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.

The 2000-2001 influenza season was mild in Florida. Three hundred sixty nine viral specimens, 29% fewer than during the 1999-2000 season, were cultured for respiratory viruses in our state laboratories this year (Figure 1). Twenty four percent were positive for influenza. Most (52%) of the isolates were influenza B however influenza A/H1N1 and influenza A/H3N2 were also isolated (Figure 2; Figure 3). The percentage of influenza-like illness (ILI) patient visits to physicians participating in the Florida Influenza Sentinel Surveillance Network stayed within baseline levels (0-3%) throughout the year (Figure 3). Last season influenza activity peaked in early January when 5% of patients sought care for ILI.

Fifty-two clinics in 25 Florida counties participated in the influenza sentinel surveillance network last year. The goal of this program is to have 1 sentinel physician/ 250,000 Florida residents, a goal we hope to achieve during the 2001-2002 season.

No outbreaks of influenza were reported to the state health office.

The overall nationwide influenza activity was also milder than normal during the 2000-2001 season but nonetheless peaked in mid-late January 2001 when 24% of the respiratory specimens submitted to WHO and NERVSS laboratories tested positive for influenza and 4% of patient visits to sentinel physicians were due to ILI. During the past 3 seasons, the peak percentages of respiratory specimens positive for influenza viruses have ranged from 28% to 33% and the peak percentages for ILI visits has ranged between 5% and 6%.

Based on genetic testing of virus strains CDC concluded that by and large, the 2000-2001 influenza vaccine strains were well matched to circulating influenza virus strains. Circulating influenza A virus strains were very similar to this years vaccine strains. For this reason, influenza A/H1N1/New Caledonia and influenza A/H3N2/Moscow will remain the influenza A virus components of the 2001-2002 years vaccine. However, more than 80% of circulating influenza B strains were more similar to the influenza B/ Sichuan than the B/Beijing strain found in the 2000-2001 vaccine. B/Sichuan will replace B/Beijing as the influenza B component of the 2001-2002 vaccine.

The Merlin system is a dynamic web-based reporting system that has gone through many changes in the last year. The most recent changes were to the hepatitis extended data screens. These are interim screens based on the new CDC Viral Hepatitis Case Report Form. We have received many change controls and suggestions from counties and headquarters’ for changes to these extended data screens and we are currently working staff to improve the screens for easier data entry. The new screens will be released in July.

With the extended data screens in place we are able to collect data electronically, eliminating the need for county health departments to send in paper forms. All the necessary data fields for the CDC NETSS weekly transmission, which were previously manually entered from paper forms, are gathered from the Merlin extended data screens. Collecting statewide hepatitis data on risk factors outside of the CDC NETSS fields also paves the way for counties to analyze this data in pre-formated reports that will be found in the Epi Analysis area of Merlin.

There have also been many questions about reporting cases of chronic hepatitis. We are currently accepting data and morbidity reports for chronic hepatitis B and C. These conditions ARE reportable diseases in Florida since the rule does not differentiate between chronic and acute cases. However, the Bureau of Epidemiology realizes there are certain counties that have difficulty reporting, and following up on all cases of hepatitis. Merlin has been designed to make these public health functions easier to manage. If you have put these cases into the system, you should report them to the Bureau of Epidemiology and you should enter them in whenever possible. The goal is to rapidly transition to complete reporting as a means of preventing the spread of viral hepatitis.

If you have any questions, please email me at the Merlin Helpdesk.

In the process of moving from submitting paper-based hepatitis case report forms to sending electronic records in Merlin there was a period of overlap that created a set of duplicates for in both 2000 and 2001 morbidity files. This gave the surveillance section a unique opportunity to compare the CDC NETSS hepatitis extended records in the Epi Info database to the records in Merlin. The mean numbers of incomplete, unknown and total fields missing per record were statistically compared to find if there was an improvement in the completeness of reporting in Merlin compared with the paper-based method using Epi Info.

These hepatitis extended records were discovered during the process of preparing the 2000 end-of-year NETSS transmission to CDC. Records from each morbidity year were analyzed separately. The total number of records analyzed from the 2000 and 2001 morbidity files was 198 and 236, comprised of 99 and 118 duplicate sets, respectively. Each record contained 42 fields that could be blank or contain the value 9 for unknown. Statistical analysis was done in Epi Info 2000 with the MEANS function to compare the mean number of blanks (null value), unknowns (value = 9), and the total per record between the Epi Info and Merlin records. A result was considered statistically significant with a p-value < 0.05.

