Los Angeles County Cysticercosis Public Health Problem Identified - - PDF document

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Los Angeles County Cysticercosis Public Health Problem Identified - - PDF document

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1 Los Angeles County Cysticercosis Public Health Problem Identified LAC Cysticercosis hospitalizations 10-15 cases in 1970s 80 by early 1980s (F. Richards et. al. 1985, JAMA) Severe Disease 56% Seizures, 21%

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Cysticercosis Los Angeles County

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Public Health Problem Identified

  • LAC Cysticercosis hospitalizations

– 10-15 cases in 1970’s – 80 by early 1980’s (F. Richards et. al. 1985, JAMA)

  • Severe Disease

– 56% Seizures, 21% hydrocephalus (N=238) among hospitalized cases (D. Scharf 1988, Arch Neurol)

  • Cysticercosis is Preventable !
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How to Prevent Cysticercosis

Review of Life Cycle

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Public Health Opportunity

In 1988 LAC Public Health identified an

  • pportunity for disease prevention:
  • Add cysticercosis to the list of reportable diseases for

LAC

  • Public health nursing to screen close contacts of

reported Cysticercosis cases for Taeniasis

  • Refer Taeniasis cases for treatment
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Public Health Results

  • This intervention method has been

successful in identifying cases

– Taeniasis cases were identified in 7% (5/72) of households tested (1988-1991).

  • F. Sorvillo et. al. 1992. Am. J. Trop. Med. Hyg
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What’s Happening With Cysticercosis in LAC Today ?

  • Review available data sources:

– Reported cases – Death Certificates – Hospital Discharge Data – Published Studies

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Reported Cases LAC

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Reported Cases, LAC

Figure 1 Cysticercosis Incidence Rates per 100,000, Los Angeles County

y = -0.0366x + 0.7763 R2 = 0.8124

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

1 988 1 990 1992 1994 1 996 1 998 2000 2002 2004

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Reported Cases, LAC 1993-2006 (N=411)

47% 192 Female 53% 216 Male Gender 12 Unknown 1% 2 Pacific Islander 1% 3 African American 2% 6 Asian 4% 17 Caucasian 93% 371 Latino Race/ Ethnicity % n

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Trends in Reported Cases, LAC

Early vs. Later Cases

Health Department Cases

91% 84% 61% 33% 6% 87% 80% 60% 48% 7% 0% 20% 40% 60% 80% 100% Latino Immigrant Born in Mexico U.S Resident >10 yrs Mortality 1988-1990 Study (N=138) 2003-2006 Study (N=60) 28 35 10 20 30 40 50 Mean Age Years

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Reported Cases by Health District

LAC, 2004-09 (n=59)

3% 15 Other Health Districts (2 or fewer cases) 5% 3 CENTRAL HD/ Central HC (9) 5% 3 BELLFLOWER HD/Bellflower HC (6) 5% 3 WEST VALLEY HD (86) 5% 3 SOUTHEAST HD/Humphrey HC (72) 5% 3 SOUTH HD/ South HC (69) 5% 3 SAN FERNANDO HD/ Pacoima HC (62) 7% 4 EAST VALLEY HD/ North Hollywood HC (19) 7% 4 POMONA HD/ Pomona HC (54) 7% 4 ANTELOPE VALLEY HD/Antelope Valley HC (5) 10% 6 SAN ANTONIO HD/ Compton HC (58) 14% 8 EL MONTE HD/ Pomona HC (23) % n HEALTH DISTRICT IMPACTED

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Mortality

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Cysticercosis Mortality

  • National Mortality
  • 221 Deaths 1990-2002 (17 per year)
  • 60% occurred in CA
  • 32% occurred in LAC
  • F. Sorvillo et. al. 2004, EID
  • LAC Mortality

– Slight decrease over time – Demographics

  • 96% Latino
  • Mean age 41.2 years
  • 62% male
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Hospitalizations

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Hospitalizations

Hospitalizations 1991-2008 (18 years)

  • 7,169 Cysticercisis hospitalizations (398 per year)
  • 3,937 NC* Hospitalization (218 per year)
  • 1,488 NC* Hospitalization

with primary Dx cysticercosis (82 per year)

*NC=neurocysticercosis

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Hospitalization Demographics

LAC, 1991-2008 (n=3937)

  • 91.6 % Latino
  • Male: Female = 1.1:1
  • Mean age 38.4 years
  • 31.3 years in 1991
  • 43.1 years in 2008
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Hospitalizations

