Friday, June 20,
"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
This Week in the News|
► Grand Rounds - Smallpox Vaccine Adverse Events Surveillance 2003
Scheduled for Tuesday, June 24 from 11:00 a.m. until 12:00 p.m. EST, this Grand Rounds will be presented from Tallahassee by Dr. Fermin Arguello and accessible via conference call.
► Communicable Disease Surveillance Quality Control Results
Begun in January 2003, the first of a series of monthly reports is provided, with Merlin supporting data.
► National Immunization Program Satellite Broadcast Set
Sponsored by the CDC, a live satellite broadcast will be aired on June 26th for health care providers of hepatitis A and B immunizations.
► Bi-Weekly Conference Call Reminder
The bi-weekly conference call for county health department personnel and bureau of epidemiology staff is set for June 27 at 10:00 a.m. EST.
► First Nasal Mist Flu Vaccine Approved by FDA
A live virus nasal vaccine is the first to be approved for use in the U.S. for children and adults.
► AMA Announces Standardized Catastrophic Disaster Training
A new program has been created to address concerns of unpreparedness should a mass bioterrorism event strike U.S.
► The History of GIS for Epidemiological Applications - First in a Series
The winner of Best Poster for Infectious Diseases at the 2003 epidemiology seminar articulates his abstract. This is first in a series of articles highlighting this year's winning posters.
► Arboviral Disease Report
Statistics through the week ending June 16, 2003. Confirmed cases only.
► Weekly Disease Table
Florida Department of Health, Bureau of Epidemiology, Weekly Morbidity Report for current week only. Selected diseases and conditions (confirmed cases).
A R T I C L E S
Fermin Arguello, M.D., EIS Officer, CDC and Bureau of Epidemiology and Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Kathryn Teates, MPH, Surveillance & Reporting Section Administrator, Bureau of Epidemiology
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Don Ward, Deputy Bureau Chief, Bureau of Epidemiology
Jaime Forth, Editorial Assistant, Bureau of Epidemiology
D'Juan Harris, MSP, GIS Specialist, Bureau of Epidemiology
Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, M.S., Vet Med. Ph.D., Deputy State Public Health Veterinarian
note that numbers are subject to change with confirmatory information
Rounds - Smallpox Vaccine Adverse Events Surveillance 2003
Of the 3,745 vaccinees, a total of 13 (0.3%) AE cases were reported, two (15%) were classified as Pyogenic Infections of the Vaccination Sight, six (46%) were classified as Other Serious AEs, and five (38%) were classified as Other Non-Serious AEs. Of the six Other Serious AE cases, one was hospitalized for acute cholecystitis, one for angina, one for chest pain and shortness of breath, one for a suspected focal neurological disorder, one for a skin lesion and urinary track infection, and one for exacerbation of an underlying lung condition then again for a myocardial infarction resulting in death. No vaccinia virus was recovered from autopsy samples. Of all vaccinees, this was the only (0.03%) death reported. No cases required Vaccinia Immunoglobulin or cidofovir for treatment. Though based on historical accounts numerous serious AEs were anticipated initially, only a small number of AEs actually occurred in Florida with the majority not likely associated with vaccination (i.e. Other Serious and Non-Serious AEs). This surveillance effort was thorough and resource intensive, and though we can speculate that Smallpox vaccine administered through such a carefully managed program is safe, duplicating this level of careful administration in the future may be difficult.
Additional Information: Further details regarding the audio-conference call and the PowerPoint files will be posted on the Bureau of Epidemiology intranet web site. Be sure to register online at the end of the program to obtain nursing CEUs. CEUs for environmental health professionals and laboratorians are pending. Information about upcoming topics and presenters will also be posted in the Epi Update. If either of these access points is unavailable to you, please e-mail Melanie Black at Melanie_Black@doh.state.fl.us, or phone her at 850.245.4444 ext. 2448 or SunCom 205.4444 ext. 2448 to request presentation materials.
Important: While we realize you may not be able to call promptly at 11:10 a.m., it can be distracting to the speaker and others when participants dial in throughout the hour. Please try to call on time and remember to set your phone on mute so as not to disturb others. We assure you this courtesy will be appreciated by all. Thank you!
The results show that the total number of lab results varies from month to month. Sampling the same number of lab results for QC each month will therefore represent a different percentage of the total. The results also do not appear to show a correlation between the total number of lab results and the number of errors found. Most errors were found in the first two months the staff member was working. This is because training data entry staff includes instruction on assigning the correct Florida disease code to lab results. Hiring students who are biology majors or who have taken some basic microbiology courses shortens training time for this aspect of the job.
The three errors in the reported laboratory result in May were due to inconclusive anti-HAV IgM results sent to us by a laboratory that the staff member was not accustomed to seeing. These results are reported with an asterisk (*) under the result column and are not reported as reactive or positive.
The Communicable Disease Surveillance & Reporting Section will continue to perform QC checks each month and report through the Epi Update each quarter. Any questions regarding data entry or QC can be directed to the Merlin Helpdesk email account.
Table 1. Total lab results and number of errors by month for the Communicable Disease Surveillance & Reporting Section, Bureau of Epidemiology.
Represents all high priority lab results entered from the Bureau of
Epidemiology into Merlin each month.
The program will highlight the 2002-2003 Recommended Adult Immunization Schedule and strategies to improve adult immunization coverage levels. This 2.5-hour broadcast will feature a question and answer session in which participants nationwide can interact with the course instructors via toll-free telephone lines. For more information, go to http://www.phppo.cdc.gov/phtn/adult-imm03. or contact Robbie Bouplon, Field Services Coordinator, at 850.245.4444, ext. 2447.
According to the AMA’s new Center for Disaster Preparedness and Emergency Response Director Dr. James James, formerly director of the Miami-Dade County Health Department, “We need to be thinking of standardization and what is required in terms of basic skills and knowledge to make our health care providers and physicians more ready.” To that end, coursework which addresses triage setup, decontamination, medical terminology and chemical and biological diagnoses and response will be offered to students at costs and locations which are expected to be confirmed within the next few months. Continuing Medical Education Credits for physicians and medical students will be applicable.
The courses were created by a team of military and civilian experts from the Medical College of Georgia, the University of Texas Southwestern Medical Center in Dallas, the University of Texas at Houston, and the University of Georgia. Oversight was provided by the U.S. Department of Health and Human Services.
For updates and information about training sessions near you, check the AMA and Department of Health and Human Services web sites. Internet training options will also be available in future.
Epidemiologists at the Bureau of Epidemiology use maps created with GIS to survey and investigate the geographical sources of disease. Similar to the early works of Dr. Snow, the Bureau of Epidemiology utilizes GIS to map patterns of disease outbreaks by incidence and/or prevalence rates. These prevalence, or incidence, maps are one of the most common types used at the headquarters of the bureau, since they provide a generalized picture of risk and a benchmark to relate rates of disease trends over time. The final product is a map that gives scientific credibility to suspected spatial clustering of a disease. Once evidence of clustering has been established, it is relatively easy for epidemiologists to determine human susceptibility to a disease in a geographic area. This concept of identifying “hot spots” is an essential element for personnel to focus prevention efforts in specified regions.
Several bureaus within the Department of Health are in early development stages to make mapping capability available to DOH personnel on the intranet, and later the general public on the internet. The Bureau of Epidemiology is planning to add a Geographic Information Report module to its Merlin reportable disease application. This web-based Merlin integrated application will allow end-users to create GIS "spot and shade" maps of reportable diseases and will require minimal training. Another advantage of internet-based maps is the ability to update maps in "real-time", as new information is entered into the maps' supporting databases. Lastly, internet-based maps have the same utility as printed GIS maps: They may be as simple as showing all the cases of food poisoning in Florida in 1999 or they may have sophisticated applications that allow the end user to build complex queries like "show me all the cases of food poisoning in Leon County during June - August, 1999 in zip code 32399."If you would like any further information on the use of geographic information systems in the Bureau of Epidemiology, e-mail D’Juan_Harris@doh.state.fl.us.
The complete report can be viewed at: http://www9.myflorida.com/Environment/hsee/arbo/weekly_summary2003.htm
|Bureau of Epidemiology|