Friday, July 9, 2004

         This Week in the News

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

►Pregnancy Risk Assessment Monitoring System Reports Online
The one-page reports are beneficial to practitioners treating women of childbearing age, or anyone interested in maternal and child health epidemiology.

►UV Exposure From Mercury Vapor Lamps
This won Best Poster by a County Health Department at the statewide epidemiology conference at Lake Mary in May. The abstract is reprinted here so readers who couldn't attend the conference have an opportunity to read the high quality of submissions presented.

A R T I C L E S

The Chronic Disease Surveillance and Epidemiology Section, under the leadership of Youjie Huang, MD, DrPH, MPH, has been hard at work during the past several months developing a series of one-page reports addressing pregnancy-related topics among women in Florida. These reports are accessible on the Internet and should be beneficial to practitioners treating women of childbearing age, or anyone interested in maternal and child health epidemiology.

Data from the Florida Pregnancy Risk Assessment Monitoring System (PRAMS) were used in the analysis for these reports. Florida PRAMS is a random survey of recent mothers of live-born infants. It is designed to monitor the physical, economic, and social health of Florida mothers and newborns. PRAMS is a mail survey with telephone follow-up of a sampling of recent mothers of live-born infants, completed when the infant is approximately three months old. The results presented are weighted to reflect the total population of Florida mothers and infants. Florida PRAMS is supported by a grant from the Centers for Disease Control and Prevention.

If you have questions or would like more information on Florida PRAMS, contact Helen Marshall, PRAMS Coordinator, at 850-245-4444 extension 2415, Helen_Marshall@doh.state.fl.us; or Curt Miller, Data Analyst, extension 2407.

The online address for these reports is http://doh.state.fl.us/disease_ctrl/epi/prams/prams.htm. Six new reports are currently in review and will join these online soon.

Announcements. Don Ward introduced Carmela Mancini as the newly appointed  administrator of the Surveillance and Reporting Section.

Bioterrorism funding has suffered a decrease for 2004-2005 over the previous year. In addition to an overall reduction of about a million dollars from the (combined) focus areas, one time funding for smallpox preparedness and response has been discontinued. In Focus Area B (surveillance and epidemiology) priority will be given to the retention of grant funded staff and support. Grant managers do not anticipate restrictions on positions already in place.

The Bureau of Epidemiology is developing a draft emergency surveillance and epidemiology response plan that will employ and all hazards approach to emergency events. The plan will address activities related to pre-event, threat of event, event and post event. Responsibilities and actions will be provided for DOH headquarters, CHDs and the non-DOH health community. County health department epidemiology staff wanting to be a member of a review team should email Don Ward. The document will be forwarded to the regional co-chairs for examination before a review by executive management.

At the request of several county health departments, Bureau of Epi staff are also developing a guide for management of suspected smallpox events. The draft document will be forwarded to CHDs for review and comment. The key message in the guidance is that health department medical/epidemiology staff should become involved in the evaluation of suspected smallpox cases as early as possible to enable an initial diagnosis that will guide intervention and emergency operations.

A plan for the 2004-05 influenza season is being developed by Angela Fix, the Bureau of Epidemiology’s respiratory disease epidemiologist. Mortality, general surveillance, availability of vaccines and other issues will be addressed in the plan and in an upcoming brochure. She is also working with CHDs to develop a consensus definition of "community outbreak", which will provide an adjunct surveillance system for determining the local, regional and statewide impact of influenza

Bacterial Meningitis. Peggy Booth, Seminole CHD, stated that a 42 year old male was seen at a hospital in Seminole County and admitted with an initial diagnosis of bacterial meningitis. He had been traveling overseas. Three family members were exposed but received follow-up prophylaxis from CHD staff. The CDC notified the airline to alert officials to the possibility that passengers on his flight could have been exposed.

Clostridium difficile. Christine Argo reported that in Hardee County, five cases of Cd have been identified since May. The nursing home in which the patient` cases reside has begun more aggressive infection control procedures and will consider isolating patients in future. No staff have become ill.

