May 1, 2006
Epi Update Managing Staff:
"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
A strike team is a pre-defined number of similar people assembled to perform a specific function. The concept originates from the Incident Command System (ICS). The Epidemiology Strike Team is a public health resource that may be called up, or deployed, in an emergency. A request is made through the Health and Medical Emergency Support Function, ESF 8. The team is equipped and trained to a capability that is known or “typed” so as to provide some assurance that what is deployed is prepared to function efficiently to meet specific mission objectives.
In Florida, we have had some opportunities to use Epidemiology Strike Teams. A recent article was published, 1 featuring the use of a strike team from Florida to conduct surveillance in Mississippi after Hurricane Katrina. The use of strike teams in Florida is becoming more sophisticated as the types of assets are defined. Equipment and supply lists are now developed and being tested, deployment protocols developing, training curriculum put into place, all of which are adding to the level of preparedness from prior years. In addition, the North Central Florida region (Region 3) consisting of 13 counties has been piloting the regional team concept, building and equipping teams “at face level” in the preparation phases of an emergency. That means to have faces connected with names on a roster, supervisory pre-approval, contact information, and some knowledge of team members' unique attributes ahead of time. This initiative has provided valuable practical experience.
During Hurricane Wilma, the regionalization of team development for all public health staff deployment began with a point of contact identified to receive these requests. The unaffected regions could assist by fulfilling ESF 8 requests for staffing. A protocol was developed in Region 3 that provided information and guidelines regarding activation and deployment of teams for response during an emergency. It was found that the team already listed on a roster for environmental health was the most prepared. It was most efficient and effective to reach and launch these individuals who had already been primed for deployment.
The time to prepare for the most obvious hazard to Florida, hurricanes, is January - May. In Region 3, epidemiology team development began with a recruitment of possible deployment personnel from the 13 counties. The county health officers were asked to identify interested individuals. Those who had been on the Wilma roster, those with training in ICS and Field Investigators Response and Surveillance Training as well as those who had prior satisfactory deployment histories were considered. A roster was developed of 25 individuals slated for special training to become ready for the 2006 hurricane season as well as other hazards. Subjects covered in January at the state lab included surveillance system presentations and an awareness of clinical specimen shipping requirements. In February, deployment protocol, core competencies for emergency readiness and responder health and medical readiness were discussed. Afterwards Hepatitis A and B, Influenza, and tetanus immunizations were offered on the spot. Additional benefits are realized at these team meetings: the team leaders are able to have face recognition with those they might be deploying with, and a sense of community is built, a database is being constructed as each meeting progresses to identify the assets better.
Remaining team preparations include communications equipment exercise, fit testing for N95, use of handheld units to collect data, and finally a mock event combined with the Environmental Health Strike Team to form a Region 3 Task Force. A task force is a defined group of different specialists with the same mission for environmental health and epidemiology.
Support personnel for the deployable assets have also been identified. A group called the Kit Keepers is responsible for the receipt, organization, upkeep, storage and final preparation of the Go Kits for each county. One regional administrative assistant tracks the purchase and distribution of the items in the kits. Database upkeep is necessary for the items purchased in the kits, for what resources have been identified by county, and finally one for the deployable personnel. Regional assistance is also necessary for the tasks of launching the teams such as locating maps and rental vehicles.
In conclusion, the regional team concept in Region 3 is well developed and providing feedback for future strike team development. Until all the public health personnel are typed, and a method of cataloging and retrieval is operational, the development of teams is the most efficient and effective method of quickly mobilizing personnel in a disaster request. In the end, when that request is received for a regional strike team, it is less stressful on everyone to have a team identified and prepared.
1Centers for Disease Control, Surveillance for Illness and injury After Hurricane Katrina, September 5 – October 11, 2005, MMWR 2006, 55;
Emily Wilson is an environmental specialist and public health preparedness planner at the Alachua County Health Department in Gainesville. She can be reached at 352.334.7971.
The full report can be found on the web at http://www.census.gov/prod/2006pubs/p23-209.pdf
Jaime Forth is managing editor of Epi Update and can be reached in Tallahassee at 850.245.4444, ext. 2440.
Florida Poison Information
Florida's poison control center situated in Jacksonville received nationwide recognition for its cutting-edge capabilities in the March 20, 2006 issue of Advance for Nurses.
With 85 percent of its funding provided by the Florida Department of Health, the center is staffed by highly skilled registered nurses, physicians assistants, epidemiologists, and other health professionals. Their previous skills, in addition to intense training in poison control, pharmacology, kinetics and calculations and other specializations totaling between 80 and 120 hours, give them the tools they need to make critical assessments over the telephone.
Although the typical call comes from parents or caregivers who are worried about children who may have consumed a poisonous substance, the mission of the center, which serves 42 counties in north Florida and the US Virgin Islands, is expanding. Its core commission is to provide emergency patient care while minimizing overall health care costs related to poison exposure through epidemiologic surveillance, preventive education, and consultation to the public and health care community. However, the center now monitors public health data in real time so the surveillance, which is forwarded to the CDC's Toxic Exposure Surveillance System, can aid in detecting aberrations in diseases as they occur. And, during the 2005 hurricane season, data on poisonous substances such as carbon monoxide, contaminated water, and other public health threats were monitored and forwarded to media outlets so they could inform the public about these hazards.
