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.

The Bureau of Epidemiology is pleased to announce that the next Annual Statewide Epidemiology Seminar (ASES) will be held in Clearwater on October 5^th-6^th. 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.

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 or faxed 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.

Kathryn Snavely, MPH, Bureau of Epidemiology

The Bureau of Epidemiology is actively soliciting poster submissions for the Annual Statewide Epidemiology Seminar being held on October 5^th and 6^th in Clearwater. Poster presentations give conference participants the opportunity to present findings to the meeting in a less formal atmosphere and to interact more closely with other attendees. Some examples of poster subjects include results of an outbreak investigation, new prevention programs at the local level, or new laboratory methods being used in disease control.

The format for posters will follow a basic scientific paper outline where applicable:

Posters can be displayed as 3-fold foam core boards or any other method. Whatever method you choose, be sure that you have a primary and back-up plan for hanging or presenting the poster. Technical assistance for displaying posters will be available through the Bureau of Epidemiology. Please contact Kathryn Snavely for additional information.

The posters will be displayed in the evening on October 5^th, the first day of the seminar. There is no deadline for poster submission because we will not be printing up a list of abstracts.

Hank Janowski, MPH, Chief, Bureau of Immunization

The Department of Health, Bureau of Immunization, in conjunction with the Office of Performance Improvement, is making available the Immunization Update 2000 interactive satellite teleconference through the Department of Health Telnet Videoconference Sites on September 14, 2000 from 9:00 a.m. to 11:30 a.m. (EDT). A second broadcast will air from 12:00 p.m. to 2:30 p.m. (EDT) that same day. The content of this teleconference is most appropriate for clinic staff, nursing personnel, physicians, particularly those who administer vaccines. Anticipated topics include:

1. Update on Pneumococcal Conjugate Vaccine

2. Update on Influenza Vaccine

3. Brief discussion on Anthrax

4. Update on Polio

5. Update on Hep B Vaccine

6. Adolescent Schedule

7. Update on Meningococcal Vaccine

8. Other topics as deemed necessary

The Centers for Disease Control and Prevention (CDC) will offer continuing education credits for a variety of professions based on 2.5 hours of instruction (see attached course announcement). County health departments that have a Florida Board of Nursing Continuing Education Provider number may opt to grant contact hours following Florida Board of Nursing protocol.

To participate in the course, please register with your local site coordinator no later than August 31, 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.

"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

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.

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.

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.

This report summarizes Vibrio infections reported to CDC through the Vibrio Surveillance System in 1999. It is broken down by two categories: non-cholera Vibrio infections, both those reported from Gulf Coast and those from other states, and Vibrio infections causing cholera.

Since 1988, CDC has maintained a voluntary surveillance system for culture-confirmed Vibrio infections in the Gulf Coast states of Alabama, Florida, Louisiana, and Texas. Using a standardized form, investigators obtain clinical data, information about underlying illness, and epidemiologic data on seafood consumption and exposure to seawater in the week before illness. When a food item is implicated in illness, a traceback investigation is performed by state field investigators or the U.S. Food and

Drug Administration (FDA). Surveillance data have been used to identify environmental risk factors, retail food outlets where high-risk exposures occur, and target groups that may benefit from consumer education.

In recent years, other states have been invited to participate in the Vibrio Surveillance System, and surveillance has expanded to include FoodNet sites as well as states along both the East and West coasts. Surveillance for sporadic cases is the primary focus of this system, although outbreak-associated culture-confirmed cases are also included. Isolates from V. parahaemolyticus cases that occur in the Gulf Coast or FoodNet sites are submitted to CDC for serotyping.

A total of 342 cases of culture-confirmed non-cholera Vibrio infections were reported to the Vibrio Surveillance System in 1999, 164 from 5 Gulf Coast states (Alabama, Florida, Louisiana, Mississippi, and Texas) and 178 from 17 other states (Figure 1). Among patients about whom this information was available, 141 (46%) of 311 were hospitalized and 33 (11%) of 300 died. Although V. parahaemolyticus was the most frequently reported Vibrio species, V. vulnificus accounted for 31 (94%) of the 33 reported deaths.

