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00' 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.48 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 5.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 1.23 2.45 0.00 0.00 0.00 1.23 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 10.84 5.42 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 6.68 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 1.06 0.00 0.53 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 5.99 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00, 0.00 0.00 0.00

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116

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995
.

County Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

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117

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995
I
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County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans

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0.00 0.00 0.00 24.21 0.00

0.00 0.00 0.00 14.41 0.00

0.00 0.00 0.00 6.54 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 4.79 0.00

0.00 0.00 0.00 7.30 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 11.48 0.00

1.37 0.00 0.00 15.92 0.00

0.00 0.00 0.00 11.29 0.00

0.00 0.00 0.00 9.98 0.00

0.00 0.00 0.00 14.39 0.00

0.00 0.00 0.00 1.23 0.00

0.00 0.00 0.00 8.46 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 6.49 0.00

0.00 0.00 0.00 36.07 0.00

4.71 0.00 0.00 56.55 0.00

0.00 0.00 0.00 11.06 0.00

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118

.
County Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995

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0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 5.56 11.86 41.44

0.00 0.00 6.81 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 2.55 0.00 0.00

0.00 0.00 0.00 4.76 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 1.81 0.90 1.58

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 10.90 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 9.49 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 1.39

0.00 0.00 1.01 2.03 2.03

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 3.09 0.00

0.00 0.00 0.00 0.00 11.70

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 11.38

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 11.72

0.00 0.00 0.00 0.00 25.23

0.00 0.00 0.00 29.94 14.97

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 4.76 2.38

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 12.99 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 1.23 6.14 3.68

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 7.42

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 17.67 17.67

0.00 0.00 4.63 4.63 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 17.64 13.23

0.00 0.00 16.09 80.44 16.09

0.00 0.00 4.84 0.00 4.84

0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 3.34

0.00 0.00 0.00 9.57 28.70

0.00 0.00 0.00 2.00 7.99

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0.00 0.00 0.00 5.69 0.00

0.00 0.00 0.00 24.51 0.00

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0.00 0.00 0.00 15.38 0.00

0.00 0.00 0.00 8.59 0.00

0.00 0.00 0.00 6.04 0.00

7.42 0.00 0.00 22.26 0.00

0.00 0.00 0.00 4.42 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 13.90 0.00

0.00 0.00 0.00 10.12 0.00

8.82 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 24.22 0.00

0.00 0.00 0.00 5.42 0.00

0.00 0.00 0.00 13.28 0.00

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119

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1995

County Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

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0.00 0.00 0.00 4.12

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0.00 0.00 0.00 0.00

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0.00 0.00 0.00 4.92

0.00 2.71 16.26 2.71

0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00

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0.00 0.00 3.80 0.00

0.00 0.00 1.65 1.65

0.00 0.00 4.62 4.62

0.00 2.78 0.00 0.00

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0.00 0.00 0.00 0.00

0.00 0.00 0.00 44.46

0.00 0.00 0.00 19.55

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0.00 0.00 0.00 13.79

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120

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County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd

Notifiable Diseases in Georgia Case Counts by County - 1995

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0 0 0 0 0 0 3 0 0 0 0 0 13 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 16 0 67 0 0 0 0 0 0 130 0 0 0 0 0 2 0 0 0 0 0 0 0 1

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171

County Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike

Notifiable Diseases in Georgia Case Counts by County - 1995

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County Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Notifiable Diseases in Georgia Case Counts by County - 1995

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123

County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd

Notifiable Diseases in Georgia Case Counts by County - 1995

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124

,
County Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike

Notifiable Diseases in Georgia Case Counts by County - 1995

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County Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Notifiable Diseases in Georgia Case Counts by County - 1995

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126

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996

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Appling

0.00 0.00 0.00 0.00 12.09 0.00 126.91 0.00 0.00 0.00 0.00 0.00 24.17 78.56 6.04 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Atkinson

0.00 0.00 0.00 0.00 0.00 0.00 16.85 0.00 0.00 0.00 0.00 0.00 67.41 101.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Bacon

