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.

Carina Blackmore, DVM, PhD 1-877-631-5445 (toll-free pager)

Steven Wiersma MD, MPH 1-877-210-5031 (toll-free pager)

Remember, all mosquito-born illnesses are preventable. Even though the weather is starting to change, the Department of Health is still urging all Floridians to take the following precautions against mosquito bites.

• 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.

Reprinted from the New York Department of Health

Note: This is the first communique from the NYCDOH to it’s consituents following last Tuesday’s terrorist attack.

FROM: Marcelle Layton, MD, Assistant Commissioner

New York City Department of Health

We are sending this broadcast alert to update you on urgent public health issues following the terrorist attack at the World Trade Center on Tuesday, September 11, 2001.

Communicable Disease Issues: 212-447-2676 or 212-578-0823

FAX: 212-532-5241 or 212-447-2678

Environmental Issues: 212-684-1710 or 212-684-1896

For other Urgent Public Health Issues, or if above numbers do not answer:

212-684-1628

If you experience difficulty getting through to any of these numbers, please call the NYC Poison Control Center at 212-764-7667 (212-POISONS).

 

Routine communicable disease reports (i.e., paper reports) should be sent by mail, as they will be forwarded to us.

 

Asbestos was used in the construction of the World Trade Center. Tests performed indicate that asbestos may be present in an area marked by Worth St. to the North, Centre and Nassau Sts. to the East, and Exchange and Thames Sts. to the South. The health risk posed by a single exposure of short duration is very low. The risk to persons who have not been present in the affected area following the disaster is also thought to be extremely low. There are no tests that can be done, including chest radiographs, to tell if exposure has occurred, nor to predict if pulmonary disease will occur in the future.

At a minimum, anyone who needs to enter the affected area should wear a disposable cup-type (i.e., not fan-folded or duck-bill) N100 or P100 respirator and goggles. Workers in contact with debris or surface dust in the affected area should contact their employers or the NYCDOH (212-684-1710 or 212-684-1896) for specific recommendations regarding needed protective equipment.

Increased particulate matter and dust released during recent days may cause eye and/or respiratory irritation, particularly for persons with underlying pulmonary disease, including asthma or COPD. Individuals who have a history of heart and lung conditions and who are in areas where smoke or dust is visible are advised to remain indoors with the windows shut. It is advised that air conditioners be operated on the "recirculate" mode, so that outside air is not pumped inside, or if this is not possible, that they be turned off. Persons who experience difficulty breathing or chest pain are advised to seek medical care immediately.

Environmental testing is continuing to better characterize levels of asbestos and other potentially hazardous materials within the affected site and in other off-site locations.

However, we do request that you be especially alert to ANY unusual disease issues over the next three weeks. Urgent health issues for which we would want to be notified immediately include:

1 – Any unusual increase or clustering in patients presenting with clinical symptoms that suggest an infectious disease outbreak (e.g., > 2 patients presenting with unexplained pneumonia, respiratory failure or sepsis – especially if occurring in persons who are otherwise healthy. In addition, please notify us regarding a sudden increase in flu-like symptoms).

 

Anthrax Brucellosis Q Fever Tularemia

Botulism Plague Smallpox Hemorrhagic fevers

 

Please report immediately to the Surveillance Office at the NYC Department of Health (interim telephone number: 212-447-2676 or 212-578-0823) if you evaluate patients with any of these suspected illnesses or conditions. If you cannot get through to these numbers, please call the NYC Poison Control Center at 212-764-7667.

 

The NYC Department of Health also has established an active surveillance program with sentinel hospitals throughout the city. Collaborating with emergency department staff, we will be monitoring for increases in patients presenting with certain disease syndromes (e.g., respiratory disease with fevers, gastrointestinal illness, neurological syndromes, and fever with rash), and other illnesses (e.g., asthma exacerbations) that may be associated with this attack. We anticipate that this surveillance will continue for 2-3 weeks.

NYC Health Department Burial Desk

Central Harlem Health Center

2238 Fifth Avenue (at 135^th Street)

New York, NY 10035

 

Telephone: 212-926-2150 or 212-368-6538

FAX: 212-926-2526

 

Clearly, many patients may present with emotional distress or grief reactions in the aftermath of this enormous tragedy. Patients and their families may be referred to the Department of Mental Health Services Hotline at 212-995-5824 for counseling.

