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March
7, 2003 Foege WH et al. |
This Week in the
News: ►Grand Rounds: “An Outbreak of Toxic Eye Inflammations (TASS) in a North Florida Cataract Surgery Center” The Grand Rounds on TASS will be held on Tuesday, March 25, 2003 10:00 AM – 12:00 PM EST. The presenters will be Carina Blackmore, MS. Vet. Med., PhD., Bureau of Epidemiology, and Carol Conroy, MPH, PhD, Duval County Health Department. ►Satellite Broadcast: Introduction to EpiCom The Bureau of Epidemiology will air a live, interactive satellite broadcast on March 11, 2003 from 10:00 AM – 11:30 AM EST. This broadcast will introduce the audience to the concepts, major components, and general terminology of the Florida EpiCom system and to the role the system will play in the overall surveillance strategy of the Bureau of Epidemiology. ►County Health Department Epidemiology Guide to Disease Surveillance and Investigations The 7th class of the Public Health Leadership Institute of Florida (PHLIF) is coordinating the development of an epidemiology guidebook for county health department (CHD) epidemiology programs. ►Influenza Virus Surveillance Summary Update During week 8 (February 16-22, 2003) influenza activity, calculated based on the proportion of patients with influenza-like illness (ILI) seeking care by physicians participating in the Florida Sentinel Physicians Surveillance Network was 3.0%. This is the highest influenza activity reported so far this season and also higher than the national baseline of 1.9% ►Bureau of Epidemiology to Host CHD Conference Calls Beginning on Friday, March 21, and on alternating Fridays thereafter, the Bureau of Epidemiology will host a scheduled conference call with county health department staff. ►Weekly Disease Table Florida Department of Health, Bureau of Epidemiology, Weekly Morbidity Report, Week 9, ending March 1, 2003 Selected Diseases and Conditions (Confirmed Cases Only) |
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Melanie
Black, MSW, Professional Training Coordinator, Bureau of Epidemiology |
►Grand
Rounds: “An Outbreak
of Toxic Eye Inflammations (TASS) in a North Florida Cataract Surgery
Center” Abstract Toxic anterior segment syndrome, or sterile hypopyon is an uncommon complication after cataract surgery, with an incidence of less than 1 case per 1000 surgeries. The cause is multifactorial. Described causes range from particles and toxins to heat and pH imbalances in intraoperative solutions. In December 2002, an outbreak of TASS, with 8 cases in 21 patients, interrupted cataract surgery services at two facilities, an ambulatory surgical center and its affiliated hospital in north Florida. An investigation was undertaken on December 12, 2002. Risk factors associated with the personnel, equipment, medications and irrigation solutions and equipment reprocessing were investigated. Interventions included personnel changes, intensification and standardization of equipment reprocessing protocols, replacements of cannulae, and repair of an ultrasonic cleaning machine. The surgeries were resumed on January 13. An additional 5 cases (n=62) were identified between January 13 and February 4. Additional studies revealed high concentrations of Cu, Zn and SO42- in the autoclave feed water and condensate. The autoclave water has been replaced but the outcome of the most recent intervention is still unknown. Additional Information Further details regarding the audio-conference call and the PowerPoint files will be posted on the Bureau of Epidemiology Intranet web site. CEU’s are pending for nursing, environmental health professionals and laboratories. Information about upcoming topics and presenters will also be posted in the Epi Update. If either of these access points is unavailable to you, please email Melanie Black [Melanie_Black@doh.state.fl.us] or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448) to request presentation materials. Important While we realize you might not always be able to call in by 11:10 AM, it can be distracting to the speaker and others in the audience when participants dial-in throughout the hour. Please try to call in on time and remember to put your phones on mute so as not to disturb others. Thank you for your cooperation. Back to top ►Satellite Broadcast: Introduction to EpiCom The Bureau of Epidemiology will air a live, interactive satellite broadcast on March 11, 2003 from 10:00 AM – 11:30 AM EST, moderated by Steven T. Wiersma, M.D., M.P.H., Bureau Chief, Bureau of Epidemiology and State Epidemiologist. This program is intended for county health department staff, physicians and other medical providers. Don Ward, Deputy Chief for Management and Pete Garner, Computer and Information Systems Manager will introduce the audience to the concepts, major components, and general terminology of the Florida EpiCom system and to the role the system will play in the overall surveillance strategy of the Bureau of Epidemiology. The program will include a question and answer session via toll free telephone and fax lines. CEU’s for nursing, environmental health professionals, and laboratories have been approved. Upon completion of the broadcast, you can register for CEU’s and fill out the program evaluation at http://www.doh.state.fl.us/disease_ctrl/epi/conf/sat/index.htm. In order to obtain CEU’s, an evaluation and online registration form must be filled out. Participants in the Tallahassee area may choose to view the broadcast in conference room 320P, Prather Building, 2585 Merchants Row Boulevard. The satellite conference may be viewed in other sites around the state by contacting your local satellite site coordinator. If you need further information, you can contact Melanie Black, M.S.W., Professional Training Coordinator at (850) 245-4444 ext. 2448 or SunCom 205-4444 ext. 2448. Back to top ►County Health Department Epidemiology Guide to Disease Surveillance and Investigations As a project for of the 7th class of the Public Health Leadership Institute of Florida (PHLIF), we are coordinating the development of an epidemiology guidebook for county health department (CHD) epidemiology programs. The goal is to produce a document that provides guidance for managing communicable disease surveillance and investigations efforts, including public health interventions and collaborations with other CHD programs and community agencies. It will also provide a framework for consistency in disease surveillance and investigations among between counties throughout the state. The guide will be available for use in training new staff and providing program standards for internal and external CHD epidemiology program reviews. The draft outline will include sections on case investigations, reporting, data analysis (including guidelines on how to write annual reports), information security, community outreach activities and basic program evaluation. Once the outline has been approved it will be made available to all CHD epidemiology programs. The final Bureau of Epidemiology approved guide will be presented at the Florida Public Health Leadership Institute’s graduation ceremony in August 2003. This document will be a collaborative effort including input from county health department epidemiology program staff. We want this to be developed with and by CHD epidemiologists for CHD epidemiologists. Many county health department epidemiology programs have developed their own epidemiology and surveillance protocols. In order to avoid duplication of efforts, we would be grateful if you would share your protocols. In addition, we welcome editorial or other assistance from persons interested in contributing to this document. Please email materials or interest to Carina_Blackmore@doh.state.fl.us or fax them to (904) 791-1567 sc 866-1567. Back to top ► Influenza Virus Surveillance Summary Update Week ending February 22, 2003-Week 8 Florida: During week 8 (February 16-22, 2003) influenza activity, calculated based on the proportion of patients with influenza-like illness (ILI) seeking care by physicians participating in the Florida Sentinel Physicians Surveillance Network was 3.0%. This is the highest influenza activity reported so far this season and also higher than the national baseline of 1.9%. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Alachua, Broward, Indian River, Monroe, Orange, Polk and Sarasota counties. The influenza activity is wide spread. During the last three weeks over 66 laboratory confirmed influenza cases (primarily influenza A (H1N1) and influenza B) were reported from 11 counties across the state. This week influenza A H1N1 viruses were reported from Duval, Indian River, Madison and Polk counties and influenza B from Duval, Indian River, Leon, Levy and Seminole counties. National report: Three hundred sixty one isolates (215 influenza A and 154 influenza B viruses) were made from 2,119 specimens tested by the World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories this week. Since September 29, 9.1% (n=4,875) of the 53,480 specimens tested nationwide have been positive. Seven hundred and seventy eight (39%) of the 2,020 influenza A viruses have been subtyped; 622 were influenza A H1 viruses and 156 were influenza A (H3N2). Laboratory confirmed influenza has been reported from all 50 states. The majority of influenza B isolates (46%; n=2,855) were identified in Texas and Missouri. Influenza A viruses were reported more frequently than influenza B viruses (range 62%-89%) in the Mountain, East North Central, Pacific, and Mid-Atlantic regions. Influenza B were reported more frequently in the South Atlantic, West South Central, West North Central and East South Central regions. CDC has characterized 45 influenza A (H1N1), 20 influenza A (H1N2), 34 influenza A (H3N2) and 86 influenza B isolates antigenically. All influenza A H1 strains were similar to corresponding vaccine strains. Seven of the 34 (21%) characterized H3N2 strains showed reduced titers to antiserum produced against the H2N2 vaccine strain (A/Panama/2007/99). One influenza B strain was more similar to B/Shizuoka/15/01 than to the B vaccine strain (B/Hong Kong/ 330/01). The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) was 2.8% nationwide. The State and Territorial Epidemiologists in thirteen states (Colorado, Indiana, Iowa, Minnesota, North Carolina, Oregon, Rhode Island, Tennessee, Texas Utah, Vermont, Virginia and Wisconsin) reported widespread influenza activity. Flu outbreaks were reported in 23 additional states. Thirteen states reported sporadic influenza activity. The proportion of deaths attributed to pneumonia and influenza as reported by the vital statistics offices of 122 U.S. cities was 7.4% during week 8. This percentage is below the epidemic threshold of 8.3% for this time. An avian flu virus strain, influenza A H5N1, has been recovered from two recent influenza cases in Hong Kong. CDC has issued recommendations on increased influenza surveillance in the United States. Of particular importance is to consider influenza cultures on patients, with recent travel histories to Asia, who are hospitalized with unexplained pneumonia, acute respiratory distress syndrome or severe respiratory illness. For additional information on influenza and influenza surveillance results, please visit our website at http://www.doh.state.fl.us/disease_ctrl/epi/htopics/flu/index.htm Back to top ►Bureau of Epidemiology to Host CHD Conference Calls Beginning on Friday, March 21, and on alternating Fridays thereafter, the Bureau of Epidemiology will host a scheduled conference call with county health department staff. The purpose of the call is to update CHD staff on Bureau activities and to discuss issues of mutual interest. Each week’s agenda will be determined by input from the CHDs and Bureau staff. While the majority of agenda topics will probably be directed to surveillance and investigations, any other CHD/Epi topics are appropriate. Any CHD staff are welcome to participate and staff conducting disease control activities are encouraged to attend. The calls will use the technology employed in the Bureau’s Grand Rounds, that is, any presentation material will be posted on the intranet the day before the call. The bi-weekly “epi-calls” will begin at 10AM and last no longer than an hour. The number for the call is (850) 487-8587 or Suncom 277-8587. Please e-mail suggestions for agenda items to Don Ward at donald_ward@doh.state.fl.us. Back to top ► Weekly Disease Table : Week 9 Florida Department of Health, Bureau of Epidemiology Weekly Morbidity Report, Week 9, ending March 1, 2003 Selected Diseases and Conditions (Confirmed Cases Only) www.doh.state.fl.us/disease_ctrl/epi/Disease%20Table/2003_weekly/diseasetable.htm Back to top |
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