0.00 0.00 0.00 0.00 0.00 0.00 112.83 0.00 0.00 0.00 0.00 0.00 30.77 92.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Baker

0.00 0.00 0.00 0.00 0.00 0.00 55.48 0.00 0.00 0.00 0.00 0.00 0.00 138.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Baldwin

0.00 0.00 0.00 0.00 7.24 0.00 301.74 0.00 2.41 0.00 0.00 0.00 2.41 531.05 4.83 0.00 0.00 2.41 0.00 0.00 0.00 0.00

Banks

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 86.13 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00

Barrow

0.00 0.00 0.00 0.00 5.72 0.00 65.83 0.00 0.00 0.00 0.00 0.00 0.00 217.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Bartow

0.00 0.00 0.00 0.00 6.14 0.00 96.78 0.00 1.54 0.00 0.00 0.00 3.07 69.13 0.00 0.00 0.00 1.54 0.00 0.00 0.00 0.00

Ben Hill

0.00 0.00 0.00 0.00 11.65 0.00 267.86 0.00 0.00 0.00 0.00 0.00 11.65 605.60 0.00 0.00 0.00 5.82 5.82 0.00 0.00 0.00

Berrien

0.00 0.00 0.00 0.00 6.88 0.00 20.65 0.00 0.00 0.00 0.00 0.00 6.88 158.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Bibb

0.00 0.00 0.00 0.00 4.05 0.00 392.69 0.00 0.67 0.00 0.00 0.00 2.02 531.68 0.67 0.00 0.00 0.67 1.35 0.00 0.00 0.00

Bleckley

0.00 0.00 0.00 0.00 0.00 0.00 63.47 0.00 0.00 0.00 0.00 0.00 9.07 235.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Brantley

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 37.46 7.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Brooks

0.00 0.00 0.00 0.00 6.23 0.00 6.23 0.00 0.00 0.00 0.00 0.00 0.00 149.45 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Bryan

0.00 0.00 0.00 0.00 0.00 0.00 48.47 0.00 0.00 0.00 0.00 0.00 0.00 21.54 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Bulloch

0.00 0.00 0.00 0.00 8.43 0.00 259.35 0.00 0.00 0.00 0.00 0.00 6.33 215.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Burke

0.00 0.00 0.00 0.00 0.00 0.00 14.41 0.00 0.00 0.00 0.00 0.00 4.80 76.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Butts

0.00 0.00 0.00 0.00 0.00 0.00 30.89 0.00 0.00 0.00 0.00 0.00 6.18 61.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Calhoun

0.00 0.00 0.00 0.00 0.00 0.00 41.25 0.00 0.00 0.00 0.00 0.00 0.00 288.78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Camden

0.00 0.00 0.00 0.00 0.00 0.00 85.89 0.00 2.68 0.00 0.00 0.00 2.68 91.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Candler

0.00 0.00 0.00 0.00 12.50 0.00 199.95 0.00 0.00 0.00 0.00 0.00 0.00 199.95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Carroll

0.00 0.00 0.00 0.00 14.97 0.00 88.58 0.00 0.00 0.00 0.00 0.00 1.25 230.81 0.00 0.00 0.00 1.25 0.00 0.00 0.00 0.00

Catoosa

10.00 0.00 0.00 0.00 10.54 0.00 56.90 0.00 0.00 0.00 2.11 0.00 4.21 12.64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Charlton

0.00 0.00 0.00 0.00 22.14 0.00 143.88 0.00 0.00 0.00 0.00 0.00 22.14 387.38 0.00 0.00 0.00 0.00 0.00 0.00 11.07 0.00

Chatham

0.00 0.00 0.00 0.00 4.28 0.00 190.08 0.00 0.43 0.00 0.43 0.00 2.14 371.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Chattahoochee 0.00 0.00 0.00 0.00 0.00 0.00 39.47 0.00 0.00 0.00 0.00 0.00 0.00 22.55 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Chattooga

0.00 0.00 0.00 0.00 4.48 0.00 44.80 0.00 0.00 0.00 0.00 0.00 0.00 35.84 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Cherokee

