A Publication by the Bureau of Epidemiology
August 23, 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
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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In this issue:
1. Global White Paper Initiative on Bacterial Resistance in Community-Acquired Respiratory Tract Infections (RTIs)
Bureau of Epidemiology, Linda M Baldy, MPH
The Global White Paper Initiative on bacterial resistance in community-acquired respiratory tract infections (RTIs) was previewed at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago, IL, December 16-19, 2001. This is the first publication of the International Forum on Antibiotic resistance (IFAR), a 22-member organization of internationally recognized experts from six continents, including infectious disease specialists, microbiologists, epidemiologists, and a diverse range of specialties and societies. The symposium had the support of the European Society of Microbiology, the International Society for Infectious Diseases, and the Infectious Diseases Society of America.
Recognizing the importance of RTIs in the overuse and misuse of antibiotics, the IFAR aims to critically evaluate current knowledge and audit various strategies to control bacterial resistance. The IFAR wants to move beyond describing the problem of bacterial resistance and focus on the implementation of comprehensive strategies to combat the problem while maintaining high-quality care for patients with bacterial infections, an approach more easily accomplished in a much more critical and open fashion due to the independent nature of the organization.
The aim of the Global White Paper Initiative is to critically evaluate current antimicrobial resistance knowledge with a view to addressing gaps in the understanding of resistance and how it can be best interpreted.
Key actions that the Global White Paper calls for include:
Surveillance Studies: Of fundamental importance in guiding empirical antimicrobial therapy and in supporting and monitoring strategies to combat the spread of resistance are local, national and international antimicrobial resistance prevalence data. Although considerable progress has been made in developing research programs, substantial challenges remain to the provision of reliable surveillance data, in relating these data to antimicrobial prescribing patterns, and in the application of this information to support resistance control.
Community-Acquired RTIs: Despite the high rates of antimicrobial resistance that have been reported through surveillance of respiratory tract isolates and isolated reports of failure of RTI treatment with macrolides, few controlled studies have demonstrated adverse effects of resistance on clinical outcomes in patients with lower RTIs. The challenge for the future is to design studies that will definitively establish the impact of bacterial resistance on lower RTIs and to use the resulting data to make clear recommendations about therapy.
Resistance factors: Essentially, we have a "black box" between antibiotic use and resistance, in which various factors determine the outcome and the extent of the latter. All of these factors must be considered in the development of resistance control strategies.
The Patient’s Role: patient-centered approaches, such as shared decision-making, have been developed most extensively in the context of long-term consultations for chronic illnesses. However, the principles would be the same for acute RTIs. The introduction of this concept of shared decision-making and behavioral changes at the physician-patient interface, coupled with education and changes in attitude on a broader level, would provide a means of maximizing the role of the patient in containing the global problem of antimicrobial resistance.
Decision Support Systems for Community-Acquired RTIs: treatment guidelines for RTIs, by encouraging prudent antimicrobial use, may help reduce the clinical impact and spread of resistance, given physicians’ knowledge, acceptance and use of such guidelines. In addition, further research is required to establish the most effective means of implementing and auditing them.
Moving from Recommendation to Implementation: Many interventions can be implemented to minimize the further emergence and spread of antimicrobial resistance. Emphasis on comprehensive intervention programs, in which both the prescriber and the consumer are targeted but without altering quality of care, is essential. Careful auditing should then aid the identification and adoption of the most cost-effective and productive approaches to resistance control.
The Global White Paper is to be published in the journal of Clinical Microbiology and Infectious Diseases in the near future.
2. Merlin and Electronic Lab Reporting Conference Calls
Kathryn S. Teates, MPH, Communicable Disease Surveillance & Reporting
With the efforts of the pilot counties, the Merlin Development Team, and the Division of Information Technology, the Electronic Lab Reporting screens and functionality are nearly ready for launch.
Electronic Lab Reporting is a broad effort of the Florida Department of Health to receive laboratory results electronically, thereby eliminating the need for paper results to be mailed to the state health office. This will also enable county health departments to make more timely, crucial public health prevention and control decisions. Along with other DOH groups, the Bureau of Epidemiology is initiating this effort with the five state laboratories, paving the way to include commercial laboratories in the near future.
In preparation for this major change in doing business, the Bureau of Epidemiology is holding 4, hour-long conference calls for county health department Merlin users and other epidemiology staff at 10AM and 2PM EST on Tuesday, August 27th and Thursday, August 29th. Each call can accomodate approximately 50 callers. The phone number for both days is 1-800-853-3891. All Merlin users will recieve an agenda, conference call phone number, website location for the call, user ID & password for the site, and flow chart for using the Electronic Lab screens. Any questions can be sent to the Merlin Helpdesk email account.
3. Announcement: Regional Epidemiology Seminar to be held November 14th & 15th, 2002 in Panama City, Florida
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
The Bureau of Epidemiology will host the next Regional Epidemiology Seminar for county health department staff, in Bay County, November 14-15, 2002, at the Bay County Health Department. The target audiences for the regional seminar are county health department staff members and partner agencies who are involved in epidemiology. County health department administrators and directors are 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, EpiCom, chronic disease surveillance, laboratory support for epidemiology and bioterrorism. On-line registration will be available on the Bureau of Epidemiology Internet web page soon. Space will be limited to 65 participants.
Additional details will be provided as they become available and posted in the Epi Update and on the Bureau of Epidemiology Internet 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. Tentative Dates: Annual Statewide Epidemiology Seminar (ASES)
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
The Bureau of Epidemiology is excited to announce the resumption of the Annual Statewide Epidemiology Seminar, which was cancelled last year due to limited resources to support a face-to-face meeting. Tentative dates have been set for October 21-22, 2002 in Clearwater, Florida pending approval by the Secretary’s Office. We are in the process of developing an interesting, informative and challenging agenda, a list of exciting speakers and an excellent poster session, not to mention time and occasion for colleagues to interact. Be sure to take advantage of this once-a-year opportunity!
Further details about this program will be made available in the Epi Update and on the
Bureau of Epidemiology Internet website. Melanie Black, MSW, will be managing this activity and can be reached at (850) 245-4444 ext. 2448 or SunCom 205-4444 ext. 2448
5. Bioterrorism Allocation Q and A
Don Ward, Deputy Chief, Bureau of Epidemiollogy
A number of counties submitted their surveillance and epidemiology staffing and project requests in advance of the August 31 deadline. A "thank you" to them. In reading those applications and responding to inquiries from other counties, we have developed a short list of questions and answers that may be of use to counties still working on the applications.
"What
kind of budget is needed for the staff request?"
The budget should descibe what the county needs to have paid for in this
category. There are no accompanying funds. If computers and equipment and travel
will be needed, they should be irtemized on the staff request . We suggest the
following breakdown. Salaries and benefits (for each request), travel,
equipment, supplies and other.
"My
county received very little on the per capita allocation, I plan to use the
staff money to pruchase some software, OK?"
No, staffing dollars can be used to
support staff and staff-related activities (e.g., on-call pay) only. Other
requests must be made as projects.
"We have
some staff who are already doing some of the tasks for which we want to hire
someone. Can we do that?"
These cooperative agreement funds
must be used to supplement, not supplant state and local resources. However, if
you will be establishing a new position that will require re-assigning duties,
that will not be a problem.
"If all
of the resources are not accounted for in the first round of applications, will
the money revert to the Bureau of Epidemiology?"
No, the intent of these resources is
to be used by the county health departments. We may; however, solicit interest
among counties for some surveillance projects we have in mind.
"When
will the monies actually be available to the county health departments?"
We intend to have our review of the
applications completed by September 13. We will make the awards at that time.
"How will
funds be provided to a consortium of counties?"
To a lead county of the consortium.
"Are we
strictly limited to one page in the application."
We will not refuse applications
longer than a page, but please be brief.
We hope this information is useful. If any other questions arise, please send them to me (Don Ward) by e-mail at donald_ward@doh.state.fl.us