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The Bureau of Epidemiology is available 24 hours a day, 7 days a week for consultation at our main number (SunCom 205-4401 or 850/245-4401) PLEASE NOTE: Consultation after 5 p.m. & on weekends is intended for emergencies.

Rob Hayes, Director of Communications and Program Marketing
Press Release
February 28, 2002

Tallahassee – The Palm Beach County Health Department and Florida Department of Health (DOH) were recognized today in Senate Resolution 2466 for their dedicated, life-saving service to the public during last year’s anthrax crisis.

"The Department of Health is extremely fortunate to have the finest public health servants in the nation," said Florida Department of Health Secretary John O. Agwunobi, M.D., M.B.A. "Through the efforts of our county health directors, epidemiologists, lab workers and countless others who prepare for and respond to health crises on a daily basis, we were able to diagnose, respond to, and contain last year’s anthrax incident."

On October 4, 2001, the Palm Beach County Health Department and officials from the Florida Department of Health announced they were investigating a case of anthrax. The case was diagnosed and subsequently reported through DOH’s statewide disease surveillance system. After a joint investigation with officials from the Centers for Disease Control and Prevention (CDC), the Department of Health identified a second case and determined a biological attack had occurred. This early detection alerted other states to a possible attack, and was most likely instrumental in the implementation of new, heightened procedures across the nation.

Steven Wiersma, MD, MPH, Chief Bureau of Epidemiology and State Epidemiologist

The following article is a summary of the results from the nationwide investigation on rash illnesses in school children CDC has been coordinating during the past few weeks. Our thanks go out to county health departments in Florida who contributed data to this report. The investigation is continuing so please continue to keep your eyes open for clusters of rash illness. Please report information about clusters of undiagnosed rash illnesses to the Bureau of Epidemiology Surveillance Section (Ms. Kathryn Teates). If you need assistance investigating a cluster you can call on your regional epidemiologist or the epidemiologist on call.

Reprinted from the CDC MMWR, March 1, 2002

The first reported incident occurred October 4, 2001, in Indiana, followed by cases in Virginia that began November 20. Subsequent cases of rashes began in late January and occurred as recently as February 21. Rashes have been reported primarily from elementary schools but also among students in a few middle and high schools. The number of affected students in each state ranges from <10 to approximately 600. A few teachers and school staff have been affected, but rarely parents or siblings. Characteristics of the rashes vary, but onset has generally been acute, typically with maculopapular erythematous lesions—possibly in a reticulated pattern—on the face, neck, hands, or arms; duration of the rash varied but in most reports it was highly pruritic. The rashes were not attributed to a defined environmental exposure or infectious agent. Children with rashes were afebrile and usually had no other associated signs or symptoms. The rashes lasted from a few hours to 2 weeks and appeared to be self-limiting. Secondary transmission has not been reported, but in-school "sympathy" cases have reportedly occurred. Diagnoses by clinicians who have examined children have included viral exanthem, contact or atopic dermatitis, eczema, chemical exposure, impetigo, and poison ivy. Approximately 40 serum samples collected in four states have been PCR or IgM negative for parvovirus B19 (1); 22 nasal swab samples have been negative for enterovirus. Environmental assessments have not identified environmental causes.

Full article

Dr. Lisa Conti, State Public Health Veterinarian, Bureau of Epidemiology
Ms. Valerie Mock, Virologist, Bureau of Laboratories

Animal rabies is a public health concern because of the potential for human exposure to the virus through the bite of an infected animal. Since the enactment of animal control and availability of animal vaccination, rabies has declined dramatically in domestic animals. However, rabies is considered enzootic in the raccoon population of Florida. While no human case of rabies due to raccoon variant has been described, public health must remain vigilant.

Testing animals to diagnose rabies requires post mortem examination of brain tissue using flourescent antibody staining. No pre-mortem tests are available for animals. In Florida, only the 5 Department of Health branch laboratories offer animal rabies testing. Animals that bite people or pets are tested for free, other animals may be tested for a $50 charge. During 2001, the 5 Florida DOH branch laboratories tested 3,751 animals (3,257 were tested in 2000 and 3,300 in 1999) of which 198 (5%) were positive: 124 raccoons, 34 foxes, 19 bats, 15 cats, 2 otters, a dog, a bobcat, a horse and a beaver (Figure 1). For the first time a beaver was diagnosed with rabies in Florida. Other changes from 2000 data include an increase in raccoon rabies from 97 (17% tested were positive) to 124 in 2001 during which 20% tested were rabies positive. The number of rabid cats still dominated the tested domestic animals; 15 in 2001 and 9 in 2000. Rabies occurred in 39 counties with 17 counties (Alachua, Brevard, Broward, Clay, Duval, Hernando, Hillsborough, Lake, Lee, Marion, Martin, Palm Beach, Pasco, Pinellas, Polk, Sarasota and Seminole) reporting 5 or more rabid animals (Figure 2). Seminole had considerably more rabid animals reported (19) in 2001 compared with 2000 (1), including this year’s only rabid horse.

The Florida Department of Health Jacksonville Laboratory conducts monoclonal rabies antibody testing on rabies positive specimens. This test is used for epidemiologic purposes to track the progress of any new rabies variant introduced into the state. Only raccoon and bat rabies variants are known to presently exist in Florida; all terrestrial (land) animals were raccoon variant.

Current rabies control efforts focus on reducing the chance of rabies transmission from wildlife to domestic animals by vaccinating dogs and cats, animal control, and providing appropriate post-exposure treatment to exposed people. For more information, please see the Rabies Prevention and Control in Florida ("Rabies Guidebook").

