Publication of the Bureau of Epidemiology & Disease Control Services

March/April 2003, Vol. 17, No. 2

Top Infectious Disease News: 2002 in Review
By Victorio Vaz, D.V.M., Ph.D

ACROSS THE NATION
◆ Bioterrorism
was the big
infectious disease issue
again in
2002. The terrorist attack
in the fall of
2001 followed by the threat posed
by the release of B. anthracis highlighted the concerns about the
public health system’s vulnerability to bioterrorist attacks.
Consequently, this awareness
was translated into new federal
investments into the nation’s public health system. The infusion of
funds in 2002 partially reversed
the trend of decades of underfunded public health infrastructures. Many issues were part of
the national agenda for bioterrorism preparedness, but the need to
formulate a plan to address the
potential threat of smallpox as a
biological agent and the ensuing
debate about “who to vaccinate
and when” were by far the most
unique and challenging topics of
discussion among government
and public health officials, medical providers, first responders and
the public. For more information
visit www.bt.cdc.gov.

◆ Another important emerging infectious disease in 2002 was West
Nile Virus (WNV) with its rapid
geographic expansion throughout
most of the country.
More than 3,800 cases
were reported nationwide as of December
31, 2002 compared to
62 cases in 1999, 21 in 2000 and
66 in 2001. This large outbreak in
2002 included approximately 250
deaths. For the first time, transmission via WNV blood products was
confirmed. Most importantly,
WNV has established itself permanently in the United States. See
related article on page 3.
◆ New hand hygiene guidelines
were developed
by the Centers
for Disease
Control and
Prevention
(CDC) advocating the use of
alcohol-based
hand rubs before and after contact
with a patient as the preferred
method of hand decontamination.
For the first time, CDC recommends the use of alcohol-based
hand rubs. Use of these products
takes less time, is more convenient to use, is effective and causes

less irritation than washing the
hands with soap and water. Given
the difficulties in adherence to
regular hand washing practices,
better acceptance of the new
requirements are hoped for, thus
reducing the nosocomial infection
rates in healthcare facilities.
www.cdc.gov/handhygiene
◆ Growing public concerns about
vaccine safety issues led to further
assessments by the
Institute of
Medicine’s (IOM)
Immunization Safety
Review Committee in
2002. Based on the
review of published scientific evidence, the
panel again reiterated the
lack of evidence associating vaccines with health issues such as
Type 1 diabetes, certain infections
such as pneumonia and meningitis, and autism. Unfortunately, on
other fronts the panel was unable
to find sufficient data to conclude
whether or not some of the polio
vaccine administered from 19551963, which was contaminated
with the simian virus 40 (SV40),
may have caused cancer. Polio
vaccines being used today do not
contain SV40. www.iom.edu
Continued on page 2

Visit the ADHS Web site at www.hs.state.az.us
Preparing for WNV
in AZ
Page 3

March/April 2003

New Targeted Screening Plan for
Preventing Childhood Lead Poisoning
Pages 4-5

Noteworthy
information
Page 6

Summary Chart
of Reportable
Diseases
Page 7
Prevention Bulletin

1

Top Infectious Disease News
◆ New national guidelines designed
to help health care providers protect patients from the health consequences of sexually transmitted
diseases (STDs) were released.
The 2002 Guidelines for the
Treatment of Sexually Transmitted
Diseases integrate recommendations on the most effective treatment regimens, screening procedures and prevention strategies for
STDs, which infect an estimated
15 million people each year in
the United States. CDC revises
these guidelines approximately
every four years. Among other
guidelines, CDC recommends
that providers consider: screening
annually for chlamydia in sexually active adolescents and young
adult females, even in the
absence of symptoms; alternative
gonorrhea treatments in the wake
of increasing drug resistance on
the west coast; and expanding
risk assessment and screening of
men who have sex with men due
to increased rates of syphilis and
gonorrhea in this population in
many areas of the country.
www.cdc.gov/std

