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Section III:
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Communicable Diseases
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    Priority: COMMUNICABLE DISEASES and IMMUNIZATIONS

    TABLE OF CONTENTS

    1. Health Data
    2. Unmet Needs
    3. Resources in Chautauqua County
    4. Opportunities for Action
    Citing the Healthy People 2010 Initiative,

    Infectious diseases remain major causes of illness, disability, and death.  Moreover, new infectious agents and diseases are being detected, and some diseases considered under control have reemerged in recent years. In addition, antimicrobial resistance is evolving rapidly in a variety of hospital- and community-acquired infections. These trends suggest that many challenges still exist in the prevention and control of infectious diseases. Likewise, foodborne illnesses impose a burden on public health and contribute significantly to the cost of health care.  In addition to acute illness, some microorganisms can cause delayed or chronic illness. Foodborne chemical contaminants also may cause chronic rather than acute problems, and specific estimates of their impact on health and the economy are not available. The success of improvements in food production, processing, preparation, and storage practices can be measured through the reduction in outbreaks of disease caused by foodborne pathogens.

    Issues and Trends

    According to Healthy People 2010,

    Between 1980 and 1992, the number of deaths from infectious diseases rose 58 percent in the United States. Even when human immunodeficiency virus (HIV)-associated diagnoses are removed, deaths from infectious diseases still increased 22 percent during this period. Considered as a group, three infectious diseases-pneumonia, influenza, and HIV infection-constituted the fifth leading cause of death in the United States in 1997. Moreover, the direct and indirect costs of infectious diseases are significant. Every hospital-acquired infection adds an average of $2,100 to a hospital bill. Infectious diseases also must be considered in a global context. Increases in international travel, importation of foods, inappropriate use of antibiotics on humans and animals, and environmental changes multiply the potential for worldwide epidemics of all types of infectious diseases. Also, underlying forces may make foodborne illnesses more of a problem in the years to come. These include emerging pathogens; improper food preparation, storage, and distribution practices; insufficient training of retail employees; an increasingly global food supply; and an increase in the number of people at risk because of aging and compromised capacity to fight foodborne diseases.

    Healthy People 2010 and Communicable Diseases and Immunizations

    The following chart presents the Healthy People 2010 targets for the objectives pertinent to food safety and to reduction in communicable diseases, along with baseline data for the year(s) indicated. This chapter examines Chautauqua County data for the indicators listed in bold type and selected other indicators.

    Healthy People 2010 Baselines and Targets for Communicable Diseases and Immunizations

    Objective

    FOOD SAFETY

     

    10.1

    Reduce infection caused by foodborne pathogens.

    (cases per 100,000)

    1997 Baseline*

    2010 Target

    10.1a

    Campylobacter species

    24.6

    12.3

    10.1b

    Escherichia coli O157-H7

    2.1

     

    1.0

    10.1c

    Listeria monocytogenus

    0.5

    0.25

    10.1d

    Salmonella species

    13.7

    6.8

    10.1e

    Cyclospora cayetanensis

    Developmental

    Developmental

    10.1f

    Postdiarrheal hemolytic uremic syndrome

    Developmental

    Developmental

    10.1g

    Congenital Toxoplasma gondii

    Developmental

    Developmental

    10.2

    Reduce outbreaks of infection caused by foodborne bacteria.

     (number of outbreaks per year)

     

     

    10.2a

    Escherichia coli O157-H7

    22

    11

    10.2b

    Salmonella serotype Enteritidis

    44

    22

    10.3

    Prevent an increase in the proportion of isolates of Salmonella species from humans and animals at slighter that are resistant to antimicrobial drugs. 

     

     

    Salmonella from humans that are resistant to: (percent of isolates)

    10.3a

    Fluoroquinolones

    0%

    0%

    10.3b

    Third-generation cephalosporins

    0%

    0%

    10.3c

    Gentamicin

    3%

    3%

    10.3d

    Ampicillin

    18%

    18%

    Salmonella from cattle at slaughter that are resistant to:

    10.3e

    Fluoroquinolones

    Developmental

    Developmental

    10.3f

    Third-generation cephalosporins

    Developmental

    Developmental

    10.3g

    Gentamicin

    Developmental

    Developmental

    10.3h

    Ampicillin

    Developmental

    Developmental

    Salmonella from broilers at slaughter that are resistant to:

    10.3i

    Fluoroquinolones

    Developmental

    Developmental

    10.3j

    Third-generation cephalosporins

    Developmental

    Developmental

    10.3k

    Gentamicin

    Developmental

    Developmental

    10.3l

    Ampicillin

    Developmental

    Developmental

    Salmonella from swine at slaughter that are resistant to:

    10.3m

    Fluoroquinolones

    Developmental

    Developmental

    10.3n

    Third-generation cephalosporins

    Developmental

    Developmental

    10.3o

    Gentamicin

    Developmental

    Developmental

    10.3p

    Ampicillin

    Developmental

    Developmental

    10.4

    (developmental) Reduce deaths from anaphylaxis caused by food allergies.

