Publication of the Division of Public Health Services

March/April 2005, Vol. 19, No. 2

West Nile Virus Season is Upon Us Again
Victorio Vaz

Another season of
West Nile Virus (WNV)
and other mosquitoborne diseases is soon
approaching. At this
point it is difficult to
predict how serious
the 2005 season will
be. However, of concern is the excessive
rainfall from
December 2004
through February 2005
and the anticipated
precipitation in early
spring. Additionally, 2004 was
extremely dry and characterized by
below normal vector mosquito numbers in most areas. Thus, health officials throughout Arizona are gearingup for an earlier and possibly serious
WNV season. To that end, surveillance efforts will be initiated in March
to guide vector control efforts, especially through the use of larvicide
agents.
In 2004, 391 WNV cases were
reported in Arizona; of these, 15 were
fatal. Eleven of the 15 counties
reported human cases, with Maricopa
County accounting for 91% of the
cases. Patients’ ages ranged from 1
month to 99 years with a median of
52 years. The male to female ratio
was 1.08: 1. Case clinical presentations included: encephalitis (109),
meningitis (105), West Nile fever

(160), acute flaccid paralysis (2)
and unknown
(15). The earliest
onset of symptoms was in late
April, and the
last case had
onset in
November. The
outbreak peaked
in June and July
with 99 and 150
cases, respectively. In addition to
WNV, four cases of St. Louis
Encephalitis (SLE) were also reported,
three in Maricopa County and one in
Mohave County. The very dry summer
and the late/weak monsoon season
may have lessened the potential
impact of WNV in 2004.
Surveillance efforts are conducted
each year from March through
October to monitor and respond to
mosquito-borne virus activity.
Surveillance includes (1) mosquito
trapping and testing, (2) dead bird
testing, (3) sick horse testing, (4) sentinel chicken flocks and (5) human
case follow-up and testing. In 2004,
over 4,500 mosquito samples were
tested, of which 250 were WNV positive in 12 counties. Also positive
were 109 horses in 11 counties, 98
dead birds (out of 750 tested) in 12
counties, and 55 chickens from nine

sentinel flocks in 3 counties. WNV
activity was documented throughout
the state and will likely become a
problem yearly for Arizona.
WNV is a reportable condition in
Arizona by both physicians and laboratories. Ordering appropriate diagnostic tests and reporting cases of
arboviral disease is a vital part of the
surveillance program. Surveillance
data helps health officials to identify
areas/communities at higher risk for
disease and helps them to prioritize
and target vector control efforts.
Laboratory testing is available through
commercial laboratories or through
the Arizona State Health Laboratory
(ASHL). The ASHL currently performs
an IgM capture ELISA for WNV and
SLE. Testing can be performed on
serum or CSF. Specimens can be sent
to: Arizona State Health Laboratory,
Attn: Serology, 250 North 17th
Avenue, Phoenix, Arizona 85007
The following information must
accompany specimens: patient name,
age or date of birth, onset of symptoms, specimen collection date, primary symptoms/clinical picture and
contact information for submitting
physician.

Clinical Suspicion
Diagnosis of WNV infection is
based on a high index of clinical suspicion and specific laboratory tests.
Continued on page 2

Visit the ADHS Web site at www.azdhs.gov
Animal Bites &
Rabies:
Page 2 and Insert

March/April 2005

PEP for
Nonoccupational
Exposures (nPEP)
to HIV
Page 3

Hantavirus
Pulmonary
Syndrome in 2005
Page 4

Clusters of
“24-Hour Stomach
Flu” Now
Reportable in AZ
Page 5

Communicable
Disease
Summary
Page 7
Prevention Bulletin

1

West Nile Virus Season
•

•
•
•

continued from page 1

WNV, or other arboviral diseases such as SLE, should
be strongly considered in persons who develop
unexplained encephalitis or meningitis in summer or
early fall.
The local presence of WNV enzootic activity or other
human cases should further raise suspicion.
Travel and exposure history is also important.
Contact your local health department to report
suspect cases and inquire about laboratory testing.

