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.

TALLAHASSEE—The Florida Department of Health has released preliminary tests showing evidence of West Nile virus (WNV) infection in three crows from Jefferson, Madison and Washington counties in North Florida. These results will be confirmed by early next week. These findings come one week following the announcement of the first confirmed WNV-positive crow in Florida from Jefferson County.

Florida Department of Health (DOH) Secretary Robert G. Brooks, M.D., states that these findings were expected and that the risk to residents and visitors to Florida still remains low. There have been no reported human cases of the disease in the state. To reduce the risk of acquiring any arboviral (mosquito-borne) disease, Brooks recommends the following:

• Avoid outdoor activities between dusk and dawn when mosquitoes are likely to be looking for blood meals;
• If you must be outdoors when mosquitoes are active, cover up by wearing shoes, socks, long pants and long-sleeved shirts;
• Use mosquito repellant; and
• Eliminate stagnant water in birdbaths and any other receptacles in which mosquitoes might breed.

DOH continues statewide surveillance for WNV, and the Interagency WNV Response Team is looking closely at how widespread the virus may be by testing mosquitoes and wild birds in the areas the crows were found.

The Department of Health laboratories provide testing services for patients with clinical signs of arboviral encephalitis. These signs may include headache, fever, fatigue, dizziness, weakness and confusion. Physicians should submit serum and/or cerebrospinal fluid samples to either the Tampa or Jacksonville Department of Health branch laboratories.

CONTACT: Frank Penela 850-245-4111 (office) or 850-933-0375 (mobile)

Lisa Conti, D.V.M. 1-877-653-0887 (toll-free pager)

Steven Wiersma, M.D. 1-877-210-5031 (toll-free pager)

Serologic testing for arboviral causes of encephalitis is available at the Florida Department of Health’s Tampa and Jacksonville Laboratories. The panel includes tests for antibodies to West Nile and SLE viruses, as well as dengue. To arrange for testing, physicians should contact their county health department first to report a suspected case.

Guidelines for Arbovirus testing:

Arboviruses of concern in Florida: St. Louis Encephalitis (SLE), West Nile Encephalitis (WN), Eastern Equine Encephalitis (EEE), Dengue (DEN) and California Group (CAL).

1. Patient less then 1 week post onset of clinical signs:

Serum: IgM ELISA and IgG HAI
            If collected at onset and clinical indications are appropriate, may be tested by molecular
            methods for detection of viral nucleic acids.

CSF: IgM ELISA, virus isolation, molecular detection of viral nucleic acids

A negative test is not definitive; a positive serology in a single specimen requires confirmation by a convalescent specimen to be valid.

2. Patient 7-14 days post onset of clinical signs:

Serum: IgM ELISA and IgG HAI; SNPR (serum neutralization assay)

CSF:     IgM

A positive serology in a single specimen requires confirmation by a convalescent specimen to be valid. Cross-reactions occur among all the flaviviruses in HAI and IFA assays for IgG and in IgM ELISA assays. The most definitive test is the SN. A single positive serological IgM or IgG must be confirmed by SN.

3. Patient greater than 2 weeks post-onset:

In addition to serum and CSF, submission of an acute stool specimen or an acute throat swab is recommended for virus isolation/detection attempts to test for an enteroviral etiology.

Even though a very early acute serum may be negative it is recommended that it be collected and submitted without waiting for the convalescent specimen. The convalescent should be routinely sent to confirm negative and positive results.

Many asymptomatic patients who have been bitten by mosquitoes may ask their doctors to test them for West Nile virus, as may patients who have mild symptoms, such as fever and headache. The likelihood of West Nile infection in these patients is low. Physicians can reassure concerned asymptomatic patients and those with mild illness by advising that (1) they are unlikely to be infected with West Nile virus; (2) those with mild symptoms are likely to recover completely, and do not require any specific medication; (3) laboratory testing for West Nile virus is not necessary, and (4) they should seek medical attention if they develop more severe symptoms, such as confusion, lethargy, muscle weakness, severe headache, stiff neck, or photophobia. Due to the cross-reactivity between West Nile and other closely related flaviviruses, positive commercial laboratory test results for antibodies to West Nile or other arboviruses should be confirmed by the Florida Department of Health. County health departments can help arrange confirmatory testing for any patient who tests positive for an arboviral infection by a commercial laboratory, regardless of the severity of illness.

The Centers for Disease Control and Prevention has provided us with a Florida-specific report of viral hepatitis data that we have reported to the National Electronic Telecommunication System for Surveillance (NETSS). This report (see attached), summarizes the cases reported during the first quarter of 2001 and covers the period of January 1, 2001 through March 30, 2001

The CDC has made some changes in their case definitions –"a revised case definition for acute hepatitis C that includes a higher alanine aminotransferase (ALT) threshold than the pervious definition was approved by CSTE in June 2000 and should now be used for evaluating suspected cases of acute hepatitis C." We will evaluate that recommendation for inclusion in a revised definition for Florida. The CDC case definitions for all reportable types of viral hepatitis are included as attachments.

The Bureau of Epidemiology is announcing plans (dependent on approval to conduct a statewide meeting) to conduct its annual statewide epidemiology seminar on October 31 through November 2, returning to the Biltmore hotel in Clearwater. We anticipate another full and challenging agenda with nationally recognized speakers to address topics such as emerging pathogens, chronic diseases with infectious origins, antibiotic resistance, influenza and bioterrorism surveillance and prevention, the Florida counties Behavior and Risk Factor Surveillance System and others. We also plan for a day-long workshop for Merlin users. More will follow as we formalize plans.

The Bureau of Immunization is collaborating with the New York State Department of Health on a special project called "Operation Snowbird." The project is designed to target seniors who leave New York prior to/or during their adult influenza immunization campaigns and fail to receive flu and pneumococcal vaccinations. The Peer Review Organizations of New York and Florida, and various other organizations with an interest in immunizing this high-risk population are also partnering in the activity. For its part, the Bureau of Immunization has agreed to create hyperlinks to the Web sites of various project partners, disseminate adult immunization information/updates to Florida's major medical societies/associations and participate in development of a poster or display.