Infectious Disease

Epidemics on the other side of the world are a threat to us all.  No epidemic is just local.

—Peter Piot 

As the population of the world grows and the ease of travel increases, it is important to monitor infectious diseases within Tulsa County as well as to monitor potential outside threats that could impact the future health of the county. Efforts to prevent and control infectious disease is continuously being challenged as illness-causing microbes evolve and adapt to the ever growing and changing population, environment and practices.

Infectious disease epidemiology is a branch of research medicine that looks at the distribution and determination of health within a population. It relies on surveillance and case investigations to monitor current and impending health threats on a local, state, national and global level.

The field of infectious disease epidemiology incorporates knowledge of epidemiological methods, analytical and laboratory methods, immunology, and pharmacology, as well as disease progression to create a timeline of when and where a person suffered a detriment. That information is then used in interventions and to help create policy that will help to reduce the prevalence of these diseases (1). In Tulsa County, epidemiologists investigate a variety of reportable diseases, such a respiratory, enteric, vector borne and sexually transmitted infections. 

Enteric Illness

Definition

This indicator includes reported cases of disease caused by the following bacteria—Campylobacter species, Escherichia coli (STEC), Salmonella species, Shigella, and Listeria monocytogenes. It is presented as the rate of the reported enteric illness cases per 100,000 population. 

Why is this indicator important?

Enteric bacteria generally enter the body through consumption of contaminated food or water, contact with animals and their environment, or by contact with the feces of an infected person. They usually cause diarrheal illness (2). Consumption of contaminated food causes an estimated 48 million foodborne illnesses and 3,000 deaths each year in the United States. Although everyone is at risk of getting a foodborne illness, certain populations, such as infants, young children, pregnant women, the elderly, and individuals with weakened immune systems, are at a greater risk of developing more serious illness or death (3).

How are we doing?

In 2018, the rate of enteric disease in Tulsa County was 28.6 cases per 100,000, which was lower than Oklahoma overall (63.6). While this trend has been consistent since 2011, there has been wide variation from year to year. 

In 2018, there were 184 cases of enteric diseases (listed above) reported in Tulsa County. The most common reported illness was Campylobacteriosis (142 cases, over 77 percent enteric diseases), followed by Escherichia coli (20 cases; almost 10.8 percent of enteric diseases). 

Following sections detail rates for shigellosis, campylobacteriosis, salmonellosis, and STEC. Listeria cases are not reported due to confidentiality concerns due to low case numbers.


Shigellosis

Shigellosis is an infection of the intestines by the Shigella bacterium. It generally causes diarrhea, fever, vomiting, and abdominal cramping (4).

In 2018, there were a total of 17 cases of shigellosis reported in Tulsa County, which was a rate of 2.6 cases per 100,000 population. This was very similar to the rate in Oklahoma (2.3 cases per 100,000). For the US in 2018, there were roughly 5 (4.9) cases per 100,000 nationally. 

Shigellosis can spread quickly, especially in high-risk settings such as childcare, healthcare, and/or restaurants (4). Fluctuations in rates between years may be a result of outbreaks in these settings. 


Campylobacteriosis

Campylobacteriosis is a diarrheal illness caused by the Campylobacter bacterium. Symptoms generally include diarrhea, vomiting, fever, and muscle aches. In immunocompromised individuals, the disease can be much more severe, as the bacteria can spread to the bloodstream (5). 

In 2018, there were a total of 142 cases of campylobacteriosis reported in Tulsa County, which was a rate of 22.1 cases per 100,000 population. This was lower than the rate in Oklahoma (29.5 cases per 100,000). This trend has been consistent since 2011.  The rate in Tulsa County in 2018 was very similar to the rate for the US which was 21.5 cases per 100,000 population.

Campylobacteriosis has increased overall in both Tulsa County and Oklahoma since 2011.  


Salmonellosis

Salmonellosis is a diarrheal illness caused by the Salmonella bacterium. Symptoms include diarrhea, fever, abdominal pain, headache, muscle aches, nausea and sometimes vomiting (6).

In 2017, there were a total of 111 cases of salmonellosis reported in Tulsa County, which was a rate of 17.4 cases per 100,000 population. This was lower than the rate in Oklahoma (24 cases per 100,000). In 2018, rate of salmonellosis in Tulsa County declined precipitously, to a rate of 0.8 cases per 100,000.  Oklahoma and the US both increased slightly from 2017 to 2018.  For Oklahoma the rate went from 23.6 to 24.8, for the US the rate went from 16.7 to 18.6.  Tulsa County has consistently had a lower rate of salmonellosis than Oklahoma since 2011.


Shiga Toxin Producing Escherichia Coli (STEC)

E. coli are among the most common bacteria found in the digestive tracts of humans and animals. While most strains of the bacteria are harmless, some strains have developed the ability to produce a toxin that can cause serious disease in humans (shiga toxin). STEC, including E. coli O157:H7 and other non-O157:H7 strains, can cause mild to severe diarrhea (7).

In 2018, there were a total of 20 STEC cases reported in Tulsa County. This was a rate of 3.1 cases per 100,000 population, which was lower than the rate in Oklahoma (6.7 cases per 100,000) and the US (4.9 cases per 100,000). 

Respiratory Illness

Definition

This indicator includes reported cases of measles, mumps, pertussis, Streptococcus, Haemophilis influenzae, and Neisseria meningitidis. It is presented as the rate of the reported respiratory illness cases per 100,000 population. Flu hospitalizations and tuberculosis rates per 100,000 population are reported separately. 

Why is this indicator important?

The respiratory diseases identified in this section can be spread from person-to-person by mucus or saliva (called 'respiratory secretions') when a person coughs, sneezes, talks, or laughs. Transmission of each disease is different, but some of these respiratory secretions can be spread far distances through the air (more than 3 feet) and can live on surfaces for extended periods of time (8). These respiratory diseases cause concern in high-risk settings such as childcare and healthcare settings, due to the ease with which they may be transmitted.

Symptoms of these diseases differ, ranging from a cough and rash to inflammation of the protective coverings of the brain and spinal cord (meningitis). Severe cases of these diseases may result in death.

All of the diseases listed above have vaccines available, although not all species are covered by vaccines, or are recommended to all age groups (9, 10, 11, 12, 13, 14, 15, 16). However, it is important to track these diseases, because changes in incidence may indicate changing vaccine coverage or vaccine perceptions in Tulsa County. 

How are we doing?

In 2018, there were 30 cases of respiratory diseases (listed above, excluding flu hospitalizations and tuberculosis) reported in Tulsa County. The most common reported illness was pertussis (22 cases; 73.3 percent of respiratory diseases).

In 2018, the rate of respiratory disease in Tulsa County was 4.7 cases per 100,000, which was lower than Oklahoma overall (6.7). Significant fluctuations in rates over time may be a result of outbreaks, as many respiratory diseases can spread quickly through high-risk settings such as childcare facilities.

Following sections detail rates for pertussis and haemophilus influenzae. Other disease specific rates are not reported due to confidentiality concerns due to low case numbers.


Pertussis

Pertussis is a respiratory disease caused by the bacteria Bordetella pertussis. Pertussis, also known as whooping cough, is characterized by spasms of severe coughing (paroxysms). These coughing fits are often followed by the characteristic inspiratory whoop and/or coughing so hard that the person vomits (11).

In 2018, there were 22 cases of pertussis reported in Tulsa County, which was a rate of 3.4 cases per 100,000 population. This was slightly higher than Oklahoma overall (2.6 cases per 100,000). In 2018, there were 4.8 cases of pertussis per 100,000 population nationally. 


