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slides: The 25 Biggest Diseases To Strike Rhode Island

Tuesday, July 16, 2013


What infectious diseases hit Rhode Island the hardest, and in the biggest numbers? The Centers for Disease Control (CDC) has just released its latest data for "notifiable diseases," defined as those infectious diseases "for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease," according to the CDC. The latest data in the July, 2013, reports the number of cases in RI from 2011.

Top 10 dominated by STDs

In Rhode Island, sexually transmitted diseases consitutued a majority of the cases; chlamydia ranked #1 in 2011, followed by gonorrhea at #2 and syphilis at #7. Cases of HIV diagnosis ranked #6. Local experts were not surprised at the prevalence of STDs in Rhode Island's data. "We are seeing increasing cases of sexually transmitted diseases in Rhode Island," said Philip A. Chan, M.D., an HIV/AIDS specialist at The Miriam Hospital. "Although rates of HIV are steady, individuals with gonorrhea, chlamydia and syphilis have increased compared to several years ago."

Chan said these STDs affect people of all ages and racial/ethnic backgrounds in Rhode Island. HIV and syphilis, though, "is most predominant among gay, bisexual, and other men who have sex with men," he said.

"What’s troubling about the increase in rate of gonorrhea now is the appearance in the US of strains that are resistant to some anti-microbials," said Jenny Carrillo, Senior Vice President of Planned Parenthood of Southern New England. "The appearance of the antimicrobial resistant strains makes it imperative to identify and treat gonorrhea early."

Brenna Anderson, MD, a maternal-fetal medicine specialist at the Integrated Program for High Risk Pregnancy, Women & Infants Hospital, pointed out that it's unclear whether the STDs are on the rise or whether we are doing a better job of testing for them and reporting them. "Regardless, testing and treating those at risk is a major goal of STD control," she said. "The other is advocating condom use to minimize the transmission of STDs." 

See all the Top 25 diseases to strike Rhode Island, below.

Note: Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review, according to the CDC.

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#24 (T) Ehrlichia

Total 2011 cases: 2

Ehrlichia chaffeensis:

Ehrlichiosis and anaplasmosis are rickettsial tickborne diseases. The number of reported cases of anaplasmosis in the US  increased by approximately 50%, from 1,761 cases in 2010 to 2,575 cases in 2011, the largest reported incidence since anaplasmosis became notifiable in 1998. The number of reported cases of ehrlichiosis increased by 15%, from 740 cases in 2010 to 850 cases in 2011. Reports of undetermined ehrlichiosis or anaplasmosis increased by approximately 40% from 104 cases in 2010 to 148 cases in 2011.

The overall increase in reported incidence of all four categories of ehrlichiosis and anaplasmosis from 2010 to 2011 might indicate an increase in tick populations, expansion of tick vector range, and an increase in the use of diagnostic assays. 

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#24 (T) HUS

Total 2011 cases: 2

Hemolytic uremic syndrome, postdiarrheal:

Hemolytic uremic syndrome, postdiarrheal (D+ HUS) is characterized by the acute onset of microangiopathic hemolytic anemia, renal injury, and low platelet count. Thrombotic thrombocytopenic purpura (TTP) also is characterized by these features but can include central nervous system (CNS) involvement and fever and may have a more gradual onset. Most cases of HUS (but few cases of TTP) occur after an acute gastrointestinal illness (usually diarrheal).

D+HUS was first described in 1955, but was not known to be secondary to E. coli infections until 1982. It is now recognized as the most common cause of acute kidney failure in infants and young children. Adolescents and adults are also susceptible, as are the elderly, who often succumb to the disease.

