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Melanie
Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Melanie
Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Melanie
Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Melanie
Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Tuesday, March 25, 2003 10:00 AM
– 12:00 PM EST
Dial-In by 11:00 AM at
(850) 487-8587 or
SunCom 277-8587
Presenters:
Carina
Blackmore, MS Vet. Med., PhD, Bureau of Epidemiology
Carol Conroy, MPH, PhD, Duval County Health Department
Don Ward, Deputy Chief, Bureau of Epidemiology
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This
is an official
CDC
Health Advisory
Following is information regarding the
current WHO investigation of atypical pneumonia. Included are: a news
release from the CDC, interim information and recommendations for health
care providers, and text of a travelers' health alert card which will be
distributed to targeted international travelers returning to the U.S.
CDC Issues Health Alert About Atypical
Pneumonia
Atlanta: In response to reports of increasing numbers
of cases of an atypical pneumonia that the World Health Organization (WHO)
has called Severe Acute Respiratory Syndrome (SARS), the Centers for
Disease Control and Prevention (CDC) today announced several steps to
alert US health authorities at local and state levels.
CDC activated its emergency operations center on Friday, March 14,
upon learning of several cases reported in Canada among travelers recently
returned from Southeast Asia and their family members. The federal
public health agency:
Issued a health alert to hospitals and clinicians on Saturday,
March 15.
Briefed state health officials on Saturday, March 15.
Is investigating illness among travelers who may have passed
through the United States after having potential exposure to the virus.
Is preparing health alert cards to give to travelers returning from
Southeast Asia.
Is preparing guidance to assist public health departments, health
care facilities and clinicians in monitoring and identifying potential
cases.
Deployed eight CDC scientists to assist the WHO in the global
investigation.
Is analyzing specimens to identify a cause for the illness.
CDC has been working with the World Health Organization (WHO) since
late February to investigate and confirm outbreaks of this severe form of
pneumonia in Viet Nam, Hong Kong, and parts of China. No cases have
been identified to date in the United States.
"The emergence of two clusters of this illness on the North
American continent indicates the potential for travelers who have been in
the affected areas of Southeast Asia to have been exposed to this serious
syndrome," said Dr. Julie L. Gerberding, CDC Director.
"The World Health Organization has been leading a global effort, in
which CDC is participating, to understand the cause of this illness and
how to prevent its spread. We do know that it may progress rapidly
and can be fatal. Therefore, we are instituting measures aimed at
identifying potential cases among travelers returning to the United States
and protecting the people with whom they may come into contact."
The WHO issued a global alert about the outbreak on March 12,
cautioning that the severe respiratory illness may spread to hospital
staff. No link has been made between this illness and any known
influenza, including the "bird flu" (A[H5N1]) outbreak
reported in Hong Kong on February 19.
Severe Acute Respiratory Syndrome (SARS)
Interim Information and Recommendations for Health Care Providers
The Centers for Disease Control and Prevention (CDC) and the World
Health Organization have received reports of patients with severe acute
respiratory syndrome (SARS) from Canada, China, Hong Kong Special
Administrative Region of China, Indonesia, Philippines, Singapore,
Thailand, and Vietnam. The cause of these illnesses is unknown and is
being investigated. Early manifestations in these patients have included
influenza-like symptoms such as fever, myalgias, headache, sore throat,
dry cough , shortness of breath, or difficulty breathing. In some cases
these symptoms are followed by hypoxia, pneumonia, and occasionally acute
respiratory distress requiring mechanical ventilation and death.
Laboratory findings may include thrombocytopenia and leukopenia. Some
close contacts, including healthcare workers, have developed similar
illnesses. In response to these developments, CDC is initiating
surveillance for cases of SARS among recent travelers or their close
contacts.