In the event that you require acute assistance, please contact the Greater New York Hospital Association (212-246-7100 or 212-506-5405).

During rescue operations, some rescue workers may come in contact with potentially contaminated body fluids. If such exposures occur percutaneously, to non-intact skin, or to mucous membranes, we suggest that facilities refer to their institutional protocols for managing potential exposures to blood-borne pathogens, or that they consult the infectious disease experts who routinely manage these situations in their hospitals.

Laboratory testing for West Nile virus is still available at the Public Health Laboratories. However, we are unable to offer transportation pick-up service at this time due to other pressing transportation needs. We request that hospitals arrange their own transportation of clinical specimens (Monday-Thursday, during regular business hours) to:

Immunology Laboratory

Public Health Laboratories

455 First Avenue (between 26 and 28^th St)

212-447-2660

Serum specimens should be kept refrigerated; cerebrospinal fluid specimens should be kept frozen at ^–70 ^oC. The West Nile case report form should be completed and a copy included with each clinical sample. A copy of the case report form should also be faxed to 212-532-5241.

Please call the laboratory at the number listed above if you have any questions regarding proper specimen transport.

Standard recommendations for use of Td vaccine should be followed for wound management. If additional vaccine supplies are needed by your hospital, please contact the NYCDOH at 212-447-2676 or 212-578-0823.

We appreciate your cooperation and understanding as we all work together to deal with the ongoing consequences of this tremendous tragedy."

Don Ward, Surveillance Section Administrator, Bureau of Epidemiology

The Bureau of Epidemiology has recently published the "Florida Morbidity Statistics" for 1998. This report provides a statistical summary of reportable diseases and a narrative analysis of disease trends for the year. Copies of the publication are presently being shipped to Florida’s county health departments and key constituents across the state. Requests for additional copies should be made by e-mail to Don Ward at: donald_ward@doh.state.fl.us

On Monday, September 17, the Bureau of Epidemiology was notified by CDC of approval and funding of its grant application for development of a component of the National Electronic Disease Surveillance System (NEDSS). Initially, in Florida, grant resources will be used to develop the infrastructure and programs leading to the electronic transmission of positive laboratory test information from laboratories throughout the state to a central database and then to the county health departments and state level public health prevention programs. This electronic transmission will, in most cases, reduce the time for the transmission of results from a week or more to less than a day, resulting in greater opportunities for prevention.

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

"Emerging Pathogens"

Timothy Dolan, Ph.D., ABMM, Laboratory Coordinator, Manatee County Health Department, Florida Department of Health

11:00 AM – 12:00 PM EST

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

"Infectious diseases are a continuing menace to all people, regardless of age, gender, lifestyle, ethnic background, and socioeconomic status. They cause suffering and death, and impose an enormous financial burden on society. Although some diseases have been conquered by modern advances, such as antibiotics and vaccines, new ones are constantly emerging (such as AIDS, Lyme disease, and Hantavirus pulmonary syndrome), while others reemerge in drug-resistant forms (such as malaria, tuberculosis, and bacteria pneumonias).

Because we do not know what new diseases will arise, we must always be prepared for the unexpected. For example, in 1997, an avian strain of influenza that had never before attacked humans began to kill previously healthy people in Hong Kong. This crisis raised the specter of an influenza pandemic similar to the one that killed 20 million people in1918. Also in 1997, strains of Staphylococcus aureus with diminished susceptibility to vancomycin were reported in Japan and the United States. If we are unable to replace drugs like vancomycin as they lose their effectiveness-and to limit the emergence and spread of resistance-some diseases may become untreatable, as they were in preantibiotic era. In addition, the recent discovery that a strain of the virus that causes HIV/AIDS has been circulating at least since 1959 illustrates the furtive way in which emerging infectious agents can insinuate themselves into human populations and remain undetected for years before emerging explosively as public health problems. Each of these examples reminds us that we are barely one step ahead of the microbes and underscores our need for a strong and vigilant public health system."

http://www.cdc.gov/ncidod/emergplan/planrequest.htm

Further details regarding the audio-conference call and the 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 and laboratory CEU’s. Environmental contact hours will also be available 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.

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.