120. Multistate Epidemiologic Description of Histoplasmosis in the United States—2004–2015
Session: Oral Abstract Session: Epidemiology and Outcomes in Mycology
Thursday, October 27, 2016: 10:30 AM
Room: 288-290

Background: Histoplasmosis is one of the most common endemic mycoses in the United States. Infection can range from asymptomatic to life-threatening disease. Histoplasmosis is reportable in 10 states and Puerto Rico; however, a standardized case definition is not used, and incidence and distribution nationwide remain poorly understood. This study summarizes available state surveillance data to better understand the epidemiologic features of histoplasmosis.

Methods: Twelve states provided de-identified data. Cases were included if they were classified as a confirmed or probable case by the state. Contributing states included 9 (Arkansas, Delaware, Illinois, Indiana, Michigan, Minnesota, Nebraska, Pennsylvania, Wisconsin) in which histoplasmosis is currently reportable, 2 (Alabama, Mississippi) in which it was previously reportable, and 1 (Ohio) in which it was not reportable, but data were available. We examined epidemiologic data during 2004-2015 and calculated county-specific mean annual incidence rates for 2012–2014 (years for which data were available in all states). Some data elements were only available from certain states.

Results: A total of 5796 cases were reported during 2004–2015; 303 additional cases were detected in Ohio during 2012-2015. County incidence ranged from zero to 39 per 100,000 population (figure). In the 11 states where histoplasmosis is or was reportable, mean patient age was 47 years (interquartile range: 33–61), and 3499 (60%) were male. Of 2519 patients for which race data were available (from 7 states), most were white (54%) or of unknown (33%) race. Common symptoms reported by 2445 patients (from 4 states) were cough (65%) and fever (54%). Thirty-four percent of 1580 patients (from 3 states) were immunocompromised and 56% of 3627 patients (from 7 states) were hospitalized.

Conclusion: The large proportion of hospitalized patients in this sample suggests that passive surveillance likely fails to capture many milder cases, underestimating the true burden of histoplasmosis. County-level incidence data enhance our understanding of endemic regions in the United States. Expanding reporting to additional states would allow for more comprehensive knowledge of histoplasmosis in the United States.

Paige Armstrong, MD MHS1,2, Kaitlin Benedict, MPH1, D Haselow, MD, PhD3, Virgie Fields, MS3, Brendan Jackson, MD, MPH1, Connie Austin, DVM4, Malia Ireland, DVM MPH5, Kimberly Signs, DVM6, Veronica Fialkowski, MPH6, Reema Patel, MPH7, Caitlin Pedati, MD MPH2,8, Peter C. Iwen, PhD.9, Thomas Dobbs, M.D., M.P.H.10, Jannifer Anderson, RN BSN11, Suzanne Gibbons-Burgener, DVM, PhD12, Kim Warren, MPH13, Sherri Davidson, MPH14, Mary G. Mcintyre, MD, MPH15, Joanne Midla, VMD MPH-VPH16 and Nhiem Luong, MD DrPH17, (1)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Atlanta, GA, (3)Arkansas Department of Health, Little Rock, AR, (4)Illinois Department of Public Health, Springfield, IL, (5)Minnesota Department of Health, St. Paul, MN, (6)Michigan Department of Health and Human Services, Lansing, MI, (7)Infectious Disease Epidemiology, Indiana State Department of Health, Indianapolis, IN, (8)Nebraska Dept. of Health & Human Services, Lincoln, NE, (9)University of Nebraska Medical Center, Omaha, NE, (10)Mississippi State Department of Health, Hattisburg, MS, (11)Mississippi State Department of Health, Jackson, MS, (12)Division of Public Health, Wisconsin Department of Health Services, Madison, WI, (13)Pennsylvania Department of Health, Wilkes-Barre, PA, (14)Alabama Department of Public Health, Montgomery, AL, (15)Bureau of Communicable Disease, Alabama Department of Public Health, Montgomery, AL, (16)Ohio Department of Health, Columbus, OH, (17)Division of Public Health/DHSS, Dover, DE


P. Armstrong, None

K. Benedict, None

D. Haselow, None

V. Fields, None

B. Jackson, None

C. Austin, None

M. Ireland, None

K. Signs, None

V. Fialkowski, None

R. Patel, None

C. Pedati, None

P. C. Iwen, None

T. Dobbs, None

J. Anderson, None

S. Gibbons-Burgener, None

K. Warren, None

S. Davidson, None

M. G. Mcintyre, None

J. Midla, None

N. Luong, None

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