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.

In this issue:

1. Outbreak at a Pinellas County Holiday Party

2. Florida Influenza Program Summary Update

3. Epidemiology Employment Opportunities

4. Ninth Symposium on Veterinarian Epidemiology and Economics, "A New Century of Opportunities", August 6-11, 2000, Breckenridge, Colorado

5. Florida Past – Yes, Dorothy! There is no Place Like Home

6. Weekly Disease Table - Week 49

Mike Friedman, MPH, Bureau of Environmental Epidemiology

The Department of Business & Professional Regulation (DBPR) office in Tampa notified the regional food and waterborne disease epidemiologist and the Pinellas County Health Department on 12/14/1999, that a complaint of illness involving approximately 60 person was received by their office. A medical group had their Christmas dinner party at a large banquet facility located in downtown Clearwater on 12/10 at 7:30 p.m. Ninety employees and family members had attended the buffet dinner. Early reports from attendees indicate symptoms including abdominal pains and severe diarrhea with varying onsets of illness. Duration of illness seems to be approximately one day. There have not been any reports anyone being hospitalized. It is believed that a catering company at the facility prepared the foods in-house that were served at the 12/10 buffet dinner. Entrees served consisted of turkey w/ dressing, mahi mahi fish and roast prime rib.

It is believed that other parties took place at the same facility on the same night, including a large party of 500 persons. Menus from these other parties will be reviewed.

A joint environmental investigation will be conducted today by the Pinellas CHD Environmental Health Office, DBPR and regional environmental epidemiologist at the Clearwater banquet facility. The facility has already been notified about this incident by attendees A contact person from the attending medical group has been requested to prepare a line-listing of attendees so that a medical & food history questionnaire can be developed.

A joint environmental investigation was performed 12/14/1999 at the banquet facility in Clearwater. Preparation of all menu items served at the banquet in question were reviewed and the kitchen facility was inspected by DBPR representatives. All food temperatures and refrigerations checked were satisfactory. The dishwashing unit, however was found to not be reaching proper sanitizing temperature.

This is a banquet facility capable of preparing and serving several large parties at one time. On Friday, December 10^th, two dinner parties were held at the facility. Very similar menus were used for both banquets, except that mini pastries were served at the banquet reporting illness. The second banquet that was held has not reported any illness associated and had 500 attendees. (The facility contacted persons from the second banquet). Both banquets shared foods that were prepared and served at the same time. In addition, according to the chef, 40-50 employees also ate food served at both banquets, except for the mini pastries. No employee illness has been reported.

Several food items that had been served at the 12/10/99 banquet were still available in the kitchen facility and were collected for laboratory testing. These foods include turkey, stuffing, gravy, scalloped potatoes, sweet potatoes, and various mini pastries. Food samples were delivered to the Bureau of Laboratories Tampa Branch by the Pinellas County Health Department. Laboratory testing will include checking for the presence of Clostridium perfringens.

A medical & food history questionnaire is presently being developed for use with a case-control study among banquet attendees.

Note: The management at the banquet facility has decided to temporarily not serve the mini pastries until cleared by laboratory testing.

Carina Blackmore, MS Vet Med., PhD

National: Since October 3, 1999, the World Health Organization (WHO) and the National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories have tested 12,738 respiratory specimens for influenza, from which 787 (6%) influenza isolates have been recovered. Virtually all (783 of 787) were influenza A. All sub-typed (339 of 783) influenza A isolates were influenza A (H3N2). Influenza B has been reported from 2 states. Both influenza A and B were isolated in Florida during this time period. Arizona, Colorado, Hawaii, Minnesota, Montana, Nebraska, New York, South Dakota and Wisconsin reported regional influenza activity as assessed by state and territorial epidemiologists, and 37 other states (including Florida) reported sporadic influenza activity. No influenza activity was reported from Alabama, Delaware, Kentucky and Oregon.

Of the total patient visits to sentinel physicians, 2% were due to ILI (influenza-like-illness) in the US overall. The percentages ranged from 1-2% in 8 of the 9 surveillance regions. In the Pacific region, 6 percent of patient visits were due to ILI. The percentage of pneumonia and influenza deaths (of all deaths) reported from the 122 cities participating in the City Mortality Reporting System was 6.7 %. For week 48, this is above the epidemic threshold of 6.9%. The percentage of pneumonia and influenza deaths exceeded threshold values for this time of year for 9 of the past 11 weeks. The increase in influenza-related mortality seen this year should be interpreted with caution. It is unclear whether it is due to early influenza activity, respiratory illness due to some other pathogen, or reporting changes under way in the 122 Cities Mortality Reporting System.

Florida During week 48 (28 November 4 December 1999) laboratory confirmed isolates of influenza A H3N2/Sydney-like were reported from Hillsborough and Palm Beach counties. Influenza A has also been isolated from Alachua (A H3N2), Brevard, Broward (A H3N2), Clay (A H3N2), Collier (A H3N2), Duval (A H3N2), Indian River (A H3N2), Lake (A H3N2), Leon (A H3N2), Miami-Dade (A H3N2), Orange, Pinellas, Sarasota and Volusia 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 48, 2% were due to ILI, the same level of activity reported for 7 of the 8 previous weeks and within the expected range of 0-3%. This week influenza-like illness was reported from providers in 15 (Brevard, Broward, Collier, Duval, Hillsborough, Indian River, Leon, Marion, Miami-Dade, Monroe, Palm Beach, Pinellas, Polk and Sarasota) of the 29 Florida counties participating in the National Sentinel Physicians Surveillance Network.

The Bureau of Epidemiology would like to announce an anticipated opening in the Florida Hepatitis and Liver Failure Prevention and Control Program. The position title is Program Administrator. The incumbent will serve as program administrator and will report directly to the Deputy State Epidemiologist in the Investigations Section of the Bureau of Epidemiology. Duties include supervision of other program staff, planning, epidemiologic analysis of hepatitis data, administration, monitoring, and evaluation of the Florida Hepatitis and Liver Failure Prevention and Control Program. The pay grade is 25 with a minimum annual salary of $41,877.55.

Strong candidates for this position are persons with experience in the development, implementation and evaluation of disease prevention and control programs. Candidates will be familiar with public health practice models and have experience with health policy and administration. Also, the candidate should have the ability to formulate budgets, prepare budget requests, develop and manage grants, analyze proposed legislation, and effectively supervise staff. An advanced degree in public heath or related field is desirable.

The Bureau of Epidemiology announces an anticipated opening for a Database Analyst in the Florida Hepatitis and Liver Failure Prevention and Control Program. The pay grade for this position is 25; the minimum annual salary is $38,070.50.

Specific duties and responsibilities include:

A new BSIV position is being advertised in the Bureau of Environmental Epidemiology, closing date: 12/22/99. The position will function as the bureau's bioterrorism coordinator and waterborne disease surveillance coordinator. Experience in working at county health departments and experience in epidemiology preferred. The position will involve training county health departments statewide in bioterrorism prevention and investigation activities. In addition, this position will further expand statewide waterborne disease surveillance activities along with training County Health Department staff in how to investigate waterborne disease outbreaks. The position will coordinate closely with the bureau's regional food and waterborne disease epidemiologists and with similar bioterrorism positions in the Bureau of Epidemiology. Applicants should be experienced in training development and implementation, public speaking, commonly used computer applications (Microsoft Word, EpiInfo, Excel, PowerPoint and Access).

The final date for all abstract submissions (oral and poster) is January 15, 2000. Notification of selection of abstracts will start in March 2000. To guarantee availability, room reservations should be received before May 5^th, 2000.

The Association of Teachers of Veterinary Public Health and Preventative Medicine (ATVPHPM) will provide funding to allow each attending ATVPHPM member to sponsor one student attendance. Participant fees for this student will be waived, but travel and hotel costs will not be covered. ATVPHPM members should provide the name of the student they are sponsoring on their Symposium registration form.

5. Florida Past - Yes Dorothy! There is No Place Like Home

William J. Bigler, PhD

For the first time in 88 years, Florida’s state health agency is moving into administrative offices exclusively dedicated to the development and management of statewide public health programs. The original building constructed for the operation of the State Board of Health in Jacksonville was finished in 1911. It is now in the process of being restored to serve as a museum of medicine and public health.

This year the new Department of Health began moving into a group of four beautiful new buildings located at the Capital Center Office Complex. By spring the majority of the state’s public health family will again be reunited in a place they can call home. It is not a moment too soon for many of the former HRS staff headquartered in Tallahassee. Some have spent the bulk of their careers in public health being shuttled from one leased facility to another.

This year, the department also presented a legislative proposal that would name the 1911 building in Jacksonville after Wilson T. Sowder, M.D., and the new administrative building in Tallahassee after E. Charlton Prather, M.D., M.S., M.P.H. That bill was signed this past summer, and both buildings will be named after these former State Health Officers. Regular subscribers to the Epi-Update are already somewhat familiar with Dr. Sowder’s career in Florida and his many accomplishments by previous Florida Past articles.

Folks who want to learn more about Dr. Sowder should read "Recollections of the 100 Year Struggle for Better Health in Florida," which he published as a series in the Journal of the Florida Medical Association Vol. 76, Nos. 8, 9 & 10, 1989. Dr. Sowder, who is now 89, was recently honored by the Florida Medical Association at its annual meeting for his many contributions to public health and was presented with a replica of the bronze plaque that will be placed at the entrance of the 1911 building when restoration is complete. In addition, this past week at their annual Christmas luncheon the Department’s Bureau of Laboratories invited Dr. Nathan Schneider, Director of the Laboratories under Dr. Sowder, to present him with a miniature bronze replica of the plaque for his mantel.

Those of us who have had the unique opportunity to work for and with Dr. Prather are especially proud that the Department’s headquarters building at 2585 Merchants Row in Tallahassee bears his name. When he retired on December 31, 1987, Dr. Prather persistently pursued his commitment to have the legislature create a separate Department of Health. During his 35+ year Public Health career in Florida, Dr. Prather also achieved distinction on many levels, as microbiologist, clinician, researcher, epidemiologist, program administrator, state health officer and assistant secretary for health. During that time he worked for the State Board of Health, the HRS Division of Health, the Health Program Office, District II and the State Health Office.

Today he still resides in Tallahassee, does blacksmithing as a hobby, is active in the Red Cross, is working with the USF College of Public Health to videotape recollections of key contributors to our public health history and still finds time to be actively involved in myriad health and medicine related activities. As chair of the Department’s Institutional Review Board, Dr. Prather regularly visits our offices and takes time to stop by the Bureau of Epidemiology to chat awhile and pick up his latest copy of the Epi-Update.

The Department is in the process of planning a formal dedication ceremony in the spring when all four of the new buildings are completed and occupied. It should be a momentous occasion for the Tallahassee Department of Health staff to celebrate the convenience of being able to comfortably work together as we move into the new millennium.