The Bureau of Epidemiology selected Robyn Kay, MPH, to serve as the epidemiology liaison at the network to perform database monitoring and analysis. Robyn, a member of the Investigations Section of the Bureau of Epidemiology, is uniquely positioned to work on a number of projects that can give colleagues a comprehensive view of the data she receives. The Florida DOH and the Florida Poison Information Center Networks are collaborating on new public health surveillance projects using poison control data. Encrypted web access to the data, a service no other health department in the nation enjoys, is among the tools at her disposal when working on projects where the Bureau of Epidemiology needs an informational edge, such as during hurricanes, national crisis or a public health alert.
At the February 2006 American Association of Poison Control Centers meeting, it was evident that the collaboration between the Florida Poison Control Information Center Networks and the Florida Department of Health is successful. This ability to diversity its mission makes Jacksonville an exceptional facility, and its willingness to partner with other organizations shows the adeptness of its leadership in facing the future.
Bureau of Epidemiology Bi-weekly
The bi-weekly conference calls which occur on alternate Fridays from 10 - 11:00 a.m. have become a very popular vehicle for discussions and information sharing among county health department personnel and Bureau of Epidemiology staff. Below is a brief synopsis of the April 21, 2006 call, for those who missed participating.
Update on 2007 County-level BRFSS. Dr. Youjie Huang explained that a second survey will be performed next year and the sample size for each county will be 500. This survey contained 76 questions and next year's number will be increased to 150. We're seeking comments on the sample survey to ensure the final product will meet the needs of county health departments. Contact Melissa Murray at 850.245.4444, ext. 2445 to obtain a copy and provide comments.
What's New in Epi Training. Melanie Black outlined several training courses scheduled for the coming months. A regional training will be held May 4-5 in Palm Beach at the Crowne Plaza Hotel. CEUs will be available for nursing and environmental health.
Grand Rounds on May 30 will feature Bill Sappenfield speaking about identification of evidenced-based resources in public health; and on May 31, Part II of the Pandemic Influenza Series will be telecast live, with a focus on zoonotic issues. Carina Blackmore will be the featured speaker with Tom Holt, Mark Cunningham and others joining the panel.
Graduation for the Epidemiology Intelligence Service fellows will be held May 10 in Tallahassee at the new Hilton Garden Inn located on Blairstone Road. A block of rooms has been reserved for out of town visitors.
Statewide Fusarium Keratitis Report. Roger Sanderson stated that Florida leads the country in the number of reported cases; there are currently between 100-120 cases in the US. Miami-Dade CHD is collaborating with CDC on a case control study with a short questionnaire. New cases should be reported through the Merlin Outbreak Module and sent to Tallahassee. The Bureau of Epidemiology in Tallahassee forwards the information to the CDC.
Robyn Kay added that Florida has a reported 64 cases of the disease.
Tetanus Case Investigation. Ruth Voss and Steve Clouse of Duval and Clay counties recited the facts of their investigation concerning a 14 year old white child who had been treated for punctures and lacerations at a local hospital. He had been attacked by a dog while attempting to separate two fighting dogs. Three days later, the patient case complained of pain and tightness in his arms and legs, and the following day he developed pains and stiffness around his neck and jaw and experienced difficulty walking. He was taken to the hospital and admitted.
The day after admission, he had muscle spasms and began to have problems swallowing so he was placed on a ventilator. He was also administered two doses of tetanus IgM and sedated with Morphine. Investigation of his medical history revealed that the child had been treated previously for dog scratches but his mother did not want her children to be immunized due to personal feelings about immunizations.
The child was removed from the ventilator after one week and relocated to the medical floor of the hospital for two days, although still complaining of some muscle stiffness. He was discharged from the hospital a day or so later and is undergoing physical therapy at home to deal with continuing pain in his legs. Steve will follow-up with the child at home if the mother permits a follow-up visit. Otherwise, the child is alert and appears to be recovering nicely.
Malaria Testing Procedures. Dr. Blackmore emphasized that procedures for malaria testing involve getting slides from the hospital laboratory and sending them to the state labs, which have the expertise to read slides digitally within a proscribed timeline. Only one case has been recorded so far this year. There will be follow-up information to share at the next conference call.
Rapid Response and Containment Protocol for Early Phases of a Flu Pandemic. Dr. Richard Hopkins spoke about the Pandemic Influenza Emerging Event Team, a partial activation of ESF8. The group is working to finalize our state pandemic influenza plan. The protocol for rapid response and containment would depend upon which phase of the pandemic we're in. We presume if there were a full-blown pandemic (known as Phase 6), it would initialize elsewhere in the world. If in Phase 3,4,5 and early Phase 6, we would implement case-based control measures. The draft protocol has been distributed to county health department directors and administrators for comments and should be returned to Dr. Hopkins as soon as possible. The proposed response relies heavily on resources, and comments from those with field experience will be particularly helpful.
