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, 
Copy Editor/Writer  

A R T I C L E S

Youjie Huang, M.D., Section Administrator, Chronic Disease Surveillance & Epidemioliology Section, Bureau of Epidemiology

Karen Wheeler, MPH,  Bioterrorism Surveillance Epidemiologist, Bureau of Epidemiology

Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology

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

► Disparities in Cancer Screening, Incidence and Outcomes
 
Background:  Cancer is a major chronic disease in Florida. In the year 1999, 95,550 cases were diagnosed and 37,314 Floridians died from cancer. Nonwhites have a higher cancer mortality rate and poorer prognosis for several cancers than do whites.  

Methods: Prostate cancer, cervical cancer, breast cancer and colorectal cancer were selected for the study, for which clinical screenings are available and recommended for early diagnosis and treatment. The Florida Cancer Data System, Hospital Discharge, Florida BRFSS, and mortality data sources were analyzed to assess disparities in access to medical care, cancer screening, incidence, hospitalization and mortality for the cancers among Floridians. Rates (per 100,000 population) were age adjusted to the 2000 U.S. standard population.

Results: In 1999, nonwhites had a higher incidence of prostate (171 vs. 138) and cervical cancer (12.5 vs. 10.5), but a lower incidence of colorectal (45 vs. 56) and breast cancer (77 vs. 127) than whites. However, more nonwhite patients were diagnosed at late stages for all four cancers (range from 13.9% to 58.4%) than whites (range from 9.5% to 53.5%).  Nonwhites had higher rates of hospitalization for the cancers than whites. Nonwhites had higher mortality rates for prostate cancer (51 vs. 23), breast cancer (25 vs. 24) and cervical cancer (6 vs. 3). On average, nonwhites had a survival period from diagnosis that was 922 to 1,609 days shorter than that of whites (from 1,213 to 2,282 days)

To explore the causes of disparities in cancer outcomes among racial groups, the BRFSS data were examined for cancer screenings and access to medical care. Fewer black (54%) and Hispanic men (55%) than white men (69%) received prostate cancer screenings. There was no difference in receipt of breast cancer or cervical cancer screening between white and nonwhite women. More blacks (14%) and Hispanics (23%) than whites (9%) reported having no medical insurance in the past year. In addition, more blacks (17%) and Hispanics (18%) than whites (7%) reported that they were unable to see a doctor when they needed medical care in the past year. 

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► Respiratory Syncytial Virus Surveillance Changes Hands

Starting July 1, Karen Wheeler will succeed Melanie Black in the management of the Florida Department of Health’s statewide Respiratory Syncytial Virus (RSV) Surveillance Project. RSV is an acute respiratory tract illness affecting persons of all ages, and is the most common cause of bronchiolitis and pneumonia among infants and children under one year of age. Although an RSV vaccination is available, its development is a high research priority. Current prevention options include good infection-control practices and administration of prophylaxis.  

The RSV project collects data on a weekly basis from sentinel hospitals in Florida. Currently, there are 19 facilities within the surveillance system, but only 13 that are actively reporting. Regional and statewide data are available via web at http://www.doh.state.fl.us/disease_ctrl/epi/RSV/rsv.htm or email request on a monthly basis. RSV surveillance data are significant because they can help alert public health officials and physicians to the timing of seasonal and regional RSV activity.

Additionally, the data obtained from RSV surveillance have been very important to Florida’s pulmonologists, neonatologists, pediatricians, and other healthcare professionals, as they provide information about when to initiate prophylaxis to high-risk children. Studies show the strategic planning of the initiation of RSV prophylaxis is significant to the effectiveness of the vaccine. Surveillance of RSV also helps practitioners, hospitals, and health management organizations justify and measure the cost effectiveness of prophylaxis programs.

The Bureau of Epidemiology values the support of Florida hospitals in the ongoing effort to prevent communicable diseases in Florida, and looks forward to expanding the RSV project’s existing capacity to allow for a more comprehensive surveillance system. Please contact Ms. Wheeler by email at Karen_Wheeler@doh.state.fl.us or phone her at 850.245-4444 ext. 2401 if you have any questions or comments. 

