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.

Don Ward, Surveillance Section Administrator

To date, 51 counties have registered one or more staff members to participate in Merlin training at one of the thirteen designated sites. That means, of course, 16 counties have not registered. There is still space in the following sessions: Orange County (Nov.15), Tallahassee (Nov.20), Tallahassee (December 1), Bay County (December 5), Broward County (December 6), Tallahassee (December 8), Tallahassee (December 15), and Tallahassee (December 19). We could also do a program in another couple of counties (if a reasonable number of trainees would be available) on December 1, 8, 15 or 19. To arrange for training programs or to register for courses, please contact John Worth.

Calhoun, Clay, Dixie, Franklin, Glades, Gulf, Hardee, Jackson, Jefferson, Lake, Liberty, Madison, Manatee, Santa Rosa, Taylor and Washington.

Carina Blackmore, MS Vet. Med, PhD

National report: During week 43 (October 22-28, 2000), 398 specimens were tested by the World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS)-collaborating laboratories across the United States. One influenza B isolate was identified. Since October 1, 5 influenza isolates [2 influenza A (H1N1) and 3 influenza B] have been recovered from 2,677 specimens tested.

The percentage of all deaths due to Pneumonia and Influenza (P&I) as reported by the vital statistics offices of 122 U.S. cities was 6.8% during week 43. This percentage is below the epidemic threshold of 7.5% for this time. Prior to the 1999-2000 season, a new case definition for a P&I death was introduced in the 122 Cities Mortality Reporting System. It was recognized that one potential effect of using this case definition was to increase P&I mortality measurement levels in comparison to previous seasons. During the summer of 2000, the P&I mortality data were analyzed to determine if the modified case definition had affected mortality estimates. On the basis of this analysis, we estimate that there was an approximately 0.8% upward shift in 1999-2000 mortality estimates. The 0.8% shift did not represent a true increase in mortality. To adjust for this upward shift in mortality estimates, the 122 cities P&I mortality baseline and epidemic threshold for the 2000-01 season have been adjusted upward as well.

Sixteen state and territorial health departments (Alaska, Arkansas, Florida, Georgia, Hawaii, Indiana, Kansas, Kentucky, Louisiana, Ohio, Nevada, New Mexico, Texas, Utah, West Virginia, and Wyoming) reported sporadic influenza activity. No influenza activity was reported from thirty-four states.

Florida: Data from Florida suggests low levels of influenza activity. Overall, two percent of patients seeking care by physicians in the influenza sentinel surveillance met the case definition for ILI (> 100 F + cough and or sore throat) during week 43. Influenza-like illness activity was detected in 18 counties from Escambia to Miami-Dade. Higher flu activity than expected for this time of year (>3%) was reported by physicians in Pasco County. Influenza A (H1N1) was isolated from 2 patients residing in Charlotte and Duval counties. Five additional flu reports were received on November 7 (week 44). Three patients, from Broward, Orange and Polk counties, were culture positive for Influenza A (H1N1). A Columbia County resident was diagnosed with influenza A by rapid antigen testing. The first influenza B isolate for this season was submitted from Broward County.

Respiratory syncytial virus (RSV) activity appears to be on the increase in Florida, according to weekly regional trends since September 2000. During week 43, six hospital laboratories in the state reported that 22-57% of RSV tests performed were positive. This is an increase from week 42 when the percentage of positive tests ranged from 9-48%. The highest percentage was reported from Central Florida, the lowest from the Northeast. Additional RSV information may be found on the Bureau of Epidemiology web site at the link below:

Carina Blackmore, MS Vet. Med, PhD

The purpose of the weekly influenza/ RSV surveillance summaries is to give feedback on current levels of influenza-like virus activity in Florida and nationwide to primary care providers who participate in the influenza sentinel surveillance program and the county health departments across the state. Our hope is that epidemiologists and other interested persons at the local level will take advantage of the weekly update and use it as a resource when connecting with other health care providers and residents in their communities. This can be done in many different ways. These are a few suggestions:

• Provide regular updates on the incidence of respiratory illnesses and virus isolation results in your newsletter.
• If you don’t have a newsletter, give feedback to infection control practitioners and other providers when you talk to them on the phone or meet them in person.
• Consider sending a broadcast fax or mail out to primary care providers, hospitals and long-term care facilities if/ when you have confirmed influenza outbreaks in your community or when new virus strains are detected. The information may help physicians decide on appropriate diagnostic testing and antiviral/ antibiotic treatment regimes for their patients and outbreak prevention strategies for their clinic, hospital or long-term care facility.
• Use the update as a resource when you get opportunities to inform the public about the nature of circulating respiratory illnesses and effective prevention measures through the media.

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

There are currently no Arbovirus Medical Alerts issued for the state. During the period October 29 through November 3, 2000, the following arbovirus activity was recorded for Florida:

Sentinel chickens: Nineteen seroconversions to SLE and one seroconversion to EEE were identified from 631 samples tested. (Source: DOH Tampa Laboratory from mosquito control agencies and county health departments). The current rate of seroconversion is within the expected parameters of SLE activity for this time of year (see attached summary graph).