January 7, 2005
Epi Update Managing Staff:
"The reason for collecting, analyzing and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow."
Foege WH., International
Journal of Epidemiology 1976; 5:29-37
Following both hurricanes there were widespread power outages across Volusia County. Many residents were without electrical power for several days. Some residents relied on gasoline fueled generators for their power needs. These small generators emit carbon monoxide as a byproduct and may pose a dangerous threat to the public if not used properly. Carbon monoxide (CO) is an odorless, colorless gas that can cause serious illness and death. It is found in combustion fumes, such as those produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, and gas ranges and heating systems (1). The gas accumulates in enclosed and semi-enclosed areas and often affects humans and animals in an insidious and often undetectable way. The common symptoms of CO poisoning include headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. Unconsciousness and death may result from high concentrations of CO in the blood (1). The following information is a brief report on the incident cases of Carbon monoxide poisonings occurring in Volusia County between August 13th and October 1st.
Incidents were not concentrated in any one area or city in the county. Ten of the eleven incidents (91%) were a direct result of the use of gasoline fueled generators; one other incident involved a suicide attempt using car exhaust in a garage. Six carbon monoxide sources (55%) were located in an attached garage where ventilation was limited. Two generators were placed inside the home and two generators were also placed in very close proximity to air conditioner window units. The location of one other generator was unknown. Nineteen of 31 individuals (61%) involved in the incidents required hyperbaric chamber treatment. The other 12 individuals (39%) required only oxygen before being discharged from the emergency department. Fifteen (48%) of the 31 poisoned individuals were children or adolescents under the age of 18 (Table 1).
Among the incidents that occurred in Volusia County, gasoline powered electrical generators were the most prolific appliance implicated in a CO accident. The garage also was the most common location for the placement of the generator. After speaking with some of the individuals affected by carbon monoxide, reasons for placing generators inside the garage or home included fear of theft, proximity to electrical outlets, insufficient extension cord length, and ignorance of proper ventilation of noxious fumes. Two generators were also found to be placed underneath and in very close proximity to air conditioner window units, the intake on the AC unit bringing carbon monoxide fumes into the home. The reason for these particular placements was the need to plug in the AC unit to the generator.
The brief descriptive report on post hurricane carbon monoxide poisonings
has revealed that the common source of post hurricane CO poisonings is a
gasoline powered electrical generator. In addition, placing the generator
in an attached garage appears to be a risk factor for carbon monoxide exposure.
Proper ventilation should be stressed, paying close attention to placing
these appliances in open areas away from open windows and doors and away
from any air intake vents. It is also recommended that when operating such
an appliance a battery powered carbon monoxide detector can be placed in
the home, similar to a smoke detector. It may be interesting to perform a
more in-depth study at the state level, collecting a much larger data set.
Andre Ourso is an epidemic intelligence service fellow assigned to the Volusia County Health Department in Daytona. He can be reached at 386.519.8300.
Ed Note: Carbon monoxide poisoning
was an issue in the wake of all four of the 2004 hurricanes. The Bureau of
Epidemiology Division of Disease Control and the Division of Environmental
Health are jointly working on a case control study of carbon monoxide
poisoning throughout the state. Look for a follow-up article
concerning this study in a future issue of Epi Update.
Second-hand Smoke Among Florida Public Middle and High School Students
Second-hand smoke exposure means that students were in a room or car where someone else was smoking during the seven days prior to the survey. In March and April 2004, 7,364 public middle school students and 7,023 public high school students responded to the questions about second-hand smoke. The Florida Youth Tobacco Survey data show that in 2004:
When compared with FYTS data in the past, the latest survey data show that:
Readers can review detailed information from this report online at the bureau’s Website at http://www.doh.state.fl.us/disease_ctrl/epi/topics/pubs.htm.
Flu Vaccines Available and Encouraged
In a press release from Secretary of Health John Agwunobi this week, it was announced that 8,000 additional doses of adult flu vaccine are being dispensed to health departments throughout the state of Florida, with more on the way as they become available.
The announcement followed earlier communications which encouraged high risk individuals to obtain vaccinations and outlined high-risk individuals to include:
Dr. Agwunobi also promoted use of the pneumonia vaccine, which helps to resist infections which frequently develop after influenza. Private physicians can provide pneumonia vaccines, as can county health departments, hospitals and nursing homes.
Flu season this year began October 3, 2004 and will run through May 21, 2005. For the latest update on how influenza is affecting specific parts of Florida, go to http://www.doh.state.fl.us/disease_ctrl/epi/htopics/flu/2005/index.htm
Jaime Forth is managing editor of, and a contributing writer to, Epi Update. She can be reached at 850.245.4444, ext. 2004.
New Approaches to Drug Resistant Bacteria
by Jaime Forth
The current arsenal at
use in the battle against drug resistant bacteria consists of prevention,
judicious use of antibiotics and development of a new class of
antibiotics. Public health experts at the Centers for Disease and Control
and elsewhere have broadcast public information campaigns designed to
create awareness of the importance of handwashing and the dangers
associated with overuse of antibiotics. Research scientists are doing
their part to bring about change in a different milieu - the laboratory.
Development of new
antibiotics for treating super bugs is a rising public health priority, and persistent researchers are beginning to make headway in their
efforts to produce antibiotics that will fight against drug-resistant
At Harvard Medical
School this past summer, research colleagues exploited bacterial enzymes
to produce a stronger class of antibiotics. Mixing and matching enzymes
that could undo DNA, these new aminocoumarins would destroy the ability of
bacteria to replicate. Their study was reported to the annual meeting of
the American Chemical Society in August 2004.
resistance, which includes penicillin-resistant pneumococcal,
multidrug-resistant TB and vancomycin-resistant Staph., has
increased the number and length of hospitalizations today. Until a
solution has been reached by scientists, the plan which has emerged within
the public health community is: Use of antibiotics should occur only when
absolutely necessary, hospital infection control practices should be
strictly enforced, and efforts should be
made to eliminate antibiotics from animal feed.
A.G. Holley State Hospital to Present Grand Rounds
in 2005" will be the topic of a two-hour presentation on Wednesday,
January 26 presented by Dr. Steven Holland, chief of the NIAID Laboratory
of Clinical Infectious Disease, at the state hospital located in Lantana,
Lunch will be provided at noon. The program is sponsored by the Florida AHEC Network and Everglades Area Health Education Center and supported by the A.G. Holley State Hospital, the American Lung Association of Florida, Inc., and the Florida Bureaus of TB, Refugee Health and Laboratories. Participation via teleconference is available.
The Bureau of Epidemiology encourages
Epi Update readers to not only register on the EpiCom system at
https://www.epicomfl.net but to sign up for features such as automatic
notification of certain events
contribute appropriate public health observations related
to any suspicious or
unusual occurrences or circumstances. EpiCom is the
of communication between the Bureau of Epidemiology
and other state medical agencies during emergency
Pete Garner is
administrator of the Bureau of Epidemiology Surveillance Systems
Click here to review the most recent disease figures provided by the Florida Department of Health Bureau of Epidemiology.
D'Juan Harris is a GIS
specialist in the Surveillance Systems Section of the Bureau of