Friday, July 4,
"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."
Forge WH et
| This Week in the News|
► Shigellosis Outbreak Hits South Florida Day Care Center
A report on the Palm Beach County Health Department investigation, held in January 2003.
► Revised Recommendations Implemented for Potential Blood Donors
New deferral questions to potential blood donors have been implemented since June 2003, based on 21 confirmed cases of West Nile Virus acquired through blood transfusions between August 2003 and March 2003.
► Bureau of Epidemiology Conference Call Scheduled for July 11th
Agenda and topics will be primarily surveillance and investigations, but it's not too late to get your agenda items in.
► CDC Clarifies Recommendations for Vaccinations Regarding Influenza-like Illnesses
The CDC responds to questions regarding its recommendations on flu shots to reduce the likelihood of getting respiratory tract illnesses that could be mistaken for SARS.
► Synthetic Anthrax Antibody on Short List for Approval
A new drug is on the fast track for approval that could provide immunity from exposure to anthrax.
► National Institute of General Medical Sciences Announces HIV Breakthrough
An international team of scientists, including members from Florida State University, have isolated an antibody that can neutralize the virus that causes AIDS.
► Arboviral Disease Report
Statistics through the week ending June 30, 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
Meghan M. Weems, MPH, Florida Epidemic Intelligence Service Officer, Bureau of Epidemiology
Carina Blackmore, DMV, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health
Melanie Black, MPH, Professional Training Coordinator, Bureau of Epidemiology
Alicia S. Postema, MPH, Influenza Branch, Centers for Disease Control and Prevention
Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology
Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, DMV, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health
note that numbers are subject to change with confirmatory information
Outbreak Hits South Florida Day Care Center
Introduction: Shigellosis is a common acute diarrhea illness caused by the Shigella bacteria, spread via fecal oral route. Symptoms include diarrhea (often bloody), fever, nausea, vomiting, cramping, and malaise. Mild and asymptomatic infections do occur. Typical incubation period is one to three days. Secondary attack rates in households can be as high as 40% due to the small dose of bacteria required to produce symptoms. Shigella sonnei is the most common serotype found in the United States, and is common in institutional settings such as jails, day care centers, mental hospitals, and nursing homes.
Background: On January 16th, 2003, the Palm Beach County Health Department (PBCHD), Division of Epidemiology and Disease Control (Epi) was notified of a positive Shigella sonnei case in an attendee of a local day care center (day care center X). It is the policy of PBCHD that any child who attends day care must be excluded from day care if symptomatic with diarrhea until the diarrhea has ended. If the agent is identified, the child can only return to day care after a negative stool specimen is obtained. An investigation was immediately begun due to the highly communicable nature of shigellosis in institutional settings. Day care center X has a roster of 116 children who attend day care and after-care programs, ages 5 months to 10 years. The infant and toddler room has diaper-changing areas equipped with exam paper, gloves, bleach and water. The 2-year old room has its own bathroom with a diaper changing area. The 3, 4 and 5-year old rooms share two separate bathrooms with 4 toilets.
Methods: Our case definition was set as any positive stool culture for shigella after January 5, 2003, found in an attendee/employee of day care center X, or any symptomatic person who could be epidemiologically linked to a positive shigellosis case who was an attendee/employee of day care center X.
A line list was obtained of all children who had been sent home with diarrhea or had been out of day care due to diarrhea since 1/5. No employees of the center reported having symptoms. No children had diarrhea at day care center X between 01/05-01/15. The patient case became symptomatic with bloody diarrhea on 01/08 (did not attend day care while symptomatic). The patient had attended day care on 01/06 and 01/07 before he became symptomatic with diarrhea. He was admitted to a local emergency department on 01/08.
Staff from the PBCHD contacted the family members of each child who had diarrhea to arrange for stool testing. Contact was made with infection control practitioners at surrounding hospitals and area physician’s offices to make them aware of the situation and to urge them to promptly report any shigellosis cases. The director of day care center X was instructed to update the line list daily and immediately inform Epidemiology of anyone fitting the patient case definition.
Each patient case/parent of a positive shigellosis case received a questionnaire asking specific questions about their illness (symptoms, onset date, possible risk factors etc.). An informational pamphlet about shigellosis (in English and Spanish) was sent to each patient's home along with the questionnaire. That pamphlet included the phone number to Epidemiology so any questions or concerns could be addressed.
Day care center X and Epidemiology coordinated to create a health alert on shigellosis that went home to each parent whose child attends day care center X. The health alert warned parents of the outbreak, how to prevent the spread of shigella, and what symptoms to look for in their child. The nursing program specialist of the PBCHD Institutional Health Program visited the day care center to give a presentation to employees and hang posters showing proper hand-washing practices.
