EPI UPDATE

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.

Kathryn S. Teates, MPH, Reportable Disease Manager

As part of the reportable function in Merlin, critical labs are entered from Tallahassee for county health departments. These labs were previously known as Stand Alones and were faxed to the counties. As of 12/28/2001, 545 labs with the status of OPEN were still waiting on Merlin county task lists. County health department staff should work to obtain and enter data to make these labs cases or close them. A lab can be closed by clicking the OPEN status, changing to CLOSED with a disposition or reason for closure, and clicking the Save button. With the recent change in policy some cases may be reported in 2002 with 2001 lab dates. Counties not listed on the attached spreadsheet have zero open labs on their task list. If you have any questions, please email the Merlin Helpdesk.

OpenLabCount.xls

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

Gérard Krause, M.D., Dr. Med. (former EIS Officer with the Bureau of Epidemiology) with Robin Terzagian, Regional Food and Waterborne Disease Epidemiologist for Southwest Florida and Roberta Hammond, Ph.D., Food and Waterborne Disease Coordinator, have recently published an article entitled: Outbreak of Salmonella Serotype Anatum Infection Associated with Unpasteurized Orange Juice. The article was published in the Southern Medical Journal (94)12, December, 2001. The outbreak occurred in 1999 in Sarasota County.

ABSTRACT
In March 1999, a patient was infected with Salmonella serotype Anatum after having consumed unpasteurized orange juice from a manufacturer in Florida. We conducted a cohort study among customers of the manufacturer, performed pulsed-field gel electrophoresis (PFGE) on isolates, and inspected the manufacturing plant. Surveillance data identified three additional patients infected with Salmonella Anatum showing indistinguishable or closely related PFGE patterns. Three of the four patients had consumed orange juice from the same manufacturer. In the cohort study, 6 of 68 persons (9%) who consumed orange juice and/or orange ice cream from the manufacturer were ill, compared with 1 of 47 (2%) who did not. A positive antigen test for Salmonella species and coliform growth in juice samples taken from the production line suggested contamination during the manufacturing process. Commercially produced orange juice should be pasteurized or otherwise processed to achieve equivalent reduction of pathogens.

The full text may be obtained by going to: http://www.sma.org/smj/fulltext.htm.

April Crowley, Office of Communications
Lisa Conti, DVM, MPH, Bureau of Epidemiology

TALLAHASSEE—Even though the medical alert for West Nile virus (WN) and Eastern Equine Encephalitis (EEE) will be lifted at the end of the year, the Florida Department of Health (DOH), Florida Department of Agriculture and Consumer Services (FDACS), Florida Fish and Wildlife Conservation Commission (FWCC), Florida Mosquito Control Association, and state universities will continue to work together year-round to protect people and animals against mosquito-borne encephalitis.

According to DOH Secretary John O. Agwunobi, M.D., M.B.A., the medical alert that covered 53 counties encouraged Floridians to take basic precautions to help limit their exposure to mosquitoes, eliminate mosquito-breeding sites around their homes, have their horses vaccinated, and to report dead birds via the Internet. "We have seen a significant drop in mosquito activity and in positive tests for the diseases among our sentinel chickens and reported dead birds," said Agwunobi.

"It’s unfortunate that the West Nile virus has made its way to our state, but now that it is here it is incumbent on state agencies to continue to take steps to protect our citizens and animals," FDACS Commissioner Charles Bronson said. He added: "It is also important for residents to be vigilant about protecting themselves during mosquito season, to keep an eye on their horses to ensure they are not exhibiting symptoms of the disease and especially to provide horses with timely vaccinations now that a vaccine is available."

State officials stressed that while the chance of humans contracting WN or EEE is reduced, people in areas with high concentrations of mosquitoes still need to take precautions, such as wearing mosquito repellant. Additionally, as this is the first year that WN virus has been found in the state, officials encourage anyone who discovers a dead bird to report it via the Internet. The reporting system is located on the Florida Fish and Wildlife Conservation Commission’s Web site at: http://wld.fwc.state.fl.us/bird. If people do not have access to the Internet, they may report dead birds at 1-800-871-9703.

A total of 11 human WN and three human EEE cases were reported to the State Health Office during 2001. The number of dead birds that were found with WN in Florida was over 800, along with close to 200 sentinel chickens testing positive for the disease. FDACS reports over 400 horses in the state contracted WN, and over 40 horses were infected with EEE. Horses should always be vaccinated against both EEE and WN by a licensed veterinarian.

For more information on West Nile virus, visit DOH’s Bureau of Epidemiology’s West Nile Web site at MyFlorida.com (click on Health and Human Services, then Consumers – Diseases and Conditions, then West Nile Virus), or www.doh.state.fl.us/disease_ctrl/epi/htopics/arbo/index.htm or call the Bureau’s hotline at 1-888-880-5782 for recorded information. The Department of Agriculture also has a Web site with information about West Nile at http://doacs.state.fl.us/ai/westnile.