  • Economic Burden over 18 years

– $136.2 million total hospitalization charges

  • Averaging $7.9 million per year

– Average charge per patient was $37.6 thousand – Most common payment method

  • Medicaid (43.9%)
  • Private insurance (24.5%)
  • The average length of stay was 7.2 days.
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Hospitalizations 1991-2008

  • 3,937 neurocysticercosis hospitalizations

identified – 72.8% seizure or convulsion (2,866) – 30.9% hydrocephalus (1,217) – 6.2% cerebral cyst (244) – 2.2% cerebral edema (866) – 2.0% death (77)

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Figure 1. Neurocysticercosis Hospitalizations and Hospital Charge by Year Los Angeles County 1991-2008

Neurocysticercosis Hospitalizations y = -0.26x + 221.09 (R2 = 0.01) Hospital Charge for Neurocysticercosis y = 0.63x + 1.89 (R2 = 0.74)

25 50 75 100 125 150 175 200 225 250 275 300

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Hospitalizations

4 8 12 16 20 24 28 32 36 40

Charge ($ Millions)

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31.9% 1256 MRI or CT Scan of Brain 0.6% 23 Craniotomy 3.3% 131 Brain Excision 3.9% 155 Ventriculostomy 5.5% 217 Shunt Removal / Replace 14.3% 564 Any Ventricular Shunt 21.4% 842 Brain Procedure 12.0% 472 Lumbar Puncture 32.3% 1273 CNS Procedure percent n Procedure Los Angeles County 1991-2008 (N=3937) Hospitalizations Procedures

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Cysticercosis Trends

1993-2006 (16 years)

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Cysticercosis in Los Angeles County

Early Cases (1993-1999) vs. Later Cases (2000-2006)

227 115 100 200 300

Reported Cases Deaths Hospitalization NC Hospitalization NC Hospitalization (Primary Dx) 1993-1999 2000-2006

Reported cases down 49%

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Cysticercosis in Los Angeles County

Early Cases (1993-1999) vs. Later Cases (2000-2006)

227 24 115 15 100 200 300

Reported Cases Hospitalization NC Hospitalization (Primary Dx)

1993-1999 2000-2006

Reported cases down 49% Mortality down 37%

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Cysticercosis in Los Angeles County

Early Cases (1993-1999) vs. Later Cases (2000-2006) 227 24 2755 115 15 2883 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200

Reported Cases Deaths Hospitalization NC Hospitalization NC Hospitalization (Primary Dx) 1991-1999 2000-2006

Reported cases down 49% Mortality down 37% Hospitalizations up 5%

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Cysticercosis in Los Angeles County

Early Cases (1993-1999) vs. Later Cases (2000-2006)

227 24 2755 1534 115 15 2883 1611 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200

Reported Cases Deaths Hospitalization NC Hospitalization NC Hospitalization (Primary Dx) 1991-1999 2000-2006

Reported cases down 49% Mortality down 37% Hospitalizations up 5% NC hospitalizations up 5%

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Cysticercosis in Los Angeles County

Early Cases (1993-1999) vs. Later Cases (2000-2006)

227 24 2755 1534 1039 115 15 2883 1611 909 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200

Reported Cases Deaths Hospitalization NC Hospitalization NC Hospitalization (Primary Dx) 1993-1999 2000-2006

Reported case down 49% Mortality down 37% Hospitalizations up 5% NC hospitalizations up 5% NC hospitalizations (primary Dx) down 12%

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Cysticercosis in LAC

Early Cases vs. Later Cases 49% decrease in reported case 37% decrease in mortality 5% increase in hospitalizations 5% increase in NC hospitalizations 12% decrease in NC hospitalizations (primary diagnosis) NC= neurocysticercosis

Cysticercosis in Los Angeles County

Early Cases (1993-1999) vs. Later Cases (2000-2006)

227 24 2755 1534 1039 115 15 2883 1611 909 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200

Reported Cases Deaths Hospitalization NC Hospitalization NC Hospitalization (Primary Dx) 1993-1999 2000-2006

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Other Published Studies

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Cysticercosis and Taeniasisis are Still Prevalent In and Around LAC

The sero-prevalence in a mostly Hispanic immigrant population in Ventura County approximates the prevalence in some endemic areas of Latin America.

(DeGiorgio C, et al, Acta Neurol Scand. 2005)

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DeGiorgio C, et al 2005

METHOD

– Obtain finger pick blood samples from 1) Select persons living in a federally funded, predominantly Hispanic residential community 2) and in two migrant farm worker camps in rural Ventura County, Californiia – Test serum immunoblots for both cysticercosis and taeniasis.