NLV accounts for 96% of
all non-bacterial outbreaks
of gastroenteritis.
◆ Norwalk-like virus (NLV) was
implicated in a couple of wellpublicized outbreaks affecting
passengers on two cruises. The
attack rate in these outbreaks
exceeded 12%. Each of these
were extensively covered by the
media, but outbreaks due to NLV
are quite common, often go
unrecognized and are estimated
to affect more than 20 million
persons each year in the United
States. NLV accounts for 96% of
all non-bacterial outbreaks of gastroenteritis. www.cdc.gov/ncidod/diseases/submenus/sub_norwalk.htm

2

Prevention Bulletin

ARIZONA HEALTH ISSUES
◆ Naegleria fowleri meningitis
claimed the lives of two
5-year old children in
Phoenix. There were
many perplexing
aspects of this investigation by the Maricopa County
Departments of Public Health and
Environmental Services, the
Arizona Department of Health
Services and the Centers for
Disease Control and Prevention. It
appears that for these two simultaneous cases of an extremely
rare disease in one city, the only
identifiable common source of
potential exposure was the community water supply. If that were
the source of exposure, this
would be the first time in recorded history that this occurred from
a groundwater source. There are
many unanswered questions that
can be resolved only by extensive
research. Until the issue is further
studied, it is believed that either
chlorination or strict quality monitoring of water for coliform bacteria has been effective in rendering
water safe under all but the most
rare of circumstances.
◆ Two major outbreaks of gastroenteritis associated with Norwalklike virus infection were investigated in 2002. One affected participants of a junior golf tournament in Maricopa County and the
other involved Colorado River
rafters at the Grand Canyon. More
than 70 and 40 cases were reported, respectively. Noroviruses
(named after the original strain of
Norwalk virus which caused an
outbreak in 1968 in Norwalk,
Ohio) were detected in some of
the stool samples of cases in both
outbreaks and also in some of the
environmental samples (portable
toilets and water samples) from
the Colorado River outbreak. One
death was reported among the
golf tournament participants,
apparently due to asphyxia from

Continued from page 1

aspiration of vomitus. Though not
conclusive, water appeared to be
the most likely primary source of
infection in each outbreak: water
and ice from manually filled jugs
available to players and staff at
the golf tournament and river
water among rafters.
Recommendations were made
to minimize the risk of such outbreaks.
◆ As shown in the table on page 7,
a considerable increase in reported cases of coccidioidomycosis
was observed in 2002.
Increasingly higher peak periods of seasonal incidence during
the winter months appear to be
responsible for the increasing
trend, since the baseline rates
between peak periods remained
relatively stable. Analyses of the
data since 1998 indicate that incidence increased in all age groups
with persons aged >= 65 years
having the highest rates but persons <20 years showing the greatest relative increases.

The number of reported
hepatitis A cases has been
declining dramatically since 1997
◆ An increase was also observed
for: animal rabies with 143 animals (a record number documented to date) testing positive for
rabies in 2002,
compared to
129 animals
in 2001. An
increase in campylobacteriosis was also noted since
1998. On a positive note, the
number of reported hepatitis A
cases has been declining dramatically since 1997, in the wake of
immunization requirements.
Victorio Vaz, D.V.M., Ph.D, is the Office Chief of
Infectious Diseases at the Bureau of
Epidemiology and Disease Control Services.
He can be reached at 602.230.5820 or
vvaz@hs.state.az.us.

March/April 2003

Preparing for West Nile Virus in Arizona
By Craig Levy

The total number of West
Nile virus (WNV) cases reported nationwide to the Centers for
Disease Control and Prevention
at the end of last year exceeded
3,800 and the number of deaths
approached 250. The WNV
was first detected in the United
States in New York City in
1999; since then, it has spread
widely throughout most of the
country. WNV activity was
detected in four states in 1999,
12 states and the District of
Columbia (D.C) in 2000, 27
states and D.C. in 2001 and 44
states and D.C. in 2002. WNV
activity has been documented
in all contiguous states (and the
District of Columbia) with the
exception of Arizona, Nevada,
Oregon and Utah.
Last year was characterized
by a more dramatic spread of
WNV westward and southward,
a higher morbidity and mortality, and the confirmation of
WNV transmission via blood
products. Thirty nine states, of
the 44 reporting WNV activity
in 2002, reported human cases;
of these, five states reported
more than 200 cases each:
Indiana (294), Louisiana (329),
Michigan (565), and Ohio
(432).
WNV is expected to spread
into Arizona this year. Currently
in Arizona, surveillance efforts
to detect and respond to the
threat of WNV include testing
mosquito pools, dead birds,
chicken blood samples and
blood and/or cerebrospinal fluid
(CSF) from suspected human
cases. The Department tested
over 750 mosquito samples,
1,600 chicken blood samples,
and over 100 human specimens
in 2002.
Culex mosquitoes, the primary vectors for WNV transmission, are active from dusk to
dawn and can be found
March/April 2003

throughout Arizona. Although
mosquito bites are the main
mode of transmission, a few
cases of WNV transmission via
contaminated blood products
and/or organ donation
(obtained from WNV infected
patients) were reported in 2002.
In Arizona, the transmission of
mosquito-borne viruses such as
St. Louis encephalitis (SLE) and
the western equine encephalitis
(WEE) tends to occur typically
from May through October.
The Arizona Department of
Health Services performs routine testing for arboviruses such
as WNV, St. Louis encephalitis
(SLE), western equine
encephalitis (WEE) and eastern
equine encephalitis (EEE) from
May through October. Testing
is available to hospitalized
patients with encephalitis or
meningitis. Please report
promptly any suspected cases
of mosquito-borne encephalitis
or meningitis to your local
health department prior to submitting specimens. Serum
and/or CSF along with the
appropriate form (Microbiology
Submission Form #1) can be
sent to: Arizona State Health
Laboratory, Attn: Serology,
1520 West Adams, Phoenix,
Arizona 85007.
Ideally, paired serum samples should be submitted,
including an acute specimen
collected during the first eight
days of illness and a convalescent serum collected 14-21
days after the acute specimen.
For more information on
WNV surveillance in Arizona,
contact your local health
department, or the ADHS
Vector-Borne Diseases Program
staff at 602.230.5820.
Craig Levy is the program manager of the
Vector-Borne and Zoonotic Disease
Section and can be reached at
602.230.5820 or clevy@hs.state.az.us

CLINICAL SUSPICION
Diagnosis of WNV infection is based on a high index
of clinical suspicion and specific laboratory tests.
• WNV, or other arboviral diseases such as St. Louis
encephalitis, should be strongly considered in persons
who develop unexplained encephalitis or meningitis
in summer or early fall, particularly those >50 years
of age.
• 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
• Most WNV infections are mild and often clinically
unapparent.
• Approximately 20% of those infected develop a mild
illness (West Nile fever).
• Approximately 1 in 150 infections will result in severe
neurological disease.
• The incubation period is thought to range from 3 to
14 days.
• Symptoms generally last 3 to 6 days.
• Mild illness tends to be characterized by sudden onset
of fever often accompanied by one or more of the following: malaise, anorexia, nausea, vomiting, eye pain,
headache, myalgia, rash or lymphadenopathy.
• 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.
• Encephalitis is more commonly reported than meningitis.
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 onethird of patients, magnetic resonance imaging showed
enhancement of the leptomeninges, the periventricular areas, or both.
For more information on West Nile Virus (WNV)
Infection Information for Clinicians visit the CDC website
at www.cdc.gov/ncidod/dvbid/westnile/resources/
fact_sheet_clinician.htm
Prevention Bulletin

