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. Florida Bird Mortality Reporting: A Tool for West Nile Virus Surveillance

2. Notice to Readers: Revision of Acute Hepatitis Panel

3. Preparing for the Next Influenza Pandemic: Satellite Teleconference

4. FDA Advises Consumers about Fresh Produce Safety

5. California State Health Director Advises Consumers to Wash Cantaloupe Before Eating

6. Florida Past - A Clean Bill Of Health

7. Weekly Disease Table: Week 21

Ms. Robin Oliveri, Arbovirus Surveillance Coordinator and Dr. Sharon Taylor, Fish and Wildlife Conservation Commission Wildlife Veterinarian

The identification of West Nile Virus (WNV) in the New York City area during 1999 was preceded by discovery of a suspicious bird die-off, especially birds in the crow family. As a new part of Florida’s West Nile surveillance system, a bird mortality reporting database has been established through cooperation between the Bureau of Epidemiology and the Florida Fish and Wildlife Conservation Commission (FWCC). Anyone who discovers a dead bird will be able to enter the requested information and submit the report via the Internet. Tracking bird mortality was shown to be a useful surveillance tool during the WNV outbreak in the Northeast.

County health departments and other agencies are encouraged to direct citizens to report dead birds using the web site. If the reporter does not have access to the Internet site, local agencies can submit the information and post the report on their behalf. A link to the Department’s home page is included on the reporting site and will provide interested consumers the possibility to view additional information on West Nile Virus. If you have questions or require additional information, please do not hesitate to contact Robin Oliveri, Arbovirus Surveillance Coordinator or Dr. Lisa Conti, State Public Health Veterinarian.

(Source: MMWR, May 19, 2000 / 49(19); 424-425)

Current Procedural Terminology (CPT) codes are standardized codes developed and maintained by the American Medical Association (AMA) for the classification and reporting of medical services. The Health Care Financing Administration (HCFA) requires the use of these codes for reporting services to Medicare and Medicaid for reimbursement. On January 1, 1998, the components of the test panel for acute viral hepatitis (CPT#80059) were changed to exclude the tests for IgM antibody to hepatitis A virus (IgM anti-HAV) and IgM antibody to hepatitis B core antigen (IgM anti-HBc), the tests that specifically identify recent infection with hepatitis A virus (HAV) and hepatitis B virus (HBV).

Effective January 1, 2000 (CPT 2000), the acute hepatitis panel has been revised (CPT#80074) to re-include the tests for IgM anti-HAV and IgM anti-HBc. This revised panel, which also includes tests for hepatitis B surface antigen (HBsAg) and antibody to hepatitis C virus (anti-HCV), should be used to diagnose any patient presenting with signs and/or symptoms of acute viral hepatitis. Additional information on CPT codes is available at the AMA World-Wide Web site.

Hank Janowski, MPH, Chief, Bureau of Immunization

In preparation for the next influenza pandemic (and its anticipated vaccine shortage and disruption of social and community services), public health experts from federal, state and local agencies have developed state and local guidelines to lessen worldwide morbidity and mortality. This summer, the Centers for Disease Control and Prevention (CDC) will broadcast a live, interactive satellite teleconference--"Preparing for the Next Influenza Pandemic." The program will update local, state and national plans; describe the federal role in the case of pandemic influenza; and provide recommendations for antiviral drug use and triage and infection control measures. The broadcast will be aired on July 13, 2000, from 9:00 a.m. to 11:00 a.m. and repeated from 1:00 p.m. to 3:00 p.m. (EDT) on the same day.

The program content is most appropriate for state and local health officers; state and local epidemiologists; federal, state and local emergency preparedness planners; immunization program managers; state governors; physician and health care organizations; laboratory managers; public information officers; pharmacists; hospital infection control practitioners; members of the media and funeral directors associations.

Continuing education credit will be offered for a variety of professions, based on 2 hours of instruction.

To participate in the course, please register with your local site coordinator no later than June 16, 2000. No registration will be accepted after that date. For the name and telephone number of the site coordinator in your area, please contact Linda Zeigler of the Bureau of Immunization.

