Friday, April 2, 2004
This Week in the News
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."
Disparities Within the Older Population in Florida
Results of the 2002 Florida County BRFSS are announced.
Exposure from Mercury Vapor Lamps
The actions of an astutue ophthalmologist partnered with a County Health Department can impactan entire community.
from the Sea
Sushi gourmets know this fish by the name wasabi. They also know a mouthful of its poison can kill them. But scientists are taking another look at the fish.
Acquainted - GIS and Computer Systems Analyst |
The backbone of any organization is information. And getting information organized, formatted and published, is the job of D'Juan Harris, M.S.P.
One Year, Bi-Weekly CHD Conference Calls Still Going Strong|
The participation level continues to be high for this popular forum.
|Epi Update Managing Staff:||
and EPA Issue Joint Advisory|
They advise women, especially women who are pregnant, to go easy on consumption of fish and shellfish.
|John Agwunobi, MD, MBA, Secretary, Department of Health||
BRFSS Report Shows Nearly Half of Adult Floridians Have Been Tested for
In 2002, almost half of Floridians aged 18 to 64 reported ever having had an HIV test.
Landis Crockett, MD,
Division of Disease
Week on EpiCom|
If you haven't logged on recently, you don't know what's going on around the state.
Acting Bureau Chief,
Influenza Surveillance For the Week Ending March 20, 2004|
Reports from the state, the nation and around the world for Week 11.
A report outlining activities for March 21-27, 2004 for confirmed cases.
A R T I C L E S
|Marie A. Bailey, MA, MSW; Zhaohui Fan, MPH; Youjie Huang, MD, MPH, DrPH, Bureau of Epidemiology, Chronic Disease Surveillance Section||►Health Disparities Within the Older Population in Florida|
Currently, Florida has almost 3 million residents who are 65 years old
and older. By 2020, that population is expected to grow to almost 5
million, surpassing the growth of any other age group in
Florida. Despite this rapid growth, little data exist on racial and
ethnic health disparities among older Floridians. To identify possible
disparities, health risk behaviors and chronic disease conditions among
those aged 65 and older were analyzed by race/ethnicity using data from
the 2002 Florida County BRFSS survey. Health-related disparities among
older Floridians were found among income, sex, and race/ethnic groups
for survival, income strata, health status, health-related behaviors,
and chronic disease conditions. Non-Hispanic Blacks and Hispanics
together represent 20% of adults age 65 to 74 years old; only 13% of
adults age 75 to 84 years old; and only 8% of adults age 85 years old
The most precipitous drop in representation among the older age groups was found among non-Hispanic Blacks, who ranged from 9% of the 65- to 74-year-old age group to just 2% of the 85-and-older age group. Among those aged 65 and older, women and non-Hispanic Blacks and Hispanics were more likely to report having an annual household income of less than $25,000 than were their counterparts. Over 25% of those 65 and older reported their health status as fair or poor (27.6%) with a larger percentage of non-Hispanic Blacks (45.1%) and Hispanics (39.5%) reporting fair or poor health than non-Hispanic Whites (24.8%). Forty percent of those 65 and older reported being overweight, and another 18.5% reported being obese. Non-Hispanic Blacks (37.4%) were more likely to report being obese than were non-Hispanic Whites (17.4%) or Hispanics (16.4%).
Over 50% of those aged 65 and older reported having high blood pressure. Non-Hispanic Blacks were more likely than either non-Hispanic Whites or Hispanics to report having high blood pressure (77.8% vs. 50.8% and 54.8%, respectively). Overall, 16% of those 65 and older reported being told by their doctor that they have diabetes. Non-Hispanic Blacks and Hispanics were more likely to report being told they have diabetes than were non-Hispanic Whites (21.8% and 22% vs. 15.3%, respectively).
Recommendations from this study include: (1) more collaboration with BRFSS program partners to use BRFSS data in planning and evaluating programs that address the specific needs of older Floridians; and (2) the dissemination of these data results to policy makers at state and local levels.
|Kelly Granger, MPH, CHES, Biological Scientist II, Pinellas County Health Department||►UV Exposure from Mercury Vapor Lamps|
Recently, a local ophthalmologist notified the Pinellas County Health Department (PinCHD) that three patients presented to his office with possible toxic exposures within the same week. According to the ophthalmologist, the patients presented with corneal damage, burning eyes and skin irritations. All three patients reported having played basketball together at the same local community center. The Environmental Health Division and the Epidemiology Program conducted a thorough investigation of the area. No toxic substances were found in the vicinity of the basketball courts, and no other complaints had been filed in the past several months. The supervisor at the community center reported no complaints from staff, clients or parents.
