Division of Disease Control and Health Protection

"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.

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.

Carina Blackmore, MS Vet Med. PhD

National:

Since October 3, 1999, laboratory confirmed influenza A virus infections were reported from 30 states. Influenza B was reported from 3 states. Both influenza A and B were isolated in Florida during this time period. Indiana and New York State reported regional influenza activity as assessed by state and territorial epidemiologists, and thirty-six other states reported sporadic influenza activity.

Of the total patient visits to sentinel physicians, 1% were due to ILI (influenza-like-illness) in the U.S. overall. The percentages were within baseline levels (0%-3%) in 8 of the 9 regions. Influenza-like illness were seen in 5% of the patients of sentinel physicians in the West South Central region 5%. The percentage of pneumonia and influenza deaths reported from the 122 cities was 7.4% for week 44, which is above the epidemic threshold of 6.5%. This is the seventh consecutive week the percentage of pneumonia and influenza deaths have exceeded the baseline limits for this time of year. It is unclear whether this increase in the percentage of deaths due to pneumonia and influenza is due to early influenza activity, respiratory illness due to some other pathogen, or reporting changes underway in the 122 Cities Mortality Reporting System.

During week 44 (31 October-6 November 1999) laboratory confirmed isolates of influenza A H3N2/Sydney-like were reported from Broward, Miami-Dade and Palm Beach Counties. Influenza A has also been isolated from Alachua, Brevard, Collier (A H3N2), Duval, Hillsborough, Indian River (A H3N2), Leon (A H3N2) and Orange Counties since October 1, 1999. Influenza B/Yamanashi-like has been isolated from Indian River County. Antigens from both influenza A/Sydney and influenza B/Yamanashi are included in the 1999-2000 influenza vaccine. Of the total patient visits to sentinel physicians for Week 44, 1% were due to ILI, which is slightly lower than the influenza activity reported for the 4 previous weeks (2%) but within the expected range of 0-3%. So far this season, influenza-like illness has been reported from 45 health care providers in 22 counties statewide.

Jill H. Parker, MSP and Laurence Burnsed, FAMU MPH Candidate,

Bureau of Epidemiology

The Bureau of Epidemiology began data collection for the Florida RSV Surveillance Program on October 15, 1999. Thirteen hospitals have actively participated in data collection, providing weekly counts of the total number of RSV tests performed and the total number of those tests that yielded a positive result (either through screening tests or cultures). A graph of the percent of positive RSV tests by week and region for weeks 1-5 (October 15 - November 12) of data collection is included below.

According to the Centers for Disease Control and Prevention, periods of RSV infection are considered to be epidemic when laboratories report at least 2 consecutive weeks when more than 10 percent of all specimens are tested positive. From July 1990 through June 1998, peak activity has been recorded primarily in temperate climates, beginning in November and continuing for an average of 22 weeks (range of 20 – 26 weeks) to April or mid-May.

Data collected during the first five weeks of the Florida RSV Surveillance Program indicate the percent of positive RSV tests have consistently remained above 10 percent, with the exception of week 4 data in the Northern region. These data illustrate possible peak activities occurring in Florida that are consistent with national trends.

Additional graphs may be accessed from the Bureau of Epidemiology web site at www.doh.state.fl.us (choose epidemiology, then scroll down to "FL Respiratory Syncytial Virus").

• Three outbreaks of V. parahaemolyticus infections linked to the consumption of raw oysters occurred in 1997 and 1998. The first occurred in July and August 1997, and involved 209 culture-confirmed cases in persons who consumed raw oysters harvested from the coasts of California, Oregon, Washington, and British Columbia [MMWR Vol. 47 No.22]. In the summer of 1988, 416 persons developed diarrhea after consuming oysters harvested from Galveston Bay, Texas; 110 of these had culture-confirmed V. parahaemolyticus infection. Between July and September 1988, 23 culture- confirmed cases of V. parahaemolyticus infections were identified among persons who had consumed oysters and clams harvested from Long Island Sound [MMWR Vol. 48 No. 3].

• A total of 937 cases of culture-confirmed Vibrio illnesses were reported to the Vibrio Surveillance System in 1997 and 1998, 389 from 5 Gulf Coast states (Alabama, Florida, Louisiana, Mississippi, and Texas) and 548 from 26 other states and one territory. Among those about whom this information was available, 300 (37%) of 809 were hospitalized and 46 (7%) of 707 died. Although V. parahaemolyticus was the most frequently reported Vibrio species, V. vulnificus accounted for 41 (89%) of the 46 reported deaths.

• 92% of the Vibrio infections could be categorized into one of three well-recognized syndromes:

• 75% (646 cases) were classified as gastroenteritis, defined as an illness with diarrhea, vomiting, or abdominal cramps, no evidence of a wound infection, and Vibrio spp isolated from stool alone.

• 16% (135 cases) were classifed as wound infections, in which the patient incurred a wound before or during exposure to seawater or seafood drippings, and Vibrio spp was subsequently cultured from the blood, wound or a normally sterile site.

• 9% (77 cases ) were classified as septicemia, characterized by fever or shock in which Vibrio spp was isolated from the blood or normally sterile site, and no evidence of a wound infection

• Vibrio infections were seasonal; 417 (65%) of gastroenteritis cases occurred between June and August, 87 (64%) of wound infections occurred between May and August, and 72 (94%) of septicemic infections occurred between May and November.

• Among illnesses with one Vibrio species in which the species was determined, V. parahaemolyticus accounted for 473 (75%) of the gastrointestinal illnesses, while V. vulnificus was isolated in 64 (51%) of wound infections and 62 (82%) of septicemia cases.

• 569 (92%) of 616 persons with gastroenteritis or septicemia consumed seafood in the 7 days before their illness onset. Of the 278 (49%) of these who consumed a single seafood, 190 (68%) ate oysters, and 173 (97%) of the 179 persons who provided the information consumed their oysters raw.

Dan Thompson, MPH, Program Administrator, Bureau of Epidemiology

We currently have an anticipated opening in the Chronic Disease Section of the Bureau of Epidemiology. The position class title is Health Services and Facilities Consultant, and most of the work involves perinatal epidemiology. The pay grade is 24 with a minimum annual salary of $35,831. This position is currently held by Chrissy Gest who will be taking another job after 11/26/99.

Good candidates for this position are persons with experience working with large data sets and programming in SPSS, SAS or similar software, and experience in perinatal epidemiology and statistics. Also important is the inclination and ability to write up the results of the work.