0.00 0.00 0.00 0.00 6.11 0.00 17.47 0.00 0.87 0.00 2.62 0.00 3.49 27.95 0.00 0.00 0.00 1.75 0.00 0.00 0.00 0.00

Clarke

0.00 0.00 0.00 0.00 50.67 0.00 120.99 0.00 0.00 0.00 2.07 0.00 3.10 433.29 0.00 0.00 0.00 2.07 0.00 0.00 0.00 0.00

Clay

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 59.63 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Clayton

0.00 0.00 0.00 0.00 7.81 0.00 162.09 0.00 1.95 0.00 0.49 0.00 2.44 161.12 0.98 0.00 0.00 4.88 0.00 0.00 0.00 0.00

Clinch

0.00 0.00 0.00 0.00 16.52 0.00 49.55 0.00 0.00 0.00 0.00 0.00 16.52 280.81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Cobb

0.00 0.00 0.00 0.00 12.87 0.00 136.46 0.00 0.74 0.00 0.37 0.00 4.78 176.73 1.66 0.00 0.00 4.97 0.00 0.00 0.00 0.00

Coffee

0.00 0.00 0.00 0.00 12.33 0.00 52.41 0.00 0.00 0.00 0.00 0.00 30.83 336.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Colquitt

0.00 0.00 0.00 0.00 0.00 0.00 31.87 0.00 0.00 0.00 0.00 0.00 10.62 361.16 0.00 0.00 0.00 7.97 0.00 0.00 0.00 0.00

Columbia

0.00 0.00 0.00 0.00 14.82 0.00 7.41 0.00 1.24 0.00 0.00 0.00 4.94 13.59 0.00 0.00 0.00 0.00 1.24 0.00 0.00 0.00

Cook

0.00 0.00 0.00 0.00 7.17 0.00 64.54 0.00 0.00 0.00 0.00 0.00 7.17 57.37 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00

Coweta

0.00 0.00 0.00 0.00 1.60 0.00 86.34 0.00 0.00 0.00 1.60 0.00 1.60 140.71 0.00 0.00 0.00 3.20 0.00 0.00 0.00 0.00

Crawford

0.00 0.00 0.00 0.00 10.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 73.33 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Crisp

0.00 0.00 0.00 0.00 4.75 0.00 308.99 0.00 4.75 0.00 0.00 0.00 0.00 76.06 0.00 0.00 0.00 4.75 0.00 0.00 0.00 0.00

Dade

0.00 0.00 0.00 0.00 7.25 0.00 14.49 0.00 0.00 0.00 0.00 0.00 0.00 14.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Dawson

0.00 0.00 0.00 0.00 8.89 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35.57 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Decatur

0.00 0.00 0.00 0.00 15.24 0.00 83.82 0.00 0.00 0.00 0.00 0.00 3.81 346.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Dekalb

0.00 0.00 0.00 0.00 9.29 0.00 217.59 0.00 0.00 0.00 0.51 0.00 18.41 356.12 0.68 0.00 0.00 10.81 0.51 0.00 0.00 0.00

Dodge

0.00 0.00 0.00 0.00 0.00 0.00 22.58 0.00 0.00 0.00 0.00 0.00 0.00 129.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Dooly

0.00 0.00 0.00 0.00 0.00 0.00 59.81 0.00 0.00 0.00 0.00 0.00 0.00 169.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Dougherty

0.00 0.00 0.00 0.00 15.39 0.00 213.46 0.00 1.03 0.00 0.00 0.00 9.24 678.34 2.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Douglas

0.00 0.00 0.00 0.00 7.21 0.00 60.07 0.00 1.20 0.00 1.20 0.00 0.00 157.39 0.00 0.00 0.00 1.20 0.00 0.00 0.00 0.00

Early

0.00 0.00 0.00 0.00 0.00 0.00 144.01 0.00 0.00 0.00 0.00 0.00 0.00 313.43 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Echols

0.00 0.00 0.00 0.00 41.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Effingham

0.00 0.00 0.00 0.00 9.43 0.00 22.01 0.00 0.00 0.00 0.00 0.00 6.29 22.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Elbert

0.00 0.00 0.00 0.00 0.00 0.00 30.80 0.00 0.00 0.00 0.00 0.00 0.00 179.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Emanuel

0.00 0.00 0.00 0.00 0.00 0.00 74.98 0.00 0.00 0.00 0.00 0.00 9.37 173.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

127

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996

County Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee

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0.00 0.00 0.00 0.00 3.29 0.00 373.19 0.00 0.00 0.00 0.00 0.00 3.29 378.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 37.21 0.00 29.77 0.00 0.00 0.00 0.00 0.00 0.00 37.21 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 18.11 0.00 126.78 0.00 0.00 0.00 0.00 0.00 2.26 239.98 0.00 0.00 0.00 0.00 2.26 0.00 0.00 0.00

0.00 0.00 0.00 0.00 38.87 0.00 294.26 0.00 2.78 0.00 0.00 0.00 16.66 555.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 15.66 0.00 313.28 0.00 0.00 0.00 0.00 0.00 0.00 234.96 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 14.93 0.00 169.24 0.00 0.00 0.00 0.00 0.00 0.00 278.75 9.96 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 4.25 0.00 72.23 0.00 0.00 0.00 0.00 0.00 0.00 114.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 179.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 19.47 0.00 0.00 0.00 0.00 0.00 0.00 155.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 6.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27.01 0.00 0.00 0.00 13.50 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 41.70 0.00 109.94 0.00 0.00 0.00 0.00 0.00 1.26 70.76 0.00 0.00 0.00 2.53 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 27.49 0.00 27.49 0.00 0.00 0.00 0.00 0.00 0.00 68.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 74.52 0.00 0.00 0.00 0.00 0.00 0.00 93.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 9.46 0.00 18.92 0.00 0.00 0.00 0.00 0.00 0.00 350.05 0.00 0.00 0.00 9.46 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 62.36 0.00 0.00 0.00 0.00 0.00 4.80 254.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

129

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996

County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel

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0.00 0.00 0.00 0.00 0.00 5.39 0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 0.00 2.68 0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 0.00 2.50 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 2.11 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 11.07 0.00 0.00 0.00 0.00 0.00

0.86 0.00 0.00 0.43 0.00 0.43 0.00 0.43 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 13.44 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 2.62 0.00 0.87 0.00 0.00 0.00

0.00 0.00 0.00 1.03 0.00 2.07 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.98 0.00 1.95 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.37 0.00 2.02 0.18 0.18 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 6.17 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 2.66 0.00 0.00 0.00 0.00 0,00 0.00

0.00 0.00 0.00 0.00 0.00 2.47 0.00 1.24 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 1.60 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.81 0.00 0.00 0.00

0.34 0.00 0.00 1.69 0.00 0.68 0.17 0.68 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 5.65 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 3.08 0.00 0.00 0.00 0.00 0.00

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130

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996

,
County Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee

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0.00 0.00 0.00 11.82 1 0.00 0.00 0.00 0.00 0.00 0.00

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9.48 0.00 0.00

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0.00 0.00 0.00

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10.96 1.99 0.00

11.54 11.54 0.00

3.04 0.00 0.00

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26.64 1.21 0.00

5.91 11.82 0.00

7.39 0.00 0.00

0.00 0.00 13.08

0.00 0.00 0.00

9.15 9.15 0.00

0.00 0.00 9.89

0.00 0.00 0.00

0.00 0.00 0.00

0.00 0.00 0.00

0.00 0.00 0.00

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131

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996

County Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

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0.00 0.00 0.00 0.00 0.00 18.70 0.00 0.00 0.00 0.00 0.00 0.00 9.35 0.00 9.35 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 1.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.52 3.76 3.76 0.00 3.76

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.94 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 11.81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 47.24 5.90 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 83.39 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.21 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 2.89 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.89 2.89 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.89 0.00 12.89 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.92 7.92 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 3.45 0.00 2.46 0.00 0.00 0.00 0.00 0.00 0.00 21.69 12.81 6.41 0.49 5.42

0.00 0.00 0.00 0.00 0.00 3.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.56 19.61 3.02 0.00 1.51