In both morbidity years the total number of fields in each database and mean number of fields per record was lower in Merlin. There was no statistically significant difference in the mean number of blanks or unknowns per record between the Epi Info and Merlin 2000 morbidity records. However, Merlin records had a statistically significant lower mean number of total missing data fields per record (p < 0.001). There was a statistically significant lower mean number of blanks and total missing data fields per record (< 0.001), but not the number of unknowns between the two 2001 databases.

Table 1. Statistical comparison of the mean number of incomplete or unknown fields per record from duplicate hepatitis NETSS extended data records (N=198, except for Unknowns where N=176) from year 2000 morbidity file.

* Non-parametric Wilcoxon Two-sample test

Table 2. Statistical comparison of the mean number of incomplete or unknown fields per record from duplicate hepatitis NETSS extended data records (N=236, except for Unknowns where N=215) from year 2001 morbidity file.

Merlin records were consistently more complete than the records entered from paper case report forms. There are limitations to the inferences that can be made from this data. There is only a single UPDATED field used in the NETSS extended data record that corresponds to the last time the record was updated. It is not possible to tell which record, the Merlin record or the Epi Info record, came first. It is much easier to enter and update Merlin records than the paper case report form. Merlin records can be updated at the county health department staff’s convenience and does not require additional contact with the state office. Merlin also facilitates the review process by allowing counties to add missing data or answer reviewer’s questions with a much shorter turn around. Paper case report forms are necessary to complete extended data in the field and also allow counties to have a paper trail for Merlin records. Besides more timely reporting, the Merlin reporting system may also be a means to improve the quality of morbidity and extended data.

"Surveillance for West Nile (WN) Virus"

11:00 AM – 12:00 PM EST

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

Florida is conducting WN virus surveillance in addition to St. Louis encephalitis and eastern equine encephalitis virus monitoring activities. During its brief history, WNV has manifested itself in the United States with bird die-offs, especially American crows. Thus, tracking bird mortality in Florida is considered a useful tool for WNV detection and surveillance. WNV has also caused morbidity and mortality among people and other animals, and has been identified in a number of vector species. No human or animal cases have been reported in Florida. The state's interagency effort includes looking for evidence of WNV virus in wild birds, sentinel chickens, horses and people and a protocol for mosquito surveillance when WNV virus is detected 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 online for nursing CEU's and contact hours for environmental health professionals. We will also be providing CEU's for Veterinary Medicine. Information about up-coming topics and presenters will also be posted in the Epi Update. If either of these access points is unavailable to you, please e-mail Melanie Black [Melanie_Black@doh.state.fl] 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 speaker 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.

"Following a recent outbreak of Salmonella foodborne disease associated with eating cantaloupe in California and seven other states, State Health Director Diana M. Bontá, R.N., Dr.P.H., today reminded consumers to always thoroughly wash the skin of all fruits and vegetables that are eaten raw before consuming them.

"Contamination can occur when a consumer cuts through a cantaloupe rind that has not been scrubbed with a brush under cool, running water immediately before eating," Bontá said. To reduce the chance of contamination, Bontá said consumers should also wash their hands before and after handling the fruit and refrigerate unused cut portions immediately.

California reported 17 illnesses and the death of a Riverside woman from contaminated cantaloupes between April 6 and April 24. Thirteen other cases of illness were reported in Arizona, Missouri, New Mexico, New York, Oregon, Tennessee and Washington in the same outbreak.

An uncommon type of Salmonella, known as Salmonella Poona, caused the outbreak in California. Five individuals in Los Angeles, three in Orange, two each in Riverside, San Bernardino and Ventura and one each in Alameda, San Benito and San Diego counties became ill.

Six of the ill individuals, including the woman who died, were over 60 years of age and five were children under 5 years. While most of the individuals ate melons that were purchased whole and cut at home, some ate pre-cut cantaloupes purchased from supermarkets or were served cantaloupes in restaurants.

The source of the contamination is under investigation. California Department of Health Services investigators said it is likely that contaminated fruit was imported into the United States. Domestic production of cantaloupes has not begun in California and Arizona, and production has only recently begun in Texas.

Cantaloupe has been implicated in previous Salmonella outbreaks, including a multistate outbreak of more than 46 cases (26 in California) due to Salmonella Poona in 2000, 400 cases due to Salmonella Poona in 1991 and an outbreak in California of more than 20 cases due to Salmonella Saphra in 1997.

Because cantaloupes are grown on the ground, their skin can become contaminated in the field by human or animal waste, or during distribution prior to sale."

The symptoms of Salmonella Poona include fever, abdominal cramps and diarrhea. The symptoms generally develop one to three days after eating contaminated food. While most individuals who become ill from Salmonella Poona recover in three to five days without medical intervention, the infection can be life threatening to young children, the elderly and those with compromised immune systems. Consumers should consult with their physician if they have these symptoms.