After receiving contact information from the ophthalmologist for two of the three affected individuals, phone interviews were conducted. Initially, the interviews did not yield any distinctive information. The individuals reported that they played basketball both indoors and outdoors at the same park each Monday night. They had begun playing regularly the first week of February, alternating between indoor and outdoor play. Both individuals reported that friends supplied the basketballs used, and that they were stored in the individuals’ cars. Neither person remembered having seen any of the basketballs roll into an area that may have contaminated the ball. No items were shared except the basketballs.
The first individual reported that this was not the first occurrence of symptoms. Two weeks prior, he and his friends experienced the same symptoms after playing basketball at the same park. Both times, his eyes began to hurt approximately twenty minutes after they stopped playing basketball. The pain was described as excruciating, with an intense burning sensation.
The second individual also reported having had similar symptoms two weeks prior. Along with intense eye pain and burning, he experienced reddened skin in both instances, particularly on the forehead and upper chest (he had been playing basketball without a shirt). He also noted that the lights for the outdoor court are located directly above the rim at each end of the court, instead of on the sides, where lights are typically located. This individual visited his ophthalmologist and subsequently referred his friends. The ophthalmologist compared the damage to the individual’s eyes as similar to "what would happen if one were to look at a welder’s torch."
During the interviews with the two affected individuals, the PinCHD was informed of a recent news story reporting a basketball team that had recently experienced similar symptoms of eye irritation and skin burning after playing ball indoors. According to the report, the protective outer envelope had been broken off a mercury vapor lamp in the gymnasium, and the lamp was emitting a harmful dosage of ultraviolet radiation. According to FDA Consumer magazine, mercury vapor lamps are used extensively in gymnasiums, banks, sports arenas and stores. When the outer envelope that filters out harmful short wavelength ultraviolet radiation is intact, the lamps are a safe lighting source. However, when the outer envelope is broken, individuals exposed to the ultraviolet radiation can experience symptoms such as corneal burns, reddening of the skin, blurred or double vision, headaches, nausea and diarrhea.
The Environmental Health Division and the Epidemiology Program returned to inspect the integrity of the outer envelope of the lamps located at the park. Upon inspection, it was evident that all the outer envelopes had been broken out of the lamps. The community center manager was asked to submit a work order to have the outer envelopes replaced as soon as possible, and to keep the lights off until the outer envelopes were replaced.
The community center manager has replaced the outer envelopes and the lights have been turned back on. There have been no further complaints. The PinCHD is currently drafting an informational sheet on mercury vapor lamps and the health effects of broken outer envelopes. The fact sheets will be distributed to Pinellas County schools and community centers, where gymnasiums and basketball courts are commonly found. This situation may be unique; however, it is appropriate to raise awareness of this issue in the community. Most importantly, this case illustrates the importance of open communication between health departments and community physicians. The fact that an astute physician contacted the health department in order to assist in protecting the health of the public represents an important contribution to disease surveillance.
|Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology||
From the Sea
A potent treat known in Asia for its bittersweet taste, the toxin in the fugu fish is fatal enough to kill a human within four to six hours after consumption. Sushi chefs in Japan are specially trained and licensed to prepare the fish, as the smallest slip of their knife could release a nonprotein sodium channel blocker called tetrodotoxin (TTX), into the toxin-free areas of the delicacy.
But the founder of a Canadian neuro-bioscience company who was educated in Asia, saw potential
in the toxin of the fugu puffer fish to ease withdrawal symptoms for heroin users seeking relief
from addiction. Shum knew that tetrodotoxin had been used in Asia as a
popular folk medicine for the treatment of migraine headaches and
menstrual cramps for many years. When his company, International Wex
Technologies, confirmed through studies that the toxin had powerful pain
relieving properties, they began creating proprietary technology to
extract and purify TTX from the puffer fish and concentrated their
efforts on pain management instead.
The drug TTX has already passed two phases of clinical tests. In Phase II, patients with cancer pain who had had no relief from any other source were given microgram amounts of Tectin, a purified form of TTX, injected twice a day for four days. The results showed a majority of patients (17/22) experienced full or partial reduction in their pain, some lasting up to two weeks after the final dosage. Classified as a sodium channel blocker, the medication is not addictive and carries none of the side effects caused by existing narcotics.
A Phase III
double-blind placebo-controlled trial will be conducted in medical
centers throughout Canada next, with delivery changing from
intermuscular to subcutaneous injection. The company plans to initiate a
similar study in the United States later this year.
|Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology||
Acquainted - GIS and Computer Systems Analyst
D'Juan Harris originally conceived a career in city planning as a designer of urban infrastructures. To achieve his goal he attended Florida A&M and graduated with a BA in political science and public administration. However, his interest in the overall schema of health systems and their role in the promotion of healthy cities in aggregate subpopulations such as the elderly and/or disabled, led him to FSU and an MS in urban and regional planning, with a minor in health systems and aging policy. His employment at the Department of Health began in 2001.