Clinical Features of WNV infections
•
•

•
•
•
•

Approximately 70-80% of WNV infections are
clinically inapparent.
Approximately 20% of those infected develop West
Nile fever. West Nile fever can range from mild to
severe. West Nile fever can be characterized by sudden onset of fever often accompanied by one or more
of the following: malaise, headache, anorexia, nausea,
vomiting, eye pain, myalgia, maculopapular rash or
lymphadenopathy. Some symptoms may persist from
days to months.
Approximately 1 percent of infections will result in
neurological disease such as meningitis and/or
encephalitis.
The incubation period is thought to range from 3 to
14 days in immunocompetent individuals, and up to
21 days after organ transplantation.
The most significant risk factor for developing severe
neurological disease is advanced age.
In recent outbreaks, symptoms occurring among
patients hospitalized with severe disease included

fever, weakness, gastrointestinal symptoms and
change in mental status; also reported were severe
muscle weakness and flaccid paralysis, maculopapular or morbilliform rash involving neck, trunk, arms or
legs, ataxia and extrapyramidal signs, cranial nerve
abnormalities, myelitis, optic neuritis, polyradiculitis
and seizures.

Laboratory Findings Among Patients in
Recent Outbreaks
•

Total leukocyte counts in peripheral blood were
mostly normal or elevated, with lymphocytopenia
and anemia also occurring.
• Examination of the cerebrospinal fluid (CSF) showed
pleocytosis, usually with a predominance of
lymphocytes.
• Protein was universally elevated.
• Glucose was normal.
• Computed tomographic scans of the brain mostly did
not show evidence of acute disease, but in about
one-third of patients, magnetic resonance imaging
showed enhancement of the leptomeninges, the
periventricular areas, or both.
For more information on WNV surveillance in
Arizona, contact your local health department, or the
ADHS Vector-Borne Diseases Program staff at
602.364.4562.
For more information on West Nile Virus (WNV)
Infection Information for Clinicians visit the CDC web site
at www.cdc.gov/ncidod/dvbid/westnile/resources/
fact_sheet_clinician.htm

Animal Bites & Rabies: To Prophy or Not to Prophy?
While rabies in dogs and cats is uncommon in the United States, animal bites are not. Since
rabies is nearly 100% fatal, but exposure to rabies is rare, the decision of whether or not to provide
rabies post exposure prophylaxis (PEP) is not always straight forward. The inserted algorithm can be
used as a guide to help you decide on the best course of action. The most important factors in the decision process
are the type of animal involved, whether the animal is available for testing or quarantine, and how the exposure
occurred (provoked versus unprovoked).
In the United States, immunization of dogs and cats, effective prophylaxis and good animal control measures have
dramatically reduced the number of rabies cases in humans and companion animals. However, rabies in reservoir
wild animals (e.g., bats, skunks, foxes) is not as easy to control. Wildlife account for more than 90% of the 7,000+
animals reported each year with rabies nationwide. Exposure to rabid animals and other animals not available for testing results in an estimated 40,000 people receiving rabies PEP each year.
Bats, skunks, and foxes are the three reservoir species for rabies in Arizona. Bats are the most important source of
rabies exposure to both humans and domestic mammals in the United States and often pose the greatest challenges in
assessing exposure. Since 1985, only five dogs and eight cats in Arizona, most in rural areas, have been laboratory
confirmed as infected with rabies.
For statistics of animal rabies in Arizona, references on human rabies prevention, and other information, please
visit the Arizona Department of Health Services (ADHS) rabies home page at www.azdhs.gov/phs/oids/vector/rabies.
If you need assistance on risk assessment or established recommendations on rabies PEP for a patient, please call your
county health department or ADHS at 602.364.4562. Additionally, presentations on rabies exposure risk assessment
can be provided to your staff upon request. SEE INSERT
2

Prevention Bulletin

March/April 2005

PEP for Nonoccupational Exposures (nPEP) to HIV
by Karen Lewis, MD

New Recommendations

Counsel patients

Guidelines for postexposure prophylaxis (PEP) to HIV
exposure in occupational settings have been previously
published(1). The Center for Disease Control and
Prevention (CDC) has now published recommendations for
postexposure prophylaxis in nonoccupational exposures to
HIV (nPEP)(2).
Nonoccupational exposure is any direct mucosal, percutaneous, or intravenous contact with potentially infectious body fluids that occurs outside of perinatal or occupational situations. Potentially infectious body fluids are
blood, semen, vaginal secretions, rectal secretions, breast
milk, or other body fluid that is contaminated with visible
blood. Therefore, nPEP would be in response to HIV
exposure through situations such as sexual assault, consensual sexual activity, or sharing injection drug needles.

Side effects of antiretrovirals should be discussed with
patients. Adherence to 28 days of therapy can be challenging. Nausea (57%) and fatigue (38%) are common.
Antiemetics may be needed.
nPEP is not 100% effective. Patients need to be aware
of symptoms of acute retroviral syndrome, including fever
and rash. Patients should practice protective behaviors
with sex partners or drug-use partners during and after
nPEP.

CDC Recommendations (See Figure 1.)
CDC recommends the following approach in dealing with
a person with nonoccupational exposure to blood or
body fluids:
• If the source of blood or body fluid is known to be
HIV infected, start the exposed person on nPEP within
72 hours of exposure, and continue nPEP for 28 days.
• If there is no substantial risk of HIV infection in the
source person, or where an exposed person presents
> 72 hours after exposure, nPEP is not recommended
in most cases.
• If the source person’s HIV status is not known, CDC
has no recommendations. Decisions regarding nPEP
in such circumstances should be assessed on a
case-by-case basis.

Management pearls
Do not use nevirapine (Viramune®) for nPEP. The risk
of severe or fatal hepatitis is unacceptable for prophylactic
use.
Record HIV test results separate from the sexual assault
examination to protect the patient’s confidentiality, in the
event that medical records are later released for legal proceedings.
Additional details on nPEP is available in the January 21,
2005 Morbidity and Mortality Weekly Report(2).
1. CDC. Updated U.S. Public Health Service guidelines for the management of occupational
exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR
2001;50 (No. RR-11). www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm
2. CDC. Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other
Nonoccupational Exposure to HIV in the United States. MMWR 2005; 54 (No. RR02); 1-20.
www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm

Karen Lewis, M.D. is Medical Director for Epidemiology and Disease Control,
Arizona Department of Health Services. She can be reached at 602-364-4562 or
lewisk@azdhs.gov

Evaluation
Prior to deciding on nPEP, ask the potentially exposed
person about their own HIV status, the timing and characteristics of the most recent exposure, the frequency of past
exposures to HIV, the HIV status of the source, and the
likelihood of concomitant infection with other pathogens.
Obtain HIV serology at baseline, at 4-6 weeks, at 3
months, and at 6 months. Other bloodborne diseases
(hepatitis B, hepatitis C, other sexually transmitted diseases) and pregnancy also need to be considered.

Treatment
Start antiretroviral nPEP promptly for best chance of
success. Consider consulting specialists in HIV, obstetrics,
or pediatrics where appropriate. However, if these consultations are not immediately available, do not delay starting
nPEP. The nPEP medications can always be modified later.
The preferred regimens for nPEP are combinations of
three drugs. These are either:
1) [Efavirenz] + [lamivudine or emtricitabine] + [abacavir
or didanosine or stavudine], or,
2) [Lopinavir/ritonavir (Kaletra®)] + [lamivudine or emtricitabine] + [zidovudine]. Multiple alternate regimens
are also suggested in the new recommendations(2).
March/April 2005

