A weekly publication by the Bureau of Epidemiology
For July 12, 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
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 Department of Health has a home on the World Wide Web at http://www.doh.state.fl.us
1. Reporting Social Security Numbers
Don Ward, Surveillance Section Administrator
One of the changes (effective June 4) in the notifiable disease and reporting rule requires the inclusion of the client’s social security number (SSN) for all morbidity reports and positive laboratory results. This change has raised concern in some county health departments that collecting social security numbers is often difficult, provides no added value, and offers more opportunities for breaches of confidentiality or identity theft.
Our reasoning is somewhat different. Staff training and tactful solicitation of social security numbers with a reasonable explanation of how the number will be used, often decreases the anxiety in clients providing their SSNs. Social security numbers are collected in many other circumstances when state government requires positive identification.
The most important reason that the Bureau of Epidemiology wants social security numbers for morbidity and laboratory tests is to avoid duplication in the morbidity and laboratory databases as we move from a county-specific system to statewide databases that perform a registry function. Social security numbers are specific individual identifiers. The ability to identify specific clients is becoming increasingly important as databases and data systems are linked as part of Governor Bush’s initiatives. Discussions with other program managers confirm that for statewide registries, duplication of records is an important issue.
Finally, while opportunities for breaches of confidentiality do exist, clients are at no greater risk simply because they have provided one more piece of information. They are still protected by the state’s laws governing confidentiality. The final decision to emphasize collection of social security numbers rests with the counties-the lack of a social security number will not impede the ability to report any case of a notifiable disease. Although cases will still be accepted without a social security number, the development of an efficient file of unduplicated cases depends on documentation of social security numbers.
2. Arbovirus Activity Summary for the Week Ending July 8, 2000
Ms. Robin Oliveri, Arbovirus Surveillance Coordinator and Dr. Lisa Conti, State Public Health Veterinarian
At present, no arbovirus medical alerts are issued for the state. During the period July 2 through July 8 the following arbovirus* activity was recorded for Florida:
(*mosquito-borne virus including St. Louis encephalitis [SLE] virus, Eastern Equine encephalitis [EEE] virus, West Nile [WN] virus and dengue virus)
Human: No new arbovirus cases were reported to the State Health Office during the week. For the year-to-date, 2 dengue cases were identified (residents of Putnam and Volusia counties, respectively). (Source: County health departments and Department of Health (DOH) laboratories through private medical providers).
Sentinel chickens: No sentinel chicken seroconversions were identified (342 tested). For the year to-date, one chicken from Flagler County seroconverted to EEE virus. (Source: DOH Tampa Laboratory from mosquito control agencies and county health departments)
For additional information, please click on the DOH web site link that is listed below.
Equine: No horses were reported with arboviruses during the week. To date, 15 horses had laboratory results and clinical signs of EEE. (Source: Department of Agriculture and Consumer Services Laboratory)
Bird Mortality: One dead cardinal was reported from Hillsborough County. Although we are collecting information about all dead birds at this time, the DOH is testing crows that have died within 24 hours prior to report. To date, 4 crows were tested and none were found to have arboviruses. (Source: Florida Fish and Wildlife Conservation Commission website) and DOH Tampa Laboratory).
Mosquito Pools: No mosquito pools were tested at the DOH Laboratory for arboviruses during this period. (Source: DOH Laboratory and mosquito control agencies).
3. Florida Past – Florida’s First Indigenous Case of Human Rabies?
William J. Bigler, PhD
The first known case of rabies in Florida was recorded as ‘hydrophobia" on a death certificate of a 38 year old white male from Key West in 1881. Since there is no historical record of rabies in dogs or cats in the Keys at that time, there is a possibility the exposure of this unfortunate individual might have taken place in another country. Still, by 1899, local Key West newspapers were reporting human cases of hydrophobia following attacks by mad dogs in the city. The first thoroughly documented indigenous case of human rabies in Florida was reported in the Florida Health Notes in November 1894 by Dr. R. A. Lancaster of Gainesville."
On the 27th of last July, Margaret Anderson, a colored woman, aged 57 years , was bitten by a sick cat, the animal’s teeth fastening into the fleshy part of the hand, and holding on until choked and pried loose. Four days later I was called, and found an extensive cellulitis, for which I incised the hand liberating pus. I ordered the hand polticed with carbonized flaxseed meal and in course of time the hand returned to its normal condition. On the 19th of the present month (November) I was called again, and found the patient in nervous condition, with an ill-defined dread manifesting itself in constant change of position, and in the appealing look and words of the patient to do something for her relief. She complained of a stiffening of the hand and arm, accompanied by shooting pains extending from hand to shoulder. I at once recognized the symptoms of hydrophobia, and offered water to the patient...Already there was some difficulty in swallowing-----the sight or mention of water brought on painful laryngeal contractions, with expression of fear and pain from the patient who longed to have it removed from sight. There was an indescribable wild, scared look about the patient with constant restlessness and insomnia. The attempt to give chloral and other remedies by enema would bring on such paroxysms of fear and pain that I abandoned all remedies except hypodermic injections of morphia and atropia. This I gave freely, controlling the suffering. At no time did the patient attempt to harm her attendants----Though there was a frequent reference to the cat bite by the patient, who fully recognized her troubles, and the unfavorable prognosis. The patient died on the 20th, some forty-eight hours after the first decided symptoms.
Editorial Note: A total of 73 indigenous human cases of rabies have been reported in Florida since the 1881 case, with the last case in 1948. Most cases were presumed to be related to dog bites in counties where outbreaks of rabies in dogs were common. The most recent reported cases of human rabies in Florida were in 1994 and 1996. Both were considered imported cases as they involved adult males that had documented exposure to rabid dogs in Haiti and Mexico respectively.
4. Editor’s Note: Weekly Disease Table Will Return Next Week
The computer program that generates data for the weekly disease table is being revised to reflect recent notifiable disease rule changes. The weekly disease data will return to Epi Update next week.