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#24 (T) Spotted fever

Total 2011 cases: 2

Spotted fever rickettsiosis:

Probable: 2

Spotted fever rickettsioses are a group of tickborne infections caused by some members of the genus Rickettsia. More cases of spotted fever rickettsiosis were reported in 2011 than in any year since 1920, when spotted fever rickettsiosis became a reportable condition. Similarly, 18 states reported more cases in 2011 than any year in the last decade. Although the increase in reported cases might be influenced by testing and reporting practices, high tick vector activity and increased human exposure to infected ticks in 2011 might have resulted in an increased incidence of spotted fever rickettsiosis. 

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#24 (T) Vibriosis

Total 2011 cases: 2

Vibriosis became a nationally notifiable condition in 2007. Three states (California, Florida, and Texas) report the largest numbers of cases. Vibrio parahaemolyticus, V. vulnificus, and V. alginolyticus account for the largest proportion of reported infections. The incidence of vibriosis, both overall and for each of the three most commonly reported species has increased over the past 15 years. In 2011, an outbreak of toxigenic (i.e., producing cholera toxin) V. cholerae O75 infection was associated with consumption of raw oysters harvested from Apalachicola Bay. 

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#23 Listeriosis

Total 2011 cases: 3

Listeria monocytogenes infection (listeriosis) is rare but causes severe invasive disease (e.g., bacteremia, meningitis, and fetal death). Listeriosis has been nationally notifiable since 2000. Listeriosis is acquired predominately through contaminated food and occurs most frequently among pregnant women and their newborns, older adults, and persons with certain immunocompromising conditions. Pregnancy-associated listeriosis is usually a mild illness but can be associated with fetal death and severe neonatal disease.

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#22 Mumps

Total 2011 cases: 5

Mumps is a contagious disease that is caused by the mumps virus. Mumps typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by swelling of salivary glands. Anyone who is not immune from either previous mumps infection or from vaccination can get mumps.

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#21 Malaria

Total 2011 cases: 6

Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2010 an estimated 219 million cases of malaria occurred worldwide and 660,000 people died, most (91%) in the African Region.

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#19 (T) Hepatitis A

Total 2011 cases: 8

"Hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected.

Hepatitis A, caused by infection with the Hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease.

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#19 (T) E.Coli

Total 2011 cases: 8

During 2011, as in previous years, the age group with the highest incidence of Shiga toxin-producing Escherichia coli (STEC) infections was children aged <5 years. STEC infection is reported most frequently in late summer and early fall. In 2011, this seasonality was evident, with the highest number of reports in July, August, September, and October. During 2011, several multistate outbreaks of STEC O157 infection were linked to foods (e.g., romaine lettuce, Lebanon bologna, and hazelnuts).

Note: Includes Escherichia coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin positive, not serogrouped. 

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#18 Shigellosis

Total 2011 cases: 9

In 2011, the incidence of reported shigellosis in the US  was 4.3 infections per 100,000 population. Accounting for underdiagnosis, Shigella causes an estimated 494,000 illnesses annually in the US, approximately 131,000 of which are transmitted by food consumed in the US.

Shigella often is spread directly from one person to another, including through sexual contact between MSM, and also can be transmitted by contaminated food or by contaminated water used for drinking or recreational purposes. Some cases of shigellosis also are acquired during international travel. Daycare-associated outbreaks are common and are often difficult to control.

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#17 Cryptosporid

Total 2011 cases: 12

Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by chlorine-tolerant protozoa of the genus Cryptosporidium. Cryptosporidium is transmitted by the fecal- oral route with the ingestion of Cryptosporidium oocysts through the consumption of fecally contaminated food or water or through direct person-to-person or animal-to-person contact.

Although cryptosporidiosis affects persons in all age groups, cases are reported most frequently in children. A substantial increase in transmission of Cryptosporidium in children occurs during summer through early fall, coinciding with increased use of recreational water, which is a known risk factor for cryptosporidiosis.

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#16 Haemophilus influenza

Total 2011 cases: 16

Haemophilus influenzae (including Hib) is a bacterium that can cause a severe infection, occurring mostly in infants and children younger than five years of age. It can cause lifelong disability and be deadly. In spite of its name, Haemophilus influenzae bacteria do not cause influenza (the "flu").

