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EPI UPDATE
A weekly publication by the Bureau of Epidemiology
For August 9, 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 |
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, |
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. Don’t Forget the Merlin Web-based Reporting System Satellite Teleconference to be Held Monday, August 14, 2000, 2-4 PM EST (satellite testing from 1:30-2 PM EST)
2. Announcement: Dr. Bill Bigler’s Retirement Party
3. Dr. Hopkins Chosen as President-Elect of the Council of State and Territorial Epidemiologists (CSTE)
4. Community Health Status Indicators Web Page
5. Weekly Arbovirus Activity Summary
6. Florida Past - From the Doctor's Notes
7. Weekly Disease Table: Week 31
1. Don’t Forget the Merlin Web-based Reporting System Satellite Teleconference to be Held Monday, August 14, 2000, 2-4 PM EST (satellite testing from 1:30-2 PM EST)
Title: Introduction to the Merlin Web-based Disease Reporting System
Date: August 14, 2000
Time: 2 – 4 PM EST
Satellite Test: 1:30 PM – 2:00 PM
Specifications: Channel 18, G3
Target Audience: County health department disease reporting and epidemiology staff
Objective: To introduce the Merlin web-based disease reporting system to county health department staff that report communicable disease data to the Bureau of Epidemiology.
Description:
The purpose of this teleconference is to introduce county health department disease reporting and epidemiology personnel to the Merlin web-based disease reporting system, which will be up and running in every county health department beginning January 1, 2001. The Merlin system will become the standard disease reporting system for the Bureau of Epidemiology, replacing the current paper-based disease reporting system. Participants will be guided through the system at its current stage of development and will have an opportunity for a question and answer session. Extensive training will be provided in future sessions to be announced.
Registration: Please register with your local satellite site coordinator. A
list of the site coordinators for each county is posted on the Department of
Health Intranet web site (go to Office of Performance Improvement, then click on
"training").
2. Announcement: Dr. Bill Bigler’s Retirement Party
Zuber Mulla, MSPH, Regional Epidemiologist, Central Florida
Bill Bigler, PhD, Senior Epidemiologist with the Bureau of Epidemiology, is retiring after 35 years of distinguished service with the Florida Department of Health. Bill has served the State of Florida and its citizens in several positions including Research Director, Deputy State Epidemiologist, and Chief of the Tuberculosis Control Program. He is currently the supervisor of the field epidemiology section.
A retirement party will be held in his honor on August 30, 2000, from 2 to 4 PM in Room 310A of the Prather Building, Capital Circle Office Complex in Tallahassee. We are looking for pictures (originals will be returned), stories (written or oral), and cards/other greetings. Join us for a reunion and farewell and relive memories of how Bill has survived snakebites, overturned vehicles, attempted robbery, and reorganizations, all in the line of duty. Please contact Carina Blackmore, or Zuber Mulla for more information.
3. Dr. Hopkins Chosen as President-Elect of the Council of State and Territorial Epidemiologists (CSTE)
Don Ward, Surveillance Section Administrator
Congratulations to Dr. Richard Hopkins, State Epidemiologist and Chief of the Bureau of Epidemiology for his election as President-Elect of the Council of State and Territorial Epidemiologists (CSTE). CSTE is the leading organization for professional epidemiologists in the country. The organization’s vision, as described by the Executive Director reads," CSTE has a vision that places its members and the organization in a position to influence public health at the federal, local and state levels……." As President-Elect, Dr. Hopkins will serve one year, before becoming the President of the organization, also for one year. One of the most interesting and challenging of his duties as President-Elect will be planning the annual (2001) national meeting. We know that CSTE and professional epidemiology and the Florida Department of Health will benefit from Dr. Hopkins’ participation in the realization of the CSTE mission. We offer our good wishes and support
4. Community Health Status Indicators Web Page
Richard S. Hopkins, MD, MSPH, State Epidemiologist
A link to the Community Status Health Indicators web page is listed below. The web page was spearheaded by the Federal Health Services and Resources Administration, in collaboration with the Association of State and Territorial Health Officers, the National Association of City and County Health Officers, the Public Health Foundation, and other organizations. The site includes reports of health status indicators, one for each county in the Nation.
