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Annual Summary of Infectious Diseases 2010

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Annual summary of infectious diseases

Annual Summary of Infectious Diseases 2010

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              HAEMOPHILUS INFLUENZAE, INVASIVE
BRUCELLOSIS
LEGIONELLOSIS
VIBRIOSIS
SYPHILIS
E. COLI O157:H7 & STEC
ROCKY MOUNTAIN SPOTTED FEVER
MENINGOCOCCAL DISEASE, INVASIVE
HEPATITIS C, ACUTE
CREUTZFELDT-JAKOB DISEASE
MALARIA
BOTULISM
GONORRHEA
RABIES IN ANIMALS
TYPHOID FEVER
S. PNEUMONIAE, INVASIVE <5 YEARS OLD
SALMONELLOSIS
WEST NILE
TUBERCULOSIS
CAMPYLOBACTERIOSIS
CRYPTOSPORIDIOSIS
MUMPS
LISTERIOSIS
HEPATITIS A, ACUTE
LYME DISEASE
PERTUSSIS
CHLAMYDIA
ANTHRAX
HEPATITIS B, ACUTE
EHRLICHIOSIS
TULAREMIA
SHIGELLOSIS
‘01 ‘10
‘01 ‘10
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‘01 ‘10
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‘01 ‘10
‘01 ‘10
‘01 ‘10
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‘01 ‘10
‘01 ‘10
‘01 ‘10
‘10
‘01
‘01
‘10
‘01 ‘10
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‘01 ‘10
‘01 ‘10
1 92 235 15 105 104 0
0 185 69 32 7 48 36 0
18
6
41
0
1
5
6
1
2
4,818
4,369
60
62
1
1
58
55
503
752
0
1
194
86
308
448
16
1 122
0 2
9
116
6
0
0
43
199
10,622
14,302
0
0
115
115
7
8
148
416
24
107
2010
OKLAHOMA STATE DEPARTMENT OF HEALTH
ANNUAL SUMMARY OF
INFECTIOUS DISEASES
Executive Summary
2010 Annual Summary of Infectious Diseases
The Oklahoma State Department of Health (OSDH) is pleased to send you a copy of the 2010 Annual Summary of
Infectious Diseases. The information contained in this report consolidates summaries of communicable disease
surveillance and investigations conducted by the OSDH during 2010. Communicable disease summaries were
written by personnel in the OSDH Acute Disease Service, HIV/STD Service, and the Public Health Laboratory.
Specifically, the annual summary contains information on the number and incidence rate of infectious disease reports
at the state and county level, disease specific data collected during public health investigations, and summaries of
program activities.
Title 63 Oklahoma Statute §1-503 as well as Oklahoma Administrative Code (OAC) Title 310, Chapter 515 require
that healthcare providers and laboratories report cases of certain communicable diseases to the OSDH. This allows
the surveillance, investigation, and control of the spread of disease in the population by public health personnel. A
list of the Oklahoma notifiable disease rules is included in this annual summary for your reference. The diseases
listed in the Oklahoma disease reporting rules must be reported, along with patient identifiers, demographics, and
contact information, to the OSDH upon discovery as dictated in sections OAC 310:515-1-3 and OAC 310:515-1-4.
The current “Oklahoma Disease Reporting Manual” is the standard reference for disease-specific diagnostic test
results to be reported. The current edition of the "Oklahoma Disease Reporting Manual" and additional disease
reporting resources may be accessed from the Acute Disease Service disease reporting web page of the OSDH web
site at http://IDReportingAndAlerts.health.ok.gov.
Several service areas of the OSDH as well as the county health departments are charged with surveillance,
investigation, and control of spread of communicable diseases. Summarized below are a few notable observations
regarding the epidemiology of communicable diseases in Oklahoma reported during 2010.
In 2010, 199 cases of pertussis were reported, a 70% increase from the 117 cases reported in 2009. In addition to
the increase from 2009, pertussis cases were the highest they have been since 1985 when 209 cases were reported.
Several local community increases were observed in different parts of the state contributing to the larger number of
cases for the state. Ten cases were reported in Pittsburg county residents leading to an incidence rate (IR)
approximately four times the state’s rate (21.8 per 100,000). Additionally, Tulsa county saw an increase in cases
beginning mid fall and continuing through the end of the year, giving the county a total of 88 cases with an incidence
rate almost three times the state’s rate (14.6 per 100,000). Pertussis occurs in persons of all ages, but
disproportionately affects children less than one year of age. Nearly half of all cases in 2010 were in children less
than five years of age, with 28% in infants less than one year of age (IR = 100.6 per 100,000) and followed by 20% in
children one to four years of age (IR = 18.0 per 100,000). Forty-seven percent of infants less than one year of age
were hospitalized compared to 3.5% of all other ages.
Public health efforts of timely case diagnosis, contact investigation, administration of therapy, prevention, and
education, have resulted in a steady decline of tuberculosis (TB) in Oklahoma. The incidence rate of TB has
declined 52% from 178 (5.2 per 100,000) cases in 2004 to 86 (2.3 per 100,000) cases in 2010. Racial disparities
continued to occur among reported TB cases. In particular, the highest rates of reported TB cases occurred among
persons who reported their race as Asian (22.3 per 100,000), American Indian/Alaska Natives (4.7 per 100,000), and
Black (3.4 per 100,000) compared to persons who reported their race as White (1.1 per 100,000). Foreign born
individual accounted for 27% of reported TB cases in Oklahoma. Prevention, early diagnosis, and treatment are
paramount to successful tuberculosis control. TB should be considered in the differential diagnosis of persons
presenting with a productive cough, bloody sputum, fevers, and/or unexplained weight loss. Early suspicion and
testing are of utmost importance.
In March 2010, the OSDH rapidly responded to an outbreak of invasive meningococcal disease in a rural school
district in Northeastern Oklahoma. Five cases of invasive meningococcal disease were identified during this
investigation, including two deaths. Exposed contacts were rapidly identified and recommended to receive antibiotic
prophylaxis. During standard investigations of sporadic cases, individuals recommended to receive antibiotic
prophylaxis are referred to their private health provider for medication. Because of the magnitude of this outbreak,
epidemiologists in the Acute Disease Service and the local county health department (Rogers CHD) immediately
conducted clinics at the school to administer chemoprophylaxis to exposed individuals to prevent subsequent cases.
A total of 941 individuals were prophylaxed during these clinics. Laboratory testing subsequently identified serogroup
C as the causative serogroup and molecular subtyping of isolates revealed all outbreak-associated cases had an
indistinguishable pulsed-field gel electrophoresis pattern, which suggested a common exposure among all cases.
Based upon meningococcal outbreak control guidance and the recommendation to provide meningococcal vaccine in
which cases are due to serogroups included in the vaccine, a mass immunization clinic was held at the school to
administer meningococcal vaccine for future protection. Vaccination clinics that targeted students pre-K through
seniors, as well as faculty and employees, were conducted by Immunization Service and the Rogers CHD; 1,486
persons received the vaccine.
Significant racial and age disparities continue among reported sexually transmitted diseases. In particular, the
highest rates of reported HIV/AIDS, chlamydia and gonorrhea cases occurred among African Americans. In 2010,
the incidence rate of reported gonorrhea cases was 18.8 times higher among African Americans compared to the
incidence rate among Whites. Similarly, the incidence rate of reported chlamydia cases among African Americans
was 6.4 times higher than among Whites. The highest age-specific incidence rates of reported chlamydia and
gonorrhea cases occurred among young adults 15 to 19 years of age and 20 to 24 years of age.
The OSDH Public Health Laboratory continues to perform serogroup identification and pulsed-field gel
electrophoresis (PFGE), a molecular method of DNA fingerprinting, on all submitted Salmonella isolates. PFGE
subtyping complements disease surveillance by detecting clusters of indistinguishable PFGE patterns among isolates
of Oklahoma cases as well as patterns identified by other state public health laboratories. Once clusters are
detected, public health officials rapidly investigate to identify a common source and coordinate with food regulatory
agencies to initiate product recalls when indicated, which prevents the continued occurrence of illness among
persons who may consume the implicated products.
In 2010, two multistate outbreaks of salmonellosis involving Oklahoma residents were investigated to determine a
potential source of infection. One was a multistate outbreak of S. Chester associated with consumption of single-serve
frozen entrées; 44 cases from 18 states were identified in this outbreak, including one Oklahoma case.
Another multistate outbreak involving Oklahoma residents was due to S. Enteritidis; approximately 1,939 cases
nationwide were associated with this outbreak, including 7 from Oklahoma. An epidemiologic investigation
conducted by state public health officials and CDC determined consumption of shell eggs was associated with
development of illness. Results from the public health investigation prompted a traceback investigation by the U.S.
Food and Drug Administration (FDA) to determine the common source of these shell eggs. The affected eggs were
then recalled, and recommendations for safe food handling were provided to egg producers, retail and food
establishments, and the public.
It is part of our continuing efforts to return useful information to you from the data you have reported to us. Use of
this summary should give you a better idea of the incidence of reportable infectious diseases in your community and
epidemiologic trends of infectious diseases in the state of Oklahoma. Additional summaries of reportable diseases in
Oklahoma and resources on disease reporting are available on the OSDH website at http://www.ok.gov/health.
Table of Contents
Oklahoma State Department of Health Contact Information by Service ........................................................... 4
List of Contributors............................................................................................................................................... 5
Oklahoma State Department of Health Communicable Diseases Reporting Rules ......................................... 6
Communicable Disease Statistics
Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981-2010 ........................ 11
Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Cases of Communicable
Diseases, Oklahoma, 1981-2010 ............................................................................................................ 15
Table Three. Notable Reportable Diseases by County, Oklahoma, 2010 ....................................................... 19
Disease-Specific Summaries
Botulism ......................................................................................................................................................... 29
Campylobacteriosis ........................................................................................................................................ 30
Chlamydia trachomatis .................................................................................................................................. 32
Cryptosporidiosis ........................................................................................................................................... 34
Dengue .......................................................................................................................................................... 35
E. coli O157, O157:H7, or Shiga toxin-producing E. coli (STEC) .................................................................... 37
Ehrlichiosis/Anaplasmosis .............................................................................................................................. 39
Gonorrhea ...................................................................................................................................................... 41
Haemophilus influenzae invasive disease ...................................................................................................... 43
Hemolytic uremic syndrome, post-diarrheal .................................................................................................... 45
Hepatitis A ..................................................................................................................................................... 46
Hepatitis B and Perinatal ............................................................................................................................... 48
Hepatitis C ..................................................................................................................................................... 49
HIV/AIDS ....................................................................................................................................................... 50
Legionellosis .................................................................................................................................................. 52
Listeriosis ....................................................................................................................................................... 53
Malaria ........................................................................................................................................................... 55
Meningococcal invasive disease ..................................................................................................................... 56
Pertussis ........................................................................................................................................................ 58
Rabies (Animal) ............................................................................................................................................. 60
Rocky Mountain Spotted Fever ....................................................................................................................... 62
Salmonellosis ................................................................................................................................................. 64
Shigellosis ...................................................................................................................................................... 66
Streptococcus pneumoniae invasive disease in children less than 5 years of age ......................................... 68
Tuberculosis................................................................................................................................................... 70
Tularemia ....................................................................................................................................................... 74
Outbreak Reports
Norovirus Outbreaks in Institutional and Food Service Settings ..................................................................... 75
Outbreak of Shiga toxin-producing E. coli (STEC) Among Offenders at a Correctional Facility ..................... 78
Salmonella Outbreak in a School, Canadian County ...................................................................................... 81
Program Reports
Influenza Surveillance Summary .................................................................................................................... 84
Oklahoma Health Alert Network (OK-HAN) Annual Update ............................................................................ 87
Public Health Investigation and Disease Detection of Oklahoma (PHIDDO) Annual Update ......................... 88
Public Health Laboratory Update .................................................................................................................... 89
Oklahoma State Department of Health
Contact Information
Acute Disease Service
Communicable Disease Division
1000 NE 10th St.
Oklahoma City, OK 73117-1299
Phone Number: (405) 271-4060 — Epidemiologist-on-Call 24 hours per day
Fax Number: (405) 271-6680
Fax Number: (800) 898-6734
Division of Surveillance and Informatics
1000 NE 10th St
Oklahoma City, OK 73117-1299
Phone Number: (405) 271-4060
Fax Number: (405) 271-6680
Tuberculosis Division
1000 NE 10th St.
Oklahoma City, OK 73117-1299
Phone Number: (405) 271-4060
Fax Number: (405) 271-6680
HIV / STD Service
1000 NE 10th St.
Mail Drop 0308
Oklahoma City, OK 73117-1299
Phone Number: (405) 271-4636
Fax Number: (405) 271-5149
Public Health Laboratory
1000 NE 10th St.
Oklahoma City, OK 73117-1299
Phone Number: (405) 271-5070
Fax Number: (405) 271-4850
Mailing Isolates and Samples for Testing
Public Health Laboratory
P.O. Box 24106
OKC, OK 73124-0106
For instructions on sending isolates or clinical specimens to the Public Health Laboratory (PHL), contact the
PHL personnel between 8:00 a.m. - 4:30 p.m., Monday through Friday.
All FAX machines are located in locked offices and are monitored to ensure the confidentiality of disease
reports.
4
2010 Annual Summary
List of Contributors
Acute Disease Service
Lauri Smithee, Ph.D., Chief
Communicable Disease Division
Laurence Burnsed, M.P.H., Director
Lacey Kovar, M.P.H., Epidemiologist
Becky Coffman, M.P.H., R.N., C.I.C., Epidemiologist
Renee Powell, M.P.H., Epidemiologist
Jolianne Stone, M.P.H., Epidemiologist
Kendra Dougherty, M.S., Epidemiologist
Division of Surveillance and Informatics
Anthony Lee, M.P.H., Director
Jeannie Williams, M.P.H., C.P.H., Surveillance Officer
Christie McDonald-Hamm, M.P.H., Epidemiologist
Kim Mitchell, B.S., Health Alert Network (HAN) Coordinator
Tony McCord, A.A.S., Information Systems Services Coordinator
Tuberculosis Program
Amy Hill, RN, TB Nurse Consultant
HIV / STD Service
Jan Fox, M.P.H., R.N., Chief
Kristen Eberly, M.P.H., Director, Division of Prevention and Intervention
Debbie Purton, M.P.H., R.N., Director, Division of Care Delivery
Sam Nimo, M.P.H., Epidemiologist
Terrainia Harris, M.P.H., Manager, HIV/STD Surveillance and Analysis
Janet Wilson, RN, Manager, Viral Hepatitis and Adult Viral Hepatitis Prevention Coordinator
Mark Turner, M.P.H., Manager, Field Operations
Angela Strawderman, R.N., Perinatal Hepatitis B Coordinator
Public Health Laboratory
Steve Johnson, B.S., A.S.C.P., Clinical Laboratory Administrator
John Murray, B.A., M.B.A., M.P.H., State Training Coordinator
5
OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH
TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH
CHAPTER 515. COMMUNICABLE DISEASE AND INJURY REPORTING
EFFECTIVE 7/25/2010
310:515-1-1. Purpose
The rules in this Chapter implement the Communicable Diseases Reporting Regulations, 63 O.S. 1981, §
1-503.
310:515-1-1.1. Definitions
When used in this Chapter, the following words or terms shall have the following meaning unless the
context of the sentence requires another meaning:
"AIDS" means Acquired Immunodeficiency Syndrome.
"Anti-HAV-IgM+" means a positive test result for the hepatitis A virus immunglobulin M antibody.
"Anti-HBc-IgM+" means a positive test result for the hepatitis B core immunglobulin M antibody.
"CD4" means cluster of differentiation 4 glycoprotein that serves as a receptor for HIV on T helper cells.
"Department" or "OSDH" means the Oklahoma State Department of Health.
"E. coli" means Escherichia coli.
"EIA" means enzyme immunoassay.
"HBeAg+" means a positive test result for the hepatitis B "e" antigen.
"HBsAg+" means a positive test result for the hepatitis B surface antigen.
"HBV DNA+" means a positive test result for deoxyribonucleic acid of the hepatitis B virus.
"HIV" means Human Immunodeficiency Virus.
"PHIDDO" or "PHIDDO system" means Public Health Investigation and Disease Detection of
Oklahoma system.
"NAT for HCV RNA+" means a nucleic acid amplification test with a positive test result for hepatitis C
virus ribonucleic acid.
"Outbreak of disease" means two or more cases residing in different households that have a similar
clinical syndrome of a potentially infectious disease, toxin, or agent of known or unknown etiology.
"RIBA" means recombinant immunoblot assay.
"S/co" means the signal-to-cut-off-ratio.
"Spp." is an abbreviation referring to the term "species," and is used to broaden the anteceding term in
order to include all organisms that may be found or described within a given genus.
"Unusual disease or syndrome" means a case of an uncommon, possibly infectious disease of
known or unknown etiology, even if laboratory testing may be pending or inconclusive, or if testing for
common etiologies is negative. Such cases of disease may not normally be endemic to Oklahoma, may
be an emerging or re-emerging disease, and/or represent diseases for which a public health intervention
may be needed. Examples of such unusual diseases or syndromes include but are not limited to,
unexplained adult respiratory distress syndrome, rash illness with atypical presentation, or an illness
occurring along with an unusual pattern of illness or death among animals.
"VISA" means vancomycin intermediate Staphylococcus aureus.
"VRSA" means vancomycin resistant Staphylococcus aureus.
310:515-1-2. Diseases to be reported
The diseases listed in this Chapter must be reported, along with patient identifiers, demographics, and
contact information, to the Department upon discovery as dictated in sections OAC 310:515-1-3 and OAC
310:515-1-4. The current “Oklahoma Disease Reporting Manual” shall serve as the standard for disease-specific
diagnostic test results to be reported. Ancillary laboratory test results, signs, and symptoms must be
reported upon request. The current edition of the "Oklahoma Disease Reporting Manual" may be accessed
from the Acute Disease Service disease reporting and alerts web page of the OSDH web site at
http://IDReportingAndAlerts.health.ok.gov. Laboratories having greater than 400 positive tests performed on-site
per year for reportable diseases described in 310:515-1-3, 310:515-1-4(1) and 310:515-1-4(2), or as may
be otherwise required to be reported by OSDH, shall begin reporting no later than August 30, 2010 using
secure electronic data transmission.
6
OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH
310:515-1-3. Diseases to be reported immediately
The following diseases must be reported by any health practitioner or laboratory personnel to the OSDH
electronically via the secure web-based Public Health Investigation and Disease Detection of Oklahoma
system or by telephone (405-271-4060 or 800-234-5963) immediately upon suspicion, diagnosis, or testing as
specified in the “Oklahoma Disease Reporting Manual”.
(1) Anthrax (Bacillus anthracis).
(2) Bioterrorism – suspected disease.
(3) Botulism (Clostridium botulinum).
(4) Diphtheria (Corynebacterium diphtheriae).
(5) Haemophilus influenzae invasive disease.
(6) Hepatitis A (Anti-HAV-IgM+).
(7) Hepatitis B during pregnancy (HBsAg+).
(8) Measles (Rubeola).
(9) Meningococcal invasive disease (Neisseria meningitidis).
(10) Outbreaks of apparent infectious disease.
(11) Plague (Yersinia pestis).
(12) Poliomyelitis.
(13) Rabies.
(14) Smallpox.
(15) Tularemia (Francisella tularensis).
(16) Typhoid fever (Salmonella Typhi).
(17) Viral hemorrhagic fever.
310:515-1-4. Additional diseases, conditions, and injuries to be reported
The following diseases, conditions and injuries must be reported by physicians, laboratories, and
hospitals (by infection control practitioners, medical records personnel, and other designees) to the OSDH as
dictated in the following subsections:
(1) Infectious diseases. Reports of infectious diseases and conditions listed in this subsection must
be submitted electronically via the PHIDDO system, telephoned, faxed, or submitted via secure
electronic data transmission to the OSDH within one (1) business day of diagnosis or positive test as
specified in the “Oklahoma Disease Reporting Manual”.
(A) Acid Fast Bacillus (AFB) positive smear.
(B) AIDS (Acquired Immunodeficiency Syndrome).
(C) Arboviral infections (West Nile virus, St. Louis encephalitis virus, Eastern equine
encephalitis virus, Western equine encephalitis virus, Powassan virus, California
serogroup virus).
(D) Brucellosis (Brucella spp.).
(E) Campylobacteriosis (Campylobacter spp.).
(F) Congenital rubella syndrome.
(G) Cryptosporidiosis (Cryptosporidium spp.).
(H) Dengue Fever.
(I) E. coli O157, O157:H7, or a Shiga toxin producing E. coli (STEC infections).
(J) Ehrlichiosis (Ehrlichia or Anaplasma spp.).
(K) Hantavirus pulmonary syndrome.
(L) Hemolytic uremic syndrome, postdiarrheal.
(M) Hepatitis B. If HBsAg+, anti-HBc-IgM+, HBeAg+, or HBV DNA+ then report results
of the entire hepatitis panel.
(N) Hepatitis C in persons < or = 40 years or in persons having jaundice or ALT > or =
400 regardless of age with laboratory confirmation. If hepatitis C EIA is confirmed
by RIBA or NAT for HCV RNA, or signal-to-cut-off (s/co) ratio or index is predictive of
a true positive then report results of the entire hepatitis panel.
(O) Human Immunodeficiency Virus (HIV) infection.
7
OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH
(P) Influenza associated pediatric mortality
(Q) Legionellosis (Legionella spp.).
(R) Leptospirosis (Leptospira interrogans).
(S) Listeriosis (Listeria monocytogenes).
(T) Lyme disease (Borrelia burgdorferi).
(U) Malaria (Plasmodium spp.).
(V) Mumps.
(W) Pertussis (Bordetella pertussis).
(X) Psittacosis (Chlamydophia psittaci).
(Y) Q Fever (Coxiella burnetti).
(Z) Rocky Mountain Spotted Fever (Rickettsia rickettsii).
(AA) Rubella.
(BB) Salmonellosis (Salmonella spp.).
(CC) Shigellosis (Shigella spp.).
(DD) Staphylococcus aureus with reduced susceptibility to vancomycin (VISA or VRSA).
(EE) Streptococcus pneumoniae invasive disease, in persons less than 5 years of age.
(FF) Syphilis (Treponema pallidum).
(GG) Tetanus (Clostridium tetani).
(HH) Trichinellosis (Trichinella spiralis).
(II) Tuberculosis (Mycobacterium tuberculosis).
(JJ) Unusual disease or syndrome.
(KK) Vibrio spp. infections including cholera.
(LL) Yellow Fever.
(2) Infectious diseases. Reports of infectious diseases and conditions listed in this subsection must
be reported to the OSDH within one (1) month of diagnosis or positive test as specified in the OSDH
Disease Reporting Manual.
(A) CD4 cell count < 500 with corresponding CD4 cell count percentage of total (by
laboratories only).
(B) Chlamydia infections (Chlamydia trachomatis).
(C) Creutzfeldt-Jakob disease.
(D) Gonorrhea (Neisseria gonorrhoeae).
(E) HIV viral load.
(F) Pelvic inflammatory disease (PID).
(3) Occupational or Environmental diseases. Laboratories must report blood lead level results
greater than 10 ug/dL within one (1) week and results less than 10 ug/dL within one (1) month. Health
care providers must report blood lead level results 20 ug/dL or greater within twenty-four (24) hours
and results 10-19 ug/dL within one (1) week.
(4) Injuries (hospitalized and fatal cases only).
(A) Burns.
(B) Drownings and Near Drownings.
(C) Traumatic Brain Injuries.
(D) Traumatic Spinal Cord Injuries.
8
OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH
310:515-1-6. Additional diseases may be designated
The Commissioner of Health may designate any disease or condition as reportable for a designated
period of time for the purpose of special investigation.
310:515-1-7. Control of Communicable Diseases Manual
The OSDH adopts the most recently published edition of the publication, "Control of Communicable
Diseases Manual," published by the American Public Health Association, as a guideline for the prevention
and control of communicable diseases. In order to determine the most recently published edition of the
"Control of Communicable Diseases Manual," access the American Public Health Association web site at
https://secure.apha.org/source/orders/index.cfm.
310:515-1-8. Organisms/specimens to be sent to the Public Health Laboratory
(a) Isolates or appropriate specimens of the following organisms shall be sent to the OSDH Public Health
Laboratory for typing.
(1) Bacillus anthracis.
(2) Brucella spp.
(3) E. coli O157, O157:H7, or a Shiga toxin producing E. coli (STEC).
(4) Francisella tularensis.
(5) Haemophilus influenzae (sterile site).
(6) Listeria monocytogenes (sterile site).
(7) Mycobacterium tuberculosis.
(8) Neisseria meningitidis (sterile site).
(9) Plasmodium spp.
(10) Salmonella spp.
(11) Staphylococcus aureus that are VISA or VRSA
(12) Vibrio spp.
(13) Yersinia spp.
(b) Following consultation with an OSDH epidemiologist, clinical specimens from suspected cases of
Botulism must be sent to the OSDH Public Health Laboratory for testing.
9
OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH
SUBCHAPTER 3. DISCLOSURES AND USES OF DISEASE PREVENTION
AND CONTROL INFORMATION
310:515-3-1. General provisions
Information received, created and/or maintained by the Department pursuant to the provisions of the
Public Health Code relating to Disease Prevention and Control is confidential and shall be protected from
disclosure unless release or disclosure is sought in accordance with this subchapter or is otherwise
authorized by law.
310:515-3-2. Disclosures upon written consent
Information received, created and/or maintained by the Department pursuant to the provisions of the
Public Health Code relating to Disease Prevention and Control may be disclosed to a requesting person upon
the presentation of a valid written consent executed by the person whose information is being kept
confidential or the legal guardian or legal custodian of such person, under the following conditions:
(1) If the written consent is delivered to the Department by a person other than the person
whose information is being kept confidential or the legal guardian or legal custodian of such person,
the written consent must either be verified under oath or contain some form of attestation certifying or
confirming the authenticity of the signature of the person whose information is being kept confidential
or the legal guardian or legal custodian of such person.
(2) The written consent must advise the person whose information is being kept confidential or
the legal guardian or legal custodian of such person the identity of all persons and/or entities who are
likely or intended to receive or view the information sought to be released or disclosed. The identity
must include the full name, address and title or office of such person or entity identified in the written
consent. The written consent must state that the information will not be released or disclosed to any
person or entity not so identified.
(3) The written consent must include a notice thereon, in bold typeface, that the information
authorized for release may include records that may indicate the presence of a communicable or
venereal disease, which may include, but are not limited to, diseases such as hepatitis, syphilis,
gonorrhea and the human immunodeficiency virus, also known as Acquired Immune Deficiency
Syndrome (AIDS).
(4) The written consent must advise the person whose information is being kept confidential or
the legal guardian or legal custodian of such person of the provisions of 63 O.S.Supp.2005, § 1-
502.2.
310:515-3-3. Grounds for denial
A person whose information is being kept confidential or the legal guardian or legal custodian of such
person may be denied access to information if the information was obtained from someone other than a
health care provider under a promise of confidentiality, the access requested would be reasonably likely
to reveal the confidential source of the information and the requested information cannot be presented in
a manner that preserves the confidentiality of the source. The Department incorporates HIPAA, 42 C.F.R.
§ 164.524(a)(2)(v)(2006) only as guidance in applying this section.
310:515-3-4. Disclosures permitted without a written consent
Information received, created and/or maintained by the Department pursuant to the provisions of the
Public Health Code relating to Disease Prevention and Control may, without first obtaining a written consent in
accordance with this subchapter, be disclosed, shared and/or disseminated with health professionals
engaged in activities described or identified in the provisions of the Public Health Code relating to Disease
Prevention and Control.
10
Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010
Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Anthrax 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Botulism (Foodborne) 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0
Botulism (Infant) 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0
Brucellosis 8 8 6 7 5 0 5 3 4 1 2 1 0 0 1 1
Campylobacteriosis 56 116 *212 216 305 288 252 212 223 247 205 267 199 187 289 281
Chlamydia 0 0 0 0 0 0 0 0 0 0 *5714 5220 4886 3784 5050 7371
Cholera 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0
Congential Rubella Syndrome 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Creutzfeldt-Jakob disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Cryptosporidiosis 0 0 0 81 27 11 14 11 12 6 8 0 1 1 12 10
Dengue Fever 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diphtheria 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0
Escherichia coli O157:H7 and other Shiga
toxin producing E. coli 0 0 0 0 0 0 0 0 6 4 0 5 8 *13 16 14
Ehrlichiosis 0 0 0 0 0 0 23 14 1 1 3 8 0 0 0 0
Gonorrhea 15909 16021 15230 13088 13005 12572 9657 7411 6846 6464 6546 6432 4855 4935 5652 4897
Haemophilus influenzae , Invasive Disease
(Total) 97 120 *179 240 303 290 244 236 154 134 76 33 45 44 33 31
Haemophilus influenzae , Invasive
Disease, type b, <5 yrs 0 2 *13 39 6 3 0 0 0 78 33 3 1 4 3 0
Hantavirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Hemolytic Uremic Syndrome, post
diarrheal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Hepatitis A 344 821 833 548 491 390 338 580 501 588 273 217 206 395 1497 2516
Hepatitis B 256 358 354 208 256 240 250 209 221 183 198 174 193 129 176 60
Hepatitis C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8
Influenza Associated Pediatric Mortality 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Legionellosis 7 13 *12 19 24 24 32 20 26 15 24 12 14 7 8 16
Leptospirosis 0 0 4 0 1 0 0 0 0 1 0 0 0 0 0 0
Listeriosis 1 3 0 1 10 20 17 14 17 16 6 8 12 11 11 5
Lyme Disease 0 0 0 0 0 0 3 9 16 20 23 25 20 111 57 34
Malaria 8 8 9 14 8 12 5 11 8 10 9 5 5 9 1 3
Measles 6 30 1 9 1 41 4 8 73 88 0 12 0 0 0 0
Meningococcal Invasive Disease 47 33 39 30 41 38 40 27 29 21 16 18 36 52 49 46
Mumps 0 0 0 0 0 0 102 295 184 74 15 20 11 *13 1 4
Pertussis 3 10 348 248 209 149 173 72 54 48 48 53 60 19 47 21
*First year disease was reportable by law
^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 11
Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010
Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996
Plague 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0
Poliomyelitis 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0
Psittacosis 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0
Q Fever 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0
Rabies (Animal) 219 191 108 104 111 62 35 38 102 132 173 219 65 40 32 38
Rabies (Human) 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rocky Mountain spotted fever 101 89 221 137 103 110 86 103 60 68 95 111 46 36 48 45
Rubella 4 3 1 0 2 0 6 1 1 1 2 0 1 4 0 0
Staphylococcus aureus , Vancomycin
intermediate 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Staphylococcus aureus , Vancomycin
resistant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Streptococcus pneumoniae , Invasive
disease, <5 years 22 38 20 18 29 199 16 11 20 37 28 13 87 73 48 19
Salmonellosis 424 516 613 445 474 512 474 500 446 441 481 368 320 444 471 520
Shigellosis 470 440 241 220 301 256 166 233 236 510 192 252 472 200 266 305
St. Louis Encephalitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Syphilis 479 593 571 532 538 489 552 479 375 589 596 709 636 399 489 398
Tetanus 2 1 0 2 1 1 1 1 2 0 0 1 1 1 0 1
Trichinellosis 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1
Tuberculosis 381 335 331 262 264 267 250 277 218 243 206 216 209 261 237 201
Tularemia 44 36 35 24 22 19 27 17 8 10 12 10 16 4 7 4
Typhoid Fever 5 4 3 5 2 3 6 0 1 3 3 0 1 3 1 0
Vibrio spp. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 1
Vibrio parahaemolyticus 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0
Vibrio vulnificus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
West Nile Virus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*First year disease was reportable by law
^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 12
Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010
Disease
Anthrax
Botulism (Foodborne)
Botulism (Infant)
Brucellosis
Campylobacteriosis
Chlamydia
Cholera
Congential Rubella Syndrome
Creutzfeldt-Jakob disease
Cryptosporidiosis
Dengue Fever
Diphtheria
Escherichia coli O157:H7 and other Shiga
toxin producing E. coli
Ehrlichiosis
Gonorrhea
Haemophilus influenzae , Invasive Disease
(Total)
Haemophilus influenzae , Invasive
Disease, type b, <5 yrs
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 0 0 0 0 0
0 0 1 0 1 0 0 0 1 0 0 0 0 2
0 0 0 1 0 1 0 0 1 2 1 0 2 0
247 241 320 361 308 362 417 591 544 405 530 486 384 448
7566 9378 8737 9346 10622 10732 10983 10371 12957 13206 12529 14173 14991 14302
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 *0 0 0 1 1 1 1 1
12 7 14 *30 16 16 24 22 46 56 216 238 141 122
0 1 0 0 0 *0 1 0 2 0 3 2 0 4
0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 26 41 19 36 25 30 29 38 43 33 135 64 104
0 2 12 *12 24 13 36 49 96 47 106 121 147 107
4840 4225 4291 5236 4818 4624 4543 4543 5031 5170 4827 4945 4661 4369
33 35 47 ^46 48 53 52 67 74 78 93 90 92 105
1 1 0 ^0 0 0 0 0 0 0 0 0 2 0
Hantavirus
Hemolytic Uremic Syndrome, post
diarrheal
Hepatitis A
Hepatitis B
Hepatitis C
Influenza Associated Pediatric Mortality
Legionellosis
Leptospirosis
Listeriosis
Lyme Disease
Malaria
Measles
Meningococcal Invasive Disease
Mumps
Pertussis
0 0 0 *0 1 0 0 0 0 0 0 0 0 0
0 0 1 *2 4 3 4 2 5 3 8 51 17 11
1441 667 534 271 116 52 29 19 6 11 13 13 6 6
63 169 185 179 115 111 73 80 59 96 152 129 122 115
10 23 13 *13 6 21 6 7 14 19 49 21 27 41
0 0 0 0 0 0 0 0 0 0 0 2 *9 2
4 18 6 5 7 5 10 24 10 10 9 11 10 15
0 0 1 0 0 1 0 0 0 0 1 0 0 1
9 19 12 *8 2 9 3 4 4 5 2 7 8 9
45 12 8 1 0 0 0 3 0 0 1 2 2 0
9 4 2 10 5 12 4 10 12 11 10 5 2 6
1 0 0 0 0 0 0 0 0 0 0 0 0 0
45 44 40 34 32 25 24 10 18 15 23 17 17 18
3 4 5 3 0 3 2 1 2 11 7 1 3 1
60 36 40 60 43 135 106 122 125 64 58 100 117 199
*First year disease was reportable by law
^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 13
Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010
Disease
Plague
Poliomyelitis
Psittacosis
Q Fever
Rabies (Animal)
Rabies (Human)
Rocky Mountain spotted fever
Rubella
Staphylococcus aureus , Vancomycin
intermediate
Staphylococcus aureus , Vancomycin
resistant
Streptococcus pneumoniae , Invasive
disease, <5 years
Salmonellosis
Shigellosis
St. Louis Encephalitis
Syphilis
Tetanus
Trichinellosis
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 4 0 *0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 3 0 2 3 *2 0
113 107 94 58 60 126 204 113 79 69 78 42 49 62
0 0 0 0 0 0 0 1 0 0 0 0 0 0
30 39 29 37 69 99 138 190 206 135 187 267 342 235
0 0 1 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 *1 0 0 0
0 0 0 0 0 0 0 0 0 0 *0 0 0 0
22 26 45 38 58 67 81 52 48 73 77 76 63 55
392 501 468 404 503 524 494 425 448 604 709 901 657 752
293 712 560 131 148 717 1078 724 936 196 162 234 399 416
0 0 0 0 1 *0 0 0 0 0 0 0 0 0
275 264 347 245 185 183 141 88 73 193 150 212 256 92
2 0 0 0 1 0 0 0 0 1 0 0 0 0
0 0 0 *0 0 0 0 0 0 0 0 0 0 0
Tuberculosis
Tularemia
Typhoid Fever
Vibrio spp.
