FULL REPORT: Communicable Diseases in Monterey County

Annual Report of
Communicable Diseases
in Monterey County
2010
Monterey County Health Department

Public Health Bureau
Hugh F. Stallworth, MD, MPH

Health Officer
Lisa B. Hernandez, MD, MPH

Deputy Health Officer
May 5, 2011
Contents
Key Findings............................................................................................................................................ 4
Reportable Diseases and Conditions..................................................................................................... 5
Table 1: Number of Communicable Diseases among Monterey County Residents by Year of Symptom Onset: 2001-
2010....................................................................................................................................................................... 5
Enteric Illnesses ...................................................................................................................................... 9
Figure 1: Rate of Salmonellosis among Monterey County Residents by US Census Bureau Tracts: 2010 ........................ 9
Figure 2: Rate of Salmonellosis among Monterey County Residents by Gender: 1999-2010 .......................................... 10
Figure 3: Rate of Salmonellosis among Monterey County Residents by Age Group: 1999-2010 .................................... 10
Figure 4: Rate of Salmonellosis among Monterey County Residents by Race/Ethnicity: 1999-2010 .............................. 11
Figure 5: Rate of Campylobacteriosis among Monterey County Residents by Gender: 1999-2010 ................................. 11
Figure 6: Rate of Campylobacteriosis among Monterey County Residents by Age Group: 1999-2010 ........................... 12
Figure 7: Rate of Campylobacteriosis among Monterey County Residents by Race/Ethnicity: 1999-2010 ..................... 12
Figure 8: Rate of Shigellosis among Monterey County Residents by Gender: 1999-2010 ............................................... 13
Figure 9: Rate of Shigellosis among Monterey County Residents by Age Group: 1999-2010 ......................................... 13
Figure 10: Rate of Shigellosis among Monterey County Residents by Race/Ethnicity: 1999-2010 ................................. 14
Sexually Transmitted Infections.......................................................................................................... 15
Figure 11: Rate of Chlamydia Infection among Monterey County Residents by US Census Bureau Tracts: 2010 .......... 15
Figure 12: Rate of Chlamydia Infection among Monterey County Residents by Gender: 1999-2010 .............................. 16
Figure 13: Rate of Chlamydia Infection among Monterey County Residents by Age Group: 1999-2010........................ 16
Figure 14: Rate of Chlamydia Infection among Monterey County Residents by Race/Ethnicity: 1999-2010 .................. 17
Figure 15: Rate of Gonorrhea among Monterey County Residents by Gender: 1999-2010.............................................. 17
Figure 16: Rate of Gonorrhea among Monterey County Residents by Age Group: 1999-2010........................................ 18
Figure 17: Rate of Gonorrhea among Monterey County Residents by Race/Ethnicity: 1999-2010.................................. 18
Figure 18: Rate of Pelvic Inflammatory Disease, Early Syphilis, and Late Syphilis among Monterey County Residents
by Race/Ethnicity: 1999-2010............................................................................................................................. 19
Figure 19: Rate of HIV/AIDS among Monterey County Residents: 1999-2010............................................................... 19
Figure 20: Rate of HIV/AIDS among Monterey County Residents by Gender: 1999-2010 ............................................. 20
Figure 21: Rate HIV/AIDS among Monterey County Residents by Age Group: 1999-2010 ........................................... 20
Figure 22: Rate of HIV/AIDS among Monterey County Residents by Race/Ethnicity: 1999-2010 ................................. 21
Table 2. 2006-2010 Reported HIV/AIDS Population by Exposure Type and Gender ...................................................... 21
Table 3. 2008 Monterey County and 2006-2010 Reported HIV/AIDS Population Comparison by Demographic
Characteristics ..................................................................................................................................................... 22
Table 4. Living HIV and AIDS Cases by Residential Geographic Region, Monterey County, Cumulative Reported
Through December 31, 2010............................................................................................................................... 22
Table 5. Time to an AIDS Diagnosis after a Diagnosis with HIV Infection by Race/Ethnicity, Monterey County,
Cumulative Reported Through December 31, 2009............................................................................................ 23
Table 6. Proportion of Individuals Surviving for More than 12, 24, and 36 Months after an AIDS Diagnosis, Monterey
County, Cumulative Reported Through December 31, 2007 .............................................................................. 23
Vaccine-Preventable Diseases.............................................................................................................. 24
Figure 23: Rate of Pertussis among Monterey County Residents by US Census Bureau Tracts: 2010............................. 24
Figure 24: Rate of Pertussis among Monterey County Residents by Gender: 1999-2010................................................. 25
Figure 25: Rate of Pertussis among Monterey County Residents by Age Group: 1999-2010 .......................................... 25
Figure 26: Rate of Pertussis among Monterey County Residents by Race/Ethnicity: 1999-2010..................................... 26
Figure 27: Rate of Chronic Hepatitis B among Monterey County Residents by Gender: 1999-2010............................... 26
Figure 28: Rate of Chronic Hepatitis B among Monterey County Residents by Age Group: 1999-2010......................... 27
Figure 29: Rate of Chronic Hepatitis B among Monterey County Residents by Race/Ethnicity: 1999-2010 ................... 27
Figure 30: Percent of Monterey County Child Care Attendees and Kindergarteners with Required Immunizations: 2010
............................................................................................................................................................................. 28
Table 7: Number of Animals Tested for Rabies in Monterey County by Species: 2007-2010.......................................... 28
Table 8: Number of Confirmed Animal Rabies Cases in Monterey County by Geographic Region: 2007-2010 ............. 29
Vector-borne Infectious Diseases ........................................................................................................ 30
Figure 31: Rate of Most Common Vector-borne Diseases among Monterey County Residents: 1999-2010 ................... 30
Other Reportable Diseases................................................................................................................... 31
Figure 32: Rate of Chronic Hepatitis C Infection among Monterey County Residents by US Census Bureau Tracts: 2010
Annual Communicable Diseases Report: 2010 Page 1 of 41

............................................................................................................................................................................. 31
Figure 33: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Gender: 1999-2010...... 32
Figure 34: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Age Group: 1999-2010 32
Figure 35: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Race/Ethnicity: 1999-
2010..................................................................................................................................................................... 33
Figure 36: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Setting: 1999-2010 ...... 33
Figure 37: Rate of Tuberculosis Reports among Monterey County Residents by Gender: 2001-2010............................. 34
Figure 38: Rate of Tuberculosis Reports among Monterey County Residents by Age Group: 2006-2010....................... 34
Figure 39: Rate of Tuberculosis Reports among Monterey County Residents by Race/Ethnicity: 2006-2010 ................. 35
Figure 40: Rate of Coccidioidomycosis among Monterey County Residents by Gender: 1999-2010 .............................. 35
Figure 41: Rate of Coccidioidomycosis among Monterey County Residents by Age Group: 1999-2010 ........................ 36
Figure 42: Rate of Coccidioidomycosis among Monterey County Residents by Race/Ethnicity: 1999-2010 .................. 36
Disease Outbreaks ................................................................................................................................ 37
Table 9: Reported Outbreaks by First Date of Onset: 2007-2010 ..................................................................................... 37
Technical Notes ..................................................................................................................................... 38
Appendix................................................................................................................................................ 41
Table 10: Monterey County Resident Population: 1999-2010 by Gender, Age Group, and Race/Ethnicity..................... 41

