Utah Communicable Disease Report, 2018

The Utah Communicable Disease Report 2018 is a web-based report. You can navigate through the different chapters by using the tabs and drop-down menus at the top of the screen.

Acknowledgements

The UDOH recognizes the efforts of local health department (LHD) personnel throughout the state who play a critical role in data collection and case investigation; their work allows for accurate and timely reporting of communicable disease data.

UDOH also recognizes the efforts of other reporting partners, including laboratories, healthcare facilities, healthcare providers, and the public, in the provision of communicable disease data that have contributed to this report.

Reportable communicable disease data for Utah are published by the Utah Department of Health, Bureau of Epidemiology.

Please direct questions or comments to:

UDOH Bureau of Epidemiology
PO Box 142104
Salt Lake City, Utah 84114
Phone: (801) 538-6191
Email: epi@utah.gov
Website: www.health.utah.gov/epi

Preface

The Communicable Disease Annual Report for Utah, 2018 contains data related to Utah’s reportable diseases and conditions reported in Utah for 2018. The data reported are collected from Utah’s local health departments (LHDs), laboratories, healthcare providers, hospitals, and other healthcare facilities. The Utah Department of Health (UDOH) tracks more than 75 communicable diseases in Utah annually. Each case of disease is investigated in collaboration with the LHDs.

The Highlights section presents noteworthy epidemiologic information from 2018 for selected diseases and additional information to aid in the interpretation of surveillance data. Incidence data (new cases of reportable conditions in 2018), historical 5-year averages, and the incidence rates are presented in [State Disease Activity] table. In addition, a summary of cases of reportable disease by LHD is presented in the [Jurisdiction Disease Activity] section, and historical case counts and rates are presented in Yearly Disease Comparison section. Cases are counted by the year the disease occurred as determined by the Morbidity and Mortality Weekly Report (MMWR) week assigned by the Centers for Disease Control and Prevention (CDC).

Important note about influenza

Throughout this report, influenza data are presented in the year the influenza season ended, and represent data for the CDC defined influenza season. Influenza season typically begins in October and surveillance extends through May of the following year. For example, data presented for the year 2018 is indicative of data collected from the 2017–2018 influenza season. Presenting data in this way provides accurate measures for annual influenza activity. Sporadic cases of influenza that occur outside of the traditional influenza season are assigned to the previous season (i.e., an influenza case reported in August of 2017 would be assigned to the 2016–2017 influenza season). This report reflects activity for the 2017–2018 influenza season. More information on influenza activity in Utah can be found here.

Background

A multidisciplinary approach to communicable disease control has been established in Utah and includes prompt reporting, data analysis, data interpretation, case investigation, identification of common risk factors, treatment, and implementation of disease prevention interventions. The successes of medicine and public health have dramatically reduced the risk of illnesses, hospitalizations, and deaths due to infectious agents during the 20th century. However, emergence of new diseases and the rapid spread of diseases globally, made possible by advances in transportation, trade, food production, and other factors, highlight the continual threat to health from infectious diseases. Attention to these threats and cooperation among all healthcare providers, government agencies, and other entities who are partners in protecting the public’s health are crucial to maintain and improve the health of Utah’s citizens. ¹

The important role that disease surveillance plays in protecting the public’s health has been expressed by the CDC as follows:

“Case-reporting of reportable diseases at the local level protects the public’s health by ensuring the proper identification and follow-up of cases. Public health workers ensure that persons who are already ill receive appropriate treatment; trace contacts who need vaccines, treatment, quarantine, or education; investigate and halt outbreaks; eliminate environmental hazards; and close premises where spread may occur. Surveillance of notifiable conditions helps public health authorities monitor the effect of notifiable conditions, measure disease trends, assess the effectiveness of control and prevention measures, identify populations or geographic areas at high risk, allocate resources appropriately, formulate prevention strategies, and develop public health policies. Monitoring surveillance data enables public health authorities to detect sudden changes in disease occurrence and distribution, identify changes in agents and host factors, and detect changes in health-care practices.”²

Reportable Communicable Diseases in Utah, 2018

Reportable Communicable Diseases in Utah, 2018 ³

Acinetobacter species with resistance to carbapenems

Acute Flaccid Myelitis

Acquired Immunodeficiency Syndrome (AIDS)

Adverse event resulting from smallpox vaccination

Anaplasmosis

Anthrax

Arbovirus infection, including Saint Louis encephalitis and West Nile virus

Chlamydia trachomatis infection

Cholera

Coccidioidomycosis

Colorado tick fever

Creutzfeldt-Jacob disease and other transmissible human spongiform encephalopathies

Ehrlichiosis, human granulocytic, human monocytic, or unspecified

Encephalitis

Enterobacter species with resistance or intermediate resistance to carbapenems

Escherichia coli with resistance or intermediate resistance to carbapenems

Giardiasis

Gonorrhea

Haemophilus influenzae, invasive disease

Hansen’s disease (Leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, post-diarrheal

Hepatitis A

Hepatitis B, cases and carriers

Hepatitis C, acute and chronic

Hepatitis, other viral

Human Immunodeficiency Virus (HIV) infection

Influenza-associated hospitalization

Influenza-associated pediatric death

Klebsiella species with resistance or intermediate resistance to carbapenems

Meningitis (aseptic, bacterial, fungal, parasitic, protozoan, and viral)