The Food and Drug Administration is advising consumers to be aware of safe handling and preparation practices for fresh fruits and vegetables. The Centers for Disease Control and Prevention has reported that the occurrence of foodborne disease increases during the summer months for all foods, including fresh produce. Foodborne illness can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons with foodborne illness can experience fever, diarrhea, nausea, vomiting and abdominal pain.

Following are some steps that consumers can take to reduce the risk of foodborne illness from fresh produce:

* At the store, purchase produce that is not bruised or damaged. If buying fresh cut produce, be sure it is refrigerated or surrounded by ice.

* At home, chill and refrigerate foods. After purchase, put produce that needs refrigeration away promptly. (Fresh whole produce such as bananas and potatoes do not need refrigeration.) Fresh produce should be refrigerated within two hours of peeling or cutting. Leftover cut produce should be discarded if left at room temperature

for more than two hours.

* Wash hands often. Hands should be washed with hot soapy water before and after handling fresh produce, or raw meat, poultry, or seafood, as well as after using the

bathroom, changing diapers, or handling pets.

* Wash all fresh fruits and vegetables with cool tap water immediately before eating. Don't use soap or detergents. Scrub firm produce, such as melons and cucumbers, with a clean produce brush. Cut away any bruised or damaged areas before eating.

* Wash surfaces often. Cutting boards, dishes, utensils, and counter tops should be washed with hot soapy water and sanitized after coming in contact with fresh produce,

or raw meat, poultry, or seafood. Sanitize after use with a solution of 1 teaspoon of chlorine bleach in 1 quart of water.

* Don't cross contaminate. Use clean cutting boards and utensils when handling fresh produce. If possible, use one clean cutting board for fresh produce and a separate

one for raw meat, poultry, and seafood. During food preparation, wash cutting boards, utensils or dishes that have come into contact with fresh produce, raw meat,

poultry, or seafood. Do not consume ice that has come in contact with fresh produce or other raw products.

* Use a cooler with ice or use ice gel packs when transporting or storing perishable food outdoors, including cut fresh fruits and vegetables.

Following these steps will help reduce the risk of foodborne illness from fresh produce.

Sacramento - State Health Director Diana M. Bontá, R.N., Dr. P.H., today reminded consumers to always thoroughly wash the outer skin of a cantaloupe before consuming the fruit, following a multistate outbreak of Salmonella poisoning that has sickened at least 39 individuals in California, Oregon, New Mexico, Nevada and Washington.

Consumption of tainted cantaloupe has been linked to at least 19 reported illnesses from an uncommon type of Salmonella, known as Salmonella Poona, in 13 California counties between April 14 and May 1. The illnesses include two cases each in Contra Costa, Los Angeles, San Diego, San Francisco, Santa Clara, and Solano counties and one each in Alameda, Amador, Butte, Fresno, Kern, San Luis Obispo and Santa Cruz counties. The

usual number of cases of Salmonella Poona reported in California is fewer than four per month.

In California, all but five of the ill individuals were children 9 years old or under. At least six of the individuals were hospitalized; all have recovered. While most of the individuals ate melons that were purchased whole and cut at home, some ate pre-cut cantaloupes purchased from supermarkets or were served cantaloupes in restaurants. The location where the cantaloupes were grown, and the source of the contamination, are under investigation.

Cantaloupe has been implicated in previous Salmonella outbreaks, including a multi-state outbreak of more than 400 cases due to Salmonella Poona in 1991 and an outbreak in California of more than 20 cases due to Salmonella Saphra in 1997.

Because cantaloupes are grown on the ground, their outer skin can become contaminated in the field by human or animal waste, or during distribution prior to sale. "Cantaloupe meat can become contaminated when it is sliced through contaminated rind without prior scrubbing with soap and hot, running water," Bontá said. "Consumers should handle cantaloupe as they would handle raw meat: they should wash their hands before and after handling the fruit and refrigerate unused cut portions immediately. In fact, all fruits and vegetables that are not peeled should be washed."

Salmonella Poona causes the same kind of illnesses as other types of Salmonella. Symptoms, which include fever, abdominal cramps and diarrhea, generally occur one to three days after eating contaminated food and last two to five days. While most ill individuals recover without the need for medical attention, the infection can be life threatening to young children, the elderly and those with compromised immune systems.

William J. Bigler, PhD and Davis D. Janowski