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RCAHD Epidemiology Surveillance Report

Q1 2024
A Quarterly Epidemiology Update for providers in
Alleghany, Botetourt, Covington, Craig, Roanoke City and County, and Salem
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To optimally protect the community’s health, Virginia’s healthcare professionals and laboratories are required to report over 70 conditions to the Virginia Department of Health (VDH).

This newsletter provides timely updates for our local public health partners about reportable conditions in the Roanoke City and Alleghany Health Districts (RCAHD). This Q1 issue reflects disease activity reported through March 31, 2024.
In this issue:
  • Summary of Reportable Diseases
  • Spotlight on: Sexually Transmitted Infections
  • Spotlight on: Vector-borne Diseases
Summary of Reportable Diseases
Overview
  • As we reflect on the first quarter of 2024, we continue to see cases of invasive Group A strep reported to RCAHD (13 cases in the first quarter).
  • Unfortunately, we are investigating the following local healthcare-associated infections and antimicrobial resistance. We are working closely with the impacted healthcare facilities to address the issues:
  • 11 reports of A. baumannii, a Carbapenemase Producing Organism - non-Enterobacteriaceae (CPOs)
  • 7 reports of Candida auris
  • 5 reports of Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) 

Respiratory illnesses
  • Fortunately, both COVID-19 activity and influenza activity have been at low levels in our communities over the past several weeks. 

Spotlight: Sexually Transmitted Infections
  • Communities across the country are concerned about high levels of STI activity. Earlier this year, the Centers for Disease Control and Prevention released a National Overview on STIs, 2022.
  • Our local RCAHD STI numbers also demonstrate continued high levels of activity in both 2022 and 2023, and Year-to-Date (through March 2024):
RCAHD STI Demographics
  • Persons under the age of 35 years bear the greatest burden for STIs. 
  • Men and women share the burden of gonorrhea; women are disproportionately diagnosed with chlamydia; and men are disproportionately diagnosed with syphilis and HIV.

Syphilis: A Startling Comeback
One of the most startling conclusions in the CDC's 2022 STI review was that the number of reported syphilis cases nationwide in 2022 was the largest number since 1950. Locally, the 2023 RCAHD reported case count for syphilis was even higher than in 2022. 

Statewide, 38 Virginia localities had elevated rates of primary & secondary syphilis among reproductive-aged women (greater than 4.6 per 100,000) in 2022. Impacted RCAHD localities include Alleghany County, Roanoke City, and Roanoke County. To address this public health threat, the Virginia Department of Health recommends that clinicians:

  1. Address syphilis before pregnancy: Offer syphilis screening to all sexually active people ages 15-44 living in localities with high syphilis rates. For many people, the most significant risk factor for syphilis is living in a community with high rates of syphilis.
  2. Continue to screen all pregnant women for syphilis during the first trimester, preferably at their first prenatal visit. Rescreen early in the third trimester (28-32 weeks), and again at delivery if living in a locality with high syphilis rates or otherwise at higher risk. Screen women at delivery if they delivered a stillborn infant (after 20 weeks), did not receive prenatal care, or were not screened previously during pregnancy.
  3. Ensure all people with syphilis get the treatment they need. 
Spotlight: Vector-borne Diseases
As the springtime weather continues to warm up in Southwestern Virginia, we encourage residents to take steps to protect themselves from vector-borne diseases.
 
As many people know, Lyme disease is the most common tick-borne illness in Virginia. In 2023, RCAHD received more than 90 reports of Lyme disease cases. We also received 12 other reports of tick-borne diseases in 2023 including anaplasmosis, ehrlichiosis, and Rocky Mountain Spotted Fever as shown below. 
Thankfully, there were no mosquito-borne illnesses reported to RCAHD in 2023.
Although more than 15 different types of ticks have been found in Virginia, the three common ticks of particular concern include: 
  • The blacklegged tick, also known as the “deer” tick, which is associated with Lyme disease, anaplasmosis, and babesiosis.
  • The Lonestar tick, associated with ehrlichiosis and red meat allergies (alpha-gal).  
  • The American dog tick, associated with Rocky Mountain Spotted Fever.

We encourage everyone to reduce the risk of vector-borne disease by using insect repellents, wearing protective clothing, avoiding prime feeding times for mosquitoes (dawn/ dusk) and high-risk environments (brush/ long grass), showering after a high risk activity, and performing tick checks with prompt tick removal.
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