April 15, 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




CDC and WHO Advise Providers to Destroy A/H2N2 Samples Sent Through Mail
by Jaime Forth

The Centers for Disease Control and Prevention and World Health Organization are instructing laboratories in 18 countries, including the US, to destroy immediately any testing sample kits they received through the mail containing the A/H2N2 virus. The virus should not have been included in the sample kit, designed to test the proficiency of laboratories in identifying influenza strains.

Although many hospitals in Florida received the kit, none have reported any exposure or contamination of their personnel to the H2N2 virus. Most of the 3,700 + labs that received the kit were located in the United States.

At issue are the level of virus included in the testing kit and fears about national security. Basic laboratories are not equipped to handle high risk, or biohazardous, materials such as level 3 and 4 viruses. An example of a level 4 virus would be the rare Ebola-Marburg virus currently infecting people in Angola. Level 2 viruses, such as the influenza which circulates annually, can be safely handled with routine precautionary measures by most laboratories, meaning gloves, eye protection and a facial mask. Level 3 laboratories are equipped with one-way airflow equipment plus other procedures for handling the more dangerous organisms.

The A/H2N2, however, has been on the consideration list as a level 3 virus because of it's status as a 50-year-old pandemic flu to which anyone born after the year 1968 would have had no exposure and therefore no immunity. An accidental contact or a leak by unscrupulous sources could trigger a global outbreak or bioterrorism incident.

A laboratory in Canada notified the WHO that one of the viruses contained in the kit was a strain from a 1957 pandemic flu, which then quickly alerted the 18 countries to destroy the kits without delay. The WHO anticipates that most of the countries will have divested the kits by week's end.

For further updates on this topic, click on the CDC and WHO links at:

http://www.phppo.cdc.gov/HAN/ArchiveSys/
http://www.cdc.gov/flu/h2n2situation.htm
http://www.who.int/csr/disease/influenza/h2n2_2005_04_12/en/

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

Late Stages of Female Breast, Cervical and Colorectal Cancer and Associated Factors Among Hispanics in 2002
by Youjie Huang, MD, DrPH, MPH
 

Background
Cancer screening is recommended for early detection and diagnosis of breast, cervical and colorectal cancers. More than two million Floridians are Hispanics, representing 17% of the Florida population. 

Little is known about late stages of these cancers and associated factors among Hispanics in Florida.

Objectives
To examine the percentage of cervical, colorectal and breast cancers diagnosed in late stages among Hispanics in Florida; and to assess the relationship of the percentage of these cancers in late stages and risk factors. 

Methods
Florida Cancer Registry data were analyzed for percentage of regional and distant stages of cervical, colorectal and female breast cancers in 2002. Population-based prevalence of cancer screenings and medical care access was analyzed based on Florida County Behavioral Risk Factor Surveillance System data.   

Results
Among Hispanics, 37.6% of 2,953 new cases of cervical, colorectal and female breast cancers were diagnosed at late stages in 2002. The percentage was higher than that among non-Hispanic whites (34.3%), but lower than the percentage among non-Hispanic blacks (42%). The percentage of late stages of colorectal cancer was higher among Hispanics in rural counties (57%) than among Hispanics in urban counties (50%). Hispanics had the highest prevalence of having no medical insurance (33.4%), no personal health care provider (35.3%), and being unable to get medical care (14.7%), and the lowest prevalence of receiving pap smear test in the past two years (78.4%), blood stool test in the past two years (21.9%), and sigmoidoscopy exam (37.6%) among racial groups. 

Conclusions
Hispanics were more frequently diagnosed with cervical, colorectal and breast cancers in late stages than non-Hispanic whites, and also were less likely to receive cancer screening and full access to medical care.
                     
Dr. Huang is administrator of the Chronic Disease Surveillance section in the Bureau of Epidemiology. Contact him by calling 850.245.4407.

         
50th Anniversary of Salk Vaccine Spurs
Exhibits, Remembrances
contributed by Phyllis Yambor
 

Tuesday, April 12, 2005, was the 50th anniversary of the day microbiologist Dr. Thomas Francis Jr. addressed a crowd in an auditorium at the University of Michigan in Ann Arbor. Francis, who directed the field studies of the polio vaccine, told the crowd that a team of scientists led by Jonas Salk had perfected a vaccine that prevented all three types of poliomyelitis virus. "The vaccine works," Francis said. "It's safe, effective, and potent." Universities and the Smithsonian Institution are marking this historic occasion with exhibits, events, and articles. Following is information about some of them, as well as links to other polio-related resources.

UNIVERSITY OF PITTSBURGH RESOURCES
The University of Pittsburgh, where the vaccine was discovered, offers resources on a polio web page, Remembering Polio: Celebrating the 50th Anniversary of the Salk Polio Vaccine. To access it, go to http://www.polio.pitt.edu.

To access The Shot Heard Round the World, an interactive timeline about the history of polio and the development of the vaccine, go to http://museum.pharmacy.pitt.edu/salk.

