June 10, 2005
Epi Update Managing
"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
Michael Lo is an injury
epidemiologist at the Health Access and Tobacco Bureau in the Office of
Injury Prevention at Florida Department of Health. Michael can be reached
at 850.245.4444, ext. 2729.
Diabetes is an ongoing and lifelong disease that can be self-managed with the assistance of a health care provider. The American Diabetes Association (ADA) has developed the Standards of Medical Care for Patients with Diabetes, which guides health care providers and patients through the complex process of managing diabetes1. To control blood glucose levels, a person with diabetes may need access to supplies like blood glucose test strips and insulin. Usually, people with diabetes are able to get these medications and supplies covered through their health insurance policies. Unfortunately, many people with diabetes do not have health insurance coverage. In addition to a lack of health care coverage, many diabetes patients are unable to get medical care due to long distances to medical facilities, lack of knowledge of diabetes care, and long wait times for appointments.
The focus of this report is the inability to get needed medical care2 in the past 12 months among adults with diagnosed diabetes3 in Florida. Data from the 2002 Florida County Behavioral Risk Factor Surveillance System survey were used for this analysis and are based on a sample size of 34,551 respondents, of whom 3,582 reported being told by their doctors that they have diabetes, which is the definition of “diabetes” used for this report.
Among people with diagnosed diabetes, differences in the prevalence of inaccessible medical care were found by age group, racial/ethnic group, educational attainment and income.
1To access the Diabetes
Standards of Care, visit
*Confidence intervals for Table 1 are constructed utilizing the SAS 9.1 version.
The Bureau of Epidemiology has expanded by two, and both new staff members have already begun the tasks set before them.
Janet Hamilton was an EIS fellow in
Escambia County and is a recent graduate of that program. She comes to the
bureau as an epidemiologist in the Surveillance and Reporting Section
working on projects such as revision of the reportable disease list, Focus
Area B Cooperative Agreement and case definitions. She recently presented
one of the most popular Grand Rounds ever, based on the topic of MRSA.
Janet graduated from Guilford College as an honor student with a BS in
biology, and went on to the University of Georgia to study microbiology
before graduating from the University of Michigan with a Master of Public
Robyn Kay was an EIS fellow in Duval
County before the Bureau of Epidemiology hired her as an epidemiologist
headquartered at the state laboratory in Jacksonville. Robyn works in the
Investigations Section under the direction of Dr. Joann Schulte. She
attended the University of Florida in Gainesville, earning a Bachelor of
Science degree in microbiology and cell science before going on to the
Rollins School of Public Health at Emory University to earn a Master of
Public Health degree in epidemiology.
We're delighted these two professionals have agreed to join our bureau and we invite you to contact them and wish them well.
Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.
EpiCom Becomes More User Friendly
On June 3, 2005, a new version of EpiCom went into production giving registered EpiCom users more control over the type and frequency of information they receive. Users can now activate or de-activate the email notification function via their profile screen. Persons who activate this function will receive an email notification each time a message is posted to an EpiCom forum. With these changes, a moderator can now choose to send the entire message or only the message title. Registered users can also opt to receive a daily recap of all messages posted to EpiCom in the last 24 hours via their profile screen.
This once-daily email will give the title of each message posted, and the
date and time of the post. Future enhancements to the EpiCom system
include organizing EpiCom forums and topics into classifications based on
similar attributes, which would allow users to receive and view only
information of interest to them. Proposed classifications include
Environmental Health, Infectious Diseases, and Possible Bioterrorism
If you have questions or comments about future or current EpiCom enhancements, please contact Christie Luce, marketing specialist in the Bureau of Epidemiology at 850.245.4444 ext. 2450. To become a registered EpiCom user, point your Internet browser to https://www.epicomfl.net.
Christie Luce is the EpiCom consultant in the Bureau of Epidemiology Surveillance Systems Section. To contact her, call 850.245.4444, ext. 2450.
The Bi-weekly conference call among Bureau of Epidemiology staff and members of county health departments around the state was held at 10:00 a.m. on Friday, June 3, 2005. A brief synopsis of the call is recounted here for those who were unable to participate.
Vaccinia Immunization Program. Dr. Landis Crockett announced a new program to produce immune globulin at four Life Sera Plasma Centers in the U.S., one of which is located in Pensacola. The globulin will be used as stockpile in response to a bioterrorism event. All centers are FDA-licensed. The operation began in May and will last 13 weeks, and the new vaccine is called Dryvax. Adverse events from smallpox vaccines a few years ago forced many entities such as the military to give up their immunization programs. If there are questions concerning activities of the Life Sera Centers, call 850.476.7999.
Dr. Crockett advised CHD clinical staff to become familiar with rashes and to make photos of unusual rashes they encounter to aid epidemiologists in Tallahassee in identifying them.
Cyclospora Investigation. Dr. Roberta Hammond stated there were 300 lab confirmed cases of cyclospora, with 23 out-of-state cases. She reminded listeners that approximately 70 records have no disposition listed in Merlin and the records need to be updated. She also advised that the FDA wants to perform a traceback on fresh basil.
Bioterrorism Grant Guidance. Dr. Richard Hopkins updated participants on the status of the 2005-06 grant cooperative agreement. He stated that focus areas are no longer the term of reference, that the CDC instead uses goals as the new measurement standard. The Florida Department of Health has requested status quo funding for EIS and CHD bioterrorism-funded positions, with the approval of the state's regional co-chairs. Additional funding has also been requested to support Dolphin and EpiCom projects.
Merlin Data Field Changes. Dr. Hopkins emphasized that among the new CDC requirements in this year's bioterrorism grant funding package, one measurement will be timeliness in surveillance. He explained that this affects Merlin reporting, specifically the intervals between date of lab confirmation to date of first notification to a public health agency. This new requirement will be reviewed carefully by Bureau of Epi staff as they calculate the Secretary of Health's quarterly performance measures, where responsiveness is a primary objective.
