"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 available 24 hours a day, 7 days a week for consultation at our main number (SunCom 205-4401 or 850/245-4401) PLEASE NOTE: Consultation after 5 p.m. & on weekends is intended for emergencies.

2. Enhanced Surveillance for Superbowl/Gasparilla Festival

3. West Nile Virus Surveillance in Florida

The following CDC statement courtesy of Henry T. Janowski, MPH, Chief, Bureau of Immunization

Don Ward, Surveillance Section Administrator

The Gasparilla Festival and the Superbowl football game will attract hundreds of thousands of visitors to the Tampa-St. Petersburg area during a period of about two weeks at the end of January and beginning of February. With that influx will come the increased risk for disease outbreaks, whether natural or purposefully initiated. During the critical time period surrounding these events, the Hillsborough and Pinellas County Health Departments, assisted by the Bureau of Epidemiology and the Centers for Disease Control and Prevention will conduct enhanced medical surveillance in five major area hospitals. The county health departments will use two different aberration detection surveillance methods currently being tested by the Florida Department of Health and the CDC. Both of these methods attempt to identify significant variations in patient registrations in hospital emergency rooms. The CDC and DOH staff will provide frequent trend analysis and feedback to the counties. County health department staff will investigate any significant variations identified. In addition to providing actual surveillance related to the events, this program will allow further testing of the aberration algorithms, and will provide insight to the management of "special event" surveillance.

Robin Oliveri, Arbovirus Surveillance Coordinator

Bureau of Epidemiology

Information packets complete with protocols, procedures and contacts were developed and provided to all 67 county health departments, private veterinarians, wildlife rehabilitation centers, zoological parks, wildlife organizations, mosquito control districts, federal agency partners, private medical providers and university centers. Below is a brief summary of the activity conducted during the year 2000 (May – December) for each surveillance area and a summary table of the data collected.

The Florida bird mortality database received a total of 537 reports of dead birds from 43 of Florida’s 67 counties and involving more than 45 different species. 64 birds were submitted for West Nile virus evaluation, of which 56 met the testing criteria (i.e. dead within 24 hours of collection and without decay). All 56 samples were negative for West Nile virus.

Wild avian blood samples have been submitted to the Department of Health laboratory through independent research projects involving various crane species. All 194 samples have tested negative for West Nile virus. The United States Geological Survey (USGS) conducted a large-scale crow bleed in Alachua county (63 sera collected) during December 1999 and January 2000 with negative West Nile results.

• The Department of Agriculture and Consumer Services (DOACS) veterinary pathology laboratory in Kissimee processed 101 equine and 7 non-equine sera for arbovirus testing. All tests to date have been negative for WNV. Sentinel horse herds have been established in 15 strategic locations throughout the state composed of 75 horses. Negative titers for WNV have been established for all horses participating in the surveillance program. Biweekly surveillance testing will not be initiated until such time as WNV has been identified in the state. Additional surveillance herds may be added if the virus becomes established in bird populations in the state. In addition, the Kissimmee laboratory received all submitted dead birds, performing the necessary necropsy evaluation and forwarding tissues to the Department of Health laboratory in Tampa, FL for West Nile virus isolation.

The Department of Defense has submitted weekly mosquito collection information on behalf of Hurlburt AFB, Tyndall AFB, Eglin AFB, MacDill AFB, and Kennedy AFB. Pools were not submitted for West Nile testing. In addition, mosquito collection data have been submitted from the Mosquito/Aquatic Plant Management Division of Lake County.

The DOH laboratories in Tampa and Jacksonville tested more than 50 human samples for arboviruses. In addition, these laboratories provided confirmatory testing of private laboratory results. No case of West Nile virus in a Florida resident has been identified to date.

Due to fluctuating winter weather patterns, Florida will continue its West Nile surveillance activities year-round. For more information, please visit the website or contact Robin Oliveri at (850) 245-4444 ext. 2437 or SC 205-4444 ext. 2437.Epidemiology

Carina Blackmore, MS, Vet. Med., PhD, NE Florida

National report: See CDC press release from December 29 @ CDC. GOV

Florida: Data from Florida still suggest low levels of influenza activity. Overall, two percent of 9441 patients seeking care by reporting physicians in the influenza sentinel surveillance met the case definition for ILI during week 52.

Higher flu activity than expected for this time of year (>3%) was reported by physicians in Duval, Escambia, Leon, Palm Beach, Pasco and Seminole counties. Influenza B was isolated from patients in Hillsborough county.

Since October 1, 47 influenza isolations have been reported to the state health office: 23 influenza A (H1N1) isolates from Broward, Charlotte, Duval, Escambia, Lake, Leon, Orange and Polk counties, one influenza A (H3N2) from Duval county, 8 untyped influenza A isolates (from Alachua, Columbia, Hillsborough, Orange, Palm Beach and Pinellas counties) and 15 influenza B isolates from Brevard, Broward, Hillsborough, Leon Orange and Volusia counties.

Respiratory syncytial virus (RSV) activity remains high in northeastern, central and the southwestern part of the state where 42.6-51.9% of tested specimens were positive for RSV. Twenty-three percent of RSV specimens tested in the southeast were positive. Eleven hospital laboratories in the state participate in this program.

Audioconference Series - Prather Building Room 310A . Wednesday, January 17, 2001

2:00 PM -3:00 PM EST

Program Description:

This series of four one-hour audioconferences offered free to Public Health Professionals, show how to develop strategic partnerships among laboratory, epidemiology, and public health program offices in the surveillance and investigation of community disease. You will have the opportunity to learn from others' experiences how to employ the "best practices" for achieving effective programs.

Public Health Professionals who work with epidemiology and the laboratory are an integral part of their position.

Continuing education credits will be offered to Public Health Professionals based on one hour of instruction for each audioconference.

Delaware Public Health Laboratory, Maryland Department of Health & Mental Hygiene, New Jersey Department of Health & Senior Services, Pennsylvania Department of Health and National Laboratory Training Network

The usefulness and potential application of continuous molecular subtyping and antimicrobial resistance monitoring as part of a community wide infectious disease surveillance programs will be discussed. Molecular subtype surveillance and susceptibility programs for E. coli 0157:H7, Salmonella typhimurium, Campylobacter jejuni, Neisseria meningitidis, Bordetella pertussis, and Streptococcus pyogenes in Minnesota will be evaluated for scientific merit and cost effectiveness. The unique challenges and prospects facing research into the molecular epidemiology of eukaryotic pathogens such as Cryptosporidium spp, and Giardia lamblia will be reviewed. Finally, a molecular-based approach for detection of outbreaks due to new or rarely recognized pathogens will be described. Following this program, the participants will be able to:

• Describe underlying rationale for laboratory-based surveillance of infectious diseases,
• Discuss the basic theory of molecular subtyping mechanisms,
• Describe the utility and limitations of molecular subtyping in a community or clinical setting, and
• Discuss the usefulness of population-based analysis of antimicrobial resistance patterns.

John Besser, M.S.
Clinical Laboratory Manager,
Public Health Laboratory
Minnesota Department of Health

If you have any questions or plan to attend this audioconference, please contact Melanie Black, ext. 2448 in the Bureau of Epidemiology or e-mail [Melanie_Black @doh.state.fl.us].

Savita Kumar, MD. MSPH Epidemiologist, Division of Epidemiology & Disease Control, Mario Jacomino, MD., MPH Preventive Medicine Resident, Palm Beach County Health Department

11:00 AM – 12:00 PM EST

Dial-in by 11:10 AM at (850) 487-8587 or SunCom 277-8587

Abstract:

This study was designed to put into practice the recommendations from ACIP; to reduce the incidence of chicken pox in Palm Beach County by educating parents and health care providers; and to establish surveillance for varicella disease cases.

Varicella is not a nationally notifiable disease and surveillance data are limited. A live attenuated varicella virus vaccine was licensed in the United States in 1995. ACIP issued its recommendation for vaccine usage and disease interventions in 1996. The recommendations from ACIP have not been uniformly adopted in Palm Beach County. Each year many cases of Varicella occur in children in Palm Beach County. Currently there is no varicella vaccine requirement for entry to school and day care in Florida.

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 CEU's 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 at [Melanie_Black@doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448) 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.

Future Grand Rounds Topics:

1. February 27, 2001
Recreational Water-Related Outbreaks
Roberta Hammond, PhD.,Biological Administrator II, Bureau of Environmental Epidemiology

2. March 27, 2001
Arboviral Diseases
Lisa Conti, DVM, MPH, State Public Health Veterinarian

Information courtesy of the Council of State and Territorial Epidemiologists

The new "Guidelines for the Control of Pertussis Outbreaks" are on the National Immunization Program (NIP) website: