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EPI UPDATE

A weekly publication by the Bureau of Epidemiology

"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 et al. Int. J of Epidemiology 1976; 5:29-37.

For August 27, 1999

Richard S. Hopkins, MD, MSPH, Bureau Chief, State Epidemiologist

Don Ward, Surveillance Section Administrator, Epi Update Managing Editor

Jill H. Parker, MSP, Epi Update Editor

Bureau of Epidemiology Frequent Contributors:

Steven Wiersma, MD, MPH,

Deputy State Epidemiologist

William J. Bigler, PhD, MS,

Senior Epidemiologist

Jodi Baldy, MPH,

Biological Scientist IV

Ursula E. Bauer, PhD,

Chronic Disease Epidemiologist

John Werth, MA,

Bureau Education Coordinator

Lisa Conti, DVM, MPH,

State Public Health Veterinarian

 

Regional Epidemiologists:

Dolly Katz, PhD, MPH,

SE Florida

Roger Sanderson, RN, MA,

SW Florida

Carina Blackmore, MS Vet. Med., PhD, NE Florida

Zuber Mulla, MSPH,

Central Florida

Gérard Krause, MD, DTMH,

NW Florida

Please print out this material and share with epidemiology staff, county health department directors, administrators, medical directors, nursing directors, environmental health directors and others with an interest in information of this type. Thank you.

The Bureau of Epidemiology is available 24 hours a day, 7 days a week for consultation at our main number (850/245-4401) PLEASE NOTE: Consultation after 5 p.m. & on weekends is intended for emergencies.

The Department of Health has a home on the World Wide Web at --- http://www.doh.state.fl.us

 

In this issue:

1. Reporting Procedures for HbsAg Positive Pregnant Women

2. Rabies Alert Map: January through August 20, 1999

3. Environmental Control of Asthma - Two Day Seminar

4. Childhood Lead Poisoning - Teleconference Announcement

5. Upcoming Events

6. Florida Past: Preservation of "Good Order and Health" in the Florida Provinces

7. Weekly Disease Table: Week 33

1. Reporting Procedure for HbsAg Positive Pregnant Women

Don Ward, Surveillance Section Administrator

With the changes in Chapter 64D-3.013, Florida Administrative Code, all hepatitis B surface antigen (HbsAg) positive pregnant women and all HbsAg-positive children less than 25 months of age are reportable regardless of the presence of illness.

A positive hepatitis B surface antigen test (HBsAg) does not, in itself, confirm the presence of disease. Further testing is necessary to identify the infection as acute or chronic disease or asymptomatic seroconversion. The purpose of reporting HBsAg positive pregnant women is to ensure the protection of their infants against infection with hepatitis B. In the 1997 Red Book of the American Academy of Pediatrics, the authors state that, "Transmission of perinatal HBV infection can be prevented in approximately 95% of infants born to HBsAg-positive mothers by early active and passive immunoprophylaxis of the infants, i.e., vaccination and HBIG administration."

While assuring that HBsAg positive pregnant women receive appropriate follow-up; and that their infants receive immunoprophylaxis is the responsibility of the county health departments with coordination by the Bureau of Immunization, reporting of these women to the Bureau of Epidemiology is important for at least two reasons:

  1. One of the important components of the upcoming statewide viral hepatitis prevention initiative will be a hepatitis registry, which will contain information about patients infected with viral hepatitis and others at risk (such as contacts). For search and analysis purposes, it will be important to include HBsAg-positive women in the registry.
  2. Reporting to the Bureau of Epidemiology maintains consistency of reporting and provides the capacity for epidemiologic analysis as is possible with all other hepatitis infections.

