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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 September 3, 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. Don't Forget to Register for the Annual
Statewide Epidemiology Seminar!
2. Respiratory Syncytial Virus (RSV)
Surveillance in Florida
3. Serologically Confirmed Eastern Equine
Encephalitis in Horses
4. Important: Revised Case Definitions Document
5. Upcoming CDC Satellite Broadcasts:
"Immunization Update", "Diagnostic and Therapeutic Dilemmas for Gonococcal
and Chlamydial Infections", and "Biological Warfare and Terrorism"
6. Internet Resources for Public Health
Professionals
7. How to Investigate Foodborne Illness
Outbreaks: Six-Hour Course
8. Food and Waterborne Disease Training Report,
1998-1999
9. Editor's Note: Epi Update Available on
D.O.H. Web Site
10. Upcoming Events
11. Florida Past - Mosquito Day
12. Weekly Disease Table: Week 34
1. Don't
Forget to Register for the Annual Statewide Epidemiology Seminar (ASES)!
The time is rapidly approaching for the Annual Statewide Epidemiology Seminar (
September 30-October 1). We believe we have developed what will be and an interesting,
informative and challenging agenda, a list of exciting speakers and an excellent poster
session, not to mention time and occasion for colleagues to interact. Be sure to take
advantage of this once-a-year opportunity! Reserve your hotel room and register for the
meeting early. Details are available on the Department of Health internet and intranet web
sites, or by contacting John Werth, Bureau Education Coordinator.
2. Respiratory Syncytial Virus (RSV) Surveillance in Florida
Don Ward, Surveillance Section Administrator and Jill H. Parker, Policy Analyst
In October, the Florida Department of Health's Bureau of Epidemiology will begin a
sentinel surveillance program for Respiratory Syncytial Virus (RSV), a leading cause of
respiratory disease among infants and young children. The protocol for the program
follows. Hospital staff who feel that their hospitals serve significant numbers of RSV
patients and who would be interested in participating in the study should call Jill Parker.
RSV Surveillance Program Protocol
RSV (respiratory syncytial virus) is a major cause of serious lower respiratory tract
illnesses in infants and young children resulting in an estimated 90,000 hospitalizations
and 4,500 deaths annually. Children with congenital heart disease, immuno-compromised
infants, premature infants and children with chronic lung disease are at the highest risk
for developing serious complications due to RSV infection when RSV infection is active in
a community. Several studies have shown a relationship between lower respiratory infection
in infancy and early childhood and the pathogenesis of asthma. Treatment with Respiratory
Syncytial Virus Immune Globulin Intravenous (Human) (RSV-IGIV) is recommended for
those high-risk infants to prevent severe RSV infection.
The majority of RSV outbreaks are thought to occur during the winter, thus RSV testing
is often only performed between December and March of each year. This seasonality
assumption is based on experiences from the northern states and little is known about the
seasonal variations in the incidence of RSV in the southern United States.
Starting in October 1999, the Florida Department of Health (Bureau of Epidemiology)
will initiate a statewide surveillance program to assess the weekly, monthly and annual
incidence of diagnosed cases of RSV among a representative sample of hospitals that are
likely to serve the largest numbers of RSV infected children.
The surveillance plan will consist of the following:
- Bureau of Epidemiology Regional Epidemiologists will identify 6-15 children's hospitals
that perform (significant numbers of) RSV tests and secure their collaboration on the
project. The objective here is to identify the hospitals that treat the most RSV patients
in the state. The target date for completion of the solicitation of interested hospitals
is October 15.
- Establish a weekly call schedule. A staff member from the Bureau of Epidemiology will
call a pre-established contact from each (hospital lab above) every Friday morning between
10 a.m. and 11 a.m. Data elicited will include the number of RSV tests performed that week
and the number of those that were positive for RSV. Additional influenza data may also be
requested at that time. Note: some hospitals are already collecting RSV surveillance
data. The Bureau’s planned call schedule may be modified to fit the needs of
individual hospitals.
- After compiling the weekly data, the Bureau of Epidemiology clerk will develop a table
and graph to be posted to the Bureau of Epidemiology Internet web page as soon as
possible. Hard copies of the tables and graphs will be e-mailed to interested parties the
same day.
- The RSV surveillance program for the coming season will begin on October 15, 1999 and
continue until RSV diagnoses return to negligible levels. Surveillance may need to be
continuous. The program will be renewed annually.
- The contact person for RSV surveillance in the Bureau of Epidemiology is Jill Parker,
MSP. Please contact
Ms. Parker regarding details about the RSV surveillance project.
