Friday, May 16, 2003

"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 et al. 
Int. J of Epidemiology
1976; 5:29-37



Epi Update Managing Staff
John Agwunobi, MD, MBA,
Secretary, Department of Health 

Landis Crockett, MD, MPH, 
Director, 
Division of Disease Control 

Don Ward, 
Deputy Bureau Chief 
Epi Update Managing Editor 

Jaime Forth, 
Editorial Assistant 

CORRECTION!  Last week's article concerning the effectiveness of gel-based hand soaps cited the CDC as the origin of information.  The correct source was the FDA.  The editors humbly regret this error.

A r t i c l e s:

 

  Dean Bodager, R.S., MPA, Regional Environmental Epidemiologist and Roberta Hammond, Ph.D., Food and Water Borne Disease Coordinator, Bureau of Environmental Epidemiology

 Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology

  Youjie Huang, MD, Dr.PH, MPH, Chronic Disease Surveillance & Epidemiology Section Administrator, Bureau of Epidemiology

 Philip E. Reichert, MPH, Prevention Program Supervisor, Bureau of HIVAIDS 

Jeanetta Stalcup, Seminar Chair, Florida Professionals in Infection Control

Molly D'Esopo, Biodefense Quarterly, Autumn 2002

  Kathryn S. Teates, MPH, Communicable Disease Surveillance & Reporting Manager

  Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, M.S. Vet. Med., Ph.D., Deputy State Public Health Veterinarian

Please Note!  Some numbers may change with confirmatory information

► Atlantic Coast Puffer Fish Blowfish) Alert 

On April 28, 2003, the Florida Department of Health received notification from the Florida Poison Information Center of a possible single case of saxitoxin poisoning due to Puffer Fish (Blowfish) consumption. The implicated puffer fish were recreationally harvested from the Max Brewer Causeway just south of and adjacent to the Titusville Pier (Indian River Lagoon). Approximately 20 puffer fish were caught on a line from the bridge on April 26, 2003 along with 10 additional fish that were gray (species unknown). All the fish were gutted and iced at the bridge, taken home and frozen. Note that the fish were co-mingled. On April 27 all the fish were rinsed, battered in flour, and fried. They were served to family and friends between 5 and 7 pm. Two females experienced tingling in the lips, fingers, feet and light-headedness approximately 1 hour after consumption of the meal. The other five persons did not report any symptoms. No other seafood was consumed by the ill persons. The two patients were treated in an emergency room and admitted to the hospital overnight for observation. Duration of symptoms was 24 and 36 hours. Interviews of the five well people are ongoing.

Urine samples from the patients have been collected and will be shipped to the CDC laboratory for analysis for saxitoxin. Fish samples are not available for analysis. Neither patient stated knowledge of the toxicity of puffer fish and the ban on puffer fish harvesting. The person who caught the fish stated he has been catching and eating puffer fish for 6 years and had not heard of the risks associated with their consumption. Educational materials and information regarding the risks of the ingestion of puffer fish was provided by the interviewing epidemiology nurse.

A similar outbreak occurred in March-April of 2002, caused by fish caught in the same area of the Indian River Lagoon. An emergency ban on the harvest of puffer fish from the waters off Volusia, Brevard, Indian River and St. Lucie Counties was put in place on April 25, 2002 by the Fish and Wildlife Conservation Commission. The ban was extended to include Martin County on July 24, 2002. A year long ban was implemented on October 23, 2002. This report has also been posted on EpiEx.

The following press release was circulated as a result of these findings:

FOR IMMEDIATE RELEASE Contact: Rob Hayes
April 30, 2003 850-245-4111

STATEMENT FROM DEPARTMENT OF HEALTH SECRETARY
REGARDING THE CONSUMPTION OF PUFFER FISH

TALLAHASSEE—The Florida Department of Health (DOH) is currently investigating two suspected food poisoning cases that may be related to the consumption of puffer fish (also called blowfish) caught off the Atlantic Coast of Florida.

"It is important for people to understand that cooking the fish cannot destroy the toxin. The message is simple, yet serious. There is a health risk associated with the consumption of puffer fish," said DOH Secretary John O. Agwunobi, MD, MBA.

Neurotoxin Facts -
Poisoning develops fairly rapidly after the consumption of the contaminated fish, within 30 minutes to two hours, depending on the amount of toxin consumed.

