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|This Week in the
► Announcing New Merlin Reporting Module
Good news! Paper submissions will be eliminated for animal rabies reports, and direct rabies testing results for county health departments will soon be the new norm.
► First Phase of CHD EpiCom Training Begins
Administrators and directors from across the state attended the first phase of training designed to acquaint professionals with EpiCom, the department's new outbreak communication and alert system.
► Statewide Epidemiology Seminar: Call for
Avian Influenza Report from Centers for
► Annual Infection Control Seminar Coming
► Conference Call Update
Epidemiology Seminar Reservations
This week's Contributors:
Phase of CHD EpiCom Training Begins:
Epidemiology Grand Rounds:
Epidemiology Seminar Reservations:
Disclaimer: Please note that numbers are subject to change with confirmatory information.
|► Announcing New Merlin Reporting Module
A successful collaboration between the Bureau
of Laboratories, county health departments and the Bureau of Epidemiology
has resulted in a new Merlin module for reporting animal rabies. This new
module eliminates paper rabies specimen submissions to branch laboratories
as well as paper reporting to the Bureau of Epidemiology. County health
departments will now be able to submit the necessary information to a
branch laboratory for testing through Merlin.
In addition, the branch laboratories will be able to enter testing results
directly into Merlin and the county health department will receive instant
notification. The collected data will include negative results, increasing
the quality and timeliness of the data and ensuring more accuracy when
mapping animal rabies incidents in
The first sessions of CHD training for EpiCom were conducted earlier this week. Directors and administrators from all counties were invited to dial in to one of the four slide presentation and question-and-answer sessions. In fact, the EpiCom system was used to send the announcement and deliver slides to the invited participants. A number of counties included their epidemiology specialists in the training in anticipation of broader access to the EpiCom system in the near future.
EpiCom is a two-phased approach to surveillance of disease outbreaks and other public health events. The first component, EpiCom Alert, is a secure Web site where both public and private health care officials and providers can exchange anecdotal or syndromic information. The centralization of this information gives the Bureau of Epidemiology an opportunity to examine and analyze these messages from a statewide perspective and determine whether a particular event is localized or widespread, and at what rate it may be spreading.
The second component, EpiCom Alert, is a high-volume outbound communications system that will be used to call health officials at any time, day or night, to alert them to potential threats and emergencies. County health directors and administrators, along with other emergency response teams,will be called at home or at the office, on cell phones and pagers, on any phone device they might use, with a message to log on to the EpiCom Web site for information regarding new or ongoing disease outbreaks.
EpiCom is receiving a lot of media coverage for its role in the SARS outbreak with several newspapers as well as television, and radio stations contacting the Bureau and the DOH Office of Communications for details about the system.
Training for county health department personnel will continue next week on Thursday, May 1 and Friday, May 2 at 1:30 and 3:30 p.m. each day, EDT. Conference call phone number is 850.921.2583 or SC 291.2583. The PowerPoint presentation will again be sent to prospective participants. If you are interested in this or other EpiCom training, contact Pete Garner at the Bureau of Epidemiology.
of Epidemiology Grand Rounds: Investigations of Community-Association
Methicillin-Resistant Staphylococcus aureus
Abstract: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) outbreaks are rarely reported in literature; however, recent investigations suggest that MRSA is an emerging pathogen in the community setting. In September 2002, the Pinellas County Health Department (PCHD) investigated increased reports of purulent skin abscesses occurring among healthy community-dwelling individuals. Active case finding and contact tracing was conducted to identify and interview individuals with skin lesions and/or a laboratory-confirmed MRSA wound infection, resulting in the identification of 12 cases. Epidemiological links were confirmed for 11 (92%) of the 12 cases. Of the 11 linked cases, all were associated with the same Alcoholics Anonymous meeting, six (55%) with transitional housing programs and five (45%) with a recent history of incarceration. Wound cultures were collected from 8 of the 11 cases; 4 of which were laboratory confirmed as MRSA. The PCHD has received calls from hospital emergency departments, correctional facilities and transitional housing programs regarding the prevalence of skin abscesses and MRSA infections in these facilities since this investigation began. The health department continues its investigative and surveillance activities to help characterize the epidemiology and prevalence of community-acquired MRSA. Education for healthcare professionals and the public regarding community transmission of MRSA is essential to prevention and control efforts.
Additional Information: Further details regarding the audio-conference call and the PowerPoint files will be posted on the Bureau of Epidemiology Intranet web site. CEUs for nursing, environmental health professionals and laboratorians will be provided. Information about upcoming topics and presenters will also be posted in the Epi Update. If either of these access points is unavailable to you, please email Melanie Black [Melanie_Black@doh.state.fl.us] or telephone 850.245.4444 ext. 2448 (SunCom 205-4444 ext. 2448) to request presentation materials.
