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Clark County Combined Health District 2019 Annual Communicable Disease Report 1/8/2020

For questions, contact [email protected]

Clark County Combined Health District

2019 Annual Communicable Disease Report Communicable Disease Summary 2019 In 2019, Clark County experienced a 2.3% decrease in the number of communicable disease cases from 2018 to

2019 (2136 cases and 2086 cases, respectively) (Figure 1). The most frequently reported illnesses were

chlamydia infection (866 cases), gonococcal infection (387 cases), and influenza-associated hospitalizations (240

cases) (Table 1).

Reportable Conditions not Reported in Clark County in 2019: Anthrax Arboviral neuroinvasive and non-

neuroinvasive disease Babesiosis Botulism, infant Botulism, wound Brucellosis Chancroid Chikungunya Cholera Dengue Diptheria Eastern equine encephalitis virus

disease Ehrlichiosis/Anaplasmosis Hantavirus Hemolytic uremic syndrome (HUS) Hepatitis B (Perinatal) Hepatitis D Hepatitis E Influenza A – novel virus

Influenza-associated pediatric mortality

LaCrosse virus disease (other California serogroup virus disease) Leprosy (Hansen disease) Leptospirosis Listeriosis Malaria Measles Meningococcal disease MERS Other arthropod-borne diseases Plague Poliomyelitis (including vaccine-

associated cases) Powassan virus disease Psittacosis Rabies, human Rubella (congenital) Rubella (not congenital) Severe acute respiratory syndrome

(SARS) Smallpox

Spotted Fever Rickettsiosis, including Rocky Mountain spotted fever (RMSF)

St. Louis encephalitis virus disease Staphylococcus aureus, with

resistance or intermediate resistance to vancomycin (VRSA, VISA)

Streptococcal toxic shock syndrome (STSS)

Syphilis – Congenital Tetanus Toxic shock syndrome Trichinellosis Tularemia Typhoid fever Viral hemorrhagic fever (VHF) Western equine encephalitis virus

disease West Nile Virus Yellow fever Zika virus infection

Figure 1: Annual Communicable Disease Totals, Clark County, 2015-2019. Case counts include confirmed, probable, and suspect disease case classifications. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020.

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Table 1: Reportable Conditions Reported in Clark County, 2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020.

Confirmed Total Confirmed Total Confirmed Total Confirmed Total Confirmed Total

Enteric Diseases

Amebiasis 0 1 0 0 0 0 0 0 0 1

Botulism, foodborne (call health department immediately) 0 0 0 0 0 0 0 1 0 1

Campylobacteriosis 0 6 4 9 5 12 1 6 10 33

Cryptosporidiosis 0 0 1 1 3 3 0 0 4 4

Cyclosporiasis 0 0 0 0 1 1 0 0 1 1

E. coli, Shiga Toxin-Producing (O157:H7, Not O157, Unknown Serotype) 0 2 0 1 2 5 0 0 2 8

Giardiasis 2 2 2 3 2 2 0 1 6 8

Hepatitis A† 42 48 13 16 5 9 0 4 60 77

Salmonellosis 2 2 4 4 2 2 6 7 14 15

Shigellosis 0 2 0 0 0 0 0 0 0 2

Vibriosis (not cholera) 1 1 0 0 1 1 0 1 2 3

Yersiniosis 0 0 0 0 1 1 0 1 1 2

Hepatitis B & C

Hepatitis B (including delta) - acute 0 0 0 0 1 2 1 3 2 5

Hepatitis B (including delta) - chronic 4 15 2 11 0 18 1 11 7 55

Hepatitis C - acute 0 4 3 3 0 0 0 0 3 7

Hepatitis C - chronic 16 36 25 53 19 47 18 44 78 180

Hepatitis C - Perinatal Infection 0 0 1 1 0 0 0 0 1 1

Sexually Transmitted Infections

Chlamydia infection 198 198 214 214 244 244 210 210 866 866

Gonococcal infection 90 90 74 74 111 111 112 112 387 387

HIV‡ 1 1 2 2 1 3 4 5 8 11

Syphilis - early 0 2 0 0 0 4 0 4 0 10

Syphilis - primary 0 0 0 0 0 2 0 1 0 3

Syphilis - secondary 0 1 0 1 0 3 0 5 0 10

Syphilis - stage Unknown 0 4 0 3 0 7 0 11 0 25

Syphilis - unknown duration or late 0 6 0 5 0 3 0 1 0 15

Vaccine-Preventable Diseases

Haemophilus influenza (invasive disease) 0 0 0 0 0 0 1 2 1 2

Influenza - ODH Lab Results 0 0 0 0 2 2 0 0 2 2

Influenza-associated hospitalization 147 157 25 26 2 2 54 55 228 240

Meningitis - aseptic/viral 0 0 0 0 3 3 1 2 4 5

Meningitis - bacterial (Not N. meningitidis) 1 3 0 0 0 0 0 1 1 4

Quarter 4 Grand Total

2019

Reportable Condition Quarter 1 Quarter 2 Quarter 3

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Confirmed Total Confirmed Total Confirmed Total Confirmed Total Confirmed Total