Procedure (also see diagram at end of article):

  • County health departments will report all HBsAg-positive pregnant women and HbsAg-positive children <25 months of age to the Bureau of Epidemiology on a 2016 morbidity report form. When the morbidity is recorded in the Bureau of Epidemiology, the 2016 report will be forwarded to the Bureau of Immunization for matching against the "Perinatal Hepatitis B Case and Contact Reports." The ICD code for reporting on the 2016 to be used for HBsAg positive pregnant women will be 07039. The ICD code to be used for reporting cases of children less than 25 months of age with HbsAg positive surface antigen is 07744.
  • County health departments will also report (within 10 days) extended data for HBsAg-positive pregnant women directly to the Bureau of Immunization on the DH1876 (1/92), "Perinatal Hepatitis B Case and Contact Report" according to CHD Internal Operating Policy: Immun 7, and TA Immun 7. CHDs will continue to case manage the HbsAg-positive pregnant woman, her infant and contacts according to CHD Guidebook Internal Operating Policies: Immun 7 and STD 10 and Technical Assistance: Immun 7 and STD 16.
  • In the event that a HBsAg-positive pregnant woman is determined to be infected with acute hepatitis B, the county will report that acute infection separately (from the surface antigen report) on a 2016 with the ICD code 07030. That 2016 report must be accompanied by a CDC 53.1 "Viral Hepatitis Case Record." Both will be sent to the Bureau of Epidemiology.

Immunization and Epidemiology policies that specify the perinatal hepatitis B and STD follow-up in the county health department guidebook will be modified to reflect this change in reporting practices.

Reporting Procedures for HbsAg Positive Pregnant Women

IF

HbsAg+ pregnant woman or child <25 months of age

THEN

1. Complete 2016, send to Bureau of Epidemiology [ICD codes: 07039 (pregnant women) or 07744 (children < 25 months of age)]

2. Complete "Perinatal Hepatitis B Case and Contact Report" form (DH 1876) and send to Bureau of Immunization

IF the woman is found to be a case of chronic hepatitis B, or if she is determined to be a case of asymptomatic seroconversion (neither a case of acute nor chronic hepatitis B):

THEN, no further reporting is required for these two cases.

IF the woman is further diagnosed with acute hepatitis B:

THEN

1. Include the acute case on a separate 2016 report (ICD code=7030)

2. Complete the CDC 53.1 "Viral Hepatitis Case Record" form

3. send both documents to the Bureau of Epidemiology.

2. Rabies Alert Map

Dr. Lisa Conti, DVM, MPH, State Public Health Veterinarian

Attached is the rabies alert map for January through August 20, 1999. The map will also be posted on the Bureau of Epidemiology internet web page http://www.doh.state.fl.us. Should you have trouble accessing the map, either from this attachment or from the internet web page, please contact Jill Parker to request that a copy be faxed or mailed to you.

Rabies Alert Map

3. Environmental Control of Asthma is Topic of Two Day Seminar Hosted by the Bureau of Environmental Toxicology

The Florida Department of Health, Bureau of Environmental Toxicology is co-sponsoring a two-day technical seminar on the environmental control of asthma. The seminar will focus on the relationship between asthma, an important emerging public health issue, and indoor allergens. Attendees will receive practical information about identifying and controlling conditions that adversely affect the indoor environment and human health. The seminar will be lead by nationally recognized presenters who will be available before, during, and after the event for additional discussions and responses to questions.

Two regional seminars have been planned. The first will be held at the Oceanfront Auditorium in Miami on September 30 to October 1, 1999. The second is planned for November 18-19, 1999 at the Sheraton Safari Hotel in Orlando.

There will be a significantly reduced registration fee for Department of Health staff. For additional information and to receive a brochure on these events, please call Radon and Indoor Toxics Office at (850) 488-1525 or Suncom 278-1525.

4. Childhood Lead Poisoning - Teleconference Announcement

Trina Thompson, Coordinator, Childhood Lead Poisoning Surveillance Program, Bureau of Environmental Epidemiology

The Childhood Lead Poisoning Surveillance Program (Bureau of Environmental Epidemiology), with funding from the Centers for Disease Control and Prevention, is offering a teleconference on September 17, 1999, entitled "Childhood Lead Poisoning: Research Practice and Prevention."

5. Upcoming Events

  • 2000 NACCHO Annual Conference July 19-22, 2000, Los Angeles, California

This conference will be held jointly with the Association of State and Territorial Health Officials (ASTHO).

  • National Association of Community Health Centers, Inc. 30th Annual Conference September 26-29, 1999, Miami Beach, FL

For more information, visit NACHC's web page at http://www.nachc.com.