Vibrio parahaemolyticus
Vibrio vulnificus
West Nile Virus
211 198 208 154 194 190 163 178 144 144 149 100 102 86
5 5 7 11 7 10 9 19 20 3 18 7 7 8
3 1 0 1 1 2 1 1 1 0 3 3 2 1
0 9 1 0 0 1 *1 0 3 1 2 5 2 0
0 0 0 0 0 0 *0 0 1 0 0 1 0 0
0 0 0 1 0 1 *0 1 1 0 0 0 0 1
0 0 0 0 0 *17 79 22 33 48 107 9 10 1
*First year disease was reportable by law
^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 14
Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010*
Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995
Anthrax 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Botulism (Foodborne) 0.00 0.00 0.00 0.03 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00
Botulism (Infant) 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.03 0.00 0.00 0.00
Brucellosis 0.26 0.26 0.20 0.23 0.17 0.00 0.17 0.10 0.13 0.03 0.06 0.03 0.00 0.00 0.03
Campylobacteriosis 1.85 3.83 7.01 7.14 10.08 9.52 8.33 7.01 7.37 7.85 6.52 8.49 6.33 5.94 9.19
Chlamydia 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 181.7 165.9 155.3 120.3 160.5
Cholera 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Congential Rubella Syndrome 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Creutzfeldt-Jakob disease 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Cryptosporidiosis 0.00 0.00 0.00 2.68 0.89 0.36 0.46 0.36 0.40 0.19 0.25 0.00 0.03 0.03 0.38
Dengue Fever 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Diphtheria 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Escherichia coli O157:H7 and other
Shiga toxin producing E. coli 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.20 0.13 0.00 0.16 0.25 0.41 0.51
Ehrlichiosis 0.00 0.00 0.00 0.00 0.00 0.00 0.76 0.46 0.03 0.03 0.10 0.25 0.00 0.00 0.00
Gonorrhea 525.9 529.6 503.4 432.6 429.9 415.6 319.2 245.0 226.3 205.5 208.1 204.5 154.3 156.9 179.7
Haemophilus influenzae , Invasive
Disease (Total) 3.21 3.97 5.92 7.93 10.02 9.59 8.07 7.80 5.09 4.26 2.42 1.05 1.43 1.40 1.05
Haemophilus influenzae , Invasive
Disease, type b, <5 yrs 0.00 0.86 5.60 16.79 2.58 1.29 0.00 0.00 0.00 34.43 14.57 1.32 0.44 1.77 1.32
Hantavirus 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Hemolytic Uremic Syndrome, post
diarrheal 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Hepatitis A 11.37 27.14 27.53 18.11 16.23 12.89 11.17 19.17 16.56 18.69 8.68 6.90 6.55 12.56 47.59
Hepatitis B 8.46 11.83 11.70 6.88 8.46 7.93 8.26 6.91 7.31 5.82 6.29 5.53 6.14 4.10 5.60
Hepatitis C 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03
Influenza Associated Pediatric Mortality 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Legionellosis 0.23 0.43 0.40 0.63 0.79 0.79 1.06 0.66 0.86 0.48 0.76 0.38 0.45 0.22 0.25
Leptospirosis 0.00 0.00 0.13 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00
Listeriosis 0.03 0.10 0.00 0.03 0.33 0.66 0.56 0.46 0.56 0.51 0.19 0.25 0.38 0.35 0.35
Lyme Disease 0.00 0.00 0.00 0.00 0.00 0.00 0.10 0.30 0.53 0.64 0.73 0.79 0.64 3.53 1.81
Malaria 0.26 0.26 0.30 0.46 0.26 0.40 0.17 0.36 0.26 0.32 0.29 0.16 0.16 0.29 0.03
Measles 0.20 0.99 0.03 0.30 0.03 1.36 0.13 0.26 2.41 2.80 0.00 0.38 0.00 0.00 0.00
Meningococcal Invasive Disease 1.55 1.09 1.29 0.99 1.36 1.26 1.32 0.89 0.96 0.67 0.51 0.57 1.14 1.65 1.56
Mumps 0.00 0.00 0.00 0.00 0.00 0.00 3.37 9.75 6.08 2.35 0.48 0.64 0.35 0.41 0.03
Pertussis 0.10 0.33 11.50 8.20 6.91 4.93 5.72 2.38 1.78 1.53 1.53 1.68 1.91 0.60 1.49
*Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 15
Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010*
Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995
Plague 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00
Poliomyelitis 0.00 0.00 0.00 0.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Psittacosis 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00
Q Fever 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Rabies (Human) 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Rocky Mountain spotted fever 3.34 2.94 7.31 4.53 3.40 3.64 2.84 3.40 1.98 2.16 3.02 3.53 1.46 1.14 1.53
Rubella 0.13 0.10 0.03 0.00 0.07 0.00 0.20 0.03 0.03 0.03 0.06 0.00 0.03 0.13 0.00
Staphylococcus aureus , Vancomycin
intermediate 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Staphylococcus aureus , Vancomycin
resistant 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Streptococcus pneumoniae , Invasive
disease, <5 years 9.47 16.36 8.61 7.75 12.48 85.66 6.89 4.74 8.61 16.33 12.36 5.74 38.41 32.23 21.19
Salmonellosis 14.02 17.06 20.26 14.71 15.67 16.92 15.67 16.53 14.74 14.02 15.29 11.70 10.17 14.12 14.97
Shigellosis 15.54 14.54 7.97 7.27 9.95 8.46 5.49 7.70 7.80 16.21 6.10 8.01 15.01 6.36 8.46
St. Louis Encephalitis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Syphilis 15.83 19.60 18.87 17.59 17.78 16.16 18.25 15.83 12.40 18.72 18.95 22.54 20.22 12.68 15.55
Tetanus 0.07 0.03 0.00 0.07 0.03 0.03 0.03 0.03 0.07 0.00 0.00 0.03 0.03 0.03 0.00
Trichinellosis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00
Tuberculosis 12.59 11.07 10.94 8.66 8.73 8.83 8.26 9.16 7.21 7.73 6.55 6.87 6.64 8.30 7.53
Tularemia 1.45 1.19 1.16 0.79 0.73 0.63 0.89 0.56 0.26 0.32 0.38 0.32 0.51 0.13 0.22
Typhoid Fever 0.17 0.13 0.10 0.17 0.07 0.10 0.20 0.00 0.03 0.10 0.10 0.00 0.03 0.10 0.03
Vibrio spp. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.10
Vibrio parahaemolyticus 0.00 0.00 0.00 0.00 0.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Vibrio vulnificus 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
West Nile Virus 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
*Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 16
Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010*
Disease
Anthrax
Botulism (Foodborne)
Botulism (Infant)
Brucellosis
Campylobacteriosis
Chlamydia
Cholera
Congential Rubella Syndrome
Creutzfeldt-Jakob disease
Cryptosporidiosis
Dengue Fever
Diphtheria
Escherichia coli O157:H7 and other
Shiga toxin producing E. coli
Ehrlichiosis
Gonorrhea
Haemophilus influenzae , Invasive
Disease (Total)
Haemophilus influenzae , Invasive
Disease, type b, <5 yrs
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.05
0.03 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.00 0.03 0.06 0.03 0.00 0.05 0.00
8.93 7.85 7.66 10.17 10.46 8.93 10.49 12.08 17.13 15.77 11.74 15.36 13.34 10.54 12.15
234.3 240.5 298.1 277.8 270.8 307.8 311.0 318.3 300.6 375.5 382.7 363.1 389.1 411.6 387.90
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 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.03 0.03 0.03 0.03
0.32 0.38 0.22 0.45 0.87 0.46 0.46 0.70 0.64 1.33 1.62 6.26 6.53 3.87 3.31
0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.06 0.00 0.09 0.05 0.00 0.11
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.45 0.41 0.83 1.30 0.55 1.04 0.72 0.87 0.84 1.10 1.25 0.96 3.71 1.76 2.82
0.00 0.00 0.06 0.38 0.35 0.70 0.38 1.04 1.42 2.78 1.36 3.07 3.32 4.04 2.85
155.7 153.9 134.3 136.4 151.7 139.6 134.0 131.7 131.7 145.8 149.8 139.9 135.8 128.0 116.46
0.99 1.05 1.11 1.49 1.33 1.39 1.54 1.51 1.94 2.14 2.26 2.70 2.47 2.53 0.00
0.00 0.44 0.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.05 0.00
Hantavirus
Hemolytic Uremic Syndrome, post
diarrheal
Hepatitis A
Hepatitis B
Hepatitis C
Influenza Associated Pediatric Mortality
Legionellosis
Leptospirosis
Listeriosis
Lyme Disease
Malaria
Measles
Meningococcal Invasive Disease
Mumps
Pertussis
0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.03 0.06 0.12 0.09 0.12 0.06 0.14 0.09 0.23 1.40 0.47 0.29
79.99 45.81 21.20 16.98 7.85 3.36 1.51 0.84 0.55 0.17 0.32 0.38 0.36 0.16 0.16
1.91 2.00 5.37 5.88 5.19 3.33 3.22 2.12 2.32 1.71 2.78 4.40 3.54 3.35 3.12
0.25 0.32 0.73 0.41 0.38 0.17 0.61 0.17 0.20 0.41 0.55 1.42 0.58 0.74 1.09
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.22 0.98 0.22
0.51 0.13 0.57 0.19 0.14 0.20 0.14 0.29 0.70 0.29 0.29 0.26 0.30 0.27 0.40
0.00 0.00 0.00 0.03 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.03
0.16 0.29 0.60 0.38 0.23 0.06 0.26 0.09 0.12 0.12 0.14 0.06 0.19 0.22 0.24
1.08 1.43 0.38 0.25 0.03 0.00 0.00 0.00 0.09 0.00 0.00 0.03 0.05 0.05 0.00
0.10 0.29 0.13 0.06 0.29 0.14 0.35 0.12 0.29 0.35 0.32 0.29 0.14 0.05 0.16
0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
1.46 1.43 1.40 1.27 0.99 0.93 0.72 0.70 0.29 0.52 0.43 0.67 0.47 0.47 0.48
0.13 0.10 0.13 0.16 0.09 0.00 0.09 0.06 0.03 0.06 0.32 0.20 0.03 0.08 0.03
0.67 1.91 1.14 1.27 1.74 1.25 3.91 3.07 3.54 3.62 1.85 1.68 2.75 3.21 5.40
*Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 17
Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010*
Disease
Plague
Poliomyelitis
Psittacosis
Q Fever
Rabies (Human)
Rocky Mountain spotted fever
Rubella
Staphylococcus aureus , Vancomycin
intermediate
Staphylococcus aureus , Vancomycin
resistant
Streptococcus pneumoniae , Invasive
disease, <5 years
Salmonellosis
Shigellosis
St. Louis Encephalitis
Syphilis
Tetanus
Trichinellosis
Tuberculosis
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.09 0.00 0.06 0.08 0.05 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00
1.43 0.95 1.24 0.92 1.07 2.00 2.87 4.00 5.51 5.97 3.91 5.42 7.33 9.39 6.37
0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.03
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
8.39 9.71 11.48 19.87 16.08 24.54 28.35 34.27 22.00 20.31 30.89 32.58 28.60 23.17 20.23
16.53 12.46 15.93 14.88 11.71 14.58 15.19 14.32 12.32 12.98 17.50 20.55 24.74 18.04 20.05
9.70 9.31 22.63 17.80 3.80 4.29 20.78 31.24 20.98 27.13 5.68 4.69 6.42 10.95 11.09
0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
12.65 8.74 8.39 11.03 7.10 5.36 5.30 4.09 2.55 2.12 5.59 4.35 5.82 7.03 2.45
0.03 0.06 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00
0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
6.39 6.71 6.29 6.61 4.46 5.62 5.51 4.72 5.16 4.17 4.17 4.32 2.75 2.80 2.29
Tularemia
Typhoid Fever
Vibrio spp.
Vibrio parahaemolyticus
Vibrio vulnificus
West Nile Virus
0.13 0.16 0.16 0.22 0.32 0.20 0.29 0.26 0.55 0.58 0.09 0.52 0.19 0.19 0.21
0.00 0.10 0.03 0.00 0.03 0.03 0.06 0.03 0.03 0.03 0.00 0.09 0.08 0.05 0.03
0.03 0.00 0.29 0.03 0.00 0.00 0.03 0.03 0.00 0.09 0.03 0.06 0.14 0.05 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.03 0.00 0.00
0.00 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.03 0.03 0.00 0.00 0.00 0.00 0.03
0.00 0.00 0.00 0.00 0.00 0.00 0.49 2.29 0.64 0.96 1.39 3.10 0.25 0.27 0.03
*Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 18
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Campylobacteriosis Cryptosporidiosis
E. coli O157:H7 and
other STEC Ehrlichiosis
County Number Rate Number Rate Number Rate Number Rate
Adair County 5 22.88 0 * 0 * 1 4.58
Alfalfa County 3 54.73 0 * 0 * 0 *
Atoka County 2 13.80 0 * 0 * 1 6.90
Beaver County 1 18.98 1 18.98 0 * 0 *
Beckham County 3 14.21 0 * 0 * 0 *
Blaine County 2 15.86 0 * 0 * 0 *
Bryan County 2 4.90 0 * 0 * 0 *
Caddo County 4 13.16 3 9.87 1 3.29 1 3.29
Canadian County 9 8.21 4 3.65 15 13.68 0 *
Carter County 6 12.42 16 33.11 0 * 1 2.07
Cherokee County 9 19.55 0 * 2 4.35 3 6.52
Choctaw County 1 6.72 0 * 0 * 2 13.45
Cimarron County 2 76.05 0 * 0 * 0 *
Cleveland County 16 6.54 9 3.68 1 0.41 4 1.64
Coal County 1 17.08 0 * 0 * 0 *
Comanche County 2 1.77 0 * 1 0.88 0 *
Cotton County 0 * 0 * 2 31.48 0 *
Craig County 4 26.39 0 * 1 6.60 0 *
Creek County 10 14.24 0 * 1 1.42 5 7.12
Custer County 3 11.23 0 * 0 * 0 *
Delaware County 7 17.26 0 * 2 4.93 1 2.47
Dewey County 1 22.71 0 * 0 * 0 *
Ellis County 1 25.48 1 25.48 0 * 0 *
Garfield County 17 28.85 0 * 5 8.48 0 *
Garvin County 8 29.51 1 3.69 0 * 0 *
Grady County 21 40.66 0 * 3 5.81 1 1.94
Grant County 0 * 0 * 0 * 0 *
Greer County 2 34.31 1 17.15 1 17.15 0 *
Harmon County 0 * 0 * 0 * 0 *
Harper County 2 59.22 0 * 0 * 0 *
Haskell County 1 8.07 0 * 0 * 3 24.21
Hughes County 1 7.24 0 * 0 * 1 7.24
Jackson County 12 47.30 3 11.83 1 3.94 0 *
Jefferson County 2 31.65 1 15.83 0 * 0 *
Johnston County 1 9.55 3 28.66 2 19.11 0 *
Kay County 7 15.18 0 * 3 6.51 0 *
Kingfisher County 2 13.90 0 * 0 * 0 *
Kiowa County 3 32.96 0 * 0 * 0 *
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
19
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Campylobacteriosis Cryptosporidiosis
E. coli O157:H7 and
other STEC Ehrlichiosis
County Number Rate Number Rate Number Rate Number Rate
Latimer County 0 * 0 * 0 * 2 18.83
Le Flore County 10 20.03 1 2.00 0 * 6 12.02
Lincoln County 7 21.74 0 * 1 3.11 1 3.11
Logan County 9 22.90 2 5.09 1 2.54 1 2.54
Love County 0 * 2 21.92 0 * 0 *
McClain County 5 15.07 2 6.03 0 * 2 6.03
McCurtain County 3 8.99 0 * 0 * 1 3.00
McIntosh County 1 5.05 0 * 0 * 2 10.10
Major County 0 * 0 * 0 * 0 *
Marshall County 2 13.32 2 13.32 0 * 0 *
Mayes County 8 19.97 2 4.99 2 4.99 5 12.48
Murray County 3 23.15 0 * 0 * 0 *
Muskogee County 12 16.80 6 8.40 0 * 3 4.20
Noble County 4 36.53 0 * 5 45.66 1 9.13
Nowata County 0 * 1 9.50 0 * 0 *
Okfuskee County 2 18.31 0 * 0 * 2 18.31
Oklahoma County 69 9.63 22 3.07 9 1.26 6 0.84
Okmulgee County 5 12.73 1 2.55 2 5.09 5 12.73
Osage County 2 4.44 0 * 0 * 3 6.66
Ottawa County 5 15.81 0 * 1 3.16 3 9.48
Pawnee County 2 12.18 1 6.09 0 * 0 *
Payne County 14 17.56 1 1.25 5 6.27 1 1.25
Pittsburg County 5 11.06 1 2.21 2 4.42 9 19.91
Pontotoc County 6 16.03 0 * 0 * 0 *
Pottawatomie County 11 15.65 2 2.85 0 * 0 *
Pushmataha County 2 16.93 0 * 0 * 3 25.40
Roger Mills County 1 29.35 0 * 0 * 0 *
Rogers County 7 8.17 0 * 9 10.51 1 1.17
Seminole County 0 * 0 * 0 * 1 4.12
Sequoyah County 3 7.24 0 * 1 2.41 2 4.83
Stephens County 6 13.80 9 20.70 3 6.90 1 2.30
Texas County 2 9.46 1 4.73 0 * 0 *
Tillman County 1 12.83 0 * 0 * 0 *
Tulsa County 53 8.80 20 3.32 17 2.82 19 3.16
Wagoner County 5 7.10 1 1.42 2 2.84 2 2.84
Washington County 4 7.89 2 3.94 3 5.92 1 1.97
Washita County 0 * 0 * 0 * 0 *
Woods County 2 23.76 0 * 0 * 0 *
Woodward County 3 15.03 0 * 0 * 0 *
State of Oklahoma 448 12.15 122 3.31 104 2.82 107 2.90
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
20
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Haemophilus
influenzae , invasive Hepatitis A Hepatitis B Hepatitis C
County Number Rate Number Rate Number Rate Number Rate
Adair County 1 4.85 0 * 1 4.58 0 *
Alfalfa County 0 * 0 * 0 * 0 *
Atoka County 0 * 0 * 0 * 0 *
Beaver County 0 * 0 * 0 * 0 *
Beckham County 0 * 0 * 0 * 0 *
Blaine County 0 * 0 * 0 * 0 *
Bryan County 0 * 0 * 0 * 0 *
Caddo County 1 3.29 0 * 1 3.29 1 3.29
Canadian County 1 0.91 2 1.82 1 0.91 3 2.74
Carter County 3 6.21 0 * 1 2.07 1 2.07
Cherokee County 0 * 0 * 0 * 1 2.17
Choctaw County 0 * 0 * 0 * 0 *
Cimarron County 0 * 0 * 0 * 0 *
Cleveland County 7 2.86 0 * 8 3.27 1 0.41
Coal County 0 * 0 * 0 * 0 *
Comanche County 1 0.88 0 * 0 * 2 1.77
Cotton County 0 * 0 * 0 * 0 *
Craig County 0 * 0 * 0 * 0 *
Creek County 4 5.69 0 * 3 4.27 1 1.42
Custer County 0 * 0 * 1 3.74 0 *
Delaware County 0 * 0 * 0 * 0 *
Dewey County 0 * 0 * 0 * 0 *
Ellis County 0 * 0 * 0 * 0 *
Garfield County 4 6.79 1 1.70 2 3.39 0 *
Garvin County 0 * 0 * 2 7.38 0 *
Grady County 1 1.94 0 * 1 1.94 0 *
Grant County 3 69.49 0 * 0 * 0 *
Greer County 0 * 0 * 0 * 0 *
Harmon County 0 * 0 * 0 * 0 *
Harper County 0 * 0 * 0 * 0 *
Haskell County 0 * 0 * 0 * 1 8.07
Hughes County 1 7.24 0 * 1 7.24 0 *
Jackson County 0 * 0 * 1 3.94 0 *
Jefferson County 0 * 0 * 0 * 0 *
Johnston County 1 9.55 0 * 2 19.11 0 *
Kay County 1 2.17 0 * 0 * 2 4.34
Kingfisher County 0 * 0 * 1 6.95 0 *
Kiowa County 0 * 0 * 0 * 0 *
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
21
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Haemophilus
influenzae , invasive Hepatitis A Hepatitis B Hepatitis C
County Number Rate Number Rate Number Rate Number Rate
Latimer County 0 0.00 0 * 1 9.42 1 9.42
Le Flore County 0 0.00 0 * 7 14.02 0 *
Lincoln County 2 6.21 1 3.11 1 3.11 0 *
Logan County 0 0.00 0 * 1 2.54 0 *
Love County 1 10.96 0 * 0 * 0 *
McClain County 2 6.03 0 * 0 * 0 *
McCurtain County 0 0.00 0 * 0 * 1 3.00
McIntosh County 1 5.05 0 * 0 * 0 *
Major County 1 13.91 0 * 0 * 0 *
Marshall County 0 0.00 0 * 0 * 0 *
Mayes County 3 7.49 0 * 3 7.49 0 *
Murray County 1 7.72 0 * 0 * 0 *
Muskogee County 0 0.00 0 * 2 2.80 2 2.80
Noble County 0 0.00 0 * 0 * 0 *
Nowata County 0 0.00 0 * 0 * 0 *
Okfuskee County 0 0.00 0 * 0 * 0 *
Oklahoma County 28 3.91 0 * 16 2.23 3 0.42
Okmulgee County 1 2.55 0 * 4 10.18 3 7.64
Osage County 0 0.00 0 * 7 15.54 1 2.22
Ottawa County 0 0.00 0 * 2 6.32 0 *
Pawnee County 0 0.00 0 * 0 * 2 12.18
Payne County 0 0.00 0 * 0 * 1 1.25
Pittsburg County 1 2.21 0 * 5 11.06 0 *
Pontotoc County 2 5.34 0 * 1 2.67 0 *
Pottawatomie County 4 5.69 0 * 4 5.69 1
1.42
Pushmataha County 0 0.00 0 * 0 * 0 *
Roger Mills County 0 0.00 0 * 0 * 0 *
Rogers County 2 2.33 1 1.17 0 * 1 1.17
Seminole County 3 12.35 0 * 1 4.12 1 4.12
Sequoyah County 0 0.00 0 * 3 7.24 2 4.83
Stephens County 0 0.00 0 * 1 2.30 0 *
Texas County 1 4.73 0 * 0 * 0 *
Tillman County 0 0.00 0 * 0 * 0 *
Tulsa County 20 3.32 1 0.17 25 4.15 9 1.50
Wagoner County 2 2.84 0 * 2 2.84 0 *
Washington County 1 1.97 0 * 1 1.97 0 *
Washita County 0 0.00 0 * 0 * 0 *
Woods County 0 0.00 0 * 0 * 0 *
Woodward County 0 0.00 0 * 2 10.02 0 *
State of Oklahoma 105 2.85 6 0.16 115 3.12 41 1.11
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
22
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Meningococcal invasive
disease Pertussis
Rocky Mountain
Spotted Fever Salmonellosis
County Number Rate Number Rate Number Rate Number Rate
Adair County 1 4.58 1 4.58 1 4.58 1 4.58
Alfalfa County 0 * 0 * 0 * 4 72.98
Atoka County 0 * 1 6.90 2 13.80 1 6.90
Beaver County 0 * 0 * 0 * 2 37.95
Beckham County 0 * 0 * 0 * 4 18.94
Blaine County 0 * 0 * 2 15.86 0 *
Bryan County 0 * 0 * 0 * 15 36.78
Caddo County 0 * 1 3.29 1 3.29 6 19.74
Canadian County 0 * 5 4.56 7 6.38 32 29.18
Carter County 0 * 4 8.28 0 * 16 33.11
Cherokee County 0 * 1 2.17 1 2.17 3 6.52
Choctaw County 0 * 0 * 0 * 1 6.72
Cimarron County 0 * 0 * 0 * 0 *
Cleveland County 0 * 2 0.82 4 1.64 44 17.99
Coal County 0 * 0 * 0 * 3 51.23
Comanche County 0 * 2 1.77 4 3.53 23 20.31
Cotton County 0 * 0 * 0 * 1 15.92
Craig County 1 6.60 0 * 1 6.60 0 *
Creek County 0 * 6 8.54 6 8.54 17 24.20
Custer County 0 * 0 * 2 7.49 5 18.71
Delaware County 0 * 3 7.40 5 12.33 8 19.73
Dewey County 0 * 0 * 0 * 0 *
Ellis County 0 * 0 * 0 * 1 25.48
Garfield County 0 * 0 * 1 1.70 8 13.58
Garvin County 0 * 4 14.75 3 11.06 8
29.51
Grady County 0 * 7 13.55 2 3.87 13 25.17
Grant County 0 * 0 * 0 * 0 *
Greer County 0 * 0 * 0 * 1 17.15
Harmon County 0 * 0 * 0 * 0 *
Harper County 0 * 0 * 0 * 4 118.45
Haskell County 0 * 0 * 3 24.21 4 32.28
Hughes County 1 7.24 1 7.24 1 7.24 2 14.47
Jackson County 0 * 0 * 0 * 8 31.53
Jefferson County 0 * 0 * 0 * 0 *
Johnston County 0 * 0 * 0 * 3 28.66
Kay County 1 2.17 4 8.67 1 2.17 6 13.01
Kingfisher County 0 * 0 * 2 13.90 6 41.71
Kiowa County 0 * 0 * 0 * 3 32.96
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
23
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Meningococcal invasive
disease Pertussis
Rocky Mountain
Spotted Fever Salmonellosis
County Number Rate Number Rate Number Rate Number Rate
Latimer County 0 * 1 9.42 15 141.23 2 18.83
Le Flore County 0 * 0 * 19 38.06 11 22.04
Lincoln County 0 * 2 6.21 6 18.63 14 43.48
Logan County 0 * 0 * 2 5.09 13 33.08
Love County 0 * 0 * 0 * 3 32.88
McClain County 0 * 0 * 2 6.03 13 39.19
McCurtain County 0 * 0 * 8 23.97 8 23.97
McIntosh County 0 * 1 5.05 3 15.15 3 15.15
Major County 0 * 0 * 0 * 3 41.73
Marshall County 0 * 0 * 0 * 2 13.32
Mayes County 0 * 1 2.50 3 7.49 8 19.97
Murray County 0 * 1 7.72 0 * 3 23.15
Muskogee County 0 * 1 1.40 6 8.40 9 12.60
Noble County 0 * 0 * 0 * 6 54.79
Nowata County 0 * 0 * 2 19.00 3 28.50
Okfuskee County 0 * 2 18.31 3 27.46 4 36.62
Oklahoma County 2 0.28 29 4.05 15 2.09 132 18.42
Okmulgee County 0 * 4 10.18 5 12.73 4 10.18
Osage County 0 * 1 2.22 5 11.10 9 19.98
Ottawa County 1 3.16 0 * 4 12.65 8 25.29
Pawnee County 0 * 1 6.09 1 6.09 9 54.81
Payne County 0 * 1 1.25 5 6.27 30 37.63
Pittsburg County 1 2.21 10 22.12 17 37.60 10 22.12
Pontotoc County 0 * 0 * 1 2.67 10 26.72
Pottawatomie County 1 1.42 0 * 8
11.38 20 28.46
Pushmataha County 0 * 0 * 8 67.73 0 *
Roger Mills County 0 * 0 * 0 * 0 *
Rogers County 4 4.67 6 7.00 2 2.33 20 23.35
Seminole County 0 * 0 * 6 24.70 7 28.81
Sequoyah County 0 * 2 4.83 3 7.24 8 19.31
Stephens County 0 * 0 * 3 6.90 20 45.99
Texas County 0 * 0 * 0 * 7 33.12
Tillman County 0 * 0 * 0 * 4 51.31
Tulsa County 4 0.66 88 14.62 24 3.99 67 11.13
Wagoner County 1 1.42 1 1.42 8 11.36 10 14.21
Washington County 0 * 2 3.94 2 3.94 6 11.83
Washita County 0 * 0 * 0 * 2 16.93
Woods County 0 * 0 * 0 * 4 47.52
Woodward County 0 * 3 15.03 0 * 7 35.07
State of Oklahoma 18 0.49 199 5.40 235 6.37 752 20.40
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
24
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Shigellosis
S. pneumoniae ,
invasive, < 5 yrs. Tuberculosis Tularemia
County Number Rate Number Rate Number Rate Number Rate
Adair County 10 45.75 1 4.58 0 * 0 *
Alfalfa County 0 * 0 * 0 * 0 *
Atoka County 0 * 0 * 0 * 0 *
Beaver County 4 75.90 0 * 1 18.98 0 *
Beckham County 7 33.15 1 4.74 0 * 0 *
Blaine County 0 * 0 * 0 * 0 *
Bryan County 0 * 0 * 1 2.45 0 *
Caddo County 13 42.77 0 * 2 6.58 0 *
Canadian County 34 31.00 1 0.91 4 3.65 0 *
Carter County 3 6.21 1 2.07 0 * 0 *
Cherokee County 5 10.86 1 2.17 1 2.17 1 2.17
Choctaw County 0 * 1 6.72 0 * 0 *
Cimarron County 0 * 0 * 0 * 0 *
Cleveland County 38 15.54 3 1.23 1 0.41 1 0.41
Coal County 0 * 0 * 0 * 0 *
Comanche County 9 7.95 4 3.53 3 2.65 0 *
Cotton County 0 * 0 * 1 15.92 0 *
Craig County 0 * 1 6.60 0 * 0 *
Creek County 2 2.85 2 2.85 0 * 0 *
Custer County 2 7.49 0 * 1 3.74 0 *
Delaware County 0 * 0 * 1 2.47 0 *
Dewey County 0 * 0 * 1 22.71 0 *
Ellis County 1 25.48 0 * 0 * 0 *
Garfield County 2 3.39 1 1.70 4 6.79 0 *
Garvin County 0 * 0 * 0 * 0 *
Grady County 4 7.74 0 * 0 * 0 *
Grant County 0 * 1 23.16 0 * 0 *
Greer County 0 * 0 * 0 * 0 *
Harmon County 0 * 0 * 0 * 0 *
Harper County 0 * 0 * 1 29.61 0 *
Haskell County 0 * 0 * 0 * 1 8.07
Hughes County 0 * 0 * 0 * 0 *
Jackson County 14 55.19 0 * 2 7.88 0 *
Jefferson County 0 * 0 * 0 * 0 *
Johnston County 0 * 0 * 0 * 0 *
Kay County 0 * 0 * 1 2.17 1 2.17
Kingfisher County 0 * 0 * 0 * 0 *
Kiowa County 1 10.99 0 * 0 * 0 *
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
25
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Shigellosis
S. pneumoniae ,
invasive, < 5 yrs. Tuberculosis Tularemia
County Number Rate Number Rate Number Rate Number Rate
Latimer County 0 * 0 * 0 * 0 *
Le Flore County 0 * 0 * 3 6.01 0 *
Lincoln County 0 * 2 6.21 0 * 0 *
Logan County 0 * 0 * 0 * 0 *
Love County 0 * 0 * 0 * 0 *
McClain County 13 39.19 0 * 0 * 1 3.01
McCurtain County 0 * 0 * 4 11.99 0 *
McIntosh County 0 * 0 * 1 5.05 0 *
Major County 0 * 0 * 0 * 0 *
Marshall County 0 * 0 * 0 * 0 *
Mayes County 0 * 1 2.50 2 4.99 0 *
Murray County 0 * 0 * 0 * 0 *
Muskogee County 1 1.40 1 1.40 0 * 0 *
Noble County 0 * 0 * 0 * 0 *
Nowata County 0 * 0 * 0 * 0 *
Okfuskee County 6 54.92 0 * 0 * 0 *
Oklahoma County 62 8.65 13 1.81 27 3.77 0 *
Okmulgee County 9 22.91 0 * 0 * 0 *
Osage County 3 6.66 0 * 3 6.66 0 *
Ottawa County 1 3.16 0 * 2 6.32 0 *
Pawnee County 0 * 0 * 1 6.09 0 *
Payne County 5 6.27 0 * 2 2.51 0 *
Pittsburg County 0 0.00 5 11.06 1 2.21 0 *
Pontotoc County 1 2.67 1 2.67 0 * 0 *
Pottawatomie County 0 * 1 1.42 2 2.85 0 *
Pushmataha County 0 * 0 * 0 * 0 *
Roger Mills County 1 29.35 0 * 0 * 1 29.35
Rogers County 22 25.68 1 1.17 0 * 0 *
Seminole County 0 * 0 * 0 * 0 *
Sequoyah County 4 9.65 0 * 0 * 0 *
Stephens County 0 * 3 6.90 0 * 1 2.30
Texas County 0 * 0 * 1 4.73 0 *
Tillman County 0 * 0 * 0 * 0 *
Tulsa County 79 13.12 6 1.00 11 1.83 0 *
Wagoner County 60 85.23 1 1.42 0 * 1 1.42
Washington County 0 * 2 3.94 0 * 0 *
Washita County 0 * 0 * 0 * 0 *
Woods County 0 * 0 * 0 * 0 *
Woodward County 0 * 0 * 1 5.01 0 *
State of Oklahoma 416 11.28 55 1.49 86 2.33 8 0.22
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
26
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Chlamydia Gonorrhea Syphilis (Total Early)
County Number Rate Number Rate Number Rate
Adair County 67 295.38 16 70.54 0 *
Alfalfa County 3 53.17 0 * 0 *
Atoka County 46 324.35 5 35.26 0 *
Beaver County 6 106.46 0 * 0 *
Beckham County 53 239.61 9 40.69 0 *
Blaine County 17 142.34 3 25.12 0 *
Bryan County 145 341.85 21 49.51 0 *
Caddo County 92 310.81 7 23.65 0 *
Canadian County 179 154.92 34 29.43 2 1.73
Carter County 173 363.77 67 140.88 0 *
Cherokee County 175 372.44 14 29.80 0 *
Choctaw County 79 519.57 8 52.61 0 *
Cimarron County 1 40.40 0 * 0 *
Cleveland County 607 237.34 113 44.18 2 0.78
Coal County 16 270.04 3 50.63 0 *
Comanche County 1196 963.75 310 249.80 4 3.22
Cotton County 16 258.36 1 16.15 0 *
