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.

In this Issue:

Steven T. Wiersma, Acting Chief, Bureau of Epidemiology and State Epidemiologist

FOR IMMEDIATE RELEASE August 17, 2001

CONTACT: Frank Penela 1-850-245-4111/ 850-933-0375 (cell phone)
Carina Blackmore, DVM, PhD 1-877-631-5445 (toll-free pager)
Steven Wiersma MD, MPH 1-877-210-5031 (toll-free pager)

*** MOSQUITO-BORNE VIRUS UPDATE***

TALLAHASSEE—The Florida Department of Health (DOH) announced today that the second human encephalitis case caused by the Eastern equine encephalitis (EEE) virus has been confirmed. The case was reported in a 39-year-old male who was most likely exposed to the disease in Levy County. There have been two confirmed human cases of WN virus encephalitis and two confirmed cases of Eastern equine encephalitis.

A previous medical alert issued by health officials for EEE and West Nile virus has now been extended to include Levy County. The alert is now in effect for 30 north Florida counties, including: Baker, Bay, Bradford, Calhoun, Clay, Columbia, Duval, Escambia, Franklin, Gadsden, Gulf, Hamilton, Holmes, Jackson, Jefferson, Lafayette, Leon, Levy, Liberty, Madison, Nassau, Okaloosa, Santa Rosa, St. Johns, Suwannee, Taylor, Union, Wakulla, Walton and Washington counties.

The Department of Health urges all Floridians to take precautions against mosquito bites. DOH is recommending 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 containing DEET according to manufacturers directions; and
• Eliminate stagnant water in any receptacles in which mosquitoes might breed.

The Department of Health continues to track mosquito-borne viruses in dead birds collected by citizens, through the regular testing of sentinel chickens, through horse test results provided by the Department of Agriculture and Consumer Services, and through reports of human disease from Florida physicians.

Physicians are urged to report all cases of encephalitis and meningitis to their local health department. Laboratory testing by the DOH is available to physicians free-of-charge.

Animal surveillance for WN virus has detected 38 confirmed-positive dead birds, 31 horses, and 3 sentinel chickens all from counties covered by the medical alert. EEE virus surveillance has detected 20 confirmed-positive horses, none of which were reported in Levy county.

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Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology

Zuber D. Mulla, MSPH ^1,2; Paul E. Leaverton, PhD ¹, Steven T. Wiersma, MD, MPH ²

1. Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL
2. Bureau of Epidemiology, Florida Department of Health, Tallahassee, FL

11:00 AM – 12:00 PM EST

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

Group A Streptococcus can cause serious infections such as necrotizing fasciitis, septicemia, and toxic shock syndrome. Several previous studies of invasive group A streptococcal disease had small sample sizes (£ 100 patients) and only included patients from one or two hospitals. We conducted a population-based study of invasive group A streptococcal disease in Florida. The objectives of the study were to describe the clinical features of individuals who were hospitalized for invasive group A streptococcal disease and to identify risk factors for hospital mortality. The cases were 257 patients who were hospitalized throughout Florida between August of 1996 and August of 2000 and were reported to the Florida Department of Health’s Bureau of Epidemiology.

Skin was the most common focus of infection. Twenty-two percent of the cases had primary bacteremia (57/256). Multiple logistic regression was used to calculate adjusted odds ratios (AOR) for hospital mortality and 95% confidence intervals (CI). A total of 195 patient records were included in the multivariate analyses. Admission into an intensive care unit was a strong predictor of mortality (AOR=20.41, 95% CI: 6.41-64.96). Risk of mortality increased with age. Treatment with clindamycin protected against mortality in patients who had necrotizing fasciitis (AOR=0.11, 95% CI: 0.01-0.89) but not in patients who did not have necrotizing fasciitis (AOR=1.01, 95% CI: 0.31-3.33).

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.

Kathryn Snavely, MPH, Reportable Disease Manager

The Bureau of Epidemiology is no longer accepting paper hepatitis case report forms from county health departments. 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 Acute Viral Hepatitis 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. All changes to the extended data screens can be done at any time and the case will be flagged as an update.

Don Ward, Surveillance Section Administrator

In January, we provided county health department epidemiology programs with a proposed (CDC) new case report form for malaria. We asked for a trial use of the form and for comments regarding its utility. We received a number of comments and suggestions, which we have forwarded to the malaria program staff at CDC. The CDC staff are currently revising the form, and intend to have an updated version available later in the fall.  We are now asking that the use of the test version be discontinued and county health departments return to the use of the previous standard form. Thank you all for your comments and recommendations; I know that CDC appreciates your efforts.