Friday, February 13, 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
be allowed; to consume resources if action does not follow."
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►Chickenpox Diagnosed at Duval County Shelter
The Duval County Health Department and a Florida EIS fellow were called upon to investigate.
Youth Tobacco Survey Shows Smoking Has Decreased
Significant progress was made between 1998-2002 in the effort to encourage teens not to smoke and if they do, to quit.
Intelligence Service Program Recruiting
Information about the roles and recruiting processes for the EIS Fellows.
Epi Update Managing Staff:
Surveillance Epidemiologist Joins Staff
Meet Karen Wheeler, of our Surveillance and Reporting Section, in an in-depth look at what brought her here and what she does.
Point to Scope of Bureau Experience
Many of the bureau's staff members prepared abstracts for submission to the upcoming CSTE conference in Idaho.
Epidemiology Seminar Set for February 25-56 in Winter Haven
If you haven't yet made arrangements, check the HSDE Website; there's still time.
with Toxins: Laboratory Response Networks
A look into the role of laboratorians with regard to bioterrorism responses.
Safety and Security Measures Added
The FDA this week announced additional interim rules to strengthen existing firewalls against bovine spongiform encephalopathy.
Influenza Surveillance For the Week Ending January 31, 2004
Reports from the state, the nation and around the world for Week 4.
A report outlining activities for February 1-7, 2004 for confirmed cases.
A R T I C L E S
|Robyn Kay, MPH, EIS Fellow, Duval County, Terry O'Reilly, Program Manager, Reportable Diseases, Duval County Health Department||►Chickenpox Diagnosed at Duval County Shelter|
Following the interviews, the DCHD staff were given a tour of the men’s open dorm-like facility. The men’s dormitory houses 150 individuals. There are rows of bunk beds (top and bottom) at apparently full capacity. Feasible “isolation” was limited to locating the infected cases near the back of the facility. Two of the men shared bunk #1. The third case occupied Bunk #2, along with a non-infected resident.
The dormitory guards were advised to notify the facility managers if any residents or staff members reported a fever or rash, particularly those most likely at high risk. The shelter staff personnel reported that no high-risk individuals had been in direct contact with the infected people while inside the facility.
|Zhaohui Fan, MPH, Epidemiologist, Chronic Disease Surveillance & Epidemiology Section, Bureau of Epidemiology||►Florida Youth Tobacco Survey Shows Smoking Has Decreased|
The Bureau of Epidemiology has conducted the Florida Youth Tobacco Survey (FYTS) annually since 1998. A report developed by the bureau based on the 2002 FYTS reveals that the Florida Tobacco Prevention and Control Program has made significant progress in preventing and reducing youth tobacco use during 1998-2002.
public schools, the prevalence of lifetime cigarette smokers (defined as
students who have smoked one or two puffs in a lifetime) has
decreased by 30% among middle school students and by 23% among high
current tobacco use of any kind has decreased by 47% among middle school students and by 31% among high school students.
Protecting students from secondhand smoke exposure, however, has not made much progress compared to preventing and reducing tobacco use. From 1998 to 2002, prevalence of secondhand smoke exposure decreased by only 2% among middle school students and by 6% among high school students.
A comprehensive report on the 2002 FYTS with in-depth analyses will be available soon. In addition to the statewide reports, the Bureau of Epidemiology developed county-specific reports on major indicators of tobacco use from the 2002 FYTS survey. Data on individual counties can be compared with the state and other counties’ data. These reports can also be found on the Bureau of Epidemiology Website.
|Alan Rowan, DrPh, Florida Epidemic Intelligence Service Administrator, Bureau of Epidemiology||►Epidemic Intelligence Service Recruiting|
All county health departments with epidemiology programs and
strong epidemiology mentoring skills are encouraged to participate.
If counties are
interested in recruiting this year, they should send a project description
to the Bureau of Epidemiology electronically no later than close of
business, March 12. Template forms were mailed to county health
departments, but copies can be acquired by calling 850.245.4444, ext.