Important: While we realize you might not always be able to call in by 11:10 a.m., it can be distracting to the speaker and others in the audience when participants dial-in throughout the hour. Please try to call in on time and remember to put your phone on mute so as not to disturb others. Thank you for your cooperation.
The Bureau of Epidemiology is actively soliciting posters for its upcoming seminar, to be held June 3rd and 4th in Lake Mary, Florida.
Poster presentations give conference attendees an opportunity to share their research with colleagues and friends. Some examples of poster subjects include results of an outbreak investigation, new prevention programs at the local level or new laboratory methods in disease control. The poster session presents the perfect opportunity to demonstrate new computer/Web-based systems related to public health.
The format for posters will follow a basic scientific paper outline, where applicable:
Background - the problem under
investigation or a hypothesis;
Posters can be displayed as 3-fold foam core boards or any other layout. Whatever means you choose, be sure to have a primary and back-up plan for presenting your poster. Technical assistance for displaying the posters or setting up demos will be available through the Bureau of Epidemiology. The posters session will be held the evening of June 3rd, the first day of the seminar.
If you are interested in presenting a
poster, please contact Ronee' Wilson at 850.245.4401 or Suncom 205.4401,
by May 23rd.
Introduction: As you may be aware, The Netherlands first reported an outbreak of highly pathogenic avian influenza A (H7N7) in chickens at the end of February 2003. The Dutch authorities instituted several control measures including restricting transport of poultry and in some cases culling of chickens in affected areas. Despite these control measures, the H7N7 virus has spread to birds in Belgium and Germany, to swine herds in the Netherlands, and has caused infections in humans. Below is a report from the National Influenza Center in the Netherlands describing the first fatal human case of influenza A (H7N7) and other human cases of less severe illness due to H7N7.
The World Health Organizations Influenza
Collaborating Centers (CDC is 1 of the 4 collaborating centers) met via
teleconference yesterday morning and agreed to go ahead with production of
a reagent kit that would allow national influenza centers to identify H7N7
(H7N7) diagnostics RT-PCR tests performed in two laboratories were both negative. On April 11, the man was admitted to hospital where he was moved to the intensive care unit a day later, and was mechanically ventilated. On April 13, he had high fever and developed ARDS. On April 14 his renal function decreased and dialysis was started. X-thorax performed on April 15, when his condition worsened, revealing an interstitial pneumonia. A broncho-alveolar lavage (BAL) was performed for diagnostic purposes. He died on April 17. A BAL sample was sent to the NIC to test for respiratory pathogens and revealed a high virus load of influenza A (H7) virus using a real-time PCR assay specific for the matrix and haemagglutinin genes. Testing for other respiratory virus and bacteria so far are all negative. Samples collected on April 11 and 13 indicated the presence of herpes simplex virus in another laboratory, for which he was treated with Acyclovir. Specimens of the right and left lung were collected and also sent to the NIC. PCR analysis of these samples confirmed the presence of H7 influenza A virus. Serum samples collected on April 11 and 17 displayed a slight increase in H7-specific antibodies in haemagglutination inhibition assay. This result needs to be confirmed for additional serological tests.
Since the beginning of the HPAI H7N7 outbreak in chickens in The Netherlands at the end of February 2003, 82 confirmed cases of human H7N7 influenza virus infections have occurred. The majority of these (79) presented with conjunctivitis and 7 presented with influenza-like illness (ILI); 6 individuals had both conjunctivitis and ILI. The other two individuals presented with very mild symptoms and could not be classified as conjunctivitis or ILI. We have found strong evidence for transmission of H7N7 influenza from poultry workers to family members on three occasions. This first death of a previously healthy individual, which is probably caused by H7N7 HPAI, demonstrates that the HPAI outbreak in chickens, and frequent transmission to humans and probably pigs is a major concern to public and animal health. Protective measures in humans that are in close contact with infected animals (vaccination against human influenza and prophylactic treatment with antivirals) and culling of affected chicken flogs and pigs is of utmost importance to control this outbreak.
It is important to note that in the intensive monitoring that is currently implemented, no coinfections with H7N7 and human influenza A viruses have been detected so far. To date, also no significant genetic changes have been observed in virus isolates from humans, including human-to-human transmission cases. The neuraminidase subtyping and genetic analysis of the influenza A virus detected in the deceased veterinarian will be important to see if this is a "normal" avian influenza virus or one with distinct genetic and biological properties.
