A Publication by the Bureau of Epidemiology
September 20, 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.
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:
1. Division of Disease Control Collaboration Brings New Extended Data Screens To Merlin For Vaccine-Preventable Diseases-Paper Forms Eliminated
Kathryn Teates, MPH, Communicable Disease Surveillance & Reporting, Bureau of Epidemiology
On Tuesday, September 10th, the Merlin Development Team in the Bureau of Epidemiology, in collaboration with the Bureau of Immunization, published new extended data screens for collection of epidemiologic data corresponding to the paper case report forms for measles, mumps, pertussis, rubella, and tetanus.
The publication of these screens marks the second successful Merlin design collaboration between the Bureau of Epidemiology and the Bureau of Immunization; the first being for the perinatal hepatitis B prevention program. County health department staff have responded very positively to these collaborations, reporting reductions in both data entry time and in duplication of data entry. On-line data entry of extended data (which duplicates the paper case report form) is expected to immediately improve data quality and timeliness of reporting. The availability of these data in Merlin supports expedited review by the Bureau of Immunization and enables enhanced epidemiologic analysis for county health departments and the state health office staff.
The vaccine preventable diseases selected for extended data screen development were chosen because they currently have extended data requirements in weekly reporting to CDC. Paper report forms will still be required for remaining vaccine-preventable diseases like congenital rubella, diphtheria and polio.
Please direct technical questions and comments to the Merlin Helpdesk in the Bureau of Epidemiology at Merlin_Helpdesk@doh.state.fl.us. All program specific questions regarding vaccine-preventable diseases should be directed to the Bureau of Immunization at 850-245-4342.
2. The County Health Department Quarterly Performance Report and the Merlin Reporting System
Roneé Wilson, MPH, Surveillance
Section Epidemiologist
Kathryn Teates, MPH, Surveillance Section Administrator
Recently, the Bureau of EPI was asked to clarify the data discrepancies between the County Health Department Quarterly Performance Report (CHD QPR) and the reports generated from the Merlin Reporting System. Although the data sources for these reports are the same, the reports can differ. The CHD Quarterly Performance Report contains quarterly statistics on indicators for program areas in county health departments. This report is predominantly used to evaluate the quality and quantity of services provided by county health departments. The Merlin Reporting System is used to collect statewide data on reportable conditions under surveillance. The link between Merlin and the CHD QPR is the data from Merlin, which is used to generate the epidemiology section of the CHD QPR. In addition, information from the CHD QPR is used to populate the Public Health Indicator Data System (PHIDS). PHIDS is typically updated annually but the Office of Planning, Evaluation, and Data Analysis is anticipating a new system coming online in September 2002. The new system will be updated weekly. The CHD Quarterly Performance Report and PHIDS can be accessed from the Department of Health Intranet website.
The Merlin database includes selected information for reportable communicable diseases, nearly identical to the Epidemiology – Reportable Disease section of the CHD QPR. One notable exception is that the majority of the animal rabies cases, as part of the Zoonotic Diseases, are not entered into Merlin. Merlin is a person-specific database with required fields that cannot be answered in regards to an animal, such as birth date and occupation. Currently, most animal rabies cases are entered into a separate database at the state health office. New screens will be added in Merlin in the future to accommodate animal rabies reporting.
Merlin can be used to generate various reports and analyses. The diseases in these group reports match those in the PHIDS Communicable Disease Morbidity Indicator Reports. The Enteric Disease Group Report includes reported cases of campylobacteriosis, giardiasis, hepatitis A, salmonellosis, and shigellosis. The Vaccine-Preventable Disease Group Report includes cases of measles, mumps, rubella, rubella congenital syndrome, pertussis, diphtheria, tetanus, acute hepatitis B, and poliomyelitis.
When comparing similar reports from Merlin and the QPR it is important to remember that Merlin is a live, dynamic database with disease counts changing daily. The data for the QPR is static, generated at the end of the quarter. This may cause slight differences in counts. Disease rates are comparable, with the exception that quarterly rates in the QPR are multiplied by 4 to give an annual rate estimate.
Merlin can also be used to generate performance statistics. The system can calculate the median number of days from the date of diagnosis to the date the case is reported to the state health office by the county health department. Merlin can also compute the percentage of cases reported within 21 days of the date of diagnosis or lab report. Cases of chronic hepatitis and lead poisoning are not included in these calculations due to the usual lengthy lag time between the date of onset, follow-up, and date of report. In addition, cases with reporting lag times greater than 60 days are considered outliers and are excluded. The QPR calculates the percentage of cases reported within 21 days from the disease event date. Again, since Merlin data is used to generate the 21-day indicator for the QPR, the numbers should be quite close if not the same.
Merlin, PHIDS, and the CHD QPR are very valuable resources and although they share data source it is important to be mindful of their differences. Disease counts in Merlin can change daily, whereas the CHD QPR and PHIDS are updated in intervals. Any questions about the Merlin Reporting System can be emailed to the Merlin Helpdesk (Merlin_Helpdesk@doh.state.fl.us). The Office of Planning, Evaluation, and Data Analysis can be contacted at (850) 245-4009 (Suncom 205-4009) for questions concerning the CHD Quarterly Performance Reports and the Public Health Indicators Data System.
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 is pleased to announce continuation of the regional epidemiology seminar for county health department staff. The next seminar will be held 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 the first of October. Space will be limited to 60 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 interaction with the county health department epidemiology staff and the potential it offers for improving disease prevention in Florida.
4. Bureau of Epidemiology Grand Rounds
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
The Bureau of Epidemiology Grand Rounds teleconference has been cancelled for Tuesday, September 24, 2002 but will resume on October 29, 2002. Please plan to join us when David Fermin Arguello, MD, a CDC EIS Officer assigned to the Bureau of Epidemiology presents on Rubella Aboard a Disney Cruise Ship. Also scheduled, Roger Sanderson, MA, RN, Regional Epidemiologist, Bureau of Epidemiology for November 26, 2002 presenting on the clinical aspects and public health implications of Neisseria Meningitidis in Florida.
Further details regarding the audio-conference call and the PowerPoint files will be posted on the Bureau of Epidemiology Intranet website. Information about other upcoming topics and presenters will also be posted in the Epi Update. If you have a topic you would like to present or learn more about, please email Melanie Black [Melanie_Black@doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448).
5. Annual Statewide Epidemiology Seminar (ASES)
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
The Annual Statewide Epidemiology Seminar (ASES) that had been tentatively set for October 21-22, 2002 has been put on hold temporarily. We are in the process of examining other dates and locations for this event. 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.