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.

Steven Wiersma, MD, MPH, the Bureau of Epidemiology’s Executive Medical Director and Deputy State Epidemiologist has been officially appointed as the Acting Chief of the Bureau of Epidemiology and Acting State Epidemiologist. This follows the July 19 departure of Dr. Richard Hopkins who had previously served in both roles. Dr. Wiersma, who has been engaged in his present position for four years, brings a broad range of leadership experience to the Bureau. He is a nationally recognized expert in several areas including the epidemiology and prevention of hepatitis, Creutzfeldt Jakob disease and meningitis; international travel medicine; and bioterrorism preparedness and response. Dr. Wiersma serves as the member of a number of distinguished national level panels and policy development bodies. He is strongly committed to "providing the highest quality epidemiology program to the Department of Health." We welcome him to his new role.

"A crow infected with West Nile virus was found in Lowndes County, Georgia. This bird was found by a citizen on July 6 and died on July 7. The infection was confirmed today by the Centers for Disease Control and Prevention laboratory. This discovery is not unexpected, since Lowndes County is near Jefferson County, Florida where another infected crow was discovered in June. No West Nile virus infections in humans have been identified in Georgia.

In addition the following information has been added to the DHQP web site:

2. Updated information about the 2001-02 influenza season.

3. Information about control of rubella outbreaks.

"Risk Factors for Hepatitis C (HCV) Among STD Clinic Clientele: Miami, Florida"

11:00 AM – 12:00 PM EST
Dial-in by 11:10 AM at (850) 487-8587 or SunCom 277-8587

Background: Hepatitis C virus (HCV) is the most common blood borne infection in the United States. Injection drug use and history of blood transfusions prior to July 1992 are well-known risk factors for hepatitis C. Several studies have shown that HCV is transmitted through sex and through non-IV drug use. However, the extent to which HCV is spread through these routes is debated. The rate of HCV among the general population is 1.8%. Among persons reporting a history of an STD, the prevalence is 6%. We hypothesized that the prevalence of hepatitis infection among patients at the Miami-Dade County Health Department (MDCHC) STD clinic would be higher than the estimated 6%. Therefore, we undertook a study to assess the prevalence of, and risk factors for HCV among this population. We also sought to determine the sensitivity, specificity and positive predictive value (PPV) of screening criteria in this STD clinic clientele.

Methods: Study participants were recruited from the downtown STD clinic of the MDCHD. Any client 18 years or older who presented to the STD clinic for a new problem, was eligible to participate in the study. If interested in being tested for HCV as part of the study, the participant gave informed consent, received education and counseling on HCV, and was interviewed using the questionnaire. The instrument assessed CDC screening criteria, as well as uncertain risk factors such as tattooing, body piercing, snorting drugs, exchanging sex for money, number of lifetime sex partners and history of an STD.

Results: A total of 710 hepatitis tests were performed as part of the study. The overall acceptance rate was 52%. We were unable to analyze twenty-one (3%) of the 710 tests performed due to an insufficient amount of blood. Analysis was performed on 689 completed questionnaires and corresponding laboratory results. The overall prevalence rate of hepatitis infection among our study population was 4.6%. In the multivariate analysis, four risk factors were significantly associated with being hepatitis infection, independent of confounding factors. These variables included IV drug use OR=29.1, 95% CI 7.7,106.5; a history of having spent at least one night in prison/jail OR=3.7, 95% CI 1.1,12.1; sexual contact with an HCV⁺ person OR=12.4, 95% CI 2.3,66.0, and older age OR=1.1, 95% CI 1.1, 1.2. The sensitivity of the CDC’s routine HCV screening criteria in this population was 69%, specificity 91% and PPV 28%. By adding a history of having spent at least one night in prison/jail to the CDC’s screening criteria, we increased the sensitivity from 69 to 91%, but decreased the specificity to 58%, and the PPV to 18%.

Conclusions: In our STD clinic population we found a prevalence of HCV similar to that found in other studies conducted in STD clinics. Having had a sexual contact with an HCV positive person was independently associated with HCV. We also found that a history of incarceration was independently associated with hepatitis C infection. This relationship should be further studied. CDC’s routine screening criteria were not sensitive in this STD population. Based on the study’s findings, we will consider including a history of incarceration, and sex with an HCV positive person to the routine screening criteria used it the STD clinic of the MDCHC.

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. Information about upcoming 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.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448) to request presentation materials.