August 25, 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
On Thursday August 11, 2005, staff from the Florida Department of Health (DOH) Bureau of Epidemiology received a call from a community nurse practitioner in St. Lucie County regarding flu-like illness in a traveler recently returned from a two month stay in Vietnam.
The nurse practitioner described a 62 year-old Vietnamese female who presented to the clinic complaining of five days of fever, chills, unproductive cough, generalized fatigue and body aches. The patient had returned from Saigon on Sunday August 7. She denied travel outside of Saigon or contact with any live birds or pigs. She did eat duck during her trip. While in Vietnam, the woman had contact with a number of family members who were sick with a similar type of illness.
The patient presented to the clinic with her middle-aged daughter who had been having similar symptoms that morning. Staff from the clinic isolated the two patients and contacted CDC for consultation on a possible avian influenza case.
CDC directed the clinic to the Bureau of Epidemiology at Florida DOH. Florida Bureau of Epidemiology staff contacted personnel from the St. Lucie County Health Department, who coordinated the collection of throat swabs and serum samples from both patients and advised the patients to self-isolate in their homes until testing results were returned.
Samples were shipped overnight to the Bureau of Laboratories in Tampa and arrived mid-morning August 12. A real-time RT-PCR molecular assay detected Influenza A in the 62 year-old by mid afternoon, presumptively identified as hemagglutinin type H3.
Points to highlight from this scenario:
1.) Astute clinicians are the first line in the identification and control of diseases which may threaten the health of a community. The nurse practitioner in this case correctly identified a potential case of avian influenza and quickly contacted public health authorities.
2.) The first point of contact for health care providers considering avian influenza should be their local CHD. In practice, this may not always be the case. It is vital for CHDs, the Bureau of Epidemiology, and the Bureau of Laboratories to be in close communication when cases of this nature come to attention.
3.) In cases of suspected avian influenza, appropriate specimens should be collected when patients present, and should be shipped overnight to the Bureau of Laboratories in Tampa. Rapid testing and diagnosis will require CHDs to have appropriate specimen collection kits on hand.
4.) Patients suspected of avian influenza should be isolated in the initial healthcare setting and subsequently counseled to self isolate at home until testing results return.
Dr. Chertow is a CDC epidemic intelligence officer assigned to the Investigations Section at the Bureau of Epidemiology. He can be reached at 850.245.4406.
BackgroundCancer accounts for one of every four deaths in the United States. The lifetime risk for cancer for men in the United States is nearly 1 in 2; for women, the lifetime risk is little more than 1 in 3.
MethodologyAll acute care hospitals and short-term psychiatric hospitals licensed under Chapter 395, Florida Statutes are required to report inpatient discharge data to the Agency of Health Care Administration (AHCA). To assess the burden of cancer in Florida, AHCA data were analyzed to evaluate the number of hospitalizations, the length of stay, and the total cost for cancer treatment for the top cancer sites. Data were analyzed using SAS version 8.0.
The dollar cost for these hospitalizations totaled approximately $2.6 billion, with an average cost of $30,300 per hospitalization. Total hospital charges for colorectal cancer ($404 million) and lung and bronchus cancer ($335 million) accounted for 28 percent of hospital charges for all cancer hospitalizations. Total hospital charges for breast cancer, colorectal cancer, and cervical cancer, cancers in screening methods are available, were $513 million.
Conclusions/RecommendationsReducing the cancer burden requires continued efforts involving the following: (1) reducing the prevalence of behavioral and environmental factors that increase cancer risk; (2) increasing the accessibility and availability of cancer screening services and high-quality treatment; (3) conducting research studies and clinical trials on the etiology and progression of cancer, and (4) increasing cancer surveillance (incidence and mortality) through state cancer registries.
This abstract is one of many presented at the spring 2005 Statewide Epidemiology Seminar. Look for more abstracts in coming issues of Epi Update.
Tara Hylton and Zhaohui Fan are epidemiologists in the Chronic Disease Section at the Bureau of Epidemiology. Ms. Hylton can be reached at 850.245.4444, ext. 2441. Mr. Fan can be reached at extension 2418.
The CDC Miami Quarantine Station (QS) is responsible for the prevention and control of communicable diseases at all the ports of entry in Florida. The Miami QS is physically located at the Miami International Airport (MIA), and is one of 16 national field quarantine stations. The mission of DGMQ is “to make and enforce regulations necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the United States.” To enforce the legal and regulatory authority of DGMQ in support of its mission, the Miami QS works closely with other federal agencies (e.g. U.S. Customs and Border Protection, U.S. Department of Agriculture, U.S. Fish and Wildlife, and Federal Bureau of Investigations) and local partners (state and county health departments, county aviation, police, and fire rescue) in tasks such as monitoring the health status of immigrants, refugees and travelers; performing inspections of maritime vessels and cargo for infectious disease agents; distributing immunobiologics and investigational drugs when indicated; providing travelers with essential health information; and ensuring appropriate disposition as well as public health action for illnesses on planes and vessels.