  • American Public Health Association 1999 Annual Meeting November 7-11, 1999 Chicago, Illinois

For more information, see the APHA web site or contact Carroll Lewis at APHA.

  • 1999 Maternal, Infant, and Child Health Epidemiology Workshop, December 8-9, 1999, Atlanta, Georgia For more information, visit MICHEP's website.

6. Florida Past: Preservation of "Good Order and Health" in the Florida Provinces

William J. Bigler, PhD

Last week we printed a facsimile of Major General Jackson’s ordinance for creation of the Board of Health for St. Augustine. A similar ordinance was executed for Pensacola.

Since Governor Jackson had authority to appoint the Mayor and aldermen for both cities, he also produced ordinances that outlined the duties and powers of the government as they related to the preservation of "Good Order and Health" for the town. A facsimile of the Ordinance for Pensacola follows:

"AN ORDINANCE

"By Major General Andrew Jackson, Governor of the provinces of the Floridas, exercising the powers of the Captain General and of the Intendant of the Island of Cuba, over the said provinces, and of the Governors of said provinces respectively:

"That with a view to the preservation of the good order and health of the town of Pensacola – I do ordain:

"Sect. 1. That there shall be appointed by the Governor annually, a Chief Officer to be called the Mayor, and six subordinate officers to be called Aldermen, who shall form a Council, and have and exercise all the powers necessary to the good government of the said town.

"Sect. 2. That the said Mayor and Council shall have power by Ordinance or otherwise, to impose fines and forfeitures for the infraction of their regulation, and appoint such officers as they may deem necessary for the support of their town government.

"Sect. 3. As the Christian Sabbath is observed throughout the civilized world, it is ordained, that in order to remove any doubts which might be entertained with respect to the powers of the Mayor and Council on this subject, that the said Mayor and Council be authorized to make any regulation for the due observance thereof which they may deem proper.

"Sect. 4 In order to remove all doubts on the subject of the limits of the said town of Pensacola and its dependencies, as well as to place under the immediate control of the Mayor and Council, all the fountains or springs from which the inhabitants are supplied with water, it is ordained, that the incorporated limits of said town shall be as follows:

"Bounded to the south and east by the harbor, to the west by the Western Lagoon, or Bayou Chico, and to the north by a line running due east from Galvez Spring to where such line will intersect the eastern or Texar Lagoon.

"Sect. 5. That public gaming houses, as well as public gaming of every description, (billiards alone excepted) shall be and the same is thereby interdicted and prohibited, under the penalty of two hundred dollars for each conviction, and the forfeiture of all the apparatus or machinery used towards the commission of such offences, as well as all sums of money which may be seized by the public officer or other person; one half to the use of the informer, and the other to the use of the town, and that each and every person so convicted, shall be, and stand committed to prison until the whole of said fine and costs are paid, and moreover, until he shall have good and sufficient surety in the sum of five hundred dollars for his good behavior, for and during the term of one year.

"Sect. 6. That the Mayor and Alderman, as is provided for in this Ordinance, shall be known and called the City Council of Pensacola, and in that name may acquire and dispose of property for public uses, and sue and be sued, and plead and be impleaded on all subjects relating to, or connected with the said town and its dependencies.

"Sect. 7. That all inkeepers, grocers, and all other retailers of liquor, are, by this Ordinance, expressly prohibited from furnishing or selling any liquor or ardent spirits whatever, to any soldier in the service of the United States of America, under the penalty of 19 dollars for each offence, and to stand committed to the common jail until the said penalty with costs are paid.

                                                                                Pensacola, July 18,1821

                                                                                (signed) ANDREW JACKSON

                                                                                By the Governor,

                                                                                K. Call,

Acting Secretary of West Florida"