Craig County 51 339.34 7 46.58 0 *
Creek County 213 304.43 34 48.59 1 1.43
Custer County 63 229.35 8 29.12 0 *
Delaware County 82 197.65 4 9.64 0 *
Dewey County 7 145.53 1 20.79 0 *
Ellis County 2 48.18 0 * 0 *
Garfield County 231 381.31 26 42.92 0 *
Garvin County 68 246.59 9 32.64 0 *
Grady County 109 207.89 17 32.42 2 3.81
Grant County 6 132.54 3 66.27 0 *
Greer County 12 192.34 1 16.03 0 *
Harmon County 7 239.56 2 68.45 0 *
Harper County 2 54.27 1 27.14 0 0.00
Haskell County 15 117.47 0 * 0 0.00
Hughes County 35 249.95 7 49.99 0 0.00
Jackson County 131 495.35 24 90.75 0 0.00
Jefferson County 15 231.77 1 15.45 0 0.00
Johnston County 27 246.42 2 18.25 0 0.00
Kay County 164 352.22 24 51.54 0 0.00
Kingfisher County 19 126.38 2 13.30 0 0.00
Kiowa County 16 169.38 3 31.76 0 0.00
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
27
Table Three. Reportable Diseases by County, Oklahoma, 2010^
Chlamydia Gonorrhea Syphilis (Total Early)
County Number Rate Number Rate Number Rate
Latimer County 33 295.86 2 17.93 0 *
Le Flore County 119 236.19 6 11.91 0 *
Lincoln County 92 268.43 12 35.01 0 *
Logan County 177 422.96 57 136.21 2 4.78
Love County 22 233.47 0 * 0 *
McClain County 62 179.68 7 20.29 0 *
McCurtain County 156 470.57 59 177.97 0 *
McIntosh County 74 365.40 16 79.00 0 *
Major County 12 159.43 1 13.29 0 *
Marshall County 21 132.58 0 * 0 *
Mayes County 109 264.18 10 24.24 0 *
Murray County 27 200.18 0 * 0 *
Muskogee County 326 459.22 124 174.67 1 1.41
Noble County 15 129.75 2 17.30 0 *
Nowata County 22 208.81 0 * 0 *
Okfuskee County 23 188.66 4 32.81 0 *
Oklahoma County 3478 483.97 1460 203.16 47 6.54
Okmulgee County 196 489.16 87 217.13 1 2.50
Osage County 96 202.22 18 37.92 0 *
Ottawa County 136 427.03 14 43.96 0 *
Pawnee County 41 247.33 5 30.16 0 *
Payne County 365 471.88 69 89.20 1 1.29
Pittsburg County 127 277.07 25 54.54 1 2.18
Pontotoc County 121 322.74 30 80.02 0 *
Pottawatomie County 310 446.42 98 141.12 1
1.44
Pushmataha County 23 198.76 1 8.64 0 *
Roger Mills County 8 219.36 1 27.42 0 *
Rogers County 173 199.07 21 24.16 0 *
Seminole County 83 325.72 44 172.67 0 *
Sequoyah County 106 250.05 12 28.31 0 *
Stephens County 138 306.34 8 17.76 0 *
Texas County 36 174.42 8 38.76 0 *
Tillman County 27 337.84 4 50.05 0 *
Tulsa County 3146 521.38 1329 220.25 26 4.31
Wagoner County 92 125.88 25 34.21 0 *
Washington County 68 133.40 10 19.62 0 *
Washita County 21 180.58 7 60.19 0 *
Woods County 33 371.71 4 45.06 1 11.26
Woodward County 40 199.19 2 9.96 0 *
State of Oklahoma 14302 381.20 4369 116.46 92 2.45
^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of
reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000
28
Botulism
2010 Case Total 2 2010 Incidence Rate 0.06 per 100,000
2009 Case Total 0 2009 Incidence Rate 0.00 per 100,000
Botulism is a collective term for illness or intoxication caused by the bacteria Clostridium botulinum or its toxin. For
disease classification purposes, the broadest categories of the disease include foodborne botulism, infant botulism, and
wound botulism. In 2009, the US had 118 cases of botulism, 10 were categorized as foodborne botulism, 83 were infant
botulism, and 25 were either wound botulism or an unspecified category of botulism. In 2010, Oklahoma had two cases
of infant botulism. This report summarizes the clinical and laboratory results of both cases.
C. botulinum is ubiquitous in the environment and rarely causes disease when ingested by healthy adults. In infants,
ingested spores may multiply in the intestinal lumen and produce toxin, causing neurological illnessi. In the last several
years, colonization with C. botulinum in adults has also been recognized as a rare clinical entity. Infant botulism has
been epidemiologically linked to the consumption of honey, although approximately 85% of infected infants did not ingest
honey prior to illness. Some studies suggest that as many as 5% of SIDS deaths are caused by infant botulismii.
The two Oklahoma cases experienced symptoms of weak/altered cry, diminished suckling, hypotonia, and poor feeding.
One case also experienced symptoms of paralysis and constipation. Initial tests performed to rule out other diagnoses
were a CT scan, lumbar puncture, and stool cultures. Due to the cases clinical presentation and rule out testing of other
diagnoses, BabyBIG® (Botulism Immune Globulin Intravenous [Human]) was released by the Infant Botulism Treatment
and Prevention Program from the California Department of Health. Stool specimens were sent to the Centers for
Disease Control and Prevention (CDC) for C. botulinum testing. Clostridium botulinum toxin was identified in the stool of
both cases. Laboratory testing identified C. botulinum toxin type A in one case and C. botulinum toxin type B was
identified in the other case’s clinical specimen. Investigations conducted by the Acute Disease Service (ADS) did not
identify a potential source, such as consumption of honey, for either case. Prior to 2010, the last infant botulism cases
reported in Oklahoma occurred during 2001 and 2005.
Botulism is an immediately notifiable condition in Oklahoma. Clinicians should contact the ADS Epidemiologist-on-Call
(available 24/7/365 for disease reporting and consultation) immediately if botulism is suspected based on clinical
impression. The ADS Epi-on-Call will work with the clinician and the CDC to coordinate antitoxin or BabyBIG® release
and clinical specimen collection for laboratory testing. The decision to release antitoxin and BabyBIG® are based on
symptoms consistent with botulism and initial tests that rule out other potential diagnoses such as LP, brain CT or MRI,
edrophonium challenge test, physical exam for ticks, chest x-ray, and EMG. If given before paralysis is complete,
antitoxin can prevent worsening of the patient’s illness and shorten recovery time. The decision to release antitoxin
cannot depend on laboratory confirmation since routine tests cannot confirm C. botulinum with the speed required for
initiating antitoxin as early as possible during the course of illness.
The mouse bioassay is used by the CDC to test for C. botulinum. The Oklahoma State Department of Health Public
Health Lab does not perform C. botulinum testing. The CDC will only perform C. botulinum testing if the patient’s
symptoms are consistent with botulism or if the antitoxin has been released. Preferred specimens for botulism testing are
serum, feces, vomitus, or gastric contents. Serum should be collected before antitoxin treatment is given. Preferred
specimens for infant botulism testing are stool or rectal swab. For wound botulism, the preferred specimens are serum,
tissue, or feces. Pease refer to the OSDH ADS website at http://ads.health.ok.gov for additional information about
botulism.
i Nevas M. et al. Infant Botulism Acquired from Household Dust Presenting as Sudden Infant Death
Syndrome. J Clin Microb 2005;43:511-513.
ii Control of Communicable Diseases Manual, 19th Edition. Heyman D, Ed. American Public Health
Association, Washington, DC 2008.
29
Campylobacteriosis
2010 Case Total 448 2010 Incidence Rate 12.2 per 100,000
2009 Case Total 384 2009 Incidence Rate 10.5 per 100,000
Campylobacteriosis is a diarrheal illness caused by Campylobacter species and is characterized by an acute onset of
diarrhea, sometimes bloody, abdominal cramps, fever, malaise, nausea, and sometimes vomiting. Beginning in
October 2009, reported cases of campylobacteriosis are counted rather than investigated by county health
department communicable disease nurses. The number of cases reported in 2010 is a 17% increase from the 384
cases reported in 2009. A seasonal trend for campylobacteriosis was seen with more cases occurring during the
months of June through August (n = 192, 43%).
The highest incidence rate (IR) by age group occurred among cases less than five years of age (29.79 per 100,000,
n = 81), followed by cases 5 to 9 years of age (13.37 per 100,000, n = 34), and cases 60 to 69 years of age (12.90
per 100,000, n = 44). Although the IR of campylobacteriosis is 25% greater among men (13.56 per 100,000, n =
247) than women (10.78 per 100,000, n = 201), the difference is not statistically significant. No outbreaks of
campylobacteriosis were reported in 2010.
Cases of campylobacteriosis were reported from 67 counties in Oklahoma. The highest IR of cases occurred among
residents of Cimarron County (76.05 per 100,000; n = 2). Other counties with high rates included Harper County
(59.22 per 100,000; n = 2), Alfalfa County (54.73 per 100,000; n = 3), and Jackson County (47.30 per 100,000; n =
12). Population size can affect incidence rates, consequently the higher rates seen in counties with smaller
population. The largest counties had the highest numbers of cases: Oklahoma had 69 cases (9.6 per 100,000)
followed by Tulsa with 53 cases (8.78 per 100,000). Eighteen cases (4%) were hospitalized for campylobacteriosis;
there were no deaths due to this disease in 2010. The OSDH PHL received 69 isolates to confirm Campylobacter
and serogroup identification, representing 15% of the reported cases. Of these isolates, 83% were identified as C.
jejuni, 7% as C. jejuni var. doylei, and 10% as C. coli.
Incidence Rate of Reported Cases of Campylobacteriosis
by Year, Oklahoma, 2001-2010*
0
2
4
6
8
10
12
14
16
18
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Incidence Rate per 100,000
* Campylobacteriosis is not a nationally notifiable Year
condition, so national data is unavailable for comparison.
30
Demographic and Clinical Summary of Reported Campylobacteriosis Cases, Oklahoma, 2010 (N = 448)
Number (%) Incidence rate per 100,000
Gender
Male
Female
247 (55%)
201 (45%)
13.56
10.78
Age Median Age: 30 years (Range: 1 month – 93 years)
Age Groups
Less than 5 years
5 - 9
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
80+
81 (18%)
34 (8%)
46 (10%)
61 (14%)
44 (10%)
55 (12%)
46 (10%)
44 (10%)
24 (5%)
13 (3%)
29.79
13.37
9.23
10.98
9.59
11.40
9.63
12.90
11.53
9.35
Race
White
American Indian or Alaska Native
Black or African American
Asian
Two or More Races
Unknown
203 (45%)
27 (6%)
8 (2%)
5 (1%)
5 (1%)
200 (45%)
7.06
9.12
2.69
7.97
3.31
--
Hispanic or Latino Ethnicity
Unknown
20 (4%)
283 (63%)
6.63
--
Hospitalized 18 (4%) --
31
Chlamydia
2010 Case Total 14,302 2010 Incidence Rate 381 per 100,000
2009 Case Total 14,991 2009 Incidence Rate 412 per 100,000
Chlamydia is the most commonly reported notifiable sexually transmitted disease (STD) in the United States and
Oklahoma. Caused by the bacterium Chlamydia trachomatis, it is the most prevalent STD in Oklahoma accounting for
76% of reported STDs in the state for 2010. Although symptoms of chlamydia are usually mild or absent, serious
complications that cause irreversible damage can develop “silently” before a patient ever recognizes a problem. In
women, chlamydia can cause pelvic inflammatory disease, ectopic pregnancy, chronic pain, and/or infertility. However,
up to 70% of women with chlamydia are asymptomatic. In addition, a pregnant woman infected with chlamydia can
transmit the infection to her baby’s eyes during a vaginal birth. The resulting ophthalmic infection can ultimately result in
the infant’s blindness. Men infected with chlamydia may have penile discharge while about 1% to 25% of men infected
are asymptomatic. Possible complications of male infections include epididymitis, infertility, and Reiter Syndrome
(reactive arthritis). In men, receptive anal intercourse may result in chlamydial proctitis.
Oklahoma mandated chlamydia reporting in 1988, when 2,714 cases were reported. In 2010, a total of 14,302 cases
were reported. The rate of chlamydia in Oklahoma decreased 4.6% between 2009 and 2010. Oklahoma had an
incidence rate of 381.2 per 100,000 in 2010 with 72% of the reported cases being female. Women go to the doctor more
frequently than men due to yearly exams and pregnancy; this could account for some of the huge gap in the gender of
reported chlamydia cases.
While Oklahoma county had the highest number of reported cases, Comanche county had the highest rate at 963.8 per
100,000, followed by Tulsa county (521.4 per 100,000) and Oklahoma county (483.9 per 100,000). Comanche county
had a 15.9% increase between 2009 and 2010, while Oklahoma and Tulsa counties’ rates decreased. Chlamydia
occurs in all ages, but age groups 15 to 19 years (1,936.6 per 100,000) and 20 to 24 years (2,031.8 per 100,000) had
the highest rates among all the age groups. Age group 45 to 49 years had the highest rate increase at 23.6 per 100,000,
19.6% higher than 2009 (51 to 61 cases, respectively).
Blacks had the highest rate among all racial groups with a rate of 1,594.5 per 100,000, 6.4 times higher when compared
to Whites (249.9 per 100,000). Native Americans had the second highest rate (499.6 per 100,000) which was 1.9 times
higher than Whites. Asian/Hawaiian/Pacific Islanders had a rate of 227.5 per 100,000. Hispanics had a rate of 415.1
per 100,000 in 2010, which represents a 7.4% decrease from 2009.
0
50
100
150
200
250
300
350
400
450
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Incidence Rate per 100,000
Year
Chlamydia Incidence Rates per 100,000 Population,
Oklahoma and U.S., 1997-2010*
U.S Oklahoma
*U.S. Data for 2010 not available at the time of this report.
32
Chlamydia Cases and Rates by Demographics for 2010, Oklahoma
Number Percent Incidence Rate per
100,000
Male Gender (N = 14,302)* 3,9 97 27.9 % 219 .4
Female 10,297 72.0 % 552.1
Unknown 8 <1.0 % *
< 10A Ygeea rGsr oups (N = 14,302)* 2 2 <1.0 % 4. 2
10 - 14 129 <1.0 % 53.4
15 - 19 4,974 34.8 % 1,936.6
20 - 24 5,705 39.9 % 2,031.8
25 - 29 2,127 14.9 % 774.5
30 - 34 821 5.7 % 356.4
35 - 39 302 2.1 % 132.1
40 - 44 114 <1.0 % 51.0
45 - 49 61 <1.0 % 23.6
> 50 Years 47 <1.0 % 4.0
AmericanR aIncdeia (nN/ A=l a1s4k,a3 0N2a) tive 1,6 07 11.2 % 499 .6
Asian/Pacific Islander 158 1.1 % 227.5
Black/African American 4,427 30.9 % 1,594.5
White 6,764 47.3 % 249.9
Multiple Race 263 1.8 % 173.9
Other 150 1.1 % 97.1
Unknown 933 6.5 % *
HispaniEct hnicity (N = 1,253) 1,2 53 8.8 % 415 .1
*At the time of publication 2010 population data was not available; therefore, 2009 population data
was used to calculate rates.
33
Cryptosporidiosis
2010 Case Total 122 2010 Incidence Rate 3.3 per 100,000
2009 Case Total 141 2009 Incidence Rate 3.9 per 100,000
The number of cryptosporidiosis cases reported in Oklahoma during 2010 was a 13.5% decrease compared to the 141
cases reported during 2009. Of the 122 reported cases, 93 (76%) were laboratory-confirmed cases of cryptosporidiosis
and 29 (24%) were symptomatic exposed contacts to a confirmed case identified during public health investigations
conducted by county health department communicable disease nurses. No outbreaks of cryptosporidiosis were reported
in Oklahoma during 2010.
The highest incidence rate of cryptosporidiosis occurred in persons under 10 years of age (5.5 per 100,000 population).
Twelve (10%) cases reported working in or attending a child care setting. Twelve (10%) cases reported out-of-state
travel and 9 (7%) reported international travel to various countries including Mexico, Ethiopia, Morocco, and Costa Rica.
A seasonal trend was observed in 2010 with the majority of cases (60%) reporting onset of symptoms from June through
September. The highest incidence rates of cryptosporidiosis occurred among residents of Carter (33.1 per 100,000
population), Johnston (28.7 per 100,000 population), and Ellis Counties (32.8 per 100,000 population). Regular
handwashing with soap and water, whether you are ill or well, is the single most important thing you can do to prevent
cryptosporidiosis and other diarrheal illnesses. For more information about preventing cryptosporidiosis and other
waterborne diseases, visit http://ads.health.ok.gov.
Demographic Summary of Reported Cryptosporidiosis Cases, Oklahoma, 2010 (N = 122)
Number (%) Incidence Rate per 100,000
Gender
Female
Male
67 (55%)
55 (45%)
3.59
3.02
Age Median = 35.5 years (range: 6 months – 91 years)
Race
White
Black or African American
American Indian or Alaskan Native
Two or more races
Unknown
94 (77%)
5 (4%)
9 (7%)
2 (2%)
12 (10%)
3.27
1.68
3.04
1.32
-
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Unknown
7 (6%)
95 (78%)
20 (16%)
2.32
2.81
-
Hospitalization 28* (23%) -
Death 0† (0%) -
Symptoms
Diarrhea
Watery diarrhea
Abdominal cramps
Anorexia
119 (98%)
102 (84%)
87 (71%)
75 (61%)
-
-
-
-
Duration of diarrhea Median = 7 days (range: 1 – 120 days)
Number of loose stools in a 24-hour period Median = 8 stools (range: 1 – 140 stools)
* Twenty-eight cases were hospitalized with cryptosporidiosis or found to have cryptosporidiosis during a hospital stay for an underlying condition
† There were three deaths among cases. Each of these cases had additional underlying conditions at the time of death, and cryptosporidiosis
was not considered the primary cause of death for any of these cases.
34
Dengue Fever
2010 Case Total 4 2010 Incidence Rate 0.11 per 100,000
2009 Case Total 0 2009 Incidence Rate 0.00 per 100,000
Dengue fever is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean (refer
to map). Cases of dengue fever are generally acquired outside of the US (imported or travel-associated), but non-imported
cases have been identified in Hawaii in 2001, Texas in 2005, and Florida in 2009 and 2010. Most dengue
cases in U.S. citizens occur in endemic areas, such as, Puerto Rico, the U.S. Virgin Islands, Samoa, and Guam.
In Oklahoma, all dengue fever cases reported in 2010 were imported. Two cases reported visiting the Caribbean,
one case visited Central American, and one case visited Southeast Asia during the incubation period. Only one case
was hospitalized for this illness. All four cases reported being bitten by mosquitoes. Only one of the cases reported
using mosquito repellant/prevention methods. The cases’ ages ranged from 12 to 23 years. All four cases reported
fever and myalgia. Three of the cases reported chills and anorexia and two cases reported rash, vomiting, backache,
and eye pain. Other symptoms associated with dengue include intense headache, arthralgia, and a generalized
maculo-papular rash.
Dengue fever is transmitted through the bite of an infected mosquito. Prevention of dengue fever may be achieved
by routine use of an insect repellent containing 20 to 30% DEET (N, N-diethyl-m-toluamide) when visiting or residing
in an endemic area along with sleeping indoors with screened windows or mosquito netting protection. The CDC
Division of Vectorborne Infectious Diseases website has recommendations, news and updates for travelers and
clinicians regarding dengue fever at http://www.cdc.gov/NCIDOD/DVBID/dengue. Persons planning travel to areas
where dengue is endemic can check the CDC Traveler’s Health recommendations by accessing the website
www.cdc.gov/travel.
If a case of dengue fever is reported to the Oklahoma State Department of Health (OSDH), further testing may be
performed by the Center for Disease Control Dengue Branch (CDC) upon request by the Acute Disease Service
(ADS). The diagnosis and treatment of dengue and dengue hemorrhagic fever are guided by the symptoms and
findings the patient presents, and cannot depend on laboratory confirmation, since routine tests can not confirm
dengue with the speed required for patients in critical condition. Commercial laboratories are capable of testing for
dengue. Confirmatory testing is performed only by the CDC using acute and convalesce blood samples. For unique
circumstances, the OSDH ADS can arrange confirmatory testing at the CDC.
35
Source: WHO, International Travel and Health http://www.who.int/ith/en/
36
Shiga Toxin-producing Escherichia coli (STEC)
2010 Case Total 104 2010 Incidence Rate 2.82 per 100,000
2009 Case Total 64 2009 Incidence Rate 1.76 per 100,000
Nationally, E. coli O157:H7 is the most commonly reported serotype of Shiga toxin-producing E. coli (STEC); however,
the number of reported non-O157 STEC cases each year is increasing.i This increase may be partially due to more
widely used laboratory tests that identify other serotypes of STEC beyond O157:H7. The number of reported STEC
cases reported in 2010 is a 63% increase from the 64 cases reported in 2009. This increase may be in part due to an
outbreak involving a correctional facility described elsewhere in this publication. A seasonal trend was observed with the
highest number of cases reported during the summer months of June and July (n = 44, 43%).
STEC cases in 2010 occurred among residents of 30 Oklahoma counties. The five counties with the highest incidence
rates were Noble (45.66 per 100,000, n = 5), Cotton (31.84 per 100,000, n = 2), Johnston (19.11 per 100,000, n = 2),
Greer (17.15 per 100,000, n = 1), and Canadian (13.68 per 100,000, n = 15) counties. The highest incidence rate
occurred among males less than five years of age with an incidence of 18.73 per 100,000 (n = 26). The second highest
incidence rate occurred among females less than five years of age (8.27 per 100,000, n = 11).
Demographic and Clinical Summary of Reported STEC Cases, Oklahoma, 2010 (N = 104)
Number (%) Incidence Rate per 100,000
Gender
Male
Female
60 (58%)
44 (42%)
3.29
2.36
Age Median Age: 15 years (Range: 6 months – 75 years)
Race
White
African American or Black
Two or more races
American Indian or Alaska Native
Unknown
78 (75%)
8 (8%)
8 (8%)
6 (6%)
4 (4%)
2.71
2.69
5.29
2.03
--
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Unknown
4 (4%)
83 (80%)
17 (17%)
1.33
--
--
Hospitalized 18 (17%) ---
Hemolytic Uremic Syndrome 6 (6%) --
Symptoms
Diarrhea
Abdominal Cramps
Bloody Diarrhea
Nausea
Vomiting
Fever
93 (89%)
79 (76%)
51 (51%)
42 (40%)
41 (39%)
31 (30%)
--
--
--
--
--
--
Twenty-nine (28%) cases reported an affiliation with high-risk settings. Of those, 17 (59%) were associated with child
care settings, ten (34%) resided in a correctional facility, and two (7%) worked in food service. Secondary cases were
reported in two child care settings. Of the 104 cases, 87 (84%) were laboratory-confirmed STEC and 17 (16%) were
epidemiologically-linked symptomatic contacts identified by the county health department communicable disease nurse
during case investigations.
37
All suspected STEC isolates are required to be forwarded to the Oklahoma State Department of Health Public Health
Laboratory (OSDH PHL) for confirmation and serogroup identification. In 2010, STEC isolates were forwarded to the
OSDH PHL for all 87 confirmed cases. Of the 87 isolates, 41 (47%) were confirmed E. coli O157:H7 and 46 (53%) were
STEC non-O157.
Incidence Rate of Reported Cases of Shiga Toxin-producing
E. coli by Year, Oklahoma and U.S.,
2001-2010*
0
0.5
1
1.5
2
2.5
3
3.5
4
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
U.S. Oklahoma
Incidence Rate per 100,000
*U.S. 2010 Rate Unavailable Year
*
Incidence Rate of Reported Cases of Shiga Toxin-producing
E. coli by Age Group and Gender,
Oklahoma, 2010
0
2
4
6
8
10
12
14
16
18
20
0 - 4 y 5 - 9 y 10 - 19 y 20 - 29 y 30 - 39 y 40 - 49 y 50 - 59 y 60 - 69 y 70 - 79 y
Male Female
Incidence Rate per 100,000
Age Group
i Centers for Disease Control and Prevention. [Summary of notifiable diseases—United States, 2009]. Published May 12, 2011 for MMWR 2011;58(No. 53):74
38
Ehrlichiosis and Anaplasmosis
2010 Case Total 107 2010 Incidence Rate 2.90 per 100,000
2009 Case Total 147 2009 Incidence Rate 4.04 per 100,000
Human monocytic ehrlichiosis (HME) and human granulocytic anaplasmosis (HGA, formerly called human
granulocytic ehrlichiosis, or HGE) are distinct but closely related tickborne diseases with similar clinical presentations.
For purposes of epidemiologic description, ehrlichiosis and anaplasmosis will be combined in this report. In 2010, the
incidence rate (IR) of ehrlichiosis and anaplasmosis in Oklahoma represented a 27% decrease from 2009. However,
the decline in cases may have partially been affected by changes in investigation processes; the Acute Disease
Service focused on investigating reports with serologic titers above 1:64. From 2001 to 2010, the median annual
number of reported cases in Oklahoma was 73 (range, 13 to 147). Eastern Oklahoma had higher incidence rates
corresponding with its higher tick population. The counties with the highest rates of disease in 2010 were
Pushmataha county (25.40 per 100,000, n = 3), followed by Haskell county (24.21 per 100,000, n = 3). The majority
of the cases occurred during the warmer months of the year, when tick exposure is more likely. Onsets of illness
were elevated from May to August and peaked in June.
Serologic testing is the most widely available and frequently used laboratory method for diagnosis. Both IgM and IgG
antibody levels are used to confirm illness. Collection of acute (within a week of onset) and convalescent (2 to 4
weeks later) specimens are recommended for confirming the diagnosis. Treatment should be initiated before lab
confirmation, when there is high suspicion of tickborne illness, to reduce the severity of disease. Doxycycline is the
primary drug of choice for the treatment of ehrlichiosis and anaplasmosis.i
39
Descriptive and Clinical Summary of Reported Ehrlichiosis and Anaplasmosis Cases, Oklahoma, 2010 (N = 107)
Number (%) Incidence rate per 100,000
Gender
Male
Female
67 (63%)
40 (37%)
3.68
2.14
Age Median Age: 48 years (Range: 21 months – 82 years)
Race
White
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Two or More Races
Unknown
60 (56%)
27 (25%)
1 (1%)
3 (3%)
16 (15%)
2.09
9.12
25.34
1.98
--
Hispanic or Latino Ethnicity
Unknown
1 (1%)
40 (37%)
0.33
--
Disease
Human Monocytic Ehrlichiosis
Human Granulocytic Anaplasmosis
98 (92%)
9 (8%)
--
--
Symptoms
Fever
Headache
Myalgia
Rash
106 (99%)
68 (64%)
54 (50%)
28 (26%)
--
--
--
--
Reported Exposures
Wooded or tick infested area
Tick bite
15 (14%)
40 (37%)
--
--
Hospitalized due to Ehrlichiosis or Anaplasmosis 26 (24%) --
Died due to Ehrlichiosis or Anaplasmosis 0 (0%) --
Incidence Rate of Reported Ehrlichiosis and Anaplasmosis
Cases by Year, Oklahoma and U.S.,
2001-2010*
0
1
2
3
4
5
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
U.S. Oklahoma
Incidence Rate per 100,000
Year
*U.S. 2010 Rate Unavailable
i Heymann, David L., Editor. Control of Communicable Diseases Manual. 19th Edition. American Public Health Association, 2008
40
Gonorrhea
2010 Case Total 4,369 2010 Incidence Rate 116.5 per 100,000
2009 Case Total 4,661 2009 Incidence Rate 128.0 per 100,000
Gonorrhea is the second most prevalent sexually transmitted disease reported in Oklahoma after chlamydia. Gonorrhea
is caused by Neisseria gonorrhea, a bacterium that can grow and multiply in warm, moist areas of the reproductive tract,
mouth, throat, eyes, and anus. In women, gonorrhea can result in pelvic inflammatory disease, ectopic pregnancy,
cervicitis, and eventually infertility. Pregnant women infected with gonorrhea can also infect their unborn babies through
the amniotic fluid or during birth. In men, this infection most often manifests as purulent urethral discharge and dysuria,
and can cause infertility.
Oklahoma mandated gonorrhea reporting in 1943, when 4,715 cases were reported. Reported gonorrhea cases
increased until 1982 when numbers started to slowly drop following a national decline due to the implementation of a
national gonorrhea control program in the mid-1970s. In 2010, a total of 4,369 cases were reported in Oklahoma,
approximately a 6% decrease from 2009. Oklahoma had an incidence rate of 166.5 per 100,000 in 2010 with 57% of the
reported cases being female. In 1989, men made up the majority of gonorrhea cases in the U.S., but since 2002 women
have made up the majority of cases. Oklahoma has followed a similar trend.
While Oklahoma County had the highest number of reported cases, Comanche County had the highest rate at 249.8 per
100,000, followed by Tulsa County (220.3 per 100,000) and Okmulgee County (217.1 per 100,000). Comanche County
had a 35% rate increase between 2009 and 2010; however, Okmulgee County had a rate increase of 77.9% (122 per
100,000 to 217.1 per 100,000). Oklahoma County decreased by 15.9% and Tulsa County decreased by 9.7%.
Gonorrhea occurs in all ages, but age groups 20 to 24 years (562 per 100,000) and 15 to 19 years (482.4 per 100,000)
had the highest rates among all the age groups. Although most age groups had a rate decrease from 2009 to 2010,
three age groups experienced an increase: 45 to 49 years at 6.2% increase, 25 to 29 years at 3.6% increase, and 30 to
34 years at 1% increase.
Blacks had the highest rate among all racial groups with a rate of 882 per 100,000, 18.8 times higher when compared to
Whites (47 per 100,000). American Indians/Alaska Natives had the second highest rate (102 per 100,000) which was
2.2 times higher than Whites. Asian/Pacific Islanders had a rate of 29 per 100,000 but represented only 20 cases in
2010, an 81.8% increase from 2009. Hispanics had a rate of 59 per 100,000 in 2010, which represents a 14.8%
decrease from 2009. Whites had the highest increase in gonorrhea rate (10% increase from 2009), while American
Indian/Alaska Natives had the largest decrease (9.9% decrease from 2009).
0
20
40
60
80
100
120
140
160
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Incidence Rate per 100,000
Year
Incidence Rate of Reported Gonorrhea Cases,
Oklahoma and U.S., 1998-2010*
U.S Oklahoma
*United States Data for 2010 was not available at the time of this report.
41
Gonorrhea Cases and Rates by Demographics for 2010, Oklahoma
Number Percent Incidence Rate per 100,000
Gender*
Male 1,873 42.9 % 102.8
Female 2,493 57.1 % 133.7
Unknown 3 <1 % -
Age Groups (N = 4,368)*
< 10 Years 8 <1 % 1.5
10 - 14 28 <1 % 11.6
15 - 19 1,239 28.4 % 482.4
20 - 24 1,578 36.1 % 562.0
25 - 29 823 18.8 % 299.7
30 - 34 377 8.6 % 163.7
35 - 39 135 3.1 % 59.0
40 - 44 82 1.9 % 36.7
45 - 49 57 1.3 % 22.0
> 50 Years 41 <1 % 3.5
Race
American Indian/Alaska Native 327 7.5 % 101.7
Black/African American 2,450 56.1 % 882.4
White 1,262 28.9 % 46.6
Asian/Pacific Islander 20 <1 % 28.8
Two or more races 85 1.9 % N/A
Other 30 <1 % N/A
Unknown 195 4.5 % N/A
Ethnicity
Hispanic 197 4.5 % 59.3
*At the time of publication 2010 population data was not available; therefore, 2009 population data was used to calculate rates.
42
Haemophilus influenzae Invasive Disease
2010 Case Total 105 2010 Incidence Rate 2.85 per 100,000
2009 Case Total 92 2009 Incidence Rate 2.53 per 100,000
Invasive Haemophilus influenzae (H. flu) disease is a reportable condition in Oklahoma, and all H. flu sterile-site isolates
are required to be submitted to the OSDH Public Health Laboratory (PHL) for confirmation and serotype identification.
One hundred and five cases of invasive H. flu were reported to the OSDH during 2010 resulting in an incidence rate of
2.85 per 100,000 population, a 14.1% increase from 2009. H. flu isolates are serotyped based on the presence of a
capsule (serotypes a through f) or absence of a capsule (non-typeable). Both capsulated and nonencapsulated isolates
have the ability to cause severe disease. Of the 97 isolates (92% of reported cases) available for serotype identification
by the PHL, 53 (54.6%) were non-typeable, 21 (21.6%) were serotype f, 9 (9.3%) were serotype a, 6 (6.2%) were
serotype e, 4 (4.1%) were serotype d, and 4 (4.1%) were serotype b. Infection types of the cases included
bacteremia/sepsis (97%, n = 102), meningitis (4%, n = 4), and pneumonia (59%, n = 62).
Cases of invasive H. flu in 2010 ranged in age from 1 day to 93 years with a median age of 70 years. The highest age-specific
incidence rates per 100,000 population occurred among persons 80 years and older (refer to graph). Fourteen
(13%) cases occurred among children less than 5 years of age, an age-specific incidence rate of 5.15 per 100,000
population. The highest proportion of cases occurred during the winter months, with over half of reported cases (n = 55,
52%) occurring in January, February, November, and December.
When a case of invasive Haemophilus influenzae type b (Hib) is identified, an active contact investigation commences to
locate all close contacts less than 4 years of age, review vaccination history, and recommend antibiotic prophylaxis if
needed. If any exposed children less than 4 years of age who are either unvaccinated or have not yet received the full
primary series of the Hib vaccine are identified, then chemoprophylaxis is recommended to eradicate carriage of the
organism. All four Hib cases reported in 2010 were over the age of 70 years. Investigations conducted by county health
department public health nurses determined none of the close contacts were less than 4 years of age for three of the
cases; therefore, post-exposure chemoprophylaxis was not recommended. Investigation of the fourth case revealed
exposed contacts less than 4 years of age that had not yet received the full primary series of the Hib vaccine. During
this investigation, OSDH recommended chemoprophylaxis to eradicate carriage of the organism to a total of 10 exposed
close, personal contacts. No secondary cases occurred among cases reported during 2010.
Demographic Summary of Reported Haemophilus influenzae Invasive Disease Cases,
Oklahoma, 2010 (N = 105)
Number (%) Incidence Rate per 100,000
Gender
Male 49 (47%) 2.69
Female 56 (53%) 3.00
Age Median Age: 70 years (Range: 1 day – 93 years)
Hospitalized for H. flu (n = 98)* 78 (80%) -
Deaths due to H. flu 12 (11%) -
Race
White 84 (80%) 2.94
Black 4 (4%) 1.35
American Indian or Alaska Native 5 (5%) 1.69
Asian
Two or more races
Unknown
-
2 (2%)
10 (9%)
-
1.32
-
Hispanic Ethnicity (n = 66) 6 (6%) 1.99
*Number hospitalized for H. flu out of those hospitalized
43
Incidence Rate of Reported Invasive Haemophilus
influenzae Cases by Age Group, Oklahoma, 2010
0
2
4
6
8
10
12
14
16
Incidence Rate per 100,000
Age Group (years)
Haemophilus influenzae Incidence Rate by Year,
Oklahoma and U.S., 2006-2010*
0
0.5
1
1.5
2
2.5
3
2006 2007 2008 2009 2010
U.S. Oklahoma
Incidence Rate per 100,000
*US data from Centers for Disease Control and Prevention. [Summary of Year
notifiable diseases—United States, 2009]. Published May 13, 2011 for
MMWR 2009;58(No. 53):83. Data unavailable for 2010.
44
Hemolytic Uremic Syndrome, Post-diarrheal
2010 Case Total 11 2010 Incidence Rate 0.30 per 100,000
2009 Case Total 17 2009 Incidence Rate 0.47 per 100,000
Hemolytic Uremic Syndrome (HUS) is a condition characterized by an acute onset of microangiopathic hemolytic
anemia, renal injury and thrombocytopenia, with the majority of cases preceded by a diarrheal illness. In 2010, the
incidence rate (IR) of HUS in Oklahoma represented a 35% decrease from 2009. HUS became a nationally notifiable
disease in 2000 and since that time Oklahoma’s incidence rate has been similar to the national incidence. From
2001 to 2010, the median annual number of reported HUS cases in Oklahoma was 5 (range, 2 to 51), and the overall
case fatality rate was 3%.
In 2010, the highest IR occurred among persons less than 5 years of age (2.21 per 100,000, n = 6), followed by
cases 5 to 9 years of age (1.18 per 100,000, n = 3), and 70 to 79 years of age (0.48 per 100,000, n = 1). The
incidence of HUS in women (0.38 per 100,000, n = 7) was 1.7 times greater than in men (0.22 per 100,000, n = 4)
but was not statistically significant. Cases occurred among residents of nine Oklahoma counties.
The diagnosis of HUS is made through evaluation of a combination of laboratory test results. Anemia with
microangiopathic changes shown on a peripheral blood smear was documented for eight (73%) of the cases. Of
those with microangiopathic changes, schistocytes were most commonly seen (63%) compared to burr cells (38%)
and helmet cells (25%), all non-exclusive. Hematuria was reported in 73% of cases; with proteinuria in 64% of
cases. Additionally, elevated creatinine was documented for 82% of cases and thrombocytopenia in 91% of cases.
An etiologic agent was identified in six (55%) of the 11 cases, which were E. coli O157:H7 (n = 5) and E. coli
O121:H19 (n = 1) with results confirmed by the OSDH PHL.
Descriptive and Clinical Summary of Reported Hemolytic Uremic Syndrome Cases, Oklahoma, 2010 (N = 11)
Number (%) Incidence rate per 100,000
Gender
Male
Female
4 (36%)
7 (64%)
0.22
0.38
Age Median Age: 4 years (Range: 23 months – 71 years)
Race
White
American Indian or Alaska Native
10 (91%)
1 (9%)
0.35
0.34
Hispanic or Latino Ethnicity 1 (9%) 0.33
Symptoms
Diarrhea
Abdominal cramps
Bloody diarrhea
Vomiting
Fever
11 (100%)
11 (100%)
9 (82%)
9 (82%)
8 (73%)
--
--
--
--
--
Hospitalized for HUS 11 (100%) --
Hospitalization Median Hospitalization: 15 days (Range: 3 days – 31 days)
Died due to HUS 0 (0%) --
45
Hepatitis A
2010 Case Total 6 2010 Incidence Rate 0.16 per 100,000
2009 Case Total 6 2009 Incidence Rate 0.16 per 100,000
Since the hepatitis A epidemic that took place in Oklahoma from 1995 through 1997, with the peak in 1996 of 2,516
cases (incidence rate = 79.99 per 100,000), the incidence of hepatitis A in the state has dramatically declined. The
number of cases has been less than 20 per year since 2004.
Of the six cases identified in 2010, none were associated with high-risk settings. One secondary case in a household
member was identified through public health investigations. One case was hospitalized, and none of the cases expired.
A total of 45 close contacts were investigated (median: 5, range: 1 – 18 per case). Of those, 18 did not have evidence of
immunity through previous testing or history of vaccination, and therefore required post exposure prophylaxis (PEP).
The county health departments provide PEP to those identified as close contacts to confirmed hepatitis A cases. In
2007, PEP guidelines were revised by the Advisory Committee on Immunization Practices (ACIP), limiting the use of
immunoglobulin (IG) and expanding the use of the hepatitis A vaccine. For persons from 12 months to 40 years of age,
the hepatitis A vaccine is now the preferred method of PEP. IG remains the recommended PEP for persons less than 12
months of age, greater than 40 years of age, and for those who are immunocompromised or who have chronic disease
such as liver disease or other chronic medical conditions.i
Incidence Rate of Reported Hepatitis A Cases by Year,
Oklahoma and US, 1980-2010*
0
10
20
30
40
50
60
70
80
90
100
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Oklahoma United States 2010 Target
Statewide Vaccination
Program Instituted, 1998
Incidence Rate per 100,000
*US rates unavailable for 2010 Year
46
Hepatitis A should be considered in unvaccinated persons with hallmark symptoms of jaundice, very dark urine and/or
clay-colored stools (refer to table for symptoms reported by cases), particularly those with recent exposure to high-risk
regions through travel or residence. One case (17%) reported international travel during their exposure period.
A positive hepatitis A IgM titer indicates current infection, although false positive tests are common.ii Healthcare
providers should restrict testing for hepatitis A to those clients with clinical evidence of acute hepatitis A infection. Liver
function tests are usually markedly elevated in confirmed cases. Of the five cases with known liver function test results,
the median alanine transaminase (ALT) was 589 (range: 135 – 1331), median aspartate aminotransferase (AST) of 435
(range: 202 – 1158), and median total bilirubin was 3.0 (range: 0.3 – 7.4).
The hepatitis A vaccine is routinely recommended for individuals 2 years of age or older, and the two-dose regimen is
required for entry into childcare or grade school in Oklahoma. The CDC Travelers’ Health website has recommendations
regarding hepatitis A prevention for those traveling out of the US, and can be accessed at the website
www.cdc.gov/travel.
Demographic and Clinical Summary of Reported Hepatitis A Cases, Oklahoma, 2010 (N = 6)
Number (%) Incidence Rate per 100,000
Gender
Female
Male
5 (83%)
1 (17%)
0.29
0.55
Age Median = 34 years (range: 13 - 74 years)
Race
White
Two or more races
Unknown
4 (67%)
1 (17%)
1 (17%)
0.14
0.66
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Unknown
2 (33%)
3 (50%)
1 (17%)
0.66
-
-
Hospitalized for this disease 1 (17%) -
Died due to this disease 0 -
Hallmark symptoms (not exclusive)
Jaundice
Dark Urine
Clay-colored stool
4 (67%)
3 (50%)
2 (33%)
-
-
-
Recent travel out of country 1* (17%) -
*Mexico
i Centers for Disease Control and Prevention Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and
in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 2007;56:[1080-1084], available at http://www.cdc.gov/mmwr/PDF/wk/mm5641.pdf
ii Centers for Disease Control and Prevention. Positive Test Results for Acute Hepatitis A Virus Infection Among
Persons with No Recent History of Acute Hepatitis – United States, 2002-2004. MMWR 2005;54; (453-456), available at
http://www.cdc.gov/mmwr/PDF/wk/mm5418.pdf
47
Hepatitis B
2010 Case Total 115 2010 Incidence Rate 3.1 per 100,000
2009 Case Total 122 2009 Incidence Rate 3.3 per 100,000
Numbers of acute hepatitis B cases in Oklahoma reported to the Oklahoma State Department of Health (OSDH) have
declined for a third year in a row. This is a 6% decrease in reported cases from 2009 to 2010. The OSDH supports
adult vaccination for hepatitis B, and hepatitis A. Through the Adult Viral Hepatitis Program, the OSDH provides these
vaccines at no cost to high risk individuals in the Oklahoma Department of Corrections, county health department
sexually transmitted disease (STD) clinics, and two metro area medical clinics for the homeless - one in Oklahoma City
and one in Tulsa. Adult immunizations coupled with prevention education are key components to decreasing hepatitis B
infections.
Sixty-five of the 115 acute hepatitis B cases (57%) were males; fifty (43%) were female. Racial breakdown is as follows:
81 Whites (3.1 per 100,000), 19 American Indians and Alaska Natives (6.7 per 100,000), nine Black or African
Americans (3.1 per 100,000), one Hawaiian/Other Pacific Islander (31.8 per 100,000) and five cases were reported as
unknown race.
The CDC reports, in the Sexually Transmitted Diseases Treatment Guidelines 2010, the primary risk factors associated
with hepatitis B infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex
with more than one partner, men who have sex with other men (MSM), a history of other STDs, and illegal injection-drug
usei. Forty-nine (43%) of the total number of acute cases reported a risk factor of 2 or more sexual partners. Twenty-six
of these 49 respondents reported having more than five sexual partners.
Perinatal Hepatitis B
2010 Case Total 83
2009 Case Total 95
The Perinatal Hepatitis B Program identified 83 babies born to hepatitis B surface antigen (HbsAg) positive women in
Oklahoma in 2010. This number is a slight decrease (13%) from 2009.
The CDC recommends that infants born to HbsAg positive women be given hepatitis B immune globulin (HBIG) and
hepatitis B vaccine within 12 hours of birth. Seventy (85.4%) of the babies born in Oklahoma hospitals received both
injections within 12 hours, seventy-five (91.5%) received both injections within 24 hours and seventy-seven (93.9%)
received both injections within 48 hours of birth. Fifty-two (63.4%) of the infants had received HBIG and all three
hepatitis B vaccines by 12 months of age.
The ages of the women who were hepatitis B surface antigen positive and who delivered infants ranged from 17 years to
41years. Forty-seven (57%) of delivering women were between 20 and 30 years of age. Thirty-two (39%) were between
30 and 40 years of age, and four (5%) percent were under 20 years of age.
i Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR
2010;59(No. RR-#12), available on the internet at http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010-
RR5912.pdf
48
Hepatitis C
2010 Case Total 41 2010 Incidence Rate 1.1 per 100,000
2009 Case Total 27 2009 Incidence Rate 0.7 per 100,000
Hepatitis C can be either acute or chronic but the Oklahoma reportable disease rules specify reporting of hepatitis C
in persons aged 40 years or younger, or in persons having jaundice, or alanine transaminase (ALT) of 400 or higher,
regardless of age, with laboratory confirmation, which represents only acute cases of hepatitis C infectioni. The
acute form is a short-term illness that occurs within the first six months after a person is exposed to the hepatitis C
virus (HCV) which causes hepatitis C infection. However, the disease can become chronic, and people who received
a blood transfusion before 1992 or are past or current injection-drug users are at risk for chronic hepatitis C, and
should be screened for the disease. Chronic HCV infection progresses slowly over the course of 15-30 years and
can lead to cirrhosis of the liver or liver cancer. Eight to ten thousand deaths occur annually in the United States as a
result of chronic HCV infection.
In 2010, confirmed cases of acute hepatitis C in Oklahoma reflected a 52% increase from 2009. Based on the most
current national data, Oklahoma’s case rate (1.1 per 100,000) continues to be above the national rate (0.3 per
100,000) for confirmed cases of acute hepatitis C. Tulsa County had the highest number of cases of acute hepatitis
C in 2010 with nine cases (22%). The highest incidence rate occurred in Pawnee county with 12.18 cases per
100,000 (n = 2), followed by Haskell county with 8.07 per 100,000 (n = 1) and Okmulgee county with 7.64 per
100,000 (n = 3).
Cases of acute hepatitis C ranged in age from 18 years to 74 years. The highest number of cases, 20 (49%),
occurred in the 25 - 34 year age group. Age groups of the remaining cases were as follows: four (9%) 15 to 24
years, ten (24%) 35 to 44 years, five (12%) 45 to 54 years, one (2%) 55 to 64 years, and one (2%) 65 to 74 years.
There were 22 females (54%) and 19 males (46%) infected with confirmed acute hepatitis C. The confirmed acute
hepatitis C cases broken down by race occurred in: Whites (0.9 per 100,000, n = 27), Native Americans (3.7 per
100,000, n = 11), Black/African American (0.3 pr 100,000, n = 1) and unknown race (n = 2).
The Centers for Disease Control and Prevention states that “of the cases reported in 2007 for which information con-cerning
exposures during the incubation period was available, the most common risk factor identified was IDU
[injection drug use] (48%). During 1998–2007, IDU was reported for an average of 44% of persons (range: 38%–
54%)”.ii In 2010, the risk factors most frequently reported in Oklahoma were: IDU (56%), other drug use besides
IDU (54%), tattoos (56%), and 2 or more sexual partners (56%). Nineteen (46%) of the cases reported both IDU and
other drug use. Ten (24%) of the cases reported all four of the listed risk factors.
i Title 310. Oklahoma State Department of Health, Chapter 515. Communicable Disease and Injury Reporting,
Effective 7/25/2010. Available at the website
www.ok.gov/health/Disease,_Prevention,_Preparedness/Acute_Disease_Service/Disease_Reporting/index.html.
ii Centers for Disease Control and Prevention. Surveillance for Acute Viral Hepatitis—United States, 2007.
Surveillance Summaries, May 29, 2009,MMWR 2009;58(No. SS-3, available at the website
http://www.cdc.gov/mmwr/pdf/ss/ss5803.pdf
49
HIV/AIDS
2010 Case Total 300 2010 Rate 8.0 per 100,000
2009 Case Total 369 2009 Rate 10.0 per 100,000
HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). AIDS is
the result of an HIV infection and is the most advanced stage of HIV, resulting in severe damage to the immune system.
HIV progressively reduces the immune system by destroying specific blood cells, called CD4 positive T-lymphocytes
(CD4+ T-cells) and leaves individuals susceptible to opportunistic infections. HIV is transmitted through direct contact of
a mucous membrane with a bodily fluid containing HIV, such as blood, semen (including pre-seminal fluid), vaginal fluid,
and breast milk. The most common activities which place a person at risk are sexual intercourse (oral, anal, or vaginal),
sharing of needles or syringes, or exposure from mother to baby before or during birth or through breast feeding.
AIDS is defined as having HIV with fewer than 200 CD4+ T-cells per cubic milliliter of blood (or less than 14%), and/or
any at least one clinical opportunistic infection. People living with HIV may appear and feel healthy for years; however,
HIV is still affecting their bodies. Although treatments for AIDS and HIV can slow the course of the disease, there is no
known cure or vaccine. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection. Currently,
people can live much longer, even decades, with HIV before they develop AIDS. AIDS was first recognized by the
United States Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s. AIDS
became reportable in Oklahoma in 1983 and HIV infection in 1988.
In Oklahoma, two cases of AIDS were first diagnosed in 1982 and two cases of HIV in 1984. By the end of 2010, an
estimated 8,462 cases of HIV/AIDS had been diagnosed among residents of Oklahoma. A breakdown of the 8,462
HIV/AIDS cases shows 5,449 AIDS cases and 3,013 HIV cases. Of those diagnoses, 49 were perinatal infections
(mother to baby transmission). The race breakdown for the above cases is as follows: 5,441 (64.4%) in Whites, 1,794
(21.2%) in Blacks, 504 (6.0%) in Hispanics, 46 (0.5%) in Asian/Hawaiian Pacific Islanders and 536 (6.3%) in American
Indian/Alaskan Natives. Persons who reported belonging to two or more races had 141 (1.7%) cases diagnosed. The
ratio of male to female diagnoses was 17:3 (n = 7,216, 85.3% to 1,246, 14.7%). Men having sex with men (MSM)
accounted for 4,507 (53.3%) cases, and those MSM who also reported using illegal drugs (MSM/IDU) accounted for 894
(10.6%) cases. Approximately 11% (n = 962 cases) reported their risk as injection drug use (IDU). Similarly, 11.2% (n =
951) of persons reported exposure through heterosexual sex with someone with HIV. Among the age groups, 30 to 39
years of age (n = 3,213, 38.0%) accounted for the largest group of cases, followed by 20 to 29 years of age (n = 2,652,
31.3%). Teenagers (13 to 19 years of age) accounted for almost 3% (n = 224; 2.7%) of the cumulative HIV/AIDS cases,
while children under 13 years of age reported less than 1% (n = 70, 0.8%) of the infections. At the end of 2010, an
estimated 4,908 cases were living with HIV/AIDS (HIV: n = 2,552, 52.0%; AIDS: n = 2,356, 48.0%).
2010 Summary
In 2010, 300 cases (HIV, 208; AIDS, 92) of HIV/AIDS cases were diagnosed. This resulted in a 16% decrease in the
number of cases diagnosed in 2010 compared to 2009. From 2006 to 2010, 1,699 cases of HIV/AIDS have been
diagnosed at an average of 340 cases per year, an average of 9.2 cases per 100,000 population. There has been a
downward trend of AIDS only from 188 cases in 2006 to 92 cases in 2010; however, the opposite is true for newly
diagnosed HIV (not AIDS) cases. In 2006, there were a total of 157 and in 2010 the total was 208. Of the 26 deaths in
2010, seven were diagnosed and died in the same year, and 19 of the deaths were diagnoses from previous years.
Three counties in Oklahoma, Oklahoma (n = 85, 27.7%), Tulsa (n = 69, 23.0%), and Cleveland (n = 34, 11.3%), account
for the majority (62.0%) of the newly diagnosed HIV/AIDS cases.
50
0
50
100
150
200
250
300
350
400
450
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number of cases
Year of Diagnosis
HIV/AIDS Cases Diagnosed in Oklahoma by Year,
2001 ‐ 2010
HIV cases
AIDS cases
Deaths*
HIV/AIDS
*Deaths are irrespective of date of diagnosis
Among age groups, 20 to 29 year olds accounted for 35.0% (n = 105), 30 to 39 year olds accounted for 25.7% (n = 77),
40 to 49 year olds accounted for 22.0% (n = 66), and 50 to 59 year olds accounted for 10.0% (n = 30). Teenagers (13 to
19 years of age) accounted for 3.0% (n = 9). Of the 300 cases diagnosed in 2010, males represented 249 cases with a
rate of 13.7 per 100,000 population, while females reported 51 cases with a rate of 2.7 per 100,000 population.
Among race and ethnic groups, Blacks or African Americans (n = 105, 35%) had a rate of 34.4 cases per 100,000
population, Whites (n = 138, 46%) had a rate of 5.1 cases per 100,000 population, Hispanics (n = 24, 8%) had a rate of
8.0 cases per 100,000 population and American Indians /Alaskan Natives (n = 21, 7%) had at a rate of 6.6 cases per
100,000 per population.
Of the 300 newly diagnosed HIV/AIDS cases, MSM accounted for 52.0% (n = 156), MSM/IDU accounted for 8.3% (n =
25), heterosexual sex accounted for 10.7% (n = 32), and IDU only accounted for almost 5% (n = 14, 4.7%).
Approximately 3% (n = 38, 2.7%) of those diagnosed in 2010, did not report their risk.
51
Legionellosis
2010 Case Total 15 2010 Incidence Rate 0.41 per 100,000
2009 Case Total 10 2009 Incidence Rate 0.27 per 100,000
The number of legionellosis cases reported in 2010 is a 50% increase from the 10 cases reported in 2009. Since
2000, the annual incidence rate of legionellosis has ranged from 0.14 to 0.41 per 100,000 population with the
exception of 2004 when the incidence rate was 0.70 per 100,000 population due to an outbreak. In 2010, lab tests
were performed via bronchial culture (7%), sputum culture (7%), and urine antigen testing (87%). No outbreaks of
legionellosis were identified in Oklahoma during 2010.
During 2010, cases of legionellosis occurred among residents of ten Oklahoma counties and were spread
geographically across all regions of the state except the northwest region. The highest incidence rate occurred
among cases 45 to 49 years of age (IR = 1.93, n = 5) followed by cases 70 to 74 years of age (IR = 1.74, n = 2) and
65 to 69 years of age (IR = 1.34, n = 2). Of the cases reported in 2010, 1 (7%) reported travel outside of the state
during the incubation period of their illness, and 2 (13%) reported exposure to a respiratory device filled with tap
water such as a nebulizer or humidifier.
Prevention of legionellosis is based upon proper maintenance of heating, cooling and plumbing systems. Special
attention should also be given to hot tubs and whirlpool baths to keep them free of Legionella bacteria. Visit
http://ads.health.ok.gov and click on the “Disease Information” tab to obtain more information on Legionellosis.
Demographic and Clinical Summary of Reported Legionellosis Cases, Oklahoma, 2010 (N = 15)
Number (%) Incidence Rate per 100,000
Gender
Male
Female
13 (87%)
2 (13%)
0.71
0.11
Age Median = 48 years (range: 26 – 79 years)
Race
Black or African American
White
Unknown
1 (7%)
12 (80%)
2 (13%)
0.35
0.46
-
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Unknown
0 (0%)
8 (53%)
7 (47%)
0.00
0.24
-
Symptoms
Cough
Fever
Headache
Malaise
Myalgia
Chills
Chest pain
13 (87%)
12 (80%)
2 (13%)
13 (87%)
6 (40%)
9 (60%)
5 (33%)
-
-
-
-
-
-
-
Hospitalization
Possible nosocomial infection
15 (100%)
2 (13%)
-
-
Complication/Comorbidity
Death
Pneumonia
Corticosteroid treatment
1 (7%)
15 (100%)
2 (13%)
-
-
-
52
Listeriosis
2010 Case Total 9 2010 Incidence Rate 0.26 per 100,000
2009 Case Total 8 2009 Incidence Rate 0.22 per 100,000
Listeriosis is an uncommon but serious infection caused by the bacteria Listeria monocytogenes. Although most
listeriosis infections involve mild illnesses not requiring medical care, Listeria is responsible for approximately 1,591 of
the estimated 9.4 million foodborne illnesses and an estimated 257 deaths per year in the U.S.i Pregnant women are
about 20 times more likely than healthy adults to acquire the disease. In pregnancy, the infection can be passed to the
fetus and in some cases cause premature delivery, infection of the newborn, or stillbirth. Newborns, rather than the
mothers, experience the serious effects of infection during pregnancy; the case-fatality rate is 20 to 30% in infants born
alive and the occurrence of abortion and stillbirth increases the overall mortality rate to more than 50%.ii Other specific
groups at increased risk include persons with weakened immune systems such as those with cancer, diabetes, kidney
disease, AIDS, those who take glucocorticosteroid medications, and individuals older than 60 years.
In Oklahoma, 9 cases of listeriosis were reported to OSDH resulting in an incidence rate that was higher than the
previous five year average (2005 through 2009) incidence rate of 0.15 per 100,000 population. Listeria was isolated
from blood for seven cases (78%), from cerebrospinal fluid for one case (11%), and from placenta for one case (11%).
