GARY M. FELDMAN, M.D., FAAP, FABMG Public Health Officer
	COUNTY OF RIVERSIDE PUBLIC HEALTH DISPATCH
COMMUNITY HEALTH AGENCY • DEPARTMENT OF PUBLIC HEALTH • 4065 COUNTY CIRCLE DRIVE, RIVERSIDE, 92503
VOL. 8, No. 2		SPRING 2002

Leading Health Problems for African Americans in Riverside County

This February marks the 76th anniversary for Black History Month. Organized in 1926 by high school educator Carter G. Wilson to address the lack of knowledge concerning African American History, this celebration provides great opportunity to reflect not only on the contributions made to the world by those of African descent, but to also focus on other important issues, one of which includes health. A number of health disparities for African Americans exist when comparing birth, disease, and death statistics by race/ethnicity. For example, African Americans in Riverside County have the highest rates of sexually transmitted diseases, including AIDS, low birth weight births, infant mortality, and deaths due to heart disease, cancer, and stroke.

• In 2000, 11.3% of African American births were defined as low birth weight (births less than 2500 grams or 5 pounds 8 ounces). This is 79 percent higher than the 6.3% low birth weight births for all infants born in Riverside County. The “Healthy People 2010” national objective is that no more than 5% of all births are low birth weight.
• The infant mortality rate (deaths among infants under one year old per 1,000 live births) among African Americans in Riverside County in 2000 was 10.7 infant deaths per 1,000 live births, 60 percent higher than the countywide infant mortality rate for all racial/ethnic groups. The “Healthy People 2010” national objective limits the infant mortality to a rate to no more than 4.5 infant deaths per 1,000 live births.
• The AIDS case rate for African Americans was 37.6 cases per 100,000 population, more than double the countywide rate, four times the rate among Hispanics and nearly twice the rate among whites. African Americans accounted for 12% of the reported AIDS cases, yet comprise only 5.4% of the County population.
• In 2000, the Chlamydia rate was 672.9 cases per 100,000 population for African Americans, more than three times the countywide rate, nearly double the rate among Hispanics and nearly nine times the rate of whites. African Americans accounted for 18.6% of the reported Chlamydia cases in 2000, yet comprise 5.4% of the County population.
• The gonorrhea rates among African Americans was 198.5 cases per 100,000 population, sixteen and seven times higher than the rate among whites and Hispanics, respectively.
• In 2001, Riverside County completed an expanded Kindergarten retrospective immunization survey to assess the immunization status of kindergarten students when these students were 24 months of age. The survey found only 63.1% of all Riverside County kindergarten students at 24 months of age had received the recommended immunizations (4 DTP, 3 polio and at least 1 MMR). Furthermore only 50% of African American children had received these recommended immunizations at 24 months of age.
• African Americans had the highest mortality rates for three of the four leading causes of death in Riverside County – heart disease, cancer (all causes), and stroke in 2000. The mortality rate for heart disease among African Americans was 343 deaths per 100,000 population, 27 percent higher than for all racial/ethnic groups in Riverside County. Deaths due to all cancers was 27 percent higher in African Americans compared to cancer deaths among all residents in Riverside County, a rate of 233.6 deaths per 100,000 population. The mortality rate for stroke among African Americans was 77.2 deaths per 100,000 population, nearly one third higher than the countywide rate of 58.6 deaths per 100,000 population.

The above health disparities for this population represent a significant public health concern. This data requires analysis to explore potential causes of these disparities with the goal of developing targeted interventions to improve health outcomes for African-Americans in Riverside County.

DISEASE REPORTING

COMMUNITY PROTECTION

Reporting of cases of infectious diseases has been and continues to be a vital step in controlling the spread of communicable diseases in the community. The information contained in these reports is useful to both disease surveillance and disease control activities. Disease surveillance activities include identifying important changes in trends, monitoring long and short-term trends, and determining disease related morbidity and mortality.

Activities related to disease control include assurance of appropriate medical treatment, detection of common source outbreaks, contact identification and referral, and planning and evaluating disease control prevention activities.

LEGAL MANDATE

The authority to require reporting of cases of infectious diseases resides in the State legislature. The California Health and Safety Code, Section 120250 and the California Code of Regulations, Title 17, Section 2500 require the physician to report listed infectious diseases.

