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.

April Crowley, Office of Communication

January 10, 2002

TALLAHASSEE—Florida Department of Health (DOH) Secretary John O. Agwunobi, M.D., M.B.A., has announced the appointment of Bonita (Bonnie) Sorensen, M.D., M.B.A., as Deputy State Health Officer.

Sorensen brings years of public health expertise along with a commitment to improving the health of Floridians to the state health office. She began her career as a primary care physician, and has been the Director of the Volusia County Health Department since 1996. Sorensen has strategically positioned the Volusia County Health Department by spearheading many projects, most recently culminating in the Healthy Volusia Mobilizing for Action Through Planning and Partnerships Project (MAPP).

According to Agwunobi, "Sorensen’s many years of dedicated service at the county health department level will provide valuable input to our statewide health initiatives."

Sorensen is certified in Internal Medicine with a fellowship in Endocrinology/Metabolism. She received her medical training from the University of Illinois, and later received her Master of Business Administration from NOVA Southeastern University.

Sorensen is an active member of many national, state and local organizations and serves as the current president of the Florida Public Health Association and president of the Florida Society for Preventive Medicine. She has also written several articles for various medical publications. In her spare time, Sorensen enjoys competitive race walking.

Sorensen will assume her role as Deputy State Health Officer in Tallahassee on February 1, 2002. Among her responsibilities, she will oversee all 67 county health departments statewide, in addition to directing DOH’s Divisions of Disease Control, Environmental Health, and Family Health Services.

Melanie Black, MSW, Bureau of Epidemiology

Time: 11:00 AM – 12:00 PM EST

Meet Me Conference Number (850) 487-8587 or SunCom 277-8587

The Bureau of Epidemiology Grand Rounds program will resume this month. Phil Lee, Biological Scientist IV, Bureau of Laboratories, Jacksonville, Florida will be presenting on the state labs role related to bioterrorism and their capabilities for handling and testing specimens. Further details regarding the audio-conference call and PowerPoint files will be posted on the DOH Intranet site as they become available. Please plan to join us.

If you have any topics you would like to see presented or suggestions for future topics, please contact Melanie Black [Melanie_Black@doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 or SunCom 205-4444 ext. 2448

Kathryn S. Teates, MPH, Reportable Disease Manager

Merlin Basic Training courses will be held in Tallahassee on January 23^rd and February 1^st, from 8:30A – 2:00P. Please email the Merlin Helpdesk if you are interested in attending or have any questions. Include in your email: the name of your county, how many people will be attending, and which date you wish to attend. Each class size is limited to 12 and will be closed after all seats are filled.

Official CDC Health Update

The Centers for Disease Control and Prevention's medical epidemiologists have investigated the illness in a postal inspector reported in the current issue of the Journal of the American Osteopathic Association (JAOA) (1). After a thorough review of clinical, laboratory, diagnostic imaging, and serology results related to the case, CDC determined that the illness did not meet the anthrax case definition.

CDC's definition of a confirmed case of anthrax is described as 1) a clinically compatible case of cutaneous, inhalational, or gastrointestinal illness that is laboratory confirmed by isolation of B. anthracis from an affected tissue or site or 2) other laboratory evidence of B. anthracis infection based on at least two supportive laboratory tests. A suspected case of anthrax is defined as 1) a clinically compatible case of illness without isolation of B. anthracis and no alternative diagnosis, but with laboratory evidence of B. anthracis by one supportive laboratory test or 2) a clinically compatible case of anthrax epidemiologically linked to a confirmed environmental exposure, but without corroborative laboratory evidence of B. anthracis infection (2).

On November 18, 2001, CDC held a meeting of clinicians and health department personnel from areas where anthrax cases were identified, infectious disease experts, representatives of professional societies, and experts from federal agencies to discuss the prophylaxis, diagnosis, and treatment of anthrax (3). The clinical case definitions were reviewed and agreed upon by the experts at this meeting. CDC has no plans to update or to modify the anthrax case definitions at this time.

CDC understands that physicians throughout the country have a heightened awareness of suspicious illnesses. CDC is very interested in following up on reports of such illnesses as part of our ongoing surveillance and to better understand anthrax and its effects in exposed persons.

1) Symptoms Associated with Anthrax Exposure: Suspected "Aborted" Anthrax. JAOA; January, 2002, 102(1):41-43.

2) Update: Investigation of Anthrax Associated with Intentional Exposure and Interim Public Health Guidelines. October 2001 MMWR; October 19, 2001, 50(41): 889-893.

3) Meeting Summary: Clinical Issues in the Prophylaxis, Diagnosis, and Treatment of Anthrax. Journal of Emerging Infectious Diseases; February, 2002, 8 (2).

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

Week ending December 29, 2001-Week 52

National report: During week 52 (December 23-29, 2001), 20 of 608 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 17,212 specimens for influenza viruses have been tested and 356 (2.2%) specimens from 36 states were positive. Of the 356 isolates identified, 343 (96%) were influenza A viruses and 13 (4%) were influenza B viruses. Two hundred and nine (61%) of the influenza A viruses were subtyped, 203 were influenza A (H3N2) and 6 were influenza A (H1N1) viruses. One hundred and ninety-eight (56%) of the 356 influenza viruses isolated were from the Pacific region. (Alaska, California, Hawaii, Oregon, and Washington) and 136 (38%) of the 356 viruses isolated were identified in Alaska. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) overall was 2.5%, which is above 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 7.0% during week 52. This percentage is below the epidemic threshold of 7.9% for this time. Influenza activity was reported as widespread in Colorado and regional in Connecticut, Pennsylvania and Utah this week. Sporadic activity was reported from 42 states and New York.

Florida: Influenza activity appears to be increasing in Florida with 2.3% 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 52 compared to 1.3% during week 51. Influenza-like illness activity was detected in 13 counties from Leon to Monroe. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Broward, Duval, Hillsborough, Lake, Leon, Monroe, Palm Beach, Polk and Sarasota counties. Five cases of influenza A (H2N3) were confirmed from Duval, Pinellas and Indian River Counties this week. An untyped influenza A from Palm Beach and six positive rapid antigen tests from Hillsborough County were also reported this week. Between September 4 and December 27, influenza A (H3N2) was isolated from patients residing in Broward, Collier, Duval, Hillsborough, Indian River, Palm Beach, Pinellas, Polk, and St John’s Counties and influenza A of unknown subtype, was isolated from patients in Pinellas, Palm Beach and Hillsborough County. Influenza B was isolated from 2 patients in Hillsborough County. In addition, positive rapid antigen tests were reported from Duval County (1), Hillsborough (11), Palm Beach (2), Marion (7), Miami-Dade (13) Okaloosa (2) and Volusia (6) Counties.

Data reported from December 21 – December 27, 2001, continue to 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 regions encompassing 30 sentinel reporting facilities. The four regions performed a total of 555 RSV diagnostic tests with 158 returning positive. This data represents an overall percent positive rate of 28.5%. This percentage is slightly lower than the previous two weeks. Northeast and Southwest Florida led the regions with 38.5% and 33.2% of reported tests returning positive. Percentages in both regions were slightly lower than the previous two weeks.

* The column of data representing the "3-year average to week ##" is the average of years 1999, 2000 and 2001 cases to the current listed week (##).