Inside

November-December, 2017 Volume 28, Number 6

Infectious Disease Epidemiology Main Webpage www.infectiousdisease.dhh.louisiana.gov

Office of Public Health - Infectious Disease Epidemiology SectionP.O. Box 60630, New Orleans, LA 70160 - Phone: (504) 568-8313

www.ldh.louisiana.gov/LMR

Rebekah e. Gee MD MPhSeCReTaRY

John bel eDwaRDS GoVeRnoR

Louisiana Morbidity Report

Louisiana Fact - Anniversary - 60 Years in Print .................... 2

A Rapid Overview of Reportable Communicable Diseases Louisiana, 2017 .................................................................. 2

Dr. Alean Frawley Interviewing Villagers in Kenya ............... 2

One-third of Children Aged 19 to 35 Months Are Not Up-To-Date with Age Appropriate Vaccinations - Louisiana, 2016 .................................................................. 3

STD Surveillance Update - Louisiana, 2016 ...........................4

Announcements: Updates, IDEpi Webpages .......................... 6

IDEpi Question/Answer Corner ............................................. 6

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In the summer of 2017, a nematode was found in fresh salmon purchased from a grocery store and reported to the Louisiana Department of Health’s Infectious Disease Epidemiology Section to be identified. The nematode was identified as Anisakis spe-cies, likely Anisakis simplex. This identification was performed for epidemiological and informational purposes, and this finding is not intended to be a diagnosis of any potential, actual or past human infection or parasitism. The parasite was destroyed in the process of identification. It is not entirely unexpected to discover Anisakis parasites in anadromous fish, like wild salmon, which hatch in freshwater, migrate to the sea, then return to freshwater (Figures 1 and 2).

Nematode Found in Grocery Fish - Louisiana, 2017

Raychel Berkheimer, MPH

The parasite is rarely found in farmed salmon, since the farmed fish are fed a controlled diet. Nevertheless, farmed salmon may sometimes contain the parasite. Eating undercooked wild salmon may result in Anisakiasis, a parasitic gastrointestinal infection. Humans are what is known as dead-end hosts, the larval stage is unable to survive or complete its life cycle in the human gut. These larvae will die within weeks, but while alive, the parasite can attack the gastrointesti-nal tract. Symptoms include abdominal pain, nausea, vomiting, diarrhea, blood in stool, and fever. Rarely, people can experience an allergic reaction including anaphylaxis. Diagnosis of Anisa-kiasis is done through radiography, endoscopy, or surgery. For most infections, treatment is not necessary because humans are

Infant botulism is a rare, but serious disease resulting from exposure to Clostridium botulinum spores. The spores grow in the intestines which then release the toxin in the body. The in-fant’s large intestine vulnerability to spore germination and toxin production is not fully understood, but disease appears to occur when the gastrointestinal flora transiently fails to competitively inhibit outgrowth of spores, (Long in the Pediatric Infectious Disease Journal, Vol. 26119, No. 3, ‘Infant Botulism and Treat-ment with BIG-IV (BabyBIG®’). Honey is the one identified and avoidable source of botulinum spores and should not be given to children younger than one year of age. However, in most cases, the precise source is not identi-fied. C. botulinum spores are found throughout the world in soil samples and marine sediment (the California Department of Pub-lic Health [CDPH]). The CDPH reports that the testing of many different foods, beverages and other items placed in infants' mouths with negative results suggests that most infant botulism patients ingested microscopic dust particles that carry the spores. Spores have been found in infant botulism patients’ immedi-ate surroundings including yard soil, and vacuum cleaner dust; disruption of soil by farming, new construction and wind likely transmits C. botulinum in dust particles (Long). The incubation period for infant botulism is three to 30 days; illness typically begins with constipation, followed by lethargy, poor feeding, loss of head control and generalized weakness,

Infant Botulism - the Importance of Prompt BabyBIG® Treatment

Jenna Iberg Johnson, MSPH

Figures 1 and 2: Fresh Salmon at Market

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Louisiana Morbidity ReportVolume 28, Number 6 November - December, 2017

The Louisiana Morbidity Report is published bimonthly by the LDH, OPH Infectious Disease Epidemiology Section to inform physicians, nurses, and public health professionals about disease trends and patterns in Louisiana. Address correspondence to Louisiana Morbidity Report, Infectious Disease Epidemiology Section, Louisiana Department of Health, P.O. Box 60630, New Orleans, LA 70160.

