A Publication by the Bureau of Epidemiology
January 18, 2002
"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 S. Teates, MPH
Reportable Disease Manager
Jodi Baldy, MPH,
Biological Scientist IV
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.
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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. Creation of the Florida Epidemic Intelligence Service (FL EIS)
Dr. Steve Wiersma, State Epidemiologist and Bureau of Epidemiology Chief
The Florida EIS program was created by Emergency Order #01-300 and signed by Governor Jeb Bush on October 11, 2001, as part of the state’s response to terrorism. This program offers both one and two-year, post-graduate applied epidemiology training for health professionals under the direction of the Bureau of Epidemiology. It will recruit and train epidemiologists to assist county health departments in identifying and resolving disease outbreaks and to become leaders in the field of public health. The long-term goal of this program is to increase the capacity of the Department of Health to respond to new challenges in disease control and prevention.
The Bureau of Epidemiology will provide salary and didactic training and assignees will be matched with qualifying county health departments to spend their time working along with trained epidemiologists and public health professionals. There will be 6 openings for graduates of MPH programs and others who demonstrate similar skills and backgrounds. This program will provide a practical field epidemiology training program for successfully matched candidates. This program is modeled on the federal Centers for Disease Control and Prevention (CDC) EIS program and the California EIS program. The Bureau of Epidemiology has a long history of training CDC EIS officers who have gone on to hold senior positions in public health and other areas.
2. Smallpox Patient Evaluation Algorithm on DOH Website
The Bureau of Epidemiology recently posted on it’s website, a smallpox patient evaluation algorithm and other important clinical information. To view a copy of the algorithm, you must have adobe acrobat reader. After locating the following web address choose About Smallpox.
3. Merlin and Childhood Lead Prevention Program Collaboration
Trina Thompson, MA, Bureau of
Environmental Epidemiology, Childhood Lead Prevention Program
Kathryn S. Teates, MPH, Bureau of Epidemiology, Reportable Disease Manager
Susan Limbaugh, LPN, Bureau of Environmental Epidemiology, Childhood Lead Prevention Program
The Childhood Lead Poisoning Prevention Program is pleased to report that extended lead data screens have been added to the Bureau of Epidemiology’s Merlin Reporting System. The Childhood Lead Prevention Program looked to Merlin to fill gaps left by a stand-alone MS Access database. Merlin’s use by all 67 counties and acceptance level among the county health department staff made it the best vehicle for increasing follow-up and case management of lead poisoning cases.
Merlin’s lead screens provide county health departments with an instrument to report cases, track laboratory results, add follow-up details of lead poisoned children, and compile lead poisoning data in the Merlin statewide database. The flexibility of Merlin allows each county to choose how much of the tool is appropriate for the given county resources.
County programs are now able to immediately track activity through lab results received from private and state laboratories because elevated blood lead levels can be entered directly into Merlin and placed on the county task list. Receiving these details directly from Merlin, facilitates case management at the local level by decreasing the amount of time the lab result spends in transit to the county health department.
Merlin’s unique case numbers enable instant communication between the state program and local lead contacts by email without breach of confidentiality. Since Merlin is a statewide web-based application, both program and county health department staff are able to review cases simultaneously.
The Epi-Analysis feature in Merlin has proven to be most helpful in updating the state program’s main database with accurate demographic information. It also provides the latest updates for any case activity for the week.
Plans for the future of lead screens in Merlin include more reports in the Epi-Analysis area. County health department staff is encouraged to submit their suggestions to the Merlin Helpdesk email account.
The success of the collaboration between the Bureau of Epidemiology Surveillance Section and Bureau of Environmental Epidemiology Childhood Lead Prevention Program in the design and development of the lead poisoning screens is a glimpse into the future of other Bureau collaborations and shows the applicability of Merlin to bring disease reporting and other surveillance programs together under a central statewide database.
4. January is National Birth Defects Prevention Month
Bill Parizek, Office of Communications Press Release
Tallahassee -- January is National Birth Defects Prevention Month, and the Florida Department of Health recognizes the tremendous impact birth defects have on Florida’s families and children. In both the United States and Florida, birth defects have been the leading cause of infant mortality for the past 20 years, accounting for more than 1 in 5 infant deaths. The Florida Birth Defects Registry estimates that one out of every 40 babies is born with a birth defect.