5. Weekly Arbovirus Activity Summary
Robin Oliveri, Arbovirus Surveillance Coordinator and Lisa Conti, DVM, MPH, State Public Health Veterinarian
There are currently no Arbovirus Medical Alerts issued for the state. During the period July 30, 2000 through August 5, 2000, the following arbovirus* activity was recorded for Florida:
(*Mosquito-borne virus including St. Louis encephalitis virus, Eastern Equine encephalitis virus, West Nile encephalitis virus and dengue virus)
Human: No new arbovirus cases were reported to the State Health Office. For 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 from medical providers)
Sentinel chickens: No sentinel chicken seroconversions were identified (487 chickens tested). (Source: DOH Tampa Laboratory from mosquito control agencies and county health departments).
Equine: One horse was reported with EEE in Escambia county. A map entitled "EEE in Horses by Owner’s County of Residence and Month of Report, January through June 2000" is attached. (Source: Department of Agriculture and Consumer Services Laboratory from veterinarians).
Bird Mortality: Three dead birds were reported from the following counties: Alachua -2; Seminole – 1. Although we are collecting information about any dead bird, at this time, the DOH is testing crows that have died within 24 hours prior to report. To date, 5 crows and 1 cattle egret have been tested and none were found to have arboviruses. (Source: Florida Fish and Wildlife Conservation Commission website.
Mosquito Pools: No mosquito pools were tested for arboviruses during this period. (Source: DOH Laboratory and mosquito control agencies).
6. Florida Past - From the Doctor's Notes
William J. Bigler, PhD
The March 1947 issue of Florida Health Notes was devoted to Florida's School Health Program. In the opening piece entitled "Our Joint Responsibility," Dr. Wilson T. Sowder, State Health Officer and Mr. Colin English, Superintendent , State Department of Education, describe a three-pronged approach to the school health program that included a healthy physical environment, health examinations, vaccinations, etc. and effective health education. A variety of articles describe a "state of the art" program for that time. Perhaps the most moving contribution was penned by Dr. Grace Hardy, a pediatrician with the State Board of Health, Bureau of Maternal and Child Health, as she described the condition of children undergoing routine examination. Her article entitled "From the Doctors Notes" follows:
Little Miss Florida looked up at me from the examining-table. She was confused and shrinking and I hoped my face registered nothing but an indifferent friendliness though at that moment tears might have been forgiven. Her hair was dry and brittle; her skin coarse and rough and thick and wrinkled; most of her teeth were severely decayed; her blood contained just half as much oxygen-carrying substance as is normal. In a low voice I could scarcely hear, she said: "I didn't wash my feet 'cause my Mother didn't have any water. She has to carry it a whole block and there are five of us." I wondered where the eight-year-old child could find the courage to struggle to school and find a place among her classmates with so many strikes against her - anemia, severe vitamin deficiency and dirt.
Little Miss Florida looked up at me. She was clean and her shining hair was tied up pertly with red bows. Her teeth were brushed and she was sweet smelling and happy. But what is this? Her weight is much below average for her age and height and her flesh is flabby. I asked. "Do you drink milk?" "Yes." she replied, "I have a glass every morning for breakfast. There are four children in our house and Mother divides the bottle up."
Little Miss Florida looked up. She was comparatively well nourished and happy, yet even she had marked dental decay. At her dismissal she flashed a beaming smile and said, " I had a nice time."
The morning had slipped away. One after another the little ones filed through. The story grew monotonous - decayed teeth, anemia, severe vitamin deficiency, dull hearing, sores on the skin and numerous ills related to infection. I picked up a book from a pile on the table at the door of the poor cafeteria. Its title was "Building for Health" and Chapter 3 - "foods that make us GROW and GO." The picture of the two boys - brothers they were - flashed into my mind. They were really candidates for hospital beds. Their hemoglobins registered 5 and 6 gms respectively; again that paralyzing lack of oxygen-carrying substance without which weakness and poor resistance to disease is inevitable. But these boys were in seats in a school room in our state.
SIX YEARS OLD came in. His grandmother came with him because she wished to find out why the child seemed breathless after even a little exertion. We found many of the signs of rheumatic heart disease, which explained his trouble. The grandmother listened appreciatively and took him to a pediatrician for further study and instruction regarding his care.
TWELVE YEARS OLD came in. He had been playing ball that morning. He was strangely pale and the rapid heart rate did not subside as it should. Yes, the heart was dilated and he had some fever. We sent him home to bed. The family's physician came and after study found he had rheumatic heart disease and an early tubercular infection.
That night I dreamed a special dream. It was not remote and intangible but it sprang, no doubt, from much wishful thinking. It had to do with warm shower baths for children from homes where water was scarce; with low-cost cafeterias where milk and vegetables were plentiful; with a convalescent home where children with crippled hearts could recover and add many useful years to an otherwise shortened life; with more readily available medical and dental care for the many needing it: and - have you guessed? - with a continuing school health program at the heart of it all.
7. Weekly Disease Table: Week 31
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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Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
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Botulism |
0 |
0 |
0 |
0 |
4 |
0 |
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Brucellosis |
0 |
2 |
0 |
0.7 |
3 |
2 |
|
Campylobacteriosis |
557 |
422 |
523 |
500.7 |
988 |
548 |
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Ciguatera |
2 |
6 |
2 |
3.3 |
2 |
2 |
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Cryptosporidiosis |
61 |
70 |
66 |
65.7 |
180 |
41 |
|
Cyclosporiasis |
57 |
6 |
2 |
21.7 |
5 |
5 |
|
Dengue |
2 |
1 |
2 |
1.7 |
3 |
1 |
|
Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
|
E. coli O157:H7 |
32 |
19 |
28 |
26.3 |
54 |
40 |
|
E. coli , other (known serotype) |
5 |
2 |
12 |
6.3 |
16 |
8 |
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Ehrlichiosis, Human |
2 |
0 |
1 |
1 |
2 |
3 |
|
Encephalitis, Eastern Equine |
1 |
0 |
0 |
0.3 |
3 |
0 |
|
Encephalitis, St. Louis |
0 |
0 |
0 |
0 |
4 |
0 |
|
Encephalitis, other (known organism) |
7 |
3 |
2 |
4 |
5 |
4 |
|
Encephalitis, post-infectious1 |
5 |
6 |
4 |
5 |
14 |
6 |
|
Giardiasis (acute) |
812 |
710 |
583 |
701.7 |
1322 |
682 |
|
Haemophilus influenzae , invasive1 |
14 |
28 |
34 |
25.3 |
53 |
30 |
|
Hansen’s Disease (Leprosy) |
0 |
3 |
2 |
1.7 |
3 |
2 |
|
Hantavirus Infection |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hemolytic Uremic Syndrome |
3 |
5 |
6 |
4.7 |
7 |
7 |
|
