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.

1. Ongoing Investigation of a Nassau County Cryptosporidium Outbreak

2. Two Sought after Bat at Outlet Mall in San Marcos, Texas Tests Positive for Rabies

3. Don’t Forget to Register for the Annual Statewide Epidemiology Seminar to be Held in Clearwater, October 5-6, 2000

4. Florida Past

5. Weekly Disease Table: Week 35

Eugenia Ngo-Seidel, M.D., Dolvin Foreman, Kim Geib, R.N., Marie E. Riley, R.N., Nassau County Health Department; and Kathleen Ward, M.S.E.H., R.S., Bureau of Environmental Epidemiology

The Nassau County (FL) Health Department and Bureau of Environmental Epidemiology are investigating a gastrointestinal outbreak in 20 visitors from New York City to a vacation resort in north Florida. The party of 8 adults and 12 children arrived on Sunday, August 13 and departed on Sunday, August 20. The entire week was spent in the vicinity of the vacation resort, except for a day trip to St. Augustine where one meal was consumed. The women and children of the party spent every day at a pool in the resort complex, the men went golfing in the morning and spent some time at the pool in the afternoon. On Thursday, August 17, the group went to St. Augustine for the day, and consumed a meal at a restaurant there.

So far, the epidemiologic information is as follows:

Onset times range from August 21 at 4pm to August 26 at 11am, with most onsets occurring between August 22-24 (duration: 3-5 days). Symptoms consist of severe abdominal pain; projectile vomiting (in the children); watery, profuse, foul-smelling, discolored stools; low-grade fever, extreme fatigue, anorexia (one child is reported to have lost 6-7 lbs.). Secondary symptoms include sweats, chills, headache. So far 16/20 people are reporting illness. Of the eight adults in the party, 3 men and one woman report no symptoms of illness. Another group, who stayed at the resort at the same time, but who have not reported illness, is also being interviewed.

As of September 7, 2000, 13 stools from the New York group have been confirmed positive for cryptosporidium. These stools were negative for other enteric bacteria. One Nassau County, Florida resident who also had an exposure to the pool during the same time period as the New York group has also been confirmed positive for cryptosporidiosis. The New York City Health Department is working to coordinate follow-up of the stool samples from the New York group. Four other individuals who were also exposed to the pool during that time period and who have experienced a similar illness and incubation time as the New York group have also been identified. They are submitting samples this week for analysis for cryptosporidium and are being interviewed for food and recreational water (pool) exposure histories.

So far, the environmental assessment includes:

Food: menus for meals are being obtained. Extensive food histories have also been obtained. Food has not been ruled out, but nothing stands out at this time.

Pool: There is an upper pool and a lower pool at the resort. They are not physically connected. The New York group spent its time around the lower pool. On Friday, August 18, the pool was cloudy and crowded with many diaper-aged children, and zero chlorine residuals. The lower pool was closed on Saturday in order to chlorinate it and was reopened at 2pm. Given the time elapsed from onset of the illnesses, the time of chlorine exposure coupled with the amount of chlorine added, and the number of times the pool water had been back flushed since August 18, it was determined that a water sample for cryptosporidium oocysts would not be useful. However, the Centers for Disease Control and Prevention is testing a 5 gallon sample of filter sand from the pool’s filtration system for antibodies that attach to sporozoite antigens within the cryptosporidium oocysts using an experimental procedure (no standard protocol).

The following information was distributed by Jane Mahlow, DVM, MS, Director, Zoonosis Control Division, TX Dept of Health

Health authorities are looking for a man and a young boy who came in contact with a bat that tests confirmed Wednesday (Sept. 6) had rabies. The incident occurred Saturday, Sept. 2, at about 5:30 p.m. near the Dooney & Bourke store at the Prime Outlet Mall on I-35 in San Marcos, according to the Texas Department of Health (TDH) and the

City of San Marcos.

A passerby noticed a bat land on the neck of a young boy. A man with the child knocked the bat off, and the two walked away. It is not known if the bat bit either the man or child. The person who saw the incident heard the man speaking Spanish. The bat was picked up by a San Marcos animal control officer and sent to the TDH Laboratory for testing. In addition to the man and boy, anyone who came in contact with a bat at the mall is advised to immediately contact a physician to determine if rabies prevention shots are needed. Physicians and visitors to the mall may call the San Marcos Health Department for more information.

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:

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.

The ASES will be held at the Belleview Biltmore in Clearwater, Florida. If you can not attend the meeting, please cancel your reservations no later than seven (7) days prior to your scheduled arrival date to avoid forfeiture of deposit. Please contact the Belleview Biltmore to make your reservations.

Don Ward, Surveillance Section Administrator, Epi Update Managing Editor

Usually, in this space, you would expect to find the "Florida Past," Bill Bigler’s insightful and often humorous look at our public health heritage. Sadly, Bill retired at the end of August, after 35 years of service to the Florida Department of Health, and with a profound legacy of enthusiasm, dedication, vision, scientific integrity and humanism. Those of us who know Bill realize that his retirement will be yet another opportunity to re-focus his considerable energy, and hope that some of that energy is directed at continuing his writing. The stories with which he has entertained and enlightened us over the years beg to be written down. We hope that he will share them with us in the Epi Update—space for his byline is always open.