     

    10.5

    Increase the proportion of consumers who fallow key safety practices.

    72%

    (1998)

    79%

    10.6

    (developmental) improve food employee behaviors and food preparation practices that directly relate to foodborne illness in retail food establishments.

     

    10.7

    (developmental) Reduce human exposure to organophosphate pesticides from food.

     

    Objective

    IMMUNIZATION AND INFECTIOUS DISEASE

    1998 Baseline*

    2010 Target

    14.1

    Reduce of eliminate indigenous cases of vaccine-preventable diseases.  (number of cases)

     

    14.1a

    Congenital rubella syndrome (children under age 1 year)

    7

    0

    14.1b

    Diphtheria (persons under age 35 years)

    1

    0

    14.1c

    Haemophilus influenzae type b (children under age 5 years)

    163

    0

    14.1d

    Hepatitis B (persons aged 2 to 18 years)

    945

    9

    14.1e

    Measles (persons of all ages)

    74

    0

    14.1f

    Mumps (persons of all ages)

    666

    0

    14.1g

    Pertussis (children under age 7 years)

    3,471

    2,000

    14.1h

    Polio (wild-type virus) (persons of all ages)

    0

    0

    14.1i

    Rubella (persons of all ages)

    364

    0

    14.1j

    Tetanus (persons under age of 35 years)

    14

    0

    14.1k

    Varicella (chicken pox) (persons under age 18 years)

    4 million (based on average from 1990-1994, persons of all ages)

    400,00

    14.2

    Reduce chronic hepatitis B in infants and young children (prenatal infections).

    1,682

    (1995)

    400

    14.3

    Reduce hepatitis B

    1997 Baseline*

    2010 Target

    14.3a

    19 to 24 years (rate per 100,000 population)

    24.0

    2.4

    14.3b

    25 to 39 years (rate per 100,000 population)

    20.2

    5.1

    14.3c

    40 years and older (rate per 100,000 population)

    15.0

    3.8

    14.3d

    Injection drug users (number of cases)

    7,323

    1,808

    14.3e

    Heterosexually active persons (number of cases)

    15,225

    1,240

    14.3f

    Men who have sex with men (number of cases)

    7,323

    1,808

    14.3g

    Occupationally exposed workers (number of cases)

    249

    62

    14.4

    Reduce bacterial meningitis in young children. (per 100,000 children)

    13.0 new cases (1998)

    8.6 new cases

    14.5

    Reduce invasive pneumococcal infections (rate per 100,000)

    1997 Baseline*

    2010 Target

    New invasive pneumococcal infections

    14.5a

    Children under age 5 years

    76

    46

    14.5b

    Adults aged 65-years and older

    62

    42

    Invasive penicillin-resistant pneumococcal infections

    14.5c

    Children under age 5

    16

    6

    14.5d

    Adults aged 65-years and older

    9

    7

    14.6

    Reduce hepatitis A. (per 100,000 population)

    11.3 new cases

    4.5 new cases

    14.7

    Reduce meningococcal disease. (per 100,000 population)

    1.3 new cases

    1.0 new cases

    14.8

    Reduce Lyme disease (per 100,000 population)

    17.4 new cases (1992-1996)

    9.7 new cases

    14.9

    Reduce hepatitis C. (per 100,000 population)

    2.4 new cases (1996)

    1 new case

    14.10

    (developmental) Increase the proportion of persons with chronic hepatitis C infection identified by State and local health departments.

     

    14.11

    Reduce tuberculosis. (per 100,000 population)

    6.8 new cases (1998)

    1.0 new case

    14.12

    Increase the proportion of tuberculosis patients who complete curative therapy within 12 months.

    74%

    (1996)

    90%

    14.13

    Increase the proportion of contacts and other high-risk persons with latent tuberculosis who complete a course of treatment.

    62%

     (1997)

    85%

    14.14

    Reduce the average time for a laboratory to confirm and report tuberculosis cases.

    21 days to report 75% of cases (1996)

    2 days to report 75% of cases

    14.15

    (developmental) Increase the proportion of international travelers who receive recommended preventive services when traveling in areas of risk for select infectious disease: hepatitis A, malaria, and typhoid.  

