annual summary of infectious diseases for the city of ... summary of infectious diseases for the ......

2015

Cleveland Department

of Public Health

Allison LeBorgne,

Epidemiology Intern

Chenai Milton,

Epidemiologist

ANNUAL SUMMARY OF INFECTIOUS DISEASES FOR THE CITY OF CLEVELAND, 2015 Campylobacteriosis: Centers for Disease Control and Prevention (left); Hepatitis C: Centers for Disease Control and Prevention (top right); Shigella: Centers for Disease Control and Prevention (bottom right)

Annual Summary of Reportable Diseases for the City of Cleveland

This page was intentionally left blank


Published 2017

Complied and Prepared by:

Allison LeBorgne, Epidemiology Intern

Office of Communicable Disease and Surveillance and Epidemiology

Cleveland Department of Public Health

75 Erieview Plaza

Cleveland, OH 44114

www.clevelandhealth.org

Chenai Milton, Epidemiologist

Office of Communicable Disease and Surveillance and Epidemiology

Cleveland Department of Public Health

75 Erieview Plaza

Cleveland, OH 44114

www.clevelandhealth.org

http://www.clevelandhealth.org/

http://www.clevelandhealth.org/


Definitions...………………………………………………………..……………………………..1

Introduction………………………………………………………………………………………2

Cleveland Demographics…………………………………………….…………………………..3

Reportable Diseases for the State of Ohio……………………………………………………...4

Reportable Diseases……………………………………………………….……………………..6

Campylobacteriosis………………………………………………………………………………9

Hepatitis C……………………………………………………………………….……………...11

Influenza……………………………………………………………………………………..….13

Legionellosis…………………………………………………………………………………….15

Salmonellosis……………………………………………………………………………………17

Outbreak Highlights………………………………………………………………………..…..19

Methods……………………………………………………………………...………...……...…22

Limitations………………………………………………………………………………………23

Appendix………………………………………………...………………………………………24

Table of Contents


Acute: a condition or disease with a sudden onset of symptoms

Case: an accounted for instance of a health disorder or disease in a population

Chronic: condition or disease with a slow onset of symptoms

Communicable disease: infectious disease transmitted from someone infected (person,

animal or reservoir) to a susceptible host through direct or indirect contact

Food-borne Illness: also known as food poisoning and results from consuming an item

that has been contaminated with a bacteria, virus or parasite

Epidemiology: the study of the distribution and determinants of health and illness in a

population

Epidemiologist: people who monitor health trends and statistics to identify groups of

people who are affected by various diseases. They investigate cases of disease to

determine source, mode of transmission and risk factors for disease and use information

collected to implement control measures to prevent the spread of disease

Incidence: rate of new cases of a specific disease over a defined period of time

Outbreak: occurrence of more cases of a disease than expected in a given area or among

a specific group of people over a period of time

Recall bias: a systematic error caused by differences in the accuracy or completeness of

the information retrieved, or recalled, by study participants regarding information from

the past

Surveillance: the systematic collection, recording, analysis, interpretation and

distribution of data reflecting the current health status of a population

Definitions


The Cleveland Department of Public Health (CDPH) is the local public health agency for

the City of Cleveland residents. Started in 1910, the department improves the quality of life in

the city of Cleveland by promoting healthy behavior, protecting the environment, preventing

disease, and making the city a healthy place to live. The CDPH has a range of programs

providing clinical, environmental, health promotion, and population-based services.

CDPH ensures a high quality of resources and services through various partnerships in

the community. The Cleveland Department of Public Health have initiated and maintained

working relationships with Case Western Reserve University, Metro Health Medical Center,

Veterans Affairs Medical Center, Cuyahoga County Board of Health, Lakewood and Shaker

Health Departments, the Center for Community Solutions and various others. These partnerships

provide successful preventive public health services to meet the needs of the residents for the

city of Cleveland communities.

