|
EPI UPDATE
A weekly publication by the Bureau of Epidemiology
For August 16, 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:
|
Steven Wiersma, MD, MPH,
Deputy State Epidemiologist |
William J. Bigler, PhD, MS,
Senior Epidemiologist |
Jodi Baldy, MPH,
Biological Scientist IV |
|
Ursula E. Bauer, PhD,
Chronic Disease Epidemiologist |
Lisa Conti, DVM, MPH,
State Public Health Veterinarian |
Regional Epidemiologists:
|
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. Annual Statewide Epidemiology Seminar to be Held October 5-6, 2000, Clearwater
2. E. Coli Outbreak Update
3. Grand Rounds for August 29, 2000
4. The Rabies Files: Real Life Experiences as Shared by County Health Departments
5. Florida Past - Not In My Back Yard
6. Weekly Disease Table: Week 32
1. Annual Statewide Epidemiology Seminar to be Held October 5-6, 2000, Clearwater
The Bureau of Epidemiology is pleased to announce that the next Annual Statewide Epidemiology Seminar (ASES) will be held in Clearwater on October 5th-6th.
The meeting will provide current information and education to public health
professionals regarding the reporting, investigation, and control of
communicable and non-infectious diseases of public health significance, with the
focus of improving the health of Florida residents and visitors. The primary
audience is county health department epidemiologists and other related staff.
Private physicians, practitioners, professionals in infection control, state and
private laboratory staff, etc. are also welcome. Students enrolled in a public
health program are also encouraged to participate in the annual seminar.
Conference Registration
The regular registration fee for the ASES is $100 if postmarked on or before September 27, 2000 ($120 if submitted after September 27, 2000). Students providing valid identification are offered registration at a discounted fee of $50 if postmarked on or before September 27, 2000 ($60 if submitted after that date). Attached is the conference registration form. Registration forms and payments should be mailed to:
Gulfcoast North AHEC, Inc.
6763 Land O’ Lakes Blvd.
Land O’ Lakes, FL 34639
Note: Cancellations must be confirmed in writing (fax acceptable) and received by the Gulfcoast North AHEC by 5:00 pm on Wednesday, September 27, 2000 to receive a full refund. Refunds will not be offered for "no shows;" however, substitutions are welcome without additional cost.
Hotel Information
The ASES will be held at the Belleview Biltmore in Clearwater, Florida. A block of rooms has been reserved for the occasion ranging from $86 (single/double occupancy) to $159 per night. To obtain the special conference rate, reservations should be made no later than September 4, 2000. If you can not attend the meeting, please cancel your reservations no later than seven (7) days prior to your scheduled arrival data to avoid forfeiture of deposit. Please contact the Belleview Biltmore to make your reservations.
2. E. Coli Outbreak Update
Submitted by Roberta M. Hammond, Ph.D., Mike Friedman, M.P.H., Bureau of Environmental Epidemiology
The Bureau of Environmental Epidemiology and Bureau of Laboratories have been working with CDC to follow-up on one cluster of E. coli 0157:H7 cases in Florida which appears to be related to clusters in other states. The patterns for this cluster are very common, necessitating matching by at least 2 or 3 enzymes. Three other possible clusters in Florida, each with two matching cases, (1-Brevard, Marion; 2-Miami-Dade, Palm Beach; 3-Palm Beach (2), are also being monitored at this time. There was an additional group of five cases that was initially thought to be a cluster related to other state cluster patterns, but after further examination of the patterns, this has turned out to not be the case. At this point all the other E. coli 0157:H7 cases in Florida are considered to be sporadic as they do not seem to match the other clusters or each other. There are no speculations at this time as to any common exposures. If there is any further information about these clusters, it will be in next week’s update.
Cluster #1: 7 Florida cases – Orange (1), Broward (1), Sarasota (1), Hillsborough (2), Pasco (1), Ft. Walton (1- visitor from Kentucky):
Fifteen (15) states and Canada have now reported cases with matching PFGE patterns by at least one enzyme, and 9/15 states match by 2 or 3 enzymes (approximately 44 cases – this figure changes as labs report enzyme results). CDC is continuing to receive PulseNet listserv messages from new states reporting matching cases. Due to the commonality of this pattern, it is essential that the isolates are restricted by Bln 1 in addition to Xba 1 to declare a match. All of the labs involved have been notified of this and have, or are in the process of, doing further restriction analysis. This is a very common pattern and does not necessarily imply an outbreak. Nevertheless "trawling" questionnaires have been administered to attempt to determine if there is a common food. None has been identified at this time.
