January 27, 2006
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
Laboratory results from the cerebrospinal fluid (CSF) showed the following: WBC: 188, RBC: 163, neutrophils: 61, glucose: 12, and protein: 660. Gram stain showed many gram negative rods in the CSF. Peripheral blood culture also produced gram negative rods. His CSF culture detected Salmonella Group B as the contributory agent.
The infant was born at term via normal delivery. The baby and mother stayed in the hospital for two days following delivery. Interviews with both parents revealed that the infant had been breast fed only and there were currently no siblings or pets in the home.
Both parents denied having any diarrheal illness prior to the child’s birth. Further investigation revealed that on November 16, 2005, the mother of the child was taken to the hospital because she thought she was going into labor. The hospital discharged her with a diagnosis of Braxton Hicks contractions. On their way back home, the parents found a turtle in the road and took it home to keep as a pet. After having the turtle for two weeks, they decided to do Internet research on how to take care of it. During their search, they discovered that turtles can cause salmonellosis and decided to get rid of it before the baby was born. When they moved into their new home in early December, they released the turtle and did not take it with them. Both parents denied having any Salmonella related symptoms after releasing the turtle.
The infant was hospitalized for 13 days for treatment and monitoring. After improving, he was discharged to the home.
There is an important association between cases of salmonellosis and pet reptiles. This is more common in the United States where pet reptiles are prevalent. The CDC estimates that 93,000 cases of salmonellosis per year are associated with direct or indirect exposure to reptiles or amphibians. As much as 90% of reptiles are natural fecal carriers of the Salmonella bacteria. Because it is concerned about Salmonella infections associated with reptiles, the Food and Drug Administration banned the sale of small turtles less than four inches long in the mid-1970s. Despite the ban and concern for transmission, reptiles continue to be popular household pets in the United States. From 1991 to 2001, the estimated number of households with reptiles doubled from approximately 850,000 to 1.7 million. Infants and young children have higher incidences of reptile-associated salmonellosis. Because infants are more susceptible to illness, their infection is more likely to involve serious complications such as septicemia and meningitis.
Transmission of salmonellosis from reptiles to humans can be greatly reduced by thoroughly washing hands with soap and water following contact. Pregnant women, children less than five years old, elderly people, and those who are immunocompromised should avoid contact with reptiles. Pets should be kept away from food preparation areas, and kitchen sinks should not be used to clean reptiles or their cages. If a bathtub is used for bathing pets, it should be cleaned and disinfected afterward with a bleach solution. In addition, pet store owners should inform buyers of the increased risk of Salmonella infection from reptiles.
Antibiotic treatments for Salmonella meningitis in children have not been as successful as treatments for E.coli meningitis. A three-week treatment with cefotaxime or ceftriaxone was recommended in 1987; however, reports of clinical results were not as satisfactory. The American Academy of Pediatrics now recommends cefoxtaxime or ceftriaxone for four weeks or more for Salmonella meningitis. Although strains of Salmonella that are resistant to a wide range of antimicrobials have emerged and could become a serious public health issue, meningitis caused by strains of Salmonella that are resistant to cephalosporins is uncommon.
CDC. Reptile-associated salmonellosis – selected states, 1996-1998. MMWR 1999;48:1009-13
Price JH, de Louvois J, Workman MR. Antibiotics for Salmonella meningitis in children. Journal of Antimicrobial Chemotherapy 2000;46, 653-655.
Varaiya A, Saraswathi K, Tendolkar U, De A, Shah S, Mathur M. almonella enteritidis meningitis – A case report. Indian J Med Microbiol 2001;19:151-152
Sharlene Emmanuel is a Florida EIS fellow assigned to the Polk County Health Department (PCHD). Cynthia Goldstein-Hart is the epidemiology program manager at the PCHD. Dr. Somboonwit is senior physician at the PCHD specialty care clinic and Dr. Haight is the PCHD medical director. To reach any of these contributors, call the Polk County Health Department at 863.519.8300.