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.64 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.01 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 5.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.19 3.48 1.74 0.00 3.48

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24.56 0.00 16.37 0.00 4.09

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ' 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00

0.00 0.00 0.00 0.00 0.00 3.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.08 3.18 0.00 0.00 3.18

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 198.66 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00, 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.84 0.00 0.00 0.00 0.00

0.00 0.00 0.00' 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.21

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.54 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 9.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.48

0.00 0.00 0.00 0.00 0.00 4.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.20 14.64 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.43 0.00 0.00 2.69 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 46.99 31.331 0.001 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00 0.00' 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00

0.00 0.00

0.00 1.64

'

0.00 0.00

0.00 0.00 0.00. 0.00

0.00 0.001 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 9.86 6.58 4.93 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.99 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.33 0.00 0.001 0.00 0.00

1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.80 0.00 0.00 0.00 0.00 0.00 0.00 7.60 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.64 0.00 0.00 0.00 0.00 0.00 0.00 1.64 0.00 16.42 136.32 0.001 0.00 0.00

0.00 0.00 0.00 0.001 0.00 2.26 0.00 2.26 0.00 0.00 0.00 0.00 0.00 0.00 9.06 0.00 4.531 2.26 6.79

0.00 0.00 0.00 2.781 0.00 5.55 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00 124.92 49.97 2.78 2.78 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 O~OO 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 4.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.25 0.00 4.25 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00 269.06 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00' 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00' 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 1.26 2.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.85 36.65 3.79 0.00 2.53

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41.23 0.00 0.00 0.00 0.00

0.00 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.001 0.00 0.00 18.63 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.46 0.00 0.00 0.001 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.001 0.00 0.00 0.00 4.80 0.00 0.001 0.00 4.80

132

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996
,

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Appling

0.00 0.00

Atkinson

0.00 0.00

Bacon

0.00 0.00

Baker

27.74 0.00

Baldwin

2.41 0.00

Banks

0.00 0.00

Barrow

5.72 0.00

Bartow

1.54 1.54

Ben Hill

0.00 0.00

Berrien

0.00 0.00

Bibb

2.02 4.72

Bleckley

0.00 9.07

Brantley

0.00 0.00

Brooks

0.00 0.00

Bryan

0.00 5.39

Bulloch

0.00 6.33

Burke

4.80 19.21

Butts

0.00 0.00

Calhoun

0.00 0.00

Camden

0.00 0.00

Candler

0.00 0.00

Carroll

3.74 8.73

Catoosa

0.00 0.00

Charlton

0.00 33.20

Chatham

2.57 7.28

Chattahoochee

0.00 0.00

Chattooga

0.00 0.00

Cherokee Clarke

I 0.00 0.00 0.00 0.00

Clay

0.00 0.00

Clayton

0.98 0.98

Clinch

0.00 0.00

Cobb

2.76 4.97

Coffee

0.00 0.00

Colquitt

7.97 5.31

Columbia

0.00 0.00

Cook

0.00 0.00

Coweta

6.40 4.80

Crawford

0.00 0.00

Crisp

0.00 9.51

Dade

0.00 0.00

Dawson

0.00 0.00

Decatur

0.00 3.81

Dekalb

3.89 7.77

Dodge

5.65 5.65

Dooly

0.00 0.00

Dougherty

13.34 16.42

Douglas

0.00 6.01

Early

8.47 33.88

Echols

0.00 0.00

Effingham

0.00 0.00

Elbert

0.00 25.67

Emanuel

0.00 0.00

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33.70i 0.00

10.26 0.00

0.00 0.00

4.83 12.07

0.00 8.61

0.00 2.86

12.29 0.00

17.47 5.82

0.00 ' 0.00 23.62 20.24

9.07 0.00

0.00 0.00

0.00 0.00

10.77 0.00

25.30 2.11

14.41 4.80

6.18 0.00

0.00 41.25

0.00 0.00

0.00 0.00

43.67 4.99

0.00 0.00

44.27 0.00

16.27 5.14

0.00 0.00

8.96 0.00

1.75 0.87

1.03 3.10

0.00 29.82

8.30 8.30

0.00 0.00

6.62 9.01

15.41 6.17

13.28 31.87

3.71 0.00

0.00 0.00

55.96 1.60

0.00 O.OC

0.00 33.28

0.00 0.00

0.00 0.00

0.00 7.62

19.26 19.60

22.58 0.00

0.00 9.97

44.13 30.79

1.20 2.40

76.24 33.88

0.00 0.00

3.14 0.00

87.28 5.13

23.43 0.00

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0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

