Friday, July 2, 2004

         This Week in the News

Foege, WH., et al., 
International Journal of Epidemiology
1976; 5:29-37

►Merlin Survey Response Results Revealed
The survey, designed to assess user familiarity and satisfaction with the online reporting system, was analyzed recently and the results were pleasing to Bureau of Epi staff.

►Control of Shigelloses in Public Schools
Awarded Best Infectious Disease Poster by the judges at the statewide epidemiology conference in May this year, the events described occurred in Brevard County in 2003-04.

A R T I C L E S

Background
The Bureau of Epidemiology (BOE) completed a comprehensive evaluation of the Merlin system in January 2004. Distribution of a user satisfaction survey was one component of this evaluation and was designed to collect feedback on the operation, performance and overall usefulness of Merlin. 

Methods
The Merlin user satisfaction survey was pilot-tested prior to statewide distribution. Respondents completed and submitted the standardized survey electronically, through the FDOH email system.  

Results
A total of 543 survey recipients met the criteria for inclusion (registered Merlin users who did not test, design or review the survey) in the survey results analysis, of which 224 completed and returned the survey, yielding a 41% response rate.   

Among the respondents, 86% identified themselves as CHD employees and 12% as state health office employees. Fifty-nine percent (59%) of the survey respondents reported using Merlin on a weekly basis, of which 30% reported daily Merlin use.   

According to the survey results, the Merlin helpdesk was well recognized among users; 92% of respondents had knowledge of its existence and purpose. Seventy-two percent (72%) of respondents utilized the helpdesk at least once, of which, 91% were satisfied with the experience and service received.   

Among survey respondents who were involved in epidemiology and/or disease reporting pre- and post- Merlin, 62%, 59% and 63% indicated that reporting diseases, making changes to case information, and accessing/reviewing statewide surveillance data, respectively, was easier using Merlin when compared to the previous, paper-based system. 

Seventy-seven percent (77%) of all respondents reported that Merlin had helped their CHD perform disease surveillance and reporting tasks in a more effective, efficient and productive manner (i.e. meet state goals for quarterly performance indicators; increase percentage of diseases reported by the CHD within 21 days). 

Conclusion
Merlin has been well received and widely accepted among registered users, as indicated by the positive responses to the user satisfaction survey. Dissatisfaction with the system was minimal, ranging between 4% and 16% of all respondents, depending on the specific question asked. The BOE has reviewed these questions and is working on making improvements where necessary and feasible. 

If you have any questions regarding the user satisfaction survey, including the comprehensive results, please contact Carmela Mancini, BOE, at 850-245-4401 (suncom 205-4401). Thank you to all who completed and returned a survey, your feedback is invaluable and greatly appreciated.
 

This innovative management style has served the citizens or Volusia County well as Pete and his team at the health department work together to promote a more healthy community. In May this year, the board of the National Health Association and National Science Foundation International took note of his achievements, and honored him with the prestigious Walter F. Snyder Award for 2004.

Giving the award to Pete in recognition of his notable contributions to public health demonstrated his capacity to work with all interests in solving environmental problems, proficiency in using voluntary standards to obtain environmental objectives, and leadership in securing action. The president of the Florida Environmental Health Association said, "I have no reservation about his worthiness to receive this award....he is...an inspiration for generations to come by continually finding new ways and new technologies to achieve greater efficiency and ease in our field."

Thornton has a Masters of Public Health from the University of Michigan and was assistant director for environmental health at the Broward County Health Department before settling in Volusia County.
 

Methods
We evaluated past and recent outbreak of Shigelloses. It was found that causes were multifactoral.
1. Under-reporting of events.
2. Continuation of sick children in the classrooms.
    - Single/working parent resulting in unavailability to care for sick child
    - Lack of access to medical care
3. Lack of proper tools and techniques for hand hygiene in classrooms.

Results
1. Increased awareness and improved communication of school health staff (health techs, nurses, teachers and principals) for prompt reporting.
2. Increased awareness of parents through education.
3. Improved access to medical care through Brevard County Health Department clinics.
4. Improved hand hygiene by developing educational tools and implementing them in classrooms in collaboration with school board, University of Florida outreach program, epidemiology and environmental health divisions of Brevard county Health Department, and provision of hand gel in problem schools.
  - Four-minute video clips shown at the beginning of each school day as schedule permits and reinforcing the concept as illnesses occur
  - Instructional guidelines for teachers for easy reference
  - Parental brochures given to each sick child to take home for review
 - Pre and post quiz for children to assess knowledge of children in regard to hand hygiene.
 
