March 25, 2005

Epi Update Managing Staff:

John A. Agwunobi, MD, MBA, MPH, Secretary, Florida Department of Health
Landis Crockett, MD, MPH, Director, Division of Disease Control
Dian K. Sharma, MS, PhD, Bureau Chief, Bureau of Epidemiology, Editor-in-Chief
Jaime Forth, Managing Editor

"The 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."

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



Correction: An incorrect link was provided to this year's Bureau of Epidemiology Seminar in a previous issue of Epi Update. The correct link is: http://www.doh.state.fl.us/disease_ctrl/epi/conf/training/index.htm. We apologize for the confusion this may have caused any of our readers. Ed.




Bureau of Epidemiology March Grand Rounds:
Aggregates, Incidence Clusters, and the Implications for Prevention in Populations
by Matt Laidler
                                                              
Topic: A Spatial Analysis of the Leading Causes of Childhood Morbidity in Florida: Aggregates, Incidence Clusters, and the Implications for Prevention in Populations

Presenter: Matt Laidler, MA, MPH, Sarasota County Health Department, Florida Epidemic Intelligence Service Program

Date: Tuesday, March 29, 2005  11:00 a.m. EDT

Abstract:
This presentation describes a spatial analysis of the 5 leading causes of childhood morbidity in Florida as reported to the Bureau of Epidemiology through the Merlin system. The units of analysis were rates of morbidity within zip code areas throughout the state. A spatial scan test was used to identify where local clusters of incidence occur, the rates identified within these clusters, and the amount of aggregate incidence explained by the cases within the detected clusters. Statistically significant incidence clusters were detected for all 5 of the leading causes of morbidity in persons under 18 years of age. Incidence in some of the significant clusters accounts for nearly 50% of the aggregate (state-wide) incidence for particular diseases. It is suggested that addressing prevention/intervention in these areas could reduce a substantial proportion of aggregate incidence, although typical approaches may vary. 

Additional Information:
The grand rounds presentation will begin promptly at 11:00 a.m. EDT on Tuesday, March 29, 2005. The PowerPoint slides and dial-in number will be on the Bureau of Epidemiology intranet Website on Friday, March 25. CEUs will be provided for nursing and environmental health professionals. If additional information is needed, contact Professional Training Coordinator Melanie Black, MSW, at 850.245.4444 ext. 2448, or via email at Melanie_Black@doh.state.fl.us.

Matt Laidler is a fellow of the Epidemic Intelligence Service currently assigned to the Sarasota Health Department. To contact him, phone 941.861.2916.

A Quick Epidemiological Assessment Following a Natural Disaster Using a Random Telephone (or BRFSS) Survey
     by Marie Bailey, MSW
 

Background
Florida experienced four major hurricane events during August to October 2004.  In response to this natural disaster, the Florida Department of Health Bureau of Epidemiology engaged the Behavioral Risk Factor Surveillance System (BRFSS) survey to capture data specific to these hurricane events. The BRFSS was seen as a great vehicle for self-reported data that could then be triangulated with other data sources and enhance the state’s preparedness for future disasters.   

Methods
In early October, the Bureau of Epidemiology began collaborating with its partners in other bureaus and agencies for question development. Within two weeks, thirty questions were developed that addressed the following issues:  hurricane preparedness; generator use; damage assessment; physical injuries and medical care; loss of employment; and mental health status. Data collection began in November 2004. 

Results
A total of 1,690 interviews were completed and preliminary weighted data were made available by CDC in January 2005. Preliminary results show that of all Floridians, 33.2% (or approximately 1,062,506 households) had to evacuate their homes due to at least one hurricane. Television (70.6%) and radio (19.7%) were the primary sources of information for hurricane-related public health advisories, 4.4% of Floridians suffered a physical injury, and 5.5% had a health condition that was made worse as a result of the hurricanes. 