Reference 2 is the source of Figure 1 algorithm.
Prevention Bulletin

3

Hantavirus Pulmonary Syndrome in 2005
Increased precipitation levels in Arizona this winter are
likely to increase the risk for hantavirus pulmonary syndrome (HPS) in 2005. In 1993, winter precipitation associated with El Nino and subsequent increases in wild mice
populations were associated with the first recognized HPS
outbreak in the United States in the Four Corners region.
Since then, HPS has been identified throughout the country with more than 380 cases reported to date. In Arizona,
39 cases were reported during the same period of time;
these, include two cases in 2004. Contrary to common
belief, HPS cases in Arizona are not limited to northern
Arizona. HPS cases have been reported in southern
Arizona counties too; but more importantly, evidence of
Sin Nombre Virus, the causative agent of HPS in
Arizona, infection in mice has been documented
throughout the state.
Although rare, HPS continues to be potentially deadly, as attested by a 36% case-fatality rate
among all cases reported to date in the United
States. People get infected with HPS by inhaling
aerosolized virus excreted from rodents in their urine, feces
and saliva. Deer mice and other related species appear to
be the major reservoir. Given the aerosol transmission of
the virus it is warranted to assess potential exposure of suspect cases to rodents or their nests or dropping.
The incubation period for HPS ranges from a few days
to six weeks. Prodromal symptoms commonly include
fever, myalgias, abdominal pain, nausea and vomiting.
Respiratory tract symptoms or signs are absent for the first
few days. The prodrome is then followed in 4-5 days
(range 1-10 days) by cough and dyspnea, which can
progress to pulmonary edema and severe hypoxemia within a few hours.
Initially, chest X-rays may reveal signs of interstitial
edema, similar to those seen with cardiogenic pulmonary
edema. These findings include Kerley B lines, hilar indistinctness and peribronchial cuffing. However, there are no
other radiographic stigmata of pulmonary venous hypertension such as LA, LV, or RV enlargement. As HPS progresses, alveolar flooding occurs in the basilar or perihilar
areas rather than the peripheral pattern typically seen with

ARDS. Pleural effusions are also seen as the disease progresses. Patients with HPS usually require admission to the
ICU along with hemodynamic monitoring. Laboratory
findings commonly include an elevated hematocrit, thrombocytopenia, and leukocytosis with a left shift. At least 10%
of lymphocytes are either immunoblasts or plasma cells.
Other possible etiologies should also be considered in
persons presenting with unexplained respiratory distress. If
a patient has unexplained high fever or painful adenopathy
and has a history of travel to northern or eastern Arizona,
plague should be suspected and reported to the state
health department immediately. Blood for bacterial culture should be obtained prior to administration of antibiotics. Blood will also be used for plague serology.
Depending on the clinical presentation, lymph
node aspirate and sputum samples for culture
may be warranted as well. Since 1993, at least
three plague cases with respiratory involvement
were admitted to hospitals in Arizona with an initial suspicion/diagnosis of HPS.
Other etiologies that have been identified in patients
initially suspected of having HPS, include bacterial pneumonia, necrotizing herpes pneumonia, meningococcal
sepsis, and coccidiodomycosis. HPS prodromal symptoms
are indistinguishable from influenza. The best way to differentiate HPS from influenza is to obtain a viral culture.
Other common respiratory viruses (e.g., parainfluenza, respiratory syncytial virus) may also mimic HPS prodromal
symptoms.
Serologic testing for HPS is available at the Arizona
State Health Laboratory (ASHL). Collect blood specimens
in a plain red top 10 ml tube. Do not use a tube with
serum separator. The State Health Laboratory will centrifuge the blood to separate serum and clot. Contact
Vector-Borne & Zoonotic Diseases (VBZD) Section staff at
602.364.4562 for HPS consultation and to arrange for laboratory testing. Specimens should be sent to: Arizona
State Health Laboratory, Attn: Serology, 250 North 17th
Avenue, Phoenix, Arizona 85007
For more information, contact Vector-Borne &
Zoonotic Diseases (VBZD) Section staff at 602.364.4562.

Hispanic Newborns Now Lead All Races in Arizona
by Timothy Flood, M.D.