SMITHSONIAN INSTITUTION EXHIBIT AND ARTICLES
On April 12, "Whatever Happened to Polio?" a yearlong exhibit, opened at the Smithsonian's National Museum of American History. It tells the story of the U.S. polio epidemic, the vaccine's development, current global efforts to stop polio transmission, and polio survivors. Highlights include a working miniature iron lung and a pair of Franklin D. Roosevelt's leg braces. Constructed on the principles of Universal Design, the exhibit exceeds current federal standards for disability. To access information about the exhibit, go to http://americanhistory.si.edu/exhibitions/exhibition.cfm?key=38&exkey=352

In anticipation of the 50th anniversary, Smithsonian magazine published two articles, Conquering Polio (published April 2005) and Mission Impossible (published February 2003). To access Conquering Polio in ready-to-print (PDF) format, go to http://www.smithsonianmag.si.edu/smithsonian/issues05/apr05/pdf/polio.pdf. To access Mission Impossible in ready-to-print (PDF) format, go to http://www.smithsonianmag.si.edu/smithsonian/issues03/feb03/pdf/smithsonian_february_2003_mission_impossible.pdf

"END OF POLIO" PHOTOMONTAGE
In the "End of Polio," Brazilian photographer Sebastian Salgado tells the story of third-world efforts to eradicate polio. To access his photographs, go to http://www.endofpolio.org.

ROTARY INTERNATIONAL POLIO PLUS PROGRAM
In 1985, Rotary International launched the Polio Plus program to protect children worldwide from the consequences of polio. Working with partner agencies such as WHO, UNICEF, and CDC, the program has achieved a 99 percent reduction in the number of global polio cases. To access information about Polio Plus, go to http://www.rotary.org/foundation/polioplus.

CDC'S STOP (STOP TRANSMISSION OF POLIO) TEAMS
Health professionals interested in working to eradicate polio are eligible for three-month non-salaried field assignments as part of CDC's STOP Teams. For comprehensive information, go to http://www.cdc.gov/nip/global/stopteam.htm

MMWR NOTICE TO READERS
In the April 8 issue of MMWR, CDC notified readers about the anniversary. To access a web-text (HTML) version of "Notice to Readers: 50th Anniversary of the First Effective Polio Vaccine--April 12, 2005," go to http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5413a5.htm. 

Phyllis Yambor is the executive community health nursing director for the Bureau of Immunization headquartered in Tallahassee.  To reach her, call 850.245.4444, ext. 2385.

Reversing the Tide: Conference on Advancing the
Nation's Health to Convene in July

In a joint conference designed to promote policies and programs that will impact the health of our nation, the National Association of County and City Health Officials and the Association of State and Territorial Health Officials will meet in Boston this year focus their attention on the issues of obesity and related chronic diseases.

Leaders in bioterrorism, chronic disease, communicable diseases and other public health industries from cities and states around the country will gather to listen to featured speakers address issues of concern, and visit with exhibitors focused on products, services and technologies beneficial to conference attendees. 

A poster session is planned and sponsorship opportunities are available. If interested in sponsoring a portion of the conference, contact Francienne Saucedo at NACCHO at 202.783.5550, ext. 212 or Rusty Boyce at ASTHO at 202. 371.9090. In-kind donations can also be arranged.

The conference will be held July 12 - 15 at the Marriott Copley Place, located  the historic Back Bay district in downtown Boston. Deadline for registration is June 17 and hotel reservations close on June 19.  The official website for the conference is http://www.naccho.org/conferences/annual_conference.cfm.

Mosquito-borne Disease Update   April 3 - 9, 2005
Caroline Collins, Tasharra Kenion, Calvin DeSouza, Carina Blackmore, Ph.D., State Public Health Veterinarian

Weekly Update: During the period April 3-9, 2005, the following arboviral activity (St. Louis encephalitis [SLE] virus, eastern equine encephalomyelitis [EEE] virus, Highlands J [HJ] virus, West Nile [WN] virus and dengue virus) was recorded for Florida: 

West Nile (WN) virus activity: One seroconversion to WN was confirmed in a sentinel chicken from North Walton County.      

Eastern Equine Encephalomyelitis (EEE) virus activity: One seroconversion to EEE was confirmed in a sentinel chicken from South Walton County.   

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. 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 at www.MyFloridaEH.com. The Disease Outbreak Information Hotline offers recorded updates on medical alerts status and surveillance at 888-880-5782.

     

           This Week on EpiCom
                                      by Pete Garner
 

• Meningitis investigation a residential school in St. John's County
• Expired white male with reported Influenza virus type A&B antibodies at hospital in Taylor County
• Rabies alert issued for portion of Lake County
• Clay County elementary school ongoing investigation of pertussis with 6 confirmed cases, with possible links to Alachua and Putnam Counties
• No decrease in Salmonella Enteriditis and Vibrio parahaemolyticus in Florida; continue to record in Merlin.

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

                         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.

The managing editor is pleased to accept copy for publication in
Epi Update on an ongoing basis. If you'd like to submit an article,
be sure to observe the following guidelines:

1. Pieces must be between 250 and 2,000 words in length.
2. Use MS Word format for all articles.
3. Font should be 11-point Arial with no centering, boxes or other elements added to the text.
4. Charts, graphs, tables and other data should be emailed as a separate attachment to the main document.
5.  All graphics must be attached as a separate jpg or gif file. For instructions on how to accomplish this, email D'Juan Harris at D'Juan_Harris@doh.state.fl.us or 850.245.4444, ext. 2435.
6. State the author's name, title and professional designations for the byline, and include the bureau or business name and telephone/email for contact purposes.
7. Only final documents (not drafts) will be accepted. Please ensure the article has been proofread for accuracy prior to submission.
8. All articles will be subject to editing.
9. The deadline for submissions is Tuesday by 5:00 p.m. Email all submissions to jaime_forth@doh.state.fl.us. If you have questions, call 850.245.4444, ext. 2440.

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