2001 Yearly Rabies Report, Figure 1

Rabies by County, Figure 2

Submitted by Zuber Mulla, PhD, Bureau of Epidemiology

The Bureau of Epidemiology and several county health departments throughout the state have begun to participate in the Florida Comprehensive Cancer Control Initiative (FCCCI) during the past few months. The FCCCI is a CDC-funded effort to integrate cancer control activities in Florida. If you are a public health professional, health care professional, grass-roots community organization, etc, your participation is welcome.

For more information.

Jodi Baldy, MPH, Bureau of Epidemiology

Drug-resistant Streptococcus pneumoniae (DRSP) was added to Florida’s list of reportable diseases in mid-1996. The purpose of the surveillance system at that time was to define and monitor the prevalence and geographic distribution of DRSP and rapidly recognize the emergence of new patterns of resistance, with a primary goal of control and prevention of the harmful public health consequences of this organism.

To permit the assessment of the proportion of pneumococcal isolates that are drug-resistant, invasive SP disease (nondrug-resistant SP isolated from normally sterile sites) was added to the list on July 5, 1999. National surveillance goals are to allow for assessment and impact of the recently licensed conjugate pneumococcal vaccine in children and the impact of increasing pneumococcal vaccination coverage among older adults. On a state level, surveillance of invasive SP will allow states to raise awarness of vaccine recommendations and identify areas or populations in which vaccine use is sub-optimal. SP drives the train for outpatient community-acquired upper respiratory tract infections and is also a target organism for judicious antibiotic use campaigns: surveillance will assist in evaluating the impact and progress of these campaigns.

Case and laboratory report forms sent to the Bureau of Epidemiology during year 2000 were reviewed and characterized with respect to expected numbers and reported antimicrobial activity for patient isolates. The total number of reported cases of SP reviewed for the year was 1,760. Projections for expected reported cases of SP were made using a conservative case rate of 20 per 100,000 population. The expected number of frug-resistant infections was based on an estimated resistance level of 40%.

Curt Miller, Bureau of Epidemiology, Chronic Disease Section

The complete report entitled Perinatal Periods of Risk: An Assessment Approach to Understanding Fetal and Infant Deaths in Florida, 1995 - 1998, published by the Florida Department of Health, Bureau of Epidemiology, Chronic Disease Section, is now accessible on both the Florida Department of Health Intranet and Internet websites. This report gives a detailed demographical analysis of risk factors and death rates that are pertinent to understanding fetal and infant mortality in Florida. Although such analysis of citywide data are available, this report is the first formal Perinatal Periods of Risk analyses from a statewide perspective. This report received favorable recognition at the MCH Epi Conference in Clearwater, FL, in December, 2001. The experimental design used in the analysis was developed by CityMatch, an organization of urban health department MCH programs headquartered at the University of Nebraska in Omaha.

The report may be accessed through either of the following locations:

Intranet: Florida Department of Health Intranet website: http://dohiws.doh.state.fl.us/

Click on Divisions & Bureaus
Scroll down to Disease Control and click on Epidemiology
Scroll down and click on Perinatal Periods of Risk (pdf)

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

National report: During week 7 (February 10-February 16, 2002), 507 (21.1%) of 2,398 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 4-6) the highest proportion of positive influenza cultures (41%) was reported from the West South Central region of the United States (Arkansas, Louisiana, Oklahoma and Texas). Since September 30, a total of 47,974 specimens for influenza viruses have been tested and 5,574 (11.6%) specimens from 50 states were positive. Of the 5,506 isolates identified, 5,506 (99%) were influenza A viruses and 68 (1%) were influenza B viruses. One thousand seven hundred and fifty-six (32%) of the influenza A viruses were subtyped, 1,739 (99%) were H3 viruses and 17 were H1 viruses. Of the 17 H1 viruses, 3 were influenza H1N2 collected from patients in Wisconsin, Nevada and Texas from July-December, 2001.. So far this season, CDC has characterized 220 influenza A viruses antigenically. All viruses were similar to the flu A strains in the 2001-2002 vaccine. Influenza B viruses can currently be divided into 2 antigenically distinct lineages, B/Yamagata/16/88 and B/Victoria/2/87. At this time CDC has only characterized 1 B/Victoria strain in the United States, but the strain has also been detected in Asia, Canada and Europe. The B component of the current influenza vaccine belongs to the B/Yamagata lineage and is expected to provide lower levels of protection against viruses of the B/Victoria lineage. A final decision has not yet been made in the United States regarding the influenza B component of the 2002-03 vaccine. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) overall was 3.6%, 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 8.2% during week 7. This percentage is below the epidemic threshold of 8.3% for this time. Influenza activity was reported as widespread in 13 states (Arizona, Colorado, Kansas, Minnesota, Nebraska, New Mexico, New York, South Dakota, Tennessee, Texas, Utah, Virginia and Washington), regional in 22 states (Arkansas, California, Connecticut, Georgia, Idaho, Indiana, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Nevada, New Hampshire, North Carolina, Ohio, Oklahoma, South Carolina, Vermont, Wisconsin and Wyoming) this week. Sporadic activity was reported from 12 states.

Robin Oliveri, Arbovirus Surveillance Coordinator

To date in 2002, West Nile virus has been identified in two dead birds from Calhoun (1) and Alachua (1), horses in Marion (3) and Polk (1) and a sentinel chicken in Volusia counties. Previously, a human case of West Nile virus appeared in the Weekly Disease Table for 2002. To clarify, this is not a 2002 case. This is a case from the end of 2001 and was included in the final 2001 count. No human cases of West Nile virus have been reported in 2002.

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 (report date not event date) 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 (##).