3. Serologically Confirmed Eastern Equine Encephalitis (EEE) in Horses
January through August 31,1999
Dr. Lisa Conti, DVM, MPH, State Public Health Veterinarian
Attached is the updated EEE map for January through August 31, 1999. No human cases of EEE or SLE have been reported to the State Health
Office. There are no arbovirus alerts issued in Florida at this time
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.
Click to view map:
Eastern Equine
Encephalitis (EEE) in Horses
4. Important: Revised Case Definitions Document
The Case Definitions document was revised to reflect the new ICD code for cases of
pregnant women with a positive HbsAg. No other changes have been made to the document.
Should you have trouble accessing the attached document, please contact Jill Parker.
5. Upcoming CDC Satellite Broadcasts: "Immunization Update,"
Diagnostic and Therapeutic Dilemmas for Gonococcal and Chlamydial Infections," and
"Biological Warfare and Terrorism"
"Immunization Update" (excerpted from IAC Express #107, August 30, 1999)
"The Centers for Disease Control and Prevention (CDC) will sponsor
"Immunization Update," a live, interactive, satellite videoconference on
September 16, 1999. The broadcast will provide the most current information available in
the constantly changing field of immunization. Continuing education credits will be
offered for a variety of professions.
"Topics covered will include new recommendations for polio vaccination in the
United States, expanded recommendations for the use of hepatitis A vaccine,
characteristics and use of Lyme disease vaccine, and recent vaccine safety issues. Each
2.5 hour broadcast will feature a question and answer session in which participants
nationwide can interact with the course instructors via toll-free telephone lines.
"William L. Atkinson, MD, MPH, and Sharon G. Humiston, MD, MPH, medical
epidemiologists at the National Immunization Program, will host the broadcast along with
other guest experts from CDC.
"Two broadcasts of "Immunization Update" are schedule on September 16th,
1999. The first broadcast will run from 9:00-11:30 a.m. (ET), and the second from
12:00-2:30 p.m. (ET).
- "Diagnostic and Therapeutic Dilemmas for Gonococcal and Chlamydial Infections"
(excerpted from MMWR, Vol. 48, No. 32, August 20, 1999)
"The CDC-sponsored National Network of STD/HIV Prevention Training Centers
(PTC) will broadcast STD Diagnostic and Therapeutic Dilemmas: Gonococcal and Chlamydial
Infections, an interactive satellite broadcast, in English and Spanish on October 14,
1999, from 1 p.m. to 2:30 p.m. Eastern Daylight Time. The broadcast is intended for
primary-care and managed-care providers and health-care clinicians caring for patients
exposed to or infected with gonococcal and chlamydial infections. The broadcast will cover
state-of-the-art screening and diagnostic interpretations of chlamydial and gonococcal
technologies. Continuing medical education credit is available.
"Additional information is available from the STD/HIV PTC, Dallas County Health
and Human Services, 2377 N. Stemmons Fwy., #430, Dallas, TX 75207-2710; telephone (214)
819-1947."
- "Biological Warfare and Terrorism"
(excerpted from MMWR, Vol. 48, No. 32, August 20, 1999)
"CDC and the U.S. Army Medical Research Institute of Infectious Diseases will
co-sponsor a satellite broadcast on September 21, 22, and 23, 1999, from 12:30 p.m. to
4:30 p.m. Eastern Daylight Time (EDT) and taped rebroadcast on October 2 and 3, from 11:30
a.m. to 5:30 p.m., EDT. The broadcast describing the military and public health response
is intended for military, medical, and public health professionals, who will learn how to
recognize a biological attack, investigate the event, treat casualties, prevent the spread
of the agent, and manage the proper medical response.
"Additional information about this broadcast, including registration, is
available from the World-wide Web
or from Rick Stevens. Continuing education credit is available
for a variety of professions."
6. Internet Resources for
Public Health Professionals
- Web Site with Links to Other State Departments of Health
7. How to
Investigate Foodborne Illness Outbreaks: A Six-Hour Course Offered by the Bureau of
Environmental Epidemiology
Roberta M. Hammond, PhD, Coordinator of Food and
Waterborne Diseases, Bureau of Environmental Epidemiology
The Bureau of Environmental Epidemiology is offering a 6-hour course in How to
Investigate Foodborne Illness Outbreaks on October 13 in Davie (Broward County). Seating
is limited to 50 (minimum 15). Nursing CEUs are available. This course was offered last
year in St. Augustine, Ft. Myers, Ocala, West Palm Beach, Panama City, Live Oak and at
FEHA in Cocoa Beach. So far, 180 environmental health professionals and 40 nurses have
been trained with this course. Attached is the course agenda, registration information and
directions to the building where the course will be held (in .pdf Adobe files).
Should you have trouble accessing these files, please contact Roberta Hammond.