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DeGiorgio C, et al 2005

RESULTS (N=449)

– 1.8% positive for T. solium cysticercosis – 1.1%. Positive for T. solium taeniasis

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Conclusion

  • Cysticercosis remains a public health problem in

LAC

  • The disease is severe and represents a significant

economic burden to LAC

  • The disease can be prevented through detection and

treatment of taeniasis cases

  • Implementing improved testing methods for taeniasis

will increase the likelihood of detection

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Questions ?

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References

  • 1. Lescano AG , Garcia HH , Gilman RH , Gavidia CM , Tsang VC ,

Rodriguez S , Moulton LH , Villaran MV , Montano SM , Gonzalez AE , 2009 . Taenia solium cysticercosis hotspots surrounding tapeworm carriers: clustering on human seroprevalence but not

  • n seizures . PLoS Negl Trop Dis 3: e371 .
  • 2. Willingham AL 3rd , Harrison LJ , Fevre EM , Parkhouse ME , 2008 .

Inaugural meeting of the Cysticercosis Working Group in Europe . Emerg Infect Dis 14: e2 .

  • 3. Morales J , Martinez JJ , Rosetti M , Fleury A , Maza V , Hernandez M ,

Villalobos N , Fragoso G , de Aluja AS , Larralde C , Sciutto E ,

  • 2008. Spatial distribution of Taenia solium porcine cysticercosis

within a rural area of Mexico . PLoS Negl Trop Dis 2: e284 .

  • 4. Lescano AG , Garcia HH , Gilman RH , Guezala MC , Tsang VC ,

Gavidia CM , Rodriguez S , Moulton LH , Green JA , Gonzalez AE ,

  • 2007. Swine cysticercosis hotspots surrounding Taenia solium

tapeworm carriers . Am J Trop Med Hyg 76: 376 – 383 .

  • 5. Sorvillo FJ , DeGiorgio C , Waterman SH , 2007 . Deaths from cysticercosis,

United States. Emerg Infect Dis 13: 230 – 235 .

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References

  • 6. DeGiorgio C , Pietsch-Escueta S , Tsang V , Corral-Leyva G , Ng L ,

Medina MT , Astudillo S , Padilla N , Leyva P , Martinez L , Noh J , Levine M , del Villasenor R , Sorvillo F , 2005 . Sero-prevalence of Taenia solium cysticercosis and Taenia solium taeniasis in California, USA . Acta Neurol Scand 111: 84 – 88 .

  • 7. Richards FO Jr , Schantz PM , Ruiz-Tiben E , Sorvillo FJ , 1985 .

Cysticercosis in Los Angeles County . JAMA 254: 3444 – 3448 .

  • 8. Sorvillo FJ , Waterman SH , Richards FO , Schantz PM , 1992 .

Cysticercosis surveillance: locally acquired and travel-related infections and detection of intestinal tapeworm carriers in Los Angeles County . Am J Trop Med Hyg 47: 365 – 371 .

  • 9. del la Garza Y , Graviss EA , Daver NG , Gambarin KJ , Shandera

WX , Schantz PM , White AC Jr , 2005 . Epidemiology of neurocysticercosis in Houston, Texas. Am J Trop Med Hyg 73: 766 – 770 .

  • 10. Scharf D , 1988 . Neurocysticercosis. Two hundred thirty-eight cases

from a California hospital. Arch Neurol 45: 777 – 780 .

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References

  • 11. Los Angeles County Department of Public Health. Office of

Health Assessment and Epidemiology. Los Angeles County Health Survey Data. Available at: http://www.lapublichealth .org/ha/HA_DATA_TRENDS.htm. Accessed February 2, 2010

  • 12. Agency for Health Care Research and Quality , 2010 . U.S. Department
  • f Health and Human Service/HCUPnet.s . Available at:

http://hcupnet.ahrq.gov . Accessed February 2, 2010.

  • 13. DeFrances CJ , 2008 . National Health Statistics Reports . 2006

National Hospital Discharge Survey. No 5 .

  • 14. Wilkins PP , 1999 . Development of a serologic assay to detect

Taenia solium taeniasis . Am J Trop Med Hyg 60: 199 – 204 .

  • 15. Tsang VC , Brand JA , Boyer AE , 1989 . An enzyme-linked immunoelectrotransfer

blot assay and glycoprotein antigens for diagnosing human cysticercosis ( Taenia solium ) . J Infect Dis 159: 50 – 59 .