"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."

Forge 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 

A r t i c l e s:

Jaime Forth, Editorial Assistant, Bureau of Epidemiology

Shannon Lease, M.S. Director, Office of Performance Improvement

New England Journal of Medicine, May 29, 2003

Rick Dulin, Bureau of HIV/AIDS

Department of Health, Bureau of Immunization

Homeland Defense Journal, April 2003, VOL 1, Issue I

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

Please note that numbers are subject to change with confirmatory information

► Conference Closes on a High Note  

Nearly 215 attendees at the 8th annual state seminar on Epidemiology gathered in Lake Mary this week to hear the latest on subjects ranging from maternal child health to strategic planning for public health and to network with old friends and new.

At the opening night poster session and reception, judges perused nearly 35 entries to determine winners for Best Chronic Disease, Best Infectious Disease, Best EIS Officer and Best Health Department presentations.  And the awards went to....D'Juan Harris, Bureau of Epidemiology, for his poster on Utilizing Geographic Information Systems for Epidemiological Applications, in the category of Best Infectious Diseases Presentation. The winner for Best Chronic Diseases was Dr. Youjie Huang with an entry entitled, "Disparities in Cancer Screening, Incidence and Outcomes." "Bad Luck at Pot Luck" was Florida EIS Officer Carmella Mancini's winning poster, and Youjie Huang and his team were also recognized for outstanding contributions, with the greatest number of poster entries submitted.  The Miami-Dade group presentation won for Best Health Department with their entry, "Current Knowledge, Practices and Attitudes of Miami-Dade Residents about West Nile Virus and its Prevention."  A record number of posters were exhibited at this year's event and the participation was noted for its excellence .

Elsewhere at the conference, speakers enlightened their audiences on the latest in childhood lead poisoning, cancer mortality in Florida, lab innovations for infectious diseases and more. If you weren't present, you'll want to plan on attending next year!

After thoroughly examining the conference surveys and reviewing the final numbers, we'll be back in a later issue to provide a more detailed look at the conference as a whole.   

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► Quality Management Call for Projects

Applications for quality management demonstration projects are being accepted until June 20th for the 2003/04 year. Short-term projects which foster ongoing quality improvement and focus on strategic processes and goal-oriented business results will be strong candidates. Past winners have been projects which addressed ways to implement more effective billing methods, reduce paper waste, employ mediation training, and measure the effectiveness of targeted messages to at-risk patients.  

Average awards are $10,000, but can be supplemented with additional funding related to public health preparedness. Past winners are eligible to apply. For further information, contact Beth Mann or Bonnie Gaughan-Baily at the Office of Performance Improvement at 850.245.4007. For more information about the Public Health Preparedness Program, call Mark O'Neill or Debra Bragdon at 850.245.4007.

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► West Nile Virus Traced to Organ Donor

The New England Journal of Medicine recently reported that four recipients of organs from a common donor developed West Nile Virus (WNV) as a result of the transplants.

In summer 2002, headache and fever cases in Georgia and Florida after the patients had received kidney transplants led to the investigation of encephalitis. It was determined that the original organ donor had obtained blood from a person infected with viremia.  Because most individuals with West Nile Virus are asymptomatic or experience only mild symptoms, the development of more sophisticated methods for screening potential blood donors has become a priority for the public health industry.  

The U.S. Food and Drug Administration has produced a user's guide for public health professionals, and the organization is working proactively to bring to fruition the development of diagnostic tools which can aid clinicians in testing for WNV.  

For a more thorough discussion of this issue, be sure to refer to the article published in the May 29th edition of the journal.

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► HIV Testing Day Set for June 27

June 27, 2003, is National HIV Testing Day. The goal of this event is to promote people’s awareness of the need to “take the test” and then “take control” by returning for test results to learn their HIV status. In Florida, the goal this year is to have our 67 county health departments (CHD) offer free HIV testing extended hours, and incorporate creative outreach events.  

Because co-infection of HIV and hepatitis is so prevalent, many CHDs will also provide vaccinations for hepatitis A and B, and/or testing for hepatitis B and C. It is estimated that 20 to 30 percent of HIV positive clients are also infected with the hepatitis C virus (HCV). Hepatitis B and HCV share several risk factors with HIV—contact with blood or body fluids of an infected person; and the rate of HIV-HCV co-infection is highest among those who acquired HIV through sharing needles for drug use. 

Duration National HIV Testing Day last year, state records show 4,325 tests were completed—and 93 of those were positive. Of those tested—2,191 returned for their results—50.1 percent of the negatives and 78.5 percent of the positives For more information, contact April Crowley, senior health educator at the Bureau of HIV/AIDS in Tallahassee at 245.4444, ext. 2580, or at april_crowley@doh.state.fl.us.

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► Immunization Bulletin News

Adult Immunization Update Satellite Teleconference

The Department of Health, Bureau of Immunization, in conjunction with the Office of Performance Improvement, is making available the Adult Immunization Update satellite teleconference through the Department of Health Telnet Videoconference Sites on Thursday, June 26 from 12 noon to 2:30 PM (EDT). This live satellite broadcast will provide an update on current adult immunization practices; highlight the 2002-2003 Recommended Adult Immunization Schedule and present strategies to improve adult immunization coverage levels. Continuing education credit will be offered for a variety of professions, based on 2.5 hours of instruction. Those wishing to receive credit for this course must register online at the Centers for Disease Control and Prevention (CDC) website at: http://www.phppo.cdc.gov/phtn/Adult-Imm03/default.asp.

Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices

The CDC has published “Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)”.The 2003 publication updates recommendations by the ACIP regarding the use of influenza vaccine and antiviral agents. The new recommendations include new or updated information regarding: 1) the timing of influenza vaccination by age and risk group; 2) influenza vaccine for children aged 6-23 months; 3) the 2003-2004 trivalent inactivated vaccine virus strains; 4) availability of certain influenza vaccine doses with reduced thimerosal content; and 5) manufacturers of influenza vaccine for the U.S. market. Persons planning organized vaccination campaigns should consider scheduling these events after mid-October because the availability of vaccine cannot be ensured in the early fall. Campaigns conducted before November should focus efforts on persons aged 50 years and above, persons aged less than 50 years at increased risk of influenza-related complications, health care workers, and household contacts of persons at high risk to the extent feasible. Clinics conducted in November and later should continue to vaccinate persons at high risk and their contacts, but also vaccinate other persons who wish to decrease their risk for influenza infection. Vaccination efforts for all groups should continue into December and beyond. The recommendation is available on the CDC Web site at: http://www.cdc.gov/mmwr/PDF/rr/rr5208.pdf

Influenza Vaccine Bulletin # 1. At the request of the CDC’s National Immunization Program , please ensure that the attached Influenza Vaccine Bulletin # 1 for the 2003-2004 season is widely distributed to all appropriate members, colleagues, and partners with an interest in the supply, distribution, management and administration of influenza vaccine.

Influenza Vaccine Information Statement for 2003/2004

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► Bioterrorism Field Test Kit Now Available

The anthrax mailings in 2001 heightened our awareness of the need for first responders to quickly separate ordinary powders from those requiring a specific array of scientific tests. The impracticality of conducting exhaustive testing on every suspicious substance posed an awesome burden to HAZMAT officials, laboratories, 911 personnel and others dealing with citizen calls concerning suspected anthrax.  

Now, a new screening device can detect the presence of anthrax, ricin and other toxins in five minutes or less. Manufactured by 20/20 GeneSystems, Inc., the kits are now sold to fire departments and other public safety personnel at a cost of $25 or less.  

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 ► Arboviral Disease Report

Weekly Update:  During the period of May 27 through June 2, 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: 

Human:  No cases of arboviral meningo-encephalitis were reported this week. Gilchrist County is under Medical Alert for EEE virus.  
Sentinel Chickens: Nine seroconversions to EEE virus were confirmed in Hillsborough, Duval, Orange (5), Putnam and Volusia counties. This week, 759 samples were tested from 21 counties. 
Bird Mortality:  Four dead birds from Santa Rosa (3) and Union counties were reported positive for EEE virus this week.  
Equine*:  Two EEE virus infections in horses were reported from Orange and Polk 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 Guidelines:

1.  Report dead birds to www.wildflorida.org/bird/. From that site, you can link to online bird identification sites.  There is value in the information submitted even if the bird is not tested, especially for those counties which don't have sentinel chickens or which have sites situated sparsely in the county.
2.  The DOH Lab in Tampa will test anything that's shipped in good condition. Instructions for submission of dead birds are found at:  http://www9.myflorida.com/Environment/hsee/arbo/index.htm. Select "How Do I Report?," then choose "Protocol for Collecting and Shipping Bird Carcasses" under "Dead Birds" subtopic.
3.  If local agency must cut back on bird submissions, consider only sending 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 (http://www9.myflorida.com/Environment/hsee/arbo/index.htm). DOH Press releases can be seen at http://apps3.doh.state.fl.us/IRM/PressReleaseSearch/search.cfm. *Equine cases are determined by the Department of Agriculture and Consumer Services.  For more information visit the DOH web site at http://www.doh.state.fl.us/Environment/hsee/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.

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► Weekly Disease Table 

Click on the link below to access the latest data regarding this week's disease figures provided by the Florida Department of Health, Bureau of Epidemiology.

http://www.doh.state.fl.us/disease_ctrl/epi/Disease%20Table/2003_weekly/diseasetable.htm

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