Citation
This report is in the public domain and may be reproduced with appropriate citation.
Suggested Citation:
Monterey County Health Department. Annual Communicable Diseases Report: 2010. [Internet].
Salinas, California: Public Health Bureau, Communicable Disease Unit. March 2011. 41 pp.
Available at:
http://www.mtyhd.org/index.php?option=com_content&view=category&id=112%3Acommunicab
le-disease&layout=blog&Itemid=541&lang=en.
Questions or comments about the content of this report or about information not included in this
publication may be directed to:
Kristy Michie, MS, Supervising Public Health Epidemiologist
Monterey County Department of Health, Public Health Bureau
1270 Natividad Road, Salinas, CA 93906
Phone: (831) 755-4503; e-mail: michiekj@co.monterey.ca.us
Acknowledgements
Laboratories, clinicians, and other medical providers reported the illnesses upon which this publication is
based. Staff of the Communicable Disease Unit (Zonelle Cantu, Sandra Gonzales, Suzanne Moreno, and
Roz Silastre) are recognized for their crucial efforts to collect data while preventing and controlling
communicable diseases in Monterey County. Susan Barnes, MPH, completed quality assurance checks.
Reporting a Communicable Disease
Timely reporting of certain diseases and conditions is legally mandated by the California Code of
Regulations (CCR Title 17). The Monterey County Health Department Communicable Disease Unit places
the highest priority on preserving the confidentiality of whom it serves. Public health officials rely on
healthcare providers, laboratorians, and other public health personnel to report the occurrence of notifiable
diseases to their local health departments. Removing individuals from sensitive occupations (i.e., food
handlers) prevents the spread of diseases such as salmonellosis and hepatitis A. The detection and
treatment of patients with tuberculosis, the identification of asymptomatic carriers of typhoid and
gonorrhea, and the immunization of people exposed to vaccine-preventable diseases are just a few of the
benefits the entire community receives when reporting is timely and accurate. Failure to report can result
in increased disease in the community, increased absences from work or school, increased costs for
diagnosis and treatment, increased hospitalization, and increased poor health outcomes. Please visit our
website for a complete listing of reportable diseases and conditions, provider reporting procedures, and our
Confidential Morbidity Report (CMR) form for providers.
Provider morbidity reporting:

Monterey County Health Department
Communicable Disease Unit
1270 Natividad Road
Salinas, CA 93906
Phone: (831) 755-4521
Fax: (831) 754-6682
http://www.mtyhd.org/index.php?option=com_content&view=category&id=112%3Acommunicable-
disease&layout=blog&Itemid=541&lang=en

Key Findings
Text included in this report has been limited to allow for a broader presentation of data. Some of the key
points in this year’s report include:
• Specific diseases that showed a statistically significant increase in the number of cases between 2001
and 2010 were chlamydial infections, coccidioidomycosis, encephalitis and meningitis of unknown
etiology, Escherichia coli O157, chronic hepatitis C, human immunodeficiency virus (HIV),
legionellosis, malaria (international exposure), pelvic inflammatory disease, and pertussis.
• Diseases or conditions that showed a statistically significant decrease in the number of cases during the
same timeframe were acquired immune deficiency syndrome (AIDS), amebiasis, Department of Motor
Vehicle-related conditions (e.g., lapses of consciousness), giardiasis, gonococcal infections, hepatitis A,
acute hepatitis B, acute hepatitis C, shigellosis, late syphilis (latent, late latent, latent of unknown
duration, and late), and tuberculosis.
• The most commonly reported enteric illnesses were salmonellosis, campylobacteriosis, and shigellosis.
Rates of reported infections were highest among children.
• Sexually transmitted infections (STIs) represented a large portion of the diseases reported in Monterey
County. Adults age 18 to 34 accounted for the majority of reported chlamydia and gonorrhea cases.
Hispanics of any race and non-Hispanic African-Americans were disproportionately affected by STIs.
• There are currently almost 600 individuals living in Monterey County with HIV/AIDS. Rates of
HIV/AIDS infection are highest among African-Americans. Among males, men who have sex with
men represented the most common source of exposure. Among females, heterosexual exposure was
more common. A larger proportion of African-American and Hispanic individuals diagnosed with HIV
progressed to AIDS within 12 months of HIV diagnosis, indicating possible barriers to early testing,
diagnosis, and treatment for these populations.
• In 2010, pertussis reached epidemic proportions in Monterey County. Rates were highest among
children, Hispanics, and Non-Hispanic Whites.
• Asian-Americans and Pacific Islanders were disproportionately affected by chronic hepatitis B and
tuberculosis.
• The incidence of endemic vectorborne diseases such as Lyme disease, plague, tularemia, and West Nile
Virus remained low. Sporadic cases of internationally-acquired malaria and dengue continued.
• Coccidioidomycosis infections remained high among Monterey County residents. Rates increased
among individuals age 18 to 34 years.
• There were 20 reported outbreaks of communicable diseases in 2010, affecting 301 individuals. Viral
gastroenteritis, commonly caused by noroviruses, with person-to-person transmission was the most
commonly identified pathogen.

Reportable Diseases and Conditions
In 2010, the Monterey County Health Department’s Communicable Disease Unit (CDU) received 11,189
reports of communicable illness from medical providers and laboratories. These reports were screened for
duplication, investigated, and assessed according to the Centers for Disease Control and Prevention’s
standard surveillance case definitions. Of those reports, a total of 3,526 incidents representing 120 diseases
and conditions met the “confirmed,” “probable,” and/or “suspect” surveillance case definitions. Table 1
below shows the number of these cases by the year in which the case first became symptomatic. All counts
and rates shown in this publication are based on the year of symptom onset when such information was
available. The year in which symptoms first began, diagnosis was made by a provider, and the case was
reported to the local health department may differ due to delays in seeking treatment, testing, diagnosis,
reporting, and public health investigation. Please see the Technical Notes section of this document for
more information about dates of onset, diagnosis, and report.
The statistical significance of temporal trends was tested for each reportable disease or condition. Please
see the Technical Notes section of this document for more information on the methodology used and its
limitations. Overall there has been a statistically significant increase in the number of all reportable
diseases and conditions between 2001 and 2010 (p < 0.01). Specific diseases or conditions that showed a
statistically significant increase in the number of cases between 2001 and 2010 were chlamydial infections
(p < 0.01), coccidioidomycosis (p < 0.01), unspecified encephalitis (p = 0.01), Escherichia coli O157
(p < 0.01), chronic hepatitis C (p < 0.01), human immunodeficiency virus (HIV, p = 0.01), legionellosis
(p = 0.02), malaria (p = 0.04), unspecified meningitis (p = 0.04), pelvic inflammatory disease (p < 0.01),
and pertussis (p < 0.01). Diseases that showed a statistically significant decrease in the number of cases
during the same timeframe were acquired immune deficiency syndrome (AIDS, p < 0.01), amebiasis
(p = 0.01), Department of Motor Vehicle-related conditions (p < 0.01), giardiasis (p < 0.01), gonococcal
infections (p = < 0.01), hepatitis A (p < 0.01), acute hepatitis B (p < 0.01), acute hepatitis C (p = 0.01),
shigellosis (p < 0.01), late syphilis (p = 0.01), and tuberculosis (p < 0.01).
Table 1: Number of Communicable Diseases among Monterey County Residents by Year of Symptom Onset: 2001-2010
Number of Cases
Disease/Condition
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Acquired Immune Deficiency Syndrome (AIDS)1 26 28 26 26 23 19 28 24 12 4
1
Amebiasis 6 3 7 2 6 4 1 2 2 0
Anaplasmosis/Ehrlichiosis 0 0 0 0 0 0 0 0 0 0
Animal Bites -2 -2 165 186 218 167 154 134 240 155
Anthrax 0 0 0 0 0 0 0 0 0 0
Babesiosis 0 0 0 0 1 0 0 0 0 0
Botulism, Adult 0 0 0 0 1 0 0 0 0 0
Botulism, Infant 3 1 1 1 2 1 0 0 1 0
Botulism, Wound 0 0 0 0 0 0 0 0 0 0
Brucellosis 0 0 0 1 0 0 1 0 0 0
Campylobacteriosis 47 45 42 47 34 36 48 57 47 63
Chancroid 0 0 0 0 0 0 0 0 0 0
Chlamydia trachomatis Infections, including
1,164 1,206 1,229 1,193 1,290 1,380 1,303 1,292 1,354 1,416
Lymphogranuloma Venerium (LGV)3

Reportable Diseases and Conditions (Continued)
Number of Confirmed Cases

Disease/Condition
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Cholera 0 0 0 0 0 0 0 0 0 0
Ciguatera Fish Poisoning 0 0 0 0 0 0 0 0 0 0
Coccidioidomycosis3 13 7 13 19 30 40 34 23 25 32
Colorado Tick Fever NR4 NR4 NR4 NR4 NR4 NR4 0 0 0 0
Creutzfeldt-Jakob Disease (CJD) and Other
Transmissible Spongiform Encephalopathies NR4 NR4 NR4 NR4 NR4 NR4 0 0 0 1
(TSEs)
Cryptosporidiosis 0 1 1 1 2 2 4 2 1 0
Cysticercosis or Taeniasis 1 2 2 1 3 2 2 0 0 2
Dengue 0 0 0 0 4 0 1 0 0 1
Department of Motor Vehicles-Related
Conditions (Lapses of Consciousness, 223 224 247 201 219 213 194 177 215 177
Alzheimer's Disease, etc.)1
Diphtheria 0 0 0 0 0 0 0 0 0 0
Domoic Acid Poisoning (Amnesic Shellfish
0 0 0 0 0 0 0 0 0 0
Poisoning)
Encephalitis, Bacterial Not Otherwise Specified 0 0 0 1 0 0 0 0 0 0
Encephalitis, Non-Arboviral Viral 0 0 4 1 0 0 0 0 0 0
3
Encephalitis, Unspecified 1 2 1 1 3 2 2 5 5 5
Encephalitis, Western Equine 0 0 0 0 1 0 0 0 0 0
Escherichia coli O157:H7 Infection3 0 1 1 2 0 1 4 2 8 2
Escherichia coli non-O157, Shiga Toxin
0 0 0 0 0 0 0 0 1 0
Producing
Foodborne Disease, Single Case Not
0 0 1 1 0 13 0 0 0 5
Otherwise Reportable
1
Giardiasis 24 29 25 29 21 36 31 11 9 8
1
Gonococcal Infections 85 117 201 212 188 204 140 131 93 83
Haemophilus influenzae, Pediatric Invasive
1 0 2 3 0 0 0 1 2 2
Disease
Hantavirus Infection 0 0 0 0 0 0 0 0 0 0
Hemolytic Uremic Syndrome (HUS) 0 1 0 0 0 0 0 1 0 0
Hepatitis A1 27 11 11 8 7 2 2 4 3 1
1
Hepatitis B, Acute 3 2 5 2 1 0 0 0 1 0
Hepatitis B, Chronic 103 73 78 76 63 78 72 87 75 83
Hepatitis B, Perinatal 0 1 0 0 0 0 0 0 0 0
1
Hepatitis C, Acute 4 1 2 1 0 0 0 1 0 0
3
Hepatitis C, Chronic 565 630 315 340 456 647 720 1,254 1,077 1,078
Hepatitis D, Acute 0 0 0 0 0 0 0 0 2 0
Hepatitis, Other Acute 0 0 0 0 0 0 0 0 0 0
3
Human Immunodeficiency Syndrome (HIV) 8 10 15 9 17 19 22 21 22 13
4 4 4 4 4 4
Influenza, Severe Novel NR NR NR NR NR NR 0 0 159 2
Influenza, Severe Seasonal NR4 NR4 NR4 NR4 NR4 NR4 0 1 1 0
Kawasaki Syndrome (Mucocutaneous Lymph
1 0 1 0 2 2 0 0 0 2
Node Syndrome)
3
Legionellosis 0 0 0 0 1 2 1 2 1 3


Disease/Condition
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Leprosy (Hansen Disease) 1 0 0 0 0 0 0 0 0 0
Leptospirosis 0 0 0 0 0 0 0 0 0 0
Listeriosis 1 1 1 3 1 1 1 2 2 2
Lyme Disease 2 4 1 1 2 0 0 1 3 1
3
Malaria 0 1 0 0 2 0 0 1 2 3
Measles (Rubeola) 1 0 0 0 0 1 0 0 0 0
Meningitis, Bacterial Not Otherwise Specified 4 5 8 6 7 4 5 4 3 7
Meningitis, Fungal 1 2 0 1 0 1 1 2 3 2
Meningitis, Parasitic 0 0 0 0 0 0 1 0 0 0
Meningitis, Unspecified3 2 2 1 1 1 0 1 2 0 9
Meningitis, Viral Not Otherwise Specified 38 27 48 82 22 13 17 26 40 49
Meningococcal Infection 2 4 7 2 1 0 1 3 0 1
Mumps 3 1 2 0 3 0 3 5 3 1
Paralytic Shellfish Poisoning 0 0 0 0 0 0 0 0 0 0
3
Pelvic Inflammatory Disease (PID) 5 6 8 11 23 18 13 8 14 24
3
Pertussis (Whooping Cough) 7 7 5 50 34 10 22 4 19 132
Pesticide-Related Illness or Injury5 -2 -2 37 22 22 12 41 20 42 33
Plague, Animal 0 0 0 0 1 0 0 0 0 0
Plague, Human 0 0 0 0 0 0 0 0 0 0
Poliovirus Infection 0 0 0 0 0 0 0 0 0 0
Psittacosis, Animal 0 0 0 0 0 1 0 0 0 0
Psittacosis, Human 0 1 0 0 0 0 0 0 0 0
Q Fever 0 0 0 1 0 0 1 1 0 1
Rabies, Animal 9 6 6 1 8 11 6 6 6 5
Rabies, Human 0 0 0 0 0 0 0 0 0 0
Relapsing Fever 0 0 0 0 0 0 0 0 0 0
Rheumatic Fever, Acute 0 0 0 0 0 1 0 0 0 0
Rocky Mountain Spotted Fever 0 0 0 0 0 0 0 0 0 0
Rubella (German Measles) 0 0 0 0 0 0 0 0 0 0
Rubella Syndrome, Congenital 0 0 0 0 0 0 0 0 0 0
Salmonellosis, Other than Typhoid Fever 48 63 46 40 85 55 60 40 36 52
Scombroid Fish Poisoning 0 0 0 0 0 0 0 0 1 0
4 4 4 4
Severe Acute Respiratory Syndrome (SARS) NR NR NR NR 0 0 0 0 0 0
Shiga Toxin Detected in Feces 0 0 0 0 0 0 0 0 1 1
Shigellosis1 20 41 43 24 42 22 27 16 18 19
Smallpox (Variola) 0 0 0 0 0 0 0 0 0 0
Staphylococcus aureus, Severe Community- 4 4 4 4 4 4 4
NR NR NR NR NR NR NR 4 6 6
Acquired
Streptococcal Infections in Food Handlers or Dairy
0 0 0 0 0 0 0 1 0 0
Workers
Syphilis, Congenital 0 0 0 0 0 0 0 0 0 0


Disease/Condition
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Syphilis, Early (Primary, Secondary, and Early
3 7 6 1 0 1 1 2 1 11
Latent)
Syphilis, Late (Latent, Late Latent, Latent
10 7 9 4 10 6 2 4 4 4
Unknown Duration, and Late)1
Tetanus 0 0 0 0 0 0 0 0 0 0
Toxic Shock Syndrome (TSS) 2 0 0 0 1 0 0 0 0 0
Trichinosis 0 0 0 0 0 0 0 0 0 0
Tuberculosis1,5 39 24 54 29 37 29 22 24 16 22
Tularemia 0 0 0 0 0 0 0 0 0 0
Typhoid Fever, Acute 0 0 0 0 0 0 0 0 0 0
Typhoid Fever, Carrier 0 0 0 0 0 0 0 0 0 0
Typhus Fever 0 0 0 0 0 1 0 0 0 0
Varicella, Severe 0 0 0 0 0 0 1 2 1 1
Vibrio Infections, Other Than Cholera 1 0 2 1 0 0 0 1 0 2
4 4 4 4
Viral Hemorrhagic Fevers NR NR NR NR 0 0 0 0 0 0
Water Associated Disease (e.g., Swimmer's Itch
0 0 0 0 0 0 0 0 0 0
or Hot Tub Rash)
4 4 4 4
West Nile Virus (WNV) Infections NR NR NR NR 0 0 0 0 1 0
Yellow Fever 0 0 0 0 0 0 0 0 0 0
Yersiniosis 1 0 2 0 0 0 0 0 0 0
3
All 2,505 2,604 2,681 2,644 2,895 3,057 2,990 3,411 3,578 3,526
1
Indicates a statistically significant decrease in cases from 2001 to 2010 (p < 0.05).
2
Data not available.
3
Indicates a statistically significant increase in cases from 2001 to 2010 (p < 0.05).
4
NR = Disease/condition not reportable under Title 17 of the California Code of Regulations.
5
Counts shown are by year of case report; information on year of onset and diagnosis were unavailable.
Sources: California Department of Public Health Infant Botulism Treatment and Prevention Program, Monterey County Animal Services,
Monterey County Environmental Health Bureau, Monterey County Communicable Disease Unit, and Monterey County
Tuberculosis Control Unit. Data are current as of March 10, 2011.

Enteric Illnesses
Enteric illnesses enter the body through the mouth and intestinal tract. They are usually spread through
contaminated food and water or by contact with emesis or feces. The most commonly reported enteric
illnesses in Monterey County (for which there is no vaccine) include salmonellosis, campylobacteriosis,
and shigellosis. Confirmed and probable cases are included in the data presented below.
Salmonellosis
Figure 1: Rate of Salmonellosis among Monterey County Residents by US Census Bureau Tracts: 2010

Rate per 100,000 Population 25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of Symptom Onset
Male Female Total
Figure 2: Rate of Salmonellosis among Monterey County Residents by Gender: 1999-2010
25
Rate per 100,000 Population
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
<18 Years 18 to 34 Years 35+ Years
Hollow symbols denote statistically unstable rates due to small numbers.
Figure 3: Rate of Salmonellosis among Monterey County Residents by Age Group: 1999-2010
Note: Three-year moving rates are shown. See Technical Notes for more information.
Source: Case data: Monterey County Health Department Communicable Disease Unit, data are current as of March 10, 2011. Population
data: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000-2050, Sacramento, CA,
July 2007.

25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
African-American Asian & Pacific Islander
Hispanic White, Non-Hispanic
Figure 4: Rate of Salmonellosis among Monterey County Residents by Race/Ethnicity: 1999-2010
Campylobacteriosis
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 5: Rate of Campylobacteriosis among Monterey County Residents by Gender: 1999-2010
July 2007.

Rate per 100,000 Population 25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 6: Rate of Campylobacteriosis among Monterey County Residents by Age Group: 1999-2010
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 7: Rate of Campylobacteriosis among Monterey County Residents by Race/Ethnicity: 1999-2010
July 2007.

Shigellosis
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 8: Rate of Shigellosis among Monterey County Residents by Gender: 1999-2010
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 9: Rate of Shigellosis among Monterey County Residents by Age Group: 1999-2010
July 2007.

25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 10: Rate of Shigellosis among Monterey County Residents by Race/Ethnicity: 1999-2010
July 2007.

Sexually Transmitted Infections
Sexually transmitted infections (STIs) represented a large portion of the diseases reported in Monterey
County. Included in this section are detailed data on chlamydia, gonorrhea, and human immunodeficiency
virus (HIV). Under-reporting of STIs may be substantial, especially among male cases of chlamydia,
because many people with STIs are asymptomatic and do not seek testing or treatment. Confirmed and
probable cases are included in the data presented below. This year’s report includes data entered into the
California Department of Public Health’s new electronic HIV/AIDS reporting system (eHARS).
Conversions to this system lead to reassignment of some cases among local jurisdictions. Reporting
regulations for HIV and AIDS changed over time, making analysis of temporal trends problematic.
Mandatory reporting of AIDS in California began in March 1983. The case definition for AIDS
changed in 1993. Mandatory HIV reporting using a no-name code began in July 2002 but was
changed to name-based reporting in 2006. Individuals reported using the code-based system only were
not included in the data below. In 2008, laboratory reporting requirements were changed to include
positive CD4 and viral load tests. Diagnosis and reporting delays may be significant with HIV/AIDS.
As a result, rates and counts for the most recent three years of data should be considered provisional
and an under-representation of the true number of cases.
Chlamydia
Figure 11: Rate of Chlamydia Infection among Monterey County Residents by US Census Bureau Tracts: 2010

1200
1000
800
600
400
200
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 12: Rate of Chlamydia Infection among Monterey County Residents by Gender: 1999-2010
1200
1000
800
600
400
200
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 13: Rate of Chlamydia Infection among Monterey County Residents by Age Group: 1999-2010
July 2007.