Conclusions
The BRFSS can be a useful and flexible tool for post-disaster assessment. Collaborations between state agencies can enhance the use of BRFSS for these types of assessments, and enhance the usefulness of the data across the state. 
                       
Marie Bailey is BRFSS coordinator for the Chronic Disease Surveillance Section at the Bureau of Epidemiology in Tallahassee. To contact her, call 850.245.4444, ext. 2434.

         
Environmental Health Offering Regional Emergency Response Core Competency Trainings
   by Mitch Stripling
 

Ready for all hurricanes and other hazards? The Division of Environmental Health is conducting one-day trainings to help public health professionals develop increased awareness and operational knowledge of the CDC’s environmental health emergency competencies in preparation for the upcoming hurricane season.  

Through this training, we hope to increase the number of public health workers capable of participating in an environmental health response during hurricanes, as well as other all-hazards events. To do this, the training will cover concrete lessons learned from our hurricane response and give practical tools in how local environmental health staff should respond to multiple types of hazards. 

While not mandatory, it is important that as many EH staff as possible attend this training. With saturation across the state, our graduates will be successful in improving the capacity of county health departments to respond during an EH event or exercise. We also invite county preparedness staff and partner agency/organization staff to attend. Since Division of Environmental Health staff work closely with multiple partners, their involvement and collaboration during this training will set a foundation for response successes.

Our goal is to train 600 staff throughout Florida in these practical competencies for environmental health. To better serve county health departments, we will be giving the one-day trainings twice in each region this spring. We hope that this means counties will be able to stagger registrations of essential staff for each one-day session so as not to curtail normal day-to-day environmental health operations as we all prepare for the upcoming season. If additional training sessions are requested, we will accommodate these after June 1 to the best of our ability and staff availability. 

As the CDC’s environmental health preparedness core competencies reflect, environmental health can be a critical nexus for an efficient, effective and successful all-hazards and epidemiologic response. Your EH staff will be involved in vital ways throughout any disaster health response—whether it’s a hurricane, a chemical spill or a food-borne outbreak. In any of those events, it is essential that environmental health staff be fully trained to the CDC competencies and by extension, for our partners to understand our roles and responsibilities in an all-hazards response.

Registration is easy and free. You don’t even have to take the class in your own region. You can sign up for the one-day session of your choice at http://www.doh.state.fl.us/environment/preparedness/registration.htm

Agendas are also available at that site. EH directors can sign up multiple staff and can also (along with regional staff) vote for the two environmental health subject areas they’d like to focus on as part of the afternoon session. This will help us tailor the training to each region’s needs.

While you’re at our preparedness site, don’t forget to check out our online, multimedia training. Here are two examples:

Food-borne Epi Exercise: http://www.doh.state.fl.us/environment/preparedness/food/tabletop.htm

Intro to EH Preparedness: http://www.doh.state.fl.us/environment/preparedness/envt/intro_briefing.htm

Mitch Stripling is the preparedness education and media coordinator at the Division of Environmental Health in Tallahassee. For more information, contact him at  850.245.4444, ext. 2486 or via email at mitch_stripling@doh.state.fl.us

Hemolytic Uremic Syndrome Clusters Under Investigation
by Jaime Forth

The Bureau of Epidemiology and the Division of Environmental Health are conducting an investigation into hemolytic uremic syndrome, or HUS, associated with two different Florida fairs.

HUS is characterized by a low platelet count, hemolytic anemia, and kidney problems. It is a life threatening illness that develops approximately three weeks after a diarrhea illness, often caused by E. coli 0157:H7. Red blood cells are destroyed and the kidneys may fail, necessitating blood transfusion and possibly dialysis. One of the children diagnosed with the illness is currently undergoing dialysis and has been placed on a ventilator.

A suspect case is defined as an individual with diarrhea with variable severity (+/- bloody) that may be complicated by HUS who has recently attended a Florida fair or festival. A confirmed case is defined as a suspect case with laboratory confirmed E. Coli and/or HUS.

