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.

1. Welcome Aboard Florida EIS Class of 2002!
2. Department of Health Enhances Surveillance for Dengue Fever
3. Florida Youth Survey Update
4. A.G. Holley State Hospital Grand Rounds
5. Influenza Virus Surveillance Summary Update
6. Weekly Disease Table

Dana Knox, Bureau of Epidemiology

The First Class of the Florida Epidemic Intelligence Service (Florida EIS) has been selected. The Florida EIS program was created on October 11, 2001 as part of the state’s response to terrorism. The program offers post-graduate applied epidemiology training for health professionals. The new recruits will be trained 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 program commenced with the selection of six assignees. In addition, six county health departments in Florida were chosen, via a bidding process, to serve as training sites for the assignees. The first class of the Florida EIS program began their "tour of duty" with the culmination of the Florida EIS Orientation and Match Day which was held on March 19, 2002.

The Florida EIS match day was hosted by the Bureau of Epidemiology and included a general orientation for the new assignees as well as a matching session. The matching session provided the candidates and counties a chance to get to know each other through individual interviews and gave each the opportunity to rank their candidate and county of choice.

Assignees will officially begin their duties in early April. The matching process was finalized at the end of the day on March 19, 2002 with the following results:

Alachua Consortium:
Assignee: Jerne Shapiro, MPH
Primary Supervisor: Tom Belcuore, MS, Alachua County
Secondary Supervisor: Nathan Grossman, MD, Marion County

Jerne graduated from the University of South Florida in December 2001 with a Master of Public Health with a concentration in Tropical Public Health and Communicable Diseases. She currently resides in Tampa, Florida.

Collier Consortium:
Assignee: Michael Lo, MSPH
Primary Supervisor: Mark Crowley, MS, Collier County
Secondary Supervisor: Robert South, PhD, Lee County
Secondary Supervisor: Joan Colfer, MD, MPH, Lee County
Secondary Supervisor: Judith Hartner, MD, MPH Lee County
Secondary Supervisor: Martha Valiant, MD, Hendry/Glades County

Michael graduated from the University of South Florida in December 2001 with a Master of Science in Public Health in Epidemiology. He currently resides in Tampa, Florida.

Hillsborough:
Assignee: David Atrubin, MPH
Primary Supervisor: Jylmarie Kintz, MPH, Hillsborough County
Secondary Supervisor: Jordan Lewis, RS, MPH, Hillsborough County

David graduated from The Ohio State University with a Master of Public Health in Epidemiology in December 2001. He currently resides in Columbus, Ohio.

Miami-Dade:
Assignee: Edhelene Rico, MPH
Primary Supervisor: Mary Jo Trepka, MD, MSPH, Miami-Dade County
Secondary Supervisor: Fermin Leguen, MD, MPH, Miami-Dade County

Edhelene graduated from the University of South Florida with a Master of Public Health, Epidemiology with a concentration in Infectious Disease in December 2001. She currently resides in Tarpon Springs, Florida.

Palm Beach:
Assignee: Meghan Weems, MPH
Primary Supervisor: Savita Kumar, MD, MSPH, Palm Beach County
Secondary Supervisor: Judith Cobb, RN, MSPH, CHN, Palm Beach County

Meghan graduated from Tulane School of Public Health and Tropical Medicine with a Master of Public Health with a concentration in Infectious Disease Epidemiology in December 2001. She currently resides in Linville, North Carolina.

Pinellas:
Assignee: Carmella Mancini, MPH
Primary Supervisor: Julia Gill, PhD, MPH, Pinellas County
Secondary Supervisor: Debbie Healey, RN, MPH, Pinellas County

Carmella graduated from Emory University, Rollins School of Public Health with a Master of Public Health, Epidemiology in December 2000. She currently resides in Tallahassee, Florida.

The Bureau of Epidemiolgy welcomes these new staff and looks forward to the successful launching of this important program.

April Crowley, Office of Communications
Press Release

March 28, 2002

TALLAHASSEE—With epidemics of dengue fever as close as Cuba and the Caribbean, the Florida Department of Health (DOH) has enhanced its surveillance for this virus. Dengue fever is a mosquito-borne viral disease. The two types of mosquitoes that transmit dengue are found in Florida. Fortunately, no cases of dengue fever have been acquired in Florida in recent decades.

The last epidemic of dengue fever in the United States was in 1934 and 1935, with 2042 cases being diagnosed throughout Florida. Indigenous transmission occurred in Texas in 1986 and again in 1995. Between 1987 and 2001, Florida had an average of four cases per year, all imported. Symptoms of dengue may include sudden onset of fever lasting 3-5 days, eye pain, headache, muscle pain, digestive disorder, joint pain, loss of appetite, minor bleeding and possible rash.

"Even though our surveillance has not identified any dengue cases, it has demonstrated the potential for on outbreak of dengue fever in our state," said DOH Secretary John O. Agwunobi, M.D., M.B.A. He added, "Because the mosquitoes that are likely to transmit dengue prefer to live near houses, it is very important to remove standing water around your home."

• Clean out eaves, troughs and gutters;
• Remove old tires, or drill holes in those used for playground equipment to allow them to drain;
• Turn over or remove empty plastic pots;
• Pick up broken, unused or discarded toys;
• Pick up all beverage containers and cups;
• Check tarps on boats or other equipment that may collect water in pockets or indentations;
• Replace water in birdbaths and pet or other animal feeding dishes at least once a week;
• Change water in the bottom of plant containers, including hanging plants, at least once a week; and,
• Fix dripping indoor and outdoor faucets that create pools of water.

The DOH Bureau of Epidemiology intends to increase its surveillance for dengue by building partnerships with private testing labs, educating private providers and offering rapid follow-up to secure convalescent samples for testing by the Bureau of Laboratories.

Natalie Tackett, Bureau of Epidemiology

The Florida Department of Health is preparing to conduct the Florida Youth Survey. The Florida Youth Survey is conducted among a representative sample of public middle and high schools in all 67 counties and is a collaborative effort between The Department of Health, Department of Education, Department of Children and Families, Department of Juvenile Justice and the Governor’s Office of Drug Control Policy. The survey will include two survey instruments: The Florida Youth Tobacco Survey (FYTS) and the Communities that Care (CTC) survey which are both administered in middle and high school grades.

Both middle schools and high schools will be asked to participate in this important survey effort. Within each school, a small number of classrooms will be randomly selected to participate. Within selected classrooms, students will randomly receive either the FYTS or the CTC instrument. Each student will only complete one survey (either FYTS or CTC), which will take one class period to complete. Information from the surveys may be used for program planning, implementation and evaluation at both the county and state levels. Specifically, the FYTS will be used to monitor progress in reducing youth tobacco use and for the evaluation of Florida’s aggressive anti-tobacco program. Information from the CTC will establish trends in alcohol and other drug use among Florida youth and further describe the prevalence of various risk and protective factors for these behaviors.

The survey may be administered at any time during the survey period beginning on April 15 and ending on May 10, 2002. Training for conducting the survey will be held on April 8 and 9, 2002 in Orlando and Tallahassee, respectively.

If your county has not been notified about the Florida Youth Survey or you would like more information, please contact Natalie Tackett at (850) 245-4444 x2440.

Affette McIntosh, AG Holley State Hospital

Speakers:

James Cobb, Chief Bureau of TB and Refugee Health, Department of Health,

John O. Agwunobi, M.D., Secretary of Health, State of Florida

Date: Wednesday, April 10, 2002

Time: 10:00 a.m. – 12:00 p.m. (EST)

Place: Auditorium, A.G. Holley State Hospital, 1199 W. Lantana Road, Lantana, Fl.

Objectives: By the completion of the presentation, participants will be able to:

• Review overall 2001 statistical tuberculosis data for Florida
• Discuss current priorities of the Florida TB program
• Explain Current statewide TB research projects.

For more details and registration form.

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

National report: During week 11 (March 10-16, 2002), 278 (19.8%) of 1,395 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 9-11) the highest proportion of positive influenza cultures (34%) were reported from the East North Central (Illinois, Indiana, Michigan, Ohio, Wisconsin) region of the United States. Since September 30, a total of 69,323 specimens for influenza viruses have been tested and 11,041 (15.9%) specimens from 50 states were positive. Of the 11,041 isolates identified, 10,741 (97%) were influenza A viruses and 300 (3%) were influenza B viruses. Three thousand eighty-four (29%) of the influenza A viruses were subtyped, 3,045 (99%) were H3 viruses and 39 were H1 viruses. So far this season, CDC has characterized 328 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. Influenza B/Victoria will replace the B/Yamagata strain in the 2002-03 vaccine. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) overall was 2.0%, 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 9.3% during week 11. This percentage is above the epidemic threshold of 8.2% for this time. Influenza activity was reported as widespread in 5 states (Arizona, Missouri, Tennessee, Vermont and Virginia), regional in 26 states (California, Colorado, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Nebraska, Nevada, New York, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming) this week. Sporadic activity was reported from 18 states.

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 0.9% this week. The activity reached a peak (2.7%) in mid-January (week 4). Influenza-like illness activity was detected in 13 of 23 participating counties from Leon to Monroe. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Monroe, Osceola, Palm Beach, and Polk Counties. No cases of influenza were laboratory confirmed this week. Between September 4 and Mar 21, influenza A (H3N2) was isolated from 128 patients residing in Broward, Collier, Duval, Escambia, Hillsborough, Indian River, Lake, Leon, Levy, Marion, Monroe, Osceola, Palm Beach, Pinellas, Polk, Santa Rosa, Sarasota and St. John’s Counties. Influenza A (H1N1) from 3 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 Counties. Influenza B has been recovered from patients in Broward (1), Hillsborough (2) and Palm Beach (2) 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.

* 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 (##).