4. Reported Cases of St. Louis Encephalitis, Eastern Equine Encephalitis and West Nile Virus in Florida, 1980-2001

5. AG Holley Grand Rounds

Submitted by Suzy Peters, Ph.D., Bureau of TB & Refugee Health

The upcoming AG Holley Grand Rounds will be next Wednesday, January 9th from 10am-12 noon. The topic will be "Immediate Potent Anti-retroviral Therapy in HIV Infected Subjects Presenting with Acute Opportunistic Infections to an Intensive Care Unit", presented by University of San Diego researcher Dr. Denis Jones.

If you plan to attend in person, please contact Ms. McIntosh at AG Holley so she can reserve lunch for you. A registration form is attached. If you cannot attend in person, but would like to hear the presentation, we have reserved 44 lines that you may call in and listen. Registration for the call in method is not necessary. We only ask that you not put your phone on hold, only mute. Mute will keep the clinic back ground noise off the line but will give you a chance to ask questions when the speaker opens it up for on-line questions.

Please share with anyone you think may be interested. This is a no charge event and physician, nursing and laboratory credits will be available for those attending in person.

Flyer with details and registration form is attached.

GrandRounds 01/09/02

6. Influenza Virus and RSV Surveillance Summary Update

Carina Blackmore, M.S. Vet. Med., Ph.D., Bureau of Epidemiology
Samuel Crane, MPH, Bureau of Epidemiology

Week ending December 15, 2001-Week 50

National report: During week 51 (December 16-22, 2001), 18 of 756 specimens tested by the World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories across the United States were positive for influenza. Since September 30, a total of 15,389 specimens for influenza viruses have been tested and 306 (2.0%) were positive. Of the 306 isolates identified, 296 (97%) were influenza A viruses and 10 (3%) were influenza B viruses. One hundred and ninety (64%) of the influenza A viruses were subtyped, 185 were influenza A (H3N2) and 5 were influenza A (H1N1) viruses. One hundred and ninety-two (63%) of the 306 influenza viruses isolated were from the Pacific region (Alaska, California, Hawaii, Oregon, and Washington). One hundred and thirty-three (43%) of the 306 viruses isolated were identified in Alaska.  The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) overall was 1.5%, which is less than the national baseline of 1.9%. The proportion of deaths attributed to pneumonia and influenza as reported by the vital statistics offices of 122 U.S. cities was 6.4% during week 51. This percentage is below the epidemic threshold of 7.8% for this time. Influenza activity was reported as widespread in Alaska and regional in Colorado and Vermont this week. Sporadic activity was reported from 36 states, New York City and Washington, DC. No influenza activity was reported from Idaho, Arkansas, Illinois, Pennsylvania, New Jersey, New Hampshire, Rhode Island and Delaware.

Florida: Influenza activity appears to be increasing in Florida with 1.29% of patients seeking care by physicians in the influenza sentinel surveillance who met the case definition for ILI (> 100 F + cough and or sore throat) during week 51. This is less than last week’s numbers yet is still higher than in previous weeks in which fewer than 1% of patients seen have had a flu-like illness. Influenza-like illness activity was detected in 11 counties from Escambia to Monroe. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Duval, Hillsborough, Palm Beach, and Polk counties. One positive flu A culture was reported from Polk County this week. Between September 4 and December 27, influenza A (H3N2) was isolated from 12 patients residing in Broward, Collier, Duval, Hillsborough, Lee, Palm Beach, Polk, and St John’s Counties and influenza A of unknown subtype, was isolated from 4 patients in Pinellas and 1 patient from Hillsborough County. Influenza B was isolated from 1 patient in Hillsborough County. In addition, positive rapid antigen tests were reported from Duval County (1), Hillsborough (1), Palm Beach (1), Marion (2), Miami-Dade (6) Okaloosa (2) and Volusia (6) Counties.

Florida Respiratory Syncytial Virus Report: Data reported from December 14 – December 20, 2001, suggest high levels (according to the CDC definition of two consecutive weeks of over 10% of specimens reporting positive) of RSV activity throughout all four surveillance regions of Florida. The Florida RSV Surveillance Project analyzes data from four regional areas encompassing 27 sentinel reporting facilities. The four regions performed a total of 561 RSV diagnostic tests with 186 returning positive. This data represents an overall percent positive rate of 33.2%. Northeast and Southwest Florida led the regions with 52% and 44.5% of reported tests returning positive. The high positive rate of the Northeast region may be explained by a smaller number of tests and fewer facilities reporting.

* 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 (##).