Haemophilus influenzae

Haemophilus influenzae is a bacterium that is found in the nose and throat of children and adults, but does not cause illness in all individuals who carry it. Haemophilus influenzae serotype B (Hib) is commonly associated with infants and young children, but is not common due to widespread use of the Hib vaccine in children. Non-serotype B infections occur primarily among the elderly and adults with underlying disease.  Haemophilus influenzae causes a variety of illnesses including meningitis (inflammation of the coverings of the spinal column and brain), bacteremia (infection of the blood), pneumonia (infection of the lungs), and septic arthritis (infection of the joints) (13).

In 2016 and in 2018, there were too few cases of H. influenzae to report in Tulsa County. However, in 2015 there were 14 cases, which was a rate of 2.2 cases per 100,000 population, and in 2017 there were 17 cases, which was a rate of 2.7 cases per 100,000 population. Tulsa County has consistently had lower rates of H. influenzae than Oklahoma, but both of these locations have consistently had higher rates than the US overall since 2011.  


Influenza Related Hospitalizations and Deaths

Influenza, also called "the flu", is caused by a virus that affects the nose, throat, airways, and lungs. Influenza A and/or B typically circulates in the United States from the beginning of October through the middle of May (15).

In 2018, there were 1,080 flu-related hospitalizations in Tulsa County, which was a rate of 168.0 hospitalizations per 100,000 population. This was a large increase from 2017, when the reported flu hospitalizations rate was 23.2 per 100,000 population.  

In general from 2011 to 2018, Tulsa County has had slightly higher rates of flu hospitalizations than Oklahoma overall.  Data for flu hospitalizations for Oklahoma for 2017 and 2018 were not available at the time of this report.  

There were 24 deaths from influenza in 2018 in Tulsa County, which was a rate of 3.7 deaths per 100,000 population.  Although in 2011, 2012 and 2016 there were too few deaths in Tulsa County for the rates to be reported, one can see from the graph to the right that the rates of deaths from the flu are very similar to the rates for Oklahoma overall.  



Tuberculosis (TB)

Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. It usually affects the lungs, but can also attack other parts of the body such as the kidneys, spine and brain. It is spread through the air when someone with TB of the lungs or throat coughs, sneezes, speaks or sings. Individuals with TB are treated by taking several drugs for 6 – 12 months. It is very important to take the drugs exactly as prescribed, in order to lower the risk of becoming sick again or developing resistance to the drugs (16).

In 2016, there were 15 new cases of TB in Tulsa County, which was a rate of 2.4 cases per 100,000 population. In 2017, there were too few cases in Tulsa County to be reported (less than 10).  In 2018, there were 10 new cases of TB in Tulsa County, for a rate of 1.6 cases per 100,000 population.  The rate of TB in Tulsa County has consistently been higher than the rate in Oklahoma since 2011, but is showing a general downward trend from 2011 to 2018. In addition the rates for the US have consistently been higher than the rates for Tulsa County and Oklahoma since 2011.  

Vectorborne Illness

Definition

This indicator includes reported cases of tickborne illness (erlichiosis, Rocky Mountain Spotted Fever, Lyme disease, and tularemia) and West Nile Virus (West Nile Fever and West Nile Neuroinvasive). It is presented as the rate of the reported cases of vectorborne illness per 100,000 population. 'Vectorborne' refers to any disease that is transmitted through a mosquito or tick (vector).

Why is this indicator important?

Almost everyone has been bitten by a mosquito or tick, which can be vectors for spreading diseases such as West Nile Virus, Zika virus or Rocky Mountain Spotted Fever. As more people travel around the world, there is a potential for introduction of these diseases into new areas. This can also be facilitated by commerce moving moquitos and ticks around the world and introducing the vectors to new areas (17). 

Symptoms of these diseases vary, but can range from mild flu like illness or a rash to neurological damage and death (18, 19).

It is important to track these diseases in order to effectively provide prevention messaging to Tulsa County residents. Prevention tips include always using EPA-registered insect repellent, wearing long sleeves or pants, and removing standing water and high grass/weeds from around your home (17).

How are we doing?