The Office of Communicable Disease Surveillance and Epidemiology (OCDSE) is

charged with investigating and tracking the spread of communicable and chronic diseases,

conduct surveillance and data analysis on public health issues for the city of Cleveland. With the

use of the Ohio Disease Reporting System (ODRS) through the Ohio Department of Health

(ODH), the epidemiologists are able to report, track and update information of cases reported by

healthcare professionals of the city. The state of Ohio has developed a list of infectious diseases

based on spread, severity and infectivity have to be reported in certain ways by certain times and

are divided into classes A, B and C (see page 3-4).

Introduction


The estimated population for Cleveland, Ohio in 2015 is 390,584

Out of the estimated population, 51.6% of individuals are African Americans

The median age of people living in

Cleveland, Ohio is 35.9 years old

The population of Cleveland has been

steadily decreasing for the last 10 years

KEY FINDINGS:

For the City of Cleveland, including sexually

transmitted diseases, there were 9,952 cases

of reportable infectious diseases (1,585

disease cases excluding sexually transmitted

diseases)

Since the estimated population for Cleveland

is majority African Americans, they are at the

highest risk for infection in the community for most infectious diseases than any other

race

Mapping has allowed us to identify Ward 5 and Ward 7 as the areas with the most

reported incidences of infectious disease (neighborhoods included but not limited to West

Boulevard, Brooklyn Centre, Lee-Harvard, Stockyards, Mount Pleasant and Lee-Seville)2

1 These populations are estimates from the United States Census Bureau and do not directly reflect the 390,584 total estimated Cleveland population 2 This information is not based on data including HIV/AIDS information

Age

# %

< 5 years 29,075 7.0

5 to 19 years 85,214 20.2

20 to 64 years 255,825 60.7 165+ years 51,194 12.1

Sex

# %

Male 189,787 47.8

Female 203,797 52.2

Cleveland Demographics

0

50,000

100,000

150,000

200,000

250,000

Census Estimated Population of Cleveland,

Ohio by Race 2015

0

200

400

600

800

1000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Disease Incidence in Cleveland by Ward, 2015


Class A: Diseases of major public health concern because of the severity of disease or potential

spread- report immediately via telephone upon recognition that a case, a suspected case, or a

positive for epidemic case laboratory result exists.

Anthrax

Botulism, foodborne

Cholera

Diphtheria

Influenza A- novel virus infection

Measles

Meningococcal disease

Middle East Respiratory Syndrome

(MERS)

Plague

Rabies, human

Rubella (not congenital)

Severe Acute Respiratory Syndrome

(SARS)

Smallpox

Tularemia

Yellow Fever

Viral Hemorrhagic fever (VHF), including Ebola Virus disease, Lassa fever, Marburg

hemorrhagic fever, and Crimean-Congo hemorrhagic fever

Class B: Disease of a public health concern needing timely response because of potential for

epidemic spread- report by the end of the next business day after the existence of a case, a

suspected case, or a positive laboratory result is known.

Arboviral neuroinvasive and non-

neuroinvasive disease

Chikungunya virus infection

Eastern equine encephalitis virus

disease

LaCrosse virus disease (other

California serogroup virus disease)

Powassan virus disease

St. Louis encephalitis virus disease

West Nile virus infection

Western Equine encephalitis virus

disease

Other arthropod-borne diseases

Amebiasis

Babesiosis

Botulism (infant/wound)

Brucellosis

Campylobacteriosis

Chancroid

Chlamydia trachomatis infections

Coccidoidomycosis

Creutzfeldt-Jakob disease

Cryptosporidiosis

Cyclosporiasis

Dengue

E. Coli O157:H7 and Shiga toxin-

producing E. Coli

Ehrlichiosis/Anaplasmosis

Giardiasis

Gonorrhea

Haemophilus influenzae (invasive

disease)

Hantavirus

Reportable Diseases for the State of Ohio


Hemolytic uremic syndrome

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis E

Influenza-associated hospitalization

Influenza-associated pediatric

mortality

Legionnaires’ disease

Leprosy (Hansen disease)