3. Grand Rounds for August 29, 2000
"Florida's Quest for Public Health: An Epidemiologic Retrospective"
William J. Bigler, PhD,MS, Senior Epidemiologist, Bureau of Epidemiology
11:00 AM - 12:00 PM EST
Abstract:
In tracing the history of the Department of Health (DOH) and its predecessors, one can easily develop an appreciation for how much progress has been made during the past century. Over the years, dramatic political, economic, and social changes have caused development of the state's public-health agencies to have many twists-and-turns and ups-and-downs. Even though the events of Florida's history have sometimes driven public health initiatives, there have been other times the agency or the federal government with the support of allied agencies and organizations, both public and private, have taken the lead. The end result has been that overall the quality of life we all enjoy today in Florida is directly linked to a wide variety of public-health-related activities.
Archival reports vividly describe the hardships that Florida's public-health pioneers endured and the enormous amount of energy they expended to accomplish their goals. Through it all, their efforts to conduct surveys, investigate epidemics, evaluate new treatment and prevention measures and initiate special studies have consistently had an impact on policy decisions, health-care practices and public attitudes. Then as now, some unique and revolutionary concepts proposed to prevent disease were met with widespread public and professional resistance, while others were embraced without question.
Today the DOH has a unique opportunity to take a leadership position in epidemiologic research. With a clear vision, consistent approach, resourceful planning, creative financing, a bit of luck, and support from like-minded researchers throughout the state the Department should be able to use its capabilities to advance public health dramatically as we move into the new millennium.
Additional Information:
Further details regarding the audio-conference call and PowerPoint files will be posted on the Bureau of Epidemiology Intranet web site. Information about upcoming topics and presenters will also be posted in future Epi Updates. If either of these access points is unavailable to you, please e-mail Melanie Black
to request presentation materials.
Important:
While we realize you might not always be able to call in at 11:00 AM, it can be distracting to the speakers and others in the audience when participants dial-in throughout the hour. Please try to call in on time and remember to put your phones on mute so as not to disturb others. Thank you for your cooperation.
4. The Rabies Files: Real Life Experiences as Shared by County Health Departments
County health department and animal control staff can attest that interesting stories are the norm for rabies investigations. This recent account is contributed by Madeleine Wallace, RN from the Marion County Health Department:
Mr. X was walking towards a lake to get his boat to go fishing. He heard a woman screaming, "Help that dog, save the dog!" He ran towards the lake and saw a puppy attempting to crawl up a seawall and not having much success in gaining a purchase. He looked out into the water and saw that an alligator had the puppy blocked in the canal, leading out into the lake. The puppy was scrambling frantically. Mr. X jumped into the canal and tried to get a hold of the dog. The puppy slipped and, in order not to fall back into the water, grabbed onto Mr. X's hand with his teeth causing a bite wound. Mr. X then pushed the pup over the wall onto the other side. The dog then began swimming out into the lake again. By this time the victim's brother-in-law had the boat launched and Mr. X jumped into the boat and they went in pursuit of the puppy, fearing the gator would catch up to it or it would get tired and drown. They attempted to scoop it up with their fishing net. The gator was only a few feet from the animal. Mr. X said that by this time all he could think about was rescuing the dog. Finally they caught it by the tail and hauled it into the boat. The gator dived to the lake bottom without this canine meal. Initially they thought the pup was either a Shepherd dog or a fox. It was soaking wet and hard to tell during all the excitement. The pup ran off immediately upon reaching land. After a few moments reflection Mr. X started thinking about the pup and realized it was a coyote pup. The people who lived around the lake stated that they had never seen the pup around but had seen coyotes around the area. Mr. X said that had he known anything about rabies he would have never let the animal go, but in the frenzied rescue attempts he just wasn't thinking about anything but saving the dog (or whatever it was). "I'd do it again, but the next time I'll be sure he doesn't get away!" Mr. X is on rabies prevention.
