Division of Disease Control and Health Protection

May 6, 1999

Florida International University and the Dade and Broward County departments of health have published and distributed announcements for the 1999 Annual Florida Epidemiology Meeting (AFEM). The meeting will be held on July 28-30 at the Roz and Cal Kovens Conference Center at the North Miami Campus of the Florida International University. As cited in the brochure, "This two and a half day conference will cover the most recent public health information and research presented by Florida’s public health professionals. AFEM fosters collaborative research among epidemiologists, educators, students, public health researchers, physicians and nurses on topics most relevant to Florida’s present and future public health needs." The AFEM is one of the two premier annual epidemiology meetings in the state; the other being the Bureau of Epidemiology’s Annual Florida Epidemiology Seminar to be held at the end of September in Clearwater. The primary difference between the two meetings is that the AFEM has more of a research agenda, while the annual epidemiology SEMINAR (see the following article) is directed primarily toward applied epidemiology.

The Sixth Annual Statewide Epidemiology Seminar (ASES), sponsored by the Bureau of Epidemiology, is being scheduled at the Belleview Biltmore, near Clearwater, Florida, on September 29 to October 1, 1999. This seminar will provide current information and continuing education to health care professionals regarding the reporting, investigation, and control of communicable and non-infectious diseases of public health significance, with the focus of improving the health of Florida residents and visitors.

In order to best serve the seminar participants, we want to know what (epidemiology) topics they feel would be most interesting and useful. In the next couple of weeks, we will send a survey to county health department epidemiologists, directors and administrators requesting their help in formulating the agenda. We also encourage others who plan to attend to offer their comments and recommendations. We want as much input as possible.

The attached link is the announcement and registration information for the Florida Environmental Health Association's Annual Education Conference 1999 Pre-conference Training on May 25, 1999. One of the courses is the 6-hour How to Investigate Foodborne Illness Outbreaks training. Nursing CEUs are available for this course. The deadline for registration is Friday, May 14.

"This is to inform you of a cluster of 6 cases of acute liver failure of unknown etiology among residents of Kentucky, Illinois, Indiana, and Ohio between January and March 1999. This group of patients is unique in a number of respects; including their geographic clustering, the rapidity of illness onset to liver failure, and magnitude of liver enzyme elevation. The Centers for Disease Control and Prevention staff are assisting State Heath Departments and local clinicians investigating these cases to determine if there are any causal links. All cases occurred in young, previously healthy individuals (mean age 19 years, range 9 months to 42 years), and were characterized by a one to two week-long flu-like illness with fever, profound malaise, nausea/vomiting, and abdominal pain followed by rapid onset of acute liver failure. At the time of presentation, serum aminotransferase levels were high (range 2500 to greater than 10,000) with AST ALT. All serologic markers for hepatitis A, B, and C viral infection were negative. Four cases received a liver transplant and two died awaiting transplant. Liver pathology reveals acute centrilobular necrosis.

"We are heightening surveillance efforts to look for acute liver failure cases similar to those described above. Please review your current hepatitis reports to identify cases of acute liver failure with similar histories or clinical presentations.

"Also, please distribute this memo to local health departments in your jurisdictions. If you become aware of any cases with similar clinical features and with onset of illness since October 1998. Thank you very much for your assistance."

A man in central Florida was recently diagnosed with Rat-Bite Fever caused by the bacterium Streptobacillus moniliformis (Spirillum minus is another etiologic agent of rat-bite fever). He raises rats and received a deep bite injury from one of the animals. This is the usual route of transmission of the bacteria which is found in the nasopharynx (or excreted in urine) of healthy rats. S. moniliformis has caused outbreaks in rare situations where rat urine contaminated milk or water supplies.

The usual incubation period is 1 to 4 days after which a fever, rash and arthralgia typically occur. Diagnosis is by blood, synovial fluid or lymph node culture and identification. The bacteria are generally susceptible to penicillin, erythromycin and tetracycline. Untreated, the mortality rate is approximately 10%. There is no person-to person transmission.

Because the bacteria are common in rats (up to 50% prevalence), prevention of rat infestations is key to controlling disease among people. People electing to keep rats should be aware of the disease and assure that rat bites are aggressively washed.

In 1941, the Board of Health was scrambling to address a variety of new disease prevention and control challenges brought on by a booming economy, rapidly growing population, influx of military recruits and tourists. Still, the myriad major public health problems recognized by the American Public Health Association survey conducted in 1939 begged resolution. The dilemma confronting public health authorities reminds one of the old story about "swamps and alligators."