EPI UPDATE

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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.

1. Influenza Surveillance Report
2. Immunization Update
3. The Florida Quit-for-Life Line: A New Service to Help Reduce Adult Tobacco Use
4. Department of Health to Request Free Potassium Iodide Pills from the Federal Government
5. Second Annual Florida Public Health Association Regional Meeting
6. Upcoming Satellite Conferences
7. Weekly Disease Table

Carina Blackmore, M.S. Vet. Med., Ph.D.

Week ending February 2, 2002-Week 5

National report: During week 5 (January 27- February 2, 2002), 410 (20.6%) of 1,987 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. During the past three weeks (weeks 3-5) the highest proportion of positive influenza cultures were reported from the West, South, Central and Mountain regions of the United States (spanning from Texas, New Mexico and Arizona in the south to Idaho and Wyoming in the north). Since September 30, a total of 36,167 specimens for influenza viruses have been tested and 2,967 (8.2%) specimens from 48 states were positive. Of the 2,967 isolates identified, 2,925 (99%) were influenza A viruses and 42 (1%) were influenza B viruses. Nine hundred and twenty-six viruses were subtyped, 914 (99%) were influenza A (H3N2) and 12 were influenza A (H1N1) viruses. So far this season, CDC has characterized 169 influenza A (H3N2) and A (H1N1) isolates antigenically. All viruses were similar to the flu A strains in the 2001-2002 vaccine. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) overall was 3.2%, 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 7.7% during week 5. This percentage is below the epidemic threshold of 8.2% for this time. Influenza activity was reported as widespread in 9 states (Arizona, Colorado, Kansas, New Mexico, New York, Tennessee, Texas, Utah and Virginia, regional in 21 states (Connecticut, Florida, Georgia, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nebraska, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, South Dakota, Vermont, Washington and Wyoming) this week. Sporadic activity was reported from 25 states.

Influenza A (H1N2), a subtype last seen in China in 1989, was reported this week. The H1N2 strain has been recovered from patients in England, Israel and Egypt and has also been isolated from a patient specimen collected in Wisconsin in December, 2001. CDC has received 6 of the 12 H1N2 isolates identified in the United States this season for antigenic characterization. Testing of the 6 remaining isolates is underway. Because the current influenza vaccine contains strains with both H1 and N2 proteins similar to those in the new strain, the current vaccine should provide good protection against the new A (H1N2) virus. For further information about this virus please visit CDC’s website: http://www.cdc.gov/ncidod/diseases/flu

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 was 1.88% this week, the highest reported level of activity so far this season. Influenza-like illness activity was detected in 10 of 21 participating counties from Escambia to Monroe. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Broward, Duval, Escambia, Hillsborough, Lake, Leon, Monroe, Palm Beach, Polk and Seminole Counties. Nine cases of influenza were laboratory confirmed this week. Influenza A (H3N2) was confirmed from Duval (1), Indian River (2), Leon (3) Counties. Influenza A of unknown subtype was detected from a patient in Pinellas County. Influenza B was reported from Broward County. Positive rapid antigen tests were reported from Escambia, Hillsborough, Marion, Miami-Dade and Pinellas Counties. Between September 4 and February 14, influenza A (H3N2) was isolated from 83 patients residing in Broward, Collier, Duval, Escambia, Hillsborough, Indian River, Leon, Levy, Marion, Monroe, Palm Beach, Pinellas, Polk, Santa Rosa, Sarasota and St. John’s Counties. Influenza A (H1N1) was diagnosed in 2 patients in Duval and Palm Beach Counties and influenza A of unknown subtype, was diagnosed in patients in Broward, Gadsden, Lee, Martin, Orange, Pinellas, Palm Beach and Hillsborough County. Influenza B has been recovered from patients in Broward (1), Hillsborough (2) and Palm Beach (1) Counties. In addition, positive rapid antigen tests were reported from Duval County, Escambia, Hillsborough, Palm Beach, Lee, Marion, Miami-Dade, Okaloosa, Pinellas and Volusia Counties.

Charles H. Alexander, Chief, Bureau of Immunization

Recommended Childhood Immunization Schedule-United States, 2002

The 2002 recommended childhood immunization schedule was recently published in the Notice to Readers: Recommended Childhood Immunization Schedule-United States, 2002, Morbidity and Mortality Weekly Report (MMWR), January 18, 2002 / Vol. 51(02) / ; 31-3. A copy of the notice can be found on the Centers for Disease Control and Prevention’s (CDC) Web site at www.cdc.gov/mmwr/preview/mmwrhtml/mm5102a4.htm. A reproducible copy of the schedule is also available through the CDC's Web site at www.cdc.gov/nip/recs/child-schedule.htm#printable. The recommendations remain the same in content since January 2001. Revisions to the schedule are as follows:

• Preference for hepatitis B vaccine at birth, before hospital discharge. However, it is still appropriate to provide first dose at age two months if the infant's mother is HbsAg-negative.
• A new section outlining vaccines recommended for selected populations. These vaccines include hepatitis A, influenza, and pneumococcal polysaccharide. It is the first time that influenza and pneumococcal polysaccharide vaccines have appeared on the childhood schedule.
• A highlighted pre-adolescent assessment schedule to spotlight the need to reassess vaccine status for all children at their 11 through 12-year-old visit.
• Added catch-up bars across age groups emphasizing the importance of updating vaccination status for children through age 18 years.

The Advisory Committee on Immunization Practices (ACIP) has issued a Notice to Readers: Revised ACIP Recommendation for Avoiding Pregnancy After Receiving a Rubella-Containing Vaccine; Morbidity and Mortality Weekly Report (MMWR), December 14, 2001 / Vol. 50(49); 1117. The revised recommendation shortens the recommended period to avoid pregnancy after receipt of rubella-containing vaccine from three months to 28 days. The recommendation can be found on the CDC's Web site at www.cdc.gov/mmwr/preview/mmwrhtml/mm5049a5.htm.

