EPI UPDATE

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1. CDC Health Alert
2. Georgia Oyster Outbreak Linked to Florida
3. Foodborne Hepatitis A Outbreak
4. Weekly Disease Table

 

1. CDC Health Alert

Distributed Via CDC Health Alert Network

October 12, 2001

CDC is aware of a presumptive case of cutaneous anthrax in New York City and CDC will follow-up with more detailed information shortly. Approximately at noon today, there will be a public announcement. This person is an employee of NBC News at Rockefeller Plaza in New York City and received an envelope containing powder on September 25, 2001. The New York City Health Department and CDC are implementing appropriate public health actions, including closing certain parts of the building and evaluating workers for the need for chemoprophylaxis.

Florida residents and visitors potentially exposed in New York City

Several Florida county health departments have reported persons volunteering for service, claiming exposure to anthrax (by way of their presence in the NBC building in New York) and asking for testing and prophylaxis. We have contacted the New York City health department for their policy regarding management of these exposures and await their reply. We do understand that NYC will be conservative in their testing and preventive treatment. Until we receive a response from New York and coordinate development of our own policy with them, we are asking county health departments not to provide prophylaxis or testing, but to record the following information for each person requesting such services: name, address, other appropriate locating information, time periods spent in NYC and the NBC building and the location in the NBC building where they worked or spent time. They should be told that they will be contacted by the CHD if the policy on testing and treatment changes. Those demanding testing or treatment may be referred to their private physicians.

 

2. Outbreak in Georgia Linked to Florida Oysters

Submitted by Roberta Hammond, Ph.D., Bureau of Environmental Epidemiology

The Seminole County Health Department in Donaldsonville, GA (just north of the Florida/Georgia border) is investigating an oyster outbreak purported to be linked to oysters harvested from 2 areas in Apalachicola Bay. The Bureau of Environmental Epidemiology is working closely with the Florida Department of Agriculture and Consumer Services (DACS), Bureau of Aquaculture and monitoring the investigation. Harvest of these oysters occurred when the "Summer" harvesting areas were open to harvest. "Summer" harvesting areas are open from July 1 through September 30. Specifically, two areas may have been linked to the reported illnesses: Harvest areas 1662 and part of 1642 (part of East Hole) with harvest dates prior to September 30, 2001. The "Summer" harvest areas closed at Sunset, September 30, 2001. All oysters associated with this outbreak were purchased from the same retail seafood market in Donaldsonville.

So far, there are 6 clusters with a total of 29 cases plus 2 secondary cases (children who did not consume the oysters). Oysters were consumed September 29 - October 1. Time of onset is approximately 30 hours. Symptoms include nausea, vomiting and diarrhea. Samples of oysters have been collected for bacterial testing. Stools have been collected for bacterial testing. Stools for Norwalk testing were thrown out by the mistake by the hospital. Epidemiologists are considering Norwalk or Vibrio parahaemolyticus as a possible causative agent. Laboratory results are not yet available. Winter harvest areas remain open (no cases of illness have been linked to winter harvest areas). A recall for oysters remaining on the market from the two implicated harvest areas (1662 and the East Hole portion of 1642) is being initiated by DACS for oysters harvested September 15-September 30.

A surveillance alert for any possible cases in Florida related to this oyster outbreak was issued on Friday October 5. As of October 10, no cases in Florida related to this outbreak have been reported and no new cases have been reported in Georgia.

 

3. Foodborne Hepatitis A Outbreak in Broward County

James Cresanta, M.D., Epidemiology, Broward County Health Department
Karen LaFleur, Regional Food and Waterborne Disease Epidemiologist, Bureau of Environmental Epidemiology
Roberta M. Hammond, Ph.D., Bureau of Environmental Epidemiology

Broward County Health Department is investigating a Hepatitis A outbreak associated with a grocery deli in Coral Springs. Three (3) cases so far include the index case, a teenage sandwich maker at the deli: onset August 30, continued working until September 4, confirmed on September 7. The sibling of the case became ill on September 21 and may be a secondary case or co-primary, but we're not sure at this time. This second case is not a food handler and does not work in the store. On October 3, Broward CHD was notified that the cashier had been admitted to the hospital with signs and symptoms of Hep A, now confirmed (onset: September 21). While the cashier does not handle food, she may have eaten food from the deli. No further cases have been identified to date (October 10).

According to foodborne outbreak investigation procedures, Department of Agriculture and Consumer Services (DACS), the agency of jurisdiction over the grocery store, was contacted at the time of the index case. Investigators will continue to keep DACS informed until the investigation is complete. The corporate Quality Assurance Manager from the grocery store was also notified at the time of the initial case. ISG prophylaxis was discussed with the sandwich maker's family and with the grocery store's QA manager. The family did not come in to the CHD for their ISG. The cashier's family has been prophylaxed.

None of the employees of the grocery store received ISG at the time of the initial case. Karen LaFleur, Regional Food and Waterborne Disease Epidemiologist, discussed the situation with the area manager, advised them of the exclusionary policy for the employee until medically cleared to return to work, and offered ISG to the deli employees. The corporate QA manager elected not to administer ISG, and stated that a retail improvement specialist would visit the grocery and reemphasize/review safe food handling practices and procedures. Ms. LaFleur also reviewed and discussed the situation with the James Cresanta, Broward CHD Epidemiologist, and the Broward Hepatitis Coordinator. There are ~274 employees at the grocery, including 25 deli employees. Many employees eat at least one meal a day from the deli.

Karen LaFleur made contact with the QA manager on October 5. He requested a Hep A presentation for the employees perhaps on two separate days to accommodate their 260+ employees. The grocery store is still ambivalent about offering Hep A vaccinations to the employees. At this time ISG is not a viable option. The QA manager felt that after the presentation, perhaps if any of the employees opt for the vaccination series, the grocery store would pay for the vaccination shots. On Monday Oct. 8, and Tuesday Oct. 9, Bob Griffin and Karen LaFleur conducted an educational presentation on Hep A to the employees of the grocery store in an effort to educate the staff about the course of the disease. They also discussed prevention and control measures to be implemented to prevent the spread of the disease to the staff and to protect the public health.

Please contact James Cresanta, Broward CHD Epidemiologist SC 453-4865 or (954) 467-4865, or Karen LaFleur, Regional Food and Waterborne Disease Epidemiologist, SC 453-4841 or (954) 467-4841 if you have any information about suspected cases.

4.  Weekly Disease Table (40)