Friday, February 6, 2004
This Week in the News
reason for collecting, analyzing and disseminating information on a
disease is to control that disease. Collection and analysis; should not
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►Florida Influenza Surveillance For the Week Ending January 24, 2004
Reports from the state, the nation and around the world for Week 3.
County Experiences Outbreaks of Illness Associated With Exposure to Lake
The clusters were investigated by the health department and a Florida EIS fellow.
Conference Call Nets Information on Bureau Programs
Merlin, EpiCom, the EIS program, influenza surveillance and the pandemic influenza plan were all discussed during the most recent call.
Epi Update Managing Staff:
Acquainted - Meet the Bureau's Respiratory Disease Surveillance
You've been reading about her work. Now you can learn about the person behind the facts and figures.
Grand Rounds Focuses on Norovirus Outbreak in St. Lucie County School
When students and staff at this private school experienced symptoms, the St. Lucie County Health Department and Bureau of Community Environmental Health were called in to investigate.
Training Slated for February
CEUs will be available for all three of these satellite broadcasts.
Week on EpiCom
An outbreak of possible foodborne norovirus at an island resort was reported in Nassau County.
A report outlining activities for January 25-31, 2004 for confirmed cases.
A R T I C L E S
|Angela Fix, MPH, Respiratory Disease Surveillance Epidemiologist, Melissa Covey, Influenza Surveillance Coordinator||
►Florida Influenza Surveillance For the Week Ending January 24, 2004
Across the nation, regional activity was reported in 20 states, including Florida, for the week ending January 24, 2004. Only one state, Delaware, reported widespread activity. Influenza activity reported by the sentinel physicians decreased in most regions across the country. The percentage of deaths due to influenza and pneumonia also decreased for the nation, but is still above the epidemic threshold.
CDC and WHO reported that as of February 2, there are fourteen laboratory-confirmed cases of avian Influenza A (H5N1) infections in humans in Vietnam and Thailand. Ten cases were from Vietnam and four were from Thailand. Eleven of the fourteen cases have been fatal. Health officials believe those individuals who contracted the virus became infected through contact with the droppings of, or direct contact with, the infected birds. At this time the WHO is not ruling out the possibility of person-to-person transmission of the avian virus in Vietnam; however, there is still no confirmatory evidence this type of transmission. The Bureau of Epidemiology, in accordance of CDC guidelines, has established enhanced surveillance for avian influenza in the state of Florida, as well as testing protocols for individuals suspected of being infected with the avian Influenza A virus (H5N1). Physicians and health care workers are asked to report any suspected cases of avian influenza immediately to their local county health department. County health departments have been instructed to contact Dr. Joann Schulte at the Bureau of Epidemiology for immediate triage of all suspected avian influenza cases. CDC and WHO are still working in collaboration to develop a vaccine against the H5N1 strain and are providing states and other countries with testing materials to identify the H5 virus. Currently the CDC and WHO laboratories are the only facilities capable of detecting the H5 strain.
To view the complete report, click here.
|Dean Bodager, RS, DAAS, MPA, Regional Environmental Epidemiologist, Bureau of Community Environmental Health, Jose Lojo, MPH, Florida EIS, Polk County Health Department, Cynthia Goldstein-Hart, MPH, REHS, Epidemiology Program Manager, Polk County Health Department, Tim Mitchell, RS, Environmental Specialist, Polk County Health Department||►Polk County Experiences Outbreaks of Illness Associated With Exposure to Lake Water|
Swimming (RR=4.36, CI 1.20-15.86, p=0.002) and water slide use (RR=2.55, CI 1.16-5.61, p=0.009) exposures were statistically associated with illness. Water laboratory analysis results were within satisfactory limits for both the bathing facility and the potable water supply (i.e. less than 200 fecal coliforms per 100 ml of water).