Assistant Parham Jaberi, MD, MPHSecretary OPH

State Epidemiologist Raoult Ratard, MD, MPH Editors Theresa Sokol, MPH Julie Hand, MSPH Rosemarie Robertson, BS, MT(C), CNMT

Louisiana Fact

Anniversary: 60 Years in Print

A Rapid Overview of Reportable Communicable DiseasesLouisiana, 2017

Details about numbers, incidence and trends for reportable communicable disease can be found as the ‘Several Year Com-parison Report’ at website http://new.dhh.louisiana.gov/index.cfm/page/536. The data from the past years are presented there with detailed analysis up to 2017. In 2017, the picture was similar to previous years. The largest numbers of reports were for hepatitis B chronic and hepatitis C past and present infections (5,961 reports). Therefore, it can be seen that there is still a large pool of previously unreported (very likely undiagnosed) cases of hepatitis C in the community. Gastrointestinal tract infections are the second most common group of infections: Salmonella and Shigella were fewer than in previous years (low 100s); Cryptosporidium and Giardia also had lower numbers; Campylobacter is definitely on the rise prob-ably due to increased identification through polymerase chain reaction.

There is no major numerical difference in invasive diseases such as MRSA, Strepococcal Groups A and B, and Streptococcal pneumonia. Vibrio infections have small numbers, but increasingly unusual species are recognized due to improved laboratory techniques. For the major vaccine-preventable diseases, the major event was a mumps outbreak with a total of 79 cases reported. Pertus-sis case numbers have slightly increased. Chickenpox is probably much more common than is reported. There are still no rubella or measles cases. Arboviral diseases are still of concern with 27 neuroinvasive cases of West Nile and three deaths. There has been no local transmission of Zika and only one imported Zika case reported. Influenza activity was higher than normal throughout 2017 and has continued to increase since the start of the 2017-2018 season in October.

Dr. Alean Frawley Interviewing Villagers in Kenya

Dr. Frawley is an Epi-demic Intelligence Service officer from the Centers for Disease Control and Prevention currently on a 2-year assignment to the Louisiana Department of Health’s Infectious Disease Epidemiology Program. She was called to Kenya in December to asisst with a Guinea worm disease project.

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LA Morbidity Report, Nov - Dec, 2017, Vol. 28, No.6

One-third of Children Aged 19 to 35 Months Are Not Up-To-Date with Age Appropriate Vaccinations: Louisiana, 2016

Nationally after many years of improving vaccine coverage, there have been small decreases of 1% to 2% for specific vac-cines from 2015 to 2016. However, estimates of vaccination coverage among Louisiana children 19 to 35 months of age has decreased four percentage points this past year. Louisiana does very well on kindergarten vaccination rates. From this, we can infer that parents and healthcare providers in Louisiana do want and do have their children vaccinated, just not “on time” when compared to national standards and other states. It is not a problem with vaccinating as such, but rather a problem with vaccinating on time. Children who are not vaccinated on time are not protected from vaccine-preventable diseases as soon as they become vulnerable. Louisiana, along with the rest of the United States, uses the National Immunization Survey (NIS) to help assess immuniza-tion rates. NIS identifies a critical benchmark as the combined seven (7) vaccine series coverage as the percentage of children 19 to 35 months of age who are up to date for the combined 4:3:1:3:3:1:4 vaccine series, which includes: - greater than or equal to four doses of DTaP; - greater than or equal to three doses of poliovirus vaccine; - greater than or equal to one dose of measles-containing vaccine; - full series of Hib (greater than or equal to three, or greater than or equal to four doses, depending on product type); - greater than or equal to three doses of HepB; - greater than or equal to one dose of VAR; and greater than or equal to four doses of PCV. The NIS data are intended to assist state and local health departments as they focus their immunization programs while be-ing able to see trends. The NIS is a telephone survey, which asks about “up-to-date” immunization status, and then verifies with providers a subset of the phone survey. Until the advent of the Immunization Registry, this was the gold standard in determining vaccination rates, especially for those critical groups such as our benchmark 19 to 35 month old children. The Centers for Disease Control and Prevention (CDC) is now moving towards assess-ing immunization rates using State internet information systems, LINKS, which tend to be more accurate. LINKS verification of NIS data is provided on the following Table. The Healthy People 2020 Target is 80%.

Table: Immunization Coverage Rates – NIS – National, Louisiana and LINKS, 2012-2016

The CDC’s Morbidity and Mortality Weekly Report of No-vember 3, 2017 included the report Vaccination Coverage Among Children Aged 19-35 Months and CDC’s ChildVaxView is reflect-ing this new data. Nationally, for most vaccines, 2016 coverage was lower among non-Hispanic black (black) children than among non-Hispanic white (white) children and for children living below the federal poverty level compared with those living at or above the poverty level. Vaccination coverage was generally lower among children insured by Medicaid (2.5%-12.0%), and was much lower among uninsured children (12.4%-24.9%), than among children with private insurance. Reasons given for not vaccinating on time can range from parent (fear of vaccine quantity/timing/spacing, lack of provider, lack of insurance, inability to get time off for appointments, lack of knowing vaccine was due), to provider (lack of awareness vac-cine is due, lack of recommendation, lack of “on time” vaccina-tion priority, not taking all available opportunities to vaccinate), to system issues (insurance coverage, clinic hours, payment, availability). The national Vaccines for Children (VFC) program was de-signed to increase access to vaccines among children who might not otherwise be vaccinated because of inability to pay. National recommendations, include efforts focused on minimizing breaks in continuity of health insurance and eliminating missed opportu-nities to vaccinate children during visits to health care providers. Awareness and facilitating increased use of VFC might be helpful in reducing these disparities. Louisiana’s approximately 740 VFC providers administered 1,182,070 doses of vaccine valued at $74,298,430.00 during the 2016 fiscal year. Prioritization for on-time vaccinations in ac-cordance with the Louisiana Immunization Schedule now needs to happen. The Louisiana Department of Health (LDH) Office of Public Health (OPH) worked with the Louisiana Chapter of the Ameri-can Academy of Pediatrics to develop Strategies for Increasing Immunization Coverage Rates. These evidence-based practices include an immunization champion, strong provider recommen-dations, reminder-recall, convenient clinic hours, avoiding missed opportunities, provider prompts, standing orders, informed staff and parents along with record management in LINKS. Please contact your OPH Regional Immunization Consultant or the OPH Immunization Program at 504-568-2600 or stacy.hall@la.gov if you have questions or would like further discussion.

Stacy Hall, RN MSN; Frank Welch, MD MSPH FACPM

NIS 7 Vaccine Series (4:3:1:3:3:1:4) Coverage Rates (%)

Year National Louisiana LINKS 2012 68.4 68.5 2013 70.4 69.1 2014 71.6 73.2 72.7 2015 72.2 70.8 71.2 2016 70.7 66.8 69.0

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(continued on page 5...)

STD Surveillance Update: Louisiana, 2016Catherine Desmarais, DrPH

Louisiana experiences some of the highest rates of sexually transmitted diseases (STD) in the nation. The Louisiana Department of Hospital’s, Office of Public Health, STD/HIV Surveillance Program (SHP) collects and analyzes data on cases of chlamydia, gonor-rhea, syphilis (all stages), and congenital syphilis. Louisiana’s Sanitary Code* mandates that all medical providers and laboratories report these STDs to SHP along with basic demographic and residence information. The majority of new cases are received through paper and electronic laboratory reporting. Cases are also provided directly from public health providers throughout the state (Table).

* Sanitary Code list on page 8

Table: Cases and Case Rates of STDs by Sex, Race, Age Group, and Region - Louisiana, 2016

The Chlamydia Epidemic in Louisiana Nationally in 2016, chlamydia was the most frequently reported disease to the Centers for Disease Control and Prevention (CDC), with the highest number of reports of a single disease ever. In the most recent CDC STD Surveillance Report, Louisiana ranked sec-ond in the nation for chlamydia case rates. In 2016, there were 31,727 cases of chlamydia diagnosed in Louisiana with a case rate of 677.7 per 100,000 population, which was substantially higher than the national case rate of 497.3 per 100,000 population (Figure 1).