Introduction by Alicia S. Postema, MPH, Centers for Disease Control & Prevention.
Ron Fouchier, Thijs Kuiken, Gerard van Doornum, Marion Koopmans and Ab Osterhaus, National Influenza Centre, The Netherlands contributed to this article.
The Bureau of Epidemiology aired a live, interactive satellite broadcast on April 17, 2003 from 10:00 AM – 11:30 AM EST, moderated by Steven T. Wiersma, M.D., M.P.H., Bureau Chief, Bureau of Epidemiology and State Epidemiologist. Don Ward, Deputy Chief for Management, Karen Eaton, M.B.A., Director, Office of Public Health Nursing, Assistant Chief Nursing Officer and D. Fermin Arguello II, M.D., Epidemic Intelligence Service Officer, CDC, Bureau Of Epidemiology provided an overview of the role of public health, historical overview of the disease, case definition, transmission, treatment, laboratory support, recommended infection control practices and reporting requirements.
The program was a big success with participation from the county health departments, hospitals, labs and other healthcare professionals from around the state. The Bureau of Epidemiology will be re-broadcasting this program on Wednesday, April 30, 2003 from 10:00 AM – 11:30 AM EST. CEUs for nursing, environmental health professionals and laboratorians will be provided again. The coordinates for the broadcast are AMC2 (GE2 or W2), Channel 23. Upon completion of viewing the re-broadcast, you can register for CEUs and fill out the program evaluation at http://www.doh.state.fl.us/disease_ctrl/epi/conf/sat/index.htm. If you have questions about the satellite coordinates, please contact Tamela Tassinari, Director, Distance Learning Program at (850) 245-4444 ext. 2193 or SunCom 245-4444 ext. 2193. If you need further information about the program, you can contact Melanie Black, M.S.W., Professional Training Coordinator at (850) 245-4444 ext. 2448 or SunCom 205-4444 ext. 2448
Infection Control Seminar Coming Soon
The seminar will be held at the Pensacola Civic Center on Friday, May 16th. If you have any questions or would like a brochure, please call Vivian Logsdon at 850.595.6639 or email her at Vivian_Logsdon@doh.state.fl.us.
► Conference Call
► Statewide Epidemiology
To make hotel reservations, call the Orlando Marriott directly at 407.995.1100 (or toll-free at 800.228.9290). Be sure to refer to the FDOH-Epidemiology Statewide Seminar-June 2-4, 2003, group code FDOFDOA, for our special rate. You can also reserve a room on-line by logging on to their Web site at www.marriott.com/MCOML. Once there, click on the red "Reserve a Room" button, enter the dates requested and then scroll to the bottom of the screen. In the box labeled "Group Code" enter FDOFDOA and press enter. Follow the instructions to complete the reservation.
The agenda and registration form will be available next week on the Bureau of Epidemiology Internet Web site. Melanie Black, MSW, will be managing this activity and can be reached at 850.245.4444 ext. 2448 or SunCom 205.4444 ext. 2448.
► Weekly Influenza Report: Week
Florida: During week 15 (April 6-12, 2003)* influenza activity, calculated based on the proportion of patients with influenza-like illness (ILI) seeking care by physicians participating in the Florida Sentinel Physicians Surveillance Network was 1.40%. This is lower than the national baseline of 1.9%. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Duval, Indian River, Palm Beach and Polk counties. Light to moderate influenza activity was seen in seven other counties. During the past three weeks (weeks 13 - 15) four laboratory confirmed influenza cases (primarily influenza B) were reported from three counties across the state. No new cases of influenza were confirmed by laboratory reports this week.
National report: During week 15, nineteen isolates (18 influenza A and 1 influenza B viruses) were made from 722 specimens tested by the World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories this week. The proportion of deaths attributed to pneumonia and influenza as reported by the vital statistics offices of 122 U.S. cities was 7.3% during Week 15. This percentage is below the epidemic threshold of 8.0% for this time. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) was 0.9% nationwide. The State and Territorial Epidemiologists in Alaska reported widespread activity, 9 states (Colorado, Idaho, Maryland, Massachusetts, Minnesota, Montana, New York, North Dakota, and Ohio) reported regional activity. Twenty-seven states reported sporadic activity, and 9 states reported no influenza activity.
During the past 3 weeks (weeks 13-15), 25.0% of the specimens tested for influenza in the New England region and 18.8% of specimens tested in the East North Central region were positive. Between 5.0% and 10.8% of the specimens tested for influenza during the past 3 weeks in the South Atlantic, Pacific, and West North Central regions were positive, and less than 5.0% of the specimens tested for influenza during the past 3 weeks in the Mid-Atlantic, East South Central, West South Central, and Mountain regions were positive.