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I-
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

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0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

133

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996

County

Evans

Fannin

Fayette

Floyd

Forsyth

Franklin

Fulton

Gilmer

Glascock

Glynn

Gordon

Grady

Greene

Gwinnett

Habersham

Hall

Hancock

Haralson

Harris

Hart

-----

Heard

Henry

Houston

Irwin

Jackson

Jasper

Jeff Davis

Jefferson

Jenkins

Johnson

Jones

Lamar

Lanier

Laurens

Lee

Liberty

Lincoln

Long

Lowndes

Lumpkin

Macon

Madison

Marion

Mcduffie

Mcintosh

Meriwether

Miller

Mitchell

Monroe

Montgomery

Morgan

Murray

Muscogee

2:-
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0.00 I 0.00
0.00 1.19 0.00 0.00 8.41 0.00 0.00 0.00 2.50 4.74 0.00 0.65 0.00 0.91 0.00 12.46 0.00 4.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.92 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.89 0.00 0.00 43.47 5.35 0.00 7.03 0.00 3.16

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134

Notifiable Diseases in Georgia Disease Rates (per 100,000 population) by County - 1996
,

County Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

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135

Notifiable Diseases in Georgia Case Counts by County - 1996

County
Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd

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Notifiable Diseases in Georgia Case Counts by County - 1996

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County Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Notifiable Diseases in Georgia Case Counts by County - 1996

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Notifiable Diseases in Georgia Case Counts by County - 1996

.
County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd

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County
Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike

Notifiable Diseases in Georgia Case Counts by County - 1996

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aaa aaaa1 a a a 6 1 aa 2a a 2 4 a a a 1 a a

a1 a aaaa5 a a a 7 a a3 aa a a 1 a a a 4 a a

aaa aaaaa a a a a a aa aa a a a a a a 1 a a

aaa aaaa1 a a a 6 2 2a aa a 5 a 1 a a 3 a a

aaa aaaa2 a a a a a a1 a1 a 2 a a a a 3 a a

a 1 a a a a a 6 a a a 3 a a a a a 1 12 1 1 a a 2 a a

aaa aaaa3 a a a a a aa aa a 2 a a a a 1 a a

a 1 a a a a a a a a a 3 a a a a 9 12 26 2 a a a 6 a a

a1 a aaaa4 a a a a a aa a1 a 2 5 a a a a a a

aaa aaaaa a a a a a aa aa a a a a a a a a a

aaa aaaa4 a a a 4 a aa a1 1 5 2 a a a a a a

a1a aaaaa a a a 5 3 a2 1a a a a a a a 3 a a

a 3 a 1 a a a 5 a a a 9 16 a a 2 6 25 80 23 1 a a 29 a a

a1a 2 aaa4 a a a 7 8 4 1 1a a 1 8 a a a 2 a a

a 1 a a a a a 9 a 1 a 7 6 a a a a a 1 1 a a a a o. a

a2 a aaaa4 a 1 a 1 a aa aa 1 a 1 a a a a a a

a1a aaaaa a a a 4 2 2 a 2a 1 a a a a a 3 a a

aaa aaaaa a a a a 2 aa aa 1 1 9 a a a 1 a a

a2a aaa0 a a a a a 8 1a a0 a a a 0 a 0 a a a

a a a a a a 0 2 0 a a 12 a 0 a a a a 2 a 0 a a 4 a a

aaa aaaa2 a a a 2 a aa aa 3 7 0 a 0 a 1 0 0

140

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County Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Notifiable Diseases in Georgia Case Counts by County - 1996

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141