February 4, 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
A record 7,364 public middle school students and 7,023 public high school students completed the 2004 FYTS questionnaire during March and April. The term “lifetime cigar smoker” means a student who has ever smoked cigars, cigarillos, or little cigars, even one or two puffs in his or her lifetime. Current cigar smoker means the student smoked cigar products on one or more of the past 30 days prior to the survey. Frequent cigar smoker means the student smoked cigar products on 20 or more of the past 30 days prior to the survey. The survey data show that in 2004:
When compared with FYTS data in the past, the latest survey data show that:
For more information on the FYTS program, contact Melissa Murray, MS at 850.245.4444, ext. 2445 or by e-mail at Melissa_Murray@doh.state.fl.us, or contact Zhaohui Fan, MPH at ext. 2418 or by e-mail at Zhaohui_Fan@doh.state.fl.us.
Zhaohui Fan is an
epidemiologist working in the Chronic Disease Section of the Bureau of
Epidemiology in Tallahassee. He can be reached at 850.245.4444, ext. 2418.
Bi-weekly CHD Conference Call Provides Updates on County Investigations
Surveillance Update. Carmela Mancini announced the departure of Karen Wheeler, who moved to Atlanta to accept another position. Until her vacancy is filled, Carmela will assume the responsibilities handled by Karen, such as the Superbowl and the ER census projects, designed to collect data from participating hospitals through EpiCom. Carmela is also temporarily handling respiratory surveillance and other duties performed by Angela Fix, who is on maternity leave, until Angela’s job is assigned to another staff member.
Merlin Case Reporting. Travis McLean reminded listeners that February 28th is the last day for deleting and/or updating 2004 cases on Merlin. He noted that case task lists should be tackled in advance to prevent last-minute problems.
Bureau of Epi Intranet. D’Juan Harris announced a new look for the bureau Website and a new calendar for meetings and events. Anyone who would like to make additions to the calendar or who has questions or comments can contact him at 850.245.4444, ext. 2435.
Training Update. Melanie Black announced that Jill McKinnon would be the presenter at the February Grand Rounds on the 28th. EIS fellows will make presentations during the months March through May. She also stated that the dates for this year’s epidemiology seminar have been selected. The event will again be held at the Orlando Marriott in Lake Mary on May 17th and 18th. In other news, an epidemiology contact list and update bureau staff contact list have been posted on the Epi intranet site.
Interim Influenza Vaccination Recommendations. Speaking on behalf of Phyllis Yambor, Dian Sharma reported that Dr. Agwunobi lowered the recommended age for receiving a vaccination to 50. A large number of vaccines (210,000) were delivered this week. Flu season is not over, and a slight increase in cases has been seen in the rest of the country.
Unknown Etiology Death in Hillsborough County. Roger Sanderson explained that Hillsborough County CHD personnel were notified of a female patient in her early 40s who had recently returned from a trip to Brazil and other Latin countries, and had presented with x2 days of headaches of increasing severity, which quickly lapsed into a coma. She had received appropriate vaccines and boosters prior to traveling but died two days after being examined. Autopsy and viral culturing were performed due to her exposure to old world primates while in South America. Tests were negative for rabies and viruses and a non-infectious etiology is probable.
Brucellosis in Hillsborough County. Kelly Granger described the case of a 48-year-old white male who presented to a local emergency room complaining of neck pain, fatigue and fever. He had been hunting for wild hogs and butchered his catch without using gloves or other precautionary measures against disease. He was treated with antibiotics and released. Dr. Blackmore suggested using state laboratories for testing so serological testing could be provided for these types of cases. Carmela Mancini offered to assist if CHDs have difficulty obtaining the high-risk lab results within a reasonable timeframe. Dr. Hopkins suggested education should be provided at the time the hunting license is applied for.
Hepatitis A in Collier County. Peggy Burton reviewed a school breakout during which a child tested positive for Hepatitis A at the end of November 2004, followed by another child in the same special education class who tested positive. The index case had visited the Dominican Republic not long before reporting the exposure. All children in the class were consequently vaccinated and two other classes at the school received vaccines as preventatives. A follow-up clinic for teachers was arranged at their request.
Notes from the
January 28, 2005 call will be reported in the next issue of Epi Update.
The next conference call is scheduled for 10:00 a.m. on Friday, February
11th. Calls are arranged on a bi-weekly basis. Anyone wishing to be placed
on the agenda should email Melanie Black, MSW, professional training
Melanie_Black@doh.state.fl.us. or phone her at 850.245.4444, ext.
2003 Epidemiological Series Releases Latest Report on Cancer Incidence and
The 2003 Florida Annual Cancer Report: Incidence and Mortality for 2000 is the latest publication to provide annual updates on cancer incidence and mortality in Florida. The Bureau of Epidemiology at the Florida Department of Health collaborated with the Florida Cancer Data System (FCDS) to develop this series. The incidence data are collected, verified and maintained by FCDS. The agency is administered by the Florida Department of Health and operated by the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine. More detailed information can be accessed at the FCDS Web site located at www.fcds.med.miami.edu or visiting the Bureau of Epidemiology Website at www.doh.state.fl.us/disease_ctrl/epi/cancer/CancerIndex.htm. This excerpt from the Executive Summary provides an overview of the contents of the full report.