In 2016, there were 29 cases of vectorborne diseases (listed above) reported in Tulsa County for a rate of 4.6 cases per 100,000 population. In 2017, there were 51 cases of vectorborne illnesses, for a rate of 8.0 cases per 100,000.  For both of these years, tickborne illnesses were the most commonly reported. In 2018, there were too few cases of reported vectorborne illnesses for rates to be reported (less than 10).  It is clear in the first graph to the right that vectorborne illnesses have declined in Tulsa County since 2012.

In general, rates of vectorborne illnesses in Tulsa County have been lower than rates for Oklahoma overall and for the US as a whole.  Data for vectorborne illness as a category were not available for the US for 2017 and 2018.

Following sections detail rates for tickborne illnesses and West Nile Virus. Tick disease specific rates are not reported due to confidentiality concerns due to low case numbers.


Tickborne Illness

Tickborne illnesses includes erlichiosis, Rocky Mountain Spotted Fever (RMSF), Lyme disease, and tularemia. In Tulsa County, the most common tickborne illnesses are erlichiosis and RMSF.

In 2018, there were too few reported cases of tickborne illnesses for a rate to be reported (less than 10).  In general, the rates of tickborne illnesses have consistently been lower in Tulsa County than in Oklahoma and the US overall.  The trend for rates of tickborne illness in Tulsa County is showing a clear decrease in rates from 2011.  


West Nile Virus

West Nile Virus is primarily transmitted by the bite of an infected mosquito. Persons of any age can become ill after being bitten by an infected mosquito, but those over the age of 50 are at greater risk of developing serious illness involving the nervous system. Over 80 percent of people infected with the virus never have symptoms. If people do become ill, most cases have symptoms such as a fever, headache, tiredness and body aches that go away on their own (West Nile Fever). Some people may develop a rash on the trunk of the body. In more severe cases, persons can develop meningitis or other neurologic disease (West Nile Neuroinvasive) (18). 

There have been too few cases of West Nile Virus to report in Tulsa County since 2013. However, in 2013 there were 13 cases, which was a rate of 2.1 cases per 100,000 population. This was very similar to Oklahoma (2.2 cases) and higher than the US (0.8 cases per 100,000 population).  Oklahoma overall has shown a general downward trend in the reported cases of West Nile Virus since 2012.

Sexually Transmitted Infections

Definition

This indicator includes reported cases of sexually transmitted infections (chlamydia, gonorrhea, syphilis, HIV, and AIDS). It is presented as the number of cases and/or rate per 100,000 of each disease individually. It is presented as newly diagnosed cases. 

Why is this indicator important?

The Centers for Disease Control and Prevention (CDC) estimates that there are approximately 20 million new sexually transmitted infections (STIs) in the US each year, with almost half of those occurring young adults age 15 - 24. The cost burden of STIs on the health care system is significant- it is estimated to be as high as $16 billion annually. STIs are also commonly undiagnosed and therefore unreported, indicating that the true burden may be much higher.

Untreated STIs can have serious health complications, including reproductive health problems, fetal and perinatal health problems, cancer, and facilitation of sexual transmission of HIV. CDC also estimates that undiagnosed and untreated STIs cause at least 24,000 US women to become infertile each year (20).

How are we doing?

In 2018, there were 8,627 cases of sexually transmitted infections (List above, excluding data on HIV and AIDS which was not available at the time of this report) reported in Tulsa County. Chlamydia was the most commonly reported (5,754 cases, 66.7 percent), followed by gonorrhea (2,526 cases, 29.2 percent). It is important to note that the same person may have multiple STIs.  Tulsa County showed increases in all types of sexually transmitted infections from 2017 to 2018, although the increase in reported cases of chlamydia is most striking.  During the time period 2016-2018, the Downtown and North Tulsa regions had the highest rates of chlamydia, gonorrhea and all stages of syphilis of all of the regions in Tulsa County.  