There are six identifiable types of Haemophilus influenzae bacteria (a through f) and other non-identifiable types (called nontypeable). The one most people are familiar with is Haemophilus influenzae type b, or Hib. There's a vaccine that can prevent disease caused by Hib, but not the other types of Haemophilus influenzae bacteria.

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#14 (T) Rabies

Total 2011 cases: 27

Rabies (animal): 27

The recent decline in animals submitted for rabies diagnosis continued during 2011. A total of 99,905 suspected rabid animals were tested in the US in 2011, compared with 104,647 in 2010, a decline of 4.5%. Despite this decline, substantial increases in reported rabid animals were observed among some reservoir species, most notably skunks. 

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#14 (T) Tuberculosis

Total 2011 cases: 27

TB is a disease caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

Note: Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of June 25, 2012.

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#13 Legionellosis

Total 2011 cases: 29

Legionnaires' disease is caused by a type of bacterium called Legionella. The bacterium is named after a 1976 outbreak, when many people who went to a Philadelphia convention of the American Legion suffered from this disease, a type of pneumonia (lung infection). A milder infection, also caused by Legionella bacteria, is called Pontiac fever. The term "legionellosis" may be used to refer to either Legionnaires' disease or Pontiac fever.

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#12 Chicken Pox/Varicella

Total 2011 cases: 42

Chickenpox is a very contagious disease caused by the varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters.

The best way to prevent chickenpox is to get the chickenpox vaccine. Before the vaccine, about 4 million people would get chickenpox each year in the United States. Also, about 10,600 people were hospitalized and 100 to 150 died each year as a result of chickenpox.

Note: Totals reported to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 30, 2012.

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#11 Pertussis

Total 2011 cases: 62

After the 2010 peak in reported pertussis (8.9 per 100,000 population), reports of the disease declined in 2011 (6.1 per 100,000 population). Consistent with previous years, age-specific rates are highest among infants aged <1 year (70.9 per 100,000 population). Similar to trends observed in 2009 and 2010, children aged 7–10 years continue to contribute the second highest rates of disease nationally (20.0 per 100,000 population). Rates of disease among adolescents remained lower than those observed before the introduction of three vaccines: tetanus, diptheria, and acellular pertussis (Tdap) in 2005.

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#10 Anaplasmosis

Total 2011 cases: 72

Anaplasma phagocytophilum:

Ehrlichiosis and anaplasmosis are rickettsial tickborne diseases. The number of reported cases of anaplasmosis increased by approximately 50%, from 1,761 cases in 2010 to 2,575 cases in 2011, the largest reported incidence since anaplasmosis became notifiable in 1998. 

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#9 Babesiosis

Total 2011 cases: 73

Babesiosis, a tickborne parasitic disease, became a nationally notifiable condition in 2011. Babesiosis is caused by protozoan parasites of the genus Babesia that infect red blood cells. Babesia infection can range from asymptomatic to life threatening. Clinical manifestations can include fever, chills, other nonspecific influenza-like symptoms, and hemolytic anemia. Babesia parasites usually are tickborne, but they also are transmissible via blood transfusion or congenitally. In recent years, reports of tickborne and transfusion-associated cases have increased in number and geographic distribution .

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#8 Giardiasis

Total 2011 cases: 79

Giardia is transmitted through the fecal-oral route with the ingestion of Giardia cysts through the consumption of fecally contaminated water or through person-to-person (or, to a lesser extent, animal-to-person) transmission. The disease normally is characterized by diarrhea, abdominal cramps, bloating, weight losss, and malabsorption.

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#7 Syphilis

Total 2011 cases: 84

All stages: 84
Primary and secondary: 46

During 2011 nationwide, overall rates of primary and secondary syphilis remained unchanged compared with 2010. Rates among women continued to decrease (33% compared with 2008), but increased among men for the 11th consecutive year. Rates were highest among men aged approximately 20–24 years and 25–29 years for the 4th consecutive year.