July Cohort: A total of 29 people out of 30 from this cohort were interviewed (96.7%). Ages ranged from 4-54 years with a mean of 25.4 years, a median of 27 years and a mode of 8 years. Ten (34.5%) of the 29 became ill after the picnic, and none of the ill sought medical treatment. Of the 10 ill, 6 were children. Incubation periods ranged from 8 to 48 hours with a median of 23.5 hours. Diarrhea (90%), vomiting (80%), abdominal cramps (70%), fever (40%), malaise (30%), headache (30%), and body aches (30%) were the reported symptoms. All of the children reported vomiting, but only 50% of adults did. Onsets of illness were July 21 and 22, 2003. (See Chart 2).
Analysis of the food items did not reveal any significant relative risks. Tubing (RR=9.64, CI 1.39-66.66, p= 0.002) and wakeboarding (RR=7.33, CI=2.562-20.99, p=0.0007) were statistically associated with illness. Investigation into whether or not a sewer break occurred in vicinity was negative. Three lake water samples taken at various points near the shore were within established fecal coliform limits.
Noroviruses (genus Norovirus, family Caliciviridae) are a group of related, single-stranded RNA, nonenveloped viruses that cause acute gastroenteritis in humans. The incubation period for Norovirus-associated gastroenteritis in humans is usually between 24 and 48 hours (median in outbreaks 33 to 36 hours), but cases can occur within 12 hours of exposure. Norovirus infection usually presents as acute-onset vomiting, watery non-bloody diarrhea with abdominal cramps, and nausea. Low-grade fever also occasionally occurs, and vomiting is more common in children. Symptoms usually last 24 to 60 hours. Recovery is usually complete and there is no evidence of any serious long-term sequellae. Noroviruses are transmitted primarily through the fecal-oral route, either by consumption of fecally contaminated food or water or by direct or indirect person-to-person spread. Noroviruses are highly contagious, and it is thought that an inoculum of as few as 10 viral particles may be sufficient to infect an individual.
Norovirus is a relatively stable virion in external environments. Much is still to be learned about its durability and survival in recreational bodies of water including lakes, ponds, interactive water fountains, water parks, spas and swimming pools. They are able to survive freezing, temperatures as high as 60°C, and have even been associated with illness after being steamed in shellfish. Moreover, noroviruses can survive chlorine contact up to 10 ppm chlorine. The spread of infection can typically be decreased by standard measures for control of diarrhea such as good infection control for densely populated facilities, proper personal hygiene (especially hand hygiene), cleanliness of surfaces, and exclusion of those ill if associated with care-giving or food service. However, in situations where mode of transmission is not person-to-person, interventions must then be based on the most likely exposure risk.
Although reports of waterborne transmission of viruses, particularly the Norovirus, are not as frequent as foodborne or person-to-person transmission, there have been a number of similar events reported. Detection of Norovirus in a water matrix is challenging, expensive and experimental. Only recent advances in laboratory detection methods have allowed the virus to be detected accurately in human specimens. It is very important that recreational and drinking water exposures be considered potential risk factors by epidemiologists during investigation of gastrointestinal illness clusters.
|Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology||►Bi-Weekly Conference Call Nets Information on Bureau Programs|
Disease Tracking in Merlin. Travis McLane explained that the Merlin reporting system is being modified to proactively track high priority diseases and notify users immediately when certain high threat diseases are entered into the system. These include smallpox, botulism, anthrax, plague, Q fever, tularemia, brucellosis, and hemorrhagic fever.
Definitions have been set for case deletions on Merlin. From now on, unconfirmed high priority diseases, those ruled out by lab or clinical results, and diseases reported by counties prior to meeting the case definition may be deleted. When the deletions are made, the affected county will be notified.
These and other modifications will be made to Merlin shortly and an e-mail will be sent to all users as soon as they’re completed.
EpiCom Changes. Pete Garner outlined changes to the EpiCom communications system coming soon. The most visible change will be the placement of the most recent forum posting to the top of each section. The most active alerts will also be stationed at the top of the Forum page. An attachment button will also be added so that if a user needs to provide documentation that goes beyond the scope of their posting, they’ll be able to add a document, spreadsheet or other file, subject to moderator approval.
Other changes will be forthcoming and future comments and suggestions are always welcome. These changes are the result of previous input. An announcement will accompany the changes when they’re completed.