During the year 2000, health care practitioners diagnosed 94, 630 cancers among Floridians, an average of 259 new cancers per day. The total number of new cancer cases decreased by 920 from 1999. A total of 38, 191 Floridians died of cancer in 2000, an average of 104 deaths per day, 877 more than in 1999.
Cancer of the lung and bronchus was the most frequently reported cancer, with 15,553 cases diagnosed in 2000. Prostate cancer ranked second with 13,600 cases, followed by female breast cancer, at 12,390 cases. The fourth and fifth most common cancers were colorectal and bladder, with 11,464 and 4,952 cases, respectively.
Sixty-four percent of newly diagnosed cancers and 74 percent of cancer deaths occurred in persons aged 65 and older. This age group accounted for 17.5 percent of Florida’s 2000 population.
Data from the North American Association of Central Cancer Registries Cancer in North America 1996-2000, Volume 3, which represents 68 percent of the total U.S. population from 29 states and five metropolitan areas, yields a crude incidence rate of 472 cases per 100,000 per year for the five-year period. The 2000 crude rate in Florida for all cancers combined was 589 cases per 100,000, or about 25 percent higher than the rate listed in the registry.
The age adjusted incidence rate for all cancers combined in Florida females for the year 2000 was 414 per 1000,000, slightly higher than the 2000 U.S. average rate for females for 409 per 100,000 given in United States Cancer Statistics: 2000 Incidence Report (USCS). Male Floridians had an age adjusted rate of 556.9 per 100,000 per year that was also higher than the U.S. average rate of 547 cases per 100,000 found in the USCS. The USCS contains cancer statistics for approximately 84 percent of the U.S. population in 41 states, six metropolitan areas, and the District of Columbia.
Cancer was the second leading cause of death in Florida in 2000, with 38,191 deaths, following heart disease at 51,124. Stroke was the third leading cause with 10,512 deaths. Cancer ranked first in terms of potential years of life lost. With 259,801 potential years of life lost, cancer surpassed heart disease at 184,779 years lost and accidents at 162,667 years lost.
Non-White males had a higher age-adjusted cancer mortality rate than either non-White females or Whites of either sex. The difference in prostate mortality rates was most remarkable: Non-White males had a rate of 73 deaths per 100,000 from prostate cancer, three times higher than the rate for White males at 23 deaths per 100,000.
Youjie Huang, MD, MPH, Dr.PH is section administrator of the Chronic Disease Surveillance Section of the Bureau of Epidemiology. To reach him, call 850.245.4444, ext. 4407.
Complicated Year for Flu Vaccine by Jaime
The first step is choosing the virus to be used in the new vaccine. Although the World Health Organization makes recommendations, each country chooses its own strain and in the U.S., this is achieved by a committee vote of vaccine flu experts late each winter. Only after the Food and Drug Administration approves the selection can the ten-month production process begin.
Timing and management are other key issues. Although new scientific methods for incubation of the seed viruses, such as monkey or human cell lines rather than fertilized chicken eggs, have been proposed, the FDA has declined to try more rapid technologies, preferring to remain with the tried and true. In addition, the number of vaccine suppliers has shrunk to just three as competitors have gone out of business in recent years. To generate profits, companies need to sell tens of thousands of doses and are required to accept back any unused vaccines, meaning a potential tens of millions of dollars in losses a year.
With few manufacturers left in
the marketplace and the price of this year's vaccine not yet set by the
federal government, healthcare professionals are left to wonder when they
should place their orders and who will fill them. Chiron Corporation is
headquartered in California but its manufacturing plant is located in the
U.K. It was the main provider of vaccines for the U.S. until contamination
was discovered in the plant last fall, resulting in a suspension of its
license to operate until April 2005. Given the 10-month production cycle,
industry watchers are uncertain about its ability to fill the number of
orders the United States will need for the upcoming flu season. Government
officials are now making arrangements with other suppliers and working for
possible approval of vaccines made outside the U.S.
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
Weekly Update: During the period January 23-29, 2005 the following arboviral activity: St. Louise encephalitis (SLE) virus, eastern equine encephalomyelitis (EEE) virus, HIghlands J (HJ) virus, West Nile (WN) virus and dengue virus were recorded for Florida.
West Nile (WN) virus activity: None this week.
Eastern Equine Encephalomyelitis (EEE) virus activity: Three live wild birds captured in Okaloose County tested positive for EEE. The infection rate is calculated using as the denominator the number of birds captured for testing on that date at that particular site. It is not known precisely when these birds became exposed to EEE.
St. Louis Encephalitis (SLE) virus activity: None yet this year.
Highlands J (HJ) Virus activity: None yet this year.
There are no counties currently under medical alert for mosquito-borne disease.
Cooler weather in many parts of the state is helping to reduce mosquito populations. Yet others are experiencing unseasonably warm weather favorable to mosquitoes. Where mosquitoes are present, people are urged to take precautions against getting bitten.
Dead birds should be reported to www.wildflorida.org/bird/. See the web page for more information: www.MyFloridaEH.com The Disease Outbreak Information Hotline offers recorded updates on medical alerts status and surveillance at 888.880.5782.
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