D'Juan's expertise at the Bureau of Epidemiology is in GIS (Geographic
Information Systems), which he uses to develop and modify disease
surveillance and investigations. The technology assists him in creating
flow charts and diagrams to demonstrate the progression of disease
outbreaks in Florida. He also researches the approach of spatial
analysis of reportable diseases and conditions for reports, and serves as
the bureau's Web manager.
|Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology||
One Year, Bi-Weekly CHD Conference Calls Still Going Strong
This call was conducted on Friday, March 26, 2004. A record is provided here for those who were unable to participate.
Working effectively with tribal governments. Soni Schulze, MPH, an EIS Fellow, relayed the substance of statewide meetings with Seminole and Miccosukee tribal representatives during a recent conference on bioterrorism preparedness. She learned that communication would be smoother during a crisis if state officials were to recognize appropriate channels of command within each tribal government. Further, bioterrorism training, funding, and equipment would be needed for the tribal communities to raise to a higher level of preparedness.
Florida EIS Update. Alan Rowan, DrPH, shared the latest information concerning recruiting efforts for the next class of EIS fellows. He began interviewing candidates this week and will let counties know the score on their applications the week of April 12th. The final six candidates and counties will be matched on April 27-28th. The current class of 2002 graduates in Tampa next week.
Hepatitis A electronic lab reporting. Sandy Roush and Jodi Baldy gave a brief overview of new procedures for changes to the chronic panel related to order #3.8 on lab slips for Hepatitis A. The State made these changes in January with the intent not to look for outbreaks, but to let the State know if a client is chronic.
Roush followed up with a reference to a February 4, 2004 memo which summarized the cut-off ratio on Hepatitis C testing. If the result is > 8.0, you may consider the result positive. This went into effect on February 9th.
Epi Update Survey. Jaime Forth, editor of the Epi Update reported that the outcome of the recent reader survey pointed to a generally high satisfaction with the direction of the journal, so no major changes would occur as a result. She noted that a large number of respondents wanted to see more articles from county health departments, so she will begin to aggressively pursue articles from those sources. She also said there was high interest in stories concerning epidemiological issues originating around the world because they impact what happens in Florida. Those articles will continue, but the focus of the journal will remain Florida. Due to popular demand, new features will be epidemiological how-to's and some policy updates.
Training announcements. Melanie Black, MSW, stated that the Website for the statewide epidemiological seminar in May is operational. The agenda will be added to the site the week of April 5th. Judges have already been selected for the poster session; 30 counties have been identified for scholarships based on EpiCom participation, flu surveillance participation and bi-weekly conference call participation. Counties should contact Melanie with staff names as soon as possible. The attending staff member must be in an epidemiological position, and the funding will provide registration, hotel and travel expenses.
General announcements. Don Ward announced five applicants for the state and deputy state epidemiologist are being interviewed by Drs. Sorensen and Crockett.
The openings for surveillance and investigations chief positions in the bureau should be referred to Don Ward. Apply directly to him, or phone him with questions at 850.245.4444, ext. 4405.
Our Website now features 14 new one-page PRAMS reports, which were completed recently by Curt Miller of the chronic disease surveillance section. These should be of value to anyone conducting research or working with mothers and children.
The next conference call will be held on Friday, April 9th at 10:00 a.m. EST.
The Center for Food Safety and Applied Nutrition of the Food and Drug Administration on March 22, 2004 issued an advisory with the Environmental Protection Agency stating that some fish and shellfish contain higher levels of mercury than advisable for consumption by women who are pregnant, might become pregnant, or are nursing, and young children, and should therefore be avoided. The fish and shellfish named were shark, swordfish, king mackerel, or tilefish.
Recommended fish and shellfish containing lower traces of mercury are shrimp, light canned tuna, salmon, pollock and catfish. Albacore, or white tuna, contains more mercury than light canned tuna.
advisory, including updates, is available on the Web at
Zhaohui Fan, MPH,
Epidemiologist, Bureau of Epidemiology, Chronic Disease Surveillance
BRFSS Report Shows Nearly Half of Adult Floridians Have Been Tested for
The Bureau of Epidemiology is pleased to announce the publication of a new report from the 2002 County BRFSS: "HIV/AIDS Prevention Among non-Hispanic Blacks and Hispanics, 18- to 64-years-old, in Florida: 2002 Florida County BRFSS Findings".