All nine cases were hospitalized and two (22%) cases died due to Listeria sepsis. The case ages ranged from 1 day to
77 years and all nine cases were female. Seven (78%) of the cases were White, one was Asian (11%), and one (11%)
race was unknown. Two (25%) of the eight cases were Hispanic. Five cases (56%) reported consuming soft cheeses
and four cases (44%) reported consuming ready-to-eat deli meats. Six (67%) cases were over the age of 60 and two of
the six had a history of underlying medical conditions that compromised their immune system. Two (22%) cases were
pregnant at the time of illness.
Most cases of listeriosis are sporadic; however, outbreaks due to consumption of contaminated food have been
identified. Prompt reporting of cases can help in the early detection of an outbreak, identification of the sources of
infection, and prevention of additional cases. The Communicable Disease Reporting Rules (OAC 310: Chapter 515)
require that Listeria isolates grown from sterile sites (e.g. blood, cerebrospinal fl

Object Description

Okla State Agency	Health, Oklahoma State Department of
Okla Agency Code	'340'
Title	Annual summary of infectious diseases
Authors	Oklahoma. State Department of Health.
Publisher	Oklahoma State Department of Health
Publication Date	2002; 2003; 2004; 2005; 2006; 2007; 2008; 2009; 2010
Publication type	Statistics
Serial holdings	Electronic holdings: 2002-2010
Subject	Communicable diseases--Oklahoma--Statistics--Periodicals.
Purpose	Oklahoma Disease Reporting Summary; The information contained in this summary consolidates surveillance and reports of disease in Oklahoma for [year]. Specifically it contains: 1) information on infectious disease reports at the state and county level, 2) disease specific data by category, and 3) additional information on special surveillance projects and outbreak reports in Oklahoma.
Contents	Contents based on 2005 issue;Infectious Disease Surveillance;Disease Specific Data by Category;Special Investigations/Outbreak Investigations;Surveillance Projects;Program Activities;Contact Information for County Health Departments
Notes	issues through 2010
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For all issues click	H845.6 I43
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ODL electronic copy	Downloaded from agency website: www.health.state.ok.us
Rights and Permissions	This Oklahoma state government publication is provided for educational purposes under U.S. copyright law. Other usage requires permission of copyright holders.
Language	English
Date created	2012-08-28
Date modified	2013-04-09
OCLC number	192175775

Description

Title	Annual Summary of Infectious Diseases 2010
OkDocs Class#	H845.6 I43 2010
Digital Format	PDF, Adobe Reader required
ODL electronic copy	Downloaded from agency website: http://www.ok.gov/health/documents/2010%20Annual%20Summary%20Web%20Posting%20Document.pdf
Rights and Permissions	This Oklahoma state government publication is provided for educational purposes under U.S. copyright law. Other usage requires permission of copyright holders.
Language	English
Full text	HAEMOPHILUS INFLUENZAE, INVASIVE BRUCELLOSIS LEGIONELLOSIS VIBRIOSIS SYPHILIS E. COLI O157:H7 & STEC ROCKY MOUNTAIN SPOTTED FEVER MENINGOCOCCAL DISEASE, INVASIVE HEPATITIS C, ACUTE CREUTZFELDT-JAKOB DISEASE MALARIA BOTULISM GONORRHEA RABIES IN ANIMALS TYPHOID FEVER S. PNEUMONIAE, INVASIVE <5 YEARS OLD SALMONELLOSIS WEST NILE TUBERCULOSIS CAMPYLOBACTERIOSIS CRYPTOSPORIDIOSIS MUMPS LISTERIOSIS HEPATITIS A, ACUTE LYME DISEASE PERTUSSIS CHLAMYDIA ANTHRAX HEPATITIS B, ACUTE EHRLICHIOSIS TULAREMIA SHIGELLOSIS ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘10 ‘01 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 ‘01 ‘10 1 92 235 15 105 104 0 0 185 69 32 7 48 36 0 18 6 41 0 1 5 6 1 2 4,818 4,369 60 62 1 1 58 55 503 752 0 1 194 86 308 448 16 1 122 0 2 9 116 6 0 0 43 199 10,622 14,302 0 0 115 115 7 8 148 416 24 107 2010 OKLAHOMA STATE DEPARTMENT OF HEALTH ANNUAL SUMMARY OF INFECTIOUS DISEASES Executive Summary 2010 Annual Summary of Infectious Diseases The Oklahoma State Department of Health (OSDH) is pleased to send you a copy of the 2010 Annual Summary of Infectious Diseases. The information contained in this report consolidates summaries of communicable disease surveillance and investigations conducted by the OSDH during 2010. Communicable disease summaries were written by personnel in the OSDH Acute Disease Service, HIV/STD Service, and the Public Health Laboratory. Specifically, the annual summary contains information on the number and incidence rate of infectious disease reports at the state and county level, disease specific data collected during public health investigations, and summaries of program activities. Title 63 Oklahoma Statute §1-503 as well as Oklahoma Administrative Code (OAC) Title 310, Chapter 515 require that healthcare providers and laboratories report cases of certain communicable diseases to the OSDH. This allows the surveillance, investigation, and control of the spread of disease in the population by public health personnel. A list of the Oklahoma notifiable disease rules is included in this annual summary for your reference. The diseases listed in the Oklahoma disease reporting rules must be reported, along with patient identifiers, demographics, and contact information, to the OSDH upon discovery as dictated in sections OAC 310:515-1-3 and OAC 310:515-1-4. The current “Oklahoma Disease Reporting Manual” is the standard reference for disease-specific diagnostic test results to be reported. The current edition of the "Oklahoma Disease Reporting Manual" and additional disease reporting resources may be accessed from the Acute Disease Service disease reporting web page of the OSDH web site at http://IDReportingAndAlerts.health.ok.gov. Several service areas of the OSDH as well as the county health departments are charged with surveillance, investigation, and control of spread of communicable diseases. Summarized below are a few notable observations regarding the epidemiology of communicable diseases in Oklahoma reported during 2010. In 2010, 199 cases of pertussis were reported, a 70% increase from the 117 cases reported in 2009. In addition to the increase from 2009, pertussis cases were the highest they have been since 1985 when 209 cases were reported. Several local community increases were observed in different parts of the state contributing to the larger number of cases for the state. Ten cases were reported in Pittsburg county residents leading to an incidence rate (IR) approximately four times the state’s rate (21.8 per 100,000). Additionally, Tulsa county saw an increase in cases beginning mid fall and continuing through the end of the year, giving the county a total of 88 cases with an incidence rate almost three times the state’s rate (14.6 per 100,000). Pertussis occurs in persons of all ages, but disproportionately affects children less than one year of age. Nearly half of all cases in 2010 were in children less than five years of age, with 28% in infants less than one year of age (IR = 100.6 per 100,000) and followed by 20% in children one to four years of age (IR = 18.0 per 100,000). Forty-seven percent of infants less than one year of age were hospitalized compared to 3.5% of all other ages. Public health efforts of timely case diagnosis, contact investigation, administration of therapy, prevention, and education, have resulted in a steady decline of tuberculosis (TB) in Oklahoma. The incidence rate of TB has declined 52% from 178 (5.2 per 100,000) cases in 2004 to 86 (2.3 per 100,000) cases in 2010. Racial disparities continued to occur among reported TB cases. In particular, the highest rates of reported TB cases occurred among persons who reported their race as Asian (22.3 per 100,000), American Indian/Alaska Natives (4.7 per 100,000), and Black (3.4 per 100,000) compared to persons who reported their race as White (1.1 per 100,000). Foreign born individual accounted for 27% of reported TB cases in Oklahoma. Prevention, early diagnosis, and treatment are paramount to successful tuberculosis control. TB should be considered in the differential diagnosis of persons presenting with a productive cough, bloody sputum, fevers, and/or unexplained weight loss. Early suspicion and testing are of utmost importance. In March 2010, the OSDH rapidly responded to an outbreak of invasive meningococcal disease in a rural school district in Northeastern Oklahoma. Five cases of invasive meningococcal disease were identified during this investigation, including two deaths. Exposed contacts were rapidly identified and recommended to receive antibiotic prophylaxis. During standard investigations of sporadic cases, individuals recommended to receive antibiotic prophylaxis are referred to their private health provider for medication. Because of the magnitude of this outbreak, epidemiologists in the Acute Disease Service and the local county health department (Rogers CHD) immediately conducted clinics at the school to administer chemoprophylaxis to exposed individuals to prevent subsequent cases. A total of 941 individuals were prophylaxed during these clinics. Laboratory testing subsequently identified serogroup C as the causative serogroup and molecular subtyping of isolates revealed all outbreak-associated cases had an indistinguishable pulsed-field gel electrophoresis pattern, which suggested a common exposure among all cases. Based upon meningococcal outbreak control guidance and the recommendation to provide meningococcal vaccine in which cases are due to serogroups included in the vaccine, a mass immunization clinic was held at the school to administer meningococcal vaccine for future protection. Vaccination clinics that targeted students pre-K through seniors, as well as faculty and employees, were conducted by Immunization Service and the Rogers CHD; 1,486 persons received the vaccine. Significant racial and age disparities continue among reported sexually transmitted diseases. In particular, the highest rates of reported HIV/AIDS, chlamydia and gonorrhea cases occurred among African Americans. In 2010, the incidence rate of reported gonorrhea cases was 18.8 times higher among African Americans compared to the incidence rate among Whites. Similarly, the incidence rate of reported chlamydia cases among African Americans was 6.4 times higher than among Whites. The highest age-specific incidence rates of reported chlamydia and gonorrhea cases occurred among young adults 15 to 19 years of age and 20 to 24 years of age. The OSDH Public Health Laboratory continues to perform serogroup identification and pulsed-field gel electrophoresis (PFGE), a molecular method of DNA fingerprinting, on all submitted Salmonella isolates. PFGE subtyping complements disease surveillance by detecting clusters of indistinguishable PFGE patterns among isolates of Oklahoma cases as well as patterns identified by other state public health laboratories. Once clusters are detected, public health officials rapidly investigate to identify a common source and coordinate with food regulatory agencies to initiate product recalls when indicated, which prevents the continued occurrence of illness among persons who may consume the implicated products. In 2010, two multistate outbreaks of salmonellosis involving Oklahoma residents were investigated to determine a potential source of infection. One was a multistate outbreak of S. Chester associated with consumption of single-serve frozen entrées; 44 cases from 18 states were identified in this outbreak, including one Oklahoma case. Another multistate outbreak involving Oklahoma residents was due to S. Enteritidis; approximately 1,939 cases nationwide were associated with this outbreak, including 7 from Oklahoma. An epidemiologic investigation conducted by state public health officials and CDC determined consumption of shell eggs was associated with development of illness. Results from the public health investigation prompted a traceback investigation by the U.S. Food and Drug Administration (FDA) to determine the common source of these shell eggs. The affected eggs were then recalled, and recommendations for safe food handling were provided to egg producers, retail and food establishments, and the public. It is part of our continuing efforts to return useful information to you from the data you have reported to us. Use of this summary should give you a better idea of the incidence of reportable infectious diseases in your community and epidemiologic trends of infectious diseases in the state of Oklahoma. Additional summaries of reportable diseases in Oklahoma and resources on disease reporting are available on the OSDH website at http://www.ok.gov/health. Table of Contents Oklahoma State Department of Health Contact Information by Service ........................................................... 4 List of Contributors............................................................................................................................................... 5 Oklahoma State Department of Health Communicable Diseases Reporting Rules ......................................... 6 Communicable Disease Statistics Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981-2010 ........................ 11 Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Cases of Communicable Diseases, Oklahoma, 1981-2010 ............................................................................................................ 15 Table Three. Notable Reportable Diseases by County, Oklahoma, 2010 ....................................................... 19 Disease-Specific Summaries Botulism ......................................................................................................................................................... 29 Campylobacteriosis ........................................................................................................................................ 30 Chlamydia trachomatis .................................................................................................................................. 32 Cryptosporidiosis ........................................................................................................................................... 34 Dengue .......................................................................................................................................................... 35 E. coli O157, O157:H7, or Shiga toxin-producing E. coli (STEC) .................................................................... 37 Ehrlichiosis/Anaplasmosis .............................................................................................................................. 39 Gonorrhea ...................................................................................................................................................... 41 Haemophilus influenzae invasive disease ...................................................................................................... 43 Hemolytic uremic syndrome, post-diarrheal .................................................................................................... 45 Hepatitis A ..................................................................................................................................................... 46 Hepatitis B and Perinatal ............................................................................................................................... 48 Hepatitis C ..................................................................................................................................................... 49 HIV/AIDS ....................................................................................................................................................... 50 Legionellosis .................................................................................................................................................. 52 Listeriosis ....................................................................................................................................................... 53 Malaria ........................................................................................................................................................... 55 Meningococcal invasive disease ..................................................................................................................... 56 Pertussis ........................................................................................................................................................ 58 Rabies (Animal) ............................................................................................................................................. 60 Rocky Mountain Spotted Fever ....................................................................................................................... 62 Salmonellosis ................................................................................................................................................. 64 Shigellosis ...................................................................................................................................................... 66 Streptococcus pneumoniae invasive disease in children less than 5 years of age ......................................... 68 Tuberculosis................................................................................................................................................... 70 Tularemia ....................................................................................................................................................... 74 Outbreak Reports Norovirus Outbreaks in Institutional and Food Service Settings ..................................................................... 75 Outbreak of Shiga toxin-producing E. coli (STEC) Among Offenders at a Correctional Facility ..................... 78 Salmonella Outbreak in a School, Canadian County ...................................................................................... 81 Program Reports Influenza Surveillance Summary .................................................................................................................... 84 Oklahoma Health Alert Network (OK-HAN) Annual Update ............................................................................ 87 Public Health Investigation and Disease Detection of Oklahoma (PHIDDO) Annual Update ......................... 88 Public Health Laboratory Update .................................................................................................................... 89 Oklahoma State Department of Health Contact Information Acute Disease Service Communicable Disease Division 1000 NE 10th St. Oklahoma City, OK 73117-1299 Phone Number: (405) 271-4060 — Epidemiologist-on-Call 24 hours per day Fax Number: (405) 271-6680 Fax Number: (800) 898-6734 Division of Surveillance and Informatics 1000 NE 10th St Oklahoma City, OK 73117-1299 Phone Number: (405) 271-4060 Fax Number: (405) 271-6680 Tuberculosis Division 1000 NE 10th St. Oklahoma City, OK 73117-1299 Phone Number: (405) 271-4060 Fax Number: (405) 271-6680 HIV / STD Service 1000 NE 10th St. Mail Drop 0308 Oklahoma City, OK 73117-1299 Phone Number: (405) 271-4636 Fax Number: (405) 271-5149 Public Health Laboratory 1000 NE 10th St. Oklahoma City, OK 73117-1299 Phone Number: (405) 271-5070 Fax Number: (405) 271-4850 Mailing Isolates and Samples for Testing Public Health Laboratory P.O. Box 24106 OKC, OK 73124-0106 For instructions on sending isolates or clinical specimens to the Public Health Laboratory (PHL), contact the PHL personnel between 8:00 a.m. - 4:30 p.m., Monday through Friday. All FAX machines are located in locked offices and are monitored to ensure the confidentiality of disease reports. 4 2010 Annual Summary List of Contributors Acute Disease Service Lauri Smithee, Ph.D., Chief Communicable Disease Division Laurence Burnsed, M.P.H., Director Lacey Kovar, M.P.H., Epidemiologist Becky Coffman, M.P.H., R.N., C.I.C., Epidemiologist Renee Powell, M.P.H., Epidemiologist Jolianne Stone, M.P.H., Epidemiologist Kendra Dougherty, M.S., Epidemiologist Division of Surveillance and Informatics Anthony Lee, M.P.H., Director Jeannie Williams, M.P.H., C.P.H., Surveillance Officer Christie McDonald-Hamm, M.P.H., Epidemiologist Kim Mitchell, B.S., Health Alert Network (HAN) Coordinator Tony McCord, A.A.S., Information Systems Services Coordinator Tuberculosis Program Amy Hill, RN, TB Nurse Consultant HIV / STD Service Jan Fox, M.P.H., R.N., Chief Kristen Eberly, M.P.H., Director, Division of Prevention and Intervention Debbie Purton, M.P.H., R.N., Director, Division of Care Delivery Sam Nimo, M.P.H., Epidemiologist Terrainia Harris, M.P.H., Manager, HIV/STD Surveillance and Analysis Janet Wilson, RN, Manager, Viral Hepatitis and Adult Viral Hepatitis Prevention Coordinator Mark Turner, M.P.H., Manager, Field Operations Angela Strawderman, R.N., Perinatal Hepatitis B Coordinator Public Health Laboratory Steve Johnson, B.S., A.S.C.P., Clinical Laboratory Administrator John Murray, B.A., M.B.A., M.P.H., State Training Coordinator 5 OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 515. COMMUNICABLE DISEASE AND INJURY REPORTING EFFECTIVE 7/25/2010 310:515-1-1. Purpose The rules in this Chapter implement the Communicable Diseases Reporting Regulations, 63 O.S. 1981, § 1-503. 310:515-1-1.1. Definitions When used in this Chapter, the following words or terms shall have the following meaning unless the context of the sentence requires another meaning: "AIDS" means Acquired Immunodeficiency Syndrome. "Anti-HAV-IgM+" means a positive test result for the hepatitis A virus immunglobulin M antibody. "Anti-HBc-IgM+" means a positive test result for the hepatitis B core immunglobulin M antibody. "CD4" means cluster of differentiation 4 glycoprotein that serves as a receptor for HIV on T helper cells. "Department" or "OSDH" means the Oklahoma State Department of Health. "E. coli" means Escherichia coli. "EIA" means enzyme immunoassay. "HBeAg+" means a positive test result for the hepatitis B "e" antigen. "HBsAg+" means a positive test result for the hepatitis B surface antigen. "HBV DNA+" means a positive test result for deoxyribonucleic acid of the hepatitis B virus. "HIV" means Human Immunodeficiency Virus. "PHIDDO" or "PHIDDO system" means Public Health Investigation and Disease Detection of Oklahoma system. "NAT for HCV RNA+" means a nucleic acid amplification test with a positive test result for hepatitis C virus ribonucleic acid. "Outbreak of disease" means two or more cases residing in different households that have a similar clinical syndrome of a potentially infectious disease, toxin, or agent of known or unknown etiology. "RIBA" means recombinant immunoblot assay. "S/co" means the signal-to-cut-off-ratio. "Spp." is an abbreviation referring to the term "species," and is used to broaden the anteceding term in order to include all organisms that may be found or described within a given genus. "Unusual disease or syndrome" means a case of an uncommon, possibly infectious disease of known or unknown etiology, even if laboratory testing may be pending or inconclusive, or if testing for common etiologies is negative. Such cases of disease may not normally be endemic to Oklahoma, may be an emerging or re-emerging disease, and/or represent diseases for which a public health intervention may be needed. Examples of such unusual diseases or syndromes include but are not limited to, unexplained adult respiratory distress syndrome, rash illness with atypical presentation, or an illness occurring along with an unusual pattern of illness or death among animals. "VISA" means vancomycin intermediate Staphylococcus aureus. "VRSA" means vancomycin resistant Staphylococcus aureus. 310:515-1-2. Diseases to be reported The diseases listed in this Chapter must be reported, along with patient identifiers, demographics, and contact information, to the Department upon discovery as dictated in sections OAC 310:515-1-3 and OAC 310:515-1-4. The current “Oklahoma Disease Reporting Manual” shall serve as the standard for disease-specific diagnostic test results to be reported. Ancillary laboratory test results, signs, and symptoms must be reported upon request. The current edition of the "Oklahoma Disease Reporting Manual" may be accessed from the Acute Disease Service disease reporting and alerts web page of the OSDH web site at http://IDReportingAndAlerts.health.ok.gov. Laboratories having greater than 400 positive tests performed on-site per year for reportable diseases described in 310:515-1-3, 310:515-1-4(1) and 310:515-1-4(2), or as may be otherwise required to be reported by OSDH, shall begin reporting no later than August 30, 2010 using secure electronic data transmission. 6 OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH 310:515-1-3. Diseases to be reported immediately The following diseases must be reported by any health practitioner or laboratory personnel to the OSDH electronically via the secure web-based Public Health Investigation and Disease Detection of Oklahoma system or by telephone (405-271-4060 or 800-234-5963) immediately upon suspicion, diagnosis, or testing as specified in the “Oklahoma Disease Reporting Manual”. (1) Anthrax (Bacillus anthracis). (2) Bioterrorism – suspected disease. (3) Botulism (Clostridium botulinum). (4) Diphtheria (Corynebacterium diphtheriae). (5) Haemophilus influenzae invasive disease. (6) Hepatitis A (Anti-HAV-IgM+). (7) Hepatitis B during pregnancy (HBsAg+). (8) Measles (Rubeola). (9) Meningococcal invasive disease (Neisseria meningitidis). (10) Outbreaks of apparent infectious disease. (11) Plague (Yersinia pestis). (12) Poliomyelitis. (13) Rabies. (14) Smallpox. (15) Tularemia (Francisella tularensis). (16) Typhoid fever (Salmonella Typhi). (17) Viral hemorrhagic fever. 310:515-1-4. Additional diseases, conditions, and injuries to be reported The following diseases, conditions and injuries must be reported by physicians, laboratories, and hospitals (by infection control practitioners, medical records personnel, and other designees) to the OSDH as dictated in the following subsections: (1) Infectious diseases. Reports of infectious diseases and conditions listed in this subsection must be submitted electronically via the PHIDDO system, telephoned, faxed, or submitted via secure electronic data transmission to the OSDH within one (1) business day of diagnosis or positive test as specified in the “Oklahoma Disease Reporting Manual”. (A) Acid Fast Bacillus (AFB) positive smear. (B) AIDS (Acquired Immunodeficiency Syndrome). (C) Arboviral infections (West Nile virus, St. Louis encephalitis virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Powassan virus, California serogroup virus). (D) Brucellosis (Brucella spp.). (E) Campylobacteriosis (Campylobacter spp.). (F) Congenital rubella syndrome. (G) Cryptosporidiosis (Cryptosporidium spp.). (H) Dengue Fever. (I) E. coli O157, O157:H7, or a Shiga toxin producing E. coli (STEC infections). (J) Ehrlichiosis (Ehrlichia or Anaplasma spp.). (K) Hantavirus pulmonary syndrome. (L) Hemolytic uremic syndrome, postdiarrheal. (M) Hepatitis B. If HBsAg+, anti-HBc-IgM+, HBeAg+, or HBV DNA+ then report results of the entire hepatitis panel. (N) Hepatitis C in persons < or = 40 years or in persons having jaundice or ALT > or = 400 regardless of age with laboratory confirmation. If hepatitis C EIA is confirmed by RIBA or NAT for HCV RNA, or signal-to-cut-off (s/co) ratio or index is predictive of a true positive then report results of the entire hepatitis panel. (O) Human Immunodeficiency Virus (HIV) infection. 7 OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH (P) Influenza associated pediatric mortality (Q) Legionellosis (Legionella spp.). (R) Leptospirosis (Leptospira interrogans). (S) Listeriosis (Listeria monocytogenes). (T) Lyme disease (Borrelia burgdorferi). (U) Malaria (Plasmodium spp.). (V) Mumps. (W) Pertussis (Bordetella pertussis). (X) Psittacosis (Chlamydophia psittaci). (Y) Q Fever (Coxiella burnetti). (Z) Rocky Mountain Spotted Fever (Rickettsia rickettsii). (AA) Rubella. (BB) Salmonellosis (Salmonella spp.). (CC) Shigellosis (Shigella spp.). (DD) Staphylococcus aureus with reduced susceptibility to vancomycin (VISA or VRSA). (EE) Streptococcus pneumoniae invasive disease, in persons less than 5 years of age. (FF) Syphilis (Treponema pallidum). (GG) Tetanus (Clostridium tetani). (HH) Trichinellosis (Trichinella spiralis). (II) Tuberculosis (Mycobacterium tuberculosis). (JJ) Unusual disease or syndrome. (KK) Vibrio spp. infections including cholera. (LL) Yellow Fever. (2) Infectious diseases. Reports of infectious diseases and conditions listed in this subsection must be reported to the OSDH within one (1) month of diagnosis or positive test as specified in the OSDH Disease Reporting Manual. (A) CD4 cell count < 500 with corresponding CD4 cell count percentage of total (by laboratories only). (B) Chlamydia infections (Chlamydia trachomatis). (C) Creutzfeldt-Jakob disease. (D) Gonorrhea (Neisseria gonorrhoeae). (E) HIV viral load. (F) Pelvic inflammatory disease (PID). (3) Occupational or Environmental diseases. Laboratories must report blood lead level results greater than 10 ug/dL within one (1) week and results less than 10 ug/dL within one (1) month. Health care providers must report blood lead level results 20 ug/dL or greater within twenty-four (24) hours and results 10-19 ug/dL within one (1) week. (4) Injuries (hospitalized and fatal cases only). (A) Burns. (B) Drownings and Near Drownings. (C) Traumatic Brain Injuries. (D) Traumatic Spinal Cord Injuries. 8 OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH 310:515-1-6. Additional diseases may be designated The Commissioner of Health may designate any disease or condition as reportable for a designated period of time for the purpose of special investigation. 310:515-1-7. Control of Communicable Diseases Manual The OSDH adopts the most recently published edition of the publication, "Control of Communicable Diseases Manual," published by the American Public Health Association, as a guideline for the prevention and control of communicable diseases. In order to determine the most recently published edition of the "Control of Communicable Diseases Manual," access the American Public Health Association web site at https://secure.apha.org/source/orders/index.cfm. 310:515-1-8. Organisms/specimens to be sent to the Public Health Laboratory (a) Isolates or appropriate specimens of the following organisms shall be sent to the OSDH Public Health Laboratory for typing. (1) Bacillus anthracis. (2) Brucella spp. (3) E. coli O157, O157:H7, or a Shiga toxin producing E. coli (STEC). (4) Francisella tularensis. (5) Haemophilus influenzae (sterile site). (6) Listeria monocytogenes (sterile site). (7) Mycobacterium tuberculosis. (8) Neisseria meningitidis (sterile site). (9) Plasmodium spp. (10) Salmonella spp. (11) Staphylococcus aureus that are VISA or VRSA (12) Vibrio spp. (13) Yersinia spp. (b) Following consultation with an OSDH epidemiologist, clinical specimens from suspected cases of Botulism must be sent to the OSDH Public Health Laboratory for testing. 