Case Finding
Clinicians should be alert for persons with onset of illness after
February 1, 2003 with:
Fever (>38° C) and one or more signs or symptoms of respiratory
illness including cough, shortness of breath, difficulty breathing,
hypoxia, radiographic findings of pneumonia, or respiratory distress AND
One or more of the following:
-History of travel to Hong Kong or Guangdong Province in People's
Republic of China, or Hanoi, Vietnam, within seven days of symptom onset.
-Close contact with persons with respiratory illness having the
above travel history.
-Close contact includes having cared for, having lived with, or having had
direct contact with respiratory secretions and body fluids of a person
with SARS.
Diagnostic Evaluation
Initial diagnostic testing should include chest radiograph, pulse
oximetry, blood cultures, sputum Gram's stain and culture, and testing for
viral respiratory pathogens, notably influenza A and B and respiratory
syncytial virus. Clinicians should save any available clinical specimens
(respiratory, blood, and serum) for additional testing until a specific
diagnosis is made. Clinicians should evaluate persons meeting the above
description and, if indicated, admit them to the hospital. Close contacts
and healthcare workers should seek medical care for symptoms of
respiratory illness.
Infection Control
If the patient is admitted to the hospital, clinicians should
notify infection control personnel immediately. Until the etiology and
route of transmission are known, in addition to standard precautions(1),
infection control measures for inpatients should include:
-Airborne precautions (including an isolation room with negative
pressure relative to the surrounding area and use of an N-95 respirator
for persons entering the room)
-Contact precautions (including use of gown and gloves for contact
with the patient or their environment)
Standard precautions routinely include careful attention to hand
hygiene. When caring for patients with SARS, clinicians should wear
eye protection for all patient contact.
To minimize the potential of transmission outside the hospital,
case patients as described above should limit interactions outside the
home until the epidemiology of illness transmission is better understood.
Placing a surgical mask on case patients in ambulatory healthcare
settings, during transport, and during contact with others at home is
prudent.
Treatment
Because the etiology of these illnesses has not yet been
determined, no specific treatment recommendations can be made at this
time. Empiric therapy should include coverage for organisms associated
with any community-acquired pneumonia of unclear etiology, including
agents with activity against both typical and atypical respiratory
pathogens (2). Treatment choices may be influenced by severity of the
illness. Infectious disease consultation is recommended.
Reporting
Healthcare providers and public health personnel should report
cases of SARS as described above to their state or local health
departments.
For more information contact your state or local health department
or the CDC Emergency Operations Center 770-488-7100. Updated information
will be available at http://www.cdc.gov
References
1. Garner JS, Hospital Infection Control Practices Advisory
Committee. Guideline for isolation precautions in hospitals. Infect
Control Hosp Epidemiol 1996;17:53-80, and Am J Infect Control
1996;24:24-52. http://www.cdc.gov/ncidod/hip/ISOLAT/Isolat.htm
2. Bartlett JG, Dowell SF, Mandell LA, File Jr, TM, Musher
DM, and Fine MJ. Practice Guidelines for the Management of
Community-Acquired Pneumonia in Adults. Clin Infect Dis
2000;31:347-82. http://www.journals.uchicago.edu/CID/journal/issues/v31n2/000441/000441.web.pdf
Text of a travelers'
health alert card:
Health
Alert Notice
For International Travelers Arriving In Or Returning To The USA From Hong
Kong And Guangdong Province, People's Republic Of China, And Hanoi,
Vietnam.
To The Traveler:
During your recent travel, you may have been exposed to cases of severe
acute respiratory disease syndrome. You should monitor your health for at
least 7 days. If you become ill with fever accompanied by cough or
difficulty in breathing, you should consult a physician. To help your
physician make a diagnosis, tell him or her about your recent travel to
these regions and whether you were in contact with someone who had these
symptoms. Please save this card and give it to your physician if you
become ill.
To The Physician: The patient presenting this card may have
recently traveled to Hong Kong or Guangdong Province in the People's
Republic of China or Hanoi, Vietnam, where cases of atypical pneumonia
have been identified. If you suspect atypical pneumonia (also being called
severe acute respiratory disease syndrome [SARS]), please contact your
city, county, or state health officer (see http://www.cdc.gov
or call the CDC Emergency Operations Center 770-488-7100).