2442. The project description should be an important
public health project for your county and ready to commence once the
candidate begins work. You may request that the Bureau of Epidemiology
review and provide comments about the content of your position
|Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology||►Bioterrorism Surveillance Epidemiologist Joins Staff|
Karen Wheeler joined the Bureau of Epidemiology several months ago to fill a high priority vacancy for an epidemiologist who would develop a program capable of identifying potential bioterrorism indicators, and then analyze the resulting data.
Karen's ability to assess threats comes from a background steeped in consequence management training. She attended the University of Northern Iowa where she received her undergraduate degree in Exercise Science, and subsequently earned her MPH at the University of North Carolina. It was during her first year of graduate school that the events of September 11th occurred, causing a shift in her interest from public health in general to bioterrorism specifically. She became involved in a project aimed at determining the preparedness level of county health departments in the event of a bioterrorist attack; conducted needs assessments and reviewed biological and chemical weapon response plans; and participated in case scenarios. She also assisted in formulating a strategic plan for emergency smallpox innoculations.
Karen's efforts in epidemiology are focused on surveillance and
detection; working with hospitals to monitor emergency room admissions,
with medical examiners to develop guidelines and infrastructure for
surveillance and evaluation of unexplained deaths and bioterrorism
mortality, with pharmacies to identify aberrations in drug sales, and working
on additional surveillance features for EpiCom and other technologies
which may prove helpful in analyzing future disease trends.
|Don Ward, Acting Chief, Bureau of Epidemiology||►Abstracts
Point to Scope of Bureau Experience
Bureau of Epidemiology staff members submitted 12 abstracts for presentation at the prestigious Council of State and Territorial Epidemiologists (CSTE) annual meeting to be held in Boise, Idaho in June. This gathering of public health professionals will give our staff an opportunity to present their work to their peers in a forum that can impact public health prevention programs throughout the country.
These abstracts, many of which were authored by newer staff epidemiologists, showcase the variety of backgrounds and expertise represented by our staff, and of the scope of the Bureau's mission. The titles and authors of the abstracts are as follows:
Supply: Lessons Learned During the 2003-2004 Epidemic
Effects of Late
Reporting on Data Quality in the Florida Sentinel Physician Influenza
Surveillance Network (FSPISN)
Between Alcohol and Drug Use and Injury Among Florida's High School
Diabetes and Risk Behaviors Among Blacks and Hispanics with Diabetes in
Related Behavioral Factors Among Florida High School Youth
Related Behavioral Factors Among Florida High School Youth
Outbreak Communication and Alerting System
Innovative Web-Based Approach to Communicable Disease Surveillance
Among New Mothers: Associations Between Hospital Staff's Encouragement,
Breastfeeding Initiation in the Hospital, and Breastfeeding Duration
Laboratory Testing for Pertussis, Florida 1999-2003
Health Practice Through Respiratory Syncytial Virus (RSV) Surveillance
After the CSTE meetings, the presentations will be available on the Bureau's Website.
|Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology||►Regional Epidemiology Seminar Set for February 25-26 in Winter Haven|
Regional Epidemiology Seminar
The Bureau of Epidemiology will be conducting a two-day seminar on public health surveillance, improving provider reporting, and principles of field epidemiology. The second day of this training will be devoted to an outbreak scenario. The agenda, faculty list, registration and other pertinent information is available on the Bureau of Epidemiology website http://www.doh.state.fl.us/disease_ctrl/epi/conf/training.html
The class is nearly full. We currently have 10 spaces open. Continuing education credits will be offered to nurses, environmental health professionals and laboratorians.