In 2018, the rate of chlamydia in Tulsa County was 655.6 cases per 100,000 population. By 2018, this rate had increased to 895.2.  The rate of gonorrhea was 273.6 cases per 100,000 in 2016, by 2018 this rate had risen to 393.0. The rate of syphilis (all stages) was 15.6 cases per 100,000 in 2016, by 2018 this rate had risen to 54.0. The rate of HIV was 10.2 cases per 100,000 and by 2017 had risen to 11.0. As stated above there was not data available on reported HIV and AIDS cases for 2018 at the time of this report.   

In general, chlamydia, gonorrohea and syphilis have been trending upward (increasing) since 2011, although there have been fluctuations between years. The HIV rate has been decreasing, and the AIDS rate has stayed relatively stable.

Following sections detail rates for each sexually transmitted infection, including comparisons to rates in the US and Oklahoma. Demographic information is shown when available. Some demographic information cannot be shown due to confidentiality concerns.


Chlamydia

Chlamydia is a STI caused by the bacterium Chlamydia trachomatis. It is the most commonly reported STI in Tulsa County. Chlamydia is often unsymptomatic, although it can still damage your reproductive system. Symptoms include abnormal vaginal discharge (women), discharge from the penis (men) and a burning sensation while urinating (both men and women). If left untreated, chlamydia can cause serious health conditions, including short and long-term reproductive problems, especially in women. Chlamydia can be transmitted to infants during birth and can result in eye infections which may lead to blindness (21).

In 2016, there were 4,129 new cases of chlamydia reported in Tulsa County, which was a rate of 655.6 cases per 100,000 population. In 2018, the number of cases had increased to 5,754 and a rate of 895.2.  The chlamydia incidence rate in Tulsa County has consistently been higher than the rate in Oklahoma and the US since 2011.  

In the time period 2016-2018, the greatest percentage of new chlamydia cases were reported in females (69.3 percent), whites (36.5 percent) and adults ages 20 – 24 years (34.5 percent). Please note that Hispanic individuals could be any race.

The Downtown and North Tulsa regions within Tulsa County consistently had the highest rates of chlamydia from 2011 to 2018.  The zip code with the highest rate of new chlamydia infection was 74103 and 74120, both of which are in the Downtown region.  


Gonorrhea

Gonorrhea is a STI caused by Neisseria gonorrhoeae. It is the second most commonly reported STI in Tulsa County. Untreated gonorrhea can lead to severe and painful infections, and infertility in both men and women. A pregnant woman risks possible blindness and/or life-threatening infections for her baby (22).

In 2011, Tulsa County reported an incidence rate of 180.9 cases of gonorrhea per 100,000 population (1,080 total cases). This was higher than the rate in Oklahoma (113.5) and the US overall (104.2). By 2018, the rates in all three locations had increased overall, with Tulsa County increasing to 392.9, Oklahoma increasing to 229.6, and the US increasing to 178.3.  

Examining reported gonorrhea cases in Tulsa County for 2018 in terms of gender, the majority of the cases were female (51.2 percent).  On race and ethnicity, the highest percentages of new gonorrhea cases were almost equally split in the white and black populations, at 36.8 percent and 36.7 percent respectively.   The highest percentage of cases in terms of age were reported in adults ages 20 – 24 years (25.7 percent). 

While there were overall increases in the rates of gonorrhea across all regions of Tulsa County, the last graph clearly shows that the largest increases occurring within Tulsa County from 2011 to 2018 were in the Downtown and North Tulsa regions.  The rates in those two regions have shown some signs of leveling off or even decreasing slightly since 2014-2016.   

The zip code with the highest rate of new gonorrhea infection was 74103, which is in downtown Tulsa.


