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EPI UPDATE
A weekly publication by the Bureau of Epidemiology
For March 22, 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. Grand Rounds for March 28, 2000
2. Lyme Disease - Personal Protection is Still the Best Prevention
3. Florida Past - Epi in Action
4. Weekly Disease Table: Week 11
1. Grand Rounds for March 28, 2000
"Detection of Viral URI Epidemic by Statistical Process Control"
Heidi T. Orme, MSPH, Research Analyst, Division of Public Health and Health Research Center, Department of Family and Preventive Medicine, University of Utah
11:00 AM – 12:00 PM EST
Abstract:
Current public health surveillance systems do not provide rapid notification of viral epidemics to primary care physicians. Identifying a viral epidemic early is important in avoiding unnecessary antibiotic use. The excessive use of antibiotics has contributed to the emergence and spread of antibiotic resistant bacteria.
We hypothesize that monitoring and detecting non-random increases in patient visits at urgent care centers via a Statistical Process Control (SPC) technique provides a sensitive and rapid indicator for viral epidemics. To test our hypothesis, we designed a clinic-based surveillance system for influenza and other respiratory viral outbreaks that can identify an epidemic within a few days, allowing primary care physicians to respond appropriately, and in a timely manner, to viral epidemics that impact their practice. SPC can be applied with minimal cost and few technical requirements, making it a cost-effective surveillance tool with wide applicability.
2. Lyme Disease - Personal Protection is Still the Best Prevention
Dr. Lisa Conti, State Public Health Veterinarian
Lyme disease is a reportable condition in Florida and the DOH Jacksonville Branch Laboratory offers serologic assays free of charge to physicians. Preliminary data for 1999 show 55 cases of Lyme disease reported in Florida. The majority of these reports indicate that tick exposure occurred in northeastern states where this disease is endemic. Florida is considered a low prevalence state for Lyme disease.
The American Academy of Pediatrics (AAP) Committee on Infectious Diseases offers sound advice about preventing Lyme disease. Their abstract appears below:
"ABSTRACT. Lyme disease is currently the most frequently reported vector-borne illness in the United States, accounting for more than 95% of such cases. The purpose of this report is to provide recommendations for preventing Lyme disease, including the use of Lyme disease vaccine. Individuals can reduce their risk of Lyme disease by avoiding tick-infested habitats when in endemic areas. If exposure to tick-infested habitats cannot be avoided, individuals may reduce their risk of infection by using repellants, wearing protective clothing, and regularly checking for and removing attached ticks. Morbidity from Lyme disease can be reduced significantly by detecting and treating the infection in its early stages; early and appropriate treatment almost always results in a prompt and uncomplicated cure. A Lyme disease vaccine (LYMErix, SmithKline Beecham, Collegeville, PA) was licensed by the US Food and Drug Administration on December 21, 1998, for persons 15 to 70 years of age. This vaccine seems to be safe and effective, but whether its use is cost-effective has yet to be clearly established. Use of this vaccine causes false-positive enzyme immunoassay results for Lyme disease. Lyme disease can be diagnosed in vaccinated persons by immunoblot testing. Decisions about the use of this vaccine should be based on an assessment of a person's risk as determined by activities and behaviors relating to tick exposure in endemic areas. This vaccine should be considered an adjunct to, not a replacement for, the practice of personal protective measures against tick exposure and the early diagnosis and treatment of Lyme disease."
The most recent (June 4, 1999) statement on Lyme disease vaccine from the Advisory Committee on Immunization Practices (ACIP) is titled "Recommendations for the Use of Lyme Disease Vaccine."
3. Florida Past - Epi in Action
William J. Bigler, PhD
At the 6th annual meeting of the Florida Public Health Association, Inc. held in Jacksonville, December 3-5, 1934, Dr. C. D. Hopkins, the Epidemiologist for the City of Tampa presented a paper entitled "Epidemiology." The main body of his discussion was focused on investigations of typhoid fever and measles outbreaks that had occurred during the previous eight years. The text of his presentation is printed in full in the January 1935 edition of Florida Health Notes, Vol. 27, No. 1. The following excerpts taken from his introductory comments stress the intense focus public health departments had on disease prevention and control at that time.
Correct diagnosis of individual cases is necessarily the beginning of epidemiological investigation, and I make it a practice to see all cases that I go out to investigate as a beginning toward establishing in my own mind the correctness of the reported diagnosis…..tact is required in having the correct and desired diagnosis prevail. Nothing is harder to find than the source of an infection which does not exist.
