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.

1. Important: Proposed Revisions to Chapter 64D-3, F.A.C.

2. Malaria Prophylaxis: CDC Notice - Dominican Republic

3. Lead Poisoning Cases from a Folk Remedy in Hillsborough County

4. Florida Influenza Program Summary Update: Week 6 (week ending February 12, 2000)

5. Influenza Sentinel Surveillance Network: Map of Influenza Activity in Florida, January 16 through February 15, 2000

6. Florida Past – Punch Cards and Electronic Tabulation

7. Weekly Disease Table: Week 7

The full text of the proposed rule and a copy of the enteric disease guidelines can be found on the Bureau of Epidemiology web page at www.doh.state.fl.us (choose epidemiology as subject). Click on the red text "Proposed Revisions to Chapter 64D-3, F.A.C.

Gregg Rottler, MPH, Hillsborough County Health Department

A 6-month-old boy and his 3-year-old brother recently underwent chelation therapy at Tampa General Hospital after blood lead levels of 83 ug/dl and 68 ug/dl, respectively, were detected. Neither child appeared to exhibit acute symptoms of lead poisoning.

The older child was initially diagnosed with the condition after visiting the Hillsborough County Health Department’s Ruskin Clinic for a nail fungus infection. A physical was performed on the child, which included a lead test. The younger child was diagnosed with lead poisoning after the health department’s lead investigator, Cynthia Keeton, wasn’t able to identify any environmental sources of contamination and suggested that the entire family be tested for lead.

When questioned by the investigator about the use of home remedies, the mother stated that she had given her children an orange-colored powder called Azarcon that she imported from Mexico. She said she used it to treat for "empacho", a folk term for gastrointestinal illness. An analysis from the state’s Jacksonville lab indicated that the substance contained 82% lead.

The use of lead-containing folk remedies can lead to permanent neurological impairment and death. Azarcon is known by other names including Ruedo, Alarcon, Maria Luisa, Ligo, and Corol. It is used as an ingredient by Mexican druggists in topical treatments for skin disorders. Another lead-containing folk remedy imported from Mexico for empacho is Greta, which is a yellow-colored powder. Greta is sold in hardware stores for use as a pottery glaze. The medicinal use of lead has been documented in other ethnic communities as well.

Health care providers should routinely inquire about the use of home remedies while performing health screenings in demographic regions with immigrant populations. Culturally competent educational efforts stressing the health hazards associated with these home remedies may help to reduce exposures.

Editorial Comment: Azarcon is particularly dangerous because it may be given to children who are suffering from gastrointestinal distress that is itself a product of lead poisoning. - RSH

Roger Sanderson, RN, MA, Bureau of Epidemiology

National:

Since October 3, 1999, the World Health Organization (WHO) and the National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories have tested 66,810 respiratory specimens for influenza, from which 11,957 (18%) influenza isolates have been recovered. Influenza A accounted for 11,935 of the 11,957 (99.8%) isolates with 22 isolates being influenza B (0.2%). Of the 3,003 influenza A viruses sub-typed 2,980 (99.2%) were A (H3N2) and 23 (0.8%) were A (H1N1). Both influenza A and B were isolated in Florida during this time period.

During week 6, influenza activity was reported as widespread in 4 states (Arizona, New York, Pennsylvania, and Tennessee). Regional influenza activity was reported in 17 states (Alabama, Colorado, Georgia, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Missouri, North Carolina, Ohio, South Carolina, Utah, Vermont, Virginia, and Wisconsin). Sporadic influenza activity was reported in 26 states, no influenza activity was reported in 1 state, and 2 states did not report. This continues the decrease in overall influenza activity seen in previous weeks. During Week 5 widespread influenza activity was reported in 8 states, regional activity in 17 states and sporadic in 21 states and 4 states did not report.

During Week 6, the proportion of deaths due to pneumonia and influenza (P&I) was 9.9% as reported by the vital statistics offices of 122 U.S. cities. This percentage is above the epidemic threshold of 7.6% for Week 6 and is unusually high. The percentage of pneumonia and influenza deaths has exceeded threshold values for this time of year for 20 of the past 21 weeks. The current season’s P&I figures must be interpreted with caution because important changes have taken place in this year’s case definition that may be contributing to higher estimates of P&I mortality than in previous years. Tampa, St. Petersburg, Jacksonville and Miami are the Florida cities that contributed to this report.

Florida:

Since the beginning of Week 6 (February 6, 2000) laboratory confirmed isolates of influenza A H3N2/Sydney-like were reported from Broward, Palm Beach and Hillsborough counties. Influnza A H3N2 has also been isolated from Alachua, Baker, Brevard, Clay, Collier, Duval, Escambia, Gadsden, Indian River, Lake, Leon, Martin, Miami-Dade, Orange, Pasco, Pinellas, Sarasota, and Volusia counties since October 1, 1999. The state's second Influenza B/Yamanashi-like isolate was from a specimen collected on February 2, 2000 from Broward County. Previously, an influenza B/Yamanashi-like isolate was collected from Indian River County. Untyped isolates of influenza A have been reported from Brevard, DeSoto, and Manatee counties. 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 6, 2% were due to ILI. This is the same as week 5 and is within the expected range of 0-3%. This week influenza-like illness was reported from providers in 14 (Broward, Collier, Duval, Escambia, Hillsborough, Indian River, Leon, Marion, Palm Beach, Pasco, Pinellas, Polk, Sarasota, and St. Lucie counties) of the 29 Florida counties participating in the National Sentinel Physicians Surveillance Network.

Florida has experienced a decline in influenza activity since the first week in January when the ILI in peaked at 5%. This was one week later than the national peak at 6% during Week 52.

5. Influenza Sentinel Surveillance Network: Map of Influenza Activity in Florida, January 16 through February 15, 2000
Carina Blackmore, MS Vet Med, PhD

William J. Bigler, PhD