     

    14.16

    Reduce invasive early onset group B streptococcal disease. (new cases per 1,000 live births)

    1.0 (1996)

    0.5

    14.17

    Reduce hospitalizations caused by peptic ulcer disease in the United States. (per 100,000 population)

    71 hospitalizations (1998)

    46 hospitalizations

    14.18

    Reduce the number of courses of antibiotics for ear infections for young children. (courses per 100 children under 5 years of age)

    108

     (1996-1997)

    88

    14.19

    Reduce the number of courses of antibiotics prescribed for the sole diagnosis of the common cold. (courses per 100,000 population)

    2,535

    (1996-1997)

    1,268

    14.20

    Reduce hospital-acquired infections in intensive care unit patients.

    Intensive care unit patients.  (infection per 1,000 days’ use)

    1998 Baseline*

    2010 Target

    14.20a

    Catheter-associated urinary tract infection

    5.9

    5.3

    14.20b

    Central line associated

    5.3

    4.8

    14.20c

    Venerator-associated pneumonia  

    11.1

    10.0

    Infants weighting 1,000 grams or less at birth in intensive care

    14.20d

    Central line-associated bloodstream infection

    12.2

    11.0

    14.20e

    Venerator-associated pneumonia  

    4.9

    4.4

    14.21

    Reduce antimicrobial use among intensive care unit patients. (daily doses per 1,000 patient days)

    150

    (1995)

    120

    14.22

    Achieve and maintain affective vaccination coverage levels for universally recommended vaccines for young children.  (among children aged 19 to 35 months)

    1998

    2010

    14.22a

    4 doses diphtheria-tetanus-acellular pertussis (DT&P) vaccine

    84%

    90%

    14.22b

    3 doses Heamophilus influenzae type b (Him) vaccine

    93%

    90%

    14.22c

    3 doses hepatitis B (hep B) vaccine

    87%

    90%

    14.22d

    I dose measles-mumps-rubella (MMR) vaccine 

    92%

    90%

    14.22e

    3 doses polio vaccine

    91%

    90%

    14.22f

    I dose varicella vaccine

    43%

    90%

    14.23

    Maintain vaccine coverage levels for children in licensed day care facilities and children in kindergarten through the first grade.

    1997-1998 Baseline*

    2010 Target

    Children in day care

    14.23a

    Diphtheria-tetanus-acellular pertussis (DTaP) vaccine

    96%

    95%

    14.23b

    Measles-mumps-rubella (MMR) vaccines 

    89%

    95%

    14.23c

    Polio vaccine

    96%

    95%

    14.23d

    Hepatitis B vaccine

    Developmental

    Developmental

    14.23e

    Varicella vaccine

    Developmental

    Developmental

    Children in K through 1st grade

    14.23f

    Diphtheria-tetanus-acellular pertussis (DTaP) vaccine

    97%

    95%

    14.23g

    Measles-mumps-rubella (MMR) vaccines 

    96%

    95%

    14.23h

    Polio vaccine

    97%

    95%

    14.23i

    Hepatitis B vaccine

    Developmental

    Developmental

    14.23j

    Varicella vaccine

    Developmental

    Developmental

    14.24

    Increase the proportion of young children and adolescents who receive all vaccines that have been universally recommended for universal administration for at least 5 years. 

    1998 Baseline*

    2010 Target

    14.24a

    Children aged 19 to 35 months who receive the recommended vaccines (4DTaP, 3 polio, 1MMR, 3Hib, 3 hep B)

    73%

    80%

    14.24b

    Adolescents aged 13 to 15 years who receive the recommended vaccines.

    Developmental

    Developmental

    14.25

    Increase the proportion of provider who have measured the vaccine coverage levels among children in their practice population within the past 2 years.

    1997 Baseline*

    2010 Target

    14.25a

    Public health providers

    66%

    90%

    14.25b

    Private providers

    6%

    90%

    14.26

    Increase the proportion of children who participate in fully operational-based immunization registries.

    32% of children under age 6 years (1999)

    95% of children under age 6 years

    14.27

    Increase routine vaccination coverage levels for adolescents. (adolescents aged 13 to 15 years)

    1997 Baseline*

    2010 Target

    14.27a

    3 or more doses of hepatitis B

    18%

    90%

    14.27b

    2 or more doses of measles, mumps, rubella

    89%

    90%

    14.27c

    1 or more doses of tetanus-diphtheria booster

    93%

    90%

    14.27d

    1 or more doses of varicella (excluding children who have had varicella)

    45%

    90%

    14.28

    Increase hepatitis B vaccine coverage among high-risk patients.