9 OAC 310:515 OKLAHOMA STATE DEPARTMENT OF HEALTH SUBCHAPTER 3. DISCLOSURES AND USES OF DISEASE PREVENTION AND CONTROL INFORMATION 310:515-3-1. General provisions Information received, created and/or maintained by the Department pursuant to the provisions of the Public Health Code relating to Disease Prevention and Control is confidential and shall be protected from disclosure unless release or disclosure is sought in accordance with this subchapter or is otherwise authorized by law. 310:515-3-2. Disclosures upon written consent Information received, created and/or maintained by the Department pursuant to the provisions of the Public Health Code relating to Disease Prevention and Control may be disclosed to a requesting person upon the presentation of a valid written consent executed by the person whose information is being kept confidential or the legal guardian or legal custodian of such person, under the following conditions: (1) If the written consent is delivered to the Department by a person other than the person whose information is being kept confidential or the legal guardian or legal custodian of such person, the written consent must either be verified under oath or contain some form of attestation certifying or confirming the authenticity of the signature of the person whose information is being kept confidential or the legal guardian or legal custodian of such person. (2) The written consent must advise the person whose information is being kept confidential or the legal guardian or legal custodian of such person the identity of all persons and/or entities who are likely or intended to receive or view the information sought to be released or disclosed. The identity must include the full name, address and title or office of such person or entity identified in the written consent. The written consent must state that the information will not be released or disclosed to any person or entity not so identified. (3) The written consent must include a notice thereon, in bold typeface, that the information authorized for release may include records that may indicate the presence of a communicable or venereal disease, which may include, but are not limited to, diseases such as hepatitis, syphilis, gonorrhea and the human immunodeficiency virus, also known as Acquired Immune Deficiency Syndrome (AIDS). (4) The written consent must advise the person whose information is being kept confidential or the legal guardian or legal custodian of such person of the provisions of 63 O.S.Supp.2005, § 1- 502.2. 310:515-3-3. Grounds for denial A person whose information is being kept confidential or the legal guardian or legal custodian of such person may be denied access to information if the information was obtained from someone other than a health care provider under a promise of confidentiality, the access requested would be reasonably likely to reveal the confidential source of the information and the requested information cannot be presented in a manner that preserves the confidentiality of the source. The Department incorporates HIPAA, 42 C.F.R. § 164.524(a)(2)(v)(2006) only as guidance in applying this section. 310:515-3-4. Disclosures permitted without a written consent Information received, created and/or maintained by the Department pursuant to the provisions of the Public Health Code relating to Disease Prevention and Control may, without first obtaining a written consent in accordance with this subchapter, be disclosed, shared and/or disseminated with health professionals engaged in activities described or identified in the provisions of the Public Health Code relating to Disease Prevention and Control. 10 Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010 Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 Anthrax 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Botulism (Foodborne) 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 Botulism (Infant) 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 Brucellosis 8 8 6 7 5 0 5 3 4 1 2 1 0 0 1 1 Campylobacteriosis 56 116 212 216 305 288 252 212 223 247 205 267 199 187 289 281 Chlamydia 0 0 0 0 0 0 0 0 0 0 5714 5220 4886 3784 5050 7371 Cholera 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 Congential Rubella Syndrome 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Creutzfeldt-Jakob disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cryptosporidiosis 0 0 0 81 27 11 14 11 12 6 8 0 1 1 12 10 Dengue Fever 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Diphtheria 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 Escherichia coli O157:H7 and other Shiga toxin producing E. coli 0 0 0 0 0 0 0 0 6 4 0 5 8 13 16 14 Ehrlichiosis 0 0 0 0 0 0 23 14 1 1 3 8 0 0 0 0 Gonorrhea 15909 16021 15230 13088 13005 12572 9657 7411 6846 6464 6546 6432 4855 4935 5652 4897 Haemophilus influenzae , Invasive Disease (Total) 97 120 179 240 303 290 244 236 154 134 76 33 45 44 33 31 Haemophilus influenzae , Invasive Disease, type b, <5 yrs 0 2 13 39 6 3 0 0 0 78 33 3 1 4 3 0 Hantavirus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Hemolytic Uremic Syndrome, post diarrheal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Hepatitis A 344 821 833 548 491 390 338 580 501 588 273 217 206 395 1497 2516 Hepatitis B 256 358 354 208 256 240 250 209 221 183 198 174 193 129 176 60 Hepatitis C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 Influenza Associated Pediatric Mortality 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Legionellosis 7 13 12 19 24 24 32 20 26 15 24 12 14 7 8 16 Leptospirosis 0 0 4 0 1 0 0 0 0 1 0 0 0 0 0 0 Listeriosis 1 3 0 1 10 20 17 14 17 16 6 8 12 11 11 5 Lyme Disease 0 0 0 0 0 0 3 9 16 20 23 25 20 111 57 34 Malaria 8 8 9 14 8 12 5 11 8 10 9 5 5 9 1 3 Measles 6 30 1 9 1 41 4 8 73 88 0 12 0 0 0 0 Meningococcal Invasive Disease 47 33 39 30 41 38 40 27 29 21 16 18 36 52 49 46 Mumps 0 0 0 0 0 0 102 295 184 74 15 20 11 13 1 4 Pertussis 3 10 348 248 209 149 173 72 54 48 48 53 60 19 47 21 First year disease was reportable by law ^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 11 Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010 Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 Plague 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 Poliomyelitis 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 Psittacosis 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 Q Fever 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 Rabies (Animal) 219 191 108 104 111 62 35 38 102 132 173 219 65 40 32 38 Rabies (Human) 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rocky Mountain spotted fever 101 89 221 137 103 110 86 103 60 68 95 111 46 36 48 45 Rubella 4 3 1 0 2 0 6 1 1 1 2 0 1 4 0 0 Staphylococcus aureus , Vancomycin intermediate 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Staphylococcus aureus , Vancomycin resistant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Streptococcus pneumoniae , Invasive disease, <5 years 22 38 20 18 29 199 16 11 20 37 28 13 87 73 48 19 Salmonellosis 424 516 613 445 474 512 474 500 446 441 481 368 320 444 471 520 Shigellosis 470 440 241 220 301 256 166 233 236 510 192 252 472 200 266 305 St. Louis Encephalitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Syphilis 479 593 571 532 538 489 552 479 375 589 596 709 636 399 489 398 Tetanus 2 1 0 2 1 1 1 1 2 0 0 1 1 1 0 1 Trichinellosis 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 Tuberculosis 381 335 331 262 264 267 250 277 218 243 206 216 209 261 237 201 Tularemia 44 36 35 24 22 19 27 17 8 10 12 10 16 4 7 4 Typhoid Fever 5 4 3 5 2 3 6 0 1 3 3 0 1 3 1 0 Vibrio spp. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 1 Vibrio parahaemolyticus 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 Vibrio vulnificus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 West Nile Virus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 First year disease was reportable by law ^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 12 Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010 Disease Anthrax Botulism (Foodborne) Botulism (Infant) Brucellosis Campylobacteriosis Chlamydia Cholera Congential Rubella Syndrome Creutzfeldt-Jakob disease Cryptosporidiosis Dengue Fever Diphtheria Escherichia coli O157:H7 and other Shiga toxin producing E. coli Ehrlichiosis Gonorrhea Haemophilus influenzae , Invasive Disease (Total) Haemophilus influenzae , Invasive Disease, type b, <5 yrs 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 2 0 0 0 1 0 1 0 0 1 2 1 0 2 0 247 241 320 361 308 362 417 591 544 405 530 486 384 448 7566 9378 8737 9346 10622 10732 10983 10371 12957 13206 12529 14173 14991 14302 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 12 7 14 30 16 16 24 22 46 56 216 238 141 122 0 1 0 0 0 0 1 0 2 0 3 2 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 26 41 19 36 25 30 29 38 43 33 135 64 104 0 2 12 12 24 13 36 49 96 47 106 121 147 107 4840 4225 4291 5236 4818 4624 4543 4543 5031 5170 4827 4945 4661 4369 33 35 47 ^46 48 53 52 67 74 78 93 90 92 105 1 1 0 ^0 0 0 0 0 0 0 0 0 2 0 Hantavirus Hemolytic Uremic Syndrome, post diarrheal Hepatitis A Hepatitis B Hepatitis C Influenza Associated Pediatric Mortality Legionellosis Leptospirosis Listeriosis Lyme Disease Malaria Measles Meningococcal Invasive Disease Mumps Pertussis 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 2 4 3 4 2 5 3 8 51 17 11 1441 667 534 271 116 52 29 19 6 11 13 13 6 6 63 169 185 179 115 111 73 80 59 96 152 129 122 115 10 23 13 13 6 21 6 7 14 19 49 21 27 41 0 0 0 0 0 0 0 0 0 0 0 2 9 2 4 18 6 5 7 5 10 24 10 10 9 11 10 15 0 0 1 0 0 1 0 0 0 0 1 0 0 1 9 19 12 8 2 9 3 4 4 5 2 7 8 9 45 12 8 1 0 0 0 3 0 0 1 2 2 0 9 4 2 10 5 12 4 10 12 11 10 5 2 6 1 0 0 0 0 0 0 0 0 0 0 0 0 0 45 44 40 34 32 25 24 10 18 15 23 17 17 18 3 4 5 3 0 3 2 1 2 11 7 1 3 1 60 36 40 60 43 135 106 122 125 64 58 100 117 199 First year disease was reportable by law ^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 13 Table One. Number of Reported Cases of Communicable Diseases, Oklahoma, 1981 - 2010 Disease Plague Poliomyelitis Psittacosis Q Fever Rabies (Animal) Rabies (Human) Rocky Mountain spotted fever Rubella Staphylococcus aureus , Vancomycin intermediate Staphylococcus aureus , Vancomycin resistant Streptococcus pneumoniae , Invasive disease, <5 years Salmonellosis Shigellosis St. Louis Encephalitis Syphilis Tetanus Trichinellosis 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 2 3 2 0 113 107 94 58 60 126 204 113 79 69 78 42 49 62 0 0 0 0 0 0 0 1 0 0 0 0 0 0 30 39 29 37 69 99 138 190 206 135 187 267 342 235 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22 26 45 38 58 67 81 52 48 73 77 76 63 55 392 501 468 404 503 524 494 425 448 604 709 901 657 752 293 712 560 131 148 717 1078 724 936 196 162 234 399 416 0 0 0 0 1 0 0 0 0 0 0 0 0 0 275 264 347 245 185 183 141 88 73 193 150 212 256 92 2 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Tuberculosis Tularemia Typhoid Fever Vibrio spp. Vibrio parahaemolyticus Vibrio vulnificus West Nile Virus 211 198 208 154 194 190 163 178 144 144 149 100 102 86 5 5 7 11 7 10 9 19 20 3 18 7 7 8 3 1 0 1 1 2 1 1 1 0 3 3 2 1 0 9 1 0 0 1 1 0 3 1 2 5 2 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 1 0 0 0 0 0 17 79 22 33 48 107 9 10 1 First year disease was reportable by law ^H. influenzae isolates required to be sent to OSDH PHL for serotyping. 14 Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010* Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Anthrax 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Botulism (Foodborne) 0.00 0.00 0.00 0.03 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 Botulism (Infant) 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.03 0.00 0.00 0.00 Brucellosis 0.26 0.26 0.20 0.23 0.17 0.00 0.17 0.10 0.13 0.03 0.06 0.03 0.00 0.00 0.03 Campylobacteriosis 1.85 3.83 7.01 7.14 10.08 9.52 8.33 7.01 7.37 7.85 6.52 8.49 6.33 5.94 9.19 Chlamydia 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 181.7 165.9 155.3 120.3 160.5 Cholera 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Congential Rubella Syndrome 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Creutzfeldt-Jakob disease 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Cryptosporidiosis 0.00 0.00 0.00 2.68 0.89 0.36 0.46 0.36 0.40 0.19 0.25 0.00 0.03 0.03 0.38 Dengue Fever 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Escherichia coli O157:H7 and other Shiga toxin producing E. coli 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.20 0.13 0.00 0.16 0.25 0.41 0.51 Ehrlichiosis 0.00 0.00 0.00 0.00 0.00 0.00 0.76 0.46 0.03 0.03 0.10 0.25 0.00 0.00 0.00 Gonorrhea 525.9 529.6 503.4 432.6 429.9 415.6 319.2 245.0 226.3 205.5 208.1 204.5 154.3 156.9 179.7 Haemophilus influenzae , Invasive Disease (Total) 3.21 3.97 5.92 7.93 10.02 9.59 8.07 7.80 5.09 4.26 2.42 1.05 1.43 1.40 1.05 Haemophilus influenzae , Invasive Disease, type b, <5 yrs 0.00 0.86 5.60 16.79 2.58 1.29 0.00 0.00 0.00 34.43 14.57 1.32 0.44 1.77 1.32 Hantavirus 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Hemolytic Uremic Syndrome, post diarrheal 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Hepatitis A 11.37 27.14 27.53 18.11 16.23 12.89 11.17 19.17 16.56 18.69 8.68 6.90 6.55 12.56 47.59 Hepatitis B 8.46 11.83 11.70 6.88 8.46 7.93 8.26 6.91 7.31 5.82 6.29 5.53 6.14 4.10 5.60 Hepatitis C 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 Influenza Associated Pediatric Mortality 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Legionellosis 0.23 0.43 0.40 0.63 0.79 0.79 1.06 0.66 0.86 0.48 0.76 0.38 0.45 0.22 0.25 Leptospirosis 0.00 0.00 0.13 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 Listeriosis 0.03 0.10 0.00 0.03 0.33 0.66 0.56 0.46 0.56 0.51 0.19 0.25 0.38 0.35 0.35 Lyme Disease 0.00 0.00 0.00 0.00 0.00 0.00 0.10 0.30 0.53 0.64 0.73 0.79 0.64 3.53 1.81 Malaria 0.26 0.26 0.30 0.46 0.26 0.40 0.17 0.36 0.26 0.32 0.29 0.16 0.16 0.29 0.03 Measles 0.20 0.99 0.03 0.30 0.03 1.36 0.13 0.26 2.41 2.80 0.00 0.38 0.00 0.00 0.00 Meningococcal Invasive Disease 1.55 1.09 1.29 0.99 1.36 1.26 1.32 0.89 0.96 0.67 0.51 0.57 1.14 1.65 1.56 Mumps 0.00 0.00 0.00 0.00 0.00 0.00 3.37 9.75 6.08 2.35 0.48 0.64 0.35 0.41 0.03 Pertussis 0.10 0.33 11.50 8.20 6.91 4.93 5.72 2.38 1.78 1.53 1.53 1.68 1.91 0.60 1.49 Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 15 Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010 Disease 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 Plague 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 Poliomyelitis 0.00 0.00 0.00 0.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Psittacosis 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 Q Fever 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Rabies (Human) 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Rocky Mountain spotted fever 3.34 2.94 7.31 4.53 3.40 3.64 2.84 3.40 1.98 2.16 3.02 3.53 1.46 1.14 1.53 Rubella 0.13 0.10 0.03 0.00 0.07 0.00 0.20 0.03 0.03 0.03 0.06 0.00 0.03 0.13 0.00 Staphylococcus aureus , Vancomycin intermediate 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Staphylococcus aureus , Vancomycin resistant 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Streptococcus pneumoniae , Invasive disease, <5 years 9.47 16.36 8.61 7.75 12.48 85.66 6.89 4.74 8.61 16.33 12.36 5.74 38.41 32.23 21.19 Salmonellosis 14.02 17.06 20.26 14.71 15.67 16.92 15.67 16.53 14.74 14.02 15.29 11.70 10.17 14.12 14.97 Shigellosis 15.54 14.54 7.97 7.27 9.95 8.46 5.49 7.70 7.80 16.21 6.10 8.01 15.01 6.36 8.46 St. Louis Encephalitis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Syphilis 15.83 19.60 18.87 17.59 17.78 16.16 18.25 15.83 12.40 18.72 18.95 22.54 20.22 12.68 15.55 Tetanus 0.07 0.03 0.00 0.07 0.03 0.03 0.03 0.03 0.07 0.00 0.00 0.03 0.03 0.03 0.00 Trichinellosis 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 Tuberculosis 12.59 11.07 10.94 8.66 8.73 8.83 8.26 9.16 7.21 7.73 6.55 6.87 6.64 8.30 7.53 Tularemia 1.45 1.19 1.16 0.79 0.73 0.63 0.89 0.56 0.26 0.32 0.38 0.32 0.51 0.13 0.22 Typhoid Fever 0.17 0.13 0.10 0.17 0.07 0.10 0.20 0.00 0.03 0.10 0.10 0.00 0.03 0.10 0.03 Vibrio spp. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.10 Vibrio parahaemolyticus 0.00 0.00 0.00 0.00 0.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Vibrio vulnificus 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 West Nile Virus 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 16 Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010 Disease Anthrax Botulism (Foodborne) Botulism (Infant) Brucellosis Campylobacteriosis Chlamydia Cholera Congential Rubella Syndrome Creutzfeldt-Jakob disease Cryptosporidiosis Dengue Fever Diphtheria Escherichia coli O157:H7 and other Shiga toxin producing E. coli Ehrlichiosis Gonorrhea Haemophilus influenzae , Invasive Disease (Total) Haemophilus influenzae , Invasive Disease, type b, <5 yrs 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.05 0.03 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.00 0.03 0.06 0.03 0.00 0.05 0.00 8.93 7.85 7.66 10.17 10.46 8.93 10.49 12.08 17.13 15.77 11.74 15.36 13.34 10.54 12.15 234.3 240.5 298.1 277.8 270.8 307.8 311.0 318.3 300.6 375.5 382.7 363.1 389.1 411.6 387.90 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 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.03 0.03 0.03 0.03 0.32 0.38 0.22 0.45 0.87 0.46 0.46 0.70 0.64 1.33 1.62 6.26 6.53 3.87 3.31 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.06 0.00 0.09 0.05 0.00 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.45 0.41 0.83 1.30 0.55 1.04 0.72 0.87 0.84 1.10 1.25 0.96 3.71 1.76 2.82 0.00 0.00 0.06 0.38 0.35 0.70 0.38 1.04 1.42 2.78 1.36 3.07 3.32 4.04 2.85 155.7 153.9 134.3 136.4 151.7 139.6 134.0 131.7 131.7 145.8 149.8 139.9 135.8 128.0 116.46 0.99 1.05 1.11 1.49 1.33 1.39 1.54 1.51 1.94 2.14 2.26 2.70 2.47 2.53 0.00 0.00 0.44 0.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.05 0.00 Hantavirus Hemolytic Uremic Syndrome, post diarrheal Hepatitis A Hepatitis B Hepatitis C Influenza Associated Pediatric Mortality Legionellosis Leptospirosis Listeriosis Lyme Disease Malaria Measles Meningococcal Invasive Disease Mumps Pertussis 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.06 0.12 0.09 0.12 0.06 0.14 0.09 0.23 1.40 0.47 0.29 79.99 45.81 21.20 16.98 7.85 3.36 1.51 0.84 0.55 0.17 0.32 0.38 0.36 0.16 0.16 1.91 2.00 5.37 5.88 5.19 3.33 3.22 2.12 2.32 1.71 2.78 4.40 3.54 3.35 3.12 0.25 0.32 0.73 0.41 0.38 0.17 0.61 0.17 0.20 0.41 0.55 1.42 0.58 0.74 1.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.22 0.98 0.22 0.51 0.13 0.57 0.19 0.14 0.20 0.14 0.29 0.70 0.29 0.29 0.26 0.30 0.27 0.40 0.00 0.00 0.00 0.03 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.03 0.16 0.29 0.60 0.38 0.23 0.06 0.26 0.09 0.12 0.12 0.14 0.06 0.19 0.22 0.24 1.08 1.43 0.38 0.25 0.03 0.00 0.00 0.00 0.09 0.00 0.00 0.03 0.05 0.05 0.00 0.10 0.29 0.13 0.06 0.29 0.14 0.35 0.12 0.29 0.35 0.32 0.29 0.14 0.05 0.16 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.46 1.43 1.40 1.27 0.99 0.93 0.72 0.70 0.29 0.52 0.43 0.67 0.47 0.47 0.48 0.13 0.10 0.13 0.16 0.09 0.00 0.09 0.06 0.03 0.06 0.32 0.20 0.03 0.08 0.03 0.67 1.91 1.14 1.27 1.74 1.25 3.91 3.07 3.54 3.62 1.85 1.68 2.75 3.21 5.40 Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 17 Table Two. Incidence Rate per 100,000 Oklahoma Population of Reported Communicable Diseases, Oklahoma 1981 - 2010 Disease Plague Poliomyelitis Psittacosis Q Fever Rabies (Human) Rocky Mountain spotted fever Rubella Staphylococcus aureus , Vancomycin intermediate Staphylococcus aureus , Vancomycin resistant Streptococcus pneumoniae , Invasive disease, <5 years Salmonellosis Shigellosis St. Louis Encephalitis Syphilis Tetanus Trichinellosis Tuberculosis 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.09 0.00 0.06 0.08 0.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 1.43 0.95 1.24 0.92 1.07 2.00 2.87 4.00 5.51 5.97 3.91 5.42 7.33 9.39 6.37 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.39 9.71 11.48 19.87 16.08 24.54 28.35 34.27 22.00 20.31 30.89 32.58 28.60 23.17 20.23 16.53 12.46 15.93 14.88 11.71 14.58 15.19 14.32 12.32 12.98 17.50 20.55 24.74 18.04 20.05 9.70 9.31 22.63 17.80 3.80 4.29 20.78 31.24 20.98 27.13 5.68 4.69 6.42 10.95 11.09 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.65 8.74 8.39 11.03 7.10 5.36 5.30 4.09 2.55 2.12 5.59 4.35 5.82 7.03 2.45 0.03 0.06 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.39 6.71 6.29 6.61 4.46 5.62 5.51 4.72 5.16 4.17 4.17 4.32 2.75 2.80 2.29 Tularemia Typhoid Fever Vibrio spp. Vibrio parahaemolyticus Vibrio vulnificus West Nile Virus 0.13 0.16 0.16 0.22 0.32 0.20 0.29 0.26 0.55 0.58 0.09 0.52 0.19 0.19 0.21 0.00 0.10 0.03 0.00 0.03 0.03 0.06 0.03 0.03 0.03 0.00 0.09 0.08 0.05 0.03 0.03 0.00 0.29 0.03 0.00 0.00 0.03 0.03 0.00 0.09 0.03 0.06 0.14 0.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.03 0.00 0.03 0.03 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.49 2.29 0.64 0.96 1.39 3.10 0.25 0.27 0.03 Oklahoma population numbers are obtained from the U.S. Census Bureau Decennial Census numbers. 18 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Campylobacteriosis Cryptosporidiosis E. coli O157:H7 and other STEC Ehrlichiosis County Number Rate Number Rate Number Rate Number Rate Adair County 5 22.88 0 0 * 1 4.58 Alfalfa County 3 54.73 0 * 0 * 0 * Atoka County 2 13.80 0 * 0 * 1 6.90 Beaver County 1 18.98 1 18.98 0 * 0 * Beckham County 3 14.21 0 * 0 * 0 * Blaine County 2 15.86 0 * 0 * 0 * Bryan County 2 4.90 0 * 0 * 0 * Caddo County 4 13.16 3 9.87 1 3.29 1 3.29 Canadian County 9 8.21 4 3.65 15 13.68 0 * Carter County 6 12.42 16 33.11 0 * 1 2.07 Cherokee County 9 19.55 0 * 2 4.35 3 6.52 Choctaw County 1 6.72 0 * 0 * 2 13.45 Cimarron County 2 76.05 0 * 0 * 0 * Cleveland County 16 6.54 9 3.68 1 0.41 4 1.64 Coal County 1 17.08 0 * 0 * 0 * Comanche County 2 1.77 0 * 1 0.88 0 * Cotton County 0 * 0 * 2 31.48 0 * Craig County 4 26.39 0 * 1 6.60 0 * Creek County 10 14.24 0 * 1 1.42 5 7.12 Custer County 3 11.23 0 * 0 * 0 * Delaware County 7 17.26 0 * 2 4.93 1 2.47 Dewey County 1 22.71 0 * 0 * 0 * Ellis County 1 25.48 1 25.48 0 * 0 * Garfield County 17 28.85 0 * 5 8.48 0 * Garvin County 8 29.51 1 3.69 0 * 0 * Grady County 21 40.66 0 * 3 5.81 1 1.94 Grant County 0 * 0 * 0 * 0 * Greer County 2 34.31 1 17.15 1 17.15 0 * Harmon County 0 * 0 * 0 * 0 * Harper County 2 59.22 0 * 0 * 0 * Haskell County 1 8.07 0 * 0 * 3 24.21 Hughes County 1 7.24 0 * 0 * 1 7.24 Jackson County 12 47.30 3 11.83 1 3.94 0 * Jefferson County 2 31.65 1 15.83 0 * 0 * Johnston County 1 9.55 3 28.66 2 19.11 0 * Kay County 7 15.18 0 * 3 6.51 0 * Kingfisher County 2 13.90 0 * 0 * 0 * Kiowa County 3 32.96 0 * 0 * 0 * ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 19 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Campylobacteriosis Cryptosporidiosis E. coli O157:H7 and other STEC Ehrlichiosis County Number Rate Number Rate Number Rate Number Rate Latimer County 0 * 0 * 0 * 2 18.83 Le Flore County 10 20.03 1 2.00 0 * 6 12.02 Lincoln County 7 21.74 0 * 1 3.11 1 3.11 Logan County 9 22.90 2 5.09 1 2.54 1 2.54 Love County 0 * 2 21.92 0 * 0 * McClain County 5 15.07 2 6.03 0 * 2 6.03 McCurtain County 3 8.99 0 * 0 * 1 3.00 McIntosh County 1 5.05 0 * 0 * 2 10.10 Major County 0 * 0 * 0 * 0 * Marshall County 2 13.32 2 13.32 0 * 0 * Mayes County 8 19.97 2 4.99 2 4.99 5 12.48 Murray County 3 23.15 0 * 0 * 0 * Muskogee County 12 16.80 6 8.40 0 * 3 4.20 Noble County 4 36.53 0 * 5 45.66 1 9.13 Nowata County 0 * 1 9.50 0 * 0 * Okfuskee County 2 18.31 0 * 0 * 2 18.31 Oklahoma County 69 9.63 22 3.07 9 1.26 6 0.84 Okmulgee County 5 12.73 1 2.55 2 5.09 5 12.73 Osage County 2 4.44 0 * 0 * 3 6.66 Ottawa County 5 15.81 0 * 1 3.16 3 9.48 Pawnee County 2 12.18 1 6.09 0 * 0 * Payne County 14 17.56 1 1.25 5 6.27 1 1.25 Pittsburg County 5 11.06 1 2.21 2 4.42 9 19.91 Pontotoc County 6 16.03 0 * 0 * 0 * Pottawatomie County 11 15.65 2 2.85 0 * 0 * Pushmataha County 2 16.93 0 * 0 * 3 25.40 Roger Mills County 1 29.35 0 * 0 * 0 * Rogers County 7 8.17 0 * 9 10.51 1 1.17 Seminole County 0 * 0 * 0 * 1 4.12 Sequoyah County 3 7.24 0 * 1 2.41 2 4.83 Stephens County 6 13.80 9 20.70 3 6.90 1 2.30 Texas County 2 9.46 1 4.73 0 * 0 * Tillman County 1 12.83 0 * 0 * 0 * Tulsa County 53 8.80 20 3.32 17 2.82 19 3.16 Wagoner County 5 7.10 1 1.42 2 2.84 2 2.84 Washington County 4 7.89 2 3.94 3 5.92 1 1.97 Washita County 0 * 0 * 0 * 0 * Woods County 2 23.76 0 * 0 * 0 * Woodward County 3 15.03 0 * 0 * 0 * State of Oklahoma 448 12.15 122 3.31 104 2.82 107 2.90 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 20 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Haemophilus influenzae , invasive Hepatitis A Hepatitis B Hepatitis C County Number Rate Number Rate Number Rate Number Rate Adair County 1 4.85 0 * 1 4.58 0 * Alfalfa County 0 * 0 * 0 * 0 * Atoka County 0 * 0 * 0 * 0 * Beaver County 0 * 0 * 0 * 0 * Beckham County 0 * 0 * 0 * 0 * Blaine County 0 * 0 * 0 * 0 * Bryan County 0 * 0 * 0 * 0 * Caddo County 1 3.29 0 * 1 3.29 1 3.29 Canadian County 1 0.91 2 1.82 1 0.91 3 2.74 Carter County 3 6.21 0 * 1 2.07 1 2.07 Cherokee County 0 * 0 * 0 * 1 2.17 Choctaw County 0 * 0 * 0 * 0 * Cimarron County 0 * 0 * 0 * 0 * Cleveland County 7 2.86 0 * 8 3.27 1 0.41 Coal County 0 * 0 * 0 * 0 * Comanche County 1 0.88 0 * 0 * 2 1.77 Cotton County 0 * 0 * 0 * 0 * Craig County 0 * 0 * 0 * 0 * Creek County 4 5.69 0 * 3 4.27 1 1.42 Custer County 0 * 0 * 1 3.74 0 * Delaware County 0 * 0 * 0 * 0 * Dewey County 0 * 0 * 0 * 0 * Ellis County 0 * 0 * 0 * 0 * Garfield County 4 6.79 1 1.70 2 3.39 0 * Garvin County 0 * 0 * 2 7.38 0 * Grady County 1 1.94 0 * 1 1.94 0 * Grant County 3 69.49 0 * 0 * 0 * Greer County 0 * 0 * 0 * 0 * Harmon County 0 * 0 * 0 * 0 * Harper County 0 * 0 * 0 * 0 * Haskell County 0 * 0 * 0 * 1 8.07 Hughes County 1 7.24 0 * 1 7.24 0 * Jackson County 0 * 0 * 1 3.94 0 * Jefferson County 0 * 0 * 0 * 0 * Johnston County 1 9.55 0 * 2 19.11 0 * Kay County 1 2.17 0 * 0 * 2 4.34 Kingfisher County 0 * 0 * 1 6.95 0 * Kiowa County 0 * 0 * 0 * 0 * ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 21 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Haemophilus influenzae , invasive Hepatitis A Hepatitis B Hepatitis C County Number Rate Number Rate Number Rate Number Rate Latimer County 0 0.00 0 * 1 9.42 1 9.42 Le Flore County 0 0.00 0 * 7 14.02 0 * Lincoln County 2 6.21 1 3.11 1 3.11 0 * Logan County 0 0.00 0 * 1 2.54 0 * Love County 1 10.96 0 * 0 * 0 * McClain County 2 6.03 0 * 0 * 0 * McCurtain County 0 0.00 0 * 0 * 1 3.00 McIntosh County 1 5.05 0 * 0 * 0 * Major County 1 13.91 0 * 0 * 0 * Marshall County 0 0.00 0 * 0 * 0 * Mayes County 3 7.49 0 * 3 7.49 0 * Murray County 1 7.72 0 * 0 * 0 * Muskogee County 0 0.00 0 * 2 2.80 2 2.80 Noble County 0 0.00 0 * 0 * 0 * Nowata County 0 0.00 0 * 0 * 0 * Okfuskee County 0 0.00 0 * 0 * 0 * Oklahoma County 28 3.91 0 * 16 2.23 3 0.42 Okmulgee County 1 2.55 0 * 4 10.18 3 7.64 Osage County 0 0.00 0 * 7 15.54 1 2.22 Ottawa County 0 0.00 0 * 2 6.32 0 * Pawnee County 0 0.00 0 * 0 * 2 12.18 Payne County 0 0.00 0 * 0 * 1 1.25 Pittsburg County 1 2.21 0 * 5 11.06 0 * Pontotoc County 2 5.34 0 * 1 2.67 0 * Pottawatomie County 4 5.69 0 * 4 5.69 1 1.42 Pushmataha County 0 0.00 0 * 0 * 0 * Roger Mills County 0 0.00 0 * 0 * 0 * Rogers County 2 2.33 1 1.17 0 * 1 1.17 Seminole County 3 12.35 0 * 1 4.12 1 4.12 Sequoyah County 0 0.00 0 * 3 7.24 2 4.83 Stephens County 0 0.00 0 * 1 2.30 0 * Texas County 1 4.73 0 * 0 * 0 * Tillman County 0 0.00 0 * 0 * 0 * Tulsa County 20 3.32 1 0.17 25 4.15 9 1.50 Wagoner County 2 2.84 0 * 2 2.84 0 * Washington County 1 1.97 0 * 1 1.97 0 * Washita County 0 0.00 0 * 0 * 0 * Woods County 0 0.00 0 * 0 * 0 * Woodward County 0 0.00 0 * 2 10.02 0 * State of Oklahoma 105 2.85 6 0.16 115 3.12 41 1.11 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 22 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Meningococcal invasive disease Pertussis Rocky Mountain Spotted Fever Salmonellosis County Number Rate Number Rate Number Rate Number Rate Adair County 1 4.58 1 4.58 1 4.58 1 4.58 Alfalfa County 0 * 0 * 0 * 4 72.98 Atoka County 0 * 1 6.90 2 13.80 1 6.90 Beaver County 0 * 0 * 0 * 2 37.95 Beckham County 0 * 0 * 0 * 4 18.94 Blaine County 0 * 0 * 2 15.86 0 * Bryan County 0 * 0 * 0 * 15 36.78 Caddo County 0 * 1 3.29 1 3.29 6 19.74 Canadian County 0 * 5 4.56 7 6.38 32 29.18 Carter County 0 * 4 8.28 0 * 16 33.11 Cherokee County 0 * 1 2.17 1 2.17 3 6.52 Choctaw County 0 * 0 * 0 * 1 6.72 Cimarron County 0 * 0 * 0 * 0 * Cleveland County 0 * 2 0.82 4 1.64 44 17.99 Coal County 0 * 0 * 0 * 3 51.23 Comanche County 0 * 2 1.77 4 3.53 23 20.31 Cotton County 0 * 0 * 0 * 1 15.92 Craig County 1 6.60 0 * 1 6.60 0 * Creek County 0 * 6 8.54 6 8.54 17 24.20 Custer County 0 * 0 * 2 7.49 5 18.71 Delaware County 0 * 3 7.40 5 12.33 8 19.73 Dewey County 0 * 0 * 0 * 0 * Ellis County 0 * 0 * 0 * 1 25.48 Garfield County 0 * 0 * 1 1.70 8 13.58 Garvin County 0 * 4 14.75 3 11.06 8 29.51 Grady County 0 * 7 13.55 2 3.87 13 25.17 Grant County 0 * 0 * 0 * 0 * Greer County 0 * 0 * 0 * 1 17.15 Harmon County 0 * 0 * 0 * 0 * Harper County 0 * 0 * 0 * 4 118.45 Haskell County 0 * 0 * 3 24.21 4 32.28 Hughes County 1 7.24 1 7.24 1 7.24 2 14.47 Jackson County 0 * 0 * 0 * 8 31.53 Jefferson County 0 * 0 * 0 * 0 * Johnston County 0 * 0 * 0 * 3 28.66 Kay County 1 2.17 4 8.67 1 2.17 6 13.01 Kingfisher County 0 * 0 * 2 13.90 6 41.71 Kiowa County 0 * 0 * 0 * 3 32.96 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 23 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Meningococcal invasive disease Pertussis Rocky Mountain Spotted Fever Salmonellosis County Number Rate Number Rate Number Rate Number Rate Latimer County 0 * 1 9.42 15 141.23 2 18.83 Le Flore County 0 * 0 * 19 38.06 11 22.04 Lincoln County 0 * 2 6.21 6 18.63 14 43.48 Logan County 0 * 0 * 2 5.09 13 33.08 Love County 0 * 0 * 0 * 3 32.88 McClain County 0 * 0 * 2 6.03 13 39.19 McCurtain County 0 * 0 * 8 23.97 8 23.97 McIntosh County 0 * 1 5.05 3 15.15 3 15.15 Major County 0 * 0 * 0 * 3 41.73 Marshall County 0 * 0 * 0 * 2 13.32 Mayes County 0 * 1 2.50 3 7.49 8 19.97 Murray County 0 * 1 7.72 0 * 3 23.15 Muskogee County 0 * 1 1.40 6 8.40 9 12.60 Noble County 0 * 0 * 0 * 6 54.79 Nowata County 0 * 0 * 2 19.00 3 28.50 Okfuskee County 0 * 2 18.31 3 27.46 4 36.62 Oklahoma County 2 0.28 29 4.05 15 2.09 132 18.42 Okmulgee County 0 * 4 10.18 5 12.73 4 10.18 Osage County 0 * 1 2.22 5 11.10 9 19.98 Ottawa County 1 3.16 0 * 4 12.65 8 25.29 Pawnee County 0 * 1 6.09 1 6.09 9 54.81 Payne County 0 * 1 1.25 5 6.27 30 37.63 Pittsburg County 1 2.21 10 22.12 17 37.60 10 22.12 Pontotoc County 0 * 0 * 1 2.67 10 26.72 Pottawatomie County 1 1.42 0 * 8 11.38 20 28.46 Pushmataha County 0 * 0 * 8 67.73 0 * Roger Mills County 0 * 0 * 0 * 0 * Rogers County 