For public inquiries, call Centers for Disease Control and
Prevention (CDC) hotline: English 888-246-2675, Español 888-246-2857, TTY
866-874-2646.
Categories of Health
Alert messages:
Health Alert:
conveys the highest level of importance; warrants immediate action or
attention.
Health Advisory:
provides important information for a specific incident or situation; may
not require immediate action.
Health Update:
provides updated information regarding an incident or situation; unlikely
to require immediate action.
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►Statewide
Epidemiology Seminar (SES)
Rescheduled
The Bureau
of Epidemiology is excited to announce the resumption of the Statewide
Epidemiology Seminar, which was cancelled last year due to the Operation
Vaccinate Florida campaign. The new dates are June 3 – 4, 2003 at the
Orlando Marriott, in Lake Mary, Florida. We are in the process of
developing an interesting, informative and challenging agenda, a list of
exciting speakers and an excellent poster session, not to mention time and
occasion for colleagues to interact.
Further details about this program, registration and accommodations 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.
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►Satellite
Broadcast a BIG Success: Introduction to EpiCom
The Bureau of Epidemiology aired
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. Don Ward, Deputy
Chief for Management and Pete Garner, Computer and Information Systems
Manager introduced 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 was a big success
with participation from the county health departments, hospitals, labs and
other healthcare professionals from around the state. The Bureau of
Epidemiology will be re-broadcasting the program on Wednesday, March 26,
2003 from 10:00 AM – 11:30 AM EST. CEU’s for nursing,
environmental health professionals, and laboratorians will be provided
again. Upon completion of viewing the re-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.
If you have questions about the satellite coordinates, please
contact Tamela Tassinari, Director, Distance Learning Program at (850)
245-4444 ext. 2193 or SunCom 245-4444 ext. 2193. If you need further
information about the program, you can contact Melanie Black, M.S.W.,
Professional Training Coordinator at (850) 245-4444 ext. 2448 or SunCom
205-4444 ext. 2448.
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►The
CDC National Clinician
Awareness Campaign for Smallpox
The
National Clinician Awareness Campaign for Smallpox and Smallpox
Vaccination began a week ago, corresponding with the initiation of most of
the States’ vaccination programs. The goal of the program is to
distribute information packets to frontline clinicians including
physicians, physician assistants, nurse practitioners, and registered
nurses via mail. The goal of this campaign is to increase every
clinician’s ability to 1) recognize smallpox should it occur, 2) assist
patients in decisions about participation in vaccination programs, and 3)
evaluate patients with reactions following vaccination.
Items included in the distribution packet included:
- A
letter signed by CDC director with an introduction to clinicians
asking “are you ready?” and opportunity to register to receive
subsequent website updates via email (clinician registry)
- A
rash evaluation poster to provide awareness level information for
evaluation of suspicious rash illness and suspected smallpox;
- A
vaccine Information Statement for awareness level information on
smallpox, vaccination, contraindications and screening, vaccination
sequelea and adverse events
- A
“Smallpox Vaccination Method and Reactions” brochure (also called
the “clinician pocket guide”)
The
Bureau of Epidemiology has worked closely with the CDC to provide the
necessary databases for the distribution of their National Clinician
Awareness Campaign and as a result received 1,000 copies of the
information pocket to distribute among the staff here at the Department of
Health and to the county health department directors/administrators around
the state.
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►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.
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►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.
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►
Weekly Disease Table
: Week 11
Florida Department of
Health, Bureau of Epidemiology
Weekly Morbidity Report, Week 11, ending
March 15, 2003
Selected Diseases and Conditions (Confirmed Cases Only)
www.doh.state.fl.us/disease_ctrl/epi/Disease%20Table/2003_weekly/diseasetable.htm
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