Florida Department of HealthEPI UPDATE

A weekly publication by the Bureau of Epidemiology

August 24, 2001

"The reason for collecting, analyzing and disseminating information on a disease is to control that disease. Collection and analysis should not be allowed to consume resources if action does not follow."

--Foege WH et al. Int. J of Epidemiology 1976; 5:29-37.

Steven T. Wiersma, MD, MPH—Acting Bureau Chief and State Epidemiologist

Don Ward, Surveillance Section Administrator, Epi Update Managing Editor

 

Bureau of Epidemiology Frequent Contributors:

Kathryn Snavely, MPH

Reportable Disease Manager

Jodi Baldy, MPH,

Biological Scientist IV

Ursula E. Bauer, PhD,

Chronic Disease Epidemiologist

Lisa Conti, DVM, MPH,

State Public Health Veterinarian

 

Regional Epidemiologists:

Dolly Katz, PhD, MPH, SE Florida

 

Roger Sanderson, RN, MA, SW Florida

 

Carina Blackmore, MS Vet. Med., PhD, NE Florida

Zuber Mulla,Phd MSPH,

Central Florida Carina Blackmore, MS Vet. Med., PhD,

Please print out this material and share with epidemiology staff, county health department directors, administrators, medical directors, nursing directors, environmental health directors and others with an interest in information of this type. Thank you.

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 Department of Health has a home on the World Wide Web at http://www.doh.state.fl.us

For information on diseases and conditions of public health importance go to MyFlorida.com, click on Health and Human Services, then Consumers--Diseases and Conditions.

 

1. Arbovirus Update

2. Professional Training Development Opportunity

3. August Grand Rounds/Tuesday August 28

4. WMD-Live Response Broadcast

5. Weekly Morbidity table


 

1. Arbovirus Update

Steven T. Wiersma, MD, MPH—Acting Bureau Chief and State Epidemiologist

News Release
FOR IMMEDIATE RELEASE August 24, 2001

CONTACT: April Crowley 1-850-245-4111
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***

Florida’s Fourth Human Case of West Nile Virus Encephalitis Confirmed
Medical Alert Extended To Include Monroe County

TALLAHASSEE— The Florida Department of Health (DOH) announced today that the fourth human encephalitis case caused by the West Nile (WN) virus has been confirmed. The case was reported in a 73-year-old female from Sarasota County. It is believed that the woman contracted the disease while visiting Marathon in the Florida Keys last month. A medical alert is now in effect for Monroe County.

According to acting State Epidemiologist Dr. Steven Wiersma, it is not unexpected that this virus has been found in south Florida. "Although it might seem unusual that West Nile virus has now been found in the extreme southern part of Florida, this is consistent with migratory bird patterns. We will intensify our surveillance for human and dead bird cases in south Florida and will continue to provide regular updates."

So far, there have been four confirmed human cases of WN virus encephalitis and two confirmed cases of Eastern equine encephalitis (EEE) in Florida. The medical alert is currently in effect for 34 Florida counties, including: Alachua, Baker, Bay, Bradford, Calhoun, Clay, Columbia, Dixie, Duval, Escambia, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Holmes, Jackson, Jefferson, Lafayette, Leon, Levy, Liberty, Madison, Monroe, 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 at 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.

For more information on mosquito-borne encephalitis, including reporting human cases and dead birds, visit the DOH Bureau of Epidemiology’s Arboviral Encephalitis and West Nile Virus website at MyFlorida.com (click on Health and Human Services, then Consumers – Diseases and Conditions, then Arboviral Encephalitis or West Nile Virus) or http://www.doh.state.fl.us/disease_ctrl/epi/htopics/arbo/index.htm, or call the Bureau’s toll-free hotline at 1-888-880-5782 for recorded information."

Arbovirus Surveillance Update 8/24/01
Carina Blackmore, MS, Vet. Med., PhD, Bureau of Epidemiology

Animal Surveillance

1. 57 total dead birds were found to have West Nile (WN) virus in North Florida, along with 43 horses and 4 chickens.

Alachua-1 mockingbird; 1 crow

Bay-1 chicken

Clay-1 horse, 1 green heron

Duval – one sentinel chicken, 1 horse

Franklin-1 crow, 1 blue jay

Hamilton-2 crows, 1 unknown

Holmes- 2 crows, 1 blue jay

Jefferson -- 9 crows, 2 blue jay, 1 mockingbird, 1 unknown and 19 horses

Leon – 1 hawk, 3 crows, 1 finch, 1 mockingbird, 3 unknown birds, 1 blue jay, 2 sentinel chickens, 4 horses

Madison – 5 crows, 2 blue jays, 1 unknown, 6 horses

Nassau, 1 horse, 1 crow

Okaloosa -- 1 blue jay

Pasco 1 unknown

Suwannee-1 blue jay, 2 horses

Taylor – 2 crows, 1 blue jay, 1 unknown bird, 9 horses

Wakulla-5 crows

Washington – 2 crows

 

2.
      Eastern Equine Encephalomyelitis virus cases, confirmed or probable, per Florida DOH case definition, have been reported from the following counties:

     

    Bay: finch(es), 1 horse

    Calhoun: emu(s)

    Duval: 1 blue jay

    Franklin: 1 pigeon

    Jackson: 2 horses

    Jefferson: 1 horse

    Holmes: 6 horses

    Leon: 1 dove, 1 "blue bird"

    Madison: 1 horse

    Nassau: quail, 1 horse

    Okeechobee, 1 horse

    Orange: 1 horse, 1 bird

    Putnam, 1 horse

    Santa Rosa, 2 horses

    Seminole, 1 horse

    Walton: 2 horses

    Washington: 1 horse

     

    Human Surveillance

3.      Four confirmed human WN cases have been reported; a 73-year-old man and a 64-year-old woman from Madison County a 40-year-old man, residing in Jefferson County, and a 73-year-old woman residing in Sarasota County but believed to have contracted the infection in the Florida Keys.

4.      Two confirmed EEE human cases have been reported. One 9-year-old Okaloosa resident and one 39-year-0ld Levy County resident.

 

Mosquito Surveillance

To date, 1006 mosquito pools containing more than 13,700 mosquitoes of 29 species, have been processed for WN virus testing. Most collections have been done in Jefferson County (714 pools), but collections from Bay (263 pools), Madison (26 pools) and Pinellas (3 pools) County are also undergoing testing. Fourteen WN virus isolates (Culex salinarius (3), Cx quinquefasciatus (5) and Cx nigripalpus (2), Cx. sp. (1), Culiseta melanura (1)) and one EEE virus isolate (from Ochlerotatus atlanticus/ tormentor) have been recovered, all from collections in Jefferson County.

 

Ship birds for WN testing directly to Tampa

Starting Tuesday after Labor Day, the Animal Diagnostic Laboratory in Kissimmee will no longer be performing necropsies of dead birds sent for WN virus testing. The necropsies will be done in the DOH Bureau of Laboratories Tampa branch laboratory, in the same facility where the virus testing takes place. Birds for WN virus testing mailed on or after September 3, should be mailed to the following address:

DOH - Tampa Branch Laboratory
3602 Spectrum Blvd.
Tampa, FL 33612

 

We also want to remind you to only ship:

Fresh birds, dead less than 24h
Birds placed in cooler with cold packs
Packages to be delivered during Monday-Friday
Packages with the appropriate paperwork
www.myflorida.com,

Horses and other mammals will still be tested for EEE or WN at the Animal Diagnostic Laboratory and handling protocols for these species are not affected by this change.

 

RECOMMENDATIONS FOR PUBLIC HEALTH RESPONSE TO MOSQUITO-BORNE DISEASES INCLUDING WEST NILE VIRUS

Dolly Katz, PhD, MPH, Bureau of Epidemiology

With the identification of human cases of West Nile virus and Eastern Equine Encephalitis virus infection in Florida, many Florida residents are calling county health departments for recommendations on how to protect themselves. A number of health departments have already formed task forces to develop response plans. The following information is intended as a guide to health departments in developing appropriate responses.

The protection message

The most important protective measures are the common ones that most Floridians already are familiar with:

·         avoid outdoor activities during dusk and dawn, when the mosquitoes most likely to carry West Nile virus are most active.
·         when outdoors during times of peak mosquito activity, wear long pants, long-sleeved shirts, shoes, and socks.
·         use mosquito repellents that contain DEET according to manufacturers recommendations.
·         remove standing water from around home.

Support materials

A variety of printed materials that explain and expand on the above information are available from the Florida Department of Health and numerous websites. Among them:

·         a pamplet, "What you should know about human arboviral encephalitis," available from the Florida Department of Health. Camera ready copy for local reproduction is available on the DOH website.
·         posters, cups, sun visors, and other items with printed messages on how to report dead bird sightings. Limited materials were delivered to county health departments for local promotional activities.
·         the Florida Department of Health website is avialable by going to www.myflorida.com, a Quick Topics: West Nile Virus link on its home page that provides a variety of materials for physicians, public health specialists, and members of the public, including links to other state, federal, and university websites.
·         the New York City Health Department website, www.ci.nyc.ny.us/html/doh/html/wnv/wnvfact.html, contains a variety of fact sheets on West Nile Virus, pesticides, response plans, and other materials.

Cancelling scheduled outdoor functions

A major issue for local health departments is whether to recommend that football games, Halloween, and other organized activities be cancelled. Cancelling these events should rarely, if ever, be necessary. Cancellations are disruptive, increase public anxiety, and do little to reduce the already low risk of exposure (people may ignore the recommendations or go out by themselves anyway). Moreover, the age groups involved in these activities tend not to be the ones at highest risk for severe illness. Emphasis on the personal protective measures listed above is the most effective way to prevent infection with West Nile and other arboviruses.

Spraying

Spraying temporarily reduces the population of adult mosquitoes in the area. Decisions on when and where to spray are made by the local mosquito control districts in consultation with the Department of Agriculture and Consumer Services in consultation with public health officials.

 

 

2. Professional Training Development Opportunity--Sixth Annual Emergency Preparedness Satellite Seminar

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

The Bureau of Epidemiology is pleased to announce the Sixth Annual Emergency Preparedness Seminar which will be delivered via satellite broadcast September 19 – 20, 2001. This presentation is sponsored by USDA/APHIS, FEMA, and DOD.

The program will be aired both days from 10:30 AM – 12:00 PM resuming after the break from 1:00 PM – 3:30 PM. This seminar has been submitted to the American Association of Veterinary State Boards to allow six (6) hours of CEU credits for attendance on both days.

Topics will include the following:

If you have any questions or plan to attend this satellite conference, please contact Melanie Black by email [Melanie_Black @doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448). If you are interested in registering as a site, further details are available through the USDA website.

http://www.aphis.usda.gov/vs/training

 

 

3. Grand Rounds Tuesday August 28, 2001

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

"Invasive Group A Streptococcal Infections in Florida: Risk Factors for Hospital Mortality"

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

Abstract

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).

Additional Information

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 at the end of the program to obtain nursing CEU’s and laboratory contact hours for this program. 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 email Melanie Black [Melanie_Black@doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448) to request presentation materials.

Important

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.

 

 

4. Training Opportunity – WMD-Live Response Broadcast

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

"WMD Incident Recovery - Creating Order out of Chaos"
Wednesday, September 26, 2001
2:00 PM – 3:00 PM EST

This live, interactive teleconference is sponsored by the National Terrorism Preparedness Training (NTPT) department of St. Petersburg College (SPC), the Department of Justice (DOJ), Office of Justice Programs (OJP)/Office for State and Local Domestic Preparedness Support (OSLDPS), the Federal Emergency Management Agency (FEMA), and the Combating Terrorism Technology Support Office (CTTSO) – Technical Support Working Group (TSWG).

Target Audiences

The primary target audiences for this program include health care administrators, physicians, nurses, and other public health professionals. Law enforcement, emergency medical services, fire department personnel as well as local, state, federal and military emergency preparedness officials may also benefit from viewing this program.

Description

The Live Response program is an hour-long, live, interactive program in which a panel of experts explores topics related to Weapons of Mass Destruction (WMD) consequence management and engages in question and answer sessions with the program audience through call-ins and message board. In this broadcast, a panel of experts will explore the local, state, and federal perspectives ion issues related to recovery from a WMD.

For those in the Tallahassee area, this program will be shown at the Florida Department of Health, Bureau of Epidemiology, Prather Building, Room 320P. If you have any questions, please contact Melanie Black, MSW, Professional Training Coordinator at (850) 245-4444 ext.2448 (SunCom 205-4444 ext. 2448) or by email at [Melanie_Black@doh.state.fl.us]. If you are interested in registering as a site contact Ed Kronholm’s office (NTPT satellite registrations coordinator) toll free at (877) 820-0305 or you may go to their website http://terrorism.spjc.edu.

 

 