Mumps 0 0 0 1 0 2 0 0 0 3

Pertussis 1 3 2 5 0 1 2 8 5 17

Streptococcal - Group A - invasive 0 0 2 2 2 2 5 5 9 9

Streptococcal - Group B - in newborn 0 0 1 1 2 2 0 0 3 3

Streptococcus pneumoniae - invasive antibiotic resistance unknown or non-resistant 7 7 6 6 2 2 4 5 19 20

Streptococcus pneumoniae - invasive antibiotic resistant/intermediate 0 0 2 2 0 0 5 5 7 7

Varicella 0 1 0 0 0 0 1 1 1 2

Vectorborne and Zoonotic Diseases

Lyme Disease 0 1 0 2 0 2 0 3 0 8

Q fever, acute 0 1 0 0 0 0 0 0 0 1

Other Reportable Infectious Diseases

Coccidioidomycosis 0 1 0 0 0 1 1 1 1 3

CP-CRE 2 2 1 1 2 3 0 0 5 6

Creutzfeldt-Jakob Disease 0 0 0 0 1 1 0 0 1 1

Immigrant Investigation 0 0 0 1 0 0 0 0 0 1

Legionellosis - Legionnaires' Disease 1 1 5 5 8 8 6 6 20 20

Staphylococcal aureus - intermediate resistance to vancomycin (VISA) 0 0 1 1 0 0 0 0 1 1

Tuberculosis 0 0 0 0 0 0 0 1 0 1

Total 2534 598 390 454 422 511 433 523 3779 2086

*Total numbers include all Confirmed, Probable, and Suspect cases.

†Hepatitis A case counts reflect total number of cases investigated in 2019.

‡HIV data were collected from ODRS and not from ODH HIV Surveillance.

Reportable Condition

2019

Quarter 1 Quarter 2 Quarter 3 Quarter 4 Grand Total

For questions, contact [email protected] 3



Disease Trends

Chlamydia Infection Chlamydia infection has been the most frequently reported condition in Clark County since 2011, and has

decreased by 1.0% over the last year (Figure 2). In the state of Ohio, Chlamydia cases have been steadily

increasing.

Gonococcal Infection The number of cases of gonococcal infection in Clark County has been increasing over time (0.5% increase in

2019) (Figure 2). This disease trend has been seen in the state of Ohio as well.

Influenza-associated Hospitalizations In 2018, the total number of confirmed influenza-associated hospitalizations decreased by 22.1% from 2018

(Figure 3).

Figure 2: Chlamydia Infection and Gonococcal Infection cases in Clark County, 2015-2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020.

Figure 3: Influenza-associated Hospitalizations, Clark County, 2015-2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020. Influenza data represents calendar year and not influenza season.

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Hepatitis C – Chronic Infection The total number of Hepatitis C – Chronic cases in Clark County has been slowly decreasing over time (Figure 4).

Hepatitis A There was a dramatic increase (250%) in the number of hepatitis A cases reported to the Clark County Combined

Health District (CCCHD) from 2018-2019 (Figure 6). In 2019, there were 77 total cases of hepatitis A reported in

Clark County (66 confirmed, 11 suspect) (Table 2). Prior to 2018, the most recent confirmed case of hepatitis A

occurred in 2011 (Table 2).

Table 2: Hepatitis A in Clark County, Ohio, 2009-2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020.

Case Classification Status Year

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Confirmed 2 0 1 0 0 0 0 0 0 18 66

Suspected 1 1 5 0 5 4 1 2 7 4 11

Figure 4: Hepatitis C - Chronic cases by case classification status, Clark County, 2015-2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020.

Figure 5: Hepatitis A, Clark County, 2015-2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/7/2020.

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In mid-2018, the Ohio Department of Health (ODH) declared a statewide community outbreak of hepatitis A

after observing an increase in cases linked to certain risk factors since the beginning of 2018. All 77 cases in

Clark County were associated with the statewide community outbreak.

2019 Clark County Outbreaks Clark County Combined Health District investigated 15 outbreaks in 2019 (Table 3). Four investigations involved

a long-term care facility and eight involved a school or day care facility.

Table 3: Outbreak Investigations in Clark County, 2019.