Leptospirosis

Listeriosis

Lyme disease

Malaria

Meningitis (Aseptic viral/bacterial)

Mumps

Pertussis

Poliomyelitis (including vaccine-

associated cases)

Psittacosis

Q fever

Rubella (congenital)

Salmonellosis

Shigellosis

Spotted fever rickettsiosis, including

Rocky Mountain Spotted Fever

Staphylococcus aureus, with

resistance or intermediate resistance

to vancomycin

Streptococcal disease, group A,

invasive

Streptococcal disease, group B, in

newborns

Streptococcal pneumoniae, invasive

disease

Syphilis

Tetanus

Toxic shock syndrome

Trichinellosis

Tuberculosis, including multi-drug

resistant tuberculosis

Typhoid fever

Varicella

Vibriosis

Yersiniosis

Class C: Report an outbreak, unusual incident or epidemic of other diseases (e.g. histoplasmosis,

pediculosis, scabies, staphylococcal infections) by the end of the next business day.

Outbreaks:

Community

Foodborne

Healthcare-associated

Institutional

Waterborne

Zoonotic

Reportable Diseases for the State of Ohio


Annual Infectious Disease Report 2015

Infectious Diseases Cleveland

Cases

Cleveland

Rate per

100,000

Ohio

Cases

2014

Ohio

Rate

per

100,000

U.S. Cases

2014

U.S. Rate

per

100,000

Amebiasis 0 0 0 0 0 0

Anthrax 0 0 0 0 0 0

Babesiosis 0 0 1 0 1,760 0.6

Botulism, Foodborne 0 0 2 0.02 15 0

Botulism, Infant/Wound 0 0 3 0.03 146 0.05

Brucellosis 0 0 1 0 92 0.03

Campylobacteriosis 70 17.6 8 0.07 N/A N/A

Chancroid 0 0 0 0 6 0

Chikungunya virus 1 0.3 0 0 0 0

Chlamydia trachomatis

infection

6,027 1,518.80 54,858 473.2 1,441,789 452.1

Cholera 0 0 0 0 5 0

Coccidioidomycosis 0 0 16 0.1 8,232 2.6

Creutzfeldt-Jakob Disease 0 0 N/A N/A N/A N/A

Cryptosporidiosis 14 3.5 324 2.8 8,682 2.7

Cyclosporiasis 0 0 1 0 398 0.1

Dengue 0 0 9 0.8 680 0.2

Diptheria 0 0 1 0 1 0

Eastern Equine

encephalitis

0 0 0 0 8 0

E. Coli, Shiga Toxin-

Producing

4 1 204 17.5 6,179 1.9

Ehrlichia

Chaffeensis/Anaplasmosis

0 0 5 0.04 4,275 1.3

Giardiasis 17 4.3 385 3.3 14,554 4.6

Gonorrhea 2,275 573.3 16,237 140 350,062 109.8

Haemophilus Influenzae

(Invasive)

3 0.8 150 1.3 3,541 1.1

Hantavirus 0 0 0 0 32 0.01

Hemolytic Uremic

Syndrome (HUS)

0 0 9 0.8 250 0.08

Hepatitis A 0 0 32 0.3 1,239 0.4

Hepatitis B,

Acute/Chronic

128 32.3 387 3.3 15,238 4.8

Reportable Diseases


Infectious Diseases

Cleveland

Cases

Cleveland

Rate per

100,000

Ohio

Cases

2014

Ohio

Rate

per

100,000

U.S. Cases

2014

U.S. Rate

per

100,000

Hepatitis C,

Acute/Chronic

672 169.3 15,860 136.8 165,067 51.8

Hepatitis D 0 0 N/A N/A N/A N/A

Hepatitis E 0 0 0 0 N/A N/A

Human

Immunodeficiency Virus

121 30.5 932 8 35,606 11.2

Influenza A, Novel

Human Virus

1 0.3 2 0.02 N/A N/A

Influenza-Associated

Hospitalization

186 46.9 N/A N/A N/A N/A

Influenza-Associated

Pediatric Mortality

0 0 2 0.02 141 0.04

Invasive Pneumococcal

disease

0 0 981 8.5 15,356 4.8

Lacrosse Virus Disease 0 0 32 0.3 96 0.03

Legionellosis 46 11.6 406 3.5 5,166 1.6

Leprosy (Hansen Disease) 0 0 2 0.02 88 0.03

Leptospirosis 0 0 2 0.02 38 0.01

Listeriosis 1 0.3 30 0.3 769 0.2

Lyme Disease 0 0 119 1 33,461 10.5

Malaria 6 1.5 38 0.3 1,653 0.5

Measles 0 0 382 3.3 667 0.2

Meningitis, Aseptic 33 8.3 N/A N/A N/A N/A

Meningitis, Bacterial 4 1 N/A N/A N/A N/A

Meningococcal Disease 0 0 12 0.1 433 0.1

Middle East Respiratory

Syndrome

0 0 0 0 N/A N/A

Mumps 0 0 552 4.8 1,223 0.4

Other Arthropod-borne

diseases

0 0 N/A N/A N/A N/A

Pertussis 5 1.3 1,463 12.6 32,971 10.3

Plague 0 0 0 0 10 0

Polioyelitis (including

vaccine-associated cases)

0 0 0 0 0 0

Powassan virus disease 0 0 0 0 8 0

Psittacosis 0 0 0 0 8 0

Q Fever 0 0 4 0.03 168 0.05

Rabies, human 0 0 0 0 1 0

Rubella (congenital) 0 0 0 0 1 0

Reportable Diseases


Infectious Diseases Cleveland

Cases

Cleveland

Rate per

100,000

Ohio

Cases

2014

Ohio

Rate

per

100,000

U.S. Cases

2014

U.S. Rate

per

100,000

Rubella (non-congenital) 0 0 0 0 6 0

Salmonellosis 45 11.3 1,199 10.3 51,455 16.1

Severe Acute Respiratory

Syndrome (SARS)

0 0 0 0 0 0

Shigellosis 46 11.6 606 5.2 20,745 6.5

Smallpox 0 0 0 0 0 0

Spotted Fever

Rickettsiosis

0 0 12 0.1 3,757 1.2

St. Louis encephalitis 0 0 0 0 10 0

Staph Aureus,

Vancomycin Intermediate

13 3.3 9 0.08 212 0.07

Strep Disease (INV),

Group A

25 6.3 N/A N/A N/A N/A

Strep Disease, Group B

(Newborn)

7 1.8 N/A N/A N/A N/A

Strep Toxic Shock

Syndrome (STSS)

2 0.5 9 0.08 259 0.08

Strep Pneumo (INV),

Drug Resistant

26 6.6 N/A N/A N/A N/A

Syphilis 164 41.3 1,229 10.6 63,450 19.9

Tetanus 0 0 1 0 25 0.01

Toxic Shock Syndrome

(TSS)

0 0 9 0.08 59 0.02

Trichinellosis 0 0 1 0 13 0

Tuberculosis (including

drug resistant)

0 0 156 1.3 9,421 3

Tularemia 0 0 1 0 180 0.06

Typhoid Fever 1 0.3 7 0.06 349 0.1

Varicella 5 1.3 535 4.6 10,172 3.2

Vibriosis (Not Cholera) 0 0 12 0.1 1,261 0.4

Viral Hemorrhagic Fever 0 0 0 0 5 0

West Nile Virus Disease 3 0.8 11 0.09 2,205 0.7

Western equine

encephalitis

0 0 N/A N/A N/A N/A

Yellow Fever 0 0 0 0 0 0

Yersiniosis 1 0.3 N/A N/A N/A N/A 1 N/A: Information for specified portions with this denotation do not have current data from the Centers for Disease Control and Prevention

2 The rates for Cleveland were calculated by using the 2010 census data population of 396,815

3 The rates for Ohio and the United States were calculated using the Centers for Disease Control and Prevention’s 2014 report of infectious

disease populations (rounded to the nearest thousandth placement) for Ohio: 11,856,000 and the United States: 11,594,000

Reportable Diseases


0123456789

10

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Campylobacteriosis in Cleveland by Month, 2015

Agent: Caused by the bacteria Campylobacter; One of the most common causes of

diarrheal illness in the US

Symptoms: diarrhea, cramping, abdominal pain, and fever within two to five days after

exposure to the organism for the most common symptoms

Incubation/Duration: illness lasts on average one week; some individuals do not have

any symptoms

Transmission: found on raw meat and un-cleaned food surfaces; Highest rate of

infection takes place in the summer months because bacteria grows rapidly in warm

weathers

Prevention: Food preparers should make sure foods are cooked to right temperatures

before serving/consuming

In 2015 here were 70 cases of Campylobacteriosis in the city of Cleveland. Ward 16 had the

highest level of disease incidence than other wards which consists of the Collinwood-

Nottingham and Glenville neighborhoods. The average age of individual infected was

approximately 48 years old and women made up 57.7 percent of these individuals. Due to the

commonality of symptoms and individuals not seeking medical attention when ill,

Campylobacteriosis could be underreported.

Campylobacteriosis


Incidences of Campylobacteriosis

by Ward in Cleveland, 2015

Incidences of Campylobacteriosis by

Neighborhood in Cleveland, 2015


Agent: blood-borne pathogen that can be transmitted from person-to-person through

blood or other body fluid contact

Symptoms: fever, fatigue, dark urine, clay-colored stool and abdominal pain, loss of

appetite, nausea, vomiting, joint pain and jaundice

Incubation: could be from 2 weeks to 6 mouths with most common span of 3 to 9 weeks

Transmission: since this is a blood-borne pathogen, people are at risk of contracting the

infection if the come onto contact with an infected persons blood or bodily fluids

Prevention: do not share needles when participating in intravenous drug use, ask about

cleanliness of tattoo and piercing equipment before use, where gloves when you might

come into contact with blood and also practice safe sex

All except 3 of the 672 cases in Cleveland in 2015 are chronic cases of Hepatitis C. Most chronic

cases belong to individuals on average 48 years old and 61.5 percent of the cases are males.

African Americans make up 36.3 percent of the individuals infected Americans and 37.9 percent

of infected individuals Caucasian. Ward 12 has the highest amount of individuals that have

Hepatitis C with 65 cases which consists of the Brooklyn Centre, Kinsman, Buckeye-Shaker

Square and Tremont neighborhoods.

Hepatitis C

050

100150200250300350400450

Female Male

Hepatitis C for Cleveland by Sex in 2015

0

50

100

150

200

250

300

Hepatitis C in Cleveland by Race, 2015


Agent: contagious respiratory illness that spreads easily through communities

Symptoms: fever, cough, sore throat, runny nose, muscle or body aches, headache,

fatigue and sometimes vomiting and diarrhea which is more common in children

Incubation/Duration: infection takes about1 to 4 days to show symptoms in the body

and the infection lasts on average for the same amount of time

Transmission: most people are infected from coming into contact with someone who is

already infected. Hospitalized-acquired influenza cases are individuals who go into the

hospital with another complication and due to their immunocompromised state, they

contracted influenza. The biggest chance of infection is when the climate switches from

cold to hot and bacteria replicates.

Prevention: wash hands regularly especially during times of the year where virus spread

is high; help improve surveillance and overall understanding of disease by seeking

medical attention when possibly infected to avoid underreporting

While there is a “flu season,” there was no significant correlation with time of year to amount of

diagnosed cases. There were 187 reported incidences of influenza in Cleveland for 2015 and

almost 67 percent of cases belonged to African Americans.1 The Cleveland ward with the

highest incidence was Ward 7 which consist of the the Stockyards, Lee-Seville and Mount

Pleasant neighborhoods.