Meningococcal disease

Mumps

Mycobacteria other than tuberculosis

Norovirus

Pertussis (whooping cough)

Plague

Poliomyelitis, paralytic

Poliovirus infection, nonparalytic

[Pregnancy associated with hepatitis B, hepatitis C, HIV, Listeria, Rubella, Syphilis, or Zika virus infection]

Psittacosis

Q Fever

Rabies, human and animal

Relapsing fever, tick-borne and louse-borne

Rubella

Rubella, congenital syndrome

Salmonellosis

Severe acute respiratory syndrome (SARS)

Shiga toxin-producing Escherichia coli (STEC) infection

Shigellosis

Smallpox

Spotted fever rickettsioses, including Rocky Mountain spotted fever

Staphylococcus aureus with resistance (VRSA)

Streptococcal disease, invasive, including:
Streptococcus pneumoniae and Groups A, B, C, and G
streptococci isolated from a normally sterile site

Syphilis, all stages and congenital

Tetanus

Toxic-shock syndrome, staphylococcal or streptococcal

Trichinellosis

Tuberculosis

Tularemia

Typhoid, cases and carriers

Vibriosis

Viral hemorrhagic fevers, including Ebola, Lassa, Marburg, and Nipah virus-related illnesses

Yellow fever

Zika Virus

The following are summaries for selected communicable diseases which are intended to highlight conditions that had notable incidence, outbreaks, or other factors.

Select Disease Highlight

Hepatitis C, acute cases

In Utah, acute HCV infections are increasing most rapidly among people 20-29 years of age. The increase within this age demographic is thought to be the result of an increase in injection drug use associated with the opioid epidemic. Injection drug use is the risk factor associated with the majority of HCV transmission in Utah, and therefore, people who inject drugs (PWIDs) are a priority population for public health intervention. Acute HCV surveillance data indicate a total of 101 acute HCV cases were reported in Utah in 2017. This number increased to 156 cases in 2018, likely due to increased numbers of PWID, coupled with implementation of several surveillance system changes including enhanced surveillance activities and investigational process improvements. These changes resulted in the increased ability to identify acute HCV cases in Utah. Public health efforts are ongoing to identify possible sources of HCV transmission in the community.

Acute Flaccid Myelitis

Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. The risk factors for AFM are unknown, but most cases are seen among children with a preceding respiratory or febrile illness. In 2018, Utah submitted seven suspect cases of AFM to the Centers for Disease Control and Prevention (CDC) and one case was classified as a confirmed case of AFM.

Human Rabies Case

In November 2018, the Utah Department of Health (UDOH) was notified of a suspect human rabies case in a resident of Utah. In collaboration with several local health departments and the Centers for Disease Control and Prevention (CDC), the UDOH conducted an investigation into the case to verify the diagnosis and determine the source of infection. Upon receipt of laboratory specimens from the Utah Public Health Laboratory and the Office of the Medical Examiner, the CDC confirmed the patient was infected with a strain of rabies virus associated with the Mexican Freetail Bat.The patient reportedly had handled several bats in the weeks before symptom onset. The patient subsequently died as a result of the infection.

Shiga toxin-producing E. coli/Hemolytic Uremic Syndrome

Shiga toxin-producing E. coli (STEC) was elevated in Utah and nationally in 2018.This increase was due to several large, multi-state outbreaks, as well as the adoption of more sensitive laboratory tests. STEC infections can lead to Hemolytic Uremic Syndrome (HUS), a complication that affects the kidneys.

The largest STEC outbreak for 2018 was associated with consumption of romaine lettuce; it affected 210 people from 36 states and resulted in 96 hospitalizations and five deaths. Utah had <5 cases associated with this outbreak.

In Utah, we identified seven outbreaks of STEC in 2018, with a total of 39 cases. These outbreaks were associated with multiple sources of infection including raw milk, cow manure, water features, and petting zoos. In total, there were 197 cases identified in Utah (outbreak-associated and sporadic), including confirmed (122) and probable (75) cases of STEC. There were a total of 40 hospitalizations which includes 12 cases of HUS. There were no deaths.

Gonorrhea

Since 2011, the rate of gonorrhea has increased 825%. However, the 2018 rate was only 11% higher than the 2017 rate (2,895 cases of gonorrhea were reported in 2018 compared with 2,541 cases reported in 2017). Gonorrhea infections are commonly asymptomatic and re-infection after treatment is possible. UDOH and Utah’s LHDs are closely monitoring the increase. LHD Disease Intervention Specialists (DIS) investigate all reported cases of gonorrhea, ensure appropriate treatment and provide partner services.

Syphilis

The U.S. and Utah have recently experienced a resurgence in syphilis cases. In 2018, the Utah rate of primary and secondary (P&S) syphilis was 5.3 cases per 100,000 persons. This represents a 39.1% increase from the 2017 rate and the upward trend is reason for concern. Syphilis is concentrated in Utah along the Wasatch Front, with more than 70% of 2018 P&S syphilis cases reported in Salt Lake County. The majority of syphilis cases occur among gay, bisexual, and other men who have sex with men (MSM). In 2018, three out of four P&S syphilis cases reported being MSM.

Enteric (intestinal) Diseases

Enteric diseases cause gastro-intestinal illness. The causative pathogens typically enter the body through the mouth through contaminated food or water, contact with animals or their environments, or contact with the feces of another infected human. For more information about enteric diseases, see the CDC website.