|Jose Marcelino, Ph.D., Elise Quaye, and Segaran Pillai, Ph.D., Florida Department of Health, Jacksonville State Laboratory||
with Toxins: Laboratory Response Networks|
The continued submission of materials contaminated with powder for select agent testing suggests that acts of terrorism are still on the minds of Americans. First responders submit samples to state public health laboratories where specimens are screened for select agents using validated protocols. First responders and public health laboratorians may suspect these samples do not contain select agents. Regardless, these materials are analyzed and treated as potential bioterrorism materials. The reaction to the terrorist attacks of 2001 was swift and decisive. The Laboratory Response Network (LRN), established by the Centers for Disease Control and Prevention (CDC) in 1999, played a pivotal role in providing “rapid and accurate” analyses of samples (environmental and clinical) suspected of containing select agents. Since anthrax (Bacillus anthracis) was the agent of choice in October 2001, materials and methods for its rapid and accurate identification were the first to be distributed to Level B/C laboratories (now called Reference Laboratories), which included most state public health laboratories. The LRN laboratories have shown competency in screening these powdery substances for the presence of B. anthracis.
However, other select agents pose an even greater threat due to being: 1. stable, 2. often lethal in a matter of hours, and 3. easy to acquire and/or produce. These include the toxins, ricin and botulinum toxin (botox). Ricin is derived from castor beans and induces its lethal effect by inhibiting protein synthesis; whereas, botox, the most poisonous substance known, causes paralysis by interfering with acetylcholine release at the neuromuscular junction (1, 2). Both of these toxins are or have potential use in medical therapeutics. Botox is used to treat a number of neurological disorders and is very popular in cosmetic treatment (3,4). Ricin is being evaluated as an immunotherapeutic agent for Hodgkin’s lymphoma (5). Despite their medical uses, these toxins are known more for their sinister applications. In January 2003, British law enforcement agencies arrested 6 Algerian men who were charged with producing ricin in their apartment. As a result, in April 2003 the FBI released a warning to law enforcement agencies about these toxins and terrorist activities. Recipes to make ricin have reportedly been found in Al Qaeda hideouts in Kabul and some U.S. supremacist groups have stockpiled the agent (6). The use or threat of use of these agents remains credible.
Clinical diagnostic assays for botox are lacking in most LRN Reference laboratories. If there is a strong suspicion of botox poisoning, hospital laboratorians or infection control practitioners should contact an epidemiologist at their local County Health Department (CHD). The epidemiologist will make the proper arrangements for direct submission of the specimen(s) to the CDC. Hospital laboratorians are encouraged to review the LRN Sentinel laboratory protocols posted on the CDC website: http://www.bt.cdc.gov/agent/botulism/index.asp, which outlines specimen collection, important telephone numbers, and proper packaging and shipping of specimens to CDC. There is currently no widely available and reliable clinical diagnostic assay to confirm that a person has been exposed to ricin.
The question remains regarding the hundreds of powdery substances screened at the LRN Reference laboratories. Most of these samples contain unknown substances with no associated adverse effects on human or animal health and well being. Fortunately, an analytical assay for ricin in environmental samples is available to LRN Reference laboratories. This antigen based assay is laborious and time-consuming, but a more rapid, nucleotide based assay will soon be available for use in LRN Reference laboratories.
Many first responders rely on immunochromatographic cards for rapid detection of these toxins despite the lack of scientific evidence for their performance. Manufacturers claim these immunochromatographic cards may detect the toxins and provide results within fifteen minutes. In addition, first responders are using analytical instruments, such as Fourier Transform Infrared Spectroscopy (FTIR), for rapid “detection and identification” of these substances. The role and use of these non-LRN validated assays and analytical methods, based on their specificity and sensitivity, is hotly debated. Consequently, the onus is on public health laboratories to provide rapid and accurate identification of these select agents.
1. Ricin Poisoning. Toxicol Rev 2003; 22 (1): 65-70.
|Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology||
Safety and Security Measures Added|
The Center for Food Safety and Applied Nutrition of the Food and Drug Administration announced on February 4th that a number of bovine-derived materials will be banned from human food, dietary supplements and cosmetics, in order to protect American consumers from possible exposure to bovine spongiform encephalopathy (BSE). The announcement was in response to a report issued by a panel formed after one case of BSE was found in a cow imported into the country from Canada in December.
