Friday, June 18, 2004
This Week in the News
|"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.,
►Seminar Poster Winners in the Spotlight
|►Bi-Weekly Conference Call Highlights|
A condensed description of the discussions held Friday, June 4, 2004 between Bureau of Epidemiology staff and CHD colleagues around the state.
►Methicillin-Resistant Staphylococcus aureus (MRSA) in Escambia County Jail
Epi Update Managing Staff:
|►CDC Realignment Explained
The federal agency has announced new goals and major changes to its organizational structure.
Secretary, Department of Health
►Stipend for Pneumococcal Vaccine Administered During CY 2004
The Bureau of Immunization announces supplemental grants for pneumococcal vaccines.
|Landis Crockett, MD,
Division of Disease
|►Center for Biological Defense Announces Training
Educational opportunities are available throughout the summer in mass casualty and anti- terrorism training.
Acting Bureau Chief,
|►This Week on EpiCom
Pinellas County reports two cases in past six months of Haempophilus influenzae bacteremia, and various food products distributed in Florida have been recalled. If you haven't been on EpiCom lately, you may be missing important information.
Copy Editor / Writer
|►Mosquito-Borne Disease Update
A report outlining activities for the week of June 6 - 12, 2004 for confirmed cases.
A R T I C L E S
|Jaime Forth, Copy Editor / Writer, Bureau of Epidemiology||►Seminar Poster Winners in the Spotlight|
Deputy Director, Florida Department of Health, Dr. Bonnie Sorensen was on hand to present certificates and deliver congratulations at luncheon on May 18th, where the judges were also recognized for their role. Julia Gill, PhD, MPH, Pinellas County; Savita Kumar, MD, MPH, Palm Beach County; Roger Sanderson, MA, RN, Regional Epidemiologist; Karen Eaton, MBA, RN, Tallahassee; Fermin Leguen, MD, MPH, Miami-Dade County; and Sterling Whisenhunt, Seminole County, presided over the judging.
The poster session was coordinated by Karen Wheeler, MPH, bioterrorism surveillance coordinator at the Bureau of Epidemiology.
Abstracts on award-winning posters as well as others submitted will be featured in upcoming issues of the Epi Update.
|Jaime Forth, Copy Editor / Writer, Bureau of Epidemiology||►Bi-weekly Conference Call Highlights|
Persons who are unable to participate in a call can read a brief summary of the discussion the following week in the Epi Update. Here, then, is a review of the June 4, 2004 call:
Announcements. Don Ward stated that after a protracted search for a state epidemiologist and a bureau chief, the positions remain to be filled.
There is a strong federal commitment to bioterrorism funding; any uncertainty states may be sensing could be due to the way in which the funding is routed through the CDC. This issue will continue to be addressed.
Medical Examiner Commissioners Meeting. Karen Wheeler reported that medical examiners in Florida have been connected to EpiCom. Their surveillance data on suspicious deaths, provided in real time, can give us the opportunity to react promptly, if needed, to related infectious diseases.
Surveillance Data Update. Carmela Mancini described the work staff is performing to upgrade the current reporting system. After a review of the extended data on case definitions, the group decided that epidemiology contacts at the CHDs will be sent correspondence seeking clarification on Merlin reports. CHD personnel will be responsible for updating their data in Merlin.
Investigating hepatitis or other infectious disease cases occurring in detention facilities or hospitals needs to be fully pursued so a complete set of data can be input to the Merlin report.
Soft tissue or waterborne microbacterium infections related to surgery in the Dominican Republic should be reported promptly.
County Outbreak Reports. (All reports were cited on EpiCom; full details can be viewed by logging on to the Web site).
Broward CHD/Community Acquired MRSA - Dr. Blankenship reported that after a report on May 13 of MRSA in inmates in the detention system, there was a walk-through by members of the CHD, and management at the jail implemented prevention measures. The number of patient cases has stabilized since then. The latest number is 31. The route of transmission appears to be random. Some cases were carried into the jail upon admission.
Indian River CHD/Bacterial Meningitis - Robin Szanc reported that a student athlete who had been in contact with others was the single confirmed case.
Bay CHD/Foodborne - Michael Fluharty stated a restaurant at St. Andrews caused 13 persons to report food poisoning with no fever. Another group of 18 persons reported food poisoning soon afterward. The DBPR was notified and inspected the restaurant. More calls from restaurant patrons followed. In the end, over 100 persons were affected. DBPR cited the restaurant for a number of health violations.
|Janet Hamilton, MPH, EIS Fellow, Bureau of Epidemiology, Escambia County Health Department||►Methicillin-Resistant Staphylococcus aureus (MRSA) in Escambia County Jail|
Nationwide, there are increasing concerns regarding antibiotic resistant organisms including Methicillin-Resistant Staphylococcus aureus (MRSA) and more recently, community acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) infections. In Florida, there have been documented outbreaks of MRSA within correctional facilities. Person-to-person contact continues to be the primary mode of transmission for MRSA.
On May 26, 2004, the Escambia County Health Department (ECHD) was notified of an increase in the number of inmates at the Escambia County Jail (ECJ) with Staphylococcus aureus (Staph) infections suspected to be MRSA. Preliminary indications were of eight suspect cases of MRSA/Staph infections within the prior week. A case was defined as the occurrence of a skin boil or large pimple that was evaluated by the infirmary physician between May 22-27, 2004. The infirmary formally identified six cases that met the case definition. ECJ has approximately 1800 inmates.
This report describes the site visit to the ECJ infirmary by the ECHD on May 27 and recommended control measures to prevent MRSA/Staph infections in the facility. During the visit, ECHD personnel were given the opportunity to speak with the three inmates in isolation, as well as their attending physician, the director of nursing, and a guard.
Infirmary Staff Discussion:
Table 1. Demographic Information, MRSA/Staph Cases, Escambia County Jail, May 22-27, 2004, (n=6)
Table 2. Clinical Information, MRSA/Staph Cases, Escambia County Jail, May
* Cases had more than one boil location.
Infirmary inmate interviews:
Two of the three inmates self reported to the infirmary after their boils/lesions became too painful to tolerate. Both found the initial boil several days before reporting to the infirmary. Both patients reported having a similar situation (the appearance of boils) within the past year before they were in the jail facility; one sought care for a lesion at the emergency department. The other indicated ?spider bites? as the source of infection. (No spider was found.)
The third patient case was new to the facility. His infection was identified during the routine medical exam given at admittance to the facility. The boils had been present for several days before commitment to the facility and while still at home, the patient attempted to pop the boils.
In all isolation cases, the lesions were appropriately covered. One of the patients was in need of having the dressings changed. It was reported that inmates are concerned about sending undergarments to the laundry because they get lost. As a result, these items are hand-washed in the shared sinks by the owner and hung to dry. Patient cases reported no recent tattoos. One patient reported inmates use the shower area for physical fitness activities (push-ups, sit-ups). One patient reported obtaining a partially used deodorant solid from another inmate.
Partial list of ECHD recommendations:
|Jaime Forth, Copy Editor / Writer, Bureau of Epidemiology||► CDC Realignment Explained|
The Centers for Disease Control and Prevention announced the outcome of its strategic development process, begun a year ago, at a press conference on May 13, 2004. The result is a major shift in the organizational structure that should enable the agency to respond more swiftly to future events such as terrorist threats, and take more initiative on long-term public health issues such as life expectancy.
Dr. Julie Gerberding, director of the CDC, said the agency will be realigned into 11 new functional centers, overseen by 4 coordinating centers, in an effort to adopt a more holistic approach to disease prevention. This will address an issue that surfaced during the year-long strategic development process, during which it became clear that much of the public is not familiar with the role of the CDC beyond newsmaking achievements in the fields of epidemiology and infectious disease. In addition, the leadership functions of the Offices of Global Health, and Terrorism Preparedness and Emergency Response will be augmented.
The 4 new coordinating centers will be:
The 11 new functional centers will be:
The essential mission of CDC, to reduce morbidity and mortality through prevention, will not change. However, as new challenges presented by medical breakthroughs and population shifts, globalization and politics began to emerge, the agency felt a responsibility to identify ways to effectively address the new health issues raised by these occurrences.
The changes should be implemented by the beginning of the fiscal year, which starts October 1, 2004.
|Charles H. Alexander, Chief, Bureau of Immunization, Florida Department of Health
|► Stipend for Pneumococcal Vaccine Administered During CY 2004
The The Bureau of Immunization has received supplemental grant funds for Calendar Year 2004. As in 2003, the bureau will use $400,000 of these funds to promote and enhance the county health departments' administration of pneumococcal vaccine among adults who are 65 years of age and older with emphasis on the at-risk elderly. The goal of this stipend is to help achieve the Healthy People 2010 goal of 90% immunization coverage for pneumococcal vaccine among adults aged 65 and above.