Infection typically occurs through consumption of undercooked meat; drinking unpasteurized juice, milk, or contaminated water; or lack of handwashing after exposure to healthy livestock which carry bacteria in intestinal cavities.

Cases should be reported to a local county health department and callers should contact the epidemiology section at the county level. The Florida Department of Health Bureau of Epidemiology can also be contacted at 850.245.4401. Updated information can be found at https://www.epicomfl.com

Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.

          CDC No Longer Requests Reports of Invasive
    Pneumococcal Disease in Children Vaccinated with
           Pneumococcal Conjugate Vaccine (PCV7)

Chris Van Beneden, Centers for Disease Control and Prevention, has announced that the Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, is no longer requesting reports of cases of invasive pneumococcal disease occurring in children who have received the pneumococcal conjugate vaccine. For the last several years, CDC has requested these reports and has been analyzing the strains to evaluate possible vaccine failures. Because the number of reported cases in vaccinated children is now adequate to permit analysis and surveillance data indicate that disease rates have dropped dramatically, these reports are no longer needed.  

Working to Reduce Pesticide Exposures Within Florida
by Rosanna Barrett, MPH

Pesticide-related illness and injury (reporting code 09894) is a reportable disease in the state of Florida. It is one of the diseases reported through the Merlin reporting system utilized by the county health departments. Cases can be reported based on clinical diagnosis, laboratory confirmation or as suspected cases based on observation of signs and symptoms related to acute pesticide exposures.

The Pesticide Surveillance Program (PESP) is designed to monitor and implement outreach programs for the detection and prevention of pesticide poisoning. The PESP is managed by the Bureau of Community Environmental Health within the Division of Environmental Health (EH), which is housed at the Department of Health (DOH) in Tallahassee. The program has been in existence since 1998.

The PESP has received reports of 1,787 pesticide-related exposures between 1998 and 2004.The program monitors agricultural and other occupational and non-occupational exposures. It also receives reports of pesticide-related exposures within the home and other environs. The program works in collaboration with the Department of Agriculture and Consumer Services (DACS) in the investigation of reported agricultural exposures, misuse of pesticides despite following label requirements, exposures associated with pest control in the home, and with mosquito control activities. DACS investigations are performed for regulatory purposes. Health related investigations are conducted within DOH through the related environmental health bureaus and county health departments.

Cases are classified according to exposure, health effects, and pesticide toxicological criteria as outlined in the National Institute of Occupational Safety and Health (NOISH) classification protocol. The PESP reports cases to NIOSH through the Sentinel Event Notification System for Occupational Risks program. The program’s annual datasets are posted on the DOH PESP website at http://www.doh.state.fl.us/environment/community/pesticide/Index.html

The program is also involved in the following activities:

• Technical assistance and consultation to health care professionals and the public on the health effects of pesticide exposures.
• Outreach and educational training for farm workers, pesticide applicators and the public on pesticide exposures and on methods of reducing exposures and preventing related illness and injury.
• Interagency meetings to discuss issues related to pesticide toxicology, exposure and prevention.

The program’s goal for 2005 is to work closer with county health departments to increase surveillance and reporting activities. To achieve this goal the following functions will be carried out: 

• The CHD staff will be kept informed about suspected pesticide poisoning cases in their counties
• Trainings for CHD staff (especially in counties with large migrant populations) in pesticide poisoning case investigation and pesticide poisoning prevention strategies will be conducted.
• Pesticide surveillance will be kept as part of the surveillance/log maintained by CHDs.
• The program will ensure that exposure incidents are reported in Merlin reporting system by CHD/Epidemiology
• Support will be provided to CHD staff interested in becoming actively involved in pesticide poisoning investigations.

Reports of suspected illness and injury related to pesticide exposures can be made to the PESP hotline number at 1-800-606-5810, or contact the local county health department. After hours calls may be made to beeper number 850-709-3066.

