Texas Outbreaks 2012 2013 Outbreaks Reported 54 local

Texas Outbreaks 2012 -2013

Outbreaks Reported • 54 local and regional health jurisdictions (8 regional and 46 local single or multi-county jurisdictions • 33 (61%) submitted outbreak-tracking forms through Dec 2013 and 15 through June 2013 (28%) • 234 outbreak investigations reported for 2012 • 237 outbreak investigations reported for 2013

Number of Outbreaks by Type Reported by HSR/LHD Type of Outbreak 2012 2013 Enteric-Campy 1 1 Meningococcal 3 2 Enteric-Crypto 0 1 Misc-Bipolaris 0 1 Enteric-Cyclospora 0 7 Misc-death 0 1 Enteric-E. coli 6 6 Misc-Rhodococcus 0 1 Enteric-Listeria 2 0 MRSA 1 0 Enteric-Norovirus 31 16 Pertussis 33 46 Enteric-Rotavirus 0 1 Rash/Fever 1 0 Enteric-Salmonella 176 131 Rash-Unknown 1 0 Enteric-Shigella 13 33 Resp-ILI 4 3 Enteric-Unknown 58 41 Resp-Influenza 11 27 Enteric-Unknown/Norovirus like 1 2 Resp-Legionella 4 1 Flood 0 1 Resp-Pneumonia 3 0 Fungal 5 0 Resp-Strep 1 0 Hepatitis A 3 6 Resp-Strep. pneum. 1 0 Hepatitis C 0 1 Resp-Unknown 3 1 Measles 0 3 Varicella 10 2 Meningitis-Aseptic 1 0 West Nile 4 0 Grand Total 377 335 712 reports/572 outbreaks/clusters

Salmonella Clusters • 2012 – 75 PFGE clusters with 366 Texas cases to investigate • 2013 – 65 PFGE clusters with 375 Texas cases to investigate

Enteric Outbreaks and Cluster Investigations by Month Reported 2012 -2013 45 40 Number of Outbreaks 35 Enteric-Campy Enteric-Crypto 30 Enteric-Cyclospora 25 Enteric-E. coli Enteric-Listeria 20 Enteric-Norovirus 15 Enteric-Rotovirus Enteric-Salmonella 10 Enteric-Shigella Enteric-Unknown 5 0 Jan Feb Mar Apr May Jun Jul Aug Month Reported Sep Oct Nov Dec

Enteric Outbreaks and Cluster Investigations by Month Reported 2012 -2013 14 12 Enteric-Campy Axis Title 10 Enteric-Crypto Enteric-Cyclospora 8 Enteric-E. coli Enteric-Listeria 6 Enteric-Norovirus Enteric-Rotovirus 4 Enteric-Shigella Enteric-Unknown 2 Enteric-Unknown/Norovirus like 0 Jan Feb Mar Apr May Jun Jul Aug Sep Month Reported Oct Nov Dec

Selected Respiratory Outbreaks by Month Reported, 2012 -2013 16 14 Number of Outbreaks 12 10 Resp-Pneumonia 8 Resp-Influenza Resp-ILI 6 4 2 0 Jan Feb Mar Apr May Jun Jul Month Reported Aug Oct Nov Dec

Varicella Outbreaks by Month Reported, 2012 -2013 3, 5 3 Number Reported 2, 5 2 Total 1, 5 1 0, 5 0 Jan Feb Apr May Month Reported Nov Dec

Pertussis Outbreaks by Month Reported, 2012 -2013 12 Number of Outbreaks 10 8 6 Pertussis 4 2 0 Jan Feb Mar Apr May Jun Jul Aug Month Reported Sep Oct Nov Dec

Other Outbreaks • Case investigation of a Aeromonas infection post replantation of a traumatically severed digit associated with medicinal leech therapy. o This is a central Texas case of interest due to the initial misidentification of the organism as vibrio and the development of the infection from an organism known to inhabit leeches despite CPx • Epi aid for Bipolaris associated with patients having Cardio- thoracic surgery o o o • 18/21 cases of cardiovascular SSI in Texas attributed to bipolaris fungal infections 2 other (AR, FL) states identified cases Texas had cases identified in 8 hospitals in central and north Texas 16/21 cases died. We know the organism and environmental source but can’t explain why we had such an increase in cases. Current hypothesis is increase was due to a fungal bloom due to the drought. Several transplant-associated investigations o West Nile o Strongyloidiasis o S. saintpaul • Outbreaks of MRSA, pseudomonas, mycobacterium mucogenicum, Chryseobacterium, and Klebsiella pneumoniae were all HAI investigations. Human or environmental sources identified for all.

Next Chapter - Texas Outbreaks 2014

Colu Field mn K Date investigation initiated V Date first onset AE # Patients Tested AQ # Male BA # Vaccinated BK Source Identified? A Record Number L Investigating Agency(s) W Date last onset AF AR # Female BB # Not Vaccinated BL Source Description B Date Reported or Identified M Lead Agency X Study Method AG # Tested at DSHS AS #<1 year BC # Vaccination unknown BM Actions Taken C Investigated? N Your Agency's Role Y Final Outbreak Case Count AH # Exposed AT # 1 -4 years BD # Vaccinated cases up to date BL Control Measures Implemented D Geographic Location O Lead Investigator Name Z # Confirmed Cases AI # Cases Interviewed AU #5 -9 years BE #Vaccinated partially BM Outbreak Report Written? E Setting P EPI-AID utilized? AA # Probable Cases AJ # Controls Interviewed AV #10 -19 years BF # Vaccine Not Applicable BN After Action Report? F NBS Outbreak Name Q Epi-AID role AB # Primary generation cases AK # Hospitalized AW #20 -49 years BG # Prophylaxed with antibiotic BO Respiratory Outbreak Form to DSHS G Primary Symptoms R Incubation range AC # Spread cases AL AX #50 -74 years BH # Prophylaxed with immune globulin BP NORS Entry H Confirmed Agent (if known) S Average length of illness AD Minimum # Spread generations AO Range length of hospitalization AY #>75 years BI BQ Comments I Suspected Agent T Outbreak Case Definition AP # Died AZ # Unknown age BJ Environmental investigation or inspection J Method Identified U Outbreak Type # Positive Average length of hospitalization # Prophylaxed with vaccine