7. Weekly Disease Table - Week 33

County-Confirmed Cases, Sorted Alphabetically by Disease

NR represents years that the disease lacked status as a reportable condition

DISEASE

1996 TO DATE

1997 TO DATE

1998 TO DATE

3 YEAR AVERAGE TO DATE

1998 TOTAL CASES

1999 TO DATE

Amebiasis

46

35

41

40.7

91

28

Anthrax

0

0

0

0

0

0

Botulism

0

0

0

0

0

0

Brucellosis

5

0

2

2.3

3

1

Campylobacteriosis

711

608

445

588

975

565

Ciguatera

8

4

7

6.3

7

2

Cryptosporidiosis

92

69

78

79.7

203

75

Cyclosporiasis

174

61

6

80.3

6

4

Dengue

0

2

2

1.3

5

2

Diphtheria

0

0

0

0

0

0

E. coli O157:H7

15

34

24

24.3

57

31

E. coli, other (known serotype)

3

5

3

3.7

12

12

Ehrlichiosis, Human

4

2

0

2

1

1

Encephalitis, Eastern Equine

0

2

0

0.7

0

0

Encephalitis, St. Louis

0

0

0

0

2

0

Encephalitis, other (known organism)

4

7

3

4.7

7

3

Encephalitis, post-infectious*

12

5

7

8

21

5

Giardiasis (acute)

1036

896

777

903

1636

638

Haemophilus influenzae*, invasive

14

16

29

19.7

45

33

Hansen’s Disease (Leprosy)

1

0

3

1.3

4

2

Hantavirus Infection

0

0

0

0

0

0

Hemolytic Uremic Syndrome

0

3

6

3

12

6

Hemorrhagic Fever

0

0

0

0

0

0

Hepatitis A

276

290

311

292.3

539

404

Hepatitis B

321

236

249

268.7

466

261

Hepatitis Non-A, Non-B

53

57

56

55.3

95

4

Hepatitis, unspecified

2

5

6

4.3

26

10

Lead Poisoning

1196

841

1094

1043.7

1805

423

Legionellosis

20

16

22

19.3

48

17

Leptospirosis

0

0

1

0.3

2

0

Lyme Disease

10

15

25

16.7

71

19

Malaria

53

47

35

45

96

53

Measles

1

3

2

2

2

2

Meningococcal Disease (N. meningitidis)

129

103

89

107

133

74

Meningitis, Group B Streptococci

17

11

11

13

22

10

Meningitis, Haemophilus influenzae

5

6

11

7.3

12

11

Meningitis, Streptococcus pneumoniae

70

50

56

58.7

96

75

Meningitis, Listeria monocytogenes

4

2

4

3.3

13

6

Meningitis, other bacterial (including unspecified)

65

37

38

46.7

75

46

Mercury Poisoning

5

2

0

2.3

4

2

Mumps

6

8

9

7.7

11

3

Neurotoxic Shellfish Poisoning

3

0

0

1

0

0

Pertussis

65

47

25

45.7

39

54

Pesticide Poisoning

1

0

1

0.7

1

1

Plague

0

0

0

0

0

0

Poliomyelitis

0

0

0

0

0

0

Psittacosis

0

0

1

0.3

2

0

Rabies, Animal

144

191

131

155.3

215

123

Rocky Mountain Spotted Fever

1

2

1

1.3

2

3

Rubella, including congenital

10

1

3

4.7

4

0

Salmonellosis

1276

1096

1271

1214.3

3038

1371

Shigellosis

886

742

1297

975

2343

858

Streptococcal Disease, invasive Group A

2

24

31

19

57

59

Streptococcus pneumoniae, Drug Resistant

1

131

291

141

493

412

Tetanus

1

1

2

1.3

3

1

Toxic Shock Syndrome

0

1

3

1.3

4

3

Toxoplasmosis

6

4

7

5.7

15

9

Typhoid Fever

12

5

10

9

16

22

Vibrio cholerae (serogrp O1)

0

0

0

0

0

1

Vibrio cholerae (serogrp Non-O1)

1

6

6

4.3

11

7

Vibrio vulnificus

7

8

15

10

35

10

Vibrio other (including unspecified)

14

20

46

26.7

73

25

Yellow Fever

0

0

0

0

0

0

*Haemophilus influenzae can be the agent responsible for disease under three of the reportable conditions listed-:

"Haemophilus influenzae, invasive" and under "Encephalitis, post infectious." Cases of Haemophilus influenzae meningitis are reported under

"Meningitis, H. influenzae."

Editor's Note: Kawasaki Disease, Histoplasmosis, Reye Syndrome, and Typhus were deleted from the weekly disease table since cases are no longer reportable.

This page was last modified on: 10/26/2012 08:54:16