EIS Program. Julia Gill stated the history and purpose of the EIS Program, and stressed the importance of employing graduates of public health disciplines as investigators at our county health facilities. The deadline for applications is March 19th and already over 100 graduate students have applied. The deadline for counties is March 12th. Interviews and orientation will be conducted on April 27-28th and assignments will begin in late May or early June.
Influenza Surveillance Update. Angela Fix reported further decreases in the number of influenza cases statewide. She warned that the month of February normally shows an increase. According to the CDC, Reporting Week 3 shows the mortality rate is down. Delaware is the only state reporting widespread activity.
She also advised that the avian flu poses no imminent threat to the U.S.
Upcoming Training. Melanie Black reminded listeners of the regional training seminar scheduled for February 25-26th. Registration is available online and only 10 slots remain. On February 24th a Grand Rounds will be presented on the topic, “ Norovirus Outbreak in a Private Elementary School in St. Lucie County, Florida.”
Announcements. Don Ward summarized a recent smallpox reporting issue, which occurred earlier in the week in Putnam County. The case was finally diagnosed as chickenpox. The after-action report will be released soon.
The Pandemic Influenza Plan is being reviewed for changes. Treatment of high-risk populations, surveillance and a few other issues will likely be modified and forwarded to the counties for further review.
The next conference call is scheduled for Friday, February 13th at 10:00 a.m. To be placed on the agenda, contact Melanie Black or Don Ward at 850.245.4444.
|Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology||►Getting Acquainted - Meet the Bureau's Respiratory Disease Surveillance Epidemiologist|
Angela received her BS in Medical Microbiology and Immunology from the University of Wisconsin in 1998. She spent the next three years at the University of Iowa, researching antimicrobial resistance, evaluating commercial testing systems, and performing statistical analyses on an international pathogenic bacterial surveillance project for a private laboratory. Her interest in epidemiology led her to the MPH program at San Diego State University where she obtained her graduate degree in 2003. Her thesis was on A Geospatial Analysis of Homicides in San Diego County, 1995-2001.
Angela's work at the Bureau of Epidemiology entails monitoring trends in infectious respiratory diseases, ensuring notifiable disease reporting accuracy within the electronic surveillance system, coordinating infectious disease surveillance and epidemiology programs within the bureau, and evaluating the program effectivess.
Prior to her decision to become involved in the science of disease control and investigation, Angela considered a role in seismology, with a career goal of being the first person capable of predicting earthquakes. Now that she maintains responsibility for surveillance and information of respiratory diseases, the state should be better prepared to address respiratory diseases.
|Edgar Morales, MPH, Environmental Epidemiologist, St. Lucie County Health Department, Karlette Peck, MPH, PA, Epidemiologist, St. Lucie County Health Department, Janet Wamnes, MS, Regional Environmental Epidemiologist, Bureau of Community Environmental Health||►February Grand Rounds Focuses on Norovirus Outbreak in St. Lucie County School|
Personnel from the Epidemiology and Environmental Health Bureaus and the Bureau of Community Environmental Health conducted the investigation. The Environmental Health Division conducted a food service inspection. The Epidemiology Bureau investigators collected a menu list and developed a questionnaire that captured personal, demographic information and food consumption of students and staff who ate lunch at the school on September 23 and 24. Recommendations were made to school officials to minimize person-to-person transmission of the virus including hand washing, using single serve utensils, a food education program for kitchen staff and closing the school for a day and a half. Norovirus was identified as the probable cause of the gastrointestinal illness. This outbreak is strongly associated with the consumption of the chef’s salad served on September 23.
|Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology||►New Training Slated for February|
Sponsored by the National Center for Environmental Health and the Public Health Training Network, this satellite broadcast will provide clinicians the most current information on possible radiological scenarios, basic information on protection, medical management of victims of a radiological incident and decontamination and treatment of victims. Visit the CDC/ATSDR Training and Continuing Education Online System at http://www.phppo.cdc.gov/phtnonline to register for this course. One hour of continuing education credit will be offered for various professions. Participants need to register and fill out an online evaluation for this program. Individuals who have questions about registration should call 1-800-41-TRAIN or email firstname.lastname@example.org. Questions regarding program content should be emailed to email@example.com. When emailing questions, please indicate Medical Response to Nuclear and Radiological Terrorism in the subject line.