1200
1000
800
600
400
200
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 14: Rate of Chlamydia Infection among Monterey County Residents by Race/Ethnicity: 1999-2010
Gonorrhea
160
140
120
100
80
60
40
20
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 15: Rate of Gonorrhea among Monterey County Residents by Gender: 1999-2010
July 2007.

160
140
120
100
80
60
40
20
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 16: Rate of Gonorrhea among Monterey County Residents by Age Group: 1999-2010
160
135
110
85
60
35
10
-15 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 17: Rate of Gonorrhea among Monterey County Residents by Race/Ethnicity: 1999-2010
July 2007.

Other STIs
5
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Pelvic Inflammatory Disease Syphilis, Early Syphilis, Late
Figure 18: Rate of Pelvic Inflammatory Disease, Early Syphilis, and Late Syphilis among Monterey County Residents by
Race/Ethnicity: 1999-2010
HIV/AIDS
60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
HIV AIDS
Figure 19: Rate of HIV/AIDS among Monterey County Residents: 1999-2010
July 2007.

60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 20: Rate of HIV/AIDS among Monterey County Residents by Gender: 1999-2010
60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 21: Rate HIV/AIDS among Monterey County Residents by Age Group: 1999-2010
July 2007.

60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 22: Rate of HIV/AIDS among Monterey County Residents by Race/Ethnicity: 1999-2010
Table 2. 2006-2010 Reported HIV/AIDS Population by Exposure Type and Gender

Males Females Total
Exposure Category
n % n % n %
Men Who Have Sex with Men (MSM) 84 56% 84 46%
Injection Drug Use (IDU) 10 7% 2 6% 12 7%
MSM and IDU 5 3% 5 3%
Recipient of Clotting Factor, Blood, Blood

Components, Organs, Tissues, or 0 0% 1 3% 1 1%
Artificial Insemination
Heterosexual Contact 13 9% 18 55% 31 17%
Perinatal Exposure 0 0% 1 3% 1 1%
Not Reported 39 26% 11 33% 50 27%
1
Total 151 100% 33 100% 184 100%
1
Percentages may not sum to 100 due to rounding.
data: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000-2050, Sacramento, CA, July
2007

Table 3. 2008 Monterey County and 2006-2010 Reported HIV/AIDS Population Comparison by Demographic
Characteristics
Monterey County 2008 2006-2010 HIV/AIDS
Demographic Group Population Population
n % n %
Race/Ethnicity
African-American, Non-Hispanic 11,283 3% 24 13%
American Indian, Non-Hispanic 1,958 0% 1 1%
Asian and Pacific Islander, Non-Hispanic 28,100 7% 9 5%
Hispanic, Any Race 236,457 55% 96 52%
Multiracial, Non-Hispanic 9,682 2% 2 1%
White, Non-Hispanic 140,091 33% 52 28%
Gender
Male 218,663 51% 151 82%
Female 208,908 49% 33 18%
Age
0 to 12 88,825 21% 1 1%
13 to 19 45,056 11% 4 2%
20 to 29 66,856 16% 40 22%
30 to 39 56,271 13% 55 30%
40 to 49 55,303 13% 61 33%
50+ 115,260 27% 23 13%
1
Total 427,571 100% 184 100%
1
Table 4. Living HIV and AIDS Cases by Residential Geographic Region, Monterey County, Cumulative Reported Through
December 31, 2010
2 2 2
1 HIV AIDS Total
Geographic Region
n % n % n %
Monterey Peninsula/Big Sur 64 45% 201 46% 265 46%
North County 9 6% 18 4% 27 5%
Salinas Urban Area 54 38% 161 37% 215 37%
South County 15 11% 60 14% 75 13%
3
Total 142 100% 440 100% 582 100%
1
Geographic regions include areas within Monterey County of the following cities: Monterey Peninsula/Big Sur: Big Sur, Carmel,
Carmel Valley, Del Rey Oaks, Fort Ord, Marina, Monterey, Pacific Grove, Pebble Beach, Sand City, Seaside; North County:
Aromas, Castroville, Las Lomas, Moss Landing, Prunedale, Watsonville; Salinas Urban Area: Corral de Tierra Salinas, Spreckles;
South County: Bradley, Chualar, Gonzales, Greenfield, Jolon, King City, Lockwood, Parkfield, San Ardo, San Lucas, San Miguel,
Soledad.
2
Includes 15 HIV and 20 AIDS cases diagnosed in another jurisdiction who are currently living in Monterey County. Does not include
15 HIV and 41 AIDS cases diagnosed in Monterey County who are currently living in another jurisdiction.
3
data: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000-2050, Sacramento, CA, July
2007

Table 5. Time to an AIDS Diagnosis after a Diagnosis with HIV Infection by Race/Ethnicity, Monterey County,
Cumulative Reported Through December 31, 2009
≥ 12 Months after <12 Months after
3
Diagnosis of HIV Diagnosis of HIV Total
Race/Ethnicity Infection
1
Infection
2
n % n % n %
African-American, Non-Hispanic 38 63% 22 37% 60 100%
American Indian, Non-Hispanic 0 0% 1 100% 1 100%
Asian and Pacific Islander, Non-Hispanic 12 75% 4 25% 16 100%
Hispanic, Any Race 60 51% 58 49% 118 100%
Multiracial, Non-Hispanic 3 100% 0 0% 3 100%
White, Non-Hispanic 171 81% 40 19% 211 100%
Total 284 69% 125 31% 409 100%
1
Included individuals with HIV in whom AIDS has not developed.
3
Included individuals who were diagnosed with HIV and AIDS at the same time.
3
Excluded individuals with a missing date of HIV diagnosis, a recorded date of HIV diagnosis after date of AIDS diagnosis, and an HIV
diagnosis in 2010 to ensure each counted individual had the potential to be evaluated for at least 12 months.
Table 6. Proportion of Individuals Surviving for More than 12, 24, and 36 Months after an AIDS Diagnosis, Monterey
County, Cumulative Reported Through December 31, 2007
Survival in Months
1
Category n >12 >24 >36
% % %
Race/Ethnicity
African-American, Non-Hispanic 157 79% 69% 64%
American Indian, Non-Hispanic 5 60% 60% 20%
Asian and Pacific Islander, Non-Hispanic 31 90% 81% 71%
Hispanic, Any Race 287 83% 73% 68%
Multiracial, Non-Hispanic 2 100% 100% 50%
White, Non-Hispanic 459 78% 60% 47%
Unknown 1 100% 100% 100%
Total 942 80% 66% 57%
Year of AIDS Diagnosis
Before 1988 71 46% 18% 8%
1988 to 1992 258 68% 43% 26%
1993 to 1997 345 87% 76% 67%
1998 to 2002 146 89% 86% 85%
2003 to 2007 122 93% 91% 88%
Total 942 80% 66% 57%
1
Included only individuals diagnosed through December 31, 2007, to ensure each counted individual had the potential of surviving
greater than 36 months.
Source: Monterey County Health Department Communicable Disease Unit, data are current as of March 10, 2011.