4 4.67 6 7.00 2 2.33 20 23.35 Seminole County 0 * 0 * 6 24.70 7 28.81 Sequoyah County 0 * 2 4.83 3 7.24 8 19.31 Stephens County 0 * 0 * 3 6.90 20 45.99 Texas County 0 * 0 * 0 * 7 33.12 Tillman County 0 * 0 * 0 * 4 51.31 Tulsa County 4 0.66 88 14.62 24 3.99 67 11.13 Wagoner County 1 1.42 1 1.42 8 11.36 10 14.21 Washington County 0 * 2 3.94 2 3.94 6 11.83 Washita County 0 * 0 * 0 * 2 16.93 Woods County 0 * 0 * 0 * 4 47.52 Woodward County 0 * 3 15.03 0 * 7 35.07 State of Oklahoma 18 0.49 199 5.40 235 6.37 752 20.40 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 24 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Shigellosis S. pneumoniae , invasive, < 5 yrs. Tuberculosis Tularemia County Number Rate Number Rate Number Rate Number Rate Adair County 10 45.75 1 4.58 0 * 0 * Alfalfa County 0 * 0 * 0 * 0 * Atoka County 0 * 0 * 0 * 0 * Beaver County 4 75.90 0 * 1 18.98 0 * Beckham County 7 33.15 1 4.74 0 * 0 * Blaine County 0 * 0 * 0 * 0 * Bryan County 0 * 0 * 1 2.45 0 * Caddo County 13 42.77 0 * 2 6.58 0 * Canadian County 34 31.00 1 0.91 4 3.65 0 * Carter County 3 6.21 1 2.07 0 * 0 * Cherokee County 5 10.86 1 2.17 1 2.17 1 2.17 Choctaw County 0 * 1 6.72 0 * 0 * Cimarron County 0 * 0 * 0 * 0 * Cleveland County 38 15.54 3 1.23 1 0.41 1 0.41 Coal County 0 * 0 * 0 * 0 * Comanche County 9 7.95 4 3.53 3 2.65 0 * Cotton County 0 * 0 * 1 15.92 0 * Craig County 0 * 1 6.60 0 * 0 * Creek County 2 2.85 2 2.85 0 * 0 * Custer County 2 7.49 0 * 1 3.74 0 * Delaware County 0 * 0 * 1 2.47 0 * Dewey County 0 * 0 * 1 22.71 0 * Ellis County 1 25.48 0 * 0 * 0 * Garfield County 2 3.39 1 1.70 4 6.79 0 * Garvin County 0 * 0 * 0 * 0 * Grady County 4 7.74 0 * 0 * 0 * Grant County 0 * 1 23.16 0 * 0 * Greer County 0 * 0 * 0 * 0 * Harmon County 0 * 0 * 0 * 0 * Harper County 0 * 0 * 1 29.61 0 * Haskell County 0 * 0 * 0 * 1 8.07 Hughes County 0 * 0 * 0 * 0 * Jackson County 14 55.19 0 * 2 7.88 0 * Jefferson County 0 * 0 * 0 * 0 * Johnston County 0 * 0 * 0 * 0 * Kay County 0 * 0 * 1 2.17 1 2.17 Kingfisher County 0 * 0 * 0 * 0 * Kiowa County 1 10.99 0 * 0 * 0 * ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 25 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Shigellosis S. pneumoniae , invasive, < 5 yrs. Tuberculosis Tularemia County Number Rate Number Rate Number Rate Number Rate Latimer County 0 * 0 * 0 * 0 * Le Flore County 0 * 0 * 3 6.01 0 * Lincoln County 0 * 2 6.21 0 * 0 * Logan County 0 * 0 * 0 * 0 * Love County 0 * 0 * 0 * 0 * McClain County 13 39.19 0 * 0 * 1 3.01 McCurtain County 0 * 0 * 4 11.99 0 * McIntosh County 0 * 0 * 1 5.05 0 * Major County 0 * 0 * 0 * 0 * Marshall County 0 * 0 * 0 * 0 * Mayes County 0 * 1 2.50 2 4.99 0 * Murray County 0 * 0 * 0 * 0 * Muskogee County 1 1.40 1 1.40 0 * 0 * Noble County 0 * 0 * 0 * 0 * Nowata County 0 * 0 * 0 * 0 * Okfuskee County 6 54.92 0 * 0 * 0 * Oklahoma County 62 8.65 13 1.81 27 3.77 0 * Okmulgee County 9 22.91 0 * 0 * 0 * Osage County 3 6.66 0 * 3 6.66 0 * Ottawa County 1 3.16 0 * 2 6.32 0 * Pawnee County 0 * 0 * 1 6.09 0 * Payne County 5 6.27 0 * 2 2.51 0 * Pittsburg County 0 0.00 5 11.06 1 2.21 0 * Pontotoc County 1 2.67 1 2.67 0 * 0 * Pottawatomie County 0 * 1 1.42 2 2.85 0 * Pushmataha County 0 * 0 * 0 * 0 * Roger Mills County 1 29.35 0 * 0 * 1 29.35 Rogers County 22 25.68 1 1.17 0 * 0 * Seminole County 0 * 0 * 0 * 0 * Sequoyah County 4 9.65 0 * 0 * 0 * Stephens County 0 * 3 6.90 0 * 1 2.30 Texas County 0 * 0 * 1 4.73 0 * Tillman County 0 * 0 * 0 * 0 * Tulsa County 79 13.12 6 1.00 11 1.83 0 * Wagoner County 60 85.23 1 1.42 0 * 1 1.42 Washington County 0 * 2 3.94 0 * 0 * Washita County 0 * 0 * 0 * 0 * Woods County 0 * 0 * 0 * 0 * Woodward County 0 * 0 * 1 5.01 0 * State of Oklahoma 416 11.28 55 1.49 86 2.33 8 0.22 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 26 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Chlamydia Gonorrhea Syphilis (Total Early) County Number Rate Number Rate Number Rate Adair County 67 295.38 16 70.54 0 * Alfalfa County 3 53.17 0 * 0 * Atoka County 46 324.35 5 35.26 0 * Beaver County 6 106.46 0 * 0 * Beckham County 53 239.61 9 40.69 0 * Blaine County 17 142.34 3 25.12 0 * Bryan County 145 341.85 21 49.51 0 * Caddo County 92 310.81 7 23.65 0 * Canadian County 179 154.92 34 29.43 2 1.73 Carter County 173 363.77 67 140.88 0 * Cherokee County 175 372.44 14 29.80 0 * Choctaw County 79 519.57 8 52.61 0 * Cimarron County 1 40.40 0 * 0 * Cleveland County 607 237.34 113 44.18 2 0.78 Coal County 16 270.04 3 50.63 0 * Comanche County 1196 963.75 310 249.80 4 3.22 Cotton County 16 258.36 1 16.15 0 * Craig County 51 339.34 7 46.58 0 * Creek County 213 304.43 34 48.59 1 1.43 Custer County 63 229.35 8 29.12 0 * Delaware County 82 197.65 4 9.64 0 * Dewey County 7 145.53 1 20.79 0 * Ellis County 2 48.18 0 * 0 * Garfield County 231 381.31 26 42.92 0 * Garvin County 68 246.59 9 32.64 0 * Grady County 109 207.89 17 32.42 2 3.81 Grant County 6 132.54 3 66.27 0 * Greer County 12 192.34 1 16.03 0 * Harmon County 7 239.56 2 68.45 0 * Harper County 2 54.27 1 27.14 0 0.00 Haskell County 15 117.47 0 * 0 0.00 Hughes County 35 249.95 7 49.99 0 0.00 Jackson County 131 495.35 24 90.75 0 0.00 Jefferson County 15 231.77 1 15.45 0 0.00 Johnston County 27 246.42 2 18.25 0 0.00 Kay County 164 352.22 24 51.54 0 0.00 Kingfisher County 19 126.38 2 13.30 0 0.00 Kiowa County 16 169.38 3 31.76 0 0.00 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 27 Table Three. Reportable Diseases by County, Oklahoma, 2010^ Chlamydia Gonorrhea Syphilis (Total Early) County Number Rate Number Rate Number Rate Latimer County 33 295.86 2 17.93 0 * Le Flore County 119 236.19 6 11.91 0 * Lincoln County 92 268.43 12 35.01 0 * Logan County 177 422.96 57 136.21 2 4.78 Love County 22 233.47 0 * 0 * McClain County 62 179.68 7 20.29 0 * McCurtain County 156 470.57 59 177.97 0 * McIntosh County 74 365.40 16 79.00 0 * Major County 12 159.43 1 13.29 0 * Marshall County 21 132.58 0 * 0 * Mayes County 109 264.18 10 24.24 0 * Murray County 27 200.18 0 * 0 * Muskogee County 326 459.22 124 174.67 1 1.41 Noble County 15 129.75 2 17.30 0 * Nowata County 22 208.81 0 * 0 * Okfuskee County 23 188.66 4 32.81 0 * Oklahoma County 3478 483.97 1460 203.16 47 6.54 Okmulgee County 196 489.16 87 217.13 1 2.50 Osage County 96 202.22 18 37.92 0 * Ottawa County 136 427.03 14 43.96 0 * Pawnee County 41 247.33 5 30.16 0 * Payne County 365 471.88 69 89.20 1 1.29 Pittsburg County 127 277.07 25 54.54 1 2.18 Pontotoc County 121 322.74 30 80.02 0 * Pottawatomie County 310 446.42 98 141.12 1 1.44 Pushmataha County 23 198.76 1 8.64 0 * Roger Mills County 8 219.36 1 27.42 0 * Rogers County 173 199.07 21 24.16 0 * Seminole County 83 325.72 44 172.67 0 * Sequoyah County 106 250.05 12 28.31 0 * Stephens County 138 306.34 8 17.76 0 * Texas County 36 174.42 8 38.76 0 * Tillman County 27 337.84 4 50.05 0 * Tulsa County 3146 521.38 1329 220.25 26 4.31 Wagoner County 92 125.88 25 34.21 0 * Washington County 68 133.40 10 19.62 0 * Washita County 21 180.58 7 60.19 0 * Woods County 33 371.71 4 45.06 1 11.26 Woodward County 40 199.19 2 9.96 0 * State of Oklahoma 14302 381.20 4369 116.46 92 2.45 ^2010 rates illustrate county specific incidence rates per 100,000 population. Rates calculated by dividing the number of reported cases by the 2009 Census Bureau county population estimate and multiplying by 100,000 28 Botulism 2010 Case Total 2 2010 Incidence Rate 0.06 per 100,000 2009 Case Total 0 2009 Incidence Rate 0.00 per 100,000 Botulism is a collective term for illness or intoxication caused by the bacteria Clostridium botulinum or its toxin. For disease classification purposes, the broadest categories of the disease include foodborne botulism, infant botulism, and wound botulism. In 2009, the US had 118 cases of botulism, 10 were categorized as foodborne botulism, 83 were infant botulism, and 25 were either wound botulism or an unspecified category of botulism. In 2010, Oklahoma had two cases of infant botulism. This report summarizes the clinical and laboratory results of both cases. C. botulinum is ubiquitous in the environment and rarely causes disease when ingested by healthy adults. In infants, ingested spores may multiply in the intestinal lumen and produce toxin, causing neurological illnessi. In the last several years, colonization with C. botulinum in adults has also been recognized as a rare clinical entity. Infant botulism has been epidemiologically linked to the consumption of honey, although approximately 85% of infected infants did not ingest honey prior to illness. Some studies suggest that as many as 5% of SIDS deaths are caused by infant botulismii. The two Oklahoma cases experienced symptoms of weak/altered cry, diminished suckling, hypotonia, and poor feeding. One case also experienced symptoms of paralysis and constipation. Initial tests performed to rule out other diagnoses were a CT scan, lumbar puncture, and stool cultures. Due to the cases clinical presentation and rule out testing of other diagnoses, BabyBIG® (Botulism Immune Globulin Intravenous [Human]) was released by the Infant Botulism Treatment and Prevention Program from the California Department of Health. Stool specimens were sent to the Centers for Disease Control and Prevention (CDC) for C. botulinum testing. Clostridium botulinum toxin was identified in the stool of both cases. Laboratory testing identified C. botulinum toxin type A in one case and C. botulinum toxin type B was identified in the other case’s clinical specimen. Investigations conducted by the Acute Disease Service (ADS) did not identify a potential source, such as consumption of honey, for either case. Prior to 2010, the last infant botulism cases reported in Oklahoma occurred during 2001 and 2005. Botulism is an immediately notifiable condition in Oklahoma. Clinicians should contact the ADS Epidemiologist-on-Call (available 24/7/365 for disease reporting and consultation) immediately if botulism is suspected based on clinical impression. The ADS Epi-on-Call will work with the clinician and the CDC to coordinate antitoxin or BabyBIG® release and clinical specimen collection for laboratory testing. The decision to release antitoxin and BabyBIG® are based on symptoms consistent with botulism and initial tests that rule out other potential diagnoses such as LP, brain CT or MRI, edrophonium challenge test, physical exam for ticks, chest x-ray, and EMG. If given before paralysis is complete, antitoxin can prevent worsening of the patient’s illness and shorten recovery time. The decision to release antitoxin cannot depend on laboratory confirmation since routine tests cannot confirm C. botulinum with the speed required for initiating antitoxin as early as possible during the course of illness. The mouse bioassay is used by the CDC to test for C. botulinum. The Oklahoma State Department of Health Public Health Lab does not perform C. botulinum testing. The CDC will only perform C. botulinum testing if the patient’s symptoms are consistent with botulism or if the antitoxin has been released. Preferred specimens for botulism testing are serum, feces, vomitus, or gastric contents. Serum should be collected before antitoxin treatment is given. Preferred specimens for infant botulism testing are stool or rectal swab. For wound botulism, the preferred specimens are serum, tissue, or feces. Pease refer to the OSDH ADS website at http://ads.health.ok.gov for additional information about botulism. i Nevas M. et al. Infant Botulism Acquired from Household Dust Presenting as Sudden Infant Death Syndrome. J Clin Microb 2005;43:511-513. ii Control of Communicable Diseases Manual, 19th Edition. Heyman D, Ed. American Public Health Association, Washington, DC 2008. 29 Campylobacteriosis 2010 Case Total 448 2010 Incidence Rate 12.2 per 100,000 2009 Case Total 384 2009 Incidence Rate 10.5 per 100,000 Campylobacteriosis is a diarrheal illness caused by Campylobacter species and is characterized by an acute onset of diarrhea, sometimes bloody, abdominal cramps, fever, malaise, nausea, and sometimes vomiting. Beginning in October 2009, reported cases of campylobacteriosis are counted rather than investigated by county health department communicable disease nurses. The number of cases reported in 2010 is a 17% increase from the 384 cases reported in 2009. A seasonal trend for campylobacteriosis was seen with more cases occurring during the months of June through August (n = 192, 43%). The highest incidence rate (IR) by age group occurred among cases less than five years of age (29.79 per 100,000, n = 81), followed by cases 5 to 9 years of age (13.37 per 100,000, n = 34), and cases 60 to 69 years of age (12.90 per 100,000, n = 44). Although the IR of campylobacteriosis is 25% greater among men (13.56 per 100,000, n = 247) than women (10.78 per 100,000, n = 201), the difference is not statistically significant. No outbreaks of campylobacteriosis were reported in 2010. Cases of campylobacteriosis were reported from 67 counties in Oklahoma. The highest IR of cases occurred among residents of Cimarron County (76.05 per 100,000; n = 2). Other counties with high rates included Harper County (59.22 per 100,000; n = 2), Alfalfa County (54.73 per 100,000; n = 3), and Jackson County (47.30 per 100,000; n = 12). Population size can affect incidence rates, consequently the higher rates seen in counties with smaller population. The largest counties had the highest numbers of cases: Oklahoma had 69 cases (9.6 per 100,000) followed by Tulsa with 53 cases (8.78 per 100,000). Eighteen cases (4%) were hospitalized for campylobacteriosis; there were no deaths due to this disease in 2010. The OSDH PHL received 69 isolates to confirm Campylobacter and serogroup identification, representing 15% of the reported cases. Of these isolates, 83% were identified as C. jejuni, 7% as C. jejuni var. doylei, and 10% as C. coli. Incidence Rate of Reported Cases of Campylobacteriosis by Year, Oklahoma, 2001-2010* 0 2 4 6 8 10 12 14 16 18 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Incidence Rate per 100,000 * Campylobacteriosis is not a nationally notifiable Year condition, so national data is unavailable for comparison. 30 Demographic and Clinical Summary of Reported Campylobacteriosis Cases, Oklahoma, 2010 (N = 448) Number (%) Incidence rate per 100,000 Gender Male Female 247 (55%) 201 (45%) 13.56 10.78 Age Median Age: 30 years (Range: 1 month – 93 years) Age Groups Less than 5 years 5 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+ 81 (18%) 34 (8%) 46 (10%) 61 (14%) 44 (10%) 55 (12%) 46 (10%) 44 (10%) 24 (5%) 13 (3%) 29.79 13.37 9.23 10.98 9.59 11.40 9.63 12.90 11.53 9.35 Race White American Indian or Alaska Native Black or African American Asian Two or More Races Unknown 203 (45%) 27 (6%) 8 (2%) 5 (1%) 5 (1%) 200 (45%) 7.06 9.12 2.69 7.97 3.31 -- Hispanic or Latino Ethnicity Unknown 20 (4%) 283 (63%) 6.63 -- Hospitalized 18 (4%) -- 31 Chlamydia 2010 Case Total 14,302 2010 Incidence Rate 381 per 100,000 2009 Case Total 14,991 2009 Incidence Rate 412 per 100,000 Chlamydia is the most commonly reported notifiable sexually transmitted disease (STD) in the United States and Oklahoma. Caused by the bacterium Chlamydia trachomatis, it is the most prevalent STD in Oklahoma accounting for 76% of reported STDs in the state for 2010. Although symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage can develop “silently” before a patient ever recognizes a problem. In women, chlamydia can cause pelvic inflammatory disease, ectopic pregnancy, chronic pain, and/or infertility. However, up to 70% of women with chlamydia are asymptomatic. In addition, a pregnant woman infected with chlamydia can transmit the infection to her baby’s eyes during a vaginal birth. The resulting ophthalmic infection can ultimately result in the infant’s blindness. Men infected with chlamydia may have penile discharge while about 1% to 25% of men infected are asymptomatic. Possible complications of male infections include epididymitis, infertility, and Reiter Syndrome (reactive arthritis). In men, receptive anal intercourse may result in chlamydial proctitis. Oklahoma mandated chlamydia reporting in 1988, when 2,714 cases were reported. In 2010, a total of 14,302 cases were reported. The rate of chlamydia in Oklahoma decreased 4.6% between 2009 and 2010. Oklahoma had an incidence rate of 381.2 per 100,000 in 2010 with 72% of the reported cases being female. Women go to the doctor more frequently than men due to yearly exams and pregnancy; this could account for some of the huge gap in the gender of reported chlamydia cases. While Oklahoma county had the highest number of reported cases, Comanche county had the highest rate at 963.8 per 100,000, followed by Tulsa county (521.4 per 100,000) and Oklahoma county (483.9 per 100,000). Comanche county had a 15.9% increase between 2009 and 2010, while Oklahoma and Tulsa counties’ rates decreased. Chlamydia occurs in all ages, but age groups 15 to 19 years (1,936.6 per 100,000) and 20 to 24 years (2,031.8 per 100,000) had the highest rates among all the age groups. Age group 45 to 49 years had the highest rate increase at 23.6 per 100,000, 19.6% higher than 2009 (51 to 61 cases, respectively). Blacks had the highest rate among all racial groups with a rate of 1,594.5 per 100,000, 6.4 times higher when compared to Whites (249.9 per 100,000). Native Americans had the second highest rate (499.6 per 100,000) which was 1.9 times higher than Whites. Asian/Hawaiian/Pacific Islanders had a rate of 227.5 per 100,000. Hispanics had a rate of 415.1 per 100,000 in 2010, which represents a 7.4% decrease from 2009. 0 50 100 150 200 250 300 350 400 450 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Incidence Rate per 100,000 Year Chlamydia Incidence Rates per 100,000 Population, Oklahoma and U.S., 1997-2010* U.S Oklahoma U.S. Data for 2010 not available at the time of this report. 32 Chlamydia Cases and Rates by Demographics for 2010, Oklahoma Number Percent Incidence Rate per 100,000 Male Gender (N = 14,302) 3,9 97 27.9 % 219 .4 Female 10,297 72.0 % 552.1 Unknown 8 <1.0 % * < 10A Ygeea rGsr oups (N = 14,302)* 2 2 <1.0 % 4. 2 10 - 14 129 <1.0 % 53.4 15 - 19 4,974 34.8 % 1,936.6 20 - 24 5,705 39.9 % 2,031.8 25 - 29 2,127 14.9 % 774.5 30 - 34 821 5.7 % 356.4 35 - 39 302 2.1 % 132.1 40 - 44 114 <1.0 % 51.0 45 - 49 61 <1.0 % 23.6 > 50 Years 47 <1.0 % 4.0 AmericanR aIncdeia (nN/ A=l a1s4k,a3 0N2a) tive 1,6 07 11.2 % 499 .6 Asian/Pacific Islander 158 1.1 % 227.5 Black/African American 4,427 30.9 % 1,594.5 White 6,764 47.3 % 249.9 Multiple Race 263 1.8 % 173.9 Other 150 1.1 % 97.1 Unknown 933 6.5 % * HispaniEct hnicity (N = 1,253) 1,2 53 8.8 % 415 .1 At the time of publication 2010 population data was not available; therefore, 2009 population data was used to calculate rates. 33 Cryptosporidiosis 2010 Case Total 122 2010 Incidence Rate 3.3 per 100,000 2009 Case Total 141 2009 Incidence Rate 3.9 per 100,000 The number of cryptosporidiosis cases reported in Oklahoma during 2010 was a 13.5% decrease compared to the 141 cases reported during 2009. Of the 122 reported cases, 93 (76%) were laboratory-confirmed cases of cryptosporidiosis and 29 (24%) were symptomatic exposed contacts to a confirmed case identified during public health investigations conducted by county health department communicable disease nurses. No outbreaks of cryptosporidiosis were reported in Oklahoma during 2010. The highest incidence rate of cryptosporidiosis occurred in persons under 10 years of age (5.5 per 100,000 population). Twelve (10%) cases reported working in or attending a child care setting. Twelve (10%) cases reported out-of-state travel and 9 (7%) reported international travel to various countries including Mexico, Ethiopia, Morocco, and Costa Rica. A seasonal trend was observed in 2010 with the majority of cases (60%) reporting onset of symptoms from June through September. The highest incidence rates of cryptosporidiosis occurred among residents of Carter (33.1 per 100,000 population), Johnston (28.7 per 100,000 population), and Ellis Counties (32.8 per 100,000 population). Regular handwashing with soap and water, whether you are ill or well, is the single most important thing you can do to prevent cryptosporidiosis and other diarrheal illnesses. For more information about preventing cryptosporidiosis and other waterborne diseases, visit http://ads.health.ok.gov. Demographic Summary of Reported Cryptosporidiosis Cases, Oklahoma, 2010 (N = 122) Number (%) Incidence Rate per 100,000 Gender Female Male 67 (55%) 55 (45%) 3.59 3.02 Age Median = 35.5 years (range: 6 months – 91 years) Race White Black or African American American Indian or Alaskan Native Two or more races Unknown 94 (77%) 5 (4%) 9 (7%) 2 (2%) 12 (10%) 3.27 1.68 3.04 1.32 - Ethnicity Hispanic or Latino Not Hispanic or Latino Unknown 7 (6%) 95 (78%) 20 (16%) 2.32 2.81 - Hospitalization 28 (23%) - Death 0† (0%) - Symptoms Diarrhea Watery diarrhea Abdominal cramps Anorexia 119 (98%) 102 (84%) 87 (71%) 75 (61%) - - - - Duration of diarrhea Median = 7 days (range: 1 – 120 days) Number of loose stools in a 24-hour period Median = 8 stools (range: 1 – 140 stools) * Twenty-eight cases were hospitalized with cryptosporidiosis or found to have cryptosporidiosis during a hospital stay for an underlying condition † There were three deaths among cases. Each of these cases had additional underlying conditions at the time of death, and cryptosporidiosis was not considered the primary cause of death for any of these cases. 34 Dengue Fever 2010 Case Total 4 2010 Incidence Rate 0.11 per 100,000 2009 Case Total 0 2009 Incidence Rate 0.00 per 100,000 Dengue fever is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean (refer to map). Cases of dengue fever are generally acquired outside of the US (imported or travel-associated), but non-imported cases have been identified in Hawaii in 2001, Texas in 2005, and Florida in 2009 and 2010. Most dengue cases in U.S. citizens occur in endemic areas, such as, Puerto Rico, the U.S. Virgin Islands, Samoa, and Guam. In Oklahoma, all dengue fever cases reported in 2010 were imported. Two cases reported visiting the Caribbean, one case visited Central American, and one case visited Southeast Asia during the incubation period. Only one case was hospitalized for this illness. All four cases reported being bitten by mosquitoes. Only one of the cases reported using mosquito repellant/prevention methods. The cases’ ages ranged from 12 to 23 years. All four cases reported fever and myalgia. Three of the cases reported chills and anorexia and two cases reported rash, vomiting, backache, and eye pain. Other symptoms associated with dengue include intense headache, arthralgia, and a generalized maculo-papular rash. Dengue fever is transmitted through the bite of an infected mosquito. Prevention of dengue fever may be achieved by routine use of an insect repellent containing 20 to 30% DEET (N, N-diethyl-m-toluamide) when visiting or residing in an endemic area along with sleeping indoors with screened windows or mosquito netting protection. The CDC Division of Vectorborne Infectious Diseases website has recommendations, news and updates for travelers and clinicians regarding dengue fever at http://www.cdc.gov/NCIDOD/DVBID/dengue. Persons planning travel to areas where dengue is endemic can check the CDC Traveler’s Health recommendations by accessing the website www.cdc.gov/travel. If a case of dengue fever is reported to the Oklahoma State Department of Health (OSDH), further testing may be performed by the Center for Disease Control Dengue Branch (CDC) upon request by the Acute Disease Service (ADS). The diagnosis and treatment of dengue and dengue hemorrhagic fever are guided by the symptoms and findings the patient presents, and cannot depend on laboratory confirmation, since routine tests can not confirm dengue with the speed required for patients in critical condition. Commercial laboratories are capable of testing for dengue. Confirmatory testing is performed only by the CDC using acute and convalesce blood samples. For unique circumstances, the OSDH ADS can arrange confirmatory testing at the CDC. 35 Source: WHO, International Travel and Health http://www.who.int/ith/en/ 36 Shiga Toxin-producing Escherichia coli (STEC) 2010 Case Total 104 2010 Incidence Rate 2.82 per 100,000 2009 Case Total 64 2009 Incidence Rate 1.76 per 100,000 Nationally, E. coli O157:H7 is the most commonly reported serotype of Shiga toxin-producing E. coli (STEC); however, the number of reported non-O157 STEC cases each year is increasing.i This increase may be partially due to more widely used laboratory tests that identify other serotypes of STEC beyond O157:H7. The number of reported STEC cases reported in 2010 is a 63% increase from the 64 cases reported in 2009. This increase may be in part due to an outbreak involving a correctional facility described elsewhere in this publication. A seasonal trend was observed with the highest number of cases reported during the summer months of June and July (n = 44, 43%). STEC cases in 2010 occurred among residents of 30 Oklahoma counties. The five counties with the highest incidence rates were Noble (45.66 per 100,000, n = 5), Cotton (31.84 per 100,000, n = 2), Johnston (19.11 per 100,000, n = 2), Greer (17.15 per 100,000, n = 1), and Canadian (13.68 per 100,000, n = 15) counties. The highest incidence rate occurred among males less than five years of age with an incidence of 18.73 per 100,000 (n = 26). The second highest incidence rate occurred among females less than five years of age (8.27 per 100,000, n = 11). Demographic and Clinical Summary of Reported STEC Cases, Oklahoma, 2010 (N = 104) Number (%) Incidence Rate per 100,000 Gender Male Female 60 (58%) 44 (42%) 3.29 2.36 Age Median Age: 15 years (Range: 6 months – 75 years) Race White African American or Black Two or more races American Indian or Alaska Native Unknown 78 (75%) 8 (8%) 8 (8%) 6 (6%) 4 (4%) 2.71 2.69 5.29 2.03 -- Ethnicity Hispanic or Latino Not Hispanic or Latino Unknown 4 (4%) 83 (80%) 17 (17%) 1.33 -- -- Hospitalized 18 (17%) --- Hemolytic Uremic Syndrome 6 (6%) -- Symptoms Diarrhea Abdominal Cramps Bloody Diarrhea Nausea Vomiting Fever 93 (89%) 79 (76%) 51 (51%) 42 (40%) 41 (39%) 31 (30%) -- -- -- -- -- -- Twenty-nine (28%) cases reported an affiliation with high-risk settings. Of those, 17 (59%) were associated with child care settings, ten (34%) resided in a correctional facility, and two (7%) worked in food service. Secondary cases were reported in two child care settings. Of the 104 cases, 87 (84%) were laboratory-confirmed STEC and 17 (16%) were epidemiologically-linked symptomatic contacts identified by the county health department communicable disease nurse during case investigations. 37 All suspected STEC isolates are required to be forwarded to the Oklahoma State Department of Health Public Health Laboratory (OSDH PHL) for confirmation and serogroup identification. In 2010, STEC isolates were forwarded to the OSDH PHL for all 87 confirmed cases. Of the 87 isolates, 41 (47%) were confirmed E. coli O157:H7 and 46 (53%) were STEC non-O157. Incidence Rate of Reported Cases of Shiga Toxin-producing E. coli by Year, Oklahoma and U.S., 2001-2010* 0 0.5 1 1.5 2 2.5 3 3.5 4 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 U.S. Oklahoma Incidence Rate per 100,000 U.S. 2010 Rate Unavailable Year Incidence Rate of Reported Cases of Shiga Toxin-producing E. coli by Age Group and Gender, Oklahoma, 2010 0 2 4 6 8 10 12 14 16 18 20 0 - 4 y 5 - 9 y 10 - 19 y 20 - 29 y 30 - 39 y 40 - 49 y 50 - 59 y 60 - 69 y 70 - 79 y Male Female Incidence Rate per 100,000 Age Group i Centers for Disease Control and Prevention. [Summary of notifiable diseases—United States, 2009]. Published May 12, 2011 for MMWR 2011;58(No. 53):74 38 Ehrlichiosis and Anaplasmosis 2010 Case Total 107 2010 Incidence Rate 2.90 per 100,000 2009 Case Total 147 2009 Incidence Rate 4.04 per 100,000 Human monocytic ehrlichiosis (HME) and human granulocytic anaplasmosis (HGA, formerly called human granulocytic ehrlichiosis, or HGE) are distinct but closely related tickborne diseases with similar clinical presentations. For purposes of epidemiologic description, ehrlichiosis and anaplasmosis will be combined in this report. In 2010, the incidence rate (IR) of ehrlichiosis and anaplasmosis in Oklahoma represented a 27% decrease from 2009. However, the decline in cases may have partially been affected by changes in investigation processes; the Acute Disease Service focused on investigating reports with serologic titers above 1:64. From 2001 to 2010, the median annual number of reported cases in Oklahoma was 73 (range, 13 to 147). Eastern Oklahoma had higher incidence rates corresponding with its higher tick population. The counties with the highest rates of disease in 2010 were Pushmataha county (25.40 per 100,000, n = 3), followed by Haskell county (24.21 per 100,000, n = 3). The majority of the cases occurred during the warmer months of the year, when tick exposure is more likely. Onsets of illness were elevated from May to August and peaked in June. Serologic testing is the most widely available and frequently used laboratory method for diagnosis. Both IgM and IgG antibody levels are used to confirm illness. Collection of acute (within a week of onset) and convalescent (2 to 4 weeks later) specimens are recommended for confirming the diagnosis. Treatment should be initiated before lab confirmation, when there is high suspicion of tickborne illness, to reduce the severity of disease. Doxycycline is the primary drug of choice for the treatment of ehrlichiosis and anaplasmosis.i 39 Descriptive and Clinical Summary of Reported Ehrlichiosis and Anaplasmosis Cases, Oklahoma, 2010 (N = 107) Number (%) Incidence rate per 100,000 Gender Male Female 67 (63%) 40 (37%) 3.68 2.14 Age Median Age: 48 years (Range: 21 months – 82 years) Race White American Indian or Alaska Native Native Hawaiian or Pacific Islander Two or More Races Unknown 60 (56%) 27 (25%) 1 (1%) 3 (3%) 16 (15%) 2.09 9.12 25.34 1.98 -- Hispanic or Latino Ethnicity Unknown 1 (1%) 40 (37%) 0.33 -- Disease Human Monocytic Ehrlichiosis Human Granulocytic Anaplasmosis 98 (92%) 9 (8%) -- -- Symptoms Fever Headache Myalgia Rash 106 (99%) 68 (64%) 54 (50%) 28 (26%) -- -- -- -- Reported Exposures Wooded or tick infested area Tick bite 15 (14%) 40 (37%) -- -- Hospitalized due to Ehrlichiosis or Anaplasmosis 26 (24%) -- Died due to Ehrlichiosis or Anaplasmosis 0 (0%) -- Incidence Rate of Reported Ehrlichiosis and Anaplasmosis Cases by Year, Oklahoma and U.S., 2001-2010* 0 1 2 3 4 5 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 U.S. Oklahoma Incidence Rate per 100,000 Year U.S. 2010 Rate Unavailable i Heymann, David L., Editor. Control of Communicable Diseases Manual. 