3

New Targeted Screening Plan for Preven
Since publication of the 1991 Centers for Disease
Lead Exposure
Control and Prevention statement Preventing Lead
Laboratories and health care providers reported 256
Poisoning in Young Children, epidemiological studies
children
with lead poisoning (>10 ug/dL) in 2002. Leadand lead poisoning prevention programs in many states
based
paint
in older homes continues to be a significant
have found that targeted (selective) screening is more
remaining
source
of lead poisoning for children in
appropriate than universal screening. In consideration of
Arizona.
The
older
the home, the more likely it is to conthese data, the CDC revised its guidelines in 1997.
tain
lead
based
paint
that can be a source of lead poisonThe revised guidelines provide, for the first time, a
ing.
Homes
built
before
1960 are the most likely to be a
basis for the Arizona Department of Health Services to
potential
source
for
lead
poisoning. Home remedies and
decide on an appropriate screening policy using local
take-home exposure were other lead sources that were
lead poisoning data and housing data collected by the
identified during environmental investigations.
US Bureau of the Census. This strategy is intended to
increase the screening and follow-up care of
children who most need these services, to ensure
that higher risk children are screened, to ensure
Greater Phoenix Area Map of ZIP Codes
that prevention approaches are appropriate to
Targeted for Childhood Lead Poisoning Screening
Arizona, and to reduce unnecessary testing of
children unlikely to be exposed to lead.

Arizona Childhood Targeted Lead
Poisoning Screening Plan
•

•

•

All children living in targeted ZIP codes
should have a blood lead test at 12 and 24
months of age. Children aged 36 to 72
months should be tested if they have not
been previously tested.
All children covered by the Arizona Health
Care Cost Containment System (AHCCCS)
should be tested according to the Centers
for Medicare and Medicaid Services requirements, as follows: test all children at 12 and
24 months of age; test children at 36 to 72
months of age if they have not been previously tested.
For children not living in a targeted ZIP
code area, health care providers should conduct an individual risk evaluation in order
to determine whether those children are at
increased risk of having an elevated blood
lead level (BLL).

85363
85021

85015
85017

4

Prevention Bulletin

85014
85013
85016
85018

85031
85019

85009

85006
85008
85003
85004
85007
85034 85034

85353
85041

Tucson Area Map of ZIP Codes
Targeted for Childhood Lead Poisoning Screening

Lead Effects
Lead has adverse effects on nearly all organ
systems in the body. It is especially harmful to
the developing brains and nervous systems of
children under the age of 6 years. At very high
blood lead levels, children can have severe
brain damage or even die. At blood lead levels
as low as 10 micrograms per deciliter (µg/dL),
children's intelligence, hearing, and growth are
affected. This damage can be stopped if a
child's lead exposure is reduced.

85020

85705
85719
85716

85705

85711

85701
85713

85708
85735

85714

March/April 2003

ting Childhood Lead Poisoning in Arizona
By Will Humble

Arizona Reporting Rules
Arizona Administrative Code
R9-4-301 requires physicians to
report elevated blood lead levels.
Children <16 years of age:
All blood lead levels of 10
ug/dL are reportable within 5
working days from the date of
receipt of the laboratory results.
Blood lead levels of 45 ug/dL are
reportable within 1 business day.
Adults >16 years of age:
All blood lead levels of 25 ug/dL are reportable within
5 working days from the date of receipt of the laboratory

results. Blood lead levels of 60 ug/dL are reportable within
1 business day.
Please submit report by phone, mail or fax. If faxed,
please call ahead to ensure confidentiality.
Lead Poisoning Prevention Program
Arizona Department of Health Services
3815 North Black Canyon Highway
Phoenix, Arizona 85015
Local: 602-230-5830
Toll Free: 1-800-367-6412
FAX: 602-230-5933
www.hs.state.az.us/phs/oeh/invsurv/lead/index.htm
Will Humble is the Chief of the Office of Environmental Health and can
be reached at 602.230.5941 or whumble@hs.state.az.us.

Development of the Lead Poisoning Risk Index (LPRI)
The Arizona Department of Health Services and the Childhood Lead Poisoning Screening Coalition used available
lead poisoning prevalence rates and pre-1960 housing data for each ZIP code to develop a Lead Poisoning Risk Index
for each ZIP code in Arizona. Data sources used to develop the LPRI include: 1) AHCCCS lead screening utilization
reports for 1998 through 2001; 2) ADHS Registry case data from 1998 to 2001; and 3) 2000 Census data for pre-1960
housing. The following table displays the results of the ZIP codes considered to be at higher risk for Lead Poisoning.