________________________________

1 These incidences are only hospitalized patients with influenza. This does not include patients

tested by primary care doctors, emergency rooms, urgent cares, patients sent home to recover,

etc.

Influenza Hospitalizations

0

5

10

15

20

25

30

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Ward Number

Reported Influenza for Cleveland by Ward, 2015


Incidences of Influenza by

Neighborhood in Cleveland, 2015


Agent: Legionella or Legionnaries’ disease is a bacterium that’s naturally found in

freshwater environments

Symptoms: fever, cough, chills and muscle aches

Incubation: may take 2 to 10 days after exposure before you experience symptoms

Transmission: the bacteria can grow in man-made water systems like showers, faucets,

air-conditioning units, hot tubs, public swimming areas, fountains, hot water tanks, etc.

Prevention: to reduce disease spread, regularly clean and disinfect any water systems

that you, your family or members of your community may come into contact with

Most healthy people exposed to the bacteria will not become ill but smokers, individuals

50 years or older, people with chronic lung disease, with weak immune systems or are

immunocompromised have a greater risk of having complications

The average age of diagnosis in 2015 was about 58 years old and African Americans make up 74

percent of individuals who had the infection. Ward 7 had the highest amount of cases, which

consist of the Stockyards, Lee-Seville and Mount Pleasant neighborhoods. This could be due to

an issue with public water supply in these areas during that time or that the population is older

and at a greater risk of contracting the illness.

0

10

20

30

40

Female Male

Legionellosis in Cleveland by Sex, 2015

0

5

10

15

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Legionellosis in Cleveland by Month, 2015

Legionellosis


Incidences of Legionnaires’ disease

by Neighborhood in Cleveland, 2015


Agent: Salmonella bacteria is found by testing a blood or stool sample

Symptoms: diarrhea, fever and abdominal pain

Incubation: within 12 to 72 hours of coming in contact with the bacteria you may

experience the symptoms

Transmission: found in raw food products especially poultry; many cases of infection

can come from having poultry as backyard or inside pets or coming into contact or eating

the food

Prevention: thoroughly cooking meats especially poultry will dramatically reduce the

chances of becoming ill as well as keeping common food surfaces clean

There were 45 cases of Salmonellosis with an average age of 38 years old. From looking at the

information provided, there was no correlation of gender or time of infection occurring that

would seem to affect risk of infection. Most of these cases took place in Ward 1 which is

comprised mostly of the Riverside neighborhood.

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Ward Number

Salmonellosis in Cleveland by Ward, 2015

Salmonellosis


Gastrointestinal Illness

The outbreak in question took place at a high school sport’s banquet in Cleveland, Ohio

and occurred in the beginning of January and was the biggest reported outbreak in 2015 for the

city. It’s expected based on the latency period of symptom onset and symptoms experienced that

the infection was norovirus. There were 158 individuals interviewed about the banquet and they

were able to give details on what types of foods they consumed. The case was defined as any

symptomatic, self-reported gastrointestinal illness that were reported through phone interview

questionnaires conducted from February 2nd

to May 20, 2015 regarding the sports banquet that

took place of January 7, 2015. The Ohio Infectious Disease A, B, C class list defines this as a

community outbreak.

There were a total of 58 symptomatic individuals in the outbreak time period of January

6, 2015 through January 10, 2015. If symptoms were reported before January 7th

or after January

9th

they were considered unrelated events to the outbreak. The different foods that were looked at

did have results that were statistically significant but since there was no laboratory investigation,

there was no specific food source to be identified as the main source of exposure. There was an

environmental investigation conducted by a registered sanitarian from the Cleveland Department

of Public Health and found no critical health violations. A major limitation of this study was

recall bias and absence of lab confirmation of the infection. Not only was the Cleveland

Department of Public Health not able to determine the virus or bacteria responsible, they also

could not narrow the scope of which foods were the source of infection. We learned from this

outbreak that our society could stand to be better educated on hand hygiene, environmental

cleaning (banquet centers) and food catering standards.

Outbreak Highlights


Shigella

On January 20, 2015, the Ohio Disease Reporting System (ODRS) notified the Office of

Communicable Disease Surveillance and Epidemiology (OCDSE) of 9 cases of Shigella at a

daycare center in Cleveland, Ohio. The 9 cases spanned 2 families, 5 being siblings from one

family and 3 children and their mother from another. Interviews of the cases were completed and

then they were subsequently provided with control measures, educational materials, fact sheets

and stool test kits.

There were 22 people total that experienced symptoms that were interviewed and had

stool samples collected. The daycare center did a thorough job of excluding individuals who did

not have positive bacterial presence while still ill during the time period. Some individuals with

this strain of infection could not use the normal antibiotic treatment to get rid of the infection and

alternate antibiotics had to be used. In preventing this kind of outbreak from spreading in the

future, individuals infected must submit 2 negative stool samples to their local health department

before they are allowed to return to direct patient care, childcare or handle food per the Ohio

revised code. Disinfecting all bathroom facilities daily and educating people who work with

children on the proper cleaning techniques for all surfaces in the location.

1Shigella bacteria, Centers for Disease Control and Prevention

Outbreak Highlights


Scabies

Scabies are caused by an infestation of the skin by a human itch mite that burrows into

the upper layer of the skin where they live and lay eggs. It occurs worldwide and effects all types

of individuals especially people living in close proximity of each other such as in prisons,

extended-care facilities and nursing homes. The most common symptoms are intense itching and

a pimple-like skin rash that usually spreads through skin-to-skin contact for prolonged periods of

time.

In May of 2015, a report was received from a treatment services location that was

experiencing an outbreak of scabies with 9 cases in total. Itching and rash were the most reported

symptoms for all individuals infested. Treatment recommendations and education material were

provided to the staff of the location. The treatment services center started using control methods

after the outbreak was reported to control the situation. All infected individuals were women

with an average age of 30. In some cases if an individual is experiencing an infestation first time,

symptoms may not show up for months but are able to transmit the infestation the entire time

they are infested. The best way to prevent scabies is by avoiding skin-to-skin contact with

someone who is already infested and cleaning, dry-cleaning or storing infested items in plastic

bags for up to a week to get rid of the mites.

1Scabies mite, Centers for Disease control and Prevention

Outbreak Highlights


All data used in this summary report was

reported to the Cleveland Department of

Public Health which was later reported to

the Ohio Department of Health as well as

the Centers for Disease Control and

Prevention. The populations that were used

to calculate rates for Cleveland (396,815)

Ohio (11,594,000) and the United States

(318,856,000) were referred to earlier and

were used for the calculations. For each

disease from each location, the following

calculation was performed:

𝑰𝒏𝒄𝒊𝒅𝒆𝒏𝒄𝒆 𝑹𝒂𝒕𝒆

= 𝐴𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑖𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑖𝑛 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑑𝑖𝑠𝑒𝑎𝑠𝑒

𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑏𝑒𝑖𝑛𝑔 𝑜𝑏𝑠𝑒𝑟𝑣𝑒𝑑

× 100,000 = 𝑅𝑎𝑡𝑒 𝑝𝑒𝑟 100,000

With these values we can see, for example,

that there was a rate of 573.3 per 100,000

people in the city of Cleveland in 2015 that

had a reported case of Gonorrhea. This

means that for every 100,000 people in the

population, approximately 573 people

mostly likely had Gonorrhea at some point

during the year.

All data collected was analyzed in SPSS

statistical software. The maps that

were shown throughout this report, were

mapped and analyzed with the use of GIS

(Geographic Information Systems) software

to help identify areas in the city that specific

disease showed to be more problematic than

others. There are 17 wards for Cleveland

and 34 neighborhoods, respectively.

