|
 EPI UPDATE
A weekly publication by the Bureau of Epidemiology
For October 8, 1999
"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.
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 Carina Blackmore, MS Vet. Med., PhD, |
Zuber Mulla, MSPH, Central
Florida Carina Blackmore, MS Vet. Med., PhD, |
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.
Thanks to All Who Participated in the
Sixth Annual Statewide Epidemiology Seminar!
Approximately 200 public health professionals attended the Sixth Annual Statewide
Epidemiology Seminar, which was held last week at the Belleview Biltmore Hotel in Pinellas
County. We didn't see or hear any ghosts this year at the historic hotel, but interesting
speakers and inquisitive minds were everywhere! Thanks to all who participated in making
the seminar a success! We look forward to seeing you at the Seventh Annual Statewide
Epidemiology Seminar!
In this issue:
1. Regional Meetings for County Health Departments
2. Reporting Procedures for Streptococcus pneumoniae
3. Control of Meningococcal Disease: Suggested Internet Resources
4. Important News About the Epi Update
5. Updated ACIP Statement on Hepatitis A
6. International Symposium on Viral Hepatitis and Liver Disease
7. Fall/Winter 1999 Issue of Immunization and Hepatitis B Publication
Available on the Internet
8. Rabies Alert Map and Updated Equine EEE Map
9. Southeast Regional Public Health and Pest & Vector Management
Conference
10. The Florida State Tuberculosis Lecture Series: The Rapid Diagnosis of
TB: The Role of Nucleic Acid Amplification"
11. Additional Internet Resources
12. Florida Past: Eustis Girl Chosen Nation's Healthiest
13. Weekly Disease Table: Week 39
1. Regional Meetings for County Health Departments
The Bureau of Epidemiology is beginning a series of regional meetings about current
topics in disease prevention for county health departments. The first meeting is scheduled
November 3rd and 4th for the counties in the Panhandle region
(counties west of, and including, Madison and Taylor Counties). However, staff from
counties outside of the Panhandle region are also welcome to attend. Future meetings will
be scheduled for the other regions of the state.
The regional meeting agenda will include: an overview of disease surveillance in
Florida, an overview of how to investigate an outbreak (including an opportunity to
participate in an outbreak investigation scenario), an update on disease reporting
requirements, an overview of Epi Info software capabilities, and a rabies update.
Additional information regarding these regional meetings will be mailed to each county
health department within the next few weeks.
2. Reporting Procedures for Streptococcus pneumoniae
Don Ward, Surveillance Section Administrator
(The following article appeared in the Epi Update on July 23, 1999. We have received
many calls requesting clarification of the reporting procedure, so we are reprinting the
article.)
On July 4, 1999, all invasive Streptococcus pneumoniae infections became
reportable. Infections caused by Streptococcus pneumoniae are among the leading
causes of illness and death for young children. Annually, in the United States,
pneumonococcal disease results in 50,000 cases of bacteremia and 3,000 cases of
meningitis. By extrapolation, Florida should expect about 3750 cases of pneumococcal
bacteremia and 225 cases of meningitis (121 cases were reported in 1996).
A critical issue in the management of infections caused by S. pneumoniae is the
increasing drug resistance of the organism. Research in parts of the U.S. has demonstrated
a growing resistance to penicillin and other commonly prescribed drugs. This drug
resistance may have developed as a result of indiscriminate or inappropriate prescription
or by natural mutation of the organism. Regardless, the extent (and type) of drug
resistance to S. pneumoniae in a community offers critical information to
physicians treating the disease. In addition to local surveillance, state data are
summarized at the national level to provide valuable insights into drug resistance
patterns for the country. The important surveillance issue for invasive Streptococcus
pneumoniae is to monitor the percent of drug resistant organisms among all invasive S.
pneumoniae organisms. In order to do so, it is necessary to collect reports of all
invasive S. pneumoniae.
County health departments will report Streptococcus pneumoniae according to the
following procedure:
- Invasive Drug Resistant Streptococcus pneumoniae, (DRSP) will be reported on
a 2016 and accompanied by a DRSP case report form (to be provided by the Bureau of
Epidemiology).
- Invasive Non-Drug Resistant Streptococcus pneumoniae
will not be
reported on a 2016, nor will a case report form be completed. In order to report
non-drug resistant S. pneumoniae, county health departments should forward the
results of all laboratory tests from sterile sites (see case definition) that are positive
for S. pneumoniae (except, of course those that are drug resistant, reportable
above) to the Surveillance Section in the Bureau of Epidemiology. It is essential that
the site from which the specimen was taken is noted on all positive laboratory reports.
Using these data, the Bureau will maintain ongoing surveillance for DRSP in the state
and will inform county health departments of the results of that surveillance.
Please direct any questions regarding this reporting procedure to Don Ward,
Surveillance Section Administrator at (850) 410-3319, Suncom 210-3319
3. Control of Meningococcal Disease: Suggested Internet Resources
Steven Wiersma, MD, MPH, Deputy State Epidemiologist
ACIP Guidelines, as outlined in MMWR, RR-5, February 14, 1997
ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4605.pdf
4. Important News About the Epi Update
The deadline for submission of articles to the Epi Update has been changed from
noon on Wednesday to noon on Tuesday of the week for which they are intended to be
published. The complete list of article submission guidelines is as follows:
- All articles are due no later than Tuesday at noon of the week for which they are
intended to be published.
- Articles must be submitted to Epi Update in final form. If medical or policy reviews
will be required (such as by Drs. Hopkins or Wiersma), those reviews must be
completed prior to submission.
- The editors reserve the right to make minor changes in articles to ensure consistency
with Epi Update editorial conventions.
- Please type articles in Arial (regular) 11 point font; do not add centering, boxes,
bolding, fancy fonts, etc. Check the spelling prior to submission and have someone else
proofread your writing if at all possible.
- Title your article and add your name/title (as you would like to be credited for the
article) at the top of each article submitted.
- Please send graphs, charts, and other data as attachments even if they are already part
of your article. These items must be imported separately when posting the Epi Update to
the Internet.
- Articles submitted via e-mail must be saved as attachments to the e-mail message. Please
do not include your article within your e-mail message.
- All final articles (ready for formatting) should be submitted to Jill H.
Parker prior to the
Tuesday deadline.
We understand that there may be exceptions to these guidelines. Referrals to websites,
other publications and brief announcements can still be e-mailed with your comments and/or
suggestions.
Thank you for your attention to these guidelines.
5. Updated ACIP Statement on Hepatitis A
(The following information appeared in the IAC Express #116 (serial online), October 4,
1999, published by the Immunization Action Coalition)
October 1, 1999
CDC PUBLISHES UPDATED ACIP STATEMENT ON HEPATITIS A
On October 1, 1999, the Advisory Committee on Immunization Practices (ACIP) released
the updated statement, "Prevention of Hepatitis A Through Active or Passive
Immunization." This report includes new information which builds on the earlier
recommendations for the use of hepatitis A vaccine which were published in 1996.
The "Summary" statement for this recommendation reads as follows:
Routine vaccination of children is the most effective way to reduce hepatitis A
incidence nationwide over time. Since licensure of hepatitis A vaccine in 1995, this
strategy has been implemented incrementally, starting with the recommendation of the
Advisory Committee on Immunization Practices (ACIP) in 1996 to vaccinate children living
in communities with the highest rates of infection and disease. These updated
recommendations represent the next phase of this hepatitis A immunization strategy.
Vaccination of children living in states and communities with consistently elevated rates
of hepatitis A will provide protection from disease and is expected to reduce the overall
incidence of hepatitis A.
This report updates the ACIP's 1996 recommendations on the prevention of hepatitis A
through immunization (MMWR 1996;45: [No. RR-15]) and includes a) new data about the
epidemiology of hepatitis A; b) recent findings about the effectiveness of community-based
hepatitis A vaccination programs; and c) recommendations for the routine vaccination of
children in states, counties, and communities with rates that are twice the 1987-1997
national average or greater (i.e., greater than or equal to 20 cases per 100,000
population) and consideration of routine vaccination of children in states, counties, and
communities with rates exceeding the 1987-1997 national average (i.e., greater than or
equal to 10 but less than 20 cases per 100,000 population). Unchanged in this report are
previous recommendations regarding the vaccination of persons in groups at increased risk
for hepatitis A or its adverse consequences and recommendations regarding the use of
immune globulin for protection against hepatitis A.
Editor's Note: Florida does not have any counties with rates twice the 1987-1997
national average and only two counties with rates that exceed the 1987-1997 national
average.
6. International Symposium on Viral Hepatitis and Liver Disease
( The following information appeared in IAC Express #115
(serial online), September 28, 1999, published by the Immunization Action Coalition)
The 10th International Symposium on Viral Hepatitis
and Liver Disease will be held April 9-13, 2000, in Atlanta, Georgia. This meeting is
sponsored by the U.S. Public Health Service in collaboration with the World Health
Organization and hosted by the Centers for Disease Control and Prevention. To take
advantage of the discounted fee offered to early registrants, you must sign up before
December 1, 1999.
7. Fall/Winter 1999 Issue of Immunization and Hepatitis B Publication
Available on the Internet!
(The following information appeared in IAC Express #113 (serial online), September 22,
1999, published by the Immunization Action Coalition.)
The Immunization Action Coalition has just released
the fall/winter 1999 issue of "VACCINATE ADULTS!" and it is available on their
Internet web site. Here are a few tips to help you navigate the information:
To download a camera-ready copy (PDF
format) of the entire fall/winter 1999-2000 issue (408,135 bytes), click here:
http://www.immunize.org/va/va5.pdf
If you are unable to download the
entire issue of "VACCINATE ADULTS!" or its table of contents, see the article
below for links to view and/or download individual items you wish to read.
8. Rabies Alert Map (January through September 28, 1999) and Updated
Equine EEE Map (January through September 30, 1999)
Lisa Conti, DVM, MPH, State Public Health Veterinarian
Attached is the updated rabies alert map and equine EEE map. Should you have
difficulties accessing these files, please contact Jill H. Parker.
Issued
Rabies Alerts Map
EEE
in Horses Map
9. Southeast Regional Public Health
Pest & Vector Management Conference
John P. Smith, Ph.D., B.C.E., Professor & Director, JAMS Public Health Entomology
Research & Education Center, Florida A&M University
February 22-24, 2000
Panama City Beach, Florida
The John A. Mulrennan, Sr. Public Health Entomology Research and Education Center of
Florida A&M University announces the fourth annual meeting of the Southeast Regional
Public Health Pest & Vector Management Conference which is scheduled for February
22-24, 2000. The conference will be held at the Sheraton Four-Point - Boardwalk Beach
Resort, Panama City Beach, Florida. The conference offers a wide variety of continuing
education topics tailored for environmental, public health, pest and mosquito control
professionals. This year's conference starts with an opening half-day plenary session
followed by two and a half days of concurrent hands-on workshops.
The purpose of the conference is to provide experiential learning opportunities through
hands-on laboratory and field workshops for professionals engaged in the identification,
biology, ecology, surveillance and control of arthropods, wildlife and associated zoonotic
diseases of public health importance. Attendees can expect to become better prepared in
conducting public health pest and vector control programs within their jurisdiction.
Continuing education credits will be available in public health, commercial and limited
governmental pest control as well as, environmental health for Florida and surrounding
states.
10. The Florida State Tuberculosis Lecture Series: The Rapid Diagnosis
of TB: The Role of Nucleic Acid Amplification"
(The following information was received from Yvonne Brown, A.G. Holley State
Tuberculosis Hospital)
Date: Wednesday, October 27, 1999
12:00 Noon to 2:00 P.M.
Location: A.G. Holley State Tuberculosis Hospital
1199 West Lantana Road
Lantana, Florida 33462 (I-95 South, Exit 46, East one block)
Topic: The Rapid Diagnosis of TB: The Role of Nucleic Acid Amplification
Speaker: Antonio Catanzaro, MD, Professor of Medicine, University of California, San
Diego Treatment Center
- CMEs and CEUs provided
- Pre-registration is required, please call (561) 540-3783 or fax to (561) 540-3788
- Anyone needing interpreters or other disability related accommodations should call or fax
the request to the above number prior to October 26, 1999.
- Jointly sponsored by the American Thoracic Society and the American Lung Association of
Florida, Inc.
11. Additional Internet Resources:
All the Virology on the WWW (ATV)
http://www.virology.net
Internet information about the West Nile virus:
CDC's web site now contains info on West Nile virus
http://www.cdc.gov/ncidod/dvbid/westnile/q&a.htm
12. Florida Past - Eustis Girl Chosen Nation’s Healthiest
William J. Bigler, PhD
According to the Florida Times Union (December 1, 1929), on
Thanksgiving of that year Miss Mary A. Stennis, extension nurtitionist, Dr. F.A. Brink
(Director of Communicable Disease) and Dr. F. L. Fort of the State Board of Health made
the final examinations of contestants that would represent Florida in the National Four-H
Congress Annual Health Contest in Chigago. Miss Florence Smock was selected as the
state’s entrant and after the dust settled, Miss Smock and Harold Deatline, an
Indiana farm boy, were named Health Champions of the United States. Excerpts from an AP
article on December 4, 1929 that was picked up by the Miami Herald and St. Augustine
Evening Record follow.
The healthiest girl in the United States, as reckoned by the Four-H
Club Annual Congress, is 17 years old, weighs 129 pounds, stands 5 feet 1/2 inches in her
medium heel shoes,...is Florence Smock....Miss Smock who hails from Eustis, Florida...is a
junior in the high school there...Brown eyes, with hair to match, and a small delicate
nose, set off her oval, smiling face..." The healthiest girl," swims, dances and
occasionally "has dates," she said "but nine o’clock is bedtime every
night, just as 7 a. m. is "getting up time." Florence uses no rouge nor
lipstick, but has rosy cheeks... she wants to be a physical education teacher...is a
senior lifesaver in the Red Cross and has been in the Four-H Club ...two and one-half
years, specializing in home improvement, nutrition and health.
Miss Smock thought that perhaps she was healthy because of
"Florida sunshine - and oranges," but with the sunshine and oranges went regular
hours, ten hours of sleep and plenty of exercise.
13. Weekly Disease Table: Week 39
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 |
59 |
41 |
49 |
49.7 |
91 |
39 |
| Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
| Botulism |
0 |
0 |
0 |
0 |
0 |
3 |
| Brucellosis |
5 |
0 |
3 |
2.7 |
3 |
1 |
| Campylobacteriosis |
878 |
737 |
576 |
730.3 |
975 |
681 |
| Ciguatera |
12 |
6 |
7 |
8.3 |
7 |
2 |
| Cryptosporidiosis |
203 |
100 |
118 |
140.3 |
203 |
107 |
| Cyclosporiasis |
183 |
65 |
6 |
84.7 |
6 |
3 |
| Dengue |
0 |
3 |
3 |
2 |
5 |
4 |
| Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
| E. coli O157:H7 |
25 |
39 |
32 |
32 |
57 |
45 |
| E. coli, other (known serotype) |
5 |
5 |
4 |
4.7 |
12 |
13 |
| Ehrlichiosis, Human |
4 |
2 |
0 |
2 |
1 |
1 |
| Encephalitis, Eastern Equine |
1 |
2 |
0 |
1 |
0 |
2 |
| Encephalitis, St. Louis |
0 |
1 |
0 |
0.3 |
2 |
0 |
| Encephalitis, other (known organism) |
5 |
9 |
4 |
6 |
7 |
3 |
| Encephalitis, post-infectious1 |
13 |
8 |
10 |
10.3 |
21 |
6 |
| Giardiasis (acute) |
1408 |
1155 |
1036 |
1199.7 |
1636 |
840 |
| Haemophilus influenzae, invasive1 |
16 |
19 |
32 |
22.3 |
45 |
35 |
| Hansen’s Disease (Leprosy) |
1 |
0 |
4 |
1.7 |
4 |
3 |
| Hantavirus Infection |
0 |
0 |
0 |
0 |
0 |
0 |
| Hemolytic Uremic Syndrome |
0 |
3 |
9 |
4 |
12 |
7 |
| Hemorrhagic Fever |
0 |
0 |
0 |
0 |
0 |
0 |
| Hepatitis A |
345 |
386 |
372 |
367.7 |
538 |
508 |
| Hepatitis B |
371 |
281 |
296 |
316 |
466 |
311 |
| Hepatitis C2 |
NR |
NR |
NR |
NR |
NR |
42 |
| Hepatitis Non-A, Non-B |
61 |
68 |
64 |
64.3 |
94 |
10 |
| Hepatitis, perinatal B2 |
NR |
NR |
NR |
NR |
NR |
3 |
| Hepatitis, unspecified |
3 |
6 |
13 |
7.3 |
27 |
10 |
| Hepatitis, +HBsAg, pregnant woman2 |
NR |
NR |
NR |
NR |
NR |
25 |
| Lead Poisoning |
1437 |
1050 |
1348 |
1278.3 |
1805 |
564 |
| Legionellosis |
29 |
18 |
24 |
23.7 |
48 |
19 |
| Leptospirosis |
0 |
0 |
1 |
0.3 |
2 |
0 |
| Listeriosis2 |
NR |
NR |
NR |
NR |
NR |
21 |
| Lyme Disease |
16 |
24 |
33 |
24.3 |
71 |
31 |
| Malaria |
65 |
59 |
45 |
56.3 |
96 |
63 |
| Measles |
1 |
3 |
2 |
2 |
2 |
2 |
| Meningococcal Disease (N. meningitidis) |
145 |
115 |
98 |
119.3 |
133 |
85 |
| Meningitis, Group B Streptococci |
21 |
12 |
14 |
15.7 |
22 |
12 |
| Meningitis, Haemophilus influenzae1 |
6 |
8 |
11 |
8.3 |
12 |
12 |
| Meningitis, Streptococcus pneumoniae |
79 |
60 |
63 |
67.3 |
96 |
76 |
| Meningitis, Listeria monocytogenes |
5 |
2 |
4 |
3.7 |
13 |
8 |
| Meningitis, other bacterial (including
unspecified) |
79 |
45 |
43 |
55.7 |
75 |
52 |
| Mercury Poisoning |
6 |
2 |
0 |
2.7 |
4 |
2 |
| Mumps |
8 |
8 |
10 |
8.7 |
11 |
4 |
| Neurotoxic Shellfish Poisoning2 |
3 |
0 |
0 |
1 |
0 |
0 |
| Pertussis |
78 |
54 |
34 |
55.3 |
39 |
64 |
| 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 |
183 |
216 |
156 |
185 |
215 |
148 |
| Rocky Mountain Spotted Fever |
1 |
2 |
1 |
1.3 |
2 |
1 |
| Rubella, including congenital |
10 |
3 |
3 |
5.3 |
4 |
0 |
| Salmonellosis |
1746 |
1501 |
1799 |
1682 |
3038 |
1829 |
| Shigellosis |
1086 |
991 |
1605 |
1227.3 |
2343 |
1030 |
| Smallpox2 |
NR |
NR |
NR |
NR |
NR |
0 |
| Staphlococcus aureus, (GISA/VISA)2 |
NR |
NR |
NR |
NR |
NR |
0 |
| Staphlococcus aureus, (GRSA/VRSA)2 |
NR |
NR |
NR |
NR |
NR |
0 |
| Streptococcal Disease, invasive Group A |
3 |
28 |
35 |
22 |
57 |
53 |
| Streptococcus pneumoniae, invasive
disease |
9 |
150 |
316 |
158.3 |
493 |
457 |
| Tetanus |
2 |
1 |
2 |
1.7 |
3 |
2 |
| Toxic Shock Syndrome |
0 |
1 |
4 |
1.7 |
4 |
6 |
| Toxoplasmosis |
8 |
4 |
9 |
7 |
15 |
13 |
| Typhoid Fever |
20 |
8 |
12 |
13.3 |
16 |
23 |
| Vibrio cholerae (serogrp O1) |
0 |
0 |
0 |
0 |
0 |
1 |
| Vibrio cholerae (serogrp Non-O1) |
2 |
7 |
6 |
5 |
11 |
8 |
| Vibrio vulnificus |
8 |
13 |
23 |
14.7 |
35 |
14 |
| Vibrio other (including unspecified) |
17 |
22 |
55 |
31.3 |
73 |
33 |
| Yellow Fever |
0 |
0 |
0 |
0 |
0 |
0 |
1 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."
2 The reportable disease rule was revised in July, 1999. 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 poisoning is now referred to as neurotoxic shellfish poisoning.
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