Publication of the Division of Public Health Services

July/August 2005, Vol. 19, No. 4

Save Hearts in Arizona Registry & Education
Sudden Cardiac Arrest: “How to Survive in '05”
Bentley J. Bobrow, Md FAAEM & Lani Clark

INCIDENCE
Heart disease is the number one
killer in the United States. Every day,
more than 2,600 Americans die from
cardiovascular disease, which is 1
death every 33 seconds.
Sudden out-of-hospital cardiac
arrest is the leading cause of death
and disability and a leading source of
health care cost in the United States.
However, unlike many other epidemics in health care, out-of-hospital
cardiac arrest caused by ventricular
fibrillation has an effective, proven
treatment called defibrillation.

PATHOPHYSIOLOGY
Most of these deaths from sudden
cardiac arrest occur with little or no
warning. The most common cause of
sudden cardiac arrest is a disturbance
in the heart rhythm called ventricular
fibrillation. Ventricular fibrillation (VF)
is a disorganized, chaotic heart rhythm
where the heart looses its ability to
effectively pump oxygen-carrying
blood to the brain and other vital
organs.
If the brain and heart do not
receive adequate blood flow, within a
few minutes they start to shut down
and cell death ensues. Specifically, if
blood flow is not immediately restored
to the brain, irreversible brain death
occurs.

For every minute that goes by
when a person remains in ventricular
fibrillation, the chances of resuscitation decrease by approximately 10%.
After 10 minutes, the chances of successful resuscitation are near zero.
In coronary care units, most people who experience ventricular fibrillation survive, because defibrillation is
performed almost immediately.
The situation is just the opposite
when cardiac arrest occurs outside a
hospital, unfortunately the more common setting. Unless defibrillation is
performed within the first few minutes
after the onset of ventricular fibrillation, the chances for reviving the person (resuscitation) are very poor. The
survival from out-of-hospital cardiac
arrest in many large urban cities is less
than 1%. However, some cities that
have put much time and energy into
public education on identifying cardiac arrest victims, bystander CPR,
and the use of Automated External
Defibrillators (AEDs) have documented greater success. In certain cities,
survival to hospital discharge for cardiac arrest victims presenting with
ventricular fibrillation has been as
high as 40%.
Cardiopulmonary resuscitation,
usually called CPR, provides temporary artificial breathing and circulation. It can deliver a limited amount

of blood and oxygen to the brain until
a defibrillator becomes available.
However, defibrillation is the only
effective way to resuscitate a victim of
ventricular fibrillation.

CHAIN OF SURVIVAL
CPR is one link in what the
American Heart Association calls the
Chain of Survival. The Chain of
Survival is a series of actions that,
when performed together, give the cardiac arrest victim the greatest chance
of survival.
✯ Early access: When an emergency
is recognized, the first link in the
Chain of Survival is early access.
This means activating the emergency medical services, or EMS,
system by calling 911. (“911”
does not work in every community. Be sure to check your local
directory, and know the correct
emergency telephone number in
your community.)
✯ CPR: The second link in the Chain
of Survival is to perform CPR until
a defibrillator becomes available.
✯ Early defibrillation: The third and
most critical link in the Chain of
Survival for a victim of ventricular
fibrillation is early defibrillation.
“Early” means up to 5 minutes
after collapse.
continued on page 2

Visit the ADHS Web site at www.azdhs.gov
Tularemia
Page 3

July/August 2005

Rubella
Page 4

Bordetella pertussis
On the Ropes
Page 5

Sun Safety
Page 6

Communicable
Disease Summary
Page 7

Prevention Bulletin

1

Sudden Cardiac Arrest: “How to Survive in '05”
✯ Early Advanced Life Support: The
last link in the Chain of Survival is
early advanced life support. This is
provided by experienced medical
personnel such as paramedics,
nurses, and doctors. Advanced life
support includes administering
medications and using advanced
oxygen delivery techniques to
resuscitate a person.

