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.

Product NDC Number Lot Numbers Expiration Dates

RabAvert 53905-501-01 261011 09/2001

RabAvert 53905-501-01 261011 09/2003

RabAvert 53905-501-01 273011 01/2004

Chiron Corporation initiated this recall after receiving reports of broken and/or cracked vials following shipment of the above identified lot numbers. County Health Departments need to check their RabAvert inventory for the affected lot numbers. Therefore, please discontinue use of lots 261011 & 273011 immediately. For those counties that aren't Rabies Repositories, please return the affected lots of RabAvert to the Repository that supplied the vaccine. Rabies repositories should collect affected lots of RabAvert and return them to Central Pharmacy for credit. Rabies Repositories may obtain Replacement Rabies Vaccine by contacting:

DOH-Central Pharmacy
(850) 922-9036 or
SunCom 292-9036

Amy Lalonde, ext. 105

Don Stephens, ext. 104

Bennie Franks, ext 110

*Please note that all Rabies Repositories have been contacted by phone regarding this issue.

On February 1, 2001, the Pinellas County Health Department was contacted by a local medical clinic regarding a cluster of illness following a catered luncheon at their facility. Twenty-four of the 40 medical staff attending a luncheon at the clinic on January 30^th catered by a local deli reported gastrointestinal symptoms that included predominantly diarrhea and vomiting. The onset of symptoms averaged 24 to 48 hours with a mean duration of 48-hours. This was the only common gathering for this group of persons where food and drink was served. A local deli had catered "la vache" roll-up sandwiches (cold cut and vegetable), which had been served buffet style in two shifts during a four-hour period on January 30^th. The medical clinic provided the health department line-listings of attendees and the luncheon menu. Norwalk virus was suspected at this time based on symptoms and onset times reported, high attack rates and also because ready-to-eat foods had been served.

The following day, the Pinellas County Health Department, Epidemiology Office had been contacted by two additional medical facilities that had catered sandwiches on January 30^th & 31^st from the same deli as the first clinic reporting illness. In each case, the catered luncheon was sponsored by same ALF facility soliciting physician offices in Pasco & Pinellas counties. The identical menu items served at both medical facilities included the same roll-up type sandwiches served at the first outbreak cluster previously described. Early case illness information identified high attack rates of 21/38 (55%) attendees and 30/52 (58%) attendees. Enteric and viral stool specimen collection was encouraged at this time at the three medical facilities. Some of the leftover roll-up sandwiches (turkey & ham) were collected from attendees and will be submitted for possible testing though the Tampa Regional Virology Laboratory.

In addition to the clinic luncheons, the Pinellas County Health Department has since received a notification that two persons that had lunch on January 30th at the same deli had also become ill with gastrointestinal symptoms. Both persons had eaten "la vache" sandwiches. Some of the sandwiches served at one of the medical centers had also been taken home and served to two household members. Both persons later became ill.

The Pinellas County Environmental Health Office performed a joint investigation with Department of Business and Professional Regulations, on February 2, 2001. An inspection of the catering deli and a food chain investigation was performed at that time. Food & patient history questionnaires were developed and are currently being administered at two of the three medical clinics that reported illness clusters. Analysis of the questionnaires may help to identify the specific food vehicle responsible.

To date, a total of 79 suspected cases have been reported among 138 luncheon attendees from three unrelated medical clinics in Pinellas & Pasco counties and four persons from the community. Early data has identified a common caterer and common foods among the three illness clusters. The Pinellas County Environmental Health and DBPR offices performed an environmental investigation on February 2, 2001. Results from the field investigation indicated that the deli facility was not properly washing produce items during preparation. Food temperatures and employee hygiene were satisfactory. No employee illness was identified. Enteric and viral stool specimens have been collected and have been sent to the Tampa Branch Lab for analysis.  

The Bureau of Epidemiology surveyed 230 physicians throughout the state for input on two important public health issues: antimicrobial resistance (AR) and influenza. Physicians were selected from the Department of Health’s Board of Medicine list of licensed pediatricians, family practice, and infectious disease practitioners. To encourage completion of the form by selected participants, the questionnaire was designed as a one-page (front and back) instrument. However, despite the questionnaire’s simplicity, the response rate was only 29%.