In the past, the Miami QS has responded to special public health challenges, posed by mass migration from Cuba and Haiti, and global outbreaks such as SARS. To better prepare for future public health emergencies, the Miami QS has developed strong partnerships with local health authorities and first responders, and together they have carried out field and table top exercises. The Miami QS will continue to promote and strengthen collaborative work with its community partners, for the development of a well-coordinated response to bioterrorism threats and communicable diseases of public health significance.
Dr. Mitruka is a
medical officer at the CDC's Miami Quarantine Station,
Division of Global Migration and Quarantine.
Over 2,000 Illnesses Linked to
Popular with tourists and a traditional fun spot for locals, the attraction has been closed by the State Office of Parks for the remainder of the season in an effort to prevent more occurrences.
Sufferers began complaining of symptoms in June, and since then cases have spread across 32 counties within the state. The New York State Health Commissioner's Office has issued precautionary notices to the general public with advice on preventive measures and avoiding exposure to gastrointestinal illness.
The most common symptom of the contagious disease is watery diarrhea, with fever, weight loss, vomiting and nausea. These symptoms begin an average of seven days after becoming infected with the cryptosporidium parasite, which lives in the intestine for about one to two weeks. According to the CDC, the symptoms may be cyclic, fading and then returning again for a few days until the illness ends. There is no standard medical treatment, although the symptoms should be treated with fluids to prevent dehydration.
Florida and other states have seen their share of crypto outbreaks associated with swimming pools and other recreational water venues. The CDC in February 2005 hosted a Recreational Waterborne Illness Workshop to address concerns and promote the latest information on the topic. Participants included Dr. Roberta Hammond of the Food and Waterborne Disease Program, Pete Thornton, Volusia CHD environmental health director, and Bob Vincent, Bureau of Water Programs.
Good hygiene practices are the best way to prevent cryptosporidiosis. Washing hands thoroughly with soap and water, avoid drinking water that could be contaminated, and postponing swimming until the symptoms abate if experiencing diarrhea were three of the pre-Labor Day precautionary measures issued to New York citizens by the health commissioner's office. Children in diapers should be monitored often, and diapers should be changed away from pool or beach settings. In addition, readers were counseled to contact their physician and their local health department if they believed they had contracted the disease.
For more on this story, click on
Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.
New Avian Flu Drug Could
A neuraminidase inhibitor called Relenza is the latest addition to a short list of drugs currently available for combating avian flu. Manufactured by GlaxoSmithKline, Relenza is used as an inhalant and joins Tamiflu as the only other inhibitor on the market. Two other drugs, Amantadine and Rimantadine, are used for treatment of the virus.
Relenza showed fewer adverse reactions in the testing phase of its development than Tamiflu, and also showed a good resistance profile which, according to some researchers, would make it a satisfactory candidate for the Strategic National Stockpile, a repository of pharmaceutical, medical and other emergency supplies pre-positioned at points across the country for quick access in the event of a national emergency. These supplies would be delivered within 12 hours of request by a state governor, and after the CDC has agreed to the release. Shipments would arrive with a small staff of CDC specialists to provide technical knowledge and assistance to local officials.
Stockpiling of antiviral drugs has been analyzed by researchers interested in determining the financial impact the move would have on the healthcare system, and its overall cost on the economy. In a study performed this year by scientists from the Israeli Ministry of Health and the University of the Negev and published in CDC's Emerging Infectious Diseases, their conclusions suggest the strategy could significantly reduce illness and death if early control measures were taken to maintain targeted prophylaxis (or judicious use of antiviral drugs) and for therapeutic use only.
Based on their modeling, stockpiling in anticipation of a pandemic presented the best-case scenario for therapeutic treatment and post exposure prophylactic treatment of close contacts of patients. It also provides cost savings to the health care system and the economy.
To read more about this issue, see the CDC report cited in this article at: http://www.cdc.gov/ncidod/EID/vol111no08/04-1156.htm
Reuters News Wire on Relenza: http://www.msnbc.msn.com/id/8915518/
Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.
Disease Update August 14 - 20, 2005
Gadsden, Leon, Pasco, Polk, Pinellas and Suwannee Counties are currently under medical alert for mosquito-borne disease. Where biting 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 at www.MyFloridaEH.com. The Disease Outbreak Information Hotline offers recorded updates on medical alerts status and surveillance at 888.880.5782.
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 an EpiCom
consultant in the Surveillance Systems Section of 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©2005 State of Florida