8. Food and Waterborne Disease Training
Report: 1998-1999
Roberta M. Hammond, PhD, Coordinator of Food and
Waterborne Diseases, Bureau of Environmental Epidemiology
Attached is the Food and Waterborne Disease Training Report submitted by the Bureau of
Environmental Epidemiology. Should you have trouble accessing the document, please contact
Roberta Hammond.
9. Editor's Note: Epi Update Available
on D.O.H. Web Site
The Epi Update is currently available on the Bureau of Epidemiology's home page within
the Department of Health intranet and internet (http://www.doh.state.fl.us) web sites . Within the next month, we plan
to transition to posting the documents as a pdf file, a process that will reduce the
amount of time it takes to post the Epi Update to the web page. The Adobe Acrobat reader
is required to read documents in the pdf format.
10. Upcoming Events
2000 NACCHO (National Association of County and City Health Officials) 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.
11. Florida Past - Mosquito Day
William J. Bigler, PhD
In the early 1920’s the State Board of Health embarked on a statewide campaign to
control mosquitoes throughout the state. Brevard County got the innovative idea of having
a "Mosquito Day" to increase public awareness of the new initiative. Excerpts
from a couple of articles by George W. Simons, Chief of the Bureau of Sanitary Engineering
appeared in the February and March 1923 issues of the Florida Health Notes, capturing the
flavor of the local celebration.
"February Issue----"What was probable the first "Mosquito
Day" ever held in Florida was that celebrated in Cocoa, Brevard County, Friday,
January twelfth, when the citizens of that enterprising city resolved to combat and
control the mosquito as a health menace and pest. It was a great success in every
particular, due mainly to the efforts and enthusiasm of Mr. Russell A. Field, secretary of
the Cocoa Chamber of Commerce. Mr. Field got his "Mosquito Day" inspiration at
the (Florida Anti-Mosquito Association sponsored) Daytona Conference in December; he
returned from that Conference determined to start a fight against the mosquito and on
January twelfth he shot his initial gun.
"At ten o’clock in the morning an address was made to the councils of Cocoa
and Rockledge; each body was informed of their respective responsibilities and the part
each would play in the program. Each council was requested to pass the model mosquito
ordinance and strongly endorse a general plan of campaign. At eleven o’clock the
school children were given a mosquito talk in the Victor theater, also shown a moving
picture, "Warfare Against the Mosquito." The school children - 350 strong –
marched in line from the school building to the theater following the Boy Scout Troops and
the Cocoa City Band. Throughout the line of march appeared appropriate slogan banners such
as, "The Mosquito Must Go"; "Do Your Part," etc. At two-thirty a
general citizens’ mass meeting was held in the Victor theater, at which time another
address was made and again the moving picture shown….
"The Cocoa program was, indeed, an inspiration, and many other towns in Florida
could well follow her lead. Cocoa will organize an Anti-Mosquito league at an early date
to carry on Intensive control measures throughout the year."
"March issue --- "And still the good work persists. Fast Florida is
acquiring a state-wide consciousness for mosquito control enterprises. The attitude being
developed is wonderful and encouraging. Recently LIVE OAK, APALACHICOLA, RIVER JUNCTION
and TALLAHASSEE started work. Now comes the word that SARASOTA, BARTOW, BRADENTOWN (sic),
SANFORD, LEESBURG, EUSTIS, GAINESVILLE, PALATKA and PANAMA CITY will commence active
fights. KEEP UP THE GOOD WORK – THE FLORIDA SPIRIT IS ASSERTING ITSELF….
"Down in St. Petersburg there is a retired physician, Dr. J. A. Paine...(He)
recently donated fifty dollars to the cause of mosquito control in that city. LET’S
HAVE MORE PUBLIC SPIRITED CITIZENS LIKE DR. PAINE who are not afraid to put forth in order
to get comfort, health and happiness in Florida."
