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. Announcement: Communicable Disease Epidemiology Regional Training to be Held July 13 ^th -14^th in Orlando

2. Pseudoepidemic of Q fever at an Animal Research Facility (Abstract from presentation made at the at the American College of Rickettsiology)

3. Florida Past – The Case of the Missing Swiss Watch

4. Weekly Disease Table: Week 22

Melanie Black, LCSW, Bureau of Epidemiology

The Bureau of Epidemiology is pleased to announce the next principles of epidemiology training program for county health department staff members, which will be held in Orlando, Florida on July 13-14, 2000. The target audiences for the regional training programs are county health department staff members and partner agencies who are involved in epidemiology. County health directors and administrators are welcome to attend.

This program will provide an overview of epidemiological principles such as disease surveillance and reporting and communicable disease outbreak investigation. On-line registration will be available Monday June 12, 2000 through July 7, 2000 on the Bureau of Epidemiology Intranet web page.

Space is limited so please register as soon as possible.

Information will be provided in the Epi Update and on the Bureau of Epidemiology web page. We intend to offer training programs in other regions of the state this year. Tentatively, we have scheduled a September session for southeast Florida and a November session for southwest Florida. If you are interested in hosting one of the training sessions or have questions related to this program, please feel free to contact Melanie Black, LCSW, Professional Training Coordinator for the Bureau of Epidemiology.

Early in 1999, a ewe at an animal research facility at the University of Florida was discovered to have antibodies to Coxiella burnetii. Sera from 14 people directly exposed to this sheep were evaluated by a commercial laboratory and 86% had elevated antibody titers to phase I or II antigens. Testing of 54 additional persons revealed an overall prevalence of 74%. Local, state, and federal health officials were notified and an investigation was initiated. Interviews were conducted with 63(93%) of these 68 people to determine exposure history and any temporally-compatible illness. Review of test reports indicated that the commercial laboratory was misinterpreting their own results; when corrected, the proportion of patients considered "positive" dropped to 26%. When these serum samples were retested in the CDC laboratory, only seven people (6%) were considered seropositive (titers >128 to phase I or II antigen). Although the discrepancies were not fully explained, additional investigation indicated that the manufactured test kits used by the commercial laboratory gave comparable results with the CDC in-house assay. Eighteen persons described exposure to the infected sheep or infected tissues. Only the attending veterinarian had an illness compatible with Q fever and seroconverted to phase II antigens. Of the remaining six people with elevated titers to C. burnetii, two had phase I titers equivalent to phase II, and four had stored sera from prior to the event. Results from testing these sera showed stationary titers (N=3) or decrease in antibody to phase I antigen (N=1). This event resulted in increased risk reduction protocols at the research facility and improved public health communication between health authorities. This pseudoepidemic resulted from a lapse in laboratory quality control. Similar errors can be avoided through standardization and improved systemic review of laboratory procedures.

William J. Bigler, PhD

Before Dr. J. Y. Porter was appointed the first State Health Officer of the State Board of Health he was serving as Assistant Surgeon in the United States Army with a duty station in Key West. While there he acquired valuable experience in the management of patients with yellow fever and had also developed immunity to the disease. When the yellow fever epidemic of 1888 caused panic in the streets and a mass exodus from Jacksonville he was sent there to help city officials bring order to the chaos. In appreciation of his contributions during that epidemic the city presented him with a beautiful jeweled and engraved watch that mysteriously disappeared for many years. Excerpts from various sources describing the events follow: