April 1, 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




Disparities in Colorectal, Breast and Cervical Cancers: Incidence, Mortality, and Stages at Diagnosis, 1981-2001
by Youjie Huang, MD, Dr.PH, MPH and Tara Hylton, MPH

Method:
Florida cancer registry data were analyzed for incidence, mortality and stages of colorectal, female breast and cervical cancer in 1981-2001. Stages of cancer were defined as later stages (regional and distant) and early stages (in situ and local). Patients of races other than black or white were excluded due to small numbers. Race, sex, age, health insurance and year of diagnosis were included in multivariable analysis of stage of cancer. 

Outcome:
A total of 438,533 cases and 132,902 deaths of colorectal, breast and cervical cancer in 1981-2001 were included in the analysis. Blacks had mortality rates of these cancers 26.8% - 85.7% higher than that among whites in 2001, even though blacks had a breast cancer incidence 27% lower than that for whites. Percentage of cancers diagnosed at later stages was higher among blacks than among whites for colorectal (67.6% vs. 62.1%), cervical (61.3% vs. 46.8%) and breast (48.5% vs. 32.3%) cancers in 2001. More blacks than whites either did not have medical insurance (3.6% vs. 1,1 %) or were Medicaid recipients (4.1% vs. 0.9%).  Compared to people with private insurance, Medicaid recipients or people without any health insurance had higher percentages of cancer diagnosed at later stages. Blacks were 24%, 40% and 71% more like to be diagnosed at later stages than whites for colorectal, cervical, and breast cancer, respectively, controlling for sex, age, and health insurance. 

Conclusion:
Blacks have disproportionately high mortality rates for colorectal, breast and cervical cancers than whites. High mortality rates of these cancers among blacks are associated with high percentage of cancers diagnosed at later stages. Efforts should be made to improve cancer screenings for early diagnosis among blacks.

Dr. Huang is section administrator of the Chronic Disease Surveillance Section in the Bureau of Epidemiology. Tara Hylton is a cancer epidemiologist in the Chronic Disease Surveillance Section.  Both can be reached via email at either Youjie_Huang@doh.state.fl.us or Tara_Hylton@doh.state.fl.us.

Emerging Issues in Epidemiology to be Focus of This Year's Bureau of Epi Statewide Seminar
by Melanie Black, MSW
 

The 10th Epidemiology Statewide Seminar, "Emerging Issues in Epidemiology," will be held at the Orlando Marriott Hotel in Lake Mary, Florida on May 17-18, 2005. Syndromic surveillance, antibiotic resistance, lab development of diseases associated with bioterrorism, hurricane-related BRFSS data, asset typing, Avian flu, competencies and applied epidemiology, maternal child health obesity and diabetes contributions to maternal morbidity, and carbon monoxide poisoning are some of the issues on this year's program. 

To take advantage of the $71.00 group rate for hotel accommodations, reservations must be made no later than April 15. Call the Marriott directly at 407.995.1100 or use their toll-free reservation line at 800.380.7724 and refer the booking agent to the Florida Department of Health, Bureau of Epidemiology Seminar, code FDO to receive the group rate. You can also reserve accommodations through the hotel website at marriott.com/MCOML. On the right side of the screen under “check rates and availability”, enter the dates you plan to arrive and depart. In the box labeled “Group Code,” enter FDOFDOA and then click on the red button labeled “Find”. Verify the information and complete the reservation by clicking on “Reserve a Room”. A confirmation number should appear at the end of the process.

Abstracts for this year's poster presentations are also due by April 15. If you have questions regarding the poster judging, contact Melissa Murray at 850.245.4444, ext. 2445, or email her at Melissa_Murray@doh.state.fl.us.

More detailed information can be found on the Bureau of Epidemiology Internet website at  http://www.doh.state.fl.us/disease_ctrl/epi/conf/training.html.

If you've never before attended one of the statewide conferences, talk to someone who has to learn about the exciting learning experiences, the expanded poster session, and the optional networking opportunities available to all participants.
                       
Melanie Black is the professional training coordinator at the Bureau of Epidemiology in Tallahassee. She can also be reached via email at Melanie_Black@doh.state.fl.us.

         
A.G. Holley Grand Rounds Presents Topics
in Disability Law
by Jaime Forth
 

The A.G. Holley State Hospital is hosting a Grand Rounds presentation entitled "Individual rights in public health law: Lessons from disability law" by John V. Jacobi on Wednesday, April 27. Jacobi is a professor and associate director of the Health Law and Policy Program at Seton Hall Law School.

Objectives of the program are to provide participants an overview of public health law and its constitutional limitations; disability law and its interpretation; an explanation of the intersection of the two areas of the law; and explanation of how conflicting goals might be accommodated.

The grand rounds will be presented from 10:00 a.m. until 12:00 noon. Lunch will be provided by reservation only. For CEU and other information, contact Affette McIntosh via fax at 561.540.3366 or email at Affette_McIntosh@doh.state.fl.us. Persons unable to travel to the site may participate through teleconference by calling 850.921.6623 and, as always, are asked to kindly place their phones on mute to avoid disturbing the speaker.

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

Changes to National Immunization Hotline Announced

On March 15, 2005, the telephone number for the national immunization hotline was changed. The new number is 1.800.232.4636 (1.800.CDC.INFO). The change is reflected on all Vaccine Information Statements (VISs). VISs are information sheets produced by the Centers for Disease Control and Prevention that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given. 

• Access the following CDC website to obtain current VISs: http://www.cdc.gov/nip/publications/VIS/default.htm
• VISs posted on this webpage contain the new number in the "How can I learn more?" section.
• Please replace your camera-ready copies of VISs with these new versions before reprinting.
• You needn't discard your existing VIS stocks; calls made to the old hotline number will be forwarded to the new number for several months. VIS dates have not changed. The new phone number is the only difference between the old VISs and the new ones. A VIS with a date several years old is not necessarily out of date. VISs are not updated on any routine schedule; an updated VIS with a new date is posted when there is a change in recommendations.

For further information, contact Charles Alexander, chief of the Bureau of Immunization in Tallahassee, at 850.245.4331. You can also reach him via email at Charles_Alexander@doh.state.fl.us.

Number of Participants in Bi-weekly CHD
Conference Calls Growing
by Jaime Forth

A record number of conference call participants were present at the Friday, March 25, 2005 call between county health department personnel throughout the state and Bureau of Epidemiology staff. A short recitation of events is provided below for persons who could not dial in. These calls are scheduled continuously throughout the year on alternate Fridays.

CHD Epidemiology Survey and Strategic Planning. Dr. Richard Hopkins reminded recipients of data collection surveys to return them to him promptly. They're important for bioterrorism grant preparations.

To set priorities for the emergency management health preparedness plan, Richard is working with a team on the surveillance component of the plan. Measures for success are being developed by this group.

E.coli 0157:H7/ HUS. Roberta Hammond and Dan Chertow briefed the group on the latest developments with regard to the investigation into the outbreaks associated with festivals and fairs. Based on information collected so far, foodborne exposure appears to be less a reason for concern than contact with animals at the petting zoos. Owners of the petting zoos have been cooperative. They do provide a place for their visitors to wash hands after contact with the animals but there is no mandated requirement to do so. There is also a coin-operated feed machine near the zoo. The possibility that some fair employees work at food booths in addition to working with the animals will be explored. Suspected cases should continue to be reported on Merlin using the established case definitions.

Orange County CHD. Dawn Ginzl reported her CHD was notified Saturday morning that a young girl had been admitted to the hospital with bloody diarrhea after visiting a petting zoo. She had also consumed foods from the fair. No one else in her family was reported ill. On Sunday, the CHD received another call from the hospital reporting that two other children had been admitted with similar symptoms. The following day, one adult was admitted who had been exposed to the animals. Personnel at the health department discovered through a posting on EpiCom that Collier County had posted similar cases, and they realized then there was a cluster of cases.

Polk County Influenza. Colleen Sullivan recounted the case of a male child with a history of ILI who died of septic shock. After initial presentation of mild fever and headache, he recovered slightly but then returned with severe fatigue and high fever. He died in the ER. A culture was positive for MRSA. The autopsy report listed cause of death as influenza B and tests showed staph A.

Miami-Dade CHD Hepatitis B. Fermin Leguen shared details of an ongoing investigation which began with two men in their 70s with no risk factors who had contracted Hepatitis B. Both had visited a chelation clinic in the same area, and an alert health department employee noted the link. A visit to the site revealed several obvious health violations. Other patients have been contacted and advised to undergo testing for the disease. The office has been closed and license revocation proceedings are underway.

Duval CHD Hepatitis A. Ruth Voss and Angela Morgan provided details of a case involving a 9 year old child diagnosed with Hepatitis A. Parents were prophylaxed and letters were sent to the child's school, resulting in the parents of another child contacting the CHD to report that her child had tested positive for Hepatitis A. The remainder of the class was consequently prophylaxed.  Approximately two weeks later, the school principal reported that a teacher had received a positive Hepatitis A result, although the individual had no shared activities with the index class. An environmental health investigator did note a sewage spill elsewhere in the school.

Palm Beach CHD Legionellosis. JoEllen Alvarez reported a cluster of Legionellosis in Palm Beach County. The index cases were a male and female, both from New York, both confirmed positive for pneumonia. Both were hospitalized. Their apartment complex has independent HVAC units. Samples from a water fountain in the common area are pending. Their link is the swimming pool. The apartment manager has been advised to alert other residents  about the condition so they can report to the CHD if they become symptomatic.

Indian River CHD Group A Strep. Maureen Feaster reported two deaths in the same household within days, from different causes. A 26 year old female with history of drug abuse gave birth to a baby in the shower at home, with assistance from her mother-in-law. Later, she was admitted to hospital with pelvic pain and tested positive for cocaine. A course of antibiotics was begun. After her release she was readmitted two days later with possible blood clots in uterus, and died with a positive growth test for Strep A.  The mother-in-law was a 61-year old woman with a history of diabetes, hypertension and bi-polar disease. She expired shortly thereafter, possibly due to toxic shock syndrome from one of her medications, such as Lithium. The husband reported rats in the house but follow-up examination found no rats in evidence.

Indian River CHD Rash Illness. Maureen Feaster reported that a nursing home called the health department to document that 8-10 residents were experiencing a rash as an aftermath of the hurricanes in December 2004. In March 2005, there were 40-50 patients with the same type of rash. After consultation with Dr. Chertow of the Bureau of Epidemiology, Maureen Feater advised nursing home medical personnel how to treat scabies. The number of patients with rashes is now eight.

Alachua CHD Pertussis. Jerne Shapiro stated that a baby, it's grandmother and the middle-aged father of the child have tested positive for pertussis. Seventeen contacts of the three have been prophylaxed and antibiotics have been proscribed for the three. Putnam County recently diagnosed two new cases, both in the same family, but there is no known connection to the cases in Alachua County.

The next conference call is scheduled for Friday, April 8 at 10:00 a.m. EDT. As always, the agenda will be posted on the Bureau of Epidemiology website prior to the event. Persons with items for the agenda should contact Melanie Black, MSW, at Melanie_Black@doh.state.fl.us.

Agriculture Department Expands Research to
Improve Food Safety
from The Weekly Homeland Security Newsletter

• $2 million in funding has been redirected to enhance research on bovine spongiform encephalopathy
• $5 million has been awarded to 17 colleges and universities to establish a Food Safety Research and Response Network
• About $750,000 will go toward a biocontainment facility now under construction at the Agricultural Research Service National Animal Disease Center in Ames, IA
• The Agricultural Research Service has an annual budget of nearly $10 million for transmissible spongiform encephalopathies research and 15 scientists involved in the research, primarily in Ames; Pullman, WA; and Albany, CA

The Food Safety Research and Response Network, spearheaded by North Carolina State University, will include a team of more than 50 food safety experts from 18 colleges and universities who will investigate several of the most prevalent food-related illness pathogens

For more information concerning homeland security, log on to The Homeland Security Institute at
http://www.homelandsecurity.org/

     

           This Week on EpiCom
                                      by Pete Garner
 

• Infant with confirmed case of Botulism in Suwannee County
• Pinellas County reporting Neisseria meningitidis in 23 year old female visitor to Clearwater
• Hillsborough County reporting adult male testing positive for Neisseria meningitidis
• Martin County has presumed case of Neisseria meningitids in 15 year old male

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

Mosquito-borne Disease Update  March 20 - 26, 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: A horse in Union County was confirmed with WN and EEE infections this week.

Eastern Equine Encephalomyelitis (EEE) virus activity: Four seroconversions to EEE were confirmed in sentinel chickens from N. Walton County this week. Thirteen counties submitted sentinel chicken samples this week.

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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