Since it can be difficult to determine from

looking at one map, each of the higher

incidence diseases that were discussed

previously in the report have two maps to

see the differences between ward and

neighborhood. Any data that was provided

and the case had an address from outside of

the city of Cleveland was removed.

While sexually transmitted diseases are

shown to have the most significant results in

this study, they are not discussed in depth in

this report because they are annually

reported separately, but are included because

they are reportable infectious diseases. Data

for HIV/AIDS for 2015 is limited and is not

reflected in any ward or neighborhood

information.

Methods


While the data provided seems complete,

there is some missing data and

underreporting that needs to be handled for

this data to be absolutely accurate. With the

use of GIS, some cases were removed from

analysis because they were not able to be

plotted due to incomplete address

information.

There is also an issue of misclassification.

For example, time of infection that’s

reported by the patient could be inaccurate

and can be recorded differently for each

disease. Some disease incidence cases

reported in ODRS have the event date as the

first day of symptom onset while other

diseases and/or cases go by the date of

positive result from a lab from the patient’s

sample. This means that the information of

date and/or month of event could be skewed

per disease.

Underreporting continues to be an issue all

over the country due to public health and

healthcare professionals not fully

understanding protocols. Since each state

has different policies and still has to follow

the national protocols, reports slip through

the cracks. This is also an issue with

diseases who have similar, common

symptoms where individuals would not seek

out medical assistance in diagnoses.

Limitations


References:

1. Centers for Disease Control and Prevention. (2014, June 3). Campylobacter. In CDC, from

https://www.cdc.gov/foodsafety/diseases/campylobacter/index.html

2. Centers for Disease Control and Prevention. (2017, January 27). Hepatitis C FAQs for Health

Professionals. In CDC, from https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#a1

3. Centers for disease Control and Prevention. (2017, March 24). Influenza (Flu). In CDC, from

https://www.cdc.gov/flu/index.htm

4. Centers for Disease Control and Prevention. (2016, July 7). Legionella (Legionnaires Disease

and Pontiac Fever). In CDC, fromhttps://www.cdc.gov/legionella/index.html

5. Centers for Disease Control and Prevention. (2015, January 1). 2015 Nationally Notifiable

Infectious Diseases (Historical). In CDC, from

https://wwwn.cdc.gov/nndss/conditions/notifiable/2015/infectious-diseases/

6. Centers for Disease Control and Prevention. (2016, December 30). Salmonella. In CDC, from

https://www.cdc.gov/salmonella/

7. Centers for Disease Control and Prevention. (2010, November 2). Parasites – Scabies. In

CDC, from https://www.cdc.gov/parasites/scabies/

8. Centers for Disease Control and Prevention. (2016, October 14). Summary of Notifiable

Infectious Diseases and Conditions – United States, 2014. In CDC, from

https://www.cdc.gov/mmwr/volumes/63/wr/mm6354a1.htm

9. Cleveland Department of Public Health. (2017). About the Cleveland Department of Public

Health. In Cleveland Health, from http://clevelandhealth.org/about.php

10. Sexually Transmitted Disease Surveillance Program of the Ohio Department of Health.

(2017, January 11). Sexually Transmitted Diseases and Data Statistics. In Ohio, from

http://www.odh.ohio.gov/healthstats/disease/std/std1

11. United States Census Bureau. (2015). Cleveland Sex by Age Population Estimate for 2015. In

American Fact Finder, from

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_5

YR_B01001B&prodType=table

12. United States Census Bureau. (2015). U.S. Department of Commerce: Tables for Cleveland,

Ohio. In Census, from https://www.census.gov/quickfacts/table/PST045215/3916000

Appendix

https://wwwn.cdc.gov/nndss/conditions/notifiable/2015/infectious-diseases/

https://www.census.gov/quickfacts/table/PST045215/3916000

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