Outbreak Agent Outbreak Type Date

Investigation Reported

Date Investigation Completed

1 Norovirus Institutional 1/25/2019 4/2/2019

2 Norovirus Foodborne 2/4/2019 4/4/2019

3 Influenza virus Healthcare-Associated 2/7/2019 6/7/2019



6 Influenza virus Institutional 2/21/2019 5/31/2019

7 Norovirus Foodborne 5/15/2019 5/31/2019

8 Unknown Respiratory Institutional 6/10/2019 7/24/2019

9 Unknown Gastrointestinal Foodborne 9/3/2019 12/6/2019

10 Streptococcus Institutional 9/10/2019 Report outstanding

11 Respiratory pathogen, unknown Institutional 9/19/2019 12/31/2019

12 Unknown Gastrointestinal Community 9/25/2019 12/31/2019

13 Impetigo Community 10/16/2019 Report outstanding (90-day window not closed)

14 Bordetella pertussis Institutional 11/18/2019 Report outstanding (90-day window not closed)

15 Impetigo Institutional 11/26/2019 Report outstanding (90-day window not closed)

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Timeliness of Disease Reporting Timely reporting of infectious diseases is important in identifying potential outbreaks and reducing disease burden. Public health relies on health care

providers and laboratories for identification and prompt reporting of these communicable diseases. The Ohio Administrative Code identifies two quality

indicators related to completeness and timeliness for nine reportable diseases (OAC 3701-36-05(B) (2)):

• Meeting the median number of days between date of diagnosis and report to the health department in ODRS.

• Increasing the percent completeness for reportable infectious diseases in ODRS by age, race, ethnicity, and sex.

The following reportable diseases were identified by the advisory committee as having the most value and opportunity to impact public health related to

improved timeliness and completeness of reporting: Camplyobacteriosis, Cryptosporidiosis, E. Coli O157:H7 and Shiga toxin-producing E. Coli (STEC),

Giardiasis, Influenza-associated hospitalization, Legionnaires’ disease, Pertussis, Salmonella, and Shigellosis.

The reporting lag is the difference in days between the date of diagnosis and the date the case was reported to Clark County Combined Health District

(CCCHD). Weekends were removed in the median lag calculation and only confirmed and probable cases were included in the analysis.

All diseases included are Class B reportable diseases with an expectation that they be reported to ODH by the next business day. Given this established

standard, an appropriate proxy that should also be monitored to see continuous improvement is the percentage of reports (locally and aggregated at the

state level) that meet or exceed the established standard (Ohio Department of Health, 2018).

Table 4: Percent Completeness of Report and Median Days Reporting Lag for Selected Diseases* in Clark County, 2019. All data queried from Ohio Disease Reporting System (ODRS) data extract on 1/8/2020.

Reportable Condition

Age Sex Race Ethnicity Reported Within 1

Business Day

Reporting Lag** Total Number of Cases

Reported Percent

Completed Percent

Completed Percent

Completed Percent

Completed Percent

Reported Median

Days

Campylobacteriosis 100% 100% 94% 79% 69.7% 1 33

Cryptosporidiosis 100% 100% 75% 75% 25.0% 3 4

E. coli O157:H7 and Shiga toxin-producing E. coli (STEC)

100% 100% 100% 100% 62.5% 0.5 8

Giardiasis 100% 100% 100% 50% 83.3% 1 6

Influenza-associated hospitalization 100% 100% 97% 66% 41.2% 2 228

Legionellosis - Legionnaires' Disease 100% 100% 100% 60% 90% 0 20

Pertussis 100% 100% 100% 100% 89% 1 9

Salmonellosis 100% 100% 93% 93% 46.7% 2 15

Shigellosis 100% 100% 100% 100% 0% 23 2 * Diseases included confirmed and probable cases of: Campylobacteriosis, Cryptosporidiosis, E. coli O157:H7 and Shiga toxin-producing E. coli (STEC), Giardiasis, Influenza-associated hospitalization, Legionnaires; disease, Pertussis, Salmonellosis and Shigellosis. ** Reporting Lag is the difference in business days between the date of diagnosis and the date of report. If blank, date of diagnosis defaulted to lab specimen collection date, then date of illness onset. NOTE: One case with concurrent infections of E. coli, Campylobacteriosis, and Shigellosis was identified out of state, resulting in a delay in reporting to the LHD (37-day reporting lag).

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Notes

Reportable Disease Changes in Ohio in 2019 The following changes took effect on August 1, 2019:

Additions: Candida auris (Class B), Salmonella Paratyphi infection (Class B), Yellow fever (moved from Class A to

Class B)

References Ohio Department of Health. (2018). Public Health Quality Indicators: Annual Report, July 2018.

https://odh.ohio.gov/wps/wcm/connect/gov/d19078a3-4144-4bb4-94f5-32d92d700f7d/Quality-Indicators-

Report-2018.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9

DDDDM3000-d19078a3-4144-4bb4-94f5-32d92d700f7d-mqNAxBh

Record of Change Date Revision(s) By Whom

1/8/2020 Report created Anna Jean Sauter

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https://odh.ohio.gov/wps/wcm/connect/gov/d19078a3-4144-4bb4-94f5-32d92d700f7d/Quality-Indicators-Report-2018.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9%20DDDDM3000-d19078a3-4144-4bb4-94f5-32d92d700f7d-mqNAxBh



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