After a correct diagnosis has been established, the energy, inquisitive nature, and time to pursue the inquiry must be available or epidemiological investigation suffers. A good investigation can hardly be made with the investigator hurrying to another case, a clinic or his office; however, routine, when sufficiently inclusive, tends to promote thoroughness in all cases, and for this reason I use standard blanks as far as possible for the gathering of data, which can be tabulated when a sufficient amount is collected to be of value. The epidemiologist of a city is often as much at a loss to account for the source of infection in a given case as the attending physician, the correct interpretation becoming apparent only when more cases have been investigated and the data tabulated…
The epidemiologist often has to make compromises in order to reach some highly desired accomplishment. A few years ago...school children were given diphtheria immunization…3,000 being given two doses of toxoid, although it was well known that giving these immunizations would not reduce the diphtheria case or death rate to any appreciable extent (in this population)…The reason for giving these diphtheria immunizations was that it paved the way for a return trip the following week for 3,000 smallpox vaccinations in a group where vaccination was most desired.
Cooperation of the individuals and groups with which you have to deal is seldom perfect. The epidemiologist has to content himself with the best that can be obtained. Too often (there) is an attitude of sufferance instead of active cooperation. Our outstanding example of perfect cooperation was the executive of a large chemical plant employing several hundred men, who ordered his paymaster to pay off anyone who did not submit to vaccination if the Health Department thought necessary after a case of smallpox had been discovered among these workers. This occurred in 1926, but it is still a shining example of real assistance in health work. All took vaccination instead of losing their jobs.
4. Weekly Disease Table: Week 11
County-Confirmed Cases, Sorted Alphabetically by Disease
(NR represents years that the disease lacked status as a reportable condition)
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DISEASE |
1997 TO DATE |
1998 TO DATE |
1999 TO DATE |
3 YEAR AVERAGE
TO DATE |
1999 TOTAL CASES |
2000 TO DATE |
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Amebiasis |
8 |
4 |
2 |
4.7 |
66 |
0 |
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Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
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Botulism |
0 |
0 |
0 |
0 |
3 |
0 |
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Brucellosis |
0 |
0 |
0 |
0 |
3 |
0 |
|
Campylobacteriosis |
124 |
99 |
126 |
116.3 |
982 |
116 |
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Ciguatera |
2 |
0 |
0 |
0.7 |
2 |
0 |
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Cryptosporidiosis |
10 |
16 |
7 |
11 |
174 |
8 |
|
Cyclosporiasis |
0 |
2 |
0 |
0.7 |
5 |
0 |
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Dengue |
0 |
1 |
1 |
0.7 |
5 |
1 |
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Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
|
E. coli O157:H7 |
12 |
3 |
8 |
7.7 |
54 |
5 |
|
E. coli , other (known serotype) |
2 |
2 |
4 |
2.7 |
16 |
2 |
|
Ehrlichiosis, Human |
0 |
0 |
0 |
0 |
2 |
0 |
|
Encephalitis, Eastern Equine |
0 |
0 |
0 |
0 |
2 |
0 |
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Encephalitis, St. Louis |
0 |
0 |
0 |
0 |
3 |
0 |
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Encephalitis, other (known organism) |
3 |
3 |
1 |
2.3 |
5 |
1 |
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Encephalitis, post-infectious1 |
0 |
0 |
1 |
0.3 |
14 |
1 |
|
Giardiasis (acute) |
208 |
187 |
133 |
176 |
1311 |
149 |
|
Haemophilus influenzae , invasive1 |
2 |
13 |
6 |
7 |
48 |
6 |