Case Number Rate per 100,000 Case Number Rate per 100,000 Case Number Rate per 100,000TOTAL 31,727 677.7 10,783 230.3 750 16.0Reported Sex Female 22,942 959.0 5,494 229.7 192 8.0 Male 8,784 383.7 5,289 231.0 558 24.4 Unknown 1 - 0 - 0Reported Race/Ethnicity Black/African American 22,426 1,491.9 8,381 557.7 552 36.7 Hispanic/Latino 1,120 474.3 167 70.7 11 4.7 White 7,786 282.0 2,143 77.6 184 6.7 Other/Multi-race 318 - 70 - 3 - Unknown 319 - 22 - 0 -Age Group 0-9 19 3.1 9 1.4 0 0.0 10-14 318 104.3 93 30.5 2 0.7 15-19 10,106 3,336.0 2,675 883.0 104 34.3 20-24 11,914 3,644.0 3,747 1,146.1 201 61.5 25-29 5,275 1,512.1 1,962 562.4 165 47.3 30-34 2,256 677.9 987 296.6 94 28.2 35-39 989 324.5 559 183.4 73 24.0 40-44 362 134.3 250 92.8 36 13.4 45+ 485 25.9 501 26.8 75 4.0 Unknown 3 - 0 - 0 -Region 1-New Orleans 7,942 885.2 2,900 323.2 216 24.1 2-Baton Rouge 4,370 638.4 1,600 233.7 117 17.1 3-Houma 2,425 599.6 786 194.4 56 13.8 4-Lafayette 3,674 603.2 1,227 201.4 69 11.3 5-Lake Charles 1,376 456.4 428 142.0 21 7.0 6-Alexandria 2,066 675.7 660 215.9 30 9.8 7-Shreveport 4,023 740.3 1,194 219.7 148 27.2 8-Monroe 3,033 855.7 1,129 318.5 73 20.6 9-Hammond/Slidell 2,772 476.9 849 146.1 20 3.4 Unknown 46 - 10 - 0

Age at Diagnosis

P&S SyphilisGonorrheaChlamydia

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LA Morbidity Report, Nov - Dec, 2017, Vol. 28, No.6

STD ... continued from page 4)Figure 1: Chlamydia Case Rates - Louisiana and the United States, 2007-2016

The majority of new chlamydia cases were diagnosed among women between the ages of 15 to 24 years. Over 70% of cases with a reported race were diagnosed among Blacks. Louisiana has a targeted gonorrhea and chlamydia screening program in family planning clinics for women younger than 31 years of age, where the majority of cases are diagnosed and treated.

The Gonorrhea Epidemic in Louisiana In 2016, Louisiana ranked second in the nation for gonorrhea case rates. In 2016, there were 10,783 cases of gonorrhea diag-nosed in Louisiana with a case rate of 230.3 per 100,000 popula-tion. The gonorrhea case rate has increased in Louisiana from 2013 to 2016, and it has remained almost twice as high as the national rate of 145.8 per 100,000 population in 2016 (Figure 2).

Figure 2: Gonorrhea Case Rates - Louisiana and the United States, 2007-2016

The majority of new gonorrhea cases diagnosed in Louisiana in 2016 were among persons between the ages of 15 to 24 years. Females made up 51% of gonorrhea diagnoses. Almost 78% of cases with a reported race were diagnosed among Blacks.

The Syphilis Epidemic in Louisiana Since 2013, Louisiana has ranked first in the nation for primary and secondary (P&S) syphilis case rates. In 2016, there

were 750 cases of P&S syphilis diagnosed in Louisiana with a case rate of 16.0 per 100,000 population. From 2012 to 2016, Louisiana’s case rate has more than doubled. The P&S syphilis rate in Louisiana is nearly twice as high as the national rate (8.7 per 100,000 population) (Figure 3).

Figure 3: Primary and Secondary Syphilis Case Rates - Louisiana and the United States, 2007-2016

In 2016, new diagnoses of primary and secondary syphilis occurred in 55 of Louisiana’s 64 parishes. The New Orleans region had the highest number of new diagnoses (216 cases). The Shreveport region had the second highest number of new dianoses (148 cases), followed by the East Baton Rouge region (117 cases). The majority of the newly diagnosed syphilis cases in Louisi-ana were among Blacks. Although Blacks make up only 32% of Louisiana’s population, almost 74% of all new syphilis diagnoses were among this population. The majority of new syphilis cases were diagnosed in persons between the ages of 15 to 29 years.

The Congenital Syphilis Epidemic in Louisiana In 2016, there were 48 cases of congenital syphilis reported from Louisiana. Louisiana ranked first in the nation for con-genital syphilis rates, with a rate of 75.2 per 100,000 live births. More than half of all congenital syphilis cases in 2016 were born in the East Baton Rouge and Monroe regions, and an additional 19% were born in the Shreveport region. Over 70% of mothers of congenital syphilis cases were younger than 25 years of age. Approximately 85% of the mothers of congenital syphilis cases were Black. The SHP office regularly reports and publishes data on web-sites www.std.dhh.louisiana.gov and www.HIV411.org. For more information, please contact Jessica Fridge at (504) 568-5566 or jessica.fridge@la.gov.

World Leprosy Week January 28 - February 3, 2018

International Prenatal Infection Prevention Month February

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LA Morbidity Report, Nov - Dec, 2017, Vol. 28, No.6

difficulty swallowing, and sometimes, respiratory insufficiency and arrest, due to the botulinum toxin blocking neuromuscular transmission. There are seven toxin types (A through G), how-ever almost all infant botulism cases are caused by type A or B. Between 80 and 110 infant botulism cases are hospitalized annu-ally; zero to three cases a year are reported in Louisiana (Arnon in Pediatrics, Vol. 119, No. 4, ‘Creation and Development of the Public Service Orphan Drug Human Botulism Immune Globu-lin’) Prompt treatment of infant botulism with BabyBIG® as soon as clinical diagnosis is made is the current standard of care, and treatment should not be delayed for confirmatory testing. BabyBIG®, an orphan drug created by the CDPH in 1991 to treat infant botulism types A and B, is derived from pooled plasma of immunized adult volunteers which neutralizes free toxin. Studies have shown that treatment within 72 hours of hospitalization is more effective than at four to seven days of hospitalization; however, late treatment remains more effective than no treatment (Long).

(Nematode ... continued from page 1)

(Infant Botulism ... continued from page 1)

Updates: Infectious Disease Epidemiology (IDEpi) Webpageswww.infectiousdisease.dhh.louisiana.gov

Annual: Amebiasis; Babesiosis; Diphtheria; Gullain Barre; Hantavirus; Hepatitis B; Histoplasmosis; Malaria; Meningococcal Invasive; Mumps; Norovirus; Pertussis; Respiratory Syncytial Virus (RSV); Several Year Comparison 2015-2017; Shigella; Streptococcal Invasive Group A (GAS); Tetanus; Trichinosis; Vancomycin Resistant Enterococcus (VRE); Viral (Aseptic) Meningitis

Arboviral: Arbovirus Collection and Shipping Information; Zika Testing Guidelines Reference

Epi Manual: Chagas Disease Info (CDC); Chagas Disease Report Form;

Announcements

a dead-end host. However, treatment with albendazole has been successful or for a severe infection the parasite can be surgically removed. Anisakiasis is most common in Japan and other areas where consuming raw fish is prevalent. Cooking or freezing (according to strict guidelines used in su-shi preparation) will destroy this nematode. Wild caught salmon that is not “sushi grade” is inspected for the presence of the para-site, however the fish should never be assumed to be parasite-free. It is strongly recommended to cook all salmon thoroughly and

As of 2007, use of BabyBIG® had resulted in more than 30 years of avoided hospital stay and more than $50 million (2005 dollars) of avoided hospital costs. In a statewide clinical trial in California, treatment shortened the mean hospital stay from 5.7 to 2.6 weeks; reduced mean hospital charges by $88,600 (2004 dollars) per patient; the mean duration of intensive care was short-ened by 3.2 weeks; the mean duration of mechanical ventilation was reduced by 2.6 weeks; and mean duration of tube or intrave-nous feeding was shortened by 6.4 weeks (Arnon). BabyBIG® must be obtained through the CDPH Infant Botu-lism Treatment and Prevention Program [(510) 231-7600, www.infantbotulism.org]. Release of BabyBIG® requires physician-to-CDPH physician contact, minimal clinical paperwork, and sig-nature of the institutional financial officer. BabyBIG® is express-shipped from one of two warehouses and is given as a single dose. The cost of treatment is $45,300 to cover production and program costs; however, this amount should be fully refundable by insurance as treatment with BabyBIG® is the standard of care. For more information, please contact Jenna Iberg Johnson at (504) 568-8312 or email jenna.ibergjohnson@la.gov.

assume the fish may contain parasites. Another preventive step is to freeze all parts of fresh salmon at -35°C (-31°F) until solid and then for a minimum of 24 hours at a temperature of -20°C (-4°F)or colder. Cooking to an internal temperature of greater than 63°C (145°F) for two minutes will also kill the parasite. Again, fresh or frozen wild caught salmon should never be assumed to be free of Anisakis parasites, unless the fish has been prepared under the strict guidelines specified for salmon intended to be eaten raw. For more information, please contact Rachel Berkheimer at (504) 568-8307 or raychel.berkheimer@la.gov.