5. Weekly Disease Table (Week 33)

DISEASE

1999 TO
WEEK 33

2000 TO
WEEK 33

3-YEAR
AVERAGE
TO WEEK 33*

2000
TOTAL
CASES

2001 TO
WEEK 33

2001
WEEK 33
ONLY

Animal Rabies

120

96

115.7

161

138

4

Anthrax

0

0

0

0

0

0

Botulism, foodborne

0

0

0

0

0

0

Botulism, infant

0

0

0

0

0

0

Botulism, wound

0

0

0

0

0

0

Botulism, other

0

0

0

0

0

0

Brucellosis

1

2

1.7

2

1

0

Campylobacteriosis

570

600

538.3

1026

571

32

Ciguatera

2

2

3.7

14

0

0

Cryptosporidiosis

77

57

70.7

180

52

6

Cyclosporiasis

3

6

5

9

28

1

Dengue Fever

2

1

1.7

3

3

0

Diphtheria

0

0

0

0

0

0

Ehrlichiosis, human

1

0

0.3

0

0

0

Encephalitis, chickenpox

0

0

0

0

0

0

Encephalitis, Eastern Equine

0

0

0

0

2

1

Encephalitis, herpes

3

3

3

7

2

1

Encephalitis, influenza

0

1

0.3

1

0

0

Encephalitis, measles

0

0

0

0

0

0

Encephalitis, mumps

0

0

0

0

0

0

Encephalitis, other

5

6

6

8

3

1

Encephalitis, St. Louis

0

0

0

0

0

0

Encephalitis, Venezuelan

0

0

0

0

0

0

Encephalitis, Western Equine

0

0

0

0

0

0

Escherichia Coli 0157:H7

29

49

34

95

19

0

Escherichia Coli, other

13

6

7.3

13

9

0

Giardiasis

641

755

723.7

1466

628

29

H. Influenzae Cellulitis

0

0

0.7

1

0

0

H. Influenzae Epiglottitis

0

1

0.3

1

0

0

H. Influenzae Meningitis

11

4

8.7

11

6

0

H. Influenzae Pneumonia

3

2

2.7

7

12

0

H. Influenzae Prim.Bacteremia

20

24

19

57

48

1

H. Influenzae Septic Arthritis

0

0

0

1

0

0

Hantaviris Infection

0

0

0

0

0

0

Hemolytic Uremic Syndrome

6

8

6.7

18

2

0

Hemorrhagic Fever

0

0

0

0

0

0

Hepatitis A

400

291

333.7

589

351

5

Hepatitis B

248

279

259

525

259

13

Hepatitis B (+HbsAg in pregnant women)

37

250

95.7

493

253

5

Hepatitis, Perinatal Hep B

1

1

0.7

1

4

0

Hepatitis C

32

11

14.3

19

13

0

Hepatitis, Non-A, Non-B

3

5

21

6

2

0

Hepatitis, Other, including unspecified

9

6

7.3

7

4

0

Lead Poisoning

1022

700

938.7

1219

389

10

Legionellosis

14

25

20.3

51

46

1

Leprosy

2

3

2.7

4

0

0

Leptospirosis

0

1

0.7

2

0

0

Listeriosis

17

19

12

32

13

0

Lyme Disease

17

19

20.3

54

20

5

Malaria

52

50

45.7

90

34

2

Measles

2

1

1.7

2

0

0

Meningitis, Group B Strep

10

11

10.7

21

9

0

Meningitis, List Monocytogenes

6

3

4.3

7

0

0

Meningitis, Meningococcal

28

26

29

41

39

1

Meningitis, other

36

58

44

110

52

0

Meningitis, Strep Pneumoniae

71

66

64.3

112

39

1

Meningococcemia, disseminated

44

47

49

80

47

3

Mercury Poisoning

2

7

3

11

2

0

Mumps

3

2

4.7

4

3

1

Neurotoxic Shellfish Poisoning

0

0

0

0

0

0

Pertussis

56

38

39.7

48

15

1

Plague, Bubonic

0

0

0

0

0

0

Plague, Pneumonic

0

0

0

0

0

0

Poliomyelitis

0

0

0

0

0

0

Psittacosis

0

0

0.3

3

0

0

Q Fever

0

0

0

0

0

0

Human Rabies

0

0

0

0

0

0

Rocky Mountain Spotted Fever

2

0

1

1

2

0

Rubella

0

2

1.7

2

2

1

Rubella, Congenital

0

1

0.3

1

0

0

Salmonellosis

1375

1328

1324.7

2755

1426

80

Shigellosis

861

801

986.3

1292

484

18

Smallpox

0

0

0

0

0

0

Staphylococcus Aureus (GISA/VISA)

0

0

0

0

0

0

Staphylococcus Aureus (GRSA/VRSA)

0

0

0

0

0

0

Streptococcal Disease, Invasive Group A

39

79

49.7

146

106

3

Streptococcus Pneumoniae, Invasive

359

646

432

1147

581

6

Tetanus

2

0

1.3

1

3

0

Toxoplasmosis

10

6

7.7

12

18

0

Trichinosis

1

0

0.3

1

0

0

Tularemia

0

0

0

0

0

0

Typhoid Fever

22

7

13

12

4

0

Vibrio Alginolyticus

6

9

6

15

3

1

Vibrio Cholerae Type 01

0

0

0

0

0

0

Vibrio Cholerae Non-01

8

4

6

4

4

0

Vibrio Fluvialis

5

2

3.7

2

3

1

Vibrio Hollisae

4

3

3.3

3

0

0

Vibrio Mimicus

1

2

2

2

1

0

Vibrio, other

2

0

1

2

0

0

Vibrio Parahaemolyticus

8

8

16

16

7

0

Vibrio Vulnificus

10

3

9.3

13

9

2

Yellow Fever

0

0

0

0

0

0

* The column of data representing the "3-year average to week ##" is the average of years 1998, 1999 and 2000 cases to the current listed week (##).