County health departments are encouraged to share the following results with their community health professionals. In addition, the Florida Department of Health (DOH), Bureau of Epidemiology is seeking input for two issues related to antibiotic resistance: 1) Would you or your county health professionals like to have specific antimicrobial resistance data, in what format, and how often; and 2) Would you like to serve on an AR task force or know someone else who would be appropriate for the task force? Antibiotic resistance is one of the nine national emerging infectious disease plan’s target categories, and the Bureau of Epidemiology is currently considering specific public health activities to address this problem. Please contact Jodi Baldy, DOH, Bureau of Epidemiology, at (850) 245-4444, x2401 or email at jodi_baldy@doh.state.fl.us.

The following results were obtained (* = question allowing more than one answer):

The respondents were asked to indicate their level of agreement with several statements:

Site: http://www.idlinks.com/antimicrobial_resistance.htm. Links to other websites.

In the March 20, 2001 issue of the Annals of Internal Medicine (volume 134, number 6), recommendations were published for appropriate antibiotic use in four common adult outpatient conditions: Acute nonspecific respiratory tract infection; acute sinusitis; acute pharyngitis; and acute bronchitis.

Reductions in inappropriate and unnecessary outpatient antibiotic will reduce the prevalence of antibiotic resistance in community-acquired infections, as well as reducing medical care costs. Reducing antibiotic resistance prevalence will allow the use of less expensive and less toxic antibiotics when they are really needed for serious infections.

Please disseminate this information to the practicing medical community where you live and work. County Health Departments that provide acute medical care services to segments of their populations should also review these recommendations and compare them to protocols currently in use in their clinics.

"Hepatitis A Outbreak Linked to a Fast-food Outlet, Florida, November-December, 2000

Submitted by: Melanie Black, MSW, Professional Training Coordinator for Bioterrorism

11:00 AM – 12:00PM EST

Dial-in at (850) 487-8587 or SunCom 277-8587

An investigation was carried out to determine the source and extent of a hepatitis A outbreak associated with a fast-food outlet that occurred in Florida in November and December 2000. The outbreak was linked by viral molecular testing to an outbreak in Kentucky.

Twenty-three cases of hepatitis A, including 15 hospitalizations, were identified among residents of Lake and Sumter counties. A Mexican fast-food outlet was identified as the source. No index cases were identified among food handlers. Eight food ingredients had a statistically significant association with illness by univariate analysis; however, we were unable to establish one ingredient as significantly associated with illness independent of others by multivariate analysis. The ingredient most strongly associated with illness was green onion. A hepatitis A RNA sequence from 12 Florida outbreak serum samples matched that of 4 Kentucky outbreak samples. The FDA has initiated a trace-back for green onions and tomatoes as a result of these findings.

Further details regarding the audio-conference call and PowerPoint files will be posted on the DOH Intranet site. Be sure to register on-line for nursing CEU's. This training is also approved for 1 contact hour for Environmental Health professionals certified under chapter 381.0101, Florida Statue. 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. Please do not call in from a mobile phone. Thank you for your cooperation.

(Week ending March 3, 2001-Week 9)

Florida: The 2000-2001 influenza season has been mild in Florida. During week 9, only one percent of 11,679 patients seeking care by reporting physicians in the influenza sentinel surveillance program met the case definition for influenza like illness and no influenza virus isolations were reported. From February 1 to date, more than 80% of isolates (n=23) have been 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 9, twelve percent (vs. 14% during week 8) of the 1,100 specimens tested in WHO and NREVSS laboratories were positive for influenza. A majority of these isolates (61%) were influenza type B. The 2000-2001 flu vaccine induces reactive antibodies against all 393-virus strains that have been antigenically characterized at CDC this year.

During week 9, the state health department in Rhode Island reported widespread influenza activity, a decline from 4 states reporting widespread activity during week 8. Eighteen state and territorial health departments reported regional influenza activity this week.

The percentage of all deaths due to pneumonia and influenza as reported by the vital statistics offices of 122 U.S. cities was 7.3%, which is below the epidemic threshold (8.4%) for week 9.

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

The percentage of specimens that tested positive for Respiratory Syncytial Virus (RSV) this week ranged from 21.6% in the southeast to 34% in the central part of the state. Twelve Florida hospital laboratories participate in this program.