5. Florida Past - Not In My Back Yard
William J. Bigler PhD
Historically, the State Board of Health and its successors have taken on the task of handling complaint and nuisance calls. Once county health departments were created they responded to such problems on a daily basis. However, early on, the public had ample opportunity to deal directly with the Board and there was an indication that the state would just as soon pass on requests for someone to bury a pig, cow, dog or cat that was found dead. A couple of interesting articles found in the July and September issues of Florida Health Notes for 1912 illustrate the frustration of the Board and its staff, not only at that time, but for many years thereafter.
July - In the good old days on the farm, when the world seemed newer than it does now, and when people lived further apart and yet nearer together, it sometimes happened that an animal died. It made no difference whose animal it was, when dead it belonged to no one, and yet it was easily disposed of. If a large one, and too much for one man, two took it in charge. One would say to another: "Let's go and bury this animal," and they went. If a third happened along he joined the other two. A few minutes labor and the ceremony was over. Nobody was out anything but the little time required for digging the grave and filing it up. Perhaps thirty minutes, when ten hours were worth a dollar and a half.
That custom still prevails among the plain country folk. No one would think of writing the State Board of Health two hundred miles away that "an animal is dead near my house,'' and "please have somebody dispose of it." They would laugh at the very thought of driving six miles to town and spend a half-day to see the chairman of the board of county commissioners to get him to have someone bury a dead pig in the vicinity. And least of all would these plain country people subject themselves to the smell while they quarreled over whose duty it was to move it, or blamed the legislature, or the county commissioners, while they held their noses at the feast of buzzards.
In the city of course the street cleaning department looks after such things, and no one thinks of doing it himself. He calls the scavenger cart and that is the last of it.
Neither in the country nor in the city is there any trouble about a carcass. But a little zone just around the city, where people are too proud for country ways, and too poor for city ways, there the buzzards feast. These poor proud denizens of this unkempt zone will try every office from governor to dog catcher, but they would hold their noses ‘til doomsday before they would touch it themselves. They will argue that it will make them sick, but what is sickness, compared to such menial labor. They would die, if need be, and think perhaps they had died the death of martyrs; they would die and be themselves wafted away in similar odors, but they would never touch that pig.
September - A certain man had a country house and lo’ and behold a horse came and fell dead, nigh unto his door. Now when he saw that the horse was dead, he wot not what to do to get him away from his house. In his perplexity he requested the man who owned the horse to move him away, but the man would not. Seeing the man would not move him, when the horse began to stink he wrote a letter to the State Board of Health, which is in the city of Jacksonville, but the State Health Officer made answer that the law did not direct that he should move the horse.
And it came to pass that when he got no relief and the stink was terrible to
bear, the man took his wife and his children and his household goods and moved a
comfortable distance, and there rested till all that remained of the horse was
only dry bones, and stank no more. And when the man saw that the horse was only
dry bones, and stank no more, he took his wife and his children and his
household goods and moved back to his home, and there abode in peace.