Clostridium difficileFungal/Mycotic Diseases: New WebpageHAI: Healthcare-Associated Infections, Antibiotic Resistance, and

Emerging Infectious Diseases Workshop-November 2, 2017; October 2017 Newsletter: Antibiotic Stewardship Edition; November 2017 Newsletter: Nursing Home Edition

Influenza: Weekly ReportParasitic Vector-borne Diseases: (New webpage) Tulane University

Triatomine Bug Submission InstructionsReportable Disease Surveillance: IDRIS 2 External User ManualSchool Resources: Don’t Let Ticks Bite Me - Crossword Puzzle and

Comic (CDC)Tickborne Diseases: New webpage

IDEpi Question/Answer Corner What is the Secure Fax Form required by the Louisiana De-partment of Health (LDH) Laboratory?

A Secure Fax Form, is required to be on file at the LDH Labo-ratory prior to faxed result release to a provider. Because confi-dential patient medical information is being transferred to a facil-ity in a facsimile transmission, the receiving fax machine must be verified as being in a secure location, as well as a requirement

that the fax number be verified. Signing the Secure Fax Form constitutes the provider’s representation that the facsimile machine identified for receiving electronic transmission of patient test results is in a non-public and confidential area and that the provider agrees to advise the LDH Laboratory prior to facsimile number changes. If, once a specimen arrives from a submitter, it is determined to be from a new facility (no Secure Fax Form on file), the LDH laboratory will contact the submitter and provide one for comple-tion.

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LA Morbidity Report, Nov - Dec, 2017, Vol. 28, No.6

Figure: Department of Health Regional Map

Table 1: Communicable Disease Surveillance, Incidence by Region and Time Period, September-October, 2017

TIME PERIOD Jan-Dec Jan-Dec Jan-Dec

DISEASE 1 2 3 4 5 6 7 8 9 Sep-Oct Sep-Oct Cum Cum %2017 2016 2017 2016 Chg*

Vaccine-preventable Hepatitis B Cases 3 2 1 0 0 0 0 0 6 12 5 78 43 81.4

Rate1 0.3 0.4 0.3 0 0 0 0 0 1.6 0.3 0.1 1.8 1.0 NA* Measles 0 0 0 0 0 0 0 0 0 0 0 0 0 NA* Mumps 0 1 0 0 0 0 0 0 0 1 1 53 1 5200Rubella 0 0 0 0 0 0 0 0 0 0 0 0 0 NA* Pertussis 1 0 0 0 2 0 0 0 0 3 9 54 46 17.4

Sexually-transmittedHIV/AIDS Cases2 69 39 8 17 10 9 22 11 15 200 174 1018 947 7.5

Rate1 7.7 5.7 2.0 2.8 3.3 2.9 4.0 3.1 2.6 4.3 3.7 21.7 20.3 NA*Chlamydia Cases1,3 1,305 873 411 546 210 294 754 510 444 5,424 5,968 29,084 26,947 7.9

Rate1 145.5 127.5 101.6 89.6 69.7 96.2 138.7 143.9 76.4 120.1 127.5 621.2 575.6 NA*Gonorrhea Cases1,3 558 305 121 184 75 116 296 179 108 1,950 2,005 9,981 9,161 9

Rate1 62.2 44.6 29.9 30.2 24.9 37.9 54.5 50.5 18.6 41.7 42.8 213.2 195.7 NA*Syphilis (P&S) Cases1,3 32 23 7 5 6 7 12 18 6 116 181 567 657 -13.7

Rate1 3.6 3.4 1.7 0.8 2.0 2.3 2.2 5.1 1.0 2.5 3.9 12.1 14.0 NA*EntericCampylobacter Cases 3 10 3 2 1 9 6 6 8 48 54 302 231 30.7Hepatitis A Cases 1 0 0 0 0 0 0 0 0 1 2 8 11 NA*

Rate1 0.1 0 0 0 0 0 0 0 0 0 0 0.2 0.3 NA*Salmonella Cases 21 22 22 35 28 15 11 49 35 238 332 848 1178 -28.0