Syphilis (all stages)

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Syphilis is transmitted by direct contact with a syphilis sore or lesion (called a chancre). The primary stage of syphilis is generally characterized by a chancre that appears about 2 – 6 weeks after exposure. These sores typically disappear after a few weeks without treatment. However, without treatment, the infection can progress to the secondary stage, which generally starts with a rash anywhere on the body. Again, the symptoms will go away on their own, but without treatment infection can progress to latent and late stages of syphilis. Late stages of syphilis may result in damage to internal organs, muscle movement difficulty, paralysis, blindness, and dementia. This damage may cause death. Pregnant females who are infected may have miscarriages, premature births, stillbirths, or death of their newborns. Without treatment, infected babies can die or have lasting complications such as cataracts, deafness or seizures (23).

In 2016, there were 98 new cases of syphilis (all stages) reported in Tulsa County, which is a rate of 15.6 cases per 100,000 population. By 2018, this rate had shot up to 53.9 cases per 100,000.  This rate is much higher than the rate for Oklahoma (22.3) and the US overall (35.2).  The rates for all three locations have increased since 2011; however, the rates for Oklahoma and the US have not risen as sharply as has the rate for Tulsa County.  

During the time period 2016-2018, the highest percentage of new cases of syphilis were males at 72.2 percent.  Over half of the new syphilis cases were reported for the white population at 52.7 percent.  Eleven percent of new syphilis cases were reported in the Hispanic population.  The highest percentages of new syphilis cases (all stages) were evenly split between adults ages 25 – 29 and 30 - 34 years (18.6 percent each, accounting for 37.3 percent of total). More than half of the new syphilis (all stages) cases in Tulsa County from 2016-2018 were reported in people who reported heterosexual contact (51.4).  An additional 31.6% of cases were in those who reported that they are men who have sex with men (MSM). However, individuals could report multiple risk factors. 

During the time period 2016-2018, the Downtown and the North Tulsa region had the highest rates of reported cases of all stages of syphilis.  In fact, prior to the 2014-2016 time period, there were too few cases of syphilis to be reported in the Downtown region.  After this period, the rates have gone up sharply.  Rates in the North Tulsa region have also risen sharply since the 2014-2016 time period.  It is not surprising that the zip code with the highest rates of new syphilis infections (all stages) were 74103, and 74120 which are in the Downtown region.


Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)

HIV is a virus spread through certain bodily fluids that affects the immune system. As HIV destroys specific cells in the immune system, the body loses the ability to fight off infections and disease, which leads to AIDS. In the United States, HIV is mainly spread through having unprotected sex or sharing injection drug equipment with someone who has HIV. HIV can be prevented by limiting the number of sexual partners, never sharing needles, and using condoms correctly and consistently. The CDC estimates that about 1.1 million people were currently living with HIV at the end of 2015, and about 15 percent did not know they were infected. Certain racial/ethnic groups, such as blacks and Hispanics/Latinos, are disproportionately affected compared to the general population (24).

The latest available data for reported HIV cases in Tulsa County was for 2017.  That year, there were 70 new cases of HIV in Tulsa County which was a rate of 11.0 cases per 100,000 population.  In 2016, there were 64 new cases of HIV reported in Tulsa County, a rate of 10.2 cases per 100,000.  The latest available data on new AIDS cases was 2016, at which time there were 21 new cases of AIDS reported in Tulsa County. This was a rate of 3.3 AIDS cases per 100,000 population. Tulsa County had a higher rate of new cases of HIV from 2013 until 2015, where the rate for Tulsa County started to fall below the rate for the US.  

Data by demographics is aggregated into 3-year rolling totals in order to maximize the ability to report rates, due to low case counts in single years.  

In terms of new cases reported by gender for the time period 2015-2017, those who's birth gender was male accounted for over 80 percent of cases (82.1 percent).  Whites had the highest percentage of new cases reported during this time period, accounting for almost half (48.5 percent) of the new cases.  The percentage was much lower for those who were reportedly Hispanic at 15.7 percent.  The greatest percentage of new HIV cases were reported in adults ages 20 – 29 years (40.3 percent). Almost 60 percent (57.5 percent) of the cases reported that they were men who have sex with men (MSM).  However, individuals could report multiple risk factors. 