Vaccine-Preventable Diseases
Many infectious diseases can be prevented through administration of a recommended schedule of vaccines.
Cases of vaccine-preventable diseases continue to be reported among Monterey County residents due to
personal belief exemptions, waning immunity, and high rates of international travel. Detailed data on
pertussis (whooping cough), chronic hepatitis B, and animal rabies are presented below. Confirmed and
probable cases are included unless otherwise noted.
Pertussis (Confirmed, Probable, and Suspect Cases)
Figure 23: Rate of Pertussis among Monterey County Residents by US Census Bureau Tracts: 2010

35
30
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 24: Rate of Pertussis among Monterey County Residents by Gender: 1999-2010
35
30
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 25: Rate of Pertussis among Monterey County Residents by Age Group: 1999-2010
July 2007.

35
30
25
20
15
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 26: Rate of Pertussis among Monterey County Residents by Race/Ethnicity: 1999-2010
Chronic Hepatitis B
80
70
60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 27: Rate of Chronic Hepatitis B among Monterey County Residents by Gender: 1999-2010
July 2007.

80
70
60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 28: Rate of Chronic Hepatitis B among Monterey County Residents by Age Group: 1999-2010
80
70
60
50
40
30
20
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 29: Rate of Chronic Hepatitis B among Monterey County Residents by Race/Ethnicity: 1999-2010
July 2007.

Immunizations for Attendees of Child Care Centers and Kindergarten
100
80
60
Percent Immunized
40
20
0
DTP 4+ Polio 3+ MMR 1 MMR 2 HIB 1+ HBV 3+ Var 1+ All Required
Attendees of Child Care Centers Kindergarteners
Figure 30: Percent of Monterey County Child Care Attendees and Kindergarteners with Required Immunizations: 2010
(DTP = diphtheria, tetanus, & pertussis; Polio = polio virus; MMR = measles, mumps, & rubella; HIB = Haemophilus influenzae
serotype B; HBV = hepatitis B virus; Var = Varicella)
Source: California Department of Health Services, Immunization Branch
Animal Rabies (Confirmed Cases)
Table 7: Number of Animals Tested for Rabies in Monterey County by Species: 2007-2010
2007 2008 2009 2010
Species N N N N N N N N
Tested Positive Tested Positive Tested Positive Tested Positive
Bat 22 0 32 3 32 2 20 0
Cat 21 0 13 0 8 0 15 0
Dog 13 0 13 0 8 0 18 0
Domestic Livestock 1 0 1 0 4 0 2 0
Other Pet 1 0 0 0 0 0 0 0
Other Wild Carnivore 1 0 7 0 4 0 1 0
Raccoon 3 0 6 0 2 0 5 0
Skunk 20 6 28 3 18 4 26 5
Total 82 6 100 6 76 6 87 5
Source: Monterey County Health Communicable Disease Unit, data are current as of March 10, 2011.

Table 8: Number of Confirmed Animal Rabies Cases in Monterey County by Geographic Region: 2007-2010
1
Bats Skunks Total
Geographic Region
n % n % n %
Monterey Peninsula/Big Sur 4 80% 0 0% 4 17%
North County 1 20% 13 72% 14 61%
Salinas Urban Area 0 0% 4 22% 4 17%
South County 0 0% 1 6% 1 4%
2
Total 5 100% 18 100% 23 100%
1
Geographic regions include areas within Monterey County of the following cities: Monterey Peninsula/Big Sur: Big Sur, Carmel,
Carmel Valley, Del Rey Oaks, Fort Ord, Marina, Monterey, Pacific Grove, Pebble Beach, Sand City, Seaside; North County: Aromas,
Castroville, Las Lomas, Moss Landing, Prunedale, Watsonville; Salinas Urban Area: Corral de Tierra Salinas, Spreckles; South
County: Bradley, Chualar, Gonzales, Greenfield, Jolon, King City, Lockwood, Parkfield, San Ardo, San Lucas, San Miguel, Soledad
2
Source: Monterey County Health Communicable Disease Unit, data are current as of March 10, 2011.

Vector-borne Infectious Diseases
From the perspective of infectious diseases, vectors are transmitters of disease-causing organisms. Vectors
carry the pathogenic organisms from one host to another. Arthropods such as ticks, mosquitoes, and fleas
are the most important disease vectors. Vector-borne illnesses include malaria, dengue, Lyme disease, and
West Nile Virus, among others. Vectors for several infections are found in Monterey County (e.g., Ixodes
pacificus, Culex tarsalis, Culex pipens). Imported cases are of concern in high-travel areas. Small case
numbers preclude analysis by demographic characteristics. Confirmed, probable, and suspect cases are
included.
4
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Dengue Lyme Disease Malaria West Nile Virus

Figure 31: Rate of Most Common Vector-borne Diseases among Monterey County Residents: 1999-2010
July 2007.

Other Reportable Diseases
Other reportable diseases with relatively high morbidity of public health concern include chronic
hepatitis C, tuberculosis, and coccidioidomycosis. Liver failure due to chronic hepatitis C infection is one
of the most common causes for liver transplants in the United States (Centers for Disease Control and
Prevention: http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1). Incidence of coccidioidomycosis
is increasing in Monterey County. At this time it is unknown whether individuals are being exposed locally
or in known highly endemic areas such as the Central Valley.
Chronic Hepatitis C (Confirmed and Probable Cases)
Figure 32: Rate of Chronic Hepatitis C Infection among Monterey County Residents by US Census Bureau Tracts: 2010

500
450
400
350
300
250
200
150
100
50
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 33: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Gender: 1999-2010
500
450
400
350
300
250
200
150
100
50
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 34: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Age Group: 1999-2010
July 2007.

500
450
400
350
300
250
200
150
100
50
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 35: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Race/Ethnicity: 1999-2010
9000 80
8000 70
Non-Incarcerated Population
Incarcerated Population
7000 60
Rate per 100,000
6000 Rate per 100,000

50
5000
40
4000
30
3000
2000 20
1000 10
0 0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Correctional Facility-Based Community-Based
Figure 36: Rate of Chronic Hepatitis C Virus Infection among Monterey County Residents by Setting: 1999-2010
July 2007.

Tuberculosis (Confirmed Cases)
35
30
25
20
15
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of Case Report
Male Female Total
Figure 37: Rate of Tuberculosis Reports among Monterey County Residents by Gender: 2001-2010
Note: Gender information only available from 2006 to 2010.
35
30
25
20
15
10
0
2006 2007 2008 2009 2010
Year of Case Report
<5 Years 5 to 19 Years
20 to 49 Years 50+ Years
Figure 38: Rate of Tuberculosis Reports among Monterey County Residents by Age Group: 2006-2010
Source: Case data: Monterey County Health Department Tuberculosis Control Unit, data are current as of March 10, 2011. Population
July 2007.

