Friday, March 5, 2004

         This Week in the News

Foege, WH.
International Journal of Epidemiology
1976; 5:29-37

A R T I C L E S

The Influenza Incident Command team first met on December 15, 2003 in response to the overwhelming demand for information regarding influenza activity in Florida, precautionary measures, vaccine availability, and general information by healthcare professionals and the public. Secretary Agwunobi appointed Jennett Wilson Baker, RN, from the Bureau of HIV/AIDS, as the incident commander to coordinate the overall preparedness and response efforts during the 2003-2004 influenza season. Members were Dr. Agwunobi, Charles Alexander, Christine Argo, Tom Arnold, Tom Belcuore, Melanie Black, Sylvia Bird, Ming Chan, Art Cooper, Landis Crockett, Jackie DiPietre, Karen Eaton, Angela Fix, Elizabeth Ford, Pete Garner, Jeff Goldhagen, Nathan Grossman, Daniel Haight, Judith Harner, Robb Hayes, Jerry Hill, Mike Hill, Lindsay Hodges, Nancy Hubert, Reid Jaffe, Jean Kline, John Lanza, Shannon Lease, Christi Luce, Carolyn McKeon, David Miller, Jean Munden, Annie Neasman, Mark O'Neil, Lillian Rivera, Daniel Runyan, Sandra Schoenfisch, Joann Schulte, Sandra Smith, Bonnie Sorensen, LaVivinne Treharnne, Don Ward and PHyllis Yambor.

One of the main tasks of the IC team was the distribution of educational materials to healthcare professionals as well as the general community on actions that the Florida Department of Health was taking in an effort to minimize the spread of influenza in Florida. The team met on a regular basis to assess what actions needed to be taken and the timeframe in which those actions should be accomplished. Recommendations were given to the incident commander for review, and delegation of responsibilities were given to the appropriate committees. 

February 9, 2004 at 5 pm EST the Influenza Incident Command structure downgraded to routine standard operating procedures. It was the consensus of the entire team that regular meetings were no longer warranted and that the transfer of command was determined. 

On February 23 an after action meeting was held by the former IC team members to discuss the challenges faced by the team and to give suggestions that would be helpful for future Incident Command teams, whether they would be dealing with influenza or any other public health crisis. Many comments pertained to the rapid and accurate dissemination of the most recent information. The group also discussed the need for follow-up with non-reporting and late reporting of influenza activity data with the appropriate coordinators. A key issue  was identifying the appropriate personnel at the beginning of the command structure to ensure leadership, quality control of data and dissemination of information. 

In all, the efforts put forth by everyone involved in the Influenza Incident Command structure exemplifies the quality of teamwork valued within the Florida Department of Health.
 

Melanie Black arrived at the Bureau of Epidemiology in February 2000, tasked with creating innovative and challenging training opportunities for professional staff and health care practitioners around the state. Her responsibilities include the Bureau of Epidemiology Grand Rounds Program, regional epidemiology training for county health departments, bi-weekly health department conference calls, the annual statewide epidemiology seminar, and satellite broadcasts as well as the development of new training programs and educational materials for healthcare professionals.   

Melanie received her BA in sociology from Queens College in North Carolina at the age of 19 and went on to earn her Masters in Social Work, specializing in health, from the University of Georgia. The majority of her career prior to joining the Bureau of Epidemiology was spent working as a licensed clinical social worker in neonatal intensive care and later in the Emergency Department at Shands Hospital at the University of Florida Department. Concurrently, she established a private practice performing court ordered assessments and conducting batter’s intervention groups through a contract with the Department of Corrections.  

Melanie's associated professional training includes certification in trauma response and membership in the Florida Association of Hostage Negotiators and the International Critical Incident Stress Foundation. She has also completed basic and advanced Critical Incident Stress Management training and is certified as a Critical Incident Stress Management Trainer.


 

To combat the virus, the vaccine is composed of bioengineered versions of proteins on the surface of the virus, which are used to attract antibodies and stimulate attacks by immune system cells. Dr. Adrian M. Di Bisceglie, chief of hepatology at the St. Louis facility, explained that this approach was used because the hepatitis C virus is a difficult target since "it mutates a lot and also because it is not a strong stimulator of the body's immune system."

Volunteers participating in the year-long trial will have blood samples drawn at periodic intervals to test for antibody and immune cell levels. The second step in the trial would involve a larger group of healthy volunteers so researchers could gain a broader sense of the vaccine's ability to protecting against hepatitis. The third and last phase would use a pool of at-risk volunteers such as health care workers and drug users who may share needles that are infected.

A final version of the vaccine is not expected until after the third phase of the trials, but scientists are approaching these trials optimistically. The St. Louis site was chosen because several members of the medical staff are experts on hepatitis viruses who remember the highly successful hepatitis B trials. "The vaccine was so effective and so safe that it now is used routinely," said Dr. Robert B. Belshe, director of the school.
 

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Florida influenza-like illness (ILI) activity continues to decrease across the state for the week ending February 21, 2004. Eight counties reported as having a high ILI% activity for the week. However, not all sentinels have reported at the time that this summary was written (74% reporting as of March 1, 2004). Compared to the previous week, seven counties reported an increase in ILI activity, while twelve counties reported a decrease and nine counties remained at a level activity. Five counties did not have at least 50% of the active sentinels reporting or did not report the previous week and therefore the change in ILI activity could not be determined. Of the thirty-three counties represented by the Florida Sentinel Physician Influenza Surveillance Network (FSPISN), nine counties reported no influenza-like illness activity for the week ending February 21, 2004. The FSPISN providers reported seeing 17,781 total patients during week 07, of which, 277 were seen with influenza-like illness symptoms (1.56% statewide ILI activity).   

Across the nation, one state (Maryland) reported regional ILI activity; nine states, including Florida, reported local activity; thirty-one states reported sporadic activity; and nine states reported no ILI activity for the week ending February 21, 2004. Mortality due to pneumonia and influenza (P&I) declined below the epidemic threshold for the first time in ten weeks. 

As of March 2, thirty-three laboratory confirmed cases of avian influenza A (H5N1) infections in humans were reported in Vietnam and Thailand. Twenty-three cases are from Vietnam, of which, fifteen have been fatal. Ten cases have been reported from Thailand, of which, seven have been fatal. A fact sheet about the significance of avian influenza for human health can be found at the World Health Organization’s website: http://www.who.int.

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