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Hansen’s Disease (Leprosy) |
0 |
2 |
0 |
0.7 |
3 |
0 |
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Hantavirus Infection |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hemolytic Uremic Syndrome |
2 |
0 |
0 |
0.7 |
7 |
2 |
|
Hemorrhagic Fever |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hepatitis A |
73 |
102 |
106 |
93.7 |
797 |
84 |
|
Hepatitis B |
43 |
44 |
47 |
44.7 |
530 |
52 |
|
Hepatitis C2 |
NR |
NR |
3 |
NR |
54 |
7 |
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Hepatitis Non-A, Non-B |
7 |
13 |
0 |
6.7 |
10 |
3 |
|
Hepatitis, perinatal B2 |
NR |
NR |
0 |
NR |
2 |
1 |
|
Hepatitis, unspecified |
0 |
0 |
1 |
0 |
16 |
2 |
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Hepatitis, +HBsAg, pregnant woman2 |
NR |
NR |
1 |
NR |
222 |
35 |
|
Lead Poisoning |
211 |
275 |
64 |
183.3 |
891 |
128 |
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Legionellosis |
1 |
12 |
6 |
6.3 |
28 |
11 |
|
Leptospirosis |
0 |
0 |
0 |
0 |
1 |
0 |
|
Listeriosis2 |
NR |
NR |
4 |
NR |
32 |
4 |
|
Lyme Disease |
2 |
3 |
2 |
2.3 |
48 |
2 |
|
Malaria |
13 |
8 |
18 |
13 |
97 |
9 |
|
Measles |
0 |
1 |
0 |
0.3 |
2 |
0 |
|
Meningococcal Disease (N. meningitidis) |
43 |
32 |
23 |
32.7 |
122 |
25 |
|
Meningitis, Group B Streptococci |
2 |
2 |
3 |
2.3 |
14 |
5 |
|
Meningitis, Haemophilus influenzae1 |
2 |
3 |
2 |
2.3 |
13 |
1 |
|
Meningitis, Streptococcus pneumoniae |
25 |
30 |
26 |
27 |
97 |
26 |
|
Meningitis, Listeria monocytogenes |
0 |
1 |
2 |
1 |
12 |
1 |
|
Meningitis, other bacterial (including unspecified) |
9 |
9 |
12 |
10 |
61 |
9 |
|
Mercury Poisoning |
0 |
0 |
0 |
0 |
7 |
1 |
|
Mumps |
6 |
2 |
0 |
2.7 |
6 |
0 |
|
Neurotoxic Shellfish Poisoning2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Pertussis |
4 |
11 |
4 |
6.3 |
85 |
3 |
|
Pesticide Poisoning |
0 |
1 |
0 |
0.3 |
32 |
1 |
|
Plague |
0 |
0 |
0 |
0 |
0 |
0 |
|
Poliomyelitis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Psittacosis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Rabies, Animal |
57 |
46 |
28 |
43.7 |
176 |
26 |
|
Rocky Mountain Spotted Fever |
1 |
1 |
1 |
1 |
2 |
0 |
|
Rubella, including congenital |
0 |
0 |
0 |
0 |
1 |
1 |
|
Salmonellosis |
221 |
253 |
260 |
244.7 |
3048 |
217 |
|
Shigellosis |
178 |
194 |
232 |
201.3 |
1484 |
213 |
|
Smallpox2 |
NR |
NR |
0 |
NR |
0 |
0 |
|
Staphylococcus aureus, (GISA/VISA)2 |
NR |
NR |
0 |
NR |
1 |
0 |
|
Staphylococcus aureus, (GRSA/VRSA)2 |
NR |
NR |
0 |
NR |
0 |
0 |
|
Streptococcal Disease, invasive Group A |
5 |
10 |
10 |
8.3 |
93 |
25 |
|
Streptococcus pneumoniae , invasive disease |
46 |
125 |
95 |
88.7 |
690 |
233 |
|
Tetanus |
0 |
1 |
1 |
0.7 |
3 |
0 |
|
Toxic Shock Syndrome |
0 |
2 |
2 |
1.3 |
6 |
0 |
|
Toxoplasmosis |
1 |
3 |
0 |
1.3 |
16 |
1 |
|
Typhoid Fever |
3 |
4 |
15 |
7.3 |
23 |
0 |
|
Vibrio cholerae (serogrp O1) |
0 |
0 |
0 |
0 |
1 |
0 |
|
Vibrio cholerae (serogrp Non-O1) |
2 |
1 |
2 |
1.7 |
9 |
1 |
|
Vibrio vulnificus |
1 |
0 |
2 |
1 |
23 |
0 |
|
Vibrio other (including unspecified) |
4 |
2 |
3 |
3 |
48 |
4 |
|
Yellow Fever |
0 |
0 |
0 |
0 |
0 |
0 |
1 Haemophilus influenzae can be the agent responsible for disease under three of the reportable conditions listed-: "Haemophilus influenzae, invasive" and under "Encephalitis, post infectious." Cases of Haemophilus influenzae meningitis are reported under "Meningitis, H. influenzae."
2 The reportable disease rule was revised in July, 1999. Kawasaki Disease, Histoplasmosis, Reye Syndrome, and Typhus were deleted from the weekly disease table since cases are no longer reportable as of July 4, 1999. Hepatitis C; perinatal hepatitis B; hepatitis B +HbsAg, pregnant woman; listeriosis; smallpox, S. aureus (GISA/VISA) and S. aureus (GRSA/VRSA) were added to the reporting requirements as of July 4, 1999. Paralytic shellfish poisoning is now referred to as neurotoxic shellfish poisoning.
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