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► Alcohol Intake Shown to Increase Hepatitis C in Human Cells

According to the U.S. Department of Health and Human Services, a team of scientists reported Thursday that recent studies have shown alcohol intake increases hepatitis C virus replication in human cells.

Their course of study followed experiments performed in the 1990s which showed a lower level of HCV virus in the blood of nonimbibers or infrequent drinkers than that of heavy drinkers. Continuing that hypothesis, scientists from the University of Pennsylvania and the school of medicine as well as the Children’s Hospital of Philadelphia were able to prove that HCV replicon expressions were enhanced at the messenger RNA and protein levels by alcohol.

The researchers were also to demonstrate that naltrexone, an opiate antagonist,  blocks the effect of alcohol on HCV and also diminishes alcohol activation of nuclear factor kappa B in opiate receptor cells. This is helpful to patients in avoiding relapse and struggling with addiction.

The HCV virus normally leads to chronic infection in a high percentage of infected individuals, in whom less than half respond to interferon-alpha therapy.  HCV-infected patients are the major receivers of liver transplanted organs. 

For more information about this study, contact the National Institute on Alcohol Abuse and Alcoholism at http://www.niaaa.nih.gov . 

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► Discovery of New Viruses on the Rise

Due to changing lifestyles, expanding travel opportunities and shifting industrial needs, a troubling new trend has begun to develop: Infections which, until now have been unknown to scientists, are emerging at a rate that is alarming to the medical community.

Many pathogens exist for years without discovery, but as humans delve deeper into the habitats of animals and widen their personal contacts with exotic species, the detection of new and strange viruses grows more likely.

Stephen S. Morse of Columbia University says, “With the global traffic of people and goods . . .  there are many more pathways, or highways, for what I called some years ago, ‘viral traffic.’  Many of the infections that we recognize today as being important human infections have relatives in other species, which suggest that they may well have gotten to them from those other species.” 

This phenomenon, in addition to the advent of bioterrorism, makes the design of an early warning system for infectious diseases especially crucial. With Monkeypox, West Nile Virus, Lyme Disease, Ebola, SARS, and AIDS believed to have been transmitted from animals to humans, the possibility for other crises always exists. 

Flu viruses are especially feared because of their ability to mutate quickly and spread. The knowledge that large numbers of pathogens are transmitted from animals to people has spurred efforts by the World Health Organization and the medical community in the U.S. to communicate the need to lawmakers to consider ways to restrict the import of exotic animals because their trade is, at the moment, largely unregulated. The Federal Wildlife Officers Association, which  assists U.S. Customs and U.S. Fish and Wildlife Agents in investigating illegal trafficking of animals, has predicted that the threat of animal smuggling will not go away, but that an outbreak of virulent and potential catastrophic diseases is just a smuggled animal away.

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► Arboviral Disease Report  

Arboviral Activity Summary is for the week ending June 23, 2003.

No human cases of arboviral meningo-encephalitis were reported yet this year. Gilchrist County has been under Medical Alert for EEE virus since mid-April. 

EEE virus activity: 21 seroconversions were reported in sentinel chickens from 10 counties this week. Three dead birds were reported positive for EEE virus. Fifteen horses were confirmed this week with EEE infection from 8 counties.

WN virus activity: Six seroconversions were reported this week. No dead birds tested positive for WN virus this week. No new horses were confirmed this week with WN infection. No mosquito pools or live wild birds were reported positive for WN or EEE virus this week. 

In summary, to date, 38 of Florida’s 67 counties have reported EEE virus activity, primarily in the North and Central regions of the state, compared to 15 counties reporting EEE last year at this time. Twenty-one counties have reported WN virus activity, compared to 11 at this time last year.  Last year, there was a confirmed human case of EEE with disease onset of June 3 in a Highlands County resident.  

The complete report can be viewed at: http://www9.myflorida.com/Environment/hsee/arbo/weekly_summary2003.htm

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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.

Current week's disease table

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