Although physicians are an integral part of communicable disease control activities, many physicians are not aware of their reporting responsibilities. Two areas frequently requiring clarification include laboratory reporting of infectious disease and confidentiality issues. Laboratory reporting of a particular disease does not relieve the physician of reporting responsibility. Patient consent is not required for reporting purposes or to supply additional information requested by Public Health staff. Failure to report is a misdemeanor (H&S Section 120295) and falls under the Cite and Fine provision. Failure to report is not limited to the omission of a report, but includes incomplete reporting and failure to report within the required time frame.

SPECIAL REGULATIONS RELATED TO BIOTERRORISM

Highlight of Changes for Health Care Providers

The following are the recent changes to the Disease Reporting Requirements. Two new diseases have been added: Smallpox, and Varicella deaths. Both require immediate reporting by telephone to the Riverside County Department of Public Health. In addition, the time interval allowed for health care providers to report after diagnosis has been shortened for two diseases: brucellosis, and tularemia. Both now require immediate reporting by telephone to the Riverside County Department of Public Health.

Highlight of Changes for Laboratories

Recent amendments now require that whenever a laboratory receives a specimen for bacterial testing of suspected human anthrax, botulism, brucellosis or tularemia, the laboratory must immediately contact by telephone the California Department of Health Services’ (CDHS) Microbial Diseases Laboratory at (510) 540-2242. Plague has already required immediate telephone notification. Similarly, any laboratory, receiving specimens for viral testing of smallpox or viral hemorrhagic fever agents must immediately contact by telephone the CDHS Viral and Rickettsial Diseases Laboratory at (510) 307-8575. In addition, laboratory findings suggestive of these same seven diseases must be reported to Riverside County Department of Public Health by telephone at (909) 782-2974 within 1 hour, followed by a written report submitted by facsimile or electronic mail within one working day.

An updated Disease Reporting Requirements sheet is available for viewing. Please contact the Disease Control Office at (909) 358-5107, if you have any questions on reporting requirements.

INTERIM GUIDELINES FOR USE OF PNEUMOCOCCAL CONJUGATE VACCINE
DURING THE PERIOD OF LIMITED VACCINE SUPPLY

Since last August there have been significant delays in the delivery of pneumococcal conjugate vaccine (PCV-7) to health care providers by the manufacturer. These delays have resulted in spot shortages of this vaccine over the past several weeks; shortages are expected to continue into 2002.

In the September 14, 2001 issue of Morbidity and Mortality Weekly Report [50(36); 783-4)], www.cdc.gov/mmwr/preview/mmwrhtml/mm5036a3.htm, the Centers for Disease Control and Prevention (CDC) published interim guidelines for prioritizing use of PCV-7 during the shortage. It is recommended that providers defer vaccination of children 2-5 years of age except for those in that age group who are at increased risk for developing pneumococcal disease (see table below). A second group for which vaccine can be deferred, if need be, are children 1-2 years of age who are not high risk for pneumococcal disease. The California Department of Health issued similar guidelines, which are printed below.

Providers are urged to give the highest priority to vaccinating all infants under 12 months and children 1-5 years of age at increased risk for pneumococcal disease. Catch-up vaccinations for healthy children 1-2 years of age and booster doses for healthy children who have completed the primary series may be deferred until the availability of PCV-7 improves. Providers are reminded to maintain records of children whose vaccinations were deferred so that these children can be brought up-to-date when the vaccine is more readily available.

The Immunization Practices’ routine recommendations can again become the standard. Until the shortage ends, providers should adhere to the interim guidelines to insure that the limited amount of this important vaccine is given to individuals at highest risk for invasive pneumococcal disease. For questions, please contact Karon Jones, RN, Immunization Coordinator, at (909) 358-5568.

Updated Recommendations for Pneumococcal Conjugate Vaccine use During Current Moderate to Severe Shortages – Advisory Committee on Immunization Practices, 2001

2002 Recommended Children Immunization Schedule

County of Riverside – Community Health Agency
Department of Public Health
Quarterly Morbidity Report
REPORTED CASES OF SPECIFIED NOTIFIABLE DISEASES

^ = Effective 11/01, new diseases added to report
+ = Effective 6/01, revision in definition for reporting acute and chronic Hepatitis B.
* = excluding Haemophilus influenza/meningococcal infections

Source: Disease Control Program, CMR Reporting
Compiled: Health Statistics Branch, Department of Public Health, Community Health Agency, County of Riverside
RL 2/7/2002