Epidemiology Grand Rounds
Influenza Surveillance: National, State and Local Approaches
Presenters: Kelly Granger, MPH, CHES, Florida EIS Fellow, Hillsborough County Health Department, Bureau of Epidemiology, Florida Department of Health and Andre Ourso, MPH, Florida EIS Fellow, Volusia County Health Department, Bureau of Epidemiology, Florida Department of Health.
The Florida Hepatitis Program Presents
On April 12, July 12, and October 11, 2006 from 2:00-3:00 p.m., the Florida Hepatitis Prevention and Control Program will offer a one-hour basic introductory training course titled "Hepatitis 101: for Counselors and Outreach Workers.”
The course is presented in a telephone conference call format, and provides an introduction to hepatitis A, hepatitis B and hepatitis C. Prior to each course date, the “Meet Me” phone number and the PowerPoint Presentation are emailed to all registrants. A continuing education credit of one contact hour is available for licensed laboratorians and nurses in the state of Florida.
To register for this course, please complete the form found on the following link: http://www.doh.state.fl.us/disease_ctrl/aids/hep/Hep101/101regform.htm
Please register early, as each session will be limited to the first 50 registrants. It’s recommended that you allow 15 minutes during registration to take the mandatory pretest.
For more information, please contact April Crowley, 850.245.4444, ext. 2580 (SC 205.4444, ext. 2580).
Ms. Crowley is a health education coordinator in the Bureau of HIV/AIDS in Tallahassee.
This is the 15th weekly Florida influenza surveillance report for the 2005-6 season. Influenza surveillance in Florida consists of six surveillance components: The Florida Sentinel Physician Influenza Surveillance Network (FSPISN), state laboratory-based viral surveillance, county influenza activity levels as determined and reported by county health department epidemiologists based on county-level influenza and influenza-like illness (ILI) surveillance, reporting of influenza-associated deaths among those <18 years of age, post-influenza infection encephalitis reporting, and reports of influenza or ILI outbreaks in communities or institutional settings. Influenza is not a reportable disease in Florida and therefore exact statewide information regarding the number of influenza cases is not available.
The aforementioned surveillance systems allow the Florida Department of Health, in collaboration with the Centers for Disease Control and Prevention, to determine when and where influenza activity is occurring, identify circulating viruses, detect changes in the circulating influenza viruses, track patterns of influenza-associated morbidity and mortality, and estimate the overall impact of influenza in the state of Florida. Almost all the reporting by counties, laboratories and healthcare providers that track these figures is voluntary.
During Week Two, ILI activity reported by FSPISN increased in four of seven regions (Central east, Central west, Southeast and Southwest). County-level influenza reporting recorded as of January 18,2006: Localized activity was reported by Hendry, Orange, and Seminole counties. Nineteen CHDs (Alachua, Bay, Brevard, Clay, Escambia, Flagler, Hernando, Hillsborough, Jackson, Lee, Martin, Nassau, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Taylor and Volusia) reported sporadic ILI activity, and 31 reported no activity. Twenty-three counties did not report this week.
For the worldwide picture and a more in-depth
look at Florida influenza activity, link to the full report at
Features Outbreak Cases
by Jaime Forth
For those unable to call in, this is a brief summary of the discussions that occurred during the bi-weekly conference call between Bureau of Epidemiology staff and county health department personnel. These calls are scheduled regularly on alternating Fridays. For more information, contact Mary Hilton, MNP, at 850.245.4444, ext. 2732.
Dr. Richard Hopkins introduced Dr. John Middaugh, the newly-appointed state epidemiologist who arrived recently from Alaska to take the position.
CHD After-hours Availability. Dr. Hopkins announced that Rick Clark will begin drills next week to demonstrate after-hours availability. Rick will be conducting these regularly; CHDs will be told in advance that the calls will occur. The national goal set by the CDC is a 15-minute response.