35
30
25
20
15
10
0
2006 2007 2008 2009 2010
Year of Case Report
Figure 39: Rate of Tuberculosis Reports among Monterey County Residents by Race/Ethnicity: 2006-2010
Source: Case data: Monterey County Health Department Tuberculosis Control Unit, data are current as of March 10, 2011. Population
July 2007.
Coccidioidomycosis (also called Valley Fever, Confirmed Cases)
16
14
12
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Male Female Total
Figure 40: Rate of Coccidioidomycosis among Monterey County Residents by Gender: 1999-2010
July 2007.

16
14
12
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 41: Rate of Coccidioidomycosis among Monterey County Residents by Age Group: 1999-2010
16
14
12
10
0
1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008-
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of Symtom Onset
Figure 42: Rate of Coccidioidomycosis among Monterey County Residents by Race/Ethnicity: 1999-2010
July 2007.

Disease Outbreaks
A disease outbreak is a greater-than-expected number of cases that occur within temporal and spatial
proximity and with a likely common source association or reasonably identifiable chain of transmission.
Viral gastroenteritis (norovirus) with person-to-person transmission is the most commonly reported cause
of outbreaks in Monterey County.
Table 9: Reported Outbreaks by First Date of Onset: 2007-2010

Number of Outbreaks
Type of Outbreak
2007 2008 2009 2010
Foodborne and Waterborne Illnesses 1 4 6 0
Influenza and Other Viral Respiratory Illnesses 1 6 8 1
Non-Foodborne Viral Gastroenteritis including Norovirus 7 7 12 12
Pertussis 1 0 0 1
Scabies 1 1 1 4
Varicella 3 0 0 0
Other 0 1 4 2
Total 14 19 31 20
Number of Individuals Affected 237 359 719 301

Source: Monterey County Health Department Communicable Disease Unit, data are current as of April 18, 2011.

Technical Notes
Background
The Monterey County Health Department maintains a mandatory passive reporting system for diseases and
conditions specified in Title 17 of the California Code of Regulations. Healthcare providers and
laboratories are required to report suspected cases of communicable diseases and conditions to their local
health departments. In turn, local health departments are required to report qualifying cases to the
California Department of Public Health, who forwards reports to the Centers for Disease Control and
Prevention. This section of the annual report describes the methods and limitations used to summarize the
epidemiology of selected communicable diseases reported to the Monterey County Health Department.
The distribution of information on the health of the community is a core function and essential service of
public health. The data in this report provide important health information on the magnitude and burden of
communicable diseases in Monterey County. Bearing in mind their limitations, these data can help identify
high risk groups needing preventative actions and track the effectiveness of control and prevention
measures.
Methods
Data Sources
Most of the data presented in this year’s report were extracted from the Monterey County Communicable
Disease Unit’s morbidity databases. Human Immunodeficiency Virus (HIV) and Acquired Immune
Deficiency Syndrome (AIDS) data were entered in the California Department of Public Health Office of
AIDS’s database (eHARS) then transferred back to the Monterey County Health Department. Infant
botulism data were provided by the California Department of Public Health Infant Botulism Treatment and
Prevention Program. Information on reported cases of tuberculosis was provided by the Monterey County
Tuberculosis Control Unit. Pesticide illness reports were provided by the Monterey County Environmental
Health Bureau. State of California Department of Finance projections were used to estimate age, gender,
and racial/ethnic specific populations within Monterey County (State of California, Department of Finance,
Race/Ethnic Population with Age and Sex Detail, 2000–2050, Sacramento, California, July 2007). Inmate
population data were obtained from mid-year census counts provided by the California Department of
Corrections and Rehabilitation.
Definitions
The race and ethnicity information included in this report are based on the following categories: African
American/Black (non-Hispanic); Hispanic/Latino (regardless of racial designation); White (non-Hispanic);
Asian/Pacific Islander (non-Hispanic); Native American/Alaskan Native (non-Hispanic); Other (non-
Hispanic), and Unknown/Not Specified (no race or ethnicity information was available).
Cases were defined using laboratory and/or clinical evidence of infection or disease as outlined by the most
recent communicable disease surveillance case definitions published by the Centers for Disease Control
and Prevention or by the Council of State and Territorial Epidemiologists. By California regulation, an
animal case was one that was determined by an authorized person to do so (e.g., licensed veterinarian or
microbiologist).

Onset date was estimated as the date closest to the time when symptoms first appeared. Because date of
onset was not recorded for many cases, date of diagnosis or date of case report – whichever was earliest in
time – was used as an approximation when date of onset was absent from the morbidity report.
Data Analysis
SAS Enterprise Guide 4.0 software (SAS Institute, Inc., Cary, North Carolina) was used to generate
frequency tables and evaluate temporal trends via Poisson regression models. Probability values <0.05
were considered statistically significant. Rates were calculated per 100,000 population unless otherwise
specified. Rates were stratified by age group, gender, and race/ethnicity. A rate was defined as statistically
unreliable when its relative standard error (RSE) was ≥23%. This threshold is consistent with
recommendations from the National Center for Health Statistics. To reduce the level of random error and
increase the stability of the rates, the timeframe for rates was expanded, and multi-year average rates were
produced. Formulae used to calculate rates, standard errors, and relative standard errors are available upon
request.
Morbidity Maps
Morbidity maps were created using ArcEditor 10.0 (ESRI, Redlands, California). Small case numbers
precluded mapping of every reportable disease; therefore, only select diseases with high rates and/or high
public health significance were included. Rates were displayed by quartiles (four equal interval categories)
for ease of visual interpretation. Selection of this type of categorization may have lead to introduction of
cut-point bias. U.S. Census Bureau tracts from the 2010 census were the unit of spatial representation.
Census tracts were designed to include about 2,500 to 8,000 individuals who are similar in terms of
economic status and living conditions. Census tracts were chosen over other geographic units (e.g., ZIP
codes) because they are more robust for spatial analysis and are the current unit of analysis for California
Department of Public Health mapping projects, allowing for better comparisons across jurisdictions.
Limitations
Because race/ethnicity can be an important marker for complex social, economic, and political factors that
influence health, rates by race/ethnicity were calculated among cases with complete information. The
substantial amount of missing race/ethnicity data from laboratory reports and Confidential Morbidity
Reports limits the interpretation of race/ethnicity influences on these data. The majority of case reports
originate from laboratories, a source which does not routinely collect data on race/ethnicity. Further, many
healthcare service providers do not routinely record the race/ethnicity of patients. The observed
racial/ethnic disparities may reflect true differences in the infection rates, differential access to healthcare,
and/or varying reporting practices of providers that serve different populations.
Age-adjusted rates were not calculated. Therefore, rate comparisons between other counties or geographic
entities should be interpreted carefully. Differences in the underlying age distribution of the populations
may account for some of the variation between locations, especially for diseases likely to occur more
frequently in a certain age group.
All rates, even those based on full population counts, are subject to random error. Random error may be
substantial when the number of cases is small (e.g., less than 20) and can make it impossible to distinguish
random fluctuations from true changes in the underlying risk of disease. Rates based on small numbers
should be interpreted with caution.