Community Acquired MRSA. Carrie Selovar received calls in April from relatives of inmates at the Okeechobee state prison who complained of running sores. Carrie contacted Roger Sanderson, RN, MS, who provided technical assistance. She phoned the prison and made recommendations concerning isolation, hand washing, and general infection control measures. She was denied entry to the prison for inspection. Although she has been assured that appropriate measures have been taken to contain the incidents, she will contact the prison again and negotiate a walk-through inspection with Roger Sanderson.

Community Acquired MRSA. Jylmarie Kintz reported that Kelly Granger was contacted by the Hillsborough County jail in mid-June about a MRSA outbreak. After a tour of the facilities, CHD made recommendations and the prison administrators agreed to install soap dispensers in bathrooms and also provide more soap to inmates. IN addition, CHD personnel will provide flyers for posting around the facilities which give information on infection control and institute in-service training on health matters.

Hepatitis A.  Jylmarie Kintz reported there are currently 11 patient cases in Hillsborough County and three in Pasco County. The symptoms were initially mild, so they were missed. Because a large family gathering had occurred at a funeral and some had traveled from northern states, the possibility exists that the carriers may have been at the gathering. Prophylaxis has been administered to 57 persons.

Nosocomial Infections. Donna McCullough reported that after noting a sharp increase in nosocomial infections, the review committee at the hospital in Putnam County could not reach agreement on the cause/s. A representative phoned Donna to request assistance. She worked with Drs. Schulte and Crockett, Roger Sanderson and Robin Kay, and the task force traveled to the hospital to meet with the panel the following day. The task force developed a chart assessment tool and will be visiting the hospital regularly for the next few weeks to assess the problem.

The next conference call is scheduled for Friday, July 16th at 10:00 a.m. If you have questions or would like to appear on the agenda, contact Professional Training Coordinator Melanie Black at 850.245.4444, ext. 2448, or email her at melanie_black@doh.state.fl.us
 

Background
Recently, a local ophthalmologist notified the Pinellas County Health Department (PinCHD) that three patients presented to his office with possible toxic exposures within the same week. According to the ophthalmologist, the patients presented with corneal damage, burning eyes and skin irritations. All three patients reported having played basketball together at the same local community center.

Methods
The Environmental Health Division and the Epidemiology Program conducted a thorough investigation of the area. No toxic substances were found in the vicinity of the basketball courts, and no other complaints had been filed in the past several months. The supervisor at the community center reported no complaints from staff, clients or parents. After receiving contact information from the ophthalmologist for two of the three affected individuals, phone interviews were conducted.

Results
The PinCHD was informed of a recent news story reporting a basketball team that had recently experienced similar symptoms of eye irritation and skin burning after playing ball indoors. The Environmental Health Division and the Epidemiology Program returned to inspect the integrity of the outer envelope of the lamps used by the  individuals. Upon inspection, it was evident that all of the outer envelopes had been broken out of the lamps. According to an article in FDA Consumer magazine, when the protective outer envelope is broken off a mercury vapor lamp, the result is a harmful dosage of ultraviolet radiation.

Conclusions
The broken protective outer envelope on the mercury vapor lamps at the community center caused the players to receive a harmful dosage of ultraviolet radiation which caused their painful symptoms. The community center manager was asked to submit a work order to have the outer envelopes replaced as soon as possible, and to keep the lights off until the outer envelopes were replaced. There have been no further complaints.
 

What is EpiCom? EpiCom is an electronic system developed and maintained by the Florida Department of Health for health care practitioners and other partners to share and receive information related to disease outbreaks. There are two components in EpiCom: The Exchange, for communicating messages related to potential or confirmed disease outbreaks, and the Alert, which is used when a threat has been identified. The Alert issues an emergency notification to select EpiCom users.

How Does it Work? Registered users post messages, which are approved by a subject matter expert. Each message is placed in a category (i.e., topic). When users log on to EpiCom, they can browse for information according to a topic of interest, or they can sign up to be notified about events via passive notification to their primary email address.

When should I post? Only a suspicion is necessary to post a message to EpiCom. Lab results and a case definition are not required. Users are encouraged to post messages at the first sign of an outbreak.