It has been illegal in the U.S. since 1997 to feed meal made from cows, sheep or goats to other hoofed mammals. It is, however, legal to use meal from hogs and chickens. The panel of international scientists from Switzerland, New Zealand, Britain and the U.S. recommended earlier this month that U.S. cattle be given no more feed containing animal content and that North Americans adopt the same testing methods for BSE as Europeans.
|Angela Fix, MPH, Respiratory Disease Surveillance Epidemiologist, Melissa Covey, Influenza Surveillance Coordinator||►Florida Influenza Surveillance For the Week Ending January 31, 2004|
Florida influenza-like illness (ILI) activity decreased across the state during the week ending January 31, 2004 (Week 04) compared to the previous weeks. Ten counties reported as having high ILI% activity for the week. However, not all sentinels have reported at the time this summary was written (82% reporting as of February 10, 2004). Nine counties have reported an increase in ILI activity from the previous week, nine counties reported a decrease, and twelve counties remained level. Three counties did not have at least 50% of the sentinels reporting or did not report the previous week and therefore the change in activity could not be determined. Of the 16,047 patients seen by the Florida Sentinel Physician Influenza Surveillance Network (FSPISN) providers during the week ending January 31, 379 were seen for influenza-like illnesses. The overall state ILI activity for the week ending January 31, 2004 was 2.36%. This is a decrease in activity compared to the previous week (3.76%). The Florida ILI activity code reported to the Centers for Disease Control and Prevention (CDC) for the week ending January 31, 2004 was regional.
Across the nation, regional activity was reported in eleven states, including Florida, for the week ending January 31, 2004. No states reported widespread activity. The percentage of deaths due to influenza and pneumonia (9.3%) continued to decrease across the nation, however, it was still above the epidemic threshold for Week 04 (8.2%).
CDC and WHO reported as of February 10, twenty-three laboratory confirmed cases of avian Influenza A (H5N1) infections in humans in Vietnam and Thailand. Eighteen cases were from Vietnam and five were form Thailand. Eighteen of the twenty-three cases have been fatal. The Bureau of Epidemiology, has distributed more information regarding CDC interim guidance for establishing enhanced surveillance of avian influenza as well as infection control precautions for managing patients 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 the local county health department and the county health department have been instructed to contacted the Bureau of Epidemiology, Dr. Joann Schulte, for immediate triage of all suspected avian influenza cases.
To view the complete report, click here.
|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, 563 samples were tested from 11 counties. There was 1 seroconversion to WN virus from Walton County. There were also four seroconversions to EEE virus from Pinellas (1) and Walton (3) Counties. So far this year, there have been 26 seroconversions to WN virus and two seroconversions to SLE virus.
Bird Mortality: One dead Cardinal from Marion County tested positive for WN virus this week. So far this year, one dead blue jay (collected on 1/14) from Miami-Dade County tested positive for WN virus.
Equine* and other mammals: No horses tested positive this week. So far this year, two horses from Alachua (onset 1/9) and Clay (onset 1/6) counties have tested positive for EEE virus and one horse from Polk county (onset 1/9) tested positive for WN virus.
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.
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, 11 of Florida’s 67 counties have reported confirmed WN activity (birds, chickens and horses), 4 have reported EEE activity (chickens and horses) and two have reported SLE activity (chickens).
See the web page for
maps and summary information on 2003 activity:
1. Report dead birds to www.wildflorida.org/bird/. From that site, you can link to online bird identification sites. There is value in the information submitted even if the bird is not tested, especially for those counties which don't have sentinel chickens or who have sites situated sparsely in the county.
2. The DOH Lab in Tampa will test anything that's shipped in good condition. Instructions for submission of dead birds are found at: Select "How Do I Report?" then choose "Protocol for Collecting and Shipping Bird Carcasses" under "Dead Birds" subtopic.
3. If local agency must limit bird submissions, consider only sending crows and jays.
4. If personnel are not able to offer pick-up service, have a drop off station and provide the caller with clear handling instructions. A county may modify their testing approach depending on the availability of other surveillance systems in the county.
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
Disclaimer: Please note that data is subject to change with confirmatory information.