Division of Disease Control and Health Protection

With the implementation of blood-donor screening, new HCV infections in children will be acquired primarily through mother-to-infant transmission. The risk of perinatal transmission from mothers with detectable serum HCV RNA may be as high as 5 to 10 percent. Given the number of women of childbearing age with chronic HCV infection, there may be a considerable number of infections by this route in newborns. There are currently no recommendations to screen women for HCV infection either before or during pregnancy. One reason is that no effective means has been identified to decrease the likelihood of perinatal HCV transmission from women with the virus. The infants of women known to be infected with HCV should be evaluated at 12 to 15 months of age, when maternal antibodies transferred through the placenta will no longer confound the results of serologic testing.

The findings of Vogt et al. and other studies suggest that HCV infection acquired by transfusion in early childhood may resolve without treatment more commonly than infection acquired later in life. In the children in whom infection does persist, hepatic injury seems to progress slowly and is typically mild within the first 20 years after infection. Does this mean that early-onset HCV infection is always a benign disease? Histologic studies of children with HCV infection confirm that some have fibrosis; the fibrosis progresses with increasing age and duration of infection. Even in the prospective studies of adults in which few symptoms and limited morbidity were noted for up to two decades after initial infection, some patients eventually had substantial morbidity. We do not know whether more serious manifestations of liver disease will appear 30 or 40 years after infection. Thus, it is important to screen and follow patients who are at risk for hepatitis C and to do more than simply reassure infected children and their families.

TO: County Health Department Directors/Administrators

County Epidemiologists

FROM: Richard S. Hopkins, M.D., M.S.P.H.

State Epidemiologist

SUBJECT: Communicable Disease Epidemiology Regional Training

REQUIRED: Information DUE DATE:

On behalf of the Bureau of Epidemiology, I am pleased to announce the resumption of the Bureau’s on-site regional epidemiology training programs for county health department staff members. This action is in response to expressions of need from the counties as well as our own assessment. We intend to offer training programs in five regions of the state (northwest, northeast, central, southeast and southwest) starting this coming November. County health department directors and administrators will determine which areas are appropriate for their staff members. The first session will be held in Okaloosa county on November 3^rd and 4^th, 1999. An agenda will be forwarded to all counties on the week of October 11. Additional details will be provided as they become available and will be posted periodically in the Epi-Update.

In the one-and one-half day program, Bureau of Epidemiology staff and some visiting faculty (primarily county health department epidemiologists) will provide an overview of epidemiologic principles such as disease surveillance and case and outbreak investigation. The group will also address specific topics that health departments have determined to be important to them including rabies management, case reporting procedures, use of the Epi-Info software, and others. The focus of these sessions will be epidemiology "for the county health departments." There will be ample time for interaction about specific issues.

The target audiences for the regional epidemiology training programs are county health department staff members who are involved in epidemiology. County health directors and administrators are certainly welcome to attend.

John Werth, the Education and Training Coordinator for the Bureau of Epidemiology will be managing this activity. He will be periodically contacting county health directors and administrators to provide updated information and to ask for assistance in obtaining meeting rooms and for other logistical support. Please feel free to contact Mr. Werth (Suncom 994-1684) if you are interested in hosting one of the training sessions or for answers to related questions.

We are truly excited about this renewed effort and the potential it offers for improving disease prevention in Florida.

RSH/jw

"A large number of children will be wearing false teeth before they are 20 unless they learn the error of their ways soon. Some children in the city between the ages of 10 and 14 need false teeth now." Dr. Henry Hansen, State Board of Health Inspector, is authority for these statements. He made them after having examined more than 1000 city school children in connection with standardization of schools.

Starts By Neglect

"It is surprising the number of parents who allow children to neglect their teeth," Dr. Hansen said. "I make a partial physical examination for the State Board covering skin, mouth, and throat and general conditions. I find more trouble with teeth than all of the other portions of the anatomy combined."

The danger of bad teeth, according to Dr. Hansen, is not alone the possibility of having to wear false teeth at an early age, but of having the entire system upset and poisoned.

"Diseased teeth can bring on such diseases as rheumatism, for instance," the inspector said. "They can lead to a number of other complications. And the pity of it all is that they could prevented so easily."

Cards Tell Story

After each examination, the child’s medical history is kept on a card and the parents notified.

"If the parents would take the precautions and advice offered by this free medical service, these examinations could do a lot of good," Dr. Hansen said. "Most of the time, however, parents think they know more about how to take care of the child than anybody else, and simply neglect to have diseased conditions remedied."