Epi Update Weekly Publication of the Bureau of Epidemiology

April 8, 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


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Analysis of Hepatitis A Virus 1995-2004
Will be Presented in Bureau of Epi Grand Rounds

by Jose Lojo, MPH


Title:
Analysis of Hepatitis A Virus Infections, Florida, 1995-2004

Presenter: José Lojo, MPH; Others to be announced

Date: Tuesday, April 26, 2005, 11:00 a.m.

Abstract:
Control of Hepatitis A, an acute infection of the liver caused by the Hepatitis A virus (HAV), continues to be a challenge for public health systems in the state of Florida. During the last 10 years in this state, Hepatitis A was the leading cause of morbidity among vaccine-preventable diseases and was also the 6th leading cause of acute reportable disease morbidity.  

For this presentation, statewide surveillance data of HAV infections from the years 1995-2004 were analyzed using Statistical Analysis Software® in order to describe the epidemiology of this disease and examine potential correlates to county-level incidence. There was variable statewide incidence of disease over time with significant declines noted in the last two years. Disparities in incidence by age, gender, ethnicity and race were also found to exist, in accordance with previously published studies. On a macro-level, the 10-year summary county incidence was correlated moderately with the proportion of migrant and seasonal farm worker populations for each county as well as county level of health care coverage and the proportion of the county population at the poverty level. Due to differential morbidity among various groups and in light of the recent decline in overall incidence, it is hypothesized that aggressive disease control and preventive efforts via targeted vaccination campaigns may still be the most cost-effective methods for controlling state-level incidence of Hepatitis A.  

Additional Information:
The grand rounds presentation will begin promptly at 11:00 a.m. EST on Tuesday, April 26, 2005. The PowerPoint slides and dial-in number will be posted on the Bureau of Epidemiology intranet website on Friday, April 22. CEUs will be provided for nursing and laboratorians. If additional information is needed, contact Professional Training Coordinator Melanie Black, MSW at 850.245.4444 ext. 2448, or email Melanie_Black@doh.state.fl.us

José Lojo is a Florida Epidemic Intelligence Service fellow, currently assigned to the Polk County Health Department. He can be reached at 863.519.8300.

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Bureau of Epidemiology Statewide Seminar
Slated for May 17-18

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, 15 miles NE of downtown Orlando 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 among just some of the issues that will be discussed. 

The evening of May 16th there will be a cook-out and the opportunity to pre-register for the first day. The poster session and reception will be held the evening of May 17th.  The poster event will be judged again this year, with awards given for the best communicable disease poster, as well as for the best presentation by a Florida EIS fellow, the best chronic disease poster and the best county health department display. Two additional categories have been added, one for environmental health and the other for spatial analysis/visualization. The winners will be announced at the following day’s luncheon.

The “County Showcase” and “Golden Partnership” awards will be featured again this year as well. The County Showcase provides county health departments the opportunity to bring educational resources they have developed for healthcare professionals, and share them with others. These items will be on display throughout the seminar. If you would like to participate in this event, please contact Melanie Black. The Golden Partnership awards will be presented during the opening ceremonies to partners who have made significant contributions in support of disease surveillance and epidemiology.

To take advantage of the special group rate of $71.00 for hotel accommodations, be sure to make your reservations by April 15th. early. Call the Marriott directly at 407.995.1100 or through 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 “Find”. Verify the information and complete the reservation by clicking on the red button “Reserve a Room”. A confirmation number should appear at the end of the process.

Further information can be found on the Bureau of Epidemiology Internet website at  http://www.doh.state.fl.us/disease_ctrl/epi/conf/training.html, or contact Melanie Black at the Bureau of Epidemiology in Tallahassee at 850.245.4444, ext. 2448.
                     

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.

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Avian PowerPoint Slides
Offer Guidelines on Bird Flu
by Jaime Forth
 

Revised guidelines on the etiology of avian flu, it's clinical symptoms, the cycle of the virus in animals and humans and other facets of the illness are available in PowerPoint format on the Bureau of Epidemiology website at
http://www.doh.state.fl.us/disease_ctrl/epi/htopics/Avian_Influenza.ppt.

The 23-slide presentation, updated by Joann Schulte, DO, MPH and Richard Hopkins, MD, MSPH of the Bureau of Epidemiology and Carina Blackmore, MS, Vet Med, PhD of Community Environmental Health, was an effort to better familiarize public health professionals in Florida with the disease in advance of an arrival in the U.S. 

This proactive approach to avian influenza is in response to World Health Organization and Centers for Disease Control and Prevention reports concerning the lethal strain of avian flu predominant in Southeast Asia which can affect even healthy people. Although the virus has not widely mutated to spread from human to human, rare cases have been cited, and the cycle is being watched by experts who worry that another flu pandemic could kill millions in this country and abroad.

Signs of avian flu in humans are fever, muscle aches and pains, sore throat and cough, conjunctivitis, and pneumonia and other life-threatening complications usually affecting the lungs. The mortality rate among all age groups and health categories is about 70 percent.

The CDC is promoting detection, diagnosis and prevention to elude the disease, and recommends that travelers avoid visiting areas in Asia with known influenza A outbreaks.

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

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Viral Hepatitis Workshop Offered
by April Crowley, et al.