    1995

    2010

    14.28a

    Long-term hemodialysis patients

    35%

    95%

    14.28b

    Men who have sex with men

    9%

    60%

    14.28c

    Occupationally exposed workers

    71%

    98%

    14.29

    Increase the proportion of adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease.

    1998 Baseline*

    2010 Target

    Noninstitutionalized adults aged 65 years and older

    14.29a

    Influenza vaccine

    64%

    90%

    14.29b

    Pneumococcal vaccine

    46%

    90%

    Noninstitutionalized high-risk adults aged 18 to 64 years

    14.29c

    Influenza vaccine

    26%

    90%

    14.29d

    Pneumococcal vaccine

    13%

    90%

    Institutionalized adults (persons in long-term or nursing homes)

    14.28e

    Influenza vaccine

    59%

    (1997)

    90%

    14.29f

    Pneumococcal vaccine

    25%

     (1997)

    90%

    14.30

    Reduce vaccine-associated adverse events.

    5 cases

    (1997)

    Zero cases

    14.31

    Increase the number of persons under active surveillance for vaccine safety via large linked data bases.

    6 million

    (1999)

    13 million


    *Except as noted.

    A. Health Data

    1.  Food Safety in Chautauqua County

    As Table 1 shows, there were no reported cases of food contamination by E. coli or shigella in Chautauqua County in 2003; there were nine cases of salmonella.  Similar frequency patterns also are evident for New York State.  The Healthy People 2010 targets are 11 reported outbreaks of E. Coli and 22 reported outbreaks for salmonella per year.

    Table 1.  Reported Cases of Communicable Diseases Associated with Food Safety
    in Chautauqua County and New York State, 2003.*

      E. coli 0157Salmonellosis
    (2002 Data)*
    Shigellosis
    (2002 Data)*
    Chautauqua County090
    New York State, excluding NYC1051613405
    New York State Total1123008912
    Healthy People 2010 Target
    (outbreaks per year)
    1122 ___
    ___

    * Based on diagnosis year  (http://www.health.state.ny.us/nysdoh/cdc/2003/cases1.htm
    http://www.health.state.ny.us/nysdoh/cdc/2002/cases3.htm).

    2. Communicable Diseases in Chautauqua County

    Table 2 indicates there were more reported cases of pertussis (8) in Chautauqua County in 2003 than any other of the infectious diseases listed.  There was one case each of Hib and Hepatitis A.  New York State (excluding NYC) also had a higher frequency of new pertussis cases than any other listed diseases.  There were no cases of tuberculosis in Chautauqua County, the most frequently reported infectious disease in New York State

    Table 2.  Reported Cases of Infectious Diseases in Chautauqua County
    and New York State, 2003.*

      MeaslesPertussisHaemophilus
    Influenzae
    (Hib)
    Hepatitis AHepatitis B
    Acute
    TuberculosisRubella*
    Chautauqua County 0 8 1 1 0 0 0
    New York State,
    excluding NYC
    2 1067 155 146 110 340 1
    New York State
    Total
    7 1217 222 592 314 1480 3

    (http://www.health.state.ny.us/nysdoh/cdc/2003/cases3.htm;
    *2002 Data. http://www.health.state.ny.us/nysdoh/cdc/2002/cases3.htm).

    The infectious disease rates for Chautauqua County (1999-2003) in Table 3 consistently are lower for tuberculosis and E. coli during this time period compared to the rates for New York State (excluding New York City). The meningococcal incidence rate, although somewhat higher in the county for some years than in the state, is based on one or two cases per year (counts not shown). Similarly, the pertussis rates are higher in the county than the state for 1999-2000, but there have been only a few cases, except for 1999, when 251 cases were reported (277 total new cases between 1997-2001), and no county cases of pertussis were reported for 2001. The rate of Lyme disease in the county has remained low.

    Table 3. Trends in New Infectious Disease Morbidity in Chautauqua County
    and New York State (Excluding NYC) per 100,000 Population, 1999-2003.

    Table 3. Trends in New Infectious Disease Morbidity in Chautauqua County and New York State - Excluding NYC - per 100,000 Population, 1999-2003

    There were no laboratory confirmed rabies cases in Chautauqua County for 2003, as Figure 3 shows.

    Figure 3: Laboratory Confirmed Rabies Cases in New York State by County, 2003.

    Figure 3. Rabies Laboratory
    Source: New York State Department of Health, 2003 Annual Summary (https://commerce.health.state.ny.us/hin/).

    3.  Immunizations

    Figure 1 shows that nearly each year between 1993-2003, an increasing percentage of persons age 65 years or older received annual flu shots in New York State, leading to a 48% increase in annual flu short during this ten year period.