All persons involved with the administration of immunizations and/or disease surveillance should read and become familiar with the revised schedule and recommendations. If you have any questions concerning the new recommendations, please contact Phyllis Yambor of the Bureau of Immunization at (850) 245-4342 or SunCom 205-4342.

Marie A. Bailey, MSW, Chronic Disease Epidemiology Section, Bureau of Epidemiology

Adults who use tobacco experience a host of adverse health effects, both acute (such as decreased cardiovascular capacity and disrupted reproductive function) and long-term (such as lung cancer, oral cancer, esophageal cancer, emphysema, and cardiovascular disease). In addition, tobacco users suffer short and long-term adverse physical effects, such as premature aging of the skin and tobacco-stained teeth and skin. Their family and household members are also at risk of asthma, ear infections, and respiratory infections from their exposure to second-hand smoke.

To help adult users of tobacco who want to quit, the Florida Department of Health launched a new toll-free phone-line on December 7, 2001. The Florida Quit-for-Life Line—at 1-877-U CAN NOW—is available in English, Spanish, Haitian Creole, and TDD for the hearing impaired. Callers receive counseling services and other information to help them quit using tobacco.

The Florida Quit-for-Life Line was made possible through a grant provided to the Florida Department of Health by the Centers for Disease Control and Prevention (CDC) in Atlanta. The Chronic Disease Tobacco Control Program in the Bureau of Chronic Disease Prevention has contracted with the American Cancer Society to staff the phone lines with trained tobacco cessation counselors. Over the past year, the American Cancer Society has coordinated the development of similar quit-lines in Texas, Colorado, Vermont, Massachusetts, and Oklahoma. The Chronic Disease Epidemiology Section in the Bureau of Epidemiology is providing epidemiological support and evaluation oversight for the Quit-for-Life Line program.

Calls from smokers and other users of tobacco are handled in a stage-based manner, which categorizes individuals into one of five stages:

• Pre-contemplative – individuals who are not aware of the need to change their tobacco use behavior and have no intention of changing it in the foreseeable future;

• Contemplative – Individuals who are aware of the need to change their tobacco use behavior but have not yet made a commitment to take action;

• Preparation – Individuals who are preparing to start making a change in their tobacco use behavior;

• Action – Individuals actively involved in modifying their tobacco use behavior; and

• Maintenance – Individuals who have consistently changed their tobacco use behavior for at least six months.

Callers are offered treatment options that are appropriate for their stage of readiness. Smokers ready to quit receive a choice of: (a) a series of five proactive counseling sessions; (b) self-help materials that are mailed to them; (c) a referral to a community health care provider; or (d) a combination of these options. Coupons for reduced-cost nicotine replacement therapy also are available.

Tobacco use cessation results in immediate and long-term benefits. According to the American Lung Association ( www.lungusa.org/tobacco/quit_ben.html ), at 20 minutes after quitting, blood pressure decreases and pulse rate drops. At eight hours, the carbon monoxide level in blood drops to normal and the oxygen level in blood increases to normal. At 24 hours, the chance of a heart attack decreases. The oxygen-carrying capacity of blood increases, and cilia lining the respiratory tracts of the respiratory system slowly become active again, sweeping materials out of the lungs, decreasing lung congestion, and increasing lung capacity.

One year after quitting, a former smoker’s excess risk of coronary heart disease is decreased to half that of a smoker. After five years smoke-free, stroke risk is reduced to that of people who have never smoked. After 10 years, the risk of lung cancer drops to as little as one-half that of continuing smokers; and the risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases. After 15 years, the risk of coronary heart disease is similar to that of people who have never smoked, and the risk of death returns to nearly the level of people who have never smoked.

With tobacco use cessation, tobacco-induced premature aging of the skin also ceases. Tobacco stains on teeth and skin fade, and tobacco-related odors of the skin, breath and clothing are washed away.

For more information on the Quit-for-Life Line, contact M.R. Street, Chronic Disease Tobacco Control Program Manager, at Suncom 205-4366 (850/245-4366) or via email at mary_street@doh.state.fl.us.

Bill Parizek, Office of Communication

February 11, 2002

Tallahassee – Governor Bush, following discussions between the Department of Health and Senate Select Committee, chaired by Sen. Ginny Brown-Waite (R-Brooksville), today directed Department of Health Secretary John O. Agwunobi, M.D., M.B.A., to accept free potassium iodide (KI) offered by the U.S. Nuclear Regulatory Commission (NRC).

"These pills will provide us an additional tool to protect the public’s health and safety in Florida," said Agwunobi. "The safety and well-being of our state’s residents and visitors is our top priority. We must seek every opportunity to expand available strategies and options."

Potassium iodide is a blocking agent that has been deemed safe and effective by the Food and Drug Administration (FDA) in reducing the risk of thyroid cancer in individuals exposed to a radiation emergency. Potassium iodide does not reduce or prevent all the harmful effects of radiation, which means that evacuation and sheltering of the general public will continue to be the preferred and primary protective actions in the event of a serious radiological or nuclear crisis.

Florida will continue its policy of having KI available to emergency workers and difficult to evacuate individuals. The acceptance of the KI will also allow the state of Florida to enhance its strategic stockpiles of the pills.

Provisional cases reported to the Bureau of Epidemiology by the county health departments. Apparent increase in total number of cases from 2001 to 2002 reflects changes in reporting policy for 2002 data in addition to any changes in disease incidence.

* 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 (##).