6. Weekly Disease Table: Week 32
County-Confirmed Cases, Sorted Alphabetically by Disease
(NR represents years that the disease lacked status as a reportable condition)
|
DISEASE |
1997 TO DATE |
1998 TO DATE |
1999 TO DATE |
3 YEAR AVERAGE
TO DATE |
1999 TOTAL CASES |
2000 TO DATE |
|
Anthrax |
0 |
0 |
0 |
0 |
0 |
0 |
|
Botulism |
0 |
0 |
0 |
0 |
4 |
0 |
|
Brucellosis |
0 |
2 |
0 |
0.7 |
3 |
2 |
|
Campylobacteriosis |
584 |
431 |
548 |
521 |
988 |
575 |
|
Ciguatera |
4 |
6 |
2 |
4 |
2 |
2 |
|
Cryptosporidiosis |
67 |
72 |
71 |
70 |
180 |
47 |
|
Cyclosporiasis |
58 |
6 |
3 |
22.3 |
5 |
6 |
|
Dengue |
2 |
1 |
2 |
1.7 |
3 |
2 |
|
Diphtheria |
0 |
0 |
0 |
0 |
0 |
0 |
|
E. coli O157:H7 |
34 |
20 |
28 |
27.3 |
54 |
42 |
|
E. coli , other (known serotype) |
5 |
2 |
13 |
6.7 |
16 |
8 |
|
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 |
3 |
4.3 |
5 |
4 |
|
Encephalitis, post-infectious1 |
5 |
7 |
5 |
5.7 |
14 |
6 |
|
Giardiasis (acute) |
844 |
743 |
606 |
731 |
1322 |
724 |
|
Haemophilus influenzae , invasive1 |
15 |
29 |
35 |
26.3 |
53 |
31 |
|
Hansen’s Disease (Leprosy) |
0 |
3 |
2 |
1.7 |
3 |
2 |
|
Hantavirus Infection |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hemolytic Uremic Syndrome |
3 |
6 |
6 |
5 |
7 |
7 |
|
Hemorrhagic Fever |
0 |
0 |
0 |
0 |
0 |
0 |
|
Hepatitis A |
273 |
302 |
381 |
318.7 |
796 |
289 |
|
Hepatitis B |
225 |
232 |
241 |
232.7 |
528 |
278 |
|
Hepatitis C |
NR |
NR |
30 |
NR |
55 |
20 |
|
Hepatitis Non-A, Non-B |
54 |
51 |
3 |
36 |
10 |
6 |
|
Hepatitis, perinatal B |
NR |
NR |
1 |
NR |
|
1 |
|
Hepatitis, unspecified |
4 |
7 |
9 |
1 |
17 |
6 |
|
Hepatitis, +HBsAg, pregnant woman |
NR |
NR |
186 |
NR |
448 |
236 |
|
Lead Poisoning |
810 |
1060 |
990 |
953.3 |
1810 |
482 |
|
Legionellosis |
15 |
22 |
14 |
17 |
27 |
29 |
|
Leptospirosis |
0 |
1 |
0 |
0.3 |
1 |
1 |
|
Listeriosis |
NR |
NR |
15 |
NR |
38 |
17 |
|
Lyme Disease |
14 |
23 |
14 |
17 |
51 |
16 |
|
Malaria |
46 |
35 |
52 |
44.3 |
97 |
50 |
|
Measles |
3 |
2 |
2 |
2.3 |
2 |
1 |
|
Meningococcal Disease (N. meningitidis) |
99 |
84 |
70 |
84.3 |
122 |
74 |
|
Meningitis, Group B Streptococci |
11 |
11 |
9 |
10.3 |
14 |
11 |
|
Meningitis, Haemophilus influenzae1 |
6 |
11 |
11 |
9.3 |
13 |
3 |
|
Meningitis, Streptococcus pneumoniae |
52 |
55 |
71 |
59.3 |
97 |
58 |
|
Meningitis, Listeria monocytogenes |
2 |
4 |
6 |
4 |
14 |
3 |
|
Meningitis, other bacterial (including unspecified) |
35 |
37 |
32 |
34.7 |
62 |
56 |
|
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 |
53 |
40.3 |
85 |
37 |
|
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 |
189 |
127 |
114 |
143.3 |
186 |
91 |
|
Rocky Mountain Spotted Fever |
2 |
1 |
2 |
1.7 |
2 |
0 |
|
Rubella, including congenital |
1 |
3 |
0 |
1.3 |
1 |
3 |
|
Salmonellosis |
1049 |
1196 |
1316 |
1187 |
3071 |
1248 |
|
Shigellosis |
699 |
1247 |
833 |
926.3 |
1491 |
788 |
|
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 |
40 |
30.7 |
94 |
78 |
|
Streptococcus pneumoniae , invasive disease |
129 |
289 |
351 |
256.3 |
701 |
657 |
|
Tetanus |
0 |
2 |
2 |
1.3 |
3 |
0 |
|
Toxoplasmosis |
3 |
7 |
9 |
6.3 |
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 |
7 |
6.3 |
10 |
4 |
|
Vibrio vulnificus |
7 |
15 |
10 |
10.7 |
23 |
3 |
|
Vibrio other (including unspecified) |
20 |
46 |
24 |
30 |
48 |
20 |
|
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.
|