LACK OF BYSTANDERINITIATED CPR
In the absence or delay of early
defibrillation, bystander initiated chest
compressions is essential for improved
survival from cardiac arrest. A metaanalysis published in 1991 of 17 studies showed that individuals receiving
bystander CPR were 4.5 times more
likely to survive.
So why do we have such dismal survival rates?
The first problem contributing to
the dismal survival rates from of outof-hospital cardiac arrest is the lack of
bystander initiated CPR. Although the
majority of out-of-hospital cardiac
arrests are witnessed, only one in five
receive bystander CPR. However,
when surveyed on whether they
would perform chest compression
only CPR without mouth-to-mouth
ventilation, 68% of those surveyed
would do so. When asked why they
were reluctant to perform CPR, over
80% confided they were afraid of contracting an infectious disease.
Research in the swine model has
clearly shown that the most critical
component of cardiopulmonary resuscitation is properly done, forceful, fast
chest compressions. Chest compressions performed in this method result
in the highest cerebral perfusion pressure and the greatest survival rates.
The supreme importance of chest
compressions and minimizing their
interruptions in adult cardiac arrest
victims has lead many leading resuscitation experts to rename the old
maxim Airway, Breathing, Circulation
(ABC) to Circulation, Breathing,
Airway (CBA).
2

Prevention Bulletin

Additionally, the complexity of
current basic life support measures
with specific ratios of chest compressions and mouth breathing frequently
confuses potential rescuers. This confusion often results in bystanders
doing nothing due to fear of performing inadequately or in the wrong
sequence.
Current scientific evidence suggests that properly done continuous
chest compression only CPR is equally
if not more beneficial to adult cardiac
arrest victims. Additionally, chest
compression only CPR is far easier for
laypersons to learn, remember and
perform.
This, along with the real life fact
that most people are unwilling or
physically unable to do mouth to
mouth breathing, is the reason for the
SHARE Program decision to endorse
cardiac resuscitation algorithms incorporating continuous chest compression only CPR.

continued from page 1

are often the first to arrive at the scene
of a medical emergency, ahead of an
EMS unit.
◆ With this knowledge, some EMS
systems began to train and equip
police officers to provide defibrillation with AEDs.
◆ This allowed defibrillation to be
performed sooner, often before an
ambulance arrived.
◆ The use of AEDs by law enforcement personnel has begun to have
a significant impact in resuscitating victims of sudden cardiac
arrest.

AUTOMATED EXTERNAL
DEFIBRILLATORS

SHARE - SAVE HEARTS IN
ARIZONA REGISTRY &
In the mid-1980s, a new generation of computerized defibrillators was EDUCATION
introduced called Automated External
Defibrillators, or "AEDs" for short.
These devices were capable of interpreting a person's heart rhythm and
automatically delivering a defibrillation shock with only minimal input
from the operator. For the first time,
EMS personnel such as basic emergency medical technicians (EMTs)
were able to provide the life-saving
technique of defibrillation without
having to interpret ECG rhythms.
As AEDs began to be placed in
more and more "basic life support"
ambulances (those not staffed by more
advanced paramedics), the survival
rates for out-of-hospital cardiac arrest
began to rise. However, the problem
of getting the defibrillator to the victim
in less than 10 minutes remained a
challenge.
The next step in reducing the
amount of time it took to get a defibrillator to a cardiac arrest victim came
with the recognition that the police

The origins of the SHARE Program
are with Lani Clark at the University of
Arizona Sarver Heart Center as a
Regional Program. Clark's collaboration with Dr. Ben Bobrow in January
2005 resulted in the evolution of the
SHARE Program into a statewide initiative now under the direction of the
Bureau of Emergency Medical
Services at the Arizona Department of
Health Services.
The long-term goal of the SHARE
Program is for Arizonans to have the
highest survival rate in the world for
out-of-hospital cardiac arrest. The
Program has set out to attain that goal
with a diverse approach including:
1. Public education that seeks to
greatly advance the awareness of
the general public in recognizing
the signs and symptoms and
immediate actions to take in the
event of a cardiac arrest. Public
education is being done through
July/August 2005

Sudden Cardiac Arrest

2.