Latest zip code level data on HIV is for the time period 2014-2016.  The Midtown region, East Tulsa region and the North Tulsa region had individual zip codes with the highest rates.  The zip code with the highest rates of new HIV infection in that time period was 74103.  This zip code is in the Downtown region.  When examining HIV rates by region, we see that rates have consistently been higher in the Downtown region.

Bloodborne Illness

Definition

This indicator is presented as the number of cases of hepatitis B and C (acute and chronic) per 100,000 population of each disease individually. It is presented as newly reported cases.

Why is this indicator important?

Hepatitis B and C are contagious liver diseases that can cause acute or chronic infection (25, 26). 

The hepatitis B virus (HBV) is 50 – 100 times more infectious than HIV and is usually spread through blood, semen, or other bodily fluids.  Approximately 15–25 percent of individuals with chronic hepatitis B develop serious liver complications, including liver damage, cirrhosis, liver failure, and liver cancer. There has been significant decline in HBV cases since 1990, when the vaccine was introduced. In the US, an estimated 850,000 people have HBV, but that number may be as high as 2.2 million (25).

Approximately 75–85 percent of people who are infected with hepatitis C virus develop chronic (lifelong) infection. Hepatitis C virus (HCV) is transmitted through contact with the blood of an infected person. Currently, most people become infected with hepatitis C by sharing needles or other equipment used to inject drugs. There is no vaccine to prevent HCV. The most effective way to prevent HCV is to avoid behaviors that can lead to spread such as injection drug use (26). Hepatitis C (acute and chronic) accounts for the majority of the cases investigated by Tulsa Health Department epidemiologists.

How are we doing?

There were 793 cases of HBV and HCV in Tulsa County in 2018. The rate of chronic HCV (105.3 cases per 100,000) was almost 10 times higher than that of chronic HBV (14.8 cases per 100,000). The rate of chronic HBV has doubled since 2016, from 7.4 to and 14.8.  The rate of chronic HCV has risen sharply from 2014 (40.9) to 2018 (105.3).  In terms of the acute types of hepatitis, rates for acute HBV have generally been decreasing since 2011. The rate of acute HCV has stayed relatively stable since 2012. 

The following sections detail rates for HBV and HCV individually, including comparisons to rates in the US and Oklahoma. Demographic information is shown when available. Some demographic information cannot be shown due to confidentiality concerns.


Hepatitis B Virus (HBV)

In 2018, there were 95 cases of chronic HBV and 9 cases of acute HBV reported in Tulsa County. This was a rate of 14.8 chronic HBV cases per 100,000 and 1.4 acute HBV cases per 100,000. Tulsa County had a slightly higher rate of acute HBV than Oklahoma and the US. In 2018, the rate of chronic HBV in Tulsa County was 14.8.  This rate was slightly higher than Oklahoma in 2016, with Tulsa County at a rate of 7.5 cases compared to Oklahoma at 6.9 cases.  Unfortunately, later data for Oklahoma for chronic HBV was not available at the time of this report.

From 2016-2018, the greatest percentage of new HBV cases (acute and chronic) were reported in males (58.5 percent).  In terms of race/ethnicity, the highest percentage of new cases were in the Asian/Pacific Islander population (34.4 percent) during the same time period.  

About a quarter (25.3 percent) of the cases reported from 2016-2018 reported that they had previously had dental or oral surgery. However, individuals could report multiple risk factors.

In terms of HBV rates by region, most of the rates for the regions over time are clustered somewhat close to each other and relatively stable over time.  There are two regions, however, which have rates higher than the other regions for the time period 2016-2018; the East Tulsa and North Tulsa regions.  The zip codes with the highest rates of HBV cases (acute or chronic) were 74104 in the Midtown region and 74136 in the South Tulsa region. 




