"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.

Marc Traeger, MD, Bureau of Epidemiology Investigations Section, Epidemiology Intelligence Service Officer

There are now 25 confirmed cases of Hepatitis A from Lake or Sumter County, all in adults with ages between teen and 55 years, and with symptoms onsets between 11/21/00 and 12/26/00. Twenty-two are primary cases, and 3 are secondary cases. This is an ongoing investigation.

A case-control study was performed to evaluate exposures and try to identify a common source. A fast food outlet in Lake County was strongly associated with the hepatitis cases as a food exposure. No other exposures were statistically significant.

Fifteen of 16 employees who worked at the fast food outlet at the likely time interval of exposure have been tested for acute or recent hepatitis A. One food handler at the fast food outlet tested positive with the outbreak cluster; however, is not the index case. Twelve employees tested negative, but two test results are pending. One former employee died suddenly of an unrelated cause before the outbreak.

An index case has not been identified. The investigation to determine an index case is ongoing. Interviews with all cases diagnosed in the state during the likely exposure period are near completion.

Another hepatitis A outbreak involving 9 cases occurred in Kentucky simultaneously with the Florida outbreak and is associated with the same fast food chain. The CDC has performed nucleic acid base sequencing tests on viral gene segments from both the Florida and Kentucky outbreaks, and found an identical match. These outbreaks are therefore related.

Further investigation is proceeding with a case-control study of those who ate at the fast food outlet, evaluating menu items and ingredient exposures. In addition, sales data from the fast food outlet is being evaluated as an indicator of exposure.

Submitted by Roberta M. Hammond, Ph.D., Bureau of Environmental Epidemiology

(From an FDA News Release)

A major component of the President's National Food Safety Initiative is the education of physicians in the diagnosis and treatment of foodborne illness. FDA, in collaboration with the American Medical Association (AMA), the Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture developed an educational tool on foodborne illness for physicians. This Primer is intended to provide physicians with current guidelines for the diagnosis, treatment, reporting, and prevention of foodborne illness. It also provides physicians with information for patients on prevention of foodborne illness.

The Primer uses presentations of patient scenarios and clinical vignettes to educate physicians on foodborne illness. The Primer material also includes information on clinical considerations; tables on foodborne illness with summaries of clinical and diagnostic considerations, laboratory tests and treatment of bacterial, viral, parasitic, and noninfectious causes of foodborne illness; current suggested food safety resources and reading lists; and patient education information on prevention of foodborne illness. There are 3.0 hours of Continuing Medical Education (CME) credits offered after submission of the CME exam to CDC/MMWR.

A free copy of the Primer can be obtained from FDA 's Center for Food Safety and Applied Nutrition (CFSAN). Fax requests to CFSAN's toll-free fax line, 1-877-FOODFACS (1-877-366-3322). An electronic version is available on CDC's website at http://www.cdc.gov/mmwr/cme/conted.html.

Steven T. Wiersma, MD, MPH, Deputy State Epidemiologist

I thought you might like to have a brief update on some recent Hepatitis Program activities:

1.) 17 counties ( Alachua, Bay, Citrus, Escambia, Highlands, Lee, Leon, Marion, Martin, Okaloosa, Orange, Pasco, Santa Rosa, Seminole, St. Johns, St. Lucie, Wakulla ) have begun to participate in a new hepatitis program, limited to hepatitis counseling, testing, and vaccination for hepatitis A and B.  A copy of the letter announcing the program is attached.

2.  The Hepatitis Program has begun a statewide awareness and educational campaign for hepatitis A, B, and C.  [Brochures (hepatitis C hotline), posters (hepatitis C hotline), and physician packets (announcing the hepatitis C hotline, with general info about hepatitis A and B, also) are available.  Please let Himal Dhotre (Hepatitis Program, health educator, 245-4401) know if you'd like some of these materials. 

3.)  A statewide awareness and education campaign has begun, using outdoor media, including billboards and placards.  The attached files are included with this email to give you information on the content and look of these media.  

The placards (like very large posters) will be posted at appropriate sites (e.g., bars, bus stops, gas stations) in various counties over the next few months.  Likewise, the billboards (hepatitis C only) will be posted throughout the state over the next few months.  The public can call the toll-free Hepatitis C Hotline (866-FLA-HEPC) for Hepatitis C questions.

Please call Sandy Roush if you have any questions about this program at SunCom 205-4444 X 2410.

(Week ending January 13, 2001-Week 2)

Florida: Data from Florida still suggest low levels of influenza activity. Overall, two percent of 14,947 patients seeking care by reporting physicians in the influenza sentinel surveillance network met the case definition for ILI during week 2. Influenza-like illness activity was detected in 16 of the 21 counties represented in this week’s data set. Higher flu activity than expected for this time of year (>3%) was reported by physicians in Duval, Escambia, Palm Beach, and Polk county. Eleven percent of patients seen by sentinels in Orange county were diagnosed with ILI. Ten isolates of influenza were recovered in the state this week: influenza A (H1N1) was isolated from patients in Dade (1) and Leon (1) counties and flu B from patients in Clay (1), Duval (2), Leon (3), Levy (1) and Santa Rosa (1) counties. An adenovirus isolation was also reported this week from a patient in Hillsborough county. Since October 1, 75 influenza isolations have been reported to the state health office: 30 influenza A (H1N1) isolates from Broward, Charlotte, Dade, Duval, Escambia, Lake, Leon, Orange and Polk counties, one influenza A (H3N2) from Duval county, 10 untyped influenza A isolates from Alachua, Clay, Columbia, Hillsborough, Orange, Palm Beach and Pinellas counties) and 34 influenza B isolates from Brevard, Broward, Clay, Duval, Hillsborough, Indian River, Leon, Levy, Orange, Palm Beach, Santa Rosa and Volusia counties.

National report: During week 2, 69% of 186 influenza isolates identified by WHO and NREVSS laboratories nationwide were influenza A. All thirty two (25%) isolates typed were flu A(H1N1). Between 20-25% of specimens tested for influenza over the past 3 weeks (weeks 52-2) were positive for influenza. The percentage of specimens testing positive in the Mid-Atlantic (New York, Pennsylvania and New Jersey) and East South Central (Alabama, Kentucky, Mississippi and Tennessee) regions was 5% or less. Influenza B viruses make up 27% of all influenza isolations this far and have predominated in the Mid-Atlantic, East South Central and Pacific regions.

Of the 86 virus strains that have been antigenically characterized at CDC, all but three have been antigenically similar to the vaccine strains. Three A(H1N1) were similar to A/Bayern/07/95. Although this is a distinct virus, the vaccine induces production of high titers of cross-reactive antibodies to A/ Bayern-like viruses.

During week 2, the percentage of all deaths due to P&I as reported by the vital statistics offices of 122 U.S. cities was 7.7%, which is below the epidemic threshold of 8.5%

Two percent of patient visits to U.S. sentinel physicians were due to influenza-like illness (ILI). The percentage of patient visits for ILI was above baseline levels (3%) in the Pacific and West South Central regions.

Savita Kumar, MD., M.S.P.H. Epidemiologist, Division of Epidemiology & Disease Control, Mario Jacomino, MD., M.P.H. 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

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). In order to receive continuing education units, you MUST submit the post test by Friday February 2, 2001 at 5:00 PM. 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