Rate1 2.0 3.9 5.8 6.8 10.4 4.9 2.2 14.0 9.1 5.5 7.7 19.7 27.3 NA*Shigella Cases 1 1 0 2 12 1 0 3 3 23 66 149 321 -53.6

Rate1 0.1 0.2 0 0.4 4.5 0.3 0 0.9 0.8 0.5 1.5 3.5 7.4 NA*Vibrio, cholera Cases 0 0 0 0 0 0 0 0 0 0 0 0 0 NA*Vibrio, other Cases 4 3 0 3 0 0 0 0 1 11 8 54 43 25.6OtherH. influenzae (other) 0 2 1 0 1 1 1 0 0 6 7 49 45 NA*N. Meningitidis 0 0 0 0 1 1 0 0 0 2 0 5 2 NA*1 = Cases Per 100 000 Population.

2 = These totals reflect people w ith HIV infection w hose status w as f irst detected during the specif ied time period. This includes people w ho w ere diagnosed w ith AIDS at the time HIV f irst w as detected. Because of delays in reporting HIV/AIDS cases, the number of persons reported is a minimal estimate. Data should be considered provisional.

3 = Prelminary data.

* = Percent change not calculated for rates or count differences less than 5.

Table 2: Diseases of Low Frequency, January-December, 2017Disease Total to DateLegionellosis 38Lyme Disease 6Malaria 9Rabies, animal 13 Varicella 53

Table 3: Animal Rabies, September - October, 2017Parish No. Cases

Species

HEALTH REGION

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Sanitary Code - State of Louisiana Part II - The Control of Disease

LAC 51:II.105: The following diseases/conditions are hereby declared reportable with reporting requirements by Class:

Class A Diseases/Conditions - Reporting Required Within 24 HoursDiseases of major public health concern because of the severity of disease and potential for epidemic spread-report by telephone immediately upon recognition that a case, a suspected case, or a positive laboratory result is known; [in addition, all cases of rare or exotic communicable diseases, unexplained death, unusual cluster of disease and all outbreaks shall be reported.

Acute Flaccid Paralysis Fish/Shellfish Poisoning (domoic acid, neurotoxic Plague (Yersinia pestis) Smallpox Anthrax shellfish poisoning, ciguatera, paralytic shellfish Poliomyelitis (paralytic & non-paralytic) Staphylococcus aureus, Vancomycin Avian or Novel Strain Influenza A poisoning, scombroid) Q Fever (Coxiella burnetii) Intermediate or Resistant (VISA/VRSA) (initial detection) Foodborne Infection Rabies (animal and human) Staphylococcal Enterotoxin B (SEB) Pulmonary Botulism Haemophilus influenzae (invasive infection) Ricin Poisoning Poisoning Brucellosis Influenza-associated Mortality Rubella (congenital syndrome) Tularemia (Francisella tularensis) Cholera Measles (Rubeola imported or indigenous) Rubella (German Measles) Viral Hemorrhagic Fever (Ebola, Lassa, Marburg, Clostridium perfringens Neisseria meningitidis (invasive infection) Severe Acute Respiratory Syndrome- Crimean Congo, etc.) (foodborne infection) Outbreaks of Any Infectious Disease associated Coronavirus (SARS-CoV) Yellow Fever Diphtheria Pertussis Class B Diseases/Conditions - Reporting Required Within 1 Business DayDiseases of public health concern needing timely response because of potential of 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.

Amoeba (free living infection: Acanthamoeba, Chagas Disease Hepatitis B (perinatal infection) Mumps Naegleria, Balamuthia, others) Chancroid Hepatitis E Salmonellosis Anaplasmosis Escherichia coli, Shiga-toxin producing Herpes (neonatal) Shigellosis Arthropod-Borne Viral Infections (West Nile, (STEC), including E. coli O157:H7 Human Immunodeficiency Virus2 [(HIV), Syphilis¹ Dengue, St, Louis, California, Eastern Granuloma Inguinale infection in pregnancy] Tetanus Equine, Western Equine, Chikungunya, Hantavirus (infection or Pulmonary Syndrome) Human Immunodeficiency Virus2 [(HIV), Tuberculosis3 (due to M. tuberculosis, Usutu, and others) Hemolytic-Uremic Syndrome perinatal exposure] M. bovis, or M. africanum) Aseptic Meningitis Hepatitis A (acute illness) Legionellosis Typhoid Fever Babesiosis Hepatitis B (acute illness and carriage in pregnancy) Malaria Class C Diseases/Conditions - Reporting Required Within 5 Business DaysDiseases of significant public health concern-report by the end of the workweek after the existence of a case, suspected case, or a positive laboratory result is known.

