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. Florida Sees Its First Influenza for the Season

2. Flu Vaccine Update

3. Merlin Web-based Reporting System Training Update

4. Grand Rounds for October 31, 2000: "Epidemiology of Motorcycle Injuries during Bike Week 2000, Daytona Beach, Florida"

5. Health Professionals: Learn about Hepatitis C with an Online Educational Program from CDC

6. Weekly Arbovirus Activity Summary

7. New Legionellosis Case Report Form

8. Weekly Disease Table: Week 42

Jodi Baldy, Staff Epidemiologist, Bureau of Epidemiology

Surveillance for influenza officially began the first week in October although three reports of laboratory-confirmed cases of influenza A in the central Florida area were received the last week of September. This is not unusual, however, as the 1999-2000 season was preceded by a few reports in late August and September. Six laboratory-confirmed isolates have been reported to-date, five from central Florida (Hillsborough, Orange, and Pinellas counties) and one from Duval County. Two of the isolates have been subtyped as influenza A/ H1N1 – the new Caledonia-like strain. The other isolates have not been subtyped.

The Influenza Branch, CDC, conducts surveillance for influenza in the United States each year from October through mid May, and Florida is an important player in this system. There are four components to this system:

1)  World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) Collaborating Laboratories, which report the total number of respiratory specimens tested and the number positive for influenza by type and subtype each week

2)  122 Cities Mortality Reporting System for which vital statistics offices of 122 cities report the total number of death certificates filed and the number of those for which pneumonia was identified as the underlying cause of death or for which influenza was listed as the underlying or as a contributing cause of death. Four Florida cities are in this program (St. Petersburg, Jacksonville, Miami, Tampa).

3)  State and Territorial Epidemiologists Reports for which state health departments report the estimated level of influenza activity in their state each week - when activity occurs, it is reported as sporadic, regional, or widespread.

4)  U.S. Influenza Sentinel Physicians Surveillance Network, in which Florida has enrolled over 100 physicians who report each week the total number of patients seen and the number of those patients with influenza-like illness by age group. They also send in specimens for viral identification.

(The following information was derived from the CDC web site and submitted by Al Sulkes, Bureau of Immunization, for publication in the Epi Update.)

The Department of Health and Human Services, the Food and Drug Administration, and the Centers for Disease Control and Prevention are working closely with vaccine manufacturers to facilitate the availability of safe and effective influenza vaccine for the upcoming flu season. Influenza vaccine manufacturers have told FDA and CDC to expect delays in flu vaccine shipments and that it is possible there will be reductions of available influenza virus vaccine for the 2000-01 season.

The total amount of vaccine available for the influenza season is uncertain at this time. However, both FDA and CDC are actively working with manufacturers to determine how much and when vaccine will be available. The amount of available flu vaccine will become clearer over the next two months.

CDC has a flu vaccine supply web site to help health professionals find sources of this year’s flu vaccine. CDC has also available a cybercast on the 2000-2001 Update on Preparing for Next Influenza Pandemic.

Who is at highest risk for complications from influenza?

Persons at high risk for complications from influenza should receive annual vaccination and include the following:

• Persons aged 65 years and older;
• Residents of nursing homes and other chronic-care facilities with residents of any age who have chronic medical conditions;
• Adults and children aged 6 months and older who have chronic pulmonary or cardiovascular disease, including asthma;
• Adults and children aged 6 months and older who have required regular medical follow-up or hospitalization during the past year because of chronic metabolic diseases (including diabetes mellitus), kidney dysfunction, blood disorders (hemoglobinopathies), or immune system problems (immunocompromised e.g. HIV infection, immunosuppressed by medication, chemotherapy or radiation therapy);
• Children and teenagers (aged 6 months to 18 years) who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye Syndrome after influenza infection;
• Women who will be in the second or third trimester of pregnancy during the influenza season.

Will those at highest risk from complications be able to get a flu shot?

It is important to stress that FDA, CDC and vaccine manufacturers are confident that vaccine will be available to vaccinate those at highest risk of complications from influenza, including those over 65, those who are immunosuppressed and others.

If a substantial shortfall of vaccine were to occur, the ACIP and CDC would provide modified recommendations for the 2000-2001 influenza season that emphasize vaccinating persons at highest risk of death from influenza (and the health care workers who take care of them) and then vaccinating, as the vaccine supply allows, the other groups for whom vaccine is traditionally recommended.

Why is there a delay in vaccine availability?

The amount of vaccine available is complicated by two important factors: 1) the yield for this year's influenza vaccine A(H3N2) component appears to be lower than expected which limits the supply that can be developed in time for this flu season and, 2) other manufacturing issues. Manufacturers are working closely with the FDA to address these issues.

Is there an alternative to flu shots?

Currently, four antiviral drugs are approved by the FDA to treat acute, uncomplicated influenza. These drugs are not a substitute for influenza vaccine and should not be used as such. The annual use of influenza vaccine is the primary means for minimizing adverse outcomes from influenza virus infections.

Over the course of the influenza season new information is expected to become available, and CDC and FDA will issue information updates.

Don Ward, Surveillance Section Administrator

This updates the Merlin training schedule published in last week’s Epi Update. New training dates include: Thursday, November 9-Duval County; Tuesday, November 14-Escambia County; and Wednesday November 15-Orange County. Negotiations are being concluded with Broward, Duval and Highlands counties.

Note: While we intend to provide training to everyone who wants to become a Merlin user, the primary audience for this initial training includes those who will be entering case reporting data (probably the same folks who now complete the 2016 forms) and their supervisors. Merlin training for all groups of users will be ongoing.

Updated schedules will be published in upcoming Epi Updates. To register or for additional information please contact John Werth.

The confirmed training schedule (valid as of 10/27/00) is as follows:

Date Location Building/Room

November 9 (Thurs.) Tallahassee 4052/215L

November 9 (Thurs.) Duval County

November 14 (Tues.) Escambia County

November 15 (Wed.) Orange County

November 17 (Fri.) Tallahassee 2585/110A

November 20 (Mon.) Tallahassee 4052/215L

November 28 (Tues.) Indian River CHD

November 29 (Wed.) Collier CHD

December 1 (Fri.) Tallahassee 2585/110A

December 4 (Mon.) Alachua CHD

December 8 (Fri.) Tallahassee 2585/110A

December 11 (Mon.) Tallahassee 4052/215L

December 12 (Tues.) Hillsborough CHD

December 15 (Fri.) Tallahassee 2585/110A

December 19 (Tues.) Tallahassee 4052/215L

"Epidemiology of Motorcycle Injuries during Bike Week 2000, Daytona Beach, Florida"

Dafna Kanny, PhD, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

11:00 AM - 12:00 PM EST

In March 2000, an annual motorcycle event in Daytona Beach, Florida resulted in a temporary local population increase from 64,000 residents to an estimated 600,000 people. Concomitantly, an unusually high number of motorcycle-related deaths were reported by the local and national press, making it the deadliest such event since its inception in 1937. The Volusia County Health Department and Florida Deparment of Health requested that the Centers for Disease Control and Prevention assist them in (a) determining the frequency, rate, and severity of unintentional injuries related to motorcycle crashes and other circumstances associated with the motorcycle event; and (b) identifying risk factors associated with these injury occurrences.

A CDC team was dispatched to Daytona Beach and abstracted data from the Volusia County Medical Examiner's Office, medical records from all Volusia County hospitals, EMS reports, and police crash reports from the period between March 2-13, 2000.

Further details regarding the audio-conference call and PowerPoint files will be posted on the Bureau of Epidemiology Intranet web site. Be sure and register on-line for nursing CEUs and contact hours for environmental health professionals (when applicable). 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.

1. November 27, 2000

2. January 23, 2001

Varicella Surveillance

Savita Kumar, Epidemiologist, Palm Beach County Health Department

3. February 27, 2001

(The following article was excerpted from IAC Express #202,October 25,2000, published by the Immunization Action Coalition.)

Additional information is also available on the Bureau of Epidemiology web site.

Robin Oliveri, Arbovirus Surveillance Coordinator and Dr. Lisa Conti, State Public Health Veterinarian

West Nile Virus (WNV) has now been detected as far south as North Carolina (in a crow near Raleigh). To date, WNV has not been detected in Florida.

There are currently no Arbovirus Medical Alerts issued for the state. During the period October 15 through October 20, 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)

Sentinel chickens: Fifteen sentinel chicken seroconversions to SLE were identified (565 chickens tested. (Source: DOH Tampa Laboratory from mosquito control agencies and county health departments). See attached figure.

In August 1999, the CDC issued a revised Legionellosis Case Report form (CDC 52.56). All county health department epidemiology staff should begin using this revised form.