Paperless Electronic Lab Reporting. Dr. Hopkins explained that posted results from state laboratories have been available via Merlin for two years. The Bureau of Epidemiology has been working with a private lab called IRL to provide the same service. Other, larger private labs will follow later. Janet Hamilton is forming a work group to set criteria, decide filters and make decisions on timelines for paper reporting vs electronic. If interested in joining this workgroup, contact Janet.
Avian Flu Testing and Reporting. Rebecca Shultz summarized the approved reporting methods for dead birds and suspected avian flu in animals. Dead birds should be reported to the Florida Fish and Wildlife Conservation Commission, the same entity that conducts testing for arboviruses. She cautioned listeners to avoid overwhelming state labs with requests for animal testing; the appropriate agency for animals is the Florida Fish and Wildlife Conservation Commission.
She also addressed the consistent rumor that the State of Florida keeps flocks of sentinel chickens for avian influenza monitoring. She reported that this is not true; we do maintain chickens for arbovirus but not avian.
Cluster of pneumonia cases associated with a hotel. Andre Ourso provided a synopsis of four confirmed pneumonia cases reported to the Volusia CHD on January 23 by the infection control section of a local hospital. All patient cases had stayed at the same Daytona Beach hotel. One tested positive for Legionella. One member of the hotel housekeeping staff developed legionellosis on August 2004. An investigation and samples taken from patient case hotel rooms and common areas such as pools and spas was conducted with business and environmental regulators, and revealed ongoing mold, mildew and water damage due to inadequate maintenance. Pools and spas were closed due to lack of sanitizer. It was noted that all patients were >55 years of age. The investigation is ongoing.
Salmonella Meningitis in an infant. Sharlene Emmanuel provided details of the case of parents who took their infant son to his pediatrician complaining that he had been sleeping excessively and not eating. The physician ascertained that the child had a fever of 101.8F and performed a lumbar puncture which indicated abnormalities. The infant was sent to the local ER to be stabilized and antibiotics were ordered. Follow-up tests revealed the child had contracted Salmonella meningitis. The parents admitted to having had a turtle in the household previously, but stated they had released it prior to moving into their new home. They had found it in the road and taken it home but when an Internet search showed that turtles harbor harmful disease, they had made the decision to release it back into the wild.
Emmanuel noted that Salmonella can remain in the human body and be excreted through stools for a year. The child was discharged after 13 days and is doing better.
Rebecca Shultz, Bureau of Environmental Health added that Merlin cases of Salmonella during a two year period number in the hundreds. Sales of turtles with a shell diameter of <4 inches are prohibited in Florida.
Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.: Two wild birds out of 19 captured in Okaloosa County on 1/11/06 and 1/12/06 tested positive for antibodies to EEE virus. One out of 14 wild birds captured 1/10/06 in Santa Rosa County also tested positive for antibodies to EEE virus. There was one seroconversion to WN virus reported in a sentinel chicken from Manatee County (12/20/05, sero rate: 1.79). There was also one seroconversion to EEE in a sentinel chicken from N. Walton County (12/14/05 sero rate: 3.12). These will both be counted as 2005 activity.
The Fish and Wildlife Conservation Commission (FWCC) collects reports of dead birds, which can be an indication of arbovirus circulation in an area. This week, 6 reports were received on a total of 6 birds from 6 counties. Of the reported birds, 1 was identified as a corvid, 2 were raptors and the remaining 3 were other species. Please note that FWCC collects reports of birds that have died from a variety of causes, not only arboviruses. Dead birds should be reported to www.myfwc.com/bird/.
Arboviral activity in Florida includes the
following viruses: St. Louis encephalitis [SLE] virus, eastern equine
encephalitis [EEE] virus, Highlands J [HJ] virus, West Nile [WN] virus,
California Group [CAL] virus and dengue virus.
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
any suspicious or unusual occurrences or circumstances. EpiCom is the primary method of communication
between the Bureau of Epidemiology and other state medical agencies during emergency situations.
Christie Luce is administrator
of the Surveillance Systems Section in the Bureau of
Epidemiology. She can be reached at 850.245.4444, ext. 2450.
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
Copyright©2006 State of Florida