Open Discussion. Richard Hopkins spoke about the mumps epidemic in Iowa that has spread to other states in the Midwest. Our first possible outbreak-associated case was detected late last week. The average age of patient cases is 18-22 years old, and the patient typically was unexposed to mumps as a child and was unvaccinated as a child. Florida averages less than 10 confirmed cases per year but it would be unusual for us to experience an outbreak. If someone suspects a case of mumps, do not advise the person to report to an emergency room, where the disease could spread. Instead, counsel the person to call, not visit, his or her private physician.
The next CHD conference call is scheduled for Friday, May 5 at 10:00 a.m. Any person who would like to add an item to the agenda or appear on the agenda should contact Mary Hilton, MNO, planning manager, at 850.245.4444, ext. 2732.
Florida Influenza Surveillance
Bureau of Immunization Goal is
In 2004, over 218,000 babies were born in Florida. They all need to be immunized against thirteen diseases before age two. These immunizations offer protection from diphtheria, pertussis (whooping cough), tetanus, polio, measles, mumps, rubella (German measles), Haemophilus influenzae, hepatitis B, varicella (chickenpox), pneumococcal, hepatitis A, and influenza. Florida's Early Childhood Immunization goal is that 90% of all 2 year-olds are fully immunized for the combined 4:3:1:3:3:1 (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B, and 1 Varicella) vaccine series by June, 2007.
As we celebrated National Infant Immunization Week from April 22-29, 2006, the Florida Early Childhood Immunization Initiative encouraged parents and physicians to be sure children receive all age-appropriate vaccines at every visit. This provides children the best protection from vaccine-preventable diseases. We can now protect children from more diseases than ever before. Because we can prevent more diseases, parents are often not aware what it takes to fully immunize a child. Infants and young children are particularly vulnerable to infectious diseases; that is why it is critical that they are protected through immunization.
Children who are not immunized increase the chance that others will get a vaccine preventable disease. Immunizations are extremely safe thanks to advancements in medical research and ongoing review by doctors, researchers, and public health officials.
Vaccines have dramatically reduced the number of children affected by communicable diseases and their complications. Vaccine-preventable viruses and bacteria-causing diseases still exist as seen in the current Iowa mumps outbreak. Florida public and private healthcare providers can prevent disease through safe, appropriate immunizations. The recommended The 2006 Childhood & Adolescent Immunization Schedule can be accessed at http://www.cdc.gov/nip/recs/child-schedule.htm
Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. The schedule is approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.
The Florida Immunization Program received two awards from the National Immunization Program in March 2006, recognizing outstanding achievement in immunization coverage and accomplishment of 88.5% coverage for the basic 4:3:1* immunization series. The next step toward surpassing the Healthy People 2010 goal is to achieve a 90% coverage rate for the 4:3:1:3:3** immunization series by June 2007. The early childhood immunization initiative includes expansion of the Vaccines for Children Program, which provides free vaccines to private and public health care providers; promotes the simultaneous administration of all vaccine doses for which a child is eligible at each office visit; and encourages community-based initiatives through local coalitions of public and private partners.
further information, contact the Bureau of Immunization at
Mosquito-borne Disease Summary April 16-22, 2006
Rebecca Shultz, MPH, Caroline Collins, Daneshia Roberts, Calvin DeSouza, Carina Blackmore, PhD
During the period April 16-22, 2006, the following arboviral activity (St. Louis Encephalitis virus [SLEv], Eastern Equine Encephalitis virus [EEEv], Highlands J virus [HJv], West Nile virus [WNv], California Group virus [CALv]) was recorded in Florida:
EEE virus activity:
There was 1 seroconversion to EEEv in
a sentinel chicken from St. Johns County sampled on 4/10. One horse
from Hendry County was reported positive for EEE virus infection this
week. Six out of 38 live wild birds collected in 5 counties from 4/11-4/17
tested positive for antibodies to EEEv; 2 birds from Okaloosa, 2 birds
from Santa Rosa, and 2 birds from Washington County. A total of 14
counties have reported EEEv activity so far this year, compared to 10 at
this time last year.
No locally-acquired human cases of arboviral infection were reported yet this year.
Wild Live Captive Birds:
The Fish and Wildlife Conservation Commission (FWCC) collects reports of dead birds, which can be an indication of arbovirus circulation in an area. This week, 71 reports were received on a total of 98 birds from 21 counties. Of the reported birds, 13 were identified as corvids (5 crows, 8 jays), 7 were identified as a type of raptor, and the remaining 78 were identified as other birds. Please note that FWCC collects reports of birds that have died from a variety of causes, not only arboviruses. Dead birds should be reported to www.myfwc.com/bird/. There were no positive test results this week.
See the web page for more information: www.MyFloridaEH.com. The Disease Outbreak Information Hotline offers recorded updates on medical alert status and surveillance at 888.880.5782. Dead birds should be reported to www.myfwc.com/bird/
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
contribute appropriate public health observations related
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.
Christie Luce is administrator
of the Surveillance Systems Section in the Bureau of
Epidemiology. She can be reached at 850.245.4444, ext. 2450.
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
Copyright©2006 State of Florida