The numbers of disease cases in this report are likely to underestimate the true magnitude of disease.
Factors that may contribute to underreporting are delays in notification, limited or appropriate testing of
specimens, healthcare seeking behavior among ill individuals, lack of cooperation of clinicians and
laboratories, and limited resources and competing priorities within the public and private healthcare
communities. Factors that may contribute to increased reporting are disease severity, the availability of
new or less expensive diagnostic tests, changes in the surveillance case definition, recent media or public
attention, and active surveillance activities.
Because of inherent delays in case reporting and depending on the length of follow-up clinical, laboratory
and epidemiologic investigations, cases with eligible onset dates may be added or rescinded after the date
of this report. Therefore, data contained in this report are provisional and may differ from data published in
past and/or future reports.

Appendix
Table 10: Monterey County Resident Population: 1999-2010 by Gender, Age Group, and Race/Ethnicity
Gender Age Group (in Years) Race/Ethnicity
Asian &
African-
Year White, Pacific Other, Total
American,
Male Female <18 18-34 35+ Hispanic Non- Islander, Non-
Non-
Hispanic Non- Hispanic
Hispanic
Hispanic
1999 204,198 190,442 113,671 106,999 173,970 180,929 164,479 28,957 16,446 3,829 394,640
2000 209,095 194,936 114,664 108,277 181,090 188,989 165,285 25,395 14,358 10,004 404,031
2001 212,070 198,414 117,215 108,905 184,364 196,748 163,264 25,944 14,141 10,387 410,484
2002 214,359 201,272 119,145 109,254 187,232 203,916 160,774 26,393 13,818 10,730 415,631
2003 216,871 204,325 121,486 109,555 190,155 211,340 158,379 26,878 13,517 11,082 421,196
2004 217,523 205,614 121,854 109,092 192,191 216,891 154,616 27,179 13,026 11,425 423,137
2005 216,819 205,687 121,174 107,909 193,423 221,824 149,744 27,284 12,101 11,553 422,506
2006 216,209 205,806 120,181 107,361 194,473 226,279 145,127 27,556 11,623 11,430 422,015
2007 217,424 207,345 120,511 108,190 196,068 231,345 142,608 27,833 11,449 11,534 424,769
2008 218,663 208,908 120,705 109,371 197,495 236,457 140,091 28,100 11,283 11,640 427,571
2009 219,923 210,495 120,841 110,712 198,865 241,625 137,563 28,361 11,119 11,750 430,418
2010 221,187 212,096 121,108 111,691 200,484 246,849 135,006 28,612 10,055 11,861 433,283
Source: State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000–2050. Sacramento, CA, July 2007.

FULL REPORT: Communicable Diseases in Monterey County

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FULL REPORT: Communicable Diseases in Monterey County

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Annual Report of

Monterey County Health Department

Hugh F. Stallworth, MD, MPH

Lisa B. Hernandez, MD, MPH

Annual Communicable Diseases Report: 2010 Page 1 of 41

Annual Communicable Diseases Report: 2010 Page 2 of 41

Reporting a Communicable Disease

Provider morbidity reporting:

Annual Communicable Diseases Report: 2010 Page 3 of 41

Annual Communicable Diseases Report: 2010 Page 4 of 41

Annual Communicable Diseases Report: 2010 Page 5 of 41

Number of Confirmed Cases

Annual Communicable Diseases Report: 2010 Page 6 of 41

Number of Confirmed Cases

Annual Communicable Diseases Report: 2010 Page 7 of 41

Number of Confirmed Cases

Annual Communicable Diseases Report: 2010 Page 8 of 41

Annual Communicable Diseases Report: 2010 Page 9 of 41

Male Female Total

Figure 2: Rate of Salmonellosis among Monterey County Residents by Gender: 1999-2010

Annual Communicable Diseases Report: 2010 Page 10 of 41

Figure 4: Rate of Salmonellosis among Monterey County Residents by Race/Ethnicity: 1999-2010

Male Female Total

Figure 5: Rate of Campylobacteriosis among Monterey County Residents by Gender: 1999-2010

Annual Communicable Diseases Report: 2010 Page 11 of 41

Figure 7: Rate of Campylobacteriosis among Monterey County Residents by Race/Ethnicity: 1999-2010

Annual Communicable Diseases Report: 2010 Page 12 of 41

Male Female Total

Figure 8: Rate of Shigellosis among Monterey County Residents by Gender: 1999-2010

Annual Communicable Diseases Report: 2010 Page 13 of 41

Annual Communicable Diseases Report: 2010 Page 14 of 41

Annual Communicable Diseases Report: 2010 Page 15 of 41

Annual Communicable Diseases Report: 2010 Page 16 of 41

Annual Communicable Diseases Report: 2010 Page 17 of 41

Annual Communicable Diseases Report: 2010 Page 18 of 41

Figure 19: Rate of HIV/AIDS among Monterey County Residents: 1999-2010

Annual Communicable Diseases Report: 2010 Page 19 of 41

Annual Communicable Diseases Report: 2010 Page 20 of 41

Table 2. 2006-2010 Reported HIV/AIDS Population by Exposure Type and Gender

Recipient of Clotting Factor, Blood, Blood

Annual Communicable Diseases Report: 2010 Page 21 of 41

Annual Communicable Diseases Report: 2010 Page 22 of 41

Annual Communicable Diseases Report: 2010 Page 23 of 41

Pertussis (Confirmed, Probable, and Suspect Cases)

Annual Communicable Diseases Report: 2010 Page 24 of 41

Annual Communicable Diseases Report: 2010 Page 25 of 41

Annual Communicable Diseases Report: 2010 Page 26 of 41

Annual Communicable Diseases Report: 2010 Page 27 of 41

Attendees of Child Care Centers Kindergarteners

Animal Rabies (Confirmed Cases)

Annual Communicable Diseases Report: 2010 Page 28 of 41

Annual Communicable Diseases Report: 2010 Page 29 of 41

Dengue Lyme Disease Malaria West Nile Virus

Annual Communicable Diseases Report: 2010 Page 30 of 41

Chronic Hepatitis C (Confirmed and Probable Cases)

Annual Communicable Diseases Report: 2010 Page 31 of 41

Annual Communicable Diseases Report: 2010 Page 32 of 41

6000 Rate per 100,000

Annual Communicable Diseases Report: 2010 Page 33 of 41

Annual Communicable Diseases Report: 2010 Page 34 of 41

Coccidioidomycosis (also called Valley Fever, Confirmed Cases)

Annual Communicable Diseases Report: 2010 Page 35 of 41

Annual Communicable Diseases Report: 2010 Page 36 of 41

Table 9: Reported Outbreaks by First Date of Onset: 2007-2010