The Epidemiology and
the Prevention of Vaccine-Preventable Diseases-Session 1
This satellite broadcast, sponsored by the CDC Public Health Training Network and the National Immunization Program, is the first of a four part series on improving immunization practices in the United States. This series of satellite broadcasts is an annual offering. The target audience is public and private healthcare providers including physicians, nurses, nurse practitioners, physician assistants, pharmacists and their colleagues who either give immunizations or set policy for their offices, clinics, communicable disease or infection control programs. At the end of this series, participants will be able to describe the difference between active and passive immunity, list two characteristics of live attenuated vaccines and list two characteristics of inactivated vaccines. For each vaccine preventable disease, the broadcast will discuss the disease including the causative agent, list high risk groups, identify those for whom routine immunization is recommended descried the characteristics of the vaccine used to prevent each disease, contraindications and/or adverse reactions and immunization schedule.
Session One will cover principles of vaccination, general recommendations on immunization, and strategies to improve immunization coverage levels, including registries and vaccine coverage assessment.
CEUs will be offered for various professions based on three hours of instruction. Participants need to register and fill out an online evaluation for this program. Individuals who have questions about registration should call 1-800-41-TRAIN or email firstname.lastname@example.org. Site registration began on December 29, 2003. Individual registration began on January 22, 2004.
The Epidemiology and
the Prevention of Vaccine-Preventable Diseases-Session 2
This satellite broadcast is the second of a four-part series provided by the CDC Public Health Training Network on improving immunization practices in the United States. This broadcast will cover Pertussis, pneumococcal disease (childhood), polio, Hib and meningococcal disease.
CEUs will be offered for various professions based on three hours of instruction. Participants need to register and fill out an online evaluation for this program. Individuals who have questions about registration should call 1-800-41-TRAIN or email email@example.com.
|Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology||►This Week on EpiCom|
Over 40 cases of a possible norovirus were reported at a resort in Nassau County this week. For details, log onto EpiCom and click on the Food and Waterborne Disease Forum.
The Bureau of Epidemiology encourages Epi Update readers not only to register with the EpiCom system at https://www.epicomfl.net but to browse EpiCom and to contribute public health observations related to any suspicious or unusual situations or circumstances as appropriate.
|Arbovirus Surveillance Team: Caroline Collins, Kristen Payne and Calvin DeSouza, and Program Manager Carina Blackmore, DVM, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health||►Mosquito-Borne Disease Update|
Human: No arboviral infections were confirmed in Florida residents this week. No counties are under medical alert. People are still encouraged to take precautions against mosquito bites, such as wearing mosquito repellent and eliminating stagnant water in birdbaths, ponds and other receptacles in which mosquitoes might breed.
Sentinel Chickens: This week, 656 samples were tested from 8 counties. There were 8 seroconversions to WN virus from Bay (1), Lee (1), Orange (1), Sarasota (1), Volusia (2), and Walton (2) counties. There was also one seroconversion to SLE virus from a chicken in Lee County. So far this year, there have been 25 seroconversions to WN virus and two seroconversions to SLE virus.
Bird Mortality: No birds tested positive this week. One dead blue jay (collected on 1/14) from Miami-Dade County tested positive for WN virus.
Equine* and other mammals: One horse from Polk county (onset 1/9/) tested positive for WN virus. So far this year, two horses from Alachua (onset 1/9) and Clay (onset 1/6) counties have tested positive for EEE virus.
Mosquito Pools: Of 362 mosquito pools received so far this year from Escambia, Monroe, Palm Beach and Sarasota counties, all have tested negative for arbovirus.
To date, 10 of Florida’s 67 counties have reported confirmed WN activity (birds, chickens and horses), 2 have reported EEE activity (horses) and two have reported SLE activity (chickens).
Wild and Captive Birds**: For capture counts and historical data, go to http://www.pherec.org/DECS and click on “Arbovirus Ecology” to download the database, then the "Bird Serology" tab.
See the web page for
maps and summary information on 2003 activity: