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EPI UPDATE
A weekly publication by the Bureau of Epidemiology
For March 1, 2000
"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:
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Steven Wiersma, MD, MPH,
Deputy State Epidemiologist |
William J. Bigler, PhD, MS,
Senior Epidemiologist |
Jodi Baldy, MPH,
Biological Scientist IV |
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Ursula E. Bauer, PhD,
Chronic Disease Epidemiologist |
John Werth, MA,
Bureau Education Coordinator |
Lisa Conti, DVM, MPH,
State Public Health Veterinarian |
Regional Epidemiologists:
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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.
In this issue:
1. Notice: Duval County Rabies Alert
2. Xth International Symposium on Viral Hepatitis and Liver Disease, April 9-13, 2000
3. Reports of Influenza-like Illness at the Lowest Level Recorded this Flu Season
[Florida Influenza Program Summary Update: Week 7 (week ending February 19, 2000)]
4. Florida Past – Hydrophobia and Madstones
1. Notice: Duval County Rabies Alert
Duval County has issued a rabies alert effective through May 25, 2000. The quarantine area includes Atlantic Beach and part of Neptune Beach. - Gale Tucker, Duval County Health Department
2. Xth International Symposium on Viral Hepatitis and Liver Disease, April 9-13, 2000
(Source: IAC Express, Issue Number 141 February 25, 2000, published by the Immunization Action Coalition)
The Centers for Disease Control and Prevention (CDC) published a "Notice to Readers" titled "Xth International Symposium on Viral Hepatitis and Liver Disease" in the February 25, 2000, issue of the MMWR. The full text of the
"Notice" reads as follows:
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Xth International Symposium on Viral Hepatitis and Liver Disease
The Public Health Service, in collaboration with the World Health Organization, is sponsoring the Xth International Symposium on Viral Hepatitis and Liver Disease, which will be hosted by CDC. The meeting will be held April 9-13, 2000, at the Marriott Marquis in Atlanta, Georgia.
The conference will include international experts to discuss the latest information about the molecular biology, diagnosis, epidemiology, clinical outcome, treatment, and prevention of each type of viral hepatitis. A major objective of the meeting is to highlight the importance of hepatitis surveillance, research, treatment, vaccination, and prevention programs in the developing world.
The meeting will consist of plenary sessions, oral and poster
sessions based on submitted abstracts, and exhibits. Information about
conference registration is available through the symposium's World-Wide Web
site. Proceedings of the symposium will be published in a comprehensive
symposium book.
3. Reports of Influenza-like Illness at the Lowest Level Recorded this Flu Season
[Florida Influenza Program Summary Update: Week 7 (week ending February 19, 2000)]
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 69,859 respiratory specimens for influenza, from which 12,348 (18%) influenza isolates have been recovered. Influenza A accounted for 12,322 of the 12,348 (99.8%) isolates with 26 isolates being influenza B (0.2%). Of the 3,185 influenza A viruses sub-typed 3,154 (99%) were A (H3N2) and 31 (1.0%) were A (H1N1). Both influenza A and B were isolated in Florida during this time period.
During Week 7, influenza activity was reported as widespread in Pennsylvania and regional in 11 states (Alabama, Arizona, Indiana, Louisiana, Maryland, Massachusetts, New York, Ohio, Tennessee, Utah, and Virginia). Sporadic influenza activity was reported in 34 states. Three states reported no influenza activity, and 1 state did not report. This continues the decrease in overall influenza activity seen in previous weeks. During Week 6 widespread influenza activity was reported in 4 states, regional activity in 17 states and sporadic activity in 26 states. No activity was reported for 1 state and 2 states did not report.