Specifically, the bureau will provide county health departments (CHDs) a stipend of $20.00 for each dose of pneumococcal vaccine administered to adults 65 years of age and older in addition to all at-risk adults in accordance with Recommendations of the Advisory Committee on Immunization Practices (ACIP). The stipend will be paid via journal transfer of funds in December for the number of doses administered retroactively between January 1 and November 30, 2004 as reported on the Client Information System doses administered report.
CHDs should be aware that the provision of this stipend does not preclude charging patients a nominal fee for the purchase and administration of pneumococcal vaccine. The $20.00 stipend will only be offered for as long as funds are available or until November 30, 2004, whichever comes first.
The bureau encourages all CHDs to administer the pneumococcal immunization throughout the year and not limit this prevention to the influenza season. Refer to the ACIP published in the Morbidity and Mortality Weekly Report dated April 4, 1997, (Vol 46, No. RR-8) for additional information on the administration of pneumococcal vaccine. Note that the pneumococcal vaccine is recommended for adults aged 65 and older and only adults younger than than 65 who fall within the ACIP-recommended risk groups.
The Bureau of Immunization requests that all doses of the pneumococcal vaccine be entered into the immunization module. This will facilitate collection of data for adult immunization for evaluation of any racial and ethnic disparities. Entry of the influenza immunizations will also contribute toward an adult immunization database.
If you have any questions please contact the following staff at 850.245.4342: Pamela Thornton regarding the journal transfer process for funding and/or Deanna Hamilton regarding CIS doses administered.
A Mass Casualty Personnel Decontamination course will be held September 8-10 in Orlando at no cost to attendees. Covered topics will be WMD technologies, intro to terrorism, decontamination principles and procedures, decon equipment and configurations, medical considerations, and a mass casualty decon exercise. For reservations, call Steve Furnace or Ed Ghantt at 407.297.2096.
State and Local Anti-Terrorism Training will offer investigative and intelligence workshops, specialized trainings, train-the-trainer workshops, and narcotics task force anti-terrorism briefings. For further information, log on to http://www.iir.com/slatt/training/htm or e-mail firstname.lastname@example.org.
|Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology||►This Week on EpiCom|
- Two cases of Haempophilus influenzae bacteremia in newborns were reported in Pinellas County
- Recalls of coconut gel, apple pie a la mode, raw alfalfa sprouts
The Bureau of Epidemiology encourages Epi Update readers to not only register on the EpiCom system at https://www.epicomfl.net but to browse EpiCom frequently and contribute public health observations related to any suspicious or unusual occurrences or circumstances, as appropriate. EpiCom is the primary method of communication between the Bureau of Epidemiology and other state medical agencies during emergency situations.
|Arbovirus Surveillance Team: Samantha Rivers, MS, Caroline Collins, Kristen Payne, Calvin DeSouza, and Carina Blackmore, MS Vet. Med., PhD., State Public Health Veterinarian||►Mosquito-Borne Disease Update
The first case of West Nile virus infection was confirmed this week in a resident of Sarasota County who traveled outside of the state during part of the probable transmission period. No Florida counties are under medical alert. Mosquito populations are increasing in many areas of the state. People are urged to take precautions against mosquito bites.
West Nile (WN) Virus activity: There were three seroconversions to WN virus in sentinel chickens from Indian River and Martin counties. To date, 21 counties have reported confirmed WN virus activity this year.
St. Louis Encephalitis (SLE) Virus activity: None this week. So far this year, five sentinel chickens from Lee County have tested positive for SLE.
Eastern Equine Encephalomyelitis (EEE) Virus activity: There were two seroconversions to EEE virus in sentinel chickens from St. Johns County. Five out of six live wild birds (four blue jays and one brown thrasher) trapped in Okaloosa County on June 4th were found to be infected with EEE virus. To date, 15 counties have reported EEE virus activity this year.
Highlands J (HJ) Virus activity: None this week. Five counties have reported HJ virus activity this year.
See the Web page for more information at www.MyFloridaEH.com.