Since September 29, 11.8% (n=9,926) of the 83,819 specimens tested nationwide have been positive. Two thousand seven hundred and forty-seven (50%) of the 5,480 influenza A viruses have been subtyped; 2,156 (78%) were influenza A (H1) viruses and 591 (22%) were influenza A (H3N2) viruses. Laboratory confirmed influenza has been reported from all 50 states. Influenza A viruses were reported more frequently than influenza B viruses (range 56% - 88%) in the New England, East North Central, Mountain, Pacific, and Mid-Atlantic regions, and influenza B viruses were reported more frequently than influenza A viruses (range 59% - 81%) in the West South Central, South Atlantic, West North Central, and East South Central regions. However, during the past 3 weeks (weeks 13-15), influenza A viruses were reported more frequently than influenza B viruses in all surveillance regions except the New England region.
CDC has characterized 140 influenza A (H1N1), 46 influenza A (H1N2), 82 influenza A (H3N2) and 188 influenza B isolates antigenically. The neuraminidase typing for 42 H1 viruses is pending. All influenza A strains were similar to corresponding vaccine strains. One influenza B strain was more similar to B/Shizuoka/15/01 than to the vaccine strain (B/Hong Kong/ 330/01).
An avian flu virus strain, influenza A H5N1, has been recovered from two influenza cases in Hong Kong. CDC has issued recommendations on increased influenza surveillance in the United States. Of particular importance is to consider influenza cultures on patients, with recent travel histories to Asia, who are hospitalized with unexplained pneumonia, acute respiratory distress syndrome or severe respiratory illness.
* Reporting is incomplete for this week. Numbers may change as more reports are received.
For additional information on influenza and influenza surveillance results, please visit our website at http://www.doh.state.fl.us/disease_ctrl/epi/htopics/flu/index.htm
Weekly Update: During the period April 15 through April 21, 2003, the following arboviral activities (St. Louis encephalitis [SLE] virus, eastern equine encephalomyelitis [EEE] virus, West Nile [WN] virus and dengue virus) were recorded in Florida:
Human: No cases of arboviral meningo-encephalitis were reported this week. Gilchrist County was placed under Medical Alert for EEE virus this week.
Sentinel Chickens: One seroconversion to EEE virus was confirmed in Flagler County. This week, 707 samples were tested from 17 counties.
Bird Mortality: A dead bird was reported positive for EEE virus this week in Hamilton County.
Equine*: Two EEE virus infections in horses were reported from Gilchrist (1) and Osceola (1) counties.
Wild and Captive Birds: See http://www.pherec.org/DECS Arbovirus Ecology to view database.
Mosquito Pools: No mosquito pools were reported positive for WN or EEE virus this week.
Current Bird Mortality Reporting
2. We will test anything that's shipped in good condition to the DOH Lab in Tampa. Instructions for submission of dead birds are found at: http://www9.myflorida.com/disease_ctrl/epi/htopics/arbo/index.htm. Select "How do I report?," then choose "Protocol for Collecting and Shipping Bird Carcasses" under "Dead Birds" subtopic.
3. If a local agency must cut back on bird submissions, consider sending only crows and jays.
4. If personnel are not able to offer pick-up service, have a drop off station and provide the caller with clear handling instructions. A county may modify its testing approach depending on the availability of other surveillance systems in the county.
The Disease Outbreak Information Hotline offers updates on medical alert status and surveillance at 888-880-5782. Florida is currently at "Level 1" in the Arbovirus Response Plan (see http://www9.myflorida.com/disease_ctrl/epi/htopics/arbo/index.htm). DOH Press releases can be seen at http://apps3.doh.state.fl.us/IRM/PressReleaseSearch/search.cfm .
2003 Cumulative Arbovirus Activity by
2. Animal Surveillance
West Nile Virus
Bay: 2 sentinel chickens (1/7, 1/7)
Eastern Equine Encephalomyelitis
Alachua: 2 horses (3/25, 3/31)
* Equine cases are determined by the Department of Agriculture and Consumer Services.
For more information please see the DOH website at http://www.doh.state.fl.us/disease_ctrl/epi/htopics/arbo/index.htm
Acknowledgements/data sources: county health departments, Department of Health Laboratories, Department of Agriculture and Consumer Services, mosquito control agencies, Florida Fish and Wildlife Conservation Commission, medical providers and veterinarians.