Conclusion
The program was implemented at the beginning of school year 2003-04. Empirical evidence reveals that the incidence of disease has substantially decreased as compared to last year.
 

► Rift Valley Fever Moving Outside Africa

As if West Nile virus weren't bad enough, the CDC is now on the lookout for another mosquito-borne disease, fearing it could become a permanent part of the American landscape if it enters the U.S. Rift Valley fever (RVF) is an acute, fever-causing viral disease that affects domestic animals (such as cattle, buffalo, sheep, goats, and camels) and humans. RVF is generally found in regions of eastern and southern Africa where sheep and cattle are raised, but the virus also exists in most countries of sub-Saharan Africa and in Madagascar. In September 2000, an RVF outbreak was reported in Saudi Arabia and, subsequently, Yemen. These represent the first Rift Valley Fever cases identified outside of Africa.

Humans can get RVF as a result of bites from mosquitoes and possibly other bloodsucking insects that serve as vectors. We can also get the disease if exposed to the blood or other body fluids of infected animals. This exposure can come from slaughtering or handling infected animals or by touching contaminated meat during the preparation of food. Infection through aerosol transmission of RVF has resulted from contact with laboratory specimens containing the virus. 

RVF virus can cause different disease syndromes. People with RVF typically have either no symptoms or a mild illness associated with fever and liver abnormalities. In some patients, however, the illness can progress to hemorrhagic fever (which can lead to shock), encephalitis (inflammation of the brain, which can lead to headaches, coma, or seizures), or ocular disease (affecting the eye). Patients who become ill usually experience fever, generalized weakness, back pain, dizziness, and extreme weight loss at the onset of illness. Patients typically recover within two days to one week after onset of illness; the case fatality rate for persons with severe RVF is about 14%. 

The virus is worrisome because at least 30 species of mosquitoes are capable of carrying it from cattle or sheep to humans, far more than the kind of mosquitoes that can carry West Nile virus. The CDC says that although the disease does not presently occur in the U.S., people need to be aware of the signs and symptoms. The Florida Departments of Health and Agriculture and Consumer Services are alerting the medical and veterinary medical communities to prepare for the possibility of its presence in this country.
      

Pete Garner is best known for heading the initiative to create EpiCom, the Web-based surveillance and emergency notification system used by health department personnel and other medical professionals throughout the state to register disease occurrences and monitor critical events as they happen.

Pete is a Microsoft Certified Systems Engineer with a BS in accounting from Florida State University with expertise in Internet technologies, imaging systems and LAN.

Before joining the Bureau of Epidemiology in 2002, Pete already had over 20 years' professional experience in private industry, working for international corporations in health and welfare in systems software design and development. He collaborated with the state's attorneys preparing the tobacco claim which resulted in the $11 billion settlement for the citizens of Florida, and was responsible for the design and development of practitioner enrollment of software applications with interfaces to the Florida Department of Law Enforcement.

Pete's responsibilities at the Department of Health have entailed establishing a disaster recovery and continuity of operations site for critical systems, and the systems application for the MERLIN reporting system. He manages server production for the bureau and oversees a staff that handles GIS applications and EpiCom marketing.  He still finds time to enjoy Tallahassee, biking the winding trails around the capitol and golfing on weekends.

To contact Pete, email him at pete_garner@doh.state.fl.us or call him at 850.245.4444, ext 2481.
 

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.
 

West Nile (WN) Virus activity: One WN positive crow was reported in Hillsborough (6/21) County. So far this year, 21 counties have reported WN activity.

St. Louis Encephalitis (SLE) Virus activity: None this week. 

Eastern Equine Encephalomyelitis (EEE) Virus activity: There were three seroconversions to EEE virus in sentinel chickens from Alachua (6/14), Orange (6/14) and St. Johns (6/14) counties. Four horses, one from Jefferson (6/08), one from Marion (6/17), one from Osceola County (6/09) and one from Polk County (6/12) were reported with EEE infections. So far this year, 19 counties have reported EEE activity.

Highlands J (HJ) Virus activity: None this week.  

* Travel outside of state for most of the probable transmission period.

See the Web page for more information at www.MyFloridaEH.com.   
 

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