A Publication by the Bureau of Epidemiology
June 14, 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, Deputy Bureau Chief (Management), Epi Update Managing Editor
Catie Richards, Editorial Assistant
Bureau of Epidemiology Frequent Contributors:
Kathryn S. Teates, MPH
Surveillance Section Administrator
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.
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.
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.
In this issue:
Confirmed Case of Eastern Equine Encephalitis in Highlands County
Major Changes For The Merlin System
*The Weekly Disease Table is not included due to technical difficulties
1. News Release: Confirmed Case of Eastern Equine Encephalitis in Highlands County
June 14, 2002
CONTACT: Paula Silverman Thaqi, M.D., M.P.H. (863) 386-6040 ext. 238
***Confirmed Case of Eastern Equine Encephalitis in Highlands County***
The Highlands County Health Department announced that a case of Eastern Equine encephalitis in a 9-year-old child from Highlands County has been confirmed. Eastern Equine virus is a naturally occurring virus endemic throughout the United States. This is a rare disease occurring sporadically that does not cause outbreaks. The last known case in Highlands County occurred in 1997. Symptoms range from mild flu-like illness to encephalitis or swelling of the brain. Symptoms of encephalitis include severe headache, high fever, neck stiffness seizures, coma, etc. The disease is circulated in nature between birds, small mammals and mosquitoes. Humans, horses and other exotic game birds may become infected when bitten by an infected mosquito. The disease is not transmissible between humans or between horses and humans. Eastern Equine encephalitis is a disease that is reportable to the Highlands County Health Department. The Health Department continually monitors for the presence of this disease.
According to Dr. Paula Silverman Thaqi, Director of the Highlands County Health Department, "All mosquito-born illnesses are preventable. Residents and visitors are urged to continue taking the following personal precautions against mosquito bites.
For more information on mosquito-borne encephalitis, including reporting human cases, please call the health department at 863/386-6040.
2. Major Changes For The Merlin System
Kathryn S. Teates, MPH, Surveillance Section Administrator
Two exciting new enhancements to the Florida Department of Health’s disease control capacity with the publishing of the next two Merlin versions, Electronic Lab Reporting and Enhanced Analysis.
Electronic lab reporting will begin in Florida with the five state laboratories. Currently, all results of laboratory tests performed at the DOH laboratories are loaded into a database at the Jacksonville laboratory. Positive results will be routed from that database (as HL7 messages) to broker/router managed by the Division of Information Technology, and then to the Merlin daytabase. The positive results will then appear on the appropriate county health department task list. With a couple of notable exceptions (such as providing all results for hepatitis panels), only positive lab results for reportable diseases will be imported directly into Merlin. The original Merlin "test " counties (Collier, Hillsborough, Pinellas and Sarasota) have worked with the bureau of Epidemiology on the project by reviewing screen designs and functionality. The response from the state lab to the county health department greatly decrease by daily downloads from the state lab that will be imported into Merlin that same day. This will enable the county health department to have the lab result information in time to make crucial public health prevention and control decisions. This stage of electronic lab reporting is important and will pave the way for including commercial laboratories in the near future.
The Enhanced Analysis version will concentrate solely on the Epi-Analysis section of the Merlin Reporting System. The Merlin team has been working with the county and headquarters’ epidemiologists to develop enhanced analysis tools for risk factor frequency analysis, export files for import into other programs, and building custom line list reports.
The Risk Factor report will enable county health department staff to analyze their data in Merlin for increased frequency of morbidity among groups based on selection criteria. From the Risk Factor report the county can see if a certain age group is being reported more than others and target the resources for control and prevention. The frequencies can be viewed or the user can create a custom line list report to get a list of the cases and the information required.
If the Risk Factor report does not meet the needs of the user they can select Export Files to create a versatile text file for import into the statistical program of their choice. This format is imported successfully into Epi Info 2000, for example.
Testing of these two versions is nearly complete, and has been successsful. There will be an orientation conference call for Merlin users near the end of June (probably the 25th), prior to the publication of these two versions. The training site will be accessed during the conference call for demonstration and opportunity to navigate the screens before publication. Once the versions have been published the Surveillance Section will send out the usual announcement by email along with the official documentation.
3. Announcement: Communicable Disease Epidemiology Regional Training to be Held July 18th – 19th 2002 in Sarasota, Florida
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
The Bureau of Epidemiology is pleased to announce the resumption of the Bureau’s regional epidemiology training programs for county health department staff. The next training program will be held in Sarasota County July 18-19, 2002, at the Edson Keith House at Phillippi Estate Park. The target audiences for the regional training programs are county health department staff members, particularly those who are directly involved in epidemiology and disease prevention. County health department administrators and directors are always welcome to attend.
The program will provide an overview of epidemiologic principles such as disease surveillance and communicable disease outbreak investigation. We will also offer other topics of interest including, Merlin, Epi Com and bioterrorism. On-line registration will be available Monday June 24, 2002 through July 12, 2002 on the Bureau of Epidemiology Intranet web page.
Space will be limited to 55, so please register as soon as possible.
Additional details will be provided as they become available and posted in the Epi Update and on the Bureau of Epidemiology Intranet web page. Melanie Black, MSW, Professional Training Coordinator for the Bureau of Epidemiology will be managing this activity. If you are interested in hosting one of the training programs or have questions related to this program, please feel free to contact Ms. Black at (850) 245-4444, ext. 2448 or SunCom 205-4444, ext. 2448.
We are truly excited about this renewed effort and the potential it offers for improving disease prevention in Florida.
4. Respiratory Syncytial Virus (RSV) Surveillance Update
Don Ward, Deputy Chief, Bureau of Epidemiology
The Bureau of Epidemiology has reformatted the presentation of its RSV surveillance data. Two graphical representations of RSV data charts are now available for each of 5 geographic regions of the state. The first displays RSV testing and positivity by each region’s participating hospitals (combined), by month for the previous 12 months. The second displays the same data by week for the current and previous 4 months. Charts detailing statewide data are also available in the same monthly and weekly configurations. RSV data may be viewed on the Bureau’s website under "Diseases and Conditions," then RSV. We have received numerous positive messages from providers and participating hospitals regarding the new formats.
The Bureau is constantly looking for additional hospitals that are willling to participate in this important surveillance program. Hospitals wishing to become RSV sentinel sites should contact Melanie Black, LCSW, at (850) 245-4444, ext. 2448.
Using epidemiologic information to identify the beginning of the RSV season aids physicians in knowing when to initiate treatment of high risk children, hopefully preventing serious respiratory conditions.
RSV Statewide by Month (pdf)
5. Arboviral Activity Summary through the Week Ending June 14, 2002
Lisa Conti, DVM, MPH, State Public Health Veterinarian and Robin Oliveri, Arbovirus Surveillance Coordinator
There are currently no Arbovirus Medical Alerts issued for the state. During the period June 8 through June 14, 2002, the following arbovirus activity (St. Louis encephalitis [SLE] virus, eastern equine encephalomyelitis [EEE] virus, West Nile [WN] virus and dengue virus) was recorded for Florida:
Human: One case of EEE in Highlands county was reported to the State Health Office.
Sentinel Chickens: Two EEE seroconversions were confirmed, one in St. Johns County and the other Orange. Two WN seroconversins were confirmed, one in Pinellas County and the other in Volusia. 657 samples tested; 22 counties submitting sentinel specimens.
Equine*: One horse was reported with EEE in Volusia County.
Bird Mortality: No new birds were reported with WN this week. 53 dead birds were reported, of which 10 (18.86%) were crows and 2 (3.77%) were jays. Cumulatively, 2,654 reports have been made for 3,861 dead birds, 732 were tested.
To report dead birds use http://wld.fwc.state.fl.us/bird/ or call toll free 1-800-871-9703.
NOTE: Online bird identification: http://www.mbr-pwrc.usgs.gov/id/framlst/framlst.html or http://data.acnatsci.org/ornithology/vireo.php
Mosquito Pools: No positive mosquito pools were identified. Cumulatively, 544 mosquito pools have been submitted for testing.
Florida is currently at "Level 3" in the Arbovirus Response Plan (see http://www9.myflorida.com/disease_ctrl/epi/htopics/arbo/index.htm). To assure data dissemination in this second year of West Nile virus actvity, weekly Friday afternoon Arbovirus Conference Calls were begun on May 17, 2002. Media releases were issued to date on local arboviral actvity in Dade, Duval, Marion, Osceola, Pinellas, Polk and St. Johns counties.
2002 Cumulative Arbovirus Activity by County
Animal SurveillanceWest Nile Virus state totals: 5 dead birds, 6 sentinel birds and 7 horses*.
Eastern Equine Encephalomyelitis virus state totals: 30 sentinel chickens, 9 horses*
(Note: 1 sentinel was removed from Walton because its first serologic evidence of WN was during late 2001. )
Note: Per DACS, a horse previously reported with EEE in Walton County was removed when additional laboratory information ruled out the disease.
Eastern Equine Encephalomyelitis
One confirmed case (Highlands) has been reported to the State Health Office.
One confirmed case (Miami-Dade) and 4 probable cases have been reported (Miami-Dade, Hillsborough, Osceola, Palm Beach). All cases were acquired outside of the United States.
No positive pools
For more information please see the DOH website at http://www.doh.state.fl.us/disease_ctrl/epi/htopics/arbo/index.htm
Acknowledgements/data sources: county health departments, Department of Health Laboratories, Department of Agriculture and Consumer Services, mosquito control agencies, Florida Fish and Wildlife Conservation Commission, medical providers and veterinarians.