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American Journal of Epidemiology Vol. 155, No. 10 : 941-948
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Population-based Trends in Pediatric Hemolytic Uremic Syndrome in California, 1994–1999: Substantial Underreporting and Public Health Implications

Kate C. Cummings, Janet C. Mohle-Boetani, S. Benson Werner and Duc J. Vugia

From the Disease Investigations and Surveillance Branch, Division of Communicable Disease Control, California Department of Health Services, Berkeley, CA.

This paper describes the epidemiology of childhood hemolytic uremic syndrome (HUS) in California, for which hospitalization data were used, and the proportion of cases reported to public health authorities. HUS discharge data for children <=17 years of age were extracted from the population-based California Patient Discharge Data Set for 1994–1999 and were linked electronically with HUS reports to public health authorities. Incidence rates per 100,000 children were calculated. The authors identified 585 HUS hospitalizations; 369 were incident cases. The average HUS incidence rate was 0.67 (95% confidence interval: 0.61, 0.74); rates rose modestly from 1994 (0.59, 95% confidence interval: 0.44, 0.78) to 1997 (0.80, 95% confidence interval: 0.63, 10.0) and decreased modestly thereafter (0.59, 95% confidence interval: 0.45, 0.77). Rates were highest for northern California children <=5 years of age (1.85, 95% confidence interval: 1.55, 2.19). The hospital case-fatality rate was 2.7% (95% confidence interval: 1.1, 4.4); the median charge was $39,500 per child. Only 43.9% of HUS cases in the California Patient Discharge Data Set were reported to public health authorities. Despite heightened efforts to control Shiga toxin-producing Escherichia coli exposures (the predominant cause of childhood HUS in the United States), HUS incidence rates remained relatively stable in California. Reporting HUS cases to public health authorities is important for disease control.

child; Escherichia coli infections; Escherichia coli O157; hemolytic-uremic syndrome; hospitalization; public health

Abbreviations: HUS, hemolytic uremic syndrome; STEC, Shiga toxin-producing Escherichia coli.


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