3.

4.

5.

6.

continued from page 2

community teaching, mass media, and via the SHARE
website at www.AZSHARE.GOV.
Working closely with EMS agencies, SHARE is scientifically
determining the most efficacious algorithms for prehospital
cardiac resuscitation. Nationally, some cities track their
cardiac arrest survival as a measure of their EMS Systems
efficiency; however Arizona is unique in its ability to do
this as a State. To accomplish this, SHARE maintains a
Statewide, secure registry of EMS data from cardiac arrest
victims and tracks cardiac arrest survivors for the rest of
their lives with a yearly quality of life survey.
SHARE has developed a registry of AEDs throughout
Arizona. SHARE provides training, QI measures, and the
required Medical Direction for private and public entities
to have AEDs.
This AED registry is yielding tremendous insight into who,
where, and how AEDs are being used in Arizona. The AED
registry also provides a method for contacting AED owners
in the case of an FDA recall or other issues of importance.
The SHARE Program seeks new and unique methods to
train first responders such as Police, Security Officers and
community response teams who may perform the lifesaving
defibrillation if on scene prior to EMS.
The Arizona Stroke Prehospital Identification Registry &
Education (ASPIRE) Program is a similar registry examining
the effects of the Phoenix Metropolitan Primary Stroke
Center Matrix on Stroke care in Arizona. The long-term
goal is to develop a plan to effectively deliver acute Stroke
care to Stroke victims across Arizona.

The SHARE Program is endorsed and developed by the
Arizona Department of Health Services, Bureau of Emergency
Medical Services (BEMS). The SHARE initiative promotes public
awareness, public education, data collection, and research of
cardiac arrest. Most of all, SHARE is designed to advance
research in Out of Hospital Cardiac Arrest (OHCA) and seek
new strategies to save lives.
Bentley J. Bobrow, MD FAAEM, is Medical Director, Bureau of Emergency
Medical Services and can be reached at 602.364.3154. Lani Clark is Research
and QI Director, Bureau of Emergency Medical Services.
References:
1. American Heart Association, International Liaison Committee on Resuscitation.
Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular
Care. Supplement to Circulation. 102. 2000:8.
2. American Heart Association, International Liaison Committee on Resuscitation
(ILCOR). Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care - an international consensus on science. Circulation. 2000;
102:I-1-I-370.
3. Kern K, Valenzuela T, Clark L, Berg R, et al. An alternative approach to advancing
resuscitation science. Resuscitation 64 (20050 261-268.
4. Cummins RO, Ornato JP, Thies WH, and Pepe PE. Improving survival from sudden
cardiac arrest: the “chain of survival” concept. A statement for health professionals
from the Advanced Cardiac Life Support Subcommittee and Emergency Cardiac
Care Committee, AHA. Circulation 1991; 83: 1832-1847.
5. Kern K, Hilwig R, Berg R, et al. The importance of continuous chest compressions
during CPR: Improved outcome during a simulated single lay rescuer scenario.
Circulation 2002; 105:645-9.
6. Berg R, Kern K, Sanders A. Bystander cardiopulmonary resuscitation: is ventilation
necessary? Circulation 1993; 88:1907-15.
July/August 2005

