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.

FMD is not a human health hazard because people very rarely contract FMD; it causes few or mild symptoms in people when it does occur, and it does not affect the human food chain.  However, people may be mechanical carriers of FMD and originate animal outbreaks.

FMD should not be confused with the similarly named, exclusively human disease, hand, foot and mouth disease, which is caused by coxsackieviruses or (less often) enterovirus 71.

As recently evidenced in the United Kingdom, FMD is devastating to an area's agricultural economy.  Florida veterinarians and animal producers are urged to recognize the signs of FMD in animals and contact the Department of Agriculture and Consumer Services (DACS) at (850) 410-0900, or toll free (877) 815-0034, if suspicious lesions are detected.  For more information about Florida's animal surveillance plan, please see the attached information provided by DACS.

Acha PN, Zoonoses and Communicable diseases Common to Man and Animals, 2nd Ed. Pan American Health Organization, 1991, pp. 344-352

With the last version published came many changes and many questions. This is a list of helpful hints and reminders based on the requests and comments I have received since the last version.

The function buttons have been moved from the Case Status screen to the bottom of the Basic Case Information and Extended Data screens. When a case has been reviewed and returned to you by the reviewing epidemiologist it will appear on your Task List as Needs Info. Once you have responded or entered laboratory results you must go back and click Submit CRF again from the bottom of the Extended Data screen before it will be sent back to the epidemiologist.

There are many help requests for cases that are already in the system, including trying to find a patient’s name when you know they have been previously entered. It’s best if you email only case numbers and lab numbers and never names. It’s a breach of confidentiality to email patient names and a state email is considered public information. If the patient’s name is necessary then you can call me and we can discuss over the phone.

Review about how to attach an unattached lab result to a case:

1. Click the hyperlinked case number from the Profile Summary or your Task List.
2. Click Case Related Lab at the top of the screen.
3. Click the box to the left of the lab result you wish to attach to the selected case.

This should automatically refresh your screen and show the lab result under the Case Related Lab Results.

Currently we have this diagnosis associated with the acute hepatitis electronic case report form. We realize this is not the correct form but in order to continue to have these cases reviewed by an epidemiologist, they must be associated with extended data. The correct form is being added as an extended data screen of it’s own but will require some design.

For the HBsAg+ cases that are sitting on your task list, submit them by going to the bottom of the Extended Data form and clicking Submit CRF. The reviewing epidemiologist knows that the form is incorrect.

We will be publishing a new version hopefully on the week of 4/12. This next version is mostly correction and debugs from the last version but there will be some new frequency reports.

(Week ending March 10, 2001-Week 10)

Florida: The 2000-2001 influenza season has been mild in Florida. During week 10, only one percent of 11,679 patients seeking care by reporting physicians in the influenza sentinel surveillance program met the case definition for ILI 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 10, 6% percent (vs 12% during week 9) of the 1,464 specimens tested in WHO and NREVSS laboratories were positive for influenza. A majority of these isolates (64%) were influenza type B. The 2000-2001 flu vaccine induces reactive antibodies against all 436-virus strains that have been antigenically characterized at CDC this year.

During week 10, the state health department in Rhode Island reported widespread influenza activity, twelve state and territorial health departments reported regional influenza activity this week, a decline from 18 states reporting regional activity during week 9.

The percentage of all deaths due to P&I as reported by the vital statistics offices of 122 U.S. cities was 8.0%, which is below the epidemic threshold (8.7%) for week 10.

Two percent of patient visits to U.S. sentinel physicians during week 10 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 (4%) in the Pacific Region.

The percentage of specimens that tested positive for Respiratory Syncytial Virus (RSV) this week ranged from 13.9% in the central part of the state to 31.4% in the northeast. Twelve Florida hospital laboratories participate in this program.

Andre Weltman, M.D., M.Sc. Public Health Physician Division of Communicable Disease Epidemiology Pennsylvania Department of Health
Submitted by Richard Hopkins,M.D., MSPH, Chief, Bureau of Epidemiology

The Pennsylvania Department of Health is investigating a cluster of acute respiratory illness among 24 students from the same college who traveled together to Acapulco, Mexico for "Spring Break." During the 3-11 March trip, the students stayed at the "Calinda Beach Hotel." (This hotel may be the same as the one described on the Internet at http://acapulco-cvb.org/calinda/ing.html.)

Of note, the hotel is said to have had "major construction" at the time of their visit. Also, there is a report of an earthquake in the region at the time of the trip. [According to a listing at http://www.iris.washington.edu/, there were two seismic events in Mexico during the trip—one of magnitude 4.1 on 5 March, off the coast of Guerrero State (where Acapulco is located).] The significance of the earthquake to this investigation is not yet clear.

As many as 10 students on the trip are now thought to have had variable symptoms possibly consistent with acute histoplasmosis. The two index cases had onsets on 19 March and 20 March of high fever and dry cough, and were hospitalized in Pennsylvania. Based on the clinical findings, highly characteristic chest radiographs, and lack of any inconsistent laboratory findings, the infectious disease consultant strongly suspects histoplasmosis. Alternative fungal infections cannot be ruled out based on the findings so far. Laboratory diagnosis will be pursued.

Other ill students were seen by the same I.D. consultant in Pennsylvania or by clinicians at their homes in Pennsylvania, New Jersey or possibly elsewhere. It appears that other ill students were less severely affected. None are known to be life-threateningly ill.

If you become aware of other ill visitors to Acapulco, please let us know at the numbers below.

Andre Weltman, M.D., M.Sc.
Public Health Physician
Division of Communicable Disease Epidemiology
Pennsylvania Department of Health
tel (717) 787-3350
fax (717) 772-6975
aweltman@state.pa.us