Symptoms -
Primarily neurological, and include tingling, burning, numbness, drowsiness, incoherent speech, and respiratory paralysis. It is also possible to experience nausea and vomiting. In severe cases, poisoning can cause death.

Treatment -
If you experience neurological symptoms as described above and have consumed puffer fish, please contact your physician or emergency room.

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► June Epidemiology Seminar Preparations Underway

The Bureau of Epidemiology Annual Seminar will be held June 3-4 at the Orlando Marriott in Lake Mary, 15 miles NE of downtown Orlando.  The complete registration form, including agenda and confirmed speakers, is now available at http://www.doh.state.fl.us/disease_ctrl/epi/conf/training/index.htm.

      Accommodations are still available but to take advantage of our special group rate, be sure to reserve your rooms as soon as possible! Call the Marriott directly at 407.995.1100, or through their reservations line at 800.228.9290. Refer the booking agent to the FDOH-Epidemiology Statewide Seminar, code FDOFDOH. You can also reserve accommodations through the hotel website at www. marriott.com/MCOML. The hotel site also contains detailed information regarding area activities and driving directions.

     Poster presentations give conference goers an opportunity to share their latest research with colleagues. This year, a judging contest will make the session even more memorable. A knowledgeable panel of judges will award the best infectious disease poster display, as well as the best presentation by a Florida EIS officer, the best chronic diseases display and, finally, the best county health department display. Don't miss this chance to receive acclaim from your peers! The winners will be announced at the following day's luncheon. Examples of poster topics include results of an outbreak investigation, new prevention programs at the local level or new laboratory methods in disease control.

Format for posters will follow the basic scientific paper outline, where applicable:
Background - the problem under investigation or a hypothesis
Methodology - the experimental methods used, including type of study, number of cases, etc.
Results - a summary of essential results
Conclusions - summary of findings, supported by your results (the conclusions should be numbered if multiple points are presented).

The poster session and reception will be held the first evening of the seminar.  Posters can be displayed in a three-fold foam board format or any other appropriate conference style. Please note that each presenter will be responsible for ensuring his/her display is assembled prior to the beginning of the session, and removed promptly afterward. Technical assistance will be available through Bureau of Epidemiology staff. If you would like to participate in this activity,  contact Ronee' Wilson at 850.245.4444, ext. 2445 by May 23rd. 

For information concerning the conference as a whole, contact Melanie Black at the Bureau of Epidemiology in Tallahassee at 850.245.4444, ext. 2448.

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► NAACCR Awards Announced

The Florida Cancer Data System (FCDS) received a gold certification for Quality, Completeness and Timeliness for its 2000 data from the North American Association of Central Cancer Registries (NAACCR) in May 2003. Being awarded a gold certification indicates that the FCDS achieved the highest standards of quality, completeness and timeliness defined by the NAACCR. The FCDS received silver certifications for outstanding quality of data during the past several years.

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► CDC Announces New HIV Strategies

On April 17, 2003 the Centers for Disease Control and Prevention (CDC) unveiled a new prevention initiative entitled Advancing HIV Prevention: New Strategies for a Changing Epidemic ---United States 2003.  The initiative primarily addresses ways to increase HIV testing and prevention for HIV positive individuals. The announcement by the CDC represents a significant change in its approach to prevention, including what types of services Directly Funded Community Based Organizations will be able to provide in future, the role of counseling for persons getting tested for HIV, and how newborn testing will be conducted.  The initiative centers on four priorities:  Making voluntary HIV testing a routine part of medical care; implementing new models for diagnoses outside medical settings; prevention of new infections by working with HIV positive persons and their partners; and decreasing perinatal HIV transmission.

While NMAC is supportive of these new initiatives, it has urged the CDC to ensure that comprehensive primary prevention interventions which target at-risk and vulnerable persons, implemented by community-based organizations, remain a top priority for the agency.  Community based organizations collaborating with state and local health agencies are uniquely positioned to address comprehensive prevention; therefore, the NMAC maintains that a balanced approach between giving at-risk and disenfranchised communities the tools, resources and information they need to stay negative, along with increased testing and prevention, remains the most productive way to assist at-risk populations.  

For more information, contact Philip E. Reichert, MPH, Prevention Program Supervisor, at the Bureau of HIVAIDS, 850.245.4444, ext. 2595.

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► FPIC Annual Conference Slated for September

The Florida Professionals in Infection Control (FPIC) Annual Conference will be held September 24-26, 2003 at the Orlando Airport Marriott in Orlando, Florida.   The conference will offer a variety of national and state speakers who will address infection control, infectious disease, and occupational health topics. There will also be a special pre-conference on September 23^rd from 1-4pm that will address IC Program Elements and more. This is a terrific opportunity for new or nearly new ICPs as well as those that may want a refresher.  Pre-conference space is limited. Registration fee is $225.00 for members and $275.00 for non-members for the full conference if registration is received by August 1, 2003.

A block of rooms has been reserved under the name Florida Professionals in Infection Control, at the rate of $109.00 per night (single or double). Contact the hotel directly at 407.821.9000 or 800.766.6752. Attendees must mention FPIC to receive seminar rates. The rate is not available online. Hotel registration deadline is August 30, 2003.  After that time, rooms may be reserved on an availability basis only and seminar rates may not apply.

Brochures will be mailed in mid-May. For further information, contact Jeanetta Stalcup at 352.323.5414 or by email at jstalcup@leesburgregional.com.

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► Biodefense Information Websites

The following Web sites should bring you up to speed on what you need to know about bioterrorism and other vital security issues:

For information related to anthrax and its vaccine, DOD policy, and selections from a library of articles, go to http://www.anthrax.osd.mil

For white papers and other information about biological weapons, go to http://www.fas.org/bwc/index.html

For comprehensive info on Category A agents plus informational resources for infectious disease practitioners, go to http://www.idsociety.org/bt/toc.htm

For access to a new news journal covering public health response, international collaborations, food safety issues and more, go to http://www.liebertpub.com/bsp/default1/asp.

For news and daily resources on security issues related to global threats from NBC weapons, go to http://www.nti/org.

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► Weekly Influenza Report

Melissa Covey, Department of Health, Bureau of Laboratories reports that the following activities occurred:

Florida: During week 18 (April 27 – May 3, 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 0.86%. 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 Indian River, Leon and Polk counties. Light to moderate influenza activity was seen in four other counties.

National report: During week 18, Fourteen isolates (10 influenza A and 4 influenza B viruses) were made from 569 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 7.1% during Week 18. This percentage is below the epidemic threshold of 7.7% for this time. The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) was 0.7% nationwide. The State and Territorial Epidemiologists in Massachusetts reported regional influenza activity. Sporadic activity was reported in 29 states, New York City and Washington, D.C. Seventeen states reported no influenza activity.

An outbreak of highly pathogenic avian influenza A (H7N7 HPAI) in chickens began during February 2003 in The Netherlands and, despite control measures (restricting transport and culling), has spread to Belgium and Germany, to swine herds in The Netherlands, and humans. Of the 83 confirmed cases of human H7N7 in The Netherlands, 79 exhibited conjunctivitis and 13 had mild ILI. Possible human-to-human transmission was suggested when three family members of two poultry workers fell ill with a minor respiratory disease. The WHO Influenza Collaborating Centers are to begin production of a reagent kit to identify H7N7 viruses. More information about this outbreak of H7N7 HPAI can be found at: http://www.who.int/csr/don/2003_04_24/en/

Severe Acute Respiratory Syndrome (SARS): http://www.doh.state.fl.us/PHNursing/SARS/SARSindex.html

For additional information on influenza and influenza surveillance results in Florida, please visit our website at http://www.doh.state.fl.us/disease_ctrl/epi/htopics/flu/2002/index.htm 

Links to current diseases of concern:  Severe Acute Respiratory Syndrome (SARS): http://www.doh.state.fl.us/PHNursing/SARS/SARSindex.html

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 ► Arboviral Activity Summary - Through the Week Ending May 12, 2003

Weekly Update: During the period of May 6 through May 12, 2003, the following arboviral activity (St. Louis encephalitis [SLE] virus, eastern equine encephalomyelitis [EEE] virus, West Nile [WN] virus and dengue virus) was recorded for Florida:

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► Weekly Disease Table
Florida Department of Health, Bureau of Epidemiology, Weekly Morbidity Report, Week 19, ending May 10, 2003.

Selected Diseases and Conditions (confirmed cases only).  Access the very latest information at:

www.doh.state.fl.us/disease_ctrl/epi/Disease%20Table2003_weekly/diseasetable.htm

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