Jose became the most popular
name for boys born in Arizona last
year, toppling the long-standing number one, Michael. The nomenclature
upset is indicative of a shift in the ethnicity of newborns that occurred in
2003. Arizona’s 2003 vital statistics
report shows that births to Hispanic
women now lead the other race/ethnic
groups.
In the Arizona data, births are
4

Prevention Bulletin

classified according to one of six categories of the mother’s race/ethnicity:
White non-Hispanic, Hispanic or
Latino, Black or African American,
American Indian or Alaska Native,
Asian or Pacific Islander, and
Other/Unknown.
As noted in the 2003 Report, and
for the first time in Arizona, the number of Hispanic newborns has exceeded the number of White Non-Hispanic

newborns. This finding extends the
trends of mothers’ race/ethnicity that
have been present during the past
decade (see Figure 1 on Page 8). It is
likely this pattern will become an
established trend in Arizona for the
foreseeable future.
Review of the underlying counts
and rates shows that the increase in
proportion of Hispanics is due to an
continued on page 8
March/April 2005

Clusters of “24-Hour Stomach Flu”
Now Reportable in Arizona
Graham Briggs

It has been called stomach flu,
calicivirus, a small round structured
virus, Norwalk, Norwalk-like virus,
and most recently norovirus. It has
been suggested that as many as 50%
of cases of gastroenteritis in the
United States are caused by it. It
can be easily transmitted through the
fecal-oral route, through food, water,
or through person-to-person contact.
A low infectious dose and ability to
survive in the environment for at
least 30 days contribute to the ease
of transmission and high attack rate
seen during outbreaks. Norovirus is
actually the genus name for a large
group of closely related singlestranded positive-sense RNA viruses
of the family Caliciviridae first recognized in 1968 in Norwalk, Ohio during an outbreak among schoolchildren. Most importantly for Arizona
residents, it is the most common lab
confirmed organism associated with
clusters of gastrointestinal illness in
the state.
Norovirus continues to solidify
its place at the top of the list as the
most commonly reported pathogen
associated with outbreaks in
Arizona. At least 26 of the 49 investigations of gastrointestinal clusters
conducted statewide in 2004 were
laboratory confirmed or suspected as
being caused by norovirus. Personto-person transmission was the most
common identified mode of transmission, however, numerous foodborne outbreaks were also identified,
often with secondary person-to-person spread.
Individuals afflicted with this “24
hour stomach flu” present to emergency departments with varying
symptoms including nausea, vomiting, diarrhea, dehydration, low grade
fever, sudden onset of acute symptoms, and often contact with an individual with similar symptoms in the
preceding 24-48 hours. While a single, sporadic case of norovirus is not
March/April 2005

a reportable condition in Arizona,
clusters of nausea, vomiting, and/or
diarrhea are now reportable to your
local health department.
The Arizona State Public Health
Laboratory has the ability to test
stool and emesis specimens for
norovirus to identify outbreaks.
Genetic sequencing is also being
performed on specimens that test
positive to determine epidemiological links and chains of infection. A
variety of strains or subtypes, which
are identified using sequencing,
were circulating in Arizona in 2004.
The dominant strain in Arizona in
2004 was first isolated in Great
Britain in 2002 and accounted for
over half of the laboratory confirmed
norovirus outbreaks reported in
2004. We also saw the introduction
of a new strain to Arizona, originally
identified in Japan. The first documented outbreak involving this strain
was traced back to an outbreak of
the same strain in Las Vegas. We
have since identified this strain
numerous times circulating in the

Phoenix area.
Education concerning transmission of norovirus is an important part
of preventing spread of this organism
in the community. We encourage
physicians to discuss routes of transmission, proper handwashing, good
hygiene, and decontamination of
potentially contaminated surfaces
and clothing with individuals suspected of having viral gastroenteritis,
particularly if there are young children in the household.
We would also encourage physicians to ask patients about ill contacts when sporadic cases of gastrointestinal illness present for treatment. Norovirus typically spreads
very easily from person to person
and a history of contact with individuals displaying similar symptoms
may be suggestive of norovirus.
Stool and/or vomitus specimens
should be collected from symptomatic individuals and may be forwarded to the Arizona State Health
Laboratory for testing if the patient is
suspected of being part of a cluster.
While testing cannot be performed
for single cases, please contact your
local health department or Graham
Briggs in the infectious disease epidemiology section at ADHS to discuss testing and investigation when a
cluster of gastrointestinal illness is
suspected.
Graham Briggs is an Epidemiologist for
Infectious Disease Epidemiology Section, Office
of Infectious Disease Services, Arizona Dept of
Health Services. He can be reached at
602.364.3669 or briggsg@azdhs.gov