    Figure 1.  Percent of Persons Age 65 Years or Older in New York State
    Who Had a Flu Shot in the Past Year, 1993-2003
    .

    Year 1993 1995 1997 1999 2001 2002 2003
    Percent 45.9 55.9 64.5 63.8 62.5 64.6 68.0

    A nearly consistent yearly increase in pneumococcal pneumonia vaccinations for age 65+ years occurred during the 10-year time period between 1993-2003 in the state (see Figure 2); the rate dropped slightly in 2003.


    Figure 2.  Percent of Persons Age 65 Years or Older in New York State Who
    Ever Had a Pneumococcal Pneumonia Immunization, 1993-2003.


    (https://commerce.health.state.ny.us/hin/)

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    B. Unmet Needs

    Summary: Communicable Diseases and Immunizations in Chautauqua County

    Pertussis and meningococcal incidence rates vary by year during 1997-2000, although for most years they are limited to a few cases, except for 1999, when 251 cases of pertussis were reported (no county cases of pertussis were reported for 2001). The rate of Lyme disease in the county has remained low, with a total of nine reported cases for this time period (counts not shown). Sixty-eight percent of persons age 65+ years in the county received an annual flu shot in 2003. Just over 60% in New York State have ever had a pneumococcal pneumonia vaccinations in this age group.

    Healthy People 2010

    According to Healthy People 2010,

    Most vaccine-preventible diseases (VPD) in the United States occur among adults. Pneumococcal disease and influenza account for more than 30,000 deaths annually, most of which occur in elderly persons. Studies have consistently shown that focusing efforts to improve coverage on health care providers, as well as health care systems, is the most effective means of raising vaccine coverage in adults. For example, all health care providers should assess routinely the vaccination status of their patients. Likewise, health plans should develop mechanisms for assessing the vaccination status of their participants. Also, nursing home facilities and hospitals should ensure that policies exist to promote vaccination.
     
    Because no vaccine is completely safe, vaccine safety research and monitoring are necessary to identify and minimize vaccine-related injuries. As programs continue to reduce the new cases of VPDs, concerns about vaccine adverse events have emerged, posing a threat to public acceptance of vaccines. Knowing the safety profile of vaccines is essential to assess accurately the risks and benefits, to formulate appropriate vaccine recommendations, and to address public concerns.

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    C. Resources in Chautauqua County

    The following are some of the Chautauqua County organizations, agencies and programs that offer health services and other forms of assistance related to communicable diseases and immunizations.

    • Internal Medicine/Infectious Disease Physician.
       
    • 3 Chest Clinics (tuberculosis control).
       
    • 8 Chautauqua County Health Department Immunization Clinics.
       
    • 87 Pediatricians and Personal Care Health Professionals offering immunizations.
       
    • Travel Clinic, Chautauqua County Health Department.
       
    • 4 Hospital Emergency Rooms.
       
    • 33 Emergency Medicine Physicians.

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    D. Opportunities for Action

    Opportunities for action in Chautauqua County pertinent to infectious/communicable diseases, adapted from the Healthy People 2010 Initiative, include the following.

    • Support use of Hazard Analysis and Critical Control Points (HACCP) programs for seafood, meat and poultry processing.
       
    • Educate food processors, preparers, and servers at all levels in the food industry and in the home to wash hands and surfaces often, don't cross-contaminate surfaces, cook to proper temperatures, and refrigerate promptly.
       
    • Improve investigation of outbreaks and sporadic cases of foodborne illness.
       
    • Increased surveillance and inform the public health community, veterinary and producer groups, and regulatory agencies of the extent of the problem of human pathogens that come from the intestines of animals.
       
    • Expand the implementation of wider and more representative testing to give a better picture of the nature and extent to which antimicrobial-resistant foodborne pathogens are transmitted from animals to humans.
       
    • Further develop coordinated countywide strategies to understand, detect, control, and prevent infectious diseases.
       
    • Increase immunization of at-risk populations including persons with impaired host defenses; pregnant women and newborns; travelers, immigrants, and refugees; older adults; and other persons identified by the Advisory Committee on Immunization Practices (ACIP).
       
    • Improve the quality and quantity of vaccination delivery services.
       
    • Minimize the financial burdens of immunizations for needy persons.
       
    • Increase community participation, education and partnership in preventing communicable diseases.
       
    • Improve the monitoring of vaccination coverage.
       
    • Develop new or improved vaccines and increase vaccination use.
       
    • Continue to support Vaccines for Children and SCHIP Initiatives, and enroll all eligible children.
       
    • Expand assessment of vaccination coverage of persons served at individual clinics and provider offices.

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