19th Edition. American Public Health Association, 2008 40 Gonorrhea 2010 Case Total 4,369 2010 Incidence Rate 116.5 per 100,000 2009 Case Total 4,661 2009 Incidence Rate 128.0 per 100,000 Gonorrhea is the second most prevalent sexually transmitted disease reported in Oklahoma after chlamydia. Gonorrhea is caused by Neisseria gonorrhea, a bacterium that can grow and multiply in warm, moist areas of the reproductive tract, mouth, throat, eyes, and anus. In women, gonorrhea can result in pelvic inflammatory disease, ectopic pregnancy, cervicitis, and eventually infertility. Pregnant women infected with gonorrhea can also infect their unborn babies through the amniotic fluid or during birth. In men, this infection most often manifests as purulent urethral discharge and dysuria, and can cause infertility. Oklahoma mandated gonorrhea reporting in 1943, when 4,715 cases were reported. Reported gonorrhea cases increased until 1982 when numbers started to slowly drop following a national decline due to the implementation of a national gonorrhea control program in the mid-1970s. In 2010, a total of 4,369 cases were reported in Oklahoma, approximately a 6% decrease from 2009. Oklahoma had an incidence rate of 166.5 per 100,000 in 2010 with 57% of the reported cases being female. In 1989, men made up the majority of gonorrhea cases in the U.S., but since 2002 women have made up the majority of cases. Oklahoma has followed a similar trend. While Oklahoma County had the highest number of reported cases, Comanche County had the highest rate at 249.8 per 100,000, followed by Tulsa County (220.3 per 100,000) and Okmulgee County (217.1 per 100,000). Comanche County had a 35% rate increase between 2009 and 2010; however, Okmulgee County had a rate increase of 77.9% (122 per 100,000 to 217.1 per 100,000). Oklahoma County decreased by 15.9% and Tulsa County decreased by 9.7%. Gonorrhea occurs in all ages, but age groups 20 to 24 years (562 per 100,000) and 15 to 19 years (482.4 per 100,000) had the highest rates among all the age groups. Although most age groups had a rate decrease from 2009 to 2010, three age groups experienced an increase: 45 to 49 years at 6.2% increase, 25 to 29 years at 3.6% increase, and 30 to 34 years at 1% increase. Blacks had the highest rate among all racial groups with a rate of 882 per 100,000, 18.8 times higher when compared to Whites (47 per 100,000). American Indians/Alaska Natives had the second highest rate (102 per 100,000) which was 2.2 times higher than Whites. Asian/Pacific Islanders had a rate of 29 per 100,000 but represented only 20 cases in 2010, an 81.8% increase from 2009. Hispanics had a rate of 59 per 100,000 in 2010, which represents a 14.8% decrease from 2009. Whites had the highest increase in gonorrhea rate (10% increase from 2009), while American Indian/Alaska Natives had the largest decrease (9.9% decrease from 2009). 0 20 40 60 80 100 120 140 160 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Incidence Rate per 100,000 Year Incidence Rate of Reported Gonorrhea Cases, Oklahoma and U.S., 1998-2010 U.S Oklahoma United States Data for 2010 was not available at the time of this report. 41 Gonorrhea Cases and Rates by Demographics for 2010, Oklahoma Number Percent Incidence Rate per 100,000 Gender Male 1,873 42.9 % 102.8 Female 2,493 57.1 % 133.7 Unknown 3 <1 % - Age Groups (N = 4,368)* < 10 Years 8 <1 % 1.5 10 - 14 28 <1 % 11.6 15 - 19 1,239 28.4 % 482.4 20 - 24 1,578 36.1 % 562.0 25 - 29 823 18.8 % 299.7 30 - 34 377 8.6 % 163.7 35 - 39 135 3.1 % 59.0 40 - 44 82 1.9 % 36.7 45 - 49 57 1.3 % 22.0 > 50 Years 41 <1 % 3.5 Race American Indian/Alaska Native 327 7.5 % 101.7 Black/African American 2,450 56.1 % 882.4 White 1,262 28.9 % 46.6 Asian/Pacific Islander 20 <1 % 28.8 Two or more races 85 1.9 % N/A Other 30 <1 % N/A Unknown 195 4.5 % N/A Ethnicity Hispanic 197 4.5 % 59.3 At the time of publication 2010 population data was not available; therefore, 2009 population data was used to calculate rates. 42 Haemophilus influenzae Invasive Disease 2010 Case Total 105 2010 Incidence Rate 2.85 per 100,000 2009 Case Total 92 2009 Incidence Rate 2.53 per 100,000 Invasive Haemophilus influenzae (H. flu) disease is a reportable condition in Oklahoma, and all H. flu sterile-site isolates are required to be submitted to the OSDH Public Health Laboratory (PHL) for confirmation and serotype identification. One hundred and five cases of invasive H. flu were reported to the OSDH during 2010 resulting in an incidence rate of 2.85 per 100,000 population, a 14.1% increase from 2009. H. flu isolates are serotyped based on the presence of a capsule (serotypes a through f) or absence of a capsule (non-typeable). Both capsulated and nonencapsulated isolates have the ability to cause severe disease. Of the 97 isolates (92% of reported cases) available for serotype identification by the PHL, 53 (54.6%) were non-typeable, 21 (21.6%) were serotype f, 9 (9.3%) were serotype a, 6 (6.2%) were serotype e, 4 (4.1%) were serotype d, and 4 (4.1%) were serotype b. Infection types of the cases included bacteremia/sepsis (97%, n = 102), meningitis (4%, n = 4), and pneumonia (59%, n = 62). Cases of invasive H. flu in 2010 ranged in age from 1 day to 93 years with a median age of 70 years. The highest age-specific incidence rates per 100,000 population occurred among persons 80 years and older (refer to graph). Fourteen (13%) cases occurred among children less than 5 years of age, an age-specific incidence rate of 5.15 per 100,000 population. The highest proportion of cases occurred during the winter months, with over half of reported cases (n = 55, 52%) occurring in January, February, November, and December. When a case of invasive Haemophilus influenzae type b (Hib) is identified, an active contact investigation commences to locate all close contacts less than 4 years of age, review vaccination history, and recommend antibiotic prophylaxis if needed. If any exposed children less than 4 years of age who are either unvaccinated or have not yet received the full primary series of the Hib vaccine are identified, then chemoprophylaxis is recommended to eradicate carriage of the organism. All four Hib cases reported in 2010 were over the age of 70 years. Investigations conducted by county health department public health nurses determined none of the close contacts were less than 4 years of age for three of the cases; therefore, post-exposure chemoprophylaxis was not recommended. Investigation of the fourth case revealed exposed contacts less than 4 years of age that had not yet received the full primary series of the Hib vaccine. During this investigation, OSDH recommended chemoprophylaxis to eradicate carriage of the organism to a total of 10 exposed close, personal contacts. No secondary cases occurred among cases reported during 2010. Demographic Summary of Reported Haemophilus influenzae Invasive Disease Cases, Oklahoma, 2010 (N = 105) Number (%) Incidence Rate per 100,000 Gender Male 49 (47%) 2.69 Female 56 (53%) 3.00 Age Median Age: 70 years (Range: 1 day – 93 years) Hospitalized for H. flu (n = 98) 78 (80%) - Deaths due to H. flu 12 (11%) - Race White 84 (80%) 2.94 Black 4 (4%) 1.35 American Indian or Alaska Native 5 (5%) 1.69 Asian Two or more races Unknown - 2 (2%) 10 (9%) - 1.32 - Hispanic Ethnicity (n = 66) 6 (6%) 1.99 Number hospitalized for H. flu out of those hospitalized 43 Incidence Rate of Reported Invasive Haemophilus influenzae Cases by Age Group, Oklahoma, 2010 0 2 4 6 8 10 12 14 16 Incidence Rate per 100,000 Age Group (years) Haemophilus influenzae Incidence Rate by Year, Oklahoma and U.S., 2006-2010 0 0.5 1 1.5 2 2.5 3 2006 2007 2008 2009 2010 U.S. Oklahoma Incidence Rate per 100,000 US data from Centers for Disease Control and Prevention. [Summary of Year notifiable diseases—United States, 2009]. Published May 13, 2011 for MMWR 2009;58(No. 53):83. Data unavailable for 2010. 44 Hemolytic Uremic Syndrome, Post-diarrheal 2010 Case Total 11 2010 Incidence Rate 0.30 per 100,000 2009 Case Total 17 2009 Incidence Rate 0.47 per 100,000 Hemolytic Uremic Syndrome (HUS) is a condition characterized by an acute onset of microangiopathic hemolytic anemia, renal injury and thrombocytopenia, with the majority of cases preceded by a diarrheal illness. In 2010, the incidence rate (IR) of HUS in Oklahoma represented a 35% decrease from 2009. HUS became a nationally notifiable disease in 2000 and since that time Oklahoma’s incidence rate has been similar to the national incidence. From 2001 to 2010, the median annual number of reported HUS cases in Oklahoma was 5 (range, 2 to 51), and the overall case fatality rate was 3%. In 2010, the highest IR occurred among persons less than 5 years of age (2.21 per 100,000, n = 6), followed by cases 5 to 9 years of age (1.18 per 100,000, n = 3), and 70 to 79 years of age (0.48 per 100,000, n = 1). The incidence of HUS in women (0.38 per 100,000, n = 7) was 1.7 times greater than in men (0.22 per 100,000, n = 4) but was not statistically significant. Cases occurred among residents of nine Oklahoma counties. The diagnosis of HUS is made through evaluation of a combination of laboratory test results. Anemia with microangiopathic changes shown on a peripheral blood smear was documented for eight (73%) of the cases. Of those with microangiopathic changes, schistocytes were most commonly seen (63%) compared to burr cells (38%) and helmet cells (25%), all non-exclusive. Hematuria was reported in 73% of cases; with proteinuria in 64% of cases. Additionally, elevated creatinine was documented for 82% of cases and thrombocytopenia in 91% of cases. An etiologic agent was identified in six (55%) of the 11 cases, which were E. coli O157:H7 (n = 5) and E. coli O121:H19 (n = 1) with results confirmed by the OSDH PHL. Descriptive and Clinical Summary of Reported Hemolytic Uremic Syndrome Cases, Oklahoma, 2010 (N = 11) Number (%) Incidence rate per 100,000 Gender Male Female 4 (36%) 7 (64%) 0.22 0.38 Age Median Age: 4 years (Range: 23 months – 71 years) Race White American Indian or Alaska Native 10 (91%) 1 (9%) 0.35 0.34 Hispanic or Latino Ethnicity 1 (9%) 0.33 Symptoms Diarrhea Abdominal cramps Bloody diarrhea Vomiting Fever 11 (100%) 11 (100%) 9 (82%) 9 (82%) 8 (73%) -- -- -- -- -- Hospitalized for HUS 11 (100%) -- Hospitalization Median Hospitalization: 15 days (Range: 3 days – 31 days) Died due to HUS 0 (0%) -- 45 Hepatitis A 2010 Case Total 6 2010 Incidence Rate 0.16 per 100,000 2009 Case Total 6 2009 Incidence Rate 0.16 per 100,000 Since the hepatitis A epidemic that took place in Oklahoma from 1995 through 1997, with the peak in 1996 of 2,516 cases (incidence rate = 79.99 per 100,000), the incidence of hepatitis A in the state has dramatically declined. The number of cases has been less than 20 per year since 2004. Of the six cases identified in 2010, none were associated with high-risk settings. One secondary case in a household member was identified through public health investigations. One case was hospitalized, and none of the cases expired. A total of 45 close contacts were investigated (median: 5, range: 1 – 18 per case). Of those, 18 did not have evidence of immunity through previous testing or history of vaccination, and therefore required post exposure prophylaxis (PEP). The county health departments provide PEP to those identified as close contacts to confirmed hepatitis A cases. In 2007, PEP guidelines were revised by the Advisory Committee on Immunization Practices (ACIP), limiting the use of immunoglobulin (IG) and expanding the use of the hepatitis A vaccine. For persons from 12 months to 40 years of age, the hepatitis A vaccine is now the preferred method of PEP. IG remains the recommended PEP for persons less than 12 months of age, greater than 40 years of age, and for those who are immunocompromised or who have chronic disease such as liver disease or other chronic medical conditions.i Incidence Rate of Reported Hepatitis A Cases by Year, Oklahoma and US, 1980-2010 0 10 20 30 40 50 60 70 80 90 100 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 Oklahoma United States 2010 Target Statewide Vaccination Program Instituted, 1998 Incidence Rate per 100,000 US rates unavailable for 2010 Year 46 Hepatitis A should be considered in unvaccinated persons with hallmark symptoms of jaundice, very dark urine and/or clay-colored stools (refer to table for symptoms reported by cases), particularly those with recent exposure to high-risk regions through travel or residence. One case (17%) reported international travel during their exposure period. A positive hepatitis A IgM titer indicates current infection, although false positive tests are common.ii Healthcare providers should restrict testing for hepatitis A to those clients with clinical evidence of acute hepatitis A infection. Liver function tests are usually markedly elevated in confirmed cases. Of the five cases with known liver function test results, the median alanine transaminase (ALT) was 589 (range: 135 – 1331), median aspartate aminotransferase (AST) of 435 (range: 202 – 1158), and median total bilirubin was 3.0 (range: 0.3 – 7.4). The hepatitis A vaccine is routinely recommended for individuals 2 years of age or older, and the two-dose regimen is required for entry into childcare or grade school in Oklahoma. The CDC Travelers’ Health website has recommendations regarding hepatitis A prevention for those traveling out of the US, and can be accessed at the website www.cdc.gov/travel. Demographic and Clinical Summary of Reported Hepatitis A Cases, Oklahoma, 2010 (N = 6) Number (%) Incidence Rate per 100,000 Gender Female Male 5 (83%) 1 (17%) 0.29 0.55 Age Median = 34 years (range: 13 - 74 years) Race White Two or more races Unknown 4 (67%) 1 (17%) 1 (17%) 0.14 0.66 Ethnicity Hispanic or Latino Not Hispanic or Latino Unknown 2 (33%) 3 (50%) 1 (17%) 0.66 - - Hospitalized for this disease 1 (17%) - Died due to this disease 0 - Hallmark symptoms (not exclusive) Jaundice Dark Urine Clay-colored stool 4 (67%) 3 (50%) 2 (33%) - - - Recent travel out of country 1 (17%) - Mexico i Centers for Disease Control and Prevention Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56:[1080-1084], available at http://www.cdc.gov/mmwr/PDF/wk/mm5641.pdf ii Centers for Disease Control and Prevention. Positive Test Results for Acute Hepatitis A Virus Infection Among Persons with No Recent History of Acute Hepatitis – United States, 2002-2004. MMWR 2005;54; (453-456), available at http://www.cdc.gov/mmwr/PDF/wk/mm5418.pdf 47 Hepatitis B 2010 Case Total 115 2010 Incidence Rate 3.1 per 100,000 2009 Case Total 122 2009 Incidence Rate 3.3 per 100,000 Numbers of acute hepatitis B cases in Oklahoma reported to the Oklahoma State Department of Health (OSDH) have declined for a third year in a row. This is a 6% decrease in reported cases from 2009 to 2010. The OSDH supports adult vaccination for hepatitis B, and hepatitis A. Through the Adult Viral Hepatitis Program, the OSDH provides these vaccines at no cost to high risk individuals in the Oklahoma Department of Corrections, county health department sexually transmitted disease (STD) clinics, and two metro area medical clinics for the homeless - one in Oklahoma City and one in Tulsa. Adult immunizations coupled with prevention education are key components to decreasing hepatitis B infections. Sixty-five of the 115 acute hepatitis B cases (57%) were males; fifty (43%) were female. Racial breakdown is as follows: 81 Whites (3.1 per 100,000), 19 American Indians and Alaska Natives (6.7 per 100,000), nine Black or African Americans (3.1 per 100,000), one Hawaiian/Other Pacific Islander (31.8 per 100,000) and five cases were reported as unknown race. The CDC reports, in the Sexually Transmitted Diseases Treatment Guidelines 2010, the primary risk factors associated with hepatitis B infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, men who have sex with other men (MSM), a history of other STDs, and illegal injection-drug usei. Forty-nine (43%) of the total number of acute cases reported a risk factor of 2 or more sexual partners. Twenty-six of these 49 respondents reported having more than five sexual partners. Perinatal Hepatitis B 2010 Case Total 83 2009 Case Total 95 The Perinatal Hepatitis B Program identified 83 babies born to hepatitis B surface antigen (HbsAg) positive women in Oklahoma in 2010. This number is a slight decrease (13%) from 2009. The CDC recommends that infants born to HbsAg positive women be given hepatitis B immune globulin (HBIG) and hepatitis B vaccine within 12 hours of birth. Seventy (85.4%) of the babies born in Oklahoma hospitals received both injections within 12 hours, seventy-five (91.5%) received both injections within 24 hours and seventy-seven (93.9%) received both injections within 48 hours of birth. Fifty-two (63.4%) of the infants had received HBIG and all three hepatitis B vaccines by 12 months of age. The ages of the women who were hepatitis B surface antigen positive and who delivered infants ranged from 17 years to 41years. Forty-seven (57%) of delivering women were between 20 and 30 years of age. Thirty-two (39%) were between 30 and 40 years of age, and four (5%) percent were under 20 years of age. i Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-#12), available on the internet at http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010- RR5912.pdf 48 Hepatitis C 2010 Case Total 41 2010 Incidence Rate 1.1 per 100,000 2009 Case Total 27 2009 Incidence Rate 0.7 per 100,000 Hepatitis C can be either acute or chronic but the Oklahoma reportable disease rules specify reporting of hepatitis C in persons aged 40 years or younger, or in persons having jaundice, or alanine transaminase (ALT) of 400 or higher, regardless of age, with laboratory confirmation, which represents only acute cases of hepatitis C infectioni. The acute form is a short-term illness that occurs within the first six months after a person is exposed to the hepatitis C virus (HCV) which causes hepatitis C infection. However, the disease can become chronic, and people who received a blood transfusion before 1992 or are past or current injection-drug users are at risk for chronic hepatitis C, and should be screened for the disease. Chronic HCV infection progresses slowly over the course of 15-30 years and can lead to cirrhosis of the liver or liver cancer. Eight to ten thousand deaths occur annually in the United States as a result of chronic HCV infection. In 2010, confirmed cases of acute hepatitis C in Oklahoma reflected a 52% increase from 2009. Based on the most current national data, Oklahoma’s case rate (1.1 per 100,000) continues to be above the national rate (0.3 per 100,000) for confirmed cases of acute hepatitis C. Tulsa County had the highest number of cases of acute hepatitis C in 2010 with nine cases (22%). The highest incidence rate occurred in Pawnee county with 12.18 cases per 100,000 (n = 2), followed by Haskell county with 8.07 per 100,000 (n = 1) and Okmulgee county with 7.64 per 100,000 (n = 3). Cases of acute hepatitis C ranged in age from 18 years to 74 years. The highest number of cases, 20 (49%), occurred in the 25 - 34 year age group. Age groups of the remaining cases were as follows: four (9%) 15 to 24 years, ten (24%) 35 to 44 years, five (12%) 45 to 54 years, one (2%) 55 to 64 years, and one (2%) 65 to 74 years. There were 22 females (54%) and 19 males (46%) infected with confirmed acute hepatitis C. The confirmed acute hepatitis C cases broken down by race occurred in: Whites (0.9 per 100,000, n = 27), Native Americans (3.7 per 100,000, n = 11), Black/African American (0.3 pr 100,000, n = 1) and unknown race (n = 2). The Centers for Disease Control and Prevention states that “of the cases reported in 2007 for which information con-cerning exposures during the incubation period was available, the most common risk factor identified was IDU [injection drug use] (48%). During 1998–2007, IDU was reported for an average of 44% of persons (range: 38%– 54%)”.ii In 2010, the risk factors most frequently reported in Oklahoma were: IDU (56%), other drug use besides IDU (54%), tattoos (56%), and 2 or more sexual partners (56%). Nineteen (46%) of the cases reported both IDU and other drug use. Ten (24%) of the cases reported all four of the listed risk factors. i Title 310. Oklahoma State Department of Health, Chapter 515. Communicable Disease and Injury Reporting, Effective 7/25/2010. Available at the website www.ok.gov/health/Disease,_Prevention,_Preparedness/Acute_Disease_Service/Disease_Reporting/index.html. ii Centers for Disease Control and Prevention. Surveillance for Acute Viral Hepatitis—United States, 2007. Surveillance Summaries, May 29, 2009,MMWR 2009;58(No. SS-3, available at the website http://www.cdc.gov/mmwr/pdf/ss/ss5803.pdf 49 HIV/AIDS 2010 Case Total 300 2010 Rate 8.0 per 100,000 2009 Case Total 369 2009 Rate 10.0 per 100,000 HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). AIDS is the result of an HIV infection and is the most advanced stage of HIV, resulting in severe damage to the immune system. HIV progressively reduces the immune system by destroying specific blood cells, called CD4 positive T-lymphocytes (CD4+ T-cells) and leaves individuals susceptible to opportunistic infections. HIV is transmitted through direct contact of a mucous membrane with a bodily fluid containing HIV, such as blood, semen (including pre-seminal fluid), vaginal fluid, and breast milk. The most common activities which place a person at risk are sexual intercourse (oral, anal, or vaginal), sharing of needles or syringes, or exposure from mother to baby before or during birth or through breast feeding. AIDS is defined as having HIV with fewer than 200 CD4+ T-cells per cubic milliliter of blood (or less than 14%), and/or any at least one clinical opportunistic infection. People living with HIV may appear and feel healthy for years; however, HIV is still affecting their bodies. Although treatments for AIDS and HIV can slow the course of the disease, there is no known cure or vaccine. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection. Currently, people can live much longer, even decades, with HIV before they develop AIDS. AIDS was first recognized by the United States Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s. AIDS became reportable in Oklahoma in 1983 and HIV infection in 1988. In Oklahoma, two cases of AIDS were first diagnosed in 1982 and two cases of HIV in 1984. By the end of 2010, an estimated 8,462 cases of HIV/AIDS had been diagnosed among residents of Oklahoma. A breakdown of the 8,462 HIV/AIDS cases shows 5,449 AIDS cases and 3,013 HIV cases. Of those diagnoses, 49 were perinatal infections (mother to baby transmission). The race breakdown for the above cases is as follows: 5,441 (64.4%) in Whites, 1,794 (21.2%) in Blacks, 504 (6.0%) in Hispanics, 46 (0.5%) in Asian/Hawaiian Pacific Islanders and 536 (6.3%) in American Indian/Alaskan Natives. Persons who reported belonging to two or more races had 141 (1.7%) cases diagnosed. The ratio of male to female diagnoses was 17:3 (n = 7,216, 85.3% to 1,246, 14.7%). Men having sex with men (MSM) accounted for 4,507 (53.3%) cases, and those MSM who also reported using illegal drugs (MSM/IDU) accounted for 894 (10.6%) cases. Approximately 11% (n = 962 cases) reported their risk as injection drug use (IDU). Similarly, 11.2% (n = 951) of persons reported exposure through heterosexual sex with someone with HIV. Among the age groups, 30 to 39 years of age (n = 3,213, 38.0%) accounted for the largest group of cases, followed by 20 to 29 years of age (n = 2,652, 31.3%). Teenagers (13 to 19 years of age) accounted for almost 3% (n = 224; 2.7%) of the cumulative HIV/AIDS cases, while children under 13 years of age reported less than 1% (n = 70, 0.8%) of the infections. At the end of 2010, an estimated 4,908 cases were living with HIV/AIDS (HIV: n = 2,552, 52.0%; AIDS: n = 2,356, 48.0%). 2010 Summary In 2010, 300 cases (HIV, 208; AIDS, 92) of HIV/AIDS cases were diagnosed. This resulted in a 16% decrease in the number of cases diagnosed in 2010 compared to 2009. From 2006 to 2010, 1,699 cases of HIV/AIDS have been diagnosed at an average of 340 cases per year, an average of 9.2 cases per 100,000 population. There has been a downward trend of AIDS only from 188 cases in 2006 to 92 cases in 2010; however, the opposite is true for newly diagnosed HIV (not AIDS) cases. In 2006, there were a total of 157 and in 2010 the total was 208. Of the 26 deaths in 2010, seven were diagnosed and died in the same year, and 19 of the deaths were diagnoses from previous years. Three counties in Oklahoma, Oklahoma (n = 85, 27.7%), Tulsa (n = 69, 23.0%), and Cleveland (n = 34, 11.3%), account for the majority (62.0%) of the newly diagnosed HIV/AIDS cases. 50 0 50 100 150 200 250 300 350 400 450 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number of cases Year of Diagnosis HIV/AIDS Cases Diagnosed in Oklahoma by Year, 2001 ‐ 2010 HIV cases AIDS cases Deaths HIV/AIDS *Deaths are irrespective of date of diagnosis Among age groups, 20 to 29 year olds accounted for 35.0% (n = 105), 30 to 39 year olds accounted for 25.7% (n = 77), 40 to 49 year olds accounted for 22.0% (n = 66), and 50 to 59 year olds accounted for 10.0% (n = 30). Teenagers (13 to 19 years of age) accounted for 3.0% (n = 9). Of the 300 cases diagnosed in 2010, males represented 249 cases with a rate of 13.7 per 100,000 population, while females reported 51 cases with a rate of 2.7 per 100,000 population. Among race and ethnic groups, Blacks or African Americans (n = 105, 35%) had a rate of 34.4 cases per 100,000 population, Whites (n = 138, 46%) had a rate of 5.1 cases per 100,000 population, Hispanics (n = 24, 8%) had a rate of 8.0 cases per 100,000 population and American Indians /Alaskan Natives (n = 21, 7%) had at a rate of 6.6 cases per 100,000 per population. Of the 300 newly diagnosed HIV/AIDS cases, MSM accounted for 52.0% (n = 156), MSM/IDU accounted for 8.3% (n = 25), heterosexual sex accounted for 10.7% (n = 32), and IDU only accounted for almost 5% (n = 14, 4.7%). Approximately 3% (n = 38, 2.7%) of those diagnosed in 2010, did not report their risk. 51 Legionellosis 2010 Case Total 15 2010 Incidence Rate 0.41 per 100,000 2009 Case Total 10 2009 Incidence Rate 0.27 per 100,000 The number of legionellosis cases reported in 2010 is a 50% increase from the 10 cases reported in 2009. Since 2000, the annual incidence rate of legionellosis has ranged from 0.14 to 0.41 per 100,000 population with the exception of 2004 when the incidence rate was 0.70 per 100,000 population due to an outbreak. In 2010, lab tests were performed via bronchial culture (7%), sputum culture (7%), and urine antigen testing (87%). No outbreaks of legionellosis were identified in Oklahoma during 2010. During 2010, cases of legionellosis occurred among residents of ten Oklahoma counties and were spread geographically across all regions of the state except the northwest region. The highest incidence rate occurred among cases 45 to 49 years of age (IR = 1.93, n = 5) followed by cases 70 to 74 years of age (IR = 1.74, n = 2) and 65 to 69 years of age (IR = 1.34, n = 2). Of the cases reported in 2010, 1 (7%) reported travel outside of the state during the incubation period of their illness, and 2 (13%) reported exposure to a respiratory device filled with tap water such as a nebulizer or humidifier. Prevention of legionellosis is based upon proper maintenance of heating, cooling and plumbing systems. Special attention should also be given to hot tubs and whirlpool baths to keep them free of Legionella bacteria. Visit http://ads.health.ok.gov and click on the “Disease Information” tab to obtain more information on Legionellosis. Demographic and Clinical Summary of Reported Legionellosis Cases, Oklahoma, 2010 (N = 15) Number (%) Incidence Rate per 100,000 Gender Male Female 13 (87%) 2 (13%) 0.71 0.11 Age Median = 48 years (range: 26 – 79 years) Race Black or African American White Unknown 1 (7%) 12 (80%) 2 (13%) 0.35 0.46 - Ethnicity Hispanic or Latino Not Hispanic or Latino Unknown 0 (0%) 8 (53%) 7 (47%) 0.00 0.24 - Symptoms Cough Fever Headache Malaise Myalgia Chills Chest pain 13 (87%) 12 (80%) 2 (13%) 13 (87%) 6 (40%) 9 (60%) 5 (33%) - - - - - - - Hospitalization Possible nosocomial infection 15 (100%) 2 (13%) - - Complication/Comorbidity Death Pneumonia Corticosteroid treatment 1 (7%) 15 (100%) 2 (13%) - - - 52 Listeriosis 2010 Case Total 9 2010 Incidence Rate 0.26 per 100,000 2009 Case Total 8 2009 Incidence Rate 0.22 per 100,000 Listeriosis is an uncommon but serious infection caused by the bacteria Listeria monocytogenes. Although most listeriosis infections involve mild illnesses not requiring medical care, Listeria is responsible for approximately 1,591 of the estimated 9.4 million foodborne illnesses and an estimated 257 deaths per year in the U.S.i Pregnant women are about 20 times more likely than healthy adults to acquire the disease. In pregnancy, the infection can be passed to the fetus and in some cases cause premature delivery, infection of the newborn, or stillbirth. Newborns, rather than the mothers, experience the serious effects of infection during pregnancy; the case-fatality rate is 20 to 30% in infants born alive and the occurrence of abortion and stillbirth increases the overall mortality rate to more than 50%.ii Other specific groups at increased risk include persons with weakened immune systems such as those with cancer, diabetes, kidney disease, AIDS, those who take glucocorticosteroid medications, and individuals older than 60 years. In Oklahoma, 9 cases of listeriosis were reported to OSDH resulting in an incidence rate that was higher than the previous five year average (2005 through 2009) incidence rate of 0.15 per 100,000 population. Listeria was isolated from blood for seven cases (78%), from cerebrospinal fluid for one case (11%), and from placenta for one case (11%). All nine cases were hospitalized and two (22%) cases died due to Listeria sepsis. The case ages ranged from 1 day to 77 years and all nine cases were female. Seven (78%) of the cases were White, one was Asian (11%), and one (11%) race was unknown. Two (25%) of the eight cases were Hispanic. Five cases (56%) reported consuming soft cheeses and four cases (44%) reported consuming ready-to-eat deli meats. Six (67%) cases were over the age of 60 and two of the six had a history of underlying medical conditions that compromised their immune system. Two (22%) cases were pregnant at the time of illness. Most cases of listeriosis are sporadic; however, outbreaks due to consumption of contaminated food have been identified. Prompt reporting of cases can help in the early detection of an outbreak, identification of the sources of infection, and prevention of additional cases. The Communicable Disease Reporting Rules (OAC 310: Chapter 515) require that Listeria isolates grown from sterile sites (e.g. blood, cerebrospinal fl
Date created	2011-08-22
Date modified	2011-10-27

Annual summary of infectious diseases

Annual Summary of Infectious Diseases 2010

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Annual summary of infectious diseases

Annual summary of infectious diseases