May 8-14, 2005 is National Women's Health Week.
In Arizona we will offer Women's Check-up Day, May 9. If you
would like to provide a free screening on Check-up Day or
throughout Women's Health Week, ADHS will publish your
organization's contact information on the ADHS web site and
will submit your information to the U.S. Department of Health
and Human Services for publication on their web site. Please
contact Catherine Hannen, Program Manager Office of
Women's and Children's Health by Friday, April 15, 2005 at channen@azdhs.gov or
telephone: 602.364.1474 if you or your organization would like to participate.
Prevention Bulletin

5

Chlamydia Screening and Morbidity in Arizona, 1999-2004
Chlamydia is the most common
cause of preventable infertility(1).
Most of the infections are asymptomatic and may persist for months
without being noticed, particularly in
women. The primary risk factors for
chlamydia are age (under 25 years),
unprotected sex and history of multiple sex partners.
Due to its impact on the public’s
health it is critical to have effective
prevention and control strategies to
reduce morbidity and subsequent
complications associated with
Chlamydia trachomatis infections,
such as salpingitis, infertility an
increased risk for HIV infection. To
that end, the Arizona Department of
Health Services’ Sexually Transmitted
Disease (STD) Control Program in
close collaboration with the Arizona
Family Planning Council has
expanded chlamydia screening
efforts in family planning clinics,
STD clinics, correctional health facilities, and the Indian Health Service
through the Infertility Prevention
Project (IPP). As a result of the of
these chlamydia screening activities,
the number of cases identified in
Arizona has increased from 12,021
cases reported in 1999 to 16,825
cases in 2004. However, the
increasing trend is more a reflection
of better case finding rather than true
increases in morbidity. More importantly, this has resulted in early
detection and treatment of young
females, particularly in family planning clinics and juvenile detention
centers.
Chlamydia case rates in general
are 3 to 4 times higher in females
than males (Figure 1). This is due in
part to the increased chlamydia
screening in females consistent
with the Infertility Prevention
Project’s (IPP) recommended
screening guidelines (www.centerforhealthtraining.org). Similarly, differences in case rates by race/ethnicity could reflect screening practices
rather than differences in morbidity
(Figure 2).
6

Prevention Bulletin

by Asraf Lasee, MBBS, MPH, DRPPH

Figure 1

Chlamydia Case Rates per 100,000 Population by Gender,
Arizona, 1999-2004
(2004 rates are prelimnary, based on the 2003 population estimates)
500

459

422

400
382

300

385

418

100

118

354

200
106

100

120

138

98

0
1999

2000

2001

2002

Male

2003

2004

Female

IPP data for 2003 shows that
20% of all tested females in juvenile
detention centers were positive compared to 7.2% positive tests in males.
This indicates significant chlamydia
morbidity in young juvenile female
and male detainees. Moreover,
chlamydia positivity rates are very
high in adult detainees as well
(13%). Over 94% of all tests in family planning clinics in 2003 were
conducted on females and 5.4% of
them were positive, and about 15
percent of the male tests were positive.
Given its widespread prevalence
it is important to routinely screen
sexually active adolescent girls and
women under age 25 years who
have multiple or new partners,
and/or use barriers contraceptives

inconsistently. Please continue to
report chlamydia, syphilis, gonorrhea, and genital herpes to your
local health department within five
business days of diagnosis. To
receive communicable disease report
forms, please contact ADHS STD
Control program at 602.364.4666.
(1) Chlamydia accounts for one-quarter to
one-half of the 1 million recognized cases of
PID in the United States each year.
Approximately 20% women treated for PID
will be infertile; another 18% will experience
chronic pelvic pain resulting from infection,
and 6% will have an ectopic pregnancy. The
increased availability of more affordable, costeffective, laboratory diagnostic test for chlamydia has resulted in improved detection of this
serious communicable disease.
Asraf Lasee, MBBS, MPH, DrPH, is the STD
Program Manager at the Arizona Department
of Health Services and can be reached at 602
364.3661 or laseea@azdhs.gov