Scenario. A health care practitioner in a rural Florida county notices an increase in gastrointestinal illnesses among school children in his area. By referring to EpiCom, he finds that a similar increase has been noticed in a nearby county. The nearby county suspects the illnesses may be related to a distributor that delivers food to schools in both counties. The practitioner posts a message and then contacts his local CHD, which now has a jump-start on its investigation. Subsequently, possible exposures in two counties are located and treated in a fraction of the time it would have taken if EpiCom had not been used. Afterwards, both county health departments post an after-action message on EpiCom outlining the actions each took to contain the outbreak.

What does it cost? Nothing! EpiCom is free. There is no software to install and the site can be accessed at any time from any computer with Internet capabilities. It couldn't be more convenient!

What can EpiCom do for me? It gives you access to the combined knowledge of hundreds of public health practitioners. Did you ever wonder if a disease is reportable? If a certain disease constitutes a public health emergency? Who the experts are? Whether anyone else is seeing similar symptoms? If so, EpiCom can help you quickly and promptly answer these and other questions by providing direct access to knowledgeable colleagues across the state.

What if there's an emergency? EpiCom is equipped with state-of-the-art alert capabilities. If an immediate threat to public safety is identified, EpiCom administrators can issue alerts to some or all EpiCom users. These users can be contacted by land line, email, fax, pager, cell phone - basically any communications device imaginable. There is no better way to stay connected in an emergency.

Who should register? Anyone with an interest in disease outbreaks that could impact the public's health and safety such as doctors, nurses, infection control practitioners, veterinarians, medical examiners, public health workers, school district employees and school nurses.

How do I register? Go to https://www.epicomfl.net. Select "Click here if you are not a registered user."

• Enter your first name
• Enter your last name
• Enter your organization (as in Florida Department of Health)
• Enter the primary email address where you would like to receive EpiCom messages
• Insert your home phone number, including area code
• Choose a user name 
• Choose a password
• Retype the password
• Choose an EpiCom Alert User ID, any number from 4-15 characters. This is a number you'll need to remember if you're ever contacted by the EpiCom alert system.
• For system access, choose EpiCom Exchange (ER surveillance is a program used by hospitals to input their emergency room census data each day).
• Click the "submit" button.

If you have questions or comments about EpiCom or any of its components, contact an EpiCom administrator at EpiCom_administrator@doh.state.fl.us, or phone 850.234.4401.
 

Mary Hilton, MNO, is the newest addition to the Bureau of Epidemiology staff. She most recently served as program manager for the Florida Tobacco Prevention and Control Program at DOH in Tallahassee, providing oversight of the state’s youth tobacco prevention program. Her experience in the areas of program planning, program evaluation, staff training, community planning, and program marketing bring a wide range programmatic expertise to the Bureau.

Her professional career began as a clinic director managing a Tallahassee family planning clinic, and shifted to HIV/AIDS prevention and intervention, where she provided technical assistance to county health departments and oversight for the HIV/AIDS educational materials review process. She also organized statewide conferences and reviewed procurement documents for compliance with programmatic regulations. More recently, Mary worked as a community partnership consultant providing training to county health departments statewide on the use of web-based reporting systems, partnership development, and community program planning.

Mary attended Vanderbilt University in Nashville, Tennessee where she graduated with a BA in Political Science before earning a Master of Management in Nonprofit Organizations degree from Case Western Reserve University in Cleveland. Her work at the Bureau of Epidemiology encompasses staff and project planning, policy management and special projects. Mary is an avid reader who owns two cats and enjoys sewing when time permits.

To contact Mary, email her at mary_hilton@doh.state.fl.us or phone her at 850.245.4444, ext. 2732.
 

• Scombroid poisoning in Collier and Miami-Dade Counties
   
• Palm Beach County reports confirmed P. vivax malaria

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: There were two seroconversions to WN virus in sentinel chickens from Hillsborough County (6/02 x2). One horse (onset pre-6/23) in Miami-Dade County tested positive for WN virus. So far this year, 21 counties have reported WN activity.

St. Louis Encephalitis (SLE) Virus activity: There were two seroconversions to SLE virus in sentinel chickens from Pinellas County (5/17 x2). 

Eastern Equine Encephalomyelitis (EEE) Virus activity: There was one seroconversion to EEE virus in a sentinel chicken from Jefferson County (6/20). Two blue jays out of five wild birds captured on 6/18 in Okaloosa County were confirmed EEE virus positive. So far this year, 19 counties have reported EEE activity.

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

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

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