During Week 7, the proportion of deaths due to pneumonia and influenza (P&I) was 9.3% as reported by the vital statistics offices of 122 U.S. cities. This percentage is above the epidemic threshold of 7.6% for Week 7 and is unusually high. The percentage of pneumonia and influenza deaths has exceeded threshold values for this time of year for 21 of the past 22 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 7 (February 13, 2000) laboratory confirmed isolates of influenza A H3N2/Sydney-like were reported from two counties (Hillsborough and Palm Beach). Influenza A H3N2 has also been isolated from Alachua, Baker, Brevard, Broward, Clay, Collier, Duval, Escambia, Gadsden, Indian River, Lake, Leon, Martin, Miami-Dade, Orange, Pasco, Pinellas, Sarasota, and Volusia counties since October 1, 1999. Previously, influenza B/Yamanashi-like isolate was collected from Broward and Indian River Counties. 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, 1% were due to ILI. This is a decrease from Week 6 and is the lowest the ILI has been this influenza season. This week influenza-like illness was reported from providers in 14 (Broward, Collier, Duval, Escambia, Lake, Martin, Miami-Dade, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, and St. Lucie counties) of the 29 Florida counties participating in the National Sentinel Physicians Surveillance Network.
Florida is continuing to experience a decline in influenza activity. The peak of ILI activity in Florida was in first week of January when the ILI was 5%. This was one week later than the national peak at 6% during Week 52.
4. Florida Past – Hydrophobia and Madstones
William J. Bigler, PhD
At the turn of the century, rabies or hydrophobia, was still a rather rare disease in the state. The first human case was documented in 1881 death records from Key West. In 1899, Key West newspapers were reporting people bitten by mad dogs and a human death from hydrophobia. During that same period of time human cases were occurring in Pensacola (3), Gainesville (2), Tallahassee (1), and other northern counties (3). However, it was not until 1905 that the State Board of Health laboratory first determined the presence of rabies virus in brain material by the inoculation of rabbits. The State Board of Health initially advertised the availability of free Pasteur treatment quite widely, but by 1908 decided that the vaccine might be compromised after 30 hours in transit from New York. From that time on until the new State Laboratory was opened in 1911, persons bitten by rabid animals were advised to go to "some near-by Pasteur Institute for treatment."
Since, there was ample evidence that rabies was gradually increasing throughout Florida and the general public knew very little about the disease the State Board decided to devote the July1908 issue of Florida Health Notes to the subject. One section of interest described a number of popular fallacies concerning the disease, including the use of a madstone.
MADSTONE
The curative value of the madstone is still devoutly believed in by a great many people in certain sections of the country. Within the last few years a madstone was forwarded to the Department, the owner stating that it had prevented several cases of rabies and he was anxious for it to be tried by the Bureau. Some of these madstones, properly called hair balls, are obtained from the stomachs of various wild and domestic animals. They are in some cases composed of matted hair which the animal has licked from its body or swallowed; but in the majority of cases they consist of masses of vegetable fiber, such as the awns of clover and beards of grain, which have gradually collected over a period of time and are formed into a spherical shape by the contraction of the gastric walls. Gallstones, intestinal calculi, and in fact any porous stones may be used as madstones.
After a person has been bitten the madstone is applied to the wound, and it is believed that the longer it adheres the more sure it is of preventing the disease. Whether it will stick or not depends entirely on the amount of hemorrhage or discharge from the wound. Where this is profuse the blood infiltrates the meshes of the madstone, soon coagulates or dries and tends to hold it in place, and it adheres for a considerable time under such circumstances. In these cases the virus is supposed to be removed and treatment is heralded a success. On the other hand, where the wound is small and the discharge slight there is nothing to hold the stone in place and it immediately falls off. Certain of these madstones have been held in families for three or four generations and are guarded as carefully as an heirloom. Cases have been known where people have made long journeys and paid large sums of money to have a madstone applied. Its specific value against rabies is no greater than that of a piece of blotting paper applied in the same manner. The application of madstones gives the unenlightened public a false sense of security, and their use should be discouraged by all possible means.
Editor's Corner
The Weekly Disease Table will return in next week's issue of Epi Update.
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