Hemorrhagic Fever |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hepatitis A |
264 |
298 |
372 |
311.3 |
796 |
278 |
|
Hepatitis B |
218 |
219 |
230 |
222.3 |
528 |
269 |
|
Hepatitis C |
NR |
NR |
28 |
NR |
56 |
19 |
|
Hepatitis Non-A, Non-B |
52 |
50 |
3 |
35 |
12 |
6 |
|
Hepatitis, perinatal B |
NR |
NR |
1 |
NR |
|
1 |
|
Hepatitis, unspecified |
4 |
5 |
9 |
1 |
17 |
6 |
|
Hepatitis, +HBsAg, pregnant woman |
NR |
NR |
183 |
NR |
449 |
232 |
|
Lead Poisoning |
776 |
1003 |
947 |
908.7 |
1810 |
434 |
|
Legionellosis |
14 |
22 |
13 |
16.3 |
27 |
27 |
|
Leptospirosis |
0 |
1 |
0 |
0.3 |
1 |
1 |
|
Listeriosis |
NR |
NR |
14 |
NR |
38 |
14 |
|
Lyme Disease |
14 |
23 |
13 |
16.7 |
51 |
16 |
|
Malaria |
44 |
34 |
48 |
42 |
97 |
49 |
|
Measles |
3 |
2 |
2 |
2.3 |
2 |
1 |
|
Meningococcal Disease (N. meningitidis) |
96 |
81 |
70 |
82.3 |
122 |
73 |
|
Meningitis, Group B Streptococci |
10 |
11 |
8 |
9.7 |
14 |
10 |
|
Meningitis, Haemophilus influenzae1 |
6 |
10 |
11 |
9 |
13 |
3 |
|
Meningitis, Streptococcus pneumoniae |
52 |
55 |
69 |
58.7 |
97 |
56 |
|
Meningitis, Listeria monocytogenes |
2 |
4 |
5 |
3.7 |
14 |
3 |
|
Meningitis, other bacterial (including unspecified) |
34 |
35 |
32 |
33.7 |
62 |
55 |
|
Mercury Poisoning |
2 |
0 |
2 |
1.3 |
7 |
7 |
|
Mumps |
8 |
9 |
2 |
6.3 |
6 |
2 |
|
Neurotoxic Shellfish Poisoning |
0 |
0 |
0 |
0 |
0 |
0 |
|
Pertussis |
45 |
23 |
51 |
39.7 |
86 |
36 |
|
Plague |
0 |
0 |
0 |
0 |
0 |
0 |
|
Poliomyelitis |
0 |
0 |
0 |
0 |
0 |
0 |
|
Psittacosis |
0 |
1 |
0 |
0.3 |
0 |
0 |
|
Q Fever2 |
NR |
NR |
NR |
NR |
0 |
0 |
|
Rabies, Animal |
181 |
122 |
107 |
136.7 |
186 |
87 |
|
Rocky Mountain Spotted Fever |
2 |
1 |
2 |
1.7 |
2 |
0 |
|
Rubella, including congenital |
1 |
3 |
0 |
1.3 |
1 |
3 |
|
Salmonellosis |
989 |
1126 |
1247 |
1120.7 |
3071 |
1170 |
|
Shigellosis |
667 |
1204 |
809 |
893.3 |
1491 |
760 |
|
Smallpox |
NR |
NR |
0 |
NR |
0 |
0 |
|
Staphylococcus aureus, (GISA/VISA) |
NR |
NR |
0 |
NR |
0 |
0 |
|
Staphylococcus aureus, (GRSA/VRSA) |
NR |
NR |
0 |
NR |
0 |
0 |
|
Streptococcal Disease, invasive Group A |
24 |
28 |
39 |
30.3 |
94 |
76 |
|
Streptococcus pneumoniae , invasive disease |
127 |
286 |
342 |
251.7 |
701 |
652 |
|
Tetanus |
0 |
2 |
2 |
1.3 |
3 |
0 |
|
Toxoplasmosis |
3 |
6 |
8 |
5.7 |
17 |
6 |
|
Typhoid Fever |
5 |
10 |
21 |
12 |
23 |
6 |
|
Vibrio cholerae (serogrp O1) |
0 |
0 |
0 |
0 |
0 |
0 |
|
Vibrio cholerae (serogrp Non-O1) |
6 |
6 |
6 |
6 |
10 |
4 |
|
Vibrio vulnificus |
7 |
14 |
9 |
10 |
23 |
2 |
|
Vibrio other (including unspecified) |
19 |
44 |
24 |
29 |
48 |
19 |
|
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 June 2000. Amebiasis and Toxic Shock Syndrome (Staphylococcal and Streptococcal) were deleted from the list of reportable diseases. Q Fever was added to the list of reportable diseases.
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