TULAREMIA

By Craig Levy

Two human cases of tularemia have been reported
in Arizona in 2005. The cases involved a mother and
son in Coconino County who became ill after skinning a tularemia infected rabbit. The mother
developed the ulceroglandular form of
tularemia (see below), whereas the boy
developed pharyngitis. Tularemia has
also been identified as the cause of illness in a pet cat in Yavapai County.
Tularemia (also known as rabbit
fever and deerfly fever) is a zoonotic
disease caused by the gram negative coccobacillus
Francisella tularensis. Incubation period varies from 1
to 14 days with an average of 3 to 5 days. In Arizona,
tularemia is transmitted to humans by direct contact
with blood and tissues of infected rabbits and rodents
(such as occurs during the skinning of game), or by
deerfly bite. In other parts of the country (especially
the Midwest) tularemia is transmitted by ticks. Less
common modes of transmission would include animal
bites, ingestion, and inhalation.
There are six clinical forms of tularemia which are
determined primarily by their route of inoculation.
1) The most common clinical presentation is ulceroglandular tularemia which occurs through direct
contact and insect bite exposures. Indolent ulcers
develop at the site of inoculation which is commonly on the hands of hunters or any exposed
skin surface in case of insect bite. Regional lymphadenopathy develops within a few days of
ulceration. Other symptoms include fever,
headache, chills and weakness. Bubonic plague
should be included in the differential diagnosis of
any patient who presents with these symptoms
and has animal or insect bite exposure.
2) The glandular form of tularemia is characterized
by lymphadenopathy and fever, but no skin ulcer.
3) Oropharyngeal tularemia is acquired through
ingestion of bacteria in meat or water and is characterized by severe pharyngitis, abdominal pain,
vomiting and diarrhea.
4) Oculoglandular infection may occur when bacteria are rubbed into the eyes, causing painful purulent conjunctivitis with regional lymphadenitis.
5) The typhoidal form may occur through inhalation
of aerosolized bacteria, or possibly through gastrointestinal or intradermal inoculation. It is characterized by fever, prostration and weight loss,
without lymphadenopathy. Pneumonia is often
associated with typhoidal tularemia, and radiographic evidence may show evidence of mediastinal lymphadenopathy.
6) The pleuropulmonary form is characterized by
pneumonia.
continued on page 6
Prevention Bulletin

3

Rubella--Not Gone But Often Forgotten
Karen Lewis, M.D.

Rubella is a viral disease that has
almost disappeared in the United
States since the rubella vaccine was
licensed in 1969. In 2004, there
were only nine rubella cases reported
in the United States. Arizona has not
had a reported case of rubella since
2000. However, a recent outbreak of
rubella in eastern Canada underscores the importance of continuing
to give rubella vaccine to children
and adults in Arizona.

Canadian outbreak 2005
In September 2004, cases of
rubella started to be seen in the
Netherlands in a group of people
opposed to vaccines. It is believed
that travel between the Netherlands
and Canada was the link that brought
rubella to Canada1. As of June 10,
2005, there have been 293 documented cases of rubella in southwestern Ontario, Canada. Seven of the
confirmed cases have been in pregnant women. All but one of the cases
were not immunized2.

Clinical presentation
Rubella can be difficult to diagnose clinically. Twenty-five to fifty
percent of cases are asymptomatically
infected. Patients infected with rubella are nontoxic. In children there is
usually not a prodrome. In adolescents and adults there may be a few
days of low grade fever and mild
upper respiratory symptoms. Then a

discrete maculopapular rash
starts on the face and travels
down the body. By the second
day, the rash begins to disappear
from the face. By the end of the
third day the rash has usually
disappeared. There may be
enlargement of the posterior
occipital, post auricular, and cervical lymph nodes.

Complications

Cataracts in a child’s eyes due to Congenital Rubella
Syndrome (CRS) Photo courtesy of CDC.

Rubella is a benign disease
unless a pregnant woman
becomes infected. Maternal rubella
during pregnancy can result in miscarriage, fetal death, and congenital
abnormalities
including microcephaly, mental
retardation, cataracts, glaucoma,
deafness, patent ductus arteriosus,
hepatosplenomegaly and purpuric
skin lesions.
During 1964 and 1965 a rubella
epidemic in the United States caused
an estimated 12.5 million cases of
rubella and 20,000 cases of congenital rubella syndrome (CRS) which led
to more than 11,600 babies born
deaf, 11,250 fetal deaths, 2,100
neonatal deaths, 3,580 babies born
blind and 1,800 babies born mentally
retarded3.

Vaccination

Rubella is prevented by vaccination. Although there is a monovalent
rubella vaccine
available, rubella
vaccination is usually given as part of a
combined vaccine
against measles,
mumps, and rubella
(MMR). The first
MMR is administered to children on
or after their first
birthday, with the
second dose usually
given between 4-6
years of age.
People born in
1957
or later should
"Blueberry muffin" skin lesions indicative of congenital rubella.

be considered susceptible to rubella
unless they have had at least one
dose of rubella vaccine or have serologic documentation of immunity.
Rubella vaccine is contraindicated in pregnant women. However,
the Centers for Disease Control and
Prevention evaluated hundreds of
infants born to women who did inadvertently receive rubella vaccine during pregnancy, and found that there
was no evidence of congenital abnormalities.

Serologic Diagnosis
The evaluation of a rash illness
for postnatally acquired rubella is
done by testing for rubella-specific
IgM and IgG. A positive IgG and a
negative IgM indicates immunity to
rubella, arguing against rubella as the
cause of the rash. A positive IgM and
a negative IgG is compatible with
acute rubella, although false positive
IgMs can occur. Acute rubella can
also be diagnosed by a four-fold rise
in IgG titer between acute and convalescent sera.
Karen Lewis, M.D. is the Medical Director,
Bureau of Epidemiology and Disease Control.

References:
(1) Eurosurveillance Weekly May 19, 2005. Rubella
outbreak in an unvaccinated religious community in
the Netherlands spreads to Canada.
(2) Public Health Agency of Canada. Infectious
Diseases News Brief. May 16, 2005 & June 20,
2005. Rubella: Ontario.
(3) CDC Press Release, March 21, 2005. Rubella
No Longer Major Public Health Treat in the United
States.

Photo courtesy of CDC.
4

Prevention Bulletin

July/August 2005

Bordetella pertussis On the Ropes
The vaccination tools are finally
here to put an end to the increase in
pertussis in the U.S. and Arizona. The
Food and Drug Administration (FDA)
approved two new vaccines to help
fight pertussis this spring. The
GlaxoSmithKline vaccine, called
Boostrix™ is approved for adolescents
from 10 to 18 years old. The sanofi
pasteur vaccine, called ADACEL™ is
approved for adolescents and adults
from 11 to 64 years old.
Pertussis immunity from the childhood vaccine series wears off within a
few years, and up until now, there has
been no vaccine for anybody over the
age of 6 years old to protect against
pertussis. As a result, adolescents and
adults have been susceptible to the
disease and have been transmitting the
disease to infants less than 6 months
of age, who represent 80% of the
deaths from pertussis.1
Despite high rates of pertussis vaccination among children less than 7
years old, pertussis cases in the U.S.
have increased from 1,248 in 1981 to
an annual average of 9,431 between
1996-2003.2 In 2003, there were
11,647 cases of pertussis, the highest
number reported since 1964.3
From January through June, more
than 500 cases of pertussis have been
reported in Arizona. Approximately
18% of the cases have been among
infants less than 1 year old.
Approximately 41% of the cases have
been in high school and middle
school students. Adults have represented approximately 25% of the pertussis cases. See Figure 1.
A study by Bisgard et.al. (2004)
found that family members were the
source of 75% of infant pertussis
infections. Of all of the sources of
infection with known age, 56% were
adults over 19 years old, 20% were
age 10-19, 17% were age 0-4 years
old, and 7% were age 5-9 years old.4
See Figure 2.
These new vaccines will help us
implement important public health
interventions that will put pertussis on
the ropes. First, we need to make sure
July/August 2005

Figure 1
that all family members and caregivers of
newborns are immunized with the new
pertussis booster vaccine prior to delivery.
Secondly, we need to
begin incorporating
the new vaccines into
the routine vaccination series for adolescents and adults as
soon as possible.
The new vaccines
contain acellular components of Bordetella
pertussis, diphtheria
Figure 2
toxoid, and tetanus
toxoid. Boostrix™ can
be used in adolescents
in place of tetanus and
diphtheria toxoids
(Td). ADACEL™ can
be used as a replacement for the current
Td booster with
administration every
10 years until age 64.
Adolescents 11 to 18
who have already
been vaccinated with
Td are encouraged to
receive a dose of Tdap
to further protect
against the pertussis.
The Arizona
Department of Health
Services has recently waived the
school entry Td booster requirement
for adolescents until October 31, 2005
in order to encourage the use of the
new vaccines for school entry.
These new pertussis booster shots
will become available through the
Vaccines for Children program as soon
as the Centers for Disease Control and
Prevention (CDC) concurs with the
new Advisory Committee on
Immunization Practices recommendations for these vaccines and the CDC
negotiates a price for the vaccines
with the manufacturer.
Once these new vaccines become
incorporated into routine vaccinations

Will Humble

for adolescents and adults we will be
on our way to eliminating another
infectious disease as a public health
hazard during your career.
1.

2.

3.
4.

Vitek, Pascual, Baugham, Murphy. Increase in
deaths from pertussis from young infants in the
United States in the 1990s, Pediar Infect Dis J.
2003:22:628:634.6.
CDC. Outbreaks of Pertussis Associated with
Hospitals- Kentucky, Pennsylvania, and Oregon,
2003. MMWR. 52 (3), 67-72.
CDC. Summary of Notifiable Diseases-United
States, 2003. MMWR. 52 (54), 1-85.
Bisgard KM, et.al. Infant Pertussis: Who Was the
Source? Pediatric Infectious Disease Journal. 2004;
23(11):985-989.

Will Humble is the Bureau Chief at can be reached
at 602.364.3855 or humblew@azdhs.gov.

Prevention Bulletin

5

Noteworthy
2005-2006 Influenza Season
Partnerships are key to success!
On August 5th, ADHS will invite
influenza vaccine providers and other
interested persons to attend a followup session to the Governor's Influenza
Vaccine Summit held in March. The
session will provide updates, perspective from last year's influenza season,
updates on this year's influenza vaccine supply, and discussion of strategies to vaccinate individuals at highest
risk of complications from influenza
(ie: children and the elderly), their
household contacts, and the health
care workers.
The Governor's Influenza Vaccine
Summit successfully brought together
vaccine providers, the Arizona
Department of Health Services, and
County Health Departments to form
partnerships to meet the needs of the

TULAREMIA

state and each community. This session will be a continuation of the first
meeting, providing the most recent
information to develop strategies for
the 2005-2006 influenza season.
If you would like to be invited,
please contact Judy Sorce-Bauman at
602.364.3638 or email
sorcej@azdhs.gov.

Sun Safety
Educators in all Arizona's K-8
public and charter schools will be
teaching children the importance of
sun safety, thanks to the Arizona
Department of Health's SunWise program and the state's new skin cancer
education law.
On August 13, educators will
begin incorporating the SunWise
School Program into their existing curriculum. Already, 650 of Arizona's
1,049 K-8 schools are enrolled in the

program. Passage of the bill will provide the remaining schools access to
the free program.
Sun safety is extremely important for Arizonans because our state
ranks No. 2 in the world in skin cancer incidence rates. (Australia is No.
1). Since 80 percent of a person's
lifetime exposure to the sun occurs
within the first 18 years, it's crucial to
protect and educate children to
reduce skin cancer rates.
Private schools can also register to
receive the free SunWise program but
are not required to teach it by law.
For more information, contact the
Arizona Department of Health
Services SunWise program at
www.azdhs.gov/phs/sunwise or program coordinator Sharon McKenna at
mckenns@azdhs.gov. An expanded
website and resources will be available on-line by August 1.

continued from page 3

Tularemia cases are relatively uncommon in Arizona with seven cases being reported during the last ten years
(1995-2004). To date, all of the human cases of tularemia in Arizona have been exposed in areas above 3,000 feet in
elevation, and as a consequence exposure risk is considered to be greater in the northern and eastern counties.
However, in year 2000 tularemia was identified as the cause of morbidity and mortality in certain animals in a
zoological park in Maricopa County. As a result, health providers cannot rule-out the potential for infection in lower
elevations. The strain of tularemia identified in the zoological park was type B or subsp. holarctica which is not the
endemic strain usually found in Arizona (type A or subsp. tularensis).
Tularemia is a reportable disease, and prompt reporting of suspect cases is strongly advised due to similarities of this
disease to plague and its potential for use as an agent of bioterrorism. Plague should be included in the differential diagnosis of Tularemia. Although infection Control measures are different for tularemia pneumonia (standard precautions) in
contrast to plague pneumonia (droplet precautions), it often takes several days to make a final diagnosis. Therefore, if
there is the concern of tularemia pneumonia, using droplet precautions until plague is excluded.
Laboratory diagnosis can be done by direct fluorescent antibody (DFA) test on lymph node aspirate or wound lesion,
and PCR can be done on whole blood or culture. Laboratory diagnosis can also be made serologically by demonstrating
a four-fold rise in specific antibody between acute and convalescent sera. F. tularensis can be cultured on special media
(ex. cysteine-glucose agar) from lesion or node aspirate material, or less likely from blood or sputum (depending on
|symptoms). Diagnostic support for serology and culture is available through the Arizona State Health Laboratory.
Antimicrobial choices for the treatment of tularemia are streptomycin, gentamicin, tetracyclines and chloramphenicol.
Tularemia infection can be prevented by doing the following:
1. Avoid direct contact with sick animals, especially rabbits.
2. Wear rubber gloves when skinning game.
3. Thoroughly cook wild game meat.
4. Avoid drinking untreated water.
5. Avoid bites from deerflies and ticks through proper use of insect repellents and protective clothing in areas where
vectors occur.
For more information on tularemia, contact Vector-Borne and Zoonotic Diseases Program staff at 602.364.4562.
Craig Levy is the Program Manager of the ADHS Vector-Borne and Zoonotic Diseases Program and can be reached at 602.364.4562 or
levyc@azdhs.gov.
6

Prevention Bulletin

July/August 2005

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

Jan - June
2004

5 Year Median
Jan - June

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

1 (0)
1
0
263 (129)
0 (0)

0 (0)
0
0
70 (39)
0 (0)

4 (1)
0
1
65 (39)
0 (0)

457
15
4
288
152

385
8
5
294
192

324
12
6
282
179

106
197
577
0
4,161 (1,663)

145
116
572
0
5, 674 (1,900)

169
92
572
4
4, 408 (1,922)

454
167
34
725
30

414
147
24
N/A
6

526
124
17
N/A
18

9,896
2,141
71 (12)

7,136
1,843
83 (23)

7,235
1,971
89 (13)

9 (0)
1,099

9 (2)
666

7 (0)
531

3
0
1
99

1
0
143
37

1
0
N/A
42

1,411
111
346
281

1,614
103
232
231

1,099
90
232
239

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 <90 days of age
Methicillin-resistant Staphylococcus aureus3
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
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:
Hantavirus Pulmonary Syndrome
Plague
West Nile virus Infection
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
1
2
3
4

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.
Based on animals submitted for rabies testing.
Data compiled by Offices of Infectious Disease and Office of HIV/AIDS Services

July/August 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
Susan Gerard, Director ADHS
Rose Conner, Assistant Director, Public Health Services
Contributors
Bentley J. Bobrow, Lani Clark, Will Humble, Craig Levy,
Karen Lewis, the Office of Infectious Disease Services,
the Arizona Immunization Program Office
and the 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.
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Prevention Bulletin

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July/August 2005