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Hemolytic uremic syndrome incidence in New York

Hemolytic uremic syndrome incidence in New York. Chang HH, Tserenpuntsag B, Kacica M, Smith PF, Morse DL. Emerging Infectious Diseases 2004;10(5):928-931.


In New York, both E. coli O157 infection and diarrhea-associated (D+) hemolytic uremic syndrome (HUS) became reportable in July 1994. Since then, the annual incidence rate for E. coli O157 has ranged from 1.6 to 8.5 per 100,000 population and the rate for HUS has ranged from 0.1 to 0.2. The New York surveillance and hospital discharge data were used to evaluate the HUS surveillance system, estimate the number of D+HUS cases, and study the epidemiologic and clinical features of HUS in New York. This paper reviews the 53 confirmed and 12 probable D+HUS cases from either data system. The average annual incidence of HUS was significantly greater in children less than five years of age. Females had higher incidence rates of HUS but not for E. coli infection. A higher proportion of culture-positive cases had shorter mean durations from diarrhea onset to specimen collection and lower BUN values within seven days of admission compared to culture-negative cases. Clinical features included 95% with diarrhea and 71% had bloody stools; the median length of hospital stay was 11 days. HUS patients less than 15 years of age were more likely to have fever and bloody stools than those older than 15 years. While hospitalized, 31% of HUS patients received antimicrobial agents and 19 were treated before HUS developed. Thrombocytopenia was present in 90% of patients and 85% had hemolytic anemia. Six patients died while hospitalized; two of these deaths were outbreak-related. All had bloody diarrhea, blood transfusions, increased leukocyte counts and elevated kidney tests. Of the 34 culture-confirmed cases, 30 were reported to the surveillance system. A higher proportion of patients with outbreak-related HUS had positive cultures than non-outbreak cases. The New York surveillance system identified 65% of D+HUS cases. Complete and rapid reporting of cases is a crucial component of public health prevention.