Figure 2

Race specific Case Rates for Chlamydia in female,
Arizona, 1999-2004
(2004 rates are prelimnary, based on the 2003 population estimates)
1600

1468

1400
1200
1000

1272
1173 979

1044
980

988

800
600

530

1335

1210

741

1027
752

902
679

716

564

549

400
200
0

147

115
1999

White

154
130
2000
Hispanic

179
159
2001

174
160
2002

African American

180
144

147
114
2003

2004

Native American

Asian

March/April 2005

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January, 2005)1, 2
January
2005

January
2004

5 Year Median
January

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis

0 (0)
1
0
14 (5)
0 (0)

0 (0)
0
0
8 (5)
0 (0)

1 (0)
0
0
8 (5)
0 (0)

70
0
1
56
32

36
2
0
56
30

36
2
1
48
32

21
33
114
0
744 (202)

24
10
64
0
813 (266)

25
14
63
1
632 (270)

76
36
7
81
1

77
13
2
N/A
1

91
13
2
N/A
5

1,612
356
11 (1)

1,788
514
12 (0)

1,083
305
13 (1)

N/A
171

0 (0)
86

0 (0)
70

0
0
0
13

0
0
0
7

0
0
0
7

222
2
83
45

295
1
32
37

294
5
32
28

VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B: acute
Hepatitis B: non-acute
Hepatitis C: acute
Hepatitis C: non-acute (confirmed to date)
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Methicillin-resistant Staphylococcus aureus3
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia5
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
West Nile virus
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies5
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
1
2
3
4
5

Data are provisional and reflect case reports during this period.
These counts reflect the year reported or tested and not the date infected.
MRSA was not reportable before October 2004.
The observed increase in Chlamydia morbidity in 2004 is due to data entry of reports from previous months.
Based on animals submitted for rabies testing.
Data compiled by Office of Infectious Disease and Office of HIV/AIDS Services

March/April 2005

Prevention Bulletin

7

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Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007
Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Contributors
Graham Briggs, Timothy Flood, Asraf Lasee, Karen Lewis,
Victorio Vaz and the Office of Infectious Disease Services
and Office of HIV/AIDS Services
Managing Editor: Mary Ehlert, M.S., ABC
e-mail: ehlertm@azdhs.gov

This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC).
Its contents do not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.364.1201 or 1.800.367.8939 (State TDD/TTY Relay).

Hispanic Newborns Now Lead All Races in Arizona
increase in urban compared to rural
Hispanic births, and relatively minimal
increase in the number of White nonHispanic births statewide. In addition,
the fertility rate among Hispanics
leads that of all races.(1)
These trends have important implications for the practice of medicine
and public health. Hispanic culture
will play an increasingly important
role in the delivery of health care. In
the short term, practitioners serving
the pediatric and maternal population
ought to increasingly recognize this
Hispanic shift. As many of these families speak Spanish as their primary
language, communication in Spanish
will become a valuable component of
medical practice.
In the long term, medical and
nursing practitioners will need to
become more prepared and attentive
to the diseases (e.g., diabetes) that are
more common among the Hispanic
population. It will be essential to
8

Prevention Bulletin

understand how pregnancy and disease are viewed within the Hispanic
culture. Customized public health
messages should be targeted in areas
where Hispanics are concentrated.

1 ADHS. Health Status and Vital Statistics,
2003. Chapter 1B: Natality www.azdhs.gov/plan

Figure 1

Resident live births by mother’s race/ethnic group, Arizona.
40

Thousand Live Births

continued from page 4

White non-Hispanic
30

Hispanic

20

10

American Indian
Black
Asian

0
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2003

March/April 2005