A weekly publication by the Bureau of Epidemiology
October 11, 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—Bureau Chief and State Epidemiologist
Don Ward, Surveillance Section Administrator, Epi Update Managing Editor
Samuel Crane, MPH, Special Projects Surveillance Coordinator, Epi Update 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
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.
In this issue:
1. Interim Guidelines for the Management of "Anthrax Contaminated" Parcels
Florida Department of Health, Bureau of Epidemiology"The Bureau of Epidemiology developed the following guidelines for county health departments and other constituents in response to requests for information regarding the proper handling of suspicious packages".
Individuals around the state and nation have received letters alleged to contain anthrax. While no single recommendation can cover all circumstances, the following recommendations should apply to most situations:
Letters or packages that may possibly contain anthrax or another hazardous substance are of concern to both public health and law enforcement agencies.
Individuals who are concerned that they may have been exposed to anthrax or another unknown agent should be assured that the Department of Health takes these threats seriously and that while hundreds of such threats have been received in the United States none have contained an infectious agent such as anthrax.
The typical response should be:
Questions concerning the handling of individuals exposed to threatening letters or packages that may contain anthrax or other biological agents should be directed to the local county health department. The Department of Heath, Bureau of Epidemiology, is available 24 hours a day, 7 days a week for consultation at the main number (850-245-4401 or SunCom 205-4401).
The CDC published interim guidelines for the management of bioterrorism alleging the use of anthrax in the February 05, 1999 issue of the MMWR.
A copy can be obtained at the following www site. http://www.cdc.gov/mmwr/PDF/wk/mm4804.pdf
2. Procedures for Suspicious Items Deemed Less Than Credible
Florida Department of Health
Office of Emergency Operations
October 10, 2001
"Dr. Ellery Gray, Director of the Office of Emergency Operations, developed the following materials for law enforcement officials".
Effective immediately the following operational procedures will be implemented to deal with suspicious objects, i.e. envelopes or substances that are deemed LESS THAN CREDIBLE THREATS BY THE FBI.
FBI must state that the item does not exhibit a criminal intent and they determine that it is non-threatening.
Local law enforcement authorities then make a decision:
If the answer is YES, they proceed as follows:
If the answer is YES and they suspect it is of a biological or chemical nature they proceed as follows:
Local Health Department:
Department of Health State Laboratory
Upon receiving notification that an item, substance or sample needs testing, determine which State Laboratory will be designated to receive it and advise the local health department to send it to designated State Health Department Laboratory.
3. GUIDELINES FOR POLICE/FIRE PERSONNEL PICKING UP SUSPICIOUS PACKAGES AND/OR LETTERS
What to do with a suspicious letter or Package
There have numerous requests for Law Enforcement and Fire Departments for information and for assistance in picking up suspicious packages or letters. Most unopened packages or Letters are safe to handle as they have already been handled extensively by the postal system prior to your arrival on the scene. There has been a lot of panic among the population due to lack of adequate information. There may be instances in which you may be assigned to pick up a package or letter. Please use your training to take charge of these situations and put them in their proper perspective. There are three (3) basic types of situations that you might be called upon to address:
Unopened Package or Letter
Opened Package or Letter With a Substance Inside
If you respond to an incident in which someone inadvertently opened a suspicious letter or package containing a substance such as a dust, powder, cream or liquid, you may do the following things.
Suspicious Package or Letter With a Contraption Inside
If you receive and inadvertently open a suspicious letter or package and find a contraption and/or wires, batteries etc. Do the following:
4. Active Laboratory Surveillance of B. anthracis
October 9, 2001
"The DOH Bureau of Laboratories and Bureau of Epidemiology will be conducting a joint surveillance project with clinical laboratories across the state. The following letter is being mailed to laboratory directors".
Dear Laboratory Director,
Due to the recent confirmation of a single case of human anthrax diagnosed in West Palm Beach on October 4, the Florida Department of Health and the Centers for Disease Control and Prevention is instituting active laboratory-based surveillance for Bacillus anthracis.
The Florida Department of Health is requesting that all Florida laboratories submit cultures that may be suspicious for Bacillus species. Cultures that should be submitted to the Florida Department of Health Bureau of Laboratories include only those that meet all of the following three criteria:
Isolates may be shipped to the Florida Department of Health Jacksonville, Miami or Tampa Branch Laboratories. The submitting laboratory should contact the Bureau of Laboratories prior to shipping for further instructions. Contact persons are as follows: Phil Lee, Jacksonville (904)-791-1712, Dr. Segaran Pillai, Miami (305) 324-2407, Dr. Phil Amuso, Tampa (813) 974-4002. Results should be available within 48h upon receipt in the laboratory.
Please contact the Bureau of Laboratories with any questions regarding laboratory testing for anthrax. Detailed laboratory protocols can also be found on the following CDC website. http://www.bt.cdc.gov/agent/anthrax/anthracis20010417.pdf
For other anthrax related questions please call 1-800-342-3557.
We greatly appreciate your assistance with this matter.
Ming Chan, Ph.D.
Chief, Bureau of Laboratories
Steven Wiersma, M.D., M.P.H
Chief, Bureau of Epidemiology and State Epidemiologist