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#6 HIV

Total 2011 cases of new diagnoses: 88

HIV, or the human immunodeficiency virus, is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life.

Note: Total number of HIV cases reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2011.

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#5 Pneumococcal disease

Total 2011 cases: 97

Streptococcus pneumonia, invasive disease:

Age <5 years: 5

Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae (pneumococcus), which has more than 91 known serotypes. The major clinical syndromes include life-threatening infections such as meningitis, bacteremia, and pneumonia. Pneumococcus is the most commonly identified cause of community-acquired pneumonia. It is also a major cause of milder but more common illnesses, such as sinusitis and otitis media.

Note: The previous categories of invasive pneumococcal disease among children aged <5 years and invasive, drug-resistant Streptococcus pneumoniae were eliminated. All cases of invasive S. pneumoniae disease, regardless of age or drug resistance are reported under a single disease code

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#4 Lyme disease

Total 2011 cases: 159

Confirmed: 111
Probable: 48

National surveillance for Lyme disease was implemented in the United States in 1991 using a case definition based on clinical and laboratory findings.

The number of confirmed and probable Lyme disease cases reported to CDC increased by 2,939 (9.7%) in 2011 over 2010. Nevertheless, the total number of reported cases remained substantially lower than in either 2008 or 2009. Unlike 2010, when reported cases decreased in nearly all Northeastern and mid-Atlantic states, no consistent regional trend was apparent in 2011.

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#3 Salmonellosis

Total 2011 cases: 194

Salmonella causes an estimated 1.2 million illnesses annually in the United States, approximately 1 million of which are transmitted by food consumed in the US. Salmonella can contaminate a wide range of foods, and different serotypes tend to have different animal reservoirs and food sources, making control challenging.

During 2011, as in previous years, the age group with the highest incidence of salmonellosis nationwide was children aged <5 years. Salmonellosis is reported most frequently in late summer and early fall; in 2011, this seasonality was again evident, with most reports during July–October. Salmonella infections have not declined over the past 10 years.

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#2 Gonorrhea

Total 2011 cases: 360

After a 79% decline in the rate of reported gonorrhea during 1975–2009, and after reaching the lowest gonorrhea rate recorded in 2009, the national gonorrhea rate increased in 2011 for the second consecutive year.

During 2009–2011, the national rate of gonorrheal infection increased by 6% to 104 cases per 100,000 population. In 2011, the rate increased among men and women, among all racial/ethnic groups, and in all four regions of the US (West, Midwest, Northeast, and South). As in previous years, the highest rates were observed among persons aged 15–24 years, among blacks, and in the South. In 2011, the gonorrhea rate among blacks was 17 times higher than the rate among whites (427 cases in blacks per 100,000 population compared with 25 cases in whites per 100,000 population.

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#1 Chlamydia

Total 2011 cases: 4,146

In 2011, approximately 1.4 million cases of Chlamydia trachomatis infections were reported, the largest number of cases ever reported to CDC for any condition. This case count corresponds to a rate of 457.6 cases per 100,000 population, an increase of 8% compared with the rate in 2010.

Rates of reported chlamydial infections among women have been increasing annually since the late 1980s, when public programs for screening and treatment of women were established to avert pelvic inflammatory disease and related complications. The continued increase in chlamydia case reports in 2011 likely represents a continued increase in screening for this usually asymptomatic infection, expanded use of more sensitive tests, and more complete national reporting; however, it also might reflect an increase in morbidity.


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Howard Miller


Jenn Palumbo

Liberalism should be #1..................

Jonathan Flynn

The sorry attempt at humor above aside, diseases can't be biggest. They can be most prevalent or even widespread in the incidence. You can't have the "Biggest diseases." Please.

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