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.

Rabies preexposure vaccine is recommended for: 1) all persons at occupational risk for infection with rabies virus either by aerosol, injection or animal exposure; and 2) persons traveling extensively in foreign countries where rabies is endemic. High-risk groups include veterinarians, veterinary students, veterinary hospital employees, animal control officers, wildlife workers, wildlife rehabilitators and animal handlers in zoological parks and exhibits. People involved in disaster animal response may consider being preimmunized if their expected frequency of animal contact is elevated (criteria 1, above). Persons most at risk for accidental infection work with live rabies virus in diagnostic and research laboratories and in vaccine facilities. CHDs will administer the vaccine at the expense of the vaccinee.

Because recent studies indicated that antibiotics maybe harmful or increase the risk of hemolytic uremic syndrome (HUS) among diarrhea patients with E. coli O157:H7 infections, we conducted a survey among physicians who managed diarrhea patients. Two sets of questionnaires were sent.

The first questionnaire (Q1) was focused on overall attitude of management of diarrhea patients. The second questionnaire (Q2) was concentrated on three specific causes of diarrhea. We received 27 Q1 and 38 Q2. Table 1/ 6 summarize the Q1 and Table 7 through 12 abstracted Q2 results.

Overall, clinicians diagnosed diarrhea cases with symptoms (97% to 100%), stool culture (67% to 71%) and other lab test. In Q1 survey, 30% of clinicians prescribed antimotility agents frequently for diarrhea patient and 70% was rarely used. All physicians in Q1 survey rarely used antibiotics to treat diarrhea patients. Forty percent of clinicians used antibiotics to treat bloody diarrhea, and 60% not. Fluoroquinolones (59%) and TMP-SMX (59%) were the most frequently used antibiotics for treatment of diarrhea patients, followed by doxycycline (19%), ampicillin (11%), and flagyl (7%). In Q2 survey, 63% of physicians used antimotility agents sometimes for diarrhea patients, 5% usually used, 32% never used and no one routinely used. For the use of antibiotics among bloody diarrhea patients with no lab information, 13% usually used, 47% used sometimes, 40% never used and no one routinely used. For treatment of lab-confirmed E. coli O157, 27% always used antibiotics, 13% usually used, 16% sometimes used, 26% never used and 16% had not seen such patients. For treatment of lab-confirmed Salmonella, 11% always used antibiotics, 11% usually used, 50% sometimes used, 26% never used and 3% did not answer. For treatment of lab-confirmed Shigella, 61% always used antibiotics, 11% usually used, 18% sometimes used, 8% never used and 3% did not answer.

Comment: The use of antimicrobial therapy for E. coli O157:H7 infections is still controversial. Recent studies suggest that antimicrobial agents may be harmful, and may increase the risk of hemolytic uremic syndrome (HUS). Antimicrobials also have not been shown to decrease illness severity. This survey shows that the use of antibiotics is extremely variable among clinicians surveyed. A consensus on appropriate treatment should be used to direct physician management of these patients.

Further information is available in the recent CDC publication "Diagnosis and Management of Foodborne Illnesses: a Primer for Physicians." It is a teaching tool to update primary care physicians about foodborne illness and remind them of their important role in recognizing suspicious symptoms, disease clusters, etiologic agents, and reporting cases of foodborne illness to public health authorities.

(Week ending February 24, 2001-Week 8)

Florida: The influenza season still appears to be mild in Florida. Overall, one percent of 13,905 patients seeking care by reporting physicians met the case definition for ILI during week 8. Four isolates of influenza B were reported to our laboratory database this week from Hillsborough and Leon counties. More than 80% of isolates reported from February 1 to date (n=23) were influenza B. Flu B isolates have been recovered from patients in Alachua, Duval, Franklin, Hillsborough, and Leon counties. Two influenza A (H1N1) isolates from Charlotte and Hillsborough counties and 2 untyped influenza A isolates from Hillsborough and Palm Beach counties have also been reported. Since October 1, 2000,132 influenza isolations have been reported to the state health office.

National report: Influenza activity seems to be declining in the United States. For the current season, the overall national percentage of respiratory specimens positive for influenza appears to have peaked at 24% at the end of January (week 4). During week 8, fourteen percent of the 1,578 specimens tested in WHO and NREVSS laboratories were positive for influenza. A majority of these isolates (62%) were influenza type B. The 2000-2001 flu vaccine induces reactive antibodies against all 375 virus strains that have been antigenically characterized at CDC this year.

During week 8, four State health departments (Colorado, Iowa, Rhode Island, and Tennessee) reported widespread, and 23 states reported regional influenza activity.

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 8.7% for this week.

Two percent of patient visits to U.S. sentinel physicians during week 8 were due to influenza-like illness (ILI). The percentage of patient visits for ILI was within baseline levels (3%) in 7 of 9 surveillance regions. Influenza activity was above baseline levels in the Mountain and Pacific Regions.

Florida RSV: The percentage of specimens that tested positive for Respiratory Syncytial Virus (RSV) this week ranged from 9.1% in the north east to 32.3% in the central part of the state. Twelve Florida hospital laboratories participate in this program.