GI Outbreak in Escambia County. Samantha Rivers described an outbreak at an elementary school where on a Monday, 11 of 17 teachers became ill from deli food with symptoms of diarrhea, nausea and vomiting for two days. Upon investigation, the CHD team learned a deli employee had been sent home ill. On Tuesday, three other individuals with no ties to the school reported illness after having eaten food from the same deli. Following Tuesday's report, another person became ill. Labs were taken and O&Ps were sent to the Jacksonville lab. Virals were sent to the Tampa lab. All samples tested positive for Norovirus G2. Better handwashing methods were recommended to restaurant workers, as the investigators felt the cause of the outbreak was a sick employee.
Neisseria Meningitis in Escambia County. Samantha Rivers reviewed the case of a 16 year old male with signs of rash followed by strong headache. The following day he died. He had experienced only a sore throat prior to the appearance of the rash. The boy attended a private religious school, which administration furnished the names of classmates to county health department investigators. The local media published extensive coverage about the incident and parents of all the victim's classmates requested prophylaxis which was subsequently administered, although as a rule it is given only to close contacts.
The following day an inmate at the local jail became ill with meningitis for the third time. Detention staff prophylaxed inmates who had had close contact with him as well as 48 other inmates who had had close contact but had been released. A POD plan was used for the response effort and it worked very well.
Training Announcements. Melanie Black announced the next Grand Rounds will be a presentation on June 28th on management of a pertussis outbreak during Hurricane Ivan. She also stated that the statewide epidemiology seminar held in May hosted a record 237 persons, and a review of the surveys is still ongoing but results will be extrapolated and released soon.
The next conference call is scheduled for Friday, June 17 at 10:00. Contact Melanie Black, MSW at 850.245.4444, ext. 2448 if you'd like to make a presentation or suggest an item for the agenda.
Jaime Forth is managing editor of Epi Update and also a published freelance writer. Contact her at firstname.lastname@example.org.
Timeliness in the Reporting of
The Bureau of Epidemiology Surveillance and Reporting Section conducted an analysis of the timeliness of reporting immediately notifiable diseases (as defined by Rule 64D-3, Florida Administrative Code) for the 2004 reporting year. The times between reporting dates were examined each quarter of the year as well as the entire reporting year. The median number of days was calculated for the three time variables for each disease. The three time variables examined were, time from:
1. Lab result date
to CHD notification date
Of the 613 cases of immediately notifiable diseases reported in 2004, the median time between Lab Result Date and CHD Notification Date was one day (Table 1). The median reporting time varied between the four quarters of the year, with second and third quarters having a median of two days between report dates and the first and forth quarter having one day between report dates. The reporting time between the Lab Results Date and CHD Notification Date ranged from zero to 81 days, with 25% of the cases being reported within less than one day and 75% of the cases within four days. The median time between CHD Notification Date and the Bureau of Epi Notification Date was five days, with 25% of the cases being reported within two days and 75% of the cases within 11 days. The total time between Lab Result Date and the Bureau of Epi Notification Date averaged eight days, with 25% of the cases being reported within four days and 75% being reported within 15 days.
Not all cases were included in this analysis due to missing report dates. Of the 613 cases reported, 232 were missing a Lab Result Date and 49 were missing a CHD Notification Date. None of the cases were missing the Bureau of Epi Notification Date, since this field is automatically populated when the case is saved in Merlin.
The Bureau of Epidemiology will be working with county health departments to determine possible changes to the Merlin System regarding these reporting dates. The first change is to make the CHD Notification Date a required field. The field could be set to automatically populate when a case is initiated in Merlin. A CHD user could then edit the field in such cases where there had been lag between the CHD being notified and the case being entered into Merlin. Another change is to require that one of following dates also be required along with the CHD Notification Date: Date of Onset, Date of Diagnosis or Lab Result Date.
If you have any questions, comments or concerns about the timeliness of reporting or changes to Merlin, please contact the Bureau of Epidemiology, Surveillance and Reporting Section.
Angela Fix is a respiratory disease epidemiologist in the Bureau of Epidemiology Surveillance and Reporting Section and can be contacted via email at Angela_Fix@doh.state.fl.us
Update May 29 -
June 4, 2005
Weekly Update: During the period May 29-June 4, 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 virus was confirmed in a sentinel chicken from N. Walton County.
Eastern Equine Encephalomyelitis (EEE) virus activity: Seven seroconversions to EEE virus were confirmed in sentinel chickens from Alachua (3), Putnam (1), St. Johns (2), and Volusia (1) Counties. Six horses from Brevard, Clay , Lake (3) and Marion Counties were confirmed with EEE virus this week. .
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 http://www.myfloridaeh.com/. The Disease Outbreak Information Hotline offers recorded updates on medical alerts status and surveillance at 888-880-5782.
Rebecca Schultz is an arbovirus surveillance coordinator at the Bureau of Community Environmental Health and can be reached at Rebecca_Schultz@doh.state.fl.us.or by calling 850.245.4444, ext. 2437.
This Week on EpiCom
|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
and contribute appropriate public health observations related to any
suspicious or unusual occurrences or circumstances. To sign up or make
contributions, send an email to
EpiCom_Administrator@doh.state.fl.us. EpiCom is the primary
method of communication between the Bureau of Epidemiology and other
state medical agencies during emergency situations.
Christie Luce is an EpiCom consultant in the Bureau of Epidemiology Surveillance Systems Section. She can be reached at Christie_Luce@doh.state.fl.us or by calling 850.245.4444, ext. 2450.
Weekly Disease Table
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.