October 7, 2001

• The ongoing investigation of anthrax in Florida has detected evidence that the bacterium that causes anthrax, (Bacillus anthracis) may be present in the building where the patient who died of anthrax worked.
• B. anthracis was identified in one nasal sample from another worker in the building, which suggests exposure. No other workers are known to have illness consistent with anthrax.
• One of many samples collected from the workplace environment contains B. anthracis. Final results on the other environmental samples will not be available for several days. In the meantime, public health officials, in cooperation with the company, have secured the building.
• The current risk of anthrax among employees and visitors to the building is extremely low. However, as a preventive measure, public health officials have begun to contact personnel who worked in the building since August 1, 2001, to provide antibiotics. Antibiotic treatment before symptoms occur will prevent anthrax. The incubation period from exposure to onset of illness with anthrax is usually 1-7 days, but may be as long as 60 days.
• Symptoms of inhalational anthrax include fever, muscle aches, and fatigue that rapidly progress to severe systemic illness. Workers who develop such symptoms will be advised to seek immediate medical attention for further evaluation.
• Anthrax is NOT contagious from one person to another. Family members and contacts of persons who work in or visited the building are not at risk and antibiotic therapy is not recommended for them. Other members of the community are not at risk. Public health officials, together with the FBI, are continuing the investigation.
• For more information regarding this public health action in Florida, after 7 a.m., Monday, October 8, call: 1 800 342-3557
• Media: Florida contact: 561 712-6400; CDC, pager 404 318-2380.

October 4, 2001

WEST PALM BEACH—The Florida Department of Health is investigating an isolated case of Bacillus anthracis (anthrax) in a 63-year-old white male in Palm Beach County. Anthrax is very rare in humans and cannot be transmitted from person to person.

Humans can contract one of three forms of Bacillus anthracis: cutaneous (skin), intestinal and respiratory. Preliminary findings indicate that the individual contracted the respiratory form of the disease. This appears to be an isolated incident.

"We were able to detect and diagnose this individual case quickly, thanks to our required reporting system," said Department of Health Secretary John O. Agwunobi, M.D., M.B.A. "Palm Beach County health officials reacted immediately and appropriately by sending an isolate of bacteria to the state lab for analysis."

Dr. Agwunobi explained that the Department of Health has an ongoing system, by which all infectious diseases are reported to county health departments. This serves as an early warning system for any potential outbreak.

Bacillus anthracis is an age-old bacterium that has caused disease for centuries in the world. Infection comes from contact with anthrax-infected animals or infected animal products. The spores are found widely in soil; therefore, animals that feed on the ground tend to be those most likely infected. These animals usually include cows, sheep and goats.

Most commonly, infected people have been exposed through their work—such as farmers, butchers and veterinarians, and those who sort raw wool and tan hides. Doctors can prescribe antibiotics for treatment of the disease. To be effective, treatment should be initiated early. If left untreated, the disease can be fatal.

From the beginning, with the initial diagnosis, Florida officials have been working with the CDC, FBI and local health officials to determine how this disease was contracted and the appropriate response.

Carina Blackmore, MS, Vet Med., PhD, Bureau of Epidemiology

The influenza season officially started this week and we already have reports of influenza virus activity in Florida. Influenza A (H3N2) was isolated 4-year-old boy residing in Palm Beach County and 4 positive rapid diagnostic tests for flu have also been reported from New Smyrna Beach in Volusia County.

The packages to the physicians participating in the Florida Sentinel Influenza Surveillance Network were sent out late last week and materials for the laboratory testing portion of the program will be sent out the week of October 8. At this time we have 116 physicians enrolled in this program. The recruiting help I have received from county health department staff has been invaluable and is most appreciated. Thank you, thank you, thank you! We are still accepting participants so if you have additional providers that express an interest in participating in the program, please let me know. Several people have contacted me offering to train and keep in contact with local participants. Any such help is also appreciated. I have included a copy of the work folder and cover letter sent out. Please feel free to contact me at 904-791-1744 with any questions, concerns or suggestions on this program.

Carina Blackmore, MS. Vet. Med, PhD, Bureau of Epidemiology

To date more than 12,901 dead bird reports have been recorded from Florida. The most commonly reported dead birds are crows (1871) and blue jays (1793). More than 4800 dead birds have been sent to the state laboratory for virus isolation testing. Between June 2 and October 3, 2001, WN virus infections have been confirmed in 277 birds of at least 18 species (blue bird, blue jay, cardinal, crow, mourning dove, duck, finch, grackle, green heron, mockingbird, pigeon, feral pigeon, quail, red shouldered hawk, sparrow, thrasher, tufted titmouse and warbler). Positive birds have been collected from 45 counties across Florida. More than 90% of the birds (251), as well as 105 horses infected with the WN virus, come from 34 North Florida counties from Escambia County in the northwest, Nassau County in the northeast to Marion County in the north central part of the state. Eighty-two sentinel chickens from 9 counties have also been infected with the virus. Highest seroconversion rates have been observed in Duval (22) and Leon (30) Counties. Six confirmed human WN cases have been reported; a 73-year-old man (onset: 7/14) and a 64-year-old woman (onset: 7/13) from Madison County, a 40-year-old man (onset 8/8) from Jefferson County, a 73-year-old woman (onset 7/25) from Sarasota County, a 73-year-old woman (onset 9/9) from Washington County and a 44-year-old make from Duval County (onset 9/8). Two probable cases have also been diagnosed; a 50-year-old man (onset 8/16) and a 54-year-old woman (onset 9/10), both from Monroe County.

A medical alert for West Nile (WN) virus is currently in effect for 49 Florida counties. The main purpose of this alert is to increase the awareness among Florida residents to the presence of the virus in their communities, the potential health risks associated with WN virus infections and the importance of taking precautions against mosquito bites. Whether to initiate a medical alert is determined based on local WN virus surveillance data. The different criteria that may be used to call medical alerts are discussed in detail in our arbovirus guidebook (http://www.doh.state.fl.us/disease_ctrl/epi/topics/pubs.htm). The decision to call off the alerts will also be based on surveillance data. With our limited understanding of the enzootic WN virus cycle in Florida, i.e. the background virus activity that is most likely going to be present throughout the year in our temperate climate, a joint decision by local and state health officials will be made taking several indicators of the risk for mosquito borne illnesses into account. These indicators include temperatures, mosquito collection data (which of course are closely linked to temperature data), dead bird reports and seroconversion rates of our sentinel chickens. We can probably also use our SLE surveillance data from previous seasons to give us some idea when arboviral transmission declines to the point where we the medical alert would be unwarranted. However, with the increasing number of detected WN virus infected sentinel chickens and with the knowledge that our peak SLE activity historically has occurred during October, it appears unlikely that the medical alerts will be called off during this month.