Zip Codes of High Risk for Lead Poisoning
APACHE
85927
85932
85936
86507
COCHISE
85603
85607
85608
85610
85613
85627
85630
85638
85643
COCONINO
86015
86022
86046
GILA
85235
85501
85539
GRAHAM
85531
85536
85543

March/April 2003

Greer
Nutrioso
St. Johns
Lukachukai
Bisbee
Douglas
Douglas
Elfrida
Ft. Huachuca
Pomerine
St. David
Tombstone
Willcox
Bellemont
Fredonia
Williams
Hayden
Globe
Miami
Central
Ft. Thomas
Pima

85546
85552
GREENLEE
85534
85540
85922
MARICOPA
85003
85004
85006
85007
85008
85009
85012
85013
85014
85015
85016
85017
85018
85019
85020
85021
85031
85032
85034
85040
85041

Safford
Thatcher
Duncan
Morenci
Blue
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix
Phoenix

85329
85353
85354
85363
85390
MOHAVE
86433
86437
86438
NAVAJO
86039
86042
86043
86047
PIMA
85321
85633
85634
85639
85701
85705
85708
85711
85713
85714
85716
85719
85735

Cashion
Tolleson
Tonopah
Youngstown
Wickenburg
Oatman
Valentine
Yucca
Kykotsmovi
Polacca
Second mesa
Winslow
Ajo
Sasabe
Sells
Towapa
Tucson
Tucson
Tucson
Tucson
Tucson
Tucson
Tucson
Tucson
Tucson

PINAL
85228
85237
85241
85245
85272
85273
85623
SANTA CRUZ
85611
85621
85640
85631
YAVAPAI
85362
86301
86303
86324
86331
86337
YUMA
85333
85347
85349
85350
85356
85364

Coolidge
Kearny
Picacho
Red Rock
Stanfield
Superior
Oracle
Elgin
Nogales
Tumacacori
San Manuel
Yarnell
Prescott
Prescott
Clarkdale
Jerome
Seligman
Dateland
Roll
San Luis
Somerton
Wellton
Yuma

Prevention Bulletin

5

Noteworthy...
Correction

ice. For those visiting this office, free
parking is available in the parking garage
In the January/February 2003 issue of Prevention
Bulletin, the article on MMR vaccine and autism on
immediately behind the main health
Page 3 was not printed in its entirety. It is reprinted
department building at 1740 W. Adams.
correctly below.
Vital Records provides copies of
birth and death records for individuals
MMR vaccine and autism
who were born or died in Arizona and
In the past few years there have
changes for those records. These docubeen some reports suggesting an associ- ments can be obtained three different
ation between the measles, mumps and ways. In-person customer service is
rubella (MMR) vaccine and autism.
available at the 1818 W. Adams locaMost of the evidence suggestive of a link tion. Certificates may be applied for via
has been based on case-series, crossinternet at www.vitalchek.com or
sectional studies and ecologic studies.
through the mail. Applications can be
Many larger studies and reviews of data obtained at many locations throughout
have failed to detect any association.
the state including hospitals, schools
Most recently, however, a populationand health departments. For information
based study conducted in Denmark pro- on requirements for obtaining a certifivided strong evidence against the
cate, Vital Records can be reached at
hypothesis that MMR vaccination causes 602.364.1300
autism (N Engl J Med 2002; 347:1477-82).

Input Invited On Draft
Communicable Disease Rules
The Bureau of Epidemiology and
Disease Control Services (BEDCS) has
completed draft rule changes for the
communicable disease rules in 9 A.A.C.
6, Articles 1, 2, 3, 5, and 6. At this time,
BEDCS is soliciting input from interested
persons so that major issues can be
identified and, if possible, resolved
before the formal rulemaking process
begins. The draft rules are available for
review on the ADHS website by going
to www.hs.state.az.us/diro/admin_rules/
draft4.htm and selecting one of the links
for “Communicable Diseases and
Infestations.” If you do not have access
to the ADHS website and would like a
copy of the draft rules, please call
602.230.5862 to request a copy.
Comments can be sent to Sarah
Harpring at 1647 E. Morten Ave,
Phoenix, AZ 85020 or sharpri@
hs.state.az.us until April 28, 2003.

Vital Records Has Moved
The Office of Vital Records for the
State of Arizona has moved from its
Glendale location to 1818 W. Adams in
downtown Phoenix. The new location
provides a more centralized location and
an improved facility for providing serv6

Prevention Bulletin

Save the Date!
Mark your calendars now for these
upcoming events:
March 17-20
National Immunization Conference in
Chicago. Online information available
at: www.cdc.gov/nip/NIC
April 8-10, 2003
3rd Annual Joint Vector-borne &
Zoonotic Disease/Bioterrorism
Conference. Hosted by the Arizona
Department of Health Services. The conference will be held at the Mesa Public
Safety Training Facility at 3260 North
40th Street. For information, please call
Teresa Navarro at 602.230.5945 or by
email at mnavarro@hs.state.az.us.
April 13-19
National Infant Immunization Week
Online information available at:
www.cdc.gov/nip/publications/niiw/
default.htm
April 16
TAPI 7th Annual “Big Shots for
Arizona” Awards Banquet. For more
information please call 602.253.0090
May 28-30
5th National Immunization Coalition
Conference at the Westin Kierland
Resort in Phoenix-Scottsdale. Online
information available at: www.publichealth.usf.edu/conted/imm03.html

New TB Testing
Highlights World TB Day
By Dr. Cheryl McRill

March 24 is World TB Day, the
anniversary of the date in 1882
when Robert Koch announced his
discovery of the organism responsible for what was then the leading
cause of death in Western Europe,
tuberculosis (TB). Few people realize the Robert Koch also developed
the tuberculin skin test (TST) using
purified protein derivative (PPD)
and recognized its significance as
an indicator of latent TB infection.
This test has remained in continuous use almost unchanged for over
100 years. In fact, until recently it
was the only test available to detect
latent TB infection. Now there is an
alternative, the new blood test
called QuantiFERON-TB.
The QuantiFERON-TB blood
test was approved by the FDA in
October 2001. Obvious advantages of a blood test over the TST
include that it does not require a
return visit by the patient for test
reading and does not rely on
skilled nursing staff to administer.
In addition, it may be better than
the tuberculin skin test at distinguishing a reaction due to TB
infection from a reaction due to
BCG vaccination or non-tuberculous mycobacteria. The test
involves drawing a heparinized
whole blood sample from the
patient, incubating the sample
overnight with a test tuberculosis
antigen and control antigens, then
drawing off the plasma and measuring the amount of interferongamma (IFN-y) which has been
produced by the patient’s lymphocytes in cell-mediated immune
response to the antigens.
One difficulty in evaluating the
new test has been the lack of a
reliable “gold standard” for comparison. The only other test for
detection of latent TB is the TST,
which is subject to both false positives and false negatives.
Continued on page 8
March/April 2003

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - December, 2002)1, 2
Jan - Dec
2002

Jan - Dec
2001

5 Year Median
Jan - Dec

7 (5)
0
1
280 (132)
0 (0)

9 (5)
1
2
382 (164)
0 (0)

6 (3)
1
6
102 (52)
2 (0)

733
40
18
825
666

635
30
10
737
483

591
42
19
844
598

305
256
1131
6
4721

409
164
1502
9
3449

700
178
*
21
*

790
314
27
32

783
187
55
21

695
187
42
44

14929
3785
200 (19)

14326
3909
180 (32)

12046
4101
180 (21)

11 (1)
1043

12 (3)
876

11 (2)
876

3
0
143

1
0
129

3
1
81

3351
263
498
537
279 (256)
21

2301
289
555
522
197 (169)
26

1809
262
498
537
275 (227)
25

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
VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B
Hepatitis B: non-acute3
Hepatitis C
Hepatitis C: non-acute3
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
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
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
Lead Poisoning (<16 years of age)
Pesticide Poisoning5
1
2
3
4
5

Data are provisional and reflect case reports during this period except Lead Poisoning which is by date of diagnosis.
These counts reflect the year reported or tested and not the date infected.
Case counts for non-acute Hepatitis B and C are not available before 1998.
Based on animals submitted for rabies testing.
Not all reports will be confirmed as meeting the case definition for pesticide poisoning upon further investigation.

March/April 2003

Prevention Bulletin

7

❍ Change of Address/Name
❍ Delete my name from your mailing list
❍ I received more than one copy
Please include your mailing label with all requests
for changes. Fax changes to 602.230.5959

PRSRT STD
US Postage
PAID
Phoenix, AZ
Permit No. 957

Arizona Department of Health Services
Public Information Office
1740 West Adams
Phoenix, AZ 85007
602.364.1201 • Fax 602.364.0844
Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Editorial Board
Bob England, M.D., M.P.H., State Epidemiologist
Victorio Vaz, D.V.M., Ph.D.
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Ken Komatsu, M.P.H.
Cheryl McRill, M.D.
Wesley Press, M.S.
Emma N. Viera, M.P.H.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: Bob England, Will Humble, Ken Komatsu,
Craig Levy, Mollie Love, Cheryl McRill, Judy Norton, Victorio Vaz
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).

Recent Pertussis Death Highlights Need
For More Awareness of Disease
By Ken Komatsu

Outbreaks of pertussis and a recent
death in a neonate stress the continuing
threat posed by the disease and its
potential severity, particularly in infants
less than four months of age. In the
past six months, outbreaks of pertussis
were reported in Maricopa, Mohave,
and Yavapai counties. The number of
cases reported in Arizona in 2002 (280)
was lower than that for 2001 (382);
however, incidence has been cyclical
with peak rates reported in 2001, 2000,
1998, 1995 and 1992. The highest rate
reported since 1990 was in 2001
(7.2/100,000). Three infant deaths were
also reported in 2001.
The last fatality was in a full term
newborn that was taken initially to an
emergency room and sent home with
a diagnosis of “viral infection.” Five
days later the infant was admitted to a
Maricopa County hospital with bronchiolitis and hypoxia. By that time, the
patient had been coughing and show8

Prevention Bulletin

ing signs of congestion for one week.
A nasal swab was positive by direct
fluorescent antibody test for RSV and a
nasopharyngeal swab was positive by
direct fluorescent antibody and ultimately grew Bordetella pertussis. The
infant progressed into severe respiratory distress and died from acute cardiogenic shock.
Please contact your county or tribal health department immediately if
pertussis is suspected. Health departments can help you identify exposed
contacts needing prophylaxis and can
facilitate culturing of nasopharyngeal
swabs through the Arizona Department
of Health Services’ Laboratory. Your
role in early identification of these
cases is critical to preventing further
spread.
Ken Komatsu, M.P.H., is the manager of the Infectious
Disease section at the Bureau of Epidemiology and
Disease Control. He can be reached at 602.230.5932
or kkomats@hs.state.az.us.

World TB Day
Continued from page 6

A recent study (JAMA Oct 10, 2001,
286(14):1740-1747) reported that
while the overall agreement
between the TST and the IFN-y assay
was 83.1%, those who had been
previously BCG-vaccinated were 7
times more likely to have a positive
TST and a negative IFN-y test than
an unvaccinated person. Among
unvaccinated persons with a positive
TST and a negative IFN-y test,
21.2% showed an IFN-y response to
non-tuberculous mycobacteria.
Robert Koch’s discovery in 1882
made it possible to dream of eliminating tuberculosis. Although the
dream is far from realized 121 years
later, the availability of a new and
improved tool for detecting latent TB
infection may help in that effort.
Cheryl McRill, M.D., is the Chief Medical
Officer and the state TB Control Officer for
the Department. She can be reached at
602.230.5808 or cmcrill@hs.state.az.us
March/April 2003