Hepatitis C Virus (HCV)

In 2018, there were 677 cases of chronic hepatitis C and 12 cases of acute hepatitis C reported in Tulsa County. This was a rate of 105.3 chronic HCV cases per 100,000 and 1.9 acute HCV cases per 100,000. Tulsa County had a slightly higher rate of acute HCV than Oklahoma and the US.  The rate of chronic HCV in Tulsa County was lower than Oklahoma (40.2 cases compared to 45.6 cases) in 2016 (the last year for which chronic hepatitis C rates were available).  However, since 2016, the rate for chronic HCV in Tulsa County has been steadily increasing.

From 2016-2018, the highest percentage of new HCV cases (acute and chronic) were reported males at 53.9 percent.  Over 60 percent (64.4 percent) of the new HCV cases were reported in the white population.  Age was not collected for HCV cases after 2016.  Almost a third of the cases reported from 2016-2018 reported that they had engaged in injection drug use (IDU). However, individuals could report multiple risk factors.

The Downtown region of Tulsa County consistently had the highest rates of HCV.  Not surprisingly, the zip code with the highest rate of HCV cases (acute and chronic) was 74103, which is in downtown Tulsa. The other regions are somewhat clustered at much lower rates than the Downtown region, although by the 2016-2018 time period, the North Tulsa region and the Midtown region had both shown slight increases from the previous time period.


Explore the Data



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References

1. Infectious Disease Epidemiology. Mailman School of Public Health. Columbia University.

2. Enteric Diseases Epidemiology Branch. Centers for Disease Control and Prevention.

3. Foodborne Illness. USDA Food Safety and Inspection Service.

4. Shigellosis. Oklahoma State Department of Health.

5. Campylobacteriosis. Oklahoma State Department of Health.

6. Salmonellosis. Oklahoma State Department of Health.

7. Shiga toxin-producing E. coli (STEC). Oklahoma State Department of Health.

8. Infectious Respiratory Diseases. North Carolina Public Health Department.

9. Measles. Oklahoma State Department of Health.

10. Mumps. Oklahoma State Department of Health.

11. Pertussis. Oklahoma State Department of Health.

12. Invasive Group A Streptococcus. Oklahoma State Department of Health.

13. Haemophilis influenzae. Oklahoma State Department of Health.

14. Meningococcal Diseases. Oklahoma State Department of Health.

15. Influenza Fact Sheets and Resources. Oklahoma State Department of Health.

16. Tuberculosis Fact Sheet. Centers for Disease Control and Prevention.

17. Illnesses on the Rise from Mosquito, Tick, and Flea Bites. Vital Signs. Centers for Disease Control and Prevention. May 2018.

18. West Nile Virus. Oklahoma State Department of Health.

19. Rocky Mountain Spotted Fever. Oklahoma State Department of Health.

20. Sexually Transmitted Diseases. Healthy People 2020. U.S. Department of Health and Human Services.

21. Chlamydia: CDC Fact Sheet. Centers for Disease Control and Prevention.

22. Gonorrhea: CDC Fact Sheet. Centers for Disease Control and Prevention.

23. Syphilis: CDC Fact Sheet. Centers for Disease Control and Prevention.

24. HIV Basics. Centers for Disease Control and Prevention.

25. Hepatitis B FAQs for the Public. Centers for Disease Control and Prevention.

26. Hepatitis C FAQs for the Public. Centers for Disease Control and Prevention.


Data sources

• Acute Disease Service. Oklahoma State Department of Health.

• CDC, Office of Public Health Scientific Services (OPHSS); Center for Surveillance, Epidemiology and Laboratory Services (CSELS); Division of Health Informatics and Surveillance (DHIS). MMWR 2016; 63(54):1-152 and CDC. Available from: http://www.cdc.gov/mmwr/mmwr_nd/index.html.

• Rosenberg R, Lindsey NP, Fischer M, et al. Vital Signs: Trends in Reported Vectorborne Disease Cases — United States and Territories, 2004–2016. MMWR Morb Mortal Wkly Rep 2018;67:496–501. DOI: http://dx.doi.org/10.15585/mmwr.mm6717e1.

• HIV/ STD Service. Oklahoma State Department of Health.

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