A viral hepatitis serology workshop will be offered on Tuesday, April 12, 2005, from 10:00-11:30 a.m. (Eastern Time) and on Tuesday, June 14, 2005, from 10:00-11:30 a.m. (Eastern Time)

This 90-minute course is presented in a telephone conference-call format, with a slide-set available on the Web.  Prior to each course date, the Meet Me phone number, with the slide-set Web address, will be emailed to all registrants. Continuing education credit of 1.5 contact hours is available for licensed laboratorians and nurses in the State of Florida. Each session will be limited to the first 50 registrants. Please allow 15 minutes during registration for the mandatory pretest.

All course participants should have a working knowledge of immunology and serology prior to taking this course. To ensure participants’ success in this course, each registrant will be notified if their pre-test score is less than 40 percent.  Individuals receiving such a notification should carefully consider whether to participate in this intermediate-level course.

To register for the course, please complete the form found on the following link: http://www.doh.state.fl.us/disease_ctrl/aids/hep/ViralHepWkshp/VHSregform.htm

Learner objectives are to provide a review of the serological tests for hepatitis A, B, and C markers; provide a review of interpretation of hepatitis A, B, and C test results; provide an understanding of the differences between acute and chronic viral hepatitis infection and the serological makers associated with each; and to provide an opportunity to apply knowledge of viral hepatitis through case study presentations and discussion.

For more information, contact April Crowley at April_Crowley@doh.state.fl.us.

April Crowley is Senior Health Educator for the Florida Hepatitis & Liver Failure Prevention and Control Program at the Bureau of HIV/AIDS in Tallahassee. To reach her, call 850.245.4444, ext. 2580.

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STD Ask Me Campaign Unveiled in April
by Adrian Cooksey, MPH


Sexually transmitted diseases (STDs), historically known as venereal diseases, are among the most common infectious diseases in the United States and affect men and women across age, race, and economic status. According to research published by the National Institutes of Health, 12 million new cases of STDs occur annually in the United States, with an estimated direct economic impact of $10 billion a year. Failure to prevent, screen, or treat STDs in a timely manner can result in adverse pregnancy outcomes, impaired fertility, increased risk for cervical cancer and transmission of HIV (Human Immunodeficiency Virus). Although modern medicine, technical advances, and behavior modification have helped to control and prevent some infections in our communities, STDs still hold a substantial disease burden in Florida. 

Nationally, April is recognized as STD Awareness Month to highlight the major impact these diseases have on health care systems each year. Sexually transmitted infections include more than 20 organisms that are bacterial, viral, or parasitic. Currently, state legislation requires that only confirmed positive cases of chlamydia, gonorrhea, and syphilis be reported to the Florida Department of Health and the Centers for Disease Control and Prevention.  

Statewide, over 60,000 cases of STDs are reported annually. In 2004, chlamydia, the most prevalent of STDs, occurred at a rate of 244.44 per 100,000 population and reported cases increased 28% from 2000. Recent trends illustrate that as chlamydia rates spiral, gonorrhea cases have plummeted in previous years. From 2000 to 2004, GC rates declined from 141.71 to 106.74 per 100,000. Even though chlamydia and gonorrhea cases account for the volume of reported STDs, syphilis continues to persist in Florida. The total number of syphilis cases decreased 9% from 2003; but increased 9% from 2000. Infectious syphilis cases escalated 77% and late latent syphilis cases increased 20% from 2000.  

Floridians from all walks of life should be aware that STDs are endemic in all communities and remain a persistent threat. Changing patterns of sexual behavior, unprotected sexual behavior, and the stigma often associated with seeking testing or treatment are factors that have played a role in the continued prevalence of STDs. Specific STDs such as chlamydia and the most infectious stages of syphilis (primary and secondary syphilis) have increased steadily since 2000; and as gonorrhea rates continue to diminish, antimicrobial resistance to Neisseria gonorrhoeae (causative agent) remains a concern.  

In recognition of STD Awareness month, the Bureau of STD has implemented the “ASK ME” Campaign intended to increase awareness in local communities across Florida and empower the general public with a better understanding of sexually transmitted infections and their health impacts. Health care professionals across the state are encouraged to actively provide an opportunity for open dialogue between clients/patients throughout the month of April.

Adrian Cooksey is the STD epidemiologist at the Bureau of STD Prevention and Control the Florida Department of Health in Tallahassee. To reach her, call 850.245.4444, ext. 2360.

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Epi Seminar Poster Abstracts Sought
New Deadline for Submissions Set for April 22

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 great 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. 

Format for posters will follow the basic scientific paper outline, where applicable: 

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 17th, however participants will be asked to set up the posters on May 16th so that the judges will have plenty of time to view all of 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 e-mail when you submit the abstract. A new category has been created for students currently enrolled in Master of Public Health programs in Florida.

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, please 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 e-mail

Melissa Murray is Coordinator of Research Services for the Chronic Disease Surveillance Section in the Bureau of Epidemiology at the Florida Department of Health. She can be reached at 850.245.4444, ext. 2445.

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           This Week on EpiCom
                                  
    by Pete Garner
 

The Bureau of Epidemiology encourages Epi Update readers to not only register on the EpiCom system at https://www.epicomfl.net but to sign up for features such as automatic notification of certain events (EpiCom_Administrator@doh.state.fl.us) and contribute appropriate public health observations related to
any suspicious or unusual occurrences or circumstances. EpiCom is the primary method of communication
between the Bureau of Epidemiology and other state medical agencies during emergency situations.
  • Infant tested positive for Clostridium botulinum Toxin Type A in Suwannee County

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

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                         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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