Tables 1 and 2 divide the data into Gulf coast versus non-Gulf coast residents. The following is a summary of data from all sites: Three hundred (88%) of the Vibrio infections could be categorized into one of three well-recognized syndromes. One hundred seventy-two (50%) were classified as gastroenteritis, defined as an illness with diarrhea, vomiting, or abdominal cramps, no evidence of a wound infection, and Vibrio spp. isolated from stool alone. Eighty-two (24%) illnesses were classified as wound infections, in which the patient incurred a wound before or during exposure to seawater

or seafood drippings, and Vibrio spp. was subsequently cultured from blood, a wound, or a normally sterile site. There were 46 (13%) cases of primary septicemia, characterized by fever or shock in which Vibrio spp. Was isolated from blood or a normally sterile site, and no evidence of a wound infection (Tables 1 and 2). In 22 (6%) cases, the organism was cultured from ear, eye, gallbladder, urine, or the abdomen; and 20 (6%) case report forms contained insufficient information to be classified into one of these syndromes, all of these cases were reported as "other or unknown" syndrome.

Among illnesses with one Vibrio species in which the species was determined, V. parahaemolyticus accounted for 95/166 (57%) of the gastrointestinal illnesses, while V. vulnificus was isolated in 41/45 (91%) of septicemia cases. Although V. vulnificus was isolated in 28/71 (39%) wound infections, V. alginolyticus and V. parahaemolyticus made up 20% and 23%, respectively.

Gastrointestinal Vibrio infections had a clear seasonal peak, with 108 (63%) occurring between June and October. The majority of both wound infections, 69 (84%), and septicemia infections, 41 (89%) occurred between April and October (Figure 2).

Of the 218 persons with gastroenteritis or septicemia, 178/191 (93%) consumed seafood in the 7 days before illness onset. Of the 91 (51%) who consumed a single seafood, 61 (67%) ate oysters, 11 (12%) ate shrimp, 9 (10%) ate fish, 8 (9%) ate crabs, and 2 persons ate only clams or lobster. Of the 86 persons who provided information, 62 (72%) consumed their seafood raw.

In 102 (46%) of 222 Vibrio cases, the species was confirmed by the state public health laboratory. Twenty-four clinical isolates of V. parahaemolyticus from 23 patients in five states (CA, GA, MN, OR, and TX) were submitted to CDC for serotyping. Of the 23 patients, 5 (22%) had serotype O3:K6, 4 (17%) had O4:K12, while the remaining 14 patients had 10 other serotypes.

Five cases of toxigenic V. cholerae O1 from 4 states were identified in 1999 (Table 3). Three patients acquired their infection in India, one in Liberia, and one had no history of travel but consumed foods brought from the Philippines the week before illness. All patients had gastroenteritis. Three patients were hospitalized, and none died.

There are currently no Arbovirus Medical Alerts issued for the state. During the period August 13 through August 18, 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: Three sentinel chicken seroconversions to SLE were identified in Lee County and one EEE in Putnam county (574 chickens tested). To date, 8,660 chicken sera have been tested (Source: DOH Tampa Laboratory from mosquito control agencies and county health departments).

Wild Bird: Four seroconversions in captive crowned cranes to EEE were identified in Osceola county. To date, 159 non-sentinel bird sera have been tested (Source: DOH Tampa Laboratory).

Equine: No horses were reported with arboviruses (Source: Department of Agriculture and Consumer Services Laboratory from veterinarians).

Mosquito Pools: No mosquito pools were tested for arboviruses during this period. (Source: DOH Laboratory and mosquito control agencies).

I am moved by Dr. Bigler's "Florida Past" articles and thought I'd share:

Before becoming a health department director I worked the health department clinics in and around Orange County. It was not unusual for us to travel from one end of the county to provide clinical services and then drive clear across to the other end to do afternoon clinics and then perhaps treat patients at the STD clinic in evening clinic.

Among many vivid memories are two that stand out:

1. It was back in the late 1980s and during pediatrics clinic we had seen a beautiful little girl presented by her grandparents for a pediatric physical and immunizations. The three of them left the clinic with child in arm and away they went in Grandpop's old trusty/rusty pick-up. It turns out he was quite a fisherman.

Soon thereafter the three ran back into clinic, child again in arms yet crying desperately. The child had been riding on the floorboard and found a wonderful purple plastic worm, it smelled like grape and unfortunately when it was tasted, the hook caught the child's lip. We quickly found a wire cutter and out came the hook. The little girl recovered quickly; however, grandmother and grandfather father remained quite shaken.

2. The other picture imbedded in my mind occurred completely on the other end of the county. I had been providing prenatal care to a very young mother, yet it was shortly after birth that mother (now 13 years old) brought her child in for a well child check.

The young mother and baby were accompanied by Grandmom. I could not have taken a more poignant picture if I were a professional photographer; for sitting in the waiting room was a baby held by a mere child with her mother; the baby's mom had the baby's pacifier in her mouth.

Signed "anonymous"

William J. Bigler, PhD