HIV/AIDS is a serious and preventable disease that can be detected before symptoms develop by using a screening test that is reliable, inexpensive, acceptable, and non-invasive. Treatment given before symptoms develop is more effective in reducing morbidity and mortality than treatment after symptoms develop. In 2002, almost half (47.9%) of Floridians aged 18 to 64 reported ever having had an HIV test. Non-Hispanic Blacks (59.7%) and Hispanics (52.7%) had a higher prevalence of ever having been tested for HIV than did non-Hispanic Whites (44.2%). The three most reported reasons for having an HIV test were:
The three most reported locations for HIV tests were a private doctor’s office or HMO, a hospital, or a clinic. The highest prevalence for having had an HIV test and for being advised by a health professional to prevent sexually-transmitted disease through condom use was found among adults aged 20 to 39.
More information on this report is available
on our website at
under the heading "2002 County BRFSS Special Reports."
|Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology||
Week on EpiCom
The Bureau of
Epidemiology encourages Epi Update readers to not only register on the
EpiCom system at
https://www.epicomfl.net but to browse EpiCom frequently and
contribute public health observations related to any suspicious or
unusual occurrences or circumstances, as appropriate. EpiCom is the
primary method of communication between the Bureau of Epidemiology and
other state medical agencies during emergency situations.
|Angela Fix, MPH, Respiratory Disease Surveillance Epidemiologist, Melissa Covey, Influenza Surveillance Coordinator||
Influenza Surveillance For the Week Ending March 20, 2004
Florida influenza-like illness (ILI) activity slightly increased across the state for the week. Seven counties reported as having a high ILI% activity for week 11. However, not all sentinels have reported at the time that this summary was written (81% reporting as of March 29, 2004). Compared to data from the previous week, thirteen counties reported an increase in ILI activity for week 11, while six counties reported a decrease and eleven counties remained at a level activity. Five counties did not have at least 50% of the active sentinels reporting and therefore the change in ILI activity could not be determined. Of the thirty-five counties represented by the Florida Sentinel Physician Influenza Surveillance Network (FSPISN), eleven counties reported no influenza-like illness activity for the week ending March 20, 2004. The FSPISN providers reported seeing 17,144 total patients during week 11, of which, 274 patients were seen with influenza-like illness symptoms (1.60% statewide ILI activity). None of the five specimens tested at the state branch laboratories during week 11 tested positive for influenza. The influenza activity code for Florida was reported to the Centers for Disease Control and Prevention as “no activity” for the week ending March 20, 2004.
Across the nation, there were no reports of widespread or local ILI activity. Twenty-one states reported sporadic activity; and all other states, including Florida, reported no ILI activity for the week ending March 20, 2004. Mortality due to pneumonia and influenza (P&I) remained below the epidemic threshold for the week ending March 20, 2004. The percentage of patient visits seen with influenza-like illness to sentinel providers across the nation remained at 1.2% for week 11.
The number of human cases of avian influenza H5N1 appears to be stable in Vietnam and Thailand. The total number of human cases confirmed by the World Health Organization (WHO) is 34, of which, 24 have been fatal. Twenty-two of the cases have occurred in Vietnam with 15 fatalities and 12 cases in Thailand with 8 fatalities. The WHO continues to monitor the situation in Southeast Asia in collaboration with Member States. A fact sheet about the significance of avian influenza for human health along with all the previous situation updates can be found at the World Health Organization’s website at http://www.who.int.
To view the complete report, [click here.]
|Arbovirus Surveillance Team: Caroline Collins, Kristen Payne and Calvin DeSouza, and Program Manager Carina Blackmore, DVM, Ph.D., State Public Health Veterinarian, Bureau of Community Environmental Health||
No Florida counties are under medical alert. There have been no human cases confirmed yet this year. In areas with mosquitoes present, people are still encouraged to take precautions against mosquito bites.
WN Virus activity: There were two seroconversions to WN virus reported this week in sentinel chickens from Walton (2/24) County. So far this year, there have been 51 seroconversions to WN virus in 10 counties, two WN-confirmed dead birds from Marion and Miami-Dade counties, three WN-positive live birds from two counties and one WN-confirmed horse from Polk County. To date, fifteen counties have reported confirmed WN virus activity this year.
SLE Virus activity: None this week. So far this year, five sentinel chickens from Lee County have tested positive for SLE.
EEE Virus activity: There was one seroconversion to EEE virus reported this week in a sentinel chicken from Walton (3/15) County. To date, ten sentinel chickens, three horses and five live birds have tested positive for EEE virus, for a total of eight counties reporting EEE virus activity this year.
Highlands J Virus
activity: None this week. To date, there has been one
seroconversion to Highlands J virus in a sentinel chicken from Volusia