Rosanna Barrett is a pesticide surveillance coordinator at the Bureau of Community Environmental Health in Tallahassee. She can be reached at 850.245.4444, ext. 2819.

Judging Criteria Announced for Bureau of Epidemiology Seminar Posters
by Melissa Murray, MS

The Bureau of Epidemiology is actively seeking posters for its annual seminar in Lake Mary, Florida, scheduled for May 17-18, 2005. 

Poster presentations give conference attendees a wonderful opportunity to share research with colleagues and friends. Examples of poster topics include results of an outbreak investigation, new prevention programs at the local level or new laboratory methods in disease control. The session also presents an opportunity to demonstrate new computer and Web-based systems related to public health. 

Poster format shall follow the basic scientific paper outline: 

Background – the problem under investigation or hypothesis

Methodology – the experimental methods used, including type of study, number of cases, etc.

Results – a summary of essential results

Conclusions/Recommendations – summary of findings, supported by your results (the conclusions should be numbered if multiple points are presented) along with the public health/policy implications of your research

The poster session and reception will occur the evening of May 17^th; however, participants will be asked to set up their displays on May 16^th so judges will have plenty of time to view all the entries. Posters can be displayed in a three-fold form board format or a flat poster board. Electricity and/or Internet connections will not be provided. Be sure to have a primary and secondary point of contact for presenting your poster. Technical assistance will be available through Bureau of Epidemiology staff.  

When submitting your abstract you will be asked to select a category which best describes your poster from the following list: Chronic Disease, Florida EIS, Spatial Analysis/Visualization, County Health Department, Environmental Health or Communicable Disease. Please indicate your selected category in the subject line or text of your email at the time you submit the abstract.

Judging Criteria:

1. Appropriate methods
2. Logical results
3. Clear objectives
4. Appropriate conclusion based on presented results
5. Originality
6. Organization (easy to follow)
7. Public health importance/significance
8. Overall success in conveying topic
9. Visual appeal

If you would like to participate, submit the abstract for your poster to Melissa Murray via e-mail at melissa_murray@doh.state.fl.us no later than April 15.  Don’t forget to indicate your selected category either in the subject line or text of the email.

Melissa Murray is coordinator of research services in the Chronic Disease Surveillance Section at the Bureau of Epidemiology. Contact her at 850.245.4444, ext. 2445.

Infectious Disease Quality Improvement Center Staff to Speak at Teleconference
by Melanie Black, MSW

The Florida Medical Quality Assurance, Inc, Health Care Quality Improvement program will be hosting a live webinar (web-based teleconference) on “Maximizing Adult Vaccination-Dispelling the Myths” on Wednesday, March 30, 2005 from 1:00 -2:00 p.m., EST and Tuesday, April 5, 2005 from 12:00 – 1:00 p.m., EDT. Dale W. Bratzler, DO, MPH, principle clinical coordinator with the Infectious Diseases Quality Improvement Organization Support Center will be discussing increasing adult immunization rates (flu and PPV) and the myths surrounding this topic such as efficacy and safety of vaccines in ill/hospitalized patients and vaccination of immunocompromised patients. He will also address issues related to underutilization of vaccinations, methods to improve vaccination rates, vaccination of healthcare workers, liability issues for failure to vaccinate and the expansion of vaccination beyond the traditional locations such as primary care providers and nursing homes such as hospitals and the use of standing order protocols. 

To enroll in this program go to https://ifmcevents.webex.com. Instructions will be emailed to you after enrolling. You can access the teleconference visual presentation through Internet Explorer. Slide presentations will be available for downloading 24 hours prior to the program by going to www.fmqai.com. Click on “Webinar Central” at the bottom of the index on the left side of the home page and then scroll down to the hospital webinars and click on the appropriate files to download. Participants will need a separate phone line for the teleconference portion of the program. 

For further information about this program, contact Rebecca Ure, RN, BSN, Med, pneumonia project coordinator, Florida Medical Quality Assurance, Inc. at 813.865.3549 or by email at rure@flqio.sdps.org.

Melanie Black is the professional training coordinator for the Bureau of Epidemiology located in Tallahassee. She can be reached via email at melanie_black@doh.state.fl.us.

     

           This Week on EpiCom
                                      by Pete Garner
 

• Suspected Salmonella typhi in 24 year old female in Lee County with exposure to Salmonella group B
• Two HUS clusters under investigation by DOH associated with petting zoo exposures, one in Orange County and the other in Collier County
• Death of child under 18 due to influenza in Broward County is still under investigation
• Testing of patients for Hepatitis B at chelation clinic in Miami-Dade is ongoing. An additional case has been confirmed.

Pete Garner is administrator of the Bureau of Epidemiology Surveillance Systems Section in
Tallahassee.  He can be reached at 850.245.4444, ext. 2481.

Qualified Epidemiologist Sought

The Food and Waterborne Disease Program within the Bureau of Community Environmental Health is looking for qualified applicants for the regional environmental epidemiologist position covering the Broward County area.

The environmental health program consultant vacancy is anticipated for March 31 and the job advertisement closes on the same date. This is a full-time SES position reporting to the state's food and waterborne disease coordinator and is responsible for surveillance, investigation and prevention education of food and waterborne disease complaints and outbreaks in a large, densely populated area. The person in this position is also a member of a statewide team of food and waterborne disease epidemiologists. Experience in food and waterborne disease epidemiology is critical; also, food and water hygiene, inspections, and food science would be helpful. Excellent public speaking and writing skills are required. Fluent Spanish would be extremely helpful with this population. Please check People First for the complete job description information: https://peoplefirst.myflorida.com/sap(bD1lbiZjPTIzMA==)/bc/bsp/sap/z_bsp_logon/logon.htm#

Call Food and Waterborne Disease Coordinator Robert Hammond, PhD, at 850.245.4116 if you have questions.

Mosquito-borne Disease Update  March 13 - 19, 2005
Caroline Collins, BS; Kristen Payne; Calvin DeSouza; Carina Blackmore, DVM, PhD 

Weekly Update: During the period March 13-19, 2005 the following arboviral activities (St. Louis encephalitis (SLE) virus, eastern equine encephalomyelitis (EEE) virus, Highlands J (HJ) virus, West Nile (WN) virus and dengue virus) were recorded for Florida.

West Nile (WN) virus activity: None this week.

Eastern Equine Encephalomyelitis (EEE) virus activity: One seroconversion to EEE was confirmed in a sentinel chicken from S. Walton County this week. One out of eight wild birds captured in N. Walton County tested positive for EEE virus. The infection rate is calculated using as the denominator the number of birds captured for testing on that day at that particular site. It is not known precisely when these birds became exposed to EEE..

St. Louis Encephalitis (SLE) virus activity: None yet this year.

Highlands J (HJ) Virus activity: None this week.

There are no counties currently under medical alert for mosquito-borne disease. 

Cooler weather in many parts of the state is helping to reduce mosquito populations. Yet others are experiencing unseasonably warm weather favorable to mosquitoes. Where mosquitoes are present, people are urged to take precautions against getting bitten.   

Dead birds should be reported to www.wildflorida.org/bird/. See the web page for more information: www.MyFloridaEH.com  The Disease Outbreak Information Hotline offers recorded updates on medical alerts status and surveillance at 888.880.5782. 

                         Weekly Disease Table
                                                          by D'Juan Harris, MSP

Click here to review the most recent disease figures provided by the Florida Department of Health Bureau of Epidemiology.

D'Juan Harris is a GIS specialist in the Surveillance Systems Section of the Bureau of Epidemiology.
He can be reached at 850.245.4444, ext. 2435.

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