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slides: The 25 Biggest Diseases To Strike Massachusetts

Monday, July 15, 2013


What infectious diseases hit Massachusetts 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 fo the disease," according to the CDC. The latest data in the July, 2013, reports the number of cases in MA from 2011.

From tick-borne diseases like Lyme to sexually transmitted diseases like chlamydia and gonorrhea, from hepatitis to HIV, what hit the Bay State the hardest? See the Top 25 diseases to strike Massachusetts. 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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#25 Meningococcal disease

Total 2011 cases: 14

Serogroup A, C, Y, and W-135: 8
Serogroup B: 3
Serogroup other: 2
Serogroup unknown: 1

Neisseria meningitidis is a major cause of bacterial meningitis and sepsis in the United States.

The highest incidence of meningococcal disease occurred among infants aged <1 year with a second peak occurring in adolescents and young adults. Among infants, disease incidence peaks within the first 6 months of life and the majority of cases in this age group are caused by serogroup B. Rates of meningococcal disease are at historic lows in the US, but meningococcal disease continues to cause substantial morbidity and mortality in persons of all ages.

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#24 Hepatitis C

Total 2011 cases: 23

"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 C virus (HCV) infection is the most common chronic bloodborne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available.

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#23 (T) Typhoid fever

Total 2011 cases: 24

Typhoid fever is rare in the United States. During 1999–2006, 1,439 out of 1,902 patients reported foreign travel within 30 days of illness, which accounted for approximately 79% of cases associated with international travel. The risk for infection is highest for travelers visiting friends and relatives in countries where typhoid fever is endemic, perhaps because they are less likely than other travelers to seek pretravel vaccination and to observe strict safe water and food practices. The risk also is higher for travelers who visit areas where disease is most highly endemic, such as the Indian subcontinent, even for a short time.

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#23 (T) Measles

Total 2011 cases: 24

Indigenous: 17
Imported: 7

Note: Imported cases include only those directly related to importation from other countries.

The elimination of endemic measles has been achieved in the US; however, measles continues to be imported, resulting in substantial morbidity and expenditure of local, state, and federal public health resources. Although measles incidence in the US remains low, the number of cases reported during 2011 was the highest since 1996.

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#21 Listeriosis

Total 2011 cases: 32

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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#20 Pneumococcal disease

Total 2011 cases: 38

Streptococcus pneumonia, invasive disease:

All ages: 38
Age <5 years: 19

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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#19 Hepatitis A

Total 2011 cases: 39

"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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#18 Hepatitis B

Total 2011 cases: 67

"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 B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic.

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#17 Malaria

Total 2011 cases: 68

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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#16 E.Coli

Total 2011 cases: 80

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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#15 Haemophilus influenza

Total 2011 cases: 121

All ages, serotypes: 121
Age <5 years ecotype b: 0
Age <5 years Nonserotype b: 7
Age <5 years Unknown serotype: 0

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 Cryptosporidiosis

Total 2011 cases: 168

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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#13 Anaplasmosis

Total 2011 cases: 172

The 172 cases in Massachusetts are of Anaplasma phagocytophilum, one of four categories of ehrlichiosis and anaplasmosis, which are rickettsial tickborne diseases.

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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#12 Shigellosis

Total 2011 cases: 179

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 contro.

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#11 Tuberculosis

Total 2011 cases: 196

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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#10 Legionellosis

Total 2011 cases: 240

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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#9 Pertussis

Total 2011 cases: 271

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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#8 Chicken Pox/Varicella

Total 2011 cases: 513

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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#7 HIV

Total 2011 cases of new diagnoses: 523

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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#6 Giardiasis

Total 2011 cases: 758

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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#5 Syphilis

Total 2011 cases: 770

All stages: 770
Primary and secondary: 266

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.

During 2007–2011, rates among black men aged 20–24 years nationwide increased from 54.9 to 96.2 cases per 100,000 population (75%); the magnitude of this increase (41.3 cases per 100,000 population) was the greatest reported regardless of age, sex, or race/ethnicity.

"All stages" data includes the following categories: primary, secondary, latent (including early latent, late latent, and latent syphilis of unknown duration), neurosyphilis, late (including late syphilis with clinical manifestations other than neurosyphilis), and congenital syphilis.

Note: All stages Totals reported to the Division of STD Prevention, NCHHSTP, as of June 7, 2012.

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#4 Salmonellosis

Total 2011 cases: 1,049

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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#3 Gonorrhea

Total 2011 cases: 2,353

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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#2 Lyme disease

Total 2011 cases: 2,476

Confirmed: 1,801
Probable: 675

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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#1 Chlamydia

Total 2011 cases: 22,764

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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