12. Weekly Disease Table - Week 34
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 |
49 |
37 |
42 |
42.7 |
91 |
29 |
| Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
| Botulism |
0 |
0 |
0 |
0 |
0 |
0 |
| Brucellosis |
5 |
0 |
2 |
2.3 |
3 |
1 |
| Campylobacteriosis |
739 |
634 |
474 |
615.7 |
975 |
592 |
| Ciguatera |
8 |
6 |
7 |
7 |
7 |
2 |
| Cryptosporidiosis |
102 |
73 |
83 |
86 |
203 |
80 |
| Cyclosporiasis |
176 |
61 |
6 |
81 |
6 |
5 |
| Dengue |
0 |
2 |
2 |
1.3 |
5 |
2 |
| Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
| E. coli O157:H7 |
19 |
35 |
25 |
26.3 |
57 |
36 |
| E. coli, other (known serotype) |
3 |
5 |
3 |
3.7 |
12 |
12 |
| Ehrlichiosis, Human |
4 |
2 |
0 |
2 |
1 |
2 |
| 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 |
6 |
7 |
8.3 |
21 |
5 |
| Giardiasis (acute) |
1094 |
940 |
824 |
952.7 |
1636 |
671 |
| Haemophilus influenzae*, invasive |
15 |
17 |
29 |
20.3 |
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 |
288 |
305 |
320 |
304.3 |
539 |
423 |
| Hepatitis B |
328 |
244 |
256 |
276 |
466 |
278 |
| Hepatitis C |
NR |
NR |
NR |
NR |
NR |
37 |
| Hepatitis Non-A, Non-B |
55 |
58 |
58 |
57 |
95 |
4 |
| Hepatitis, perinatal B |
NR |
NR |
NR |
NR |
NR |
2 |
| Hepatitis, unspecified |
2 |
5 |
6 |
4.3 |
26 |
11 |
| Hepatitis, +HBsAg, pregnant woman |
NR |
NR |
NR |
NR |
NR |
0 |
| Lead Poisoning |
1247 |
871 |
1121 |
1079.7 |
1805 |
435 |
| Legionellosis |
23 |
18 |
23 |
21.3 |
48 |
17 |
| Leptospirosis |
0 |
0 |
1 |
0.3 |
2 |
0 |
| Listeriosis |
NR |
NR |
NR |
NR |
NR |
21 |
| Lyme Disease |
10 |
17 |
26 |
17.7 |
71 |
23 |
| Malaria |
56 |
50 |
37 |
47.7 |
96 |
55 |
| Measles |
1 |
3 |
2 |
2 |
2 |
2 |
| Meningococcal Disease (N. meningitidis) |
132 |
104 |
90 |
108.7 |
133 |
77 |
| Meningitis, Group B Streptococci |
17 |
11 |
11 |
13 |
22 |
10 |
| Meningitis, Haemophilus influenzae |
5 |
6 |
11 |
7.3 |
12 |
11 |
| Meningitis, Streptococcus pneumoniae |
73 |
51 |
56 |
60 |
96 |
75 |
| Meningitis, Listeria monocytogenes |
4 |
2 |
4 |
3.3 |
13 |
6 |
| Meningitis, other bacterial (including
unspecified) |
69 |
39 |
38 |
48.7 |
75 |
47 |
| 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 |
48 |
29 |
47.3 |
39 |
56 |
| 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 |
150 |
195 |
133 |
159.3 |
215 |
129 |
| Rocky Mountain Spotted Fever |
1 |
2 |
1 |
1.3 |
2 |
2 |
| Rubella, including congenital |
10 |
1 |
3 |
4.7 |
4 |
0 |
| Salmonellosis |
1328 |
1144 |
1354 |
1275.3 |
3038 |
1447 |
| Shigellosis |
919 |
786 |
1342 |
1015.7 |
2343 |
888 |
| Smallpox |
NR |
NR |
NR |
NR |
NR |
0 |
| Staphlococcus aureus, (GISA/VISA) |
NR |
NR |
NR |
NR |
NR |
0 |
| Staphlococcus aureus, (GRSA/VRSA) |
NR |
NR |
NR |
NR |
NR |
0 |
| Streptococcal Disease, invasive Group A |
2 |
24 |
31 |
19 |
57 |
65 |
| Streptococcus pneumoniae, invasive
disease |
4 |
135 |
295 |
144.7 |
493 |
428 |
| Tetanus |
1 |
1 |
2 |
1.3 |
3 |
2 |
| Toxic Shock Syndrome |
0 |
1 |
3 |
1.3 |
4 |
4 |
| Toxoplasmosis |
6 |
4 |
7 |
5.7 |
15 |
10 |
| Typhoid Fever |
13 |
7 |
10 |
10 |
16 |
22 |
| Vibrio cholerae (serogrp O1) |
0 |
0 |
0 |
0 |
0 |
1 |
| Vibrio cholerae (serogrp Non-O1) |
2 |
6 |
6 |
4.7 |
11 |
7 |
| Vibrio vulnificus |
7 |
9 |
16 |
10.7 |
35 |
10 |
| Vibrio other (including unspecified) |
15 |
20 |
51 |
28.7 |
73 |
27 |
| 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 as of July 4,
1999. Hepatitis C; perinatal hepatitis B; hepatitis B +HbsAg, pregnant woman; listeriosis;
smallpox, S. aureus (GISA/VISA) and S. aureus (GRSA/VRSA) were added to the
reporting requirements as of July 4, 1999. Paralytic shellfish poisoining is now referred
to as neurotoxic shellfish poisoning.
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