Acquired Immune Deficiency Giardiasis Listeriosis Staphylococcal Toxic Shock Syndrome Syndrome3 (AIDS) Glanders (Burkholderia mallei) Lyme Disease Streptococcal Disease, Group A (invasive Anaplasma Phagocytophilum Gonorrhea¹ (genital, oral, ophthalmic, pelvic Lymphogranuloma Venereum1 disease) Blastomycosis inflammatory disease, rectal) Melioidosis (Burkholderia pseudomallei) Streptococcal Disease, Group B (invasive Campylobacteriosis Hansen’s Disease (leprosy) Meningitis, Eosinophilic (including disease) Chlamydial infection¹ Hepatitis C (acute illness) those due to Angiostrongylus infection) Streptococcal Toxic Shock Syndrome Coccidioidomycosis Histoplasmosis Nipah Virus Infection Streptococcus pneumoniae, invasive disease Cryptococcosis (C. neoformans and C. gattii) Human Immunodeficiency Virus2 (HIV Non-gonococcal Urethritis Transmissible Spongiform Encephalopathies Cryptosporidiosis (infection other than as in Class B) Ophthalmia neonatorum (Creutzfeldt-Jacob Disease & variants) Cyclosporiasis Human T Lymphocyte Virus (HTLV Psittacosis Trichinosis Ehrlichiosis (human granulocytic, human I and II infection) Spotted Fevers [Rickettsia species including Varicella (chickenpox) monocytic, E. chaffeensis and E. ewingii) Leptospirosis Rocky Mountain Spotted Fever (RMSF)] Vibrio Infections (other than cholera) Enterococcus, Vancomycin Resistant Staphylococcus aureus (MRSA), invasive infection Yersiniosis [(VRE), invasive disease]

Class D Diseases/Conditions - Reporting Required Within 5 Business Days

Cancer Heavy Metal (arsenic, cadmium, mercury) Phenylketonuria4 Severe Traumatic Head Injury Carbon Monoxide Exposure and/or Poisoning5 Exposure and/or Poisoning (all ages)5 Pneumoconiosis (asbestosis, berylliosis, silicosis, Severe Undernutrition (severe anemia, failure to Complications of Abortion Hemophilia4 byssinosis, etc.) thrive) Congenital Hypothyroidism4 Lead Exposure and/or Poisoning (all ages)4, 5 Radiation Exposure, Over Normal Limits Sickle Cell Disease4 (newborns) Galactosemia4 Pesticide-Related Illness or Injury (all ages)5 Reye’s Syndrome Spinal Cord Injury Sudden Infant Death Syndrome (SIDS) Case reports not requiring special reporting instructions (see below) can be reported by mail or facsimile on Confidential Disease Report forms (2430), fascimile (504) 568-8290, telephone (504) 568-8313, or (800) 256-2748 for forms and instructions.¹Report on STD-43 form. Report cases of syphilis with active lesions by telephone, within one business day, to (504) 568-8374.²Report to the Louisiana HIV/AIDS Program: Visit www.hiv.dhh.louisiana.gov or call 504-568-7474 for regional contact information.3Report on form TB 2431 (8/94). Mail form to TB Control Program, DHH-OPH, P.O. Box 60630, New Orleans, LA. 70160-0630 or fax both sides of the form to (504) 568-5016 4Report to the Louisiana Genetic Diseases Program and Louisiana Childhood Lead Poisoning Prevention Programs: www.genetics.dhh.louisiana.gov or fascimile (504) 568-8253, telephone (504) 568-8254, or (800) 242-31125Report to the Section of Environmental Epidemiology and Toxicology: www.seet.dhh.louisiana.gov or call (225) 342-7136 or (888) 293-7020

All laboratory facilities shall, in addition to reporting tests indicative of conditions found in §105, report positive or suggestive results for additional conditions of public health interest. The following findings shall be reported as detected by laboratory facilities: 1. adenoviruses; 2. coronaviruses; 3 .enteroviruses; 4. hepatitis B (carriage other than in pregnancy); 5. hepatitis C (past or present infection ); 6. human metapneumovirus; 7. parainfluenza viruses; 8. respiratory syncytial virus; and 9. rhinoviruses.