The Bureau of Epidemiology presented its initial roll-out of the County Health Department Epidemiology Hurricane Toolkit, which is now posted at: http://dohiws.doh.state.fl.us/Divisions/Disease_Control/epi/Hurricanetoolkit/index.htm.

In a Grand Rounds presentation on Tuesday, June 27, a basic training provided an overview of what the hurricane toolkit contains and how it might be utilized by CHD epidemiology units and/or epidemiology teams for post-hurricane response.

The toolkit is a document that contains guidelines, instructions, checklists, forms, templates and other devices that can be used by CHD epidemiology units to prepare for and respond to hurricanes. The toolkit has been in development since earlier this year and is the result of contributions by staff from many FDOH divisions and county health departments. The toolkit is considered a ‘living’ document (this first release is Version 1.0) that will be periodically updated based on a process of CHD feedback and user experience.

The Bureau of Epidemiology is also looking for other ways to distribute the toolkit, including providing CHD epidemiology contacts ‘thumb’ drives of the toolkit with the FDOH logo, so that the kit can become part of every CHD epidemiology unit’s go-kit for disasters. Details on the thumb drives will be provided in future email announcements.

For more information concerning this device, contact Janet Hamilton, MPH, at 850.245.4444, ext. 2403.

Janet Hamilton is administrator of the Surveillance Section at the Bureau of