Results: Our investigation revealed 11 total cases between 1/08 and 2/08. None of the patient cases were employees of day care center X. Eight patient cases (73%) were attendees of day care center X. Three cases occurred in the 2-year old class and three cases occurred in the 3,4,and 5 year old class. One case occurred in the infant/toddler class, and one in the after school class. The other 3 cases (27%) were household contacts of those attendees (mother, grandmother, and father). Three cases (27%) were severe enough to be hospitalized (one child and two adults). The ages of cases ranged from 1 to 69 years old, with a median of 4 years and a mode of 2 years old. 10 of 11 cases (91%) were laboratory confirmed with the one probable case being an attendee and household contact of a confirmed case. All laboratory confirmed cases were serotyped as S. sonnei.
A representative of (PBCHD) inspected day care center X on 01/16. No delinquencies were found on inspection. The health alert was posted at the front desk informing visitors of the ongoing situation. Proper diaper changing procedures were observed. All sink and drinking water fountains were clean. Adequate soap and paper towels were found at all hand washing stations. The kitchen was clean and proper temperatures were observed. All toys were washed, rinsed, and sanitized every afternoon. Proper hand washing procedures were observed both in employees and attendees.
Discussion: This outbreak followed the pattern of a typical shigellosis outbreak. It was interesting to note that no employees were found to be symptomatic with diarrhea before, during, or after the outbreak. It is important that proper hand washing procedures are stressed to the household contacts of shigellosis cases as this outbreak proved that attack rates can be high in household contacts. The swift control and conclusion of this shigellosis outbreak confirms the need for all children to be excluded from day care when symptomatic with diarrhea until symptoms resolve.
Any CHD staff are welcome to participate and staff conducting disease control activities are encouraged to attend. The calls will use the technology employed in the Bureau’s Grand Rounds, that is, any presentation material will be posted on the intranet the day before the call. The bi-weekly “epi-calls” begin at 10:00 AM and last no longer than an hour. The dial-in phone number, security code and the agenda will be emailed to CHD staff on Thursday, July 10, 2003. Please e-mail suggestions for agenda items and any presentation materials you may have to Melanie_Black@doh.state.fl.us
A synthetic antibody which blocks and prevents anthrax toxins from entering and killing cells, Abthrax, produced by a Rockville biotechnology firm called Human Genome Sciences Inc., has already tested successfully on animals. Because of ethical reservations regarding the testing of fatal rare diseases on humans, human test subjects cannot be exposed to anthrax spores, but the company has received a go-ahead from the FDA to proceed with human clinical trials to test for safety, tolerability and pharmacology. Following that testing phase, the company plans to consult with the government to ascertain its willingness to purchase the drug for stockpiling. Under the Bioterrorism Act of 2002 designed to eliminate delays in the interest of national security, certain drugs can win FDA approval based only on animal studies and human safety tests.
It is feared that due to its
portability and versatility, anthrax could be used as a biological weapon in a
future mass terrorism attack. Since the events of 9/11, pharmaceutical firms have
been in competition to produce a strain of anthrax which will resist the effects
of the germ itself. Although antibiotics are already available to treat exposure,
no company has yet produced an antibiotic injection which could impart immediate
protection, with the potential to save thousands of lives. Click on the
Human Genome Sciences web site for more information at www.hgsi.com//products/request/html.
National Institute of General Medical
Sciences Announces HIV Breakthrough
From these findings, the researchers were able to learn how the 2G12 antibody binds to sugars on the surface of the virus and provide immunity from the HIV virus. Since the sugars are made by human cells and attach to the virus, the immune system accepts them as part of the body and does not normally attack them. The team have theorized that if they were to were to design a template for an antigen based on the 2G12 antibody, it could help the body to produce its own 2G12, stimulating the immune system to produce sufficient antibodies to combat invading microbes.
More detailed information about the project can be found at the National Institute of General Medical Sciences website at http://www.nigms.nih.gov/
WN virus activity: Five seroconversions to WN virus were confirmed in sentinel chickens, for a YTD total of 51 WN seroconversions in 16 counties. No new WN activity has been reported in horses or birds. Twenty-three counties have reported WN activity this year, with sporadic distribution around the state, compared to 12 counties last year at this time.
The complete report can be viewed at: http://www9.myflorida.com/Environment/hsee/arbo/weekly_summary2003.htm
|Bureau of Epidemiology|