Some birth defects are preventable. Fetal Alcohol Syndrome is one of the leading causes of mental retardation and is 100% preventable. A woman who is pregnant or planning a pregnancy should avoid alcohol, smoking, street drugs and medications, as these can cause birth defects and pregnancy complications. All women capable of becoming pregnant should take a daily multivitamin containing 400 micrograms of the B-vitamin folic acid. Studies show that taking this vitamin prior to and in the early weeks of pregnancy reduces the risk of having a baby with certain birth defects of the brain and spine, including spina bifida, the leading cause of childhood paralysis.
The National Birth Defects Prevention Network (NBDPN) is holding its annual meeting January 14-16, 2002 in Orlando. This year’s opening session, "Future Perspective of Birth Defects Surveillance, Research, and Prevention" brings together national leaders such as Jose¢ Cordero, M.D., from the newly-created National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC); Jennifer Howse, President, March of Dimes Birth Defects Foundation; and Peter van Dyke, Health Resources and Services Administration, to address opportunities for expanding and enhancing birth defects surveillance and prevention activities across the nation.
Public health efforts to study birth defects and provide information and education include the Florida Birth Defects Registry, the Florida Folic Acid Council and the Fetal Alcohol Syndrome Interagency Action Group. To learn more about birth defects surveillance and prevention in Florida, visit the Department of Health web site at www.doh.state.fl.us and the Florida Folic Acid Council website at www.folicacidnow.net.
5. Influenza Virus and RSV Surveillance Summary Update
Carina Blackmore, M.S. Vet. Med.,
Samuel Crane, MPH, Bureau of Epidemiology
Week ending January 5, 2002-Week 1
National report: During week 1 (December 30, 2001-January 5, 2002), 94 (7.3%) of 1281 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 19,815 specimens for influenza viruses have been tested and 617 (3.1%) specimens from 36 states were positive. Of the 617 isolates identified, 602 (98%) were influenza A viruses and 15 (2%) were influenza B viruses. Two hundred and seventy-four (46%) of the influenza A viruses were subtyped, 268 (98%) were influenza A (H3N2) and 6 were influenza A (H1N1) viruses. Three hundred and sixteen (51%) of the 617 influenza viruses isolated were from the Pacific region. (Alaska, California, Hawaii, Oregon, and Washington) with 153 (25% of all flu isolates reported nationwide) isolates recovered in Alaska and 142 (23%) reported from Hawaii. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) overall was 2.4%, 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 6.7% during week 1. This percentage is below the epidemic threshold of 8.0% for this time. Influenza activity was reported as widespread in Colorado and regional in Alaska, Connecticut, Georgia, Louisiana, Maine, New York, Pennsylvania, Texas Utah, Virginia and Washington this week. Sporadic activity was reported from 32 states, including Florida.
Florida: Influenza activity, calculated based on the proportion of patients with influenza-like illness (ILI) seeking care by physicians participating in the Florida Sentinel Physicians Surveillance Network, remained around 2% (1.7%) this week. Influenza-like illness activity was detected in 15 of 22 participating counties from Escambia to Monroe. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Brevard, Duval, Leon, Martin, Monroe, Palm Beach and Polk Counties. Two cases of influenza A (H2N3) were confirmed from Duval, and Indian River Counties this week. Between September 4 and December 27, influenza A (H3N2) was isolated from 18 patients residing in Broward, Collier, Duval, Hillsborough, Indian River, Palm Beach, Pinellas, Polk, and St John’s Counties and infections with influenza A of unknown subtype, was diagnosed in patients in Gadsden, Martin, 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 (1), Marion (8), Miami-Dade (13) Okaloosa (2) and Volusia (6) Counties.
Florida Respiratory Syncytial Virus Report
Data reported from December 28 – January 03, 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 563 RSV diagnostic tests with 164 returning positive. This data represents an overall percent positive rate of 29%. The total reported tests and positives by all regions for the month of December was 2957 and 859 respectively. The average percent positive for the entire state reported in December was 32.2%. Graphics of these statistics available on the Bureau of Epidemiology website at: http://www9.myflorida.com/Disease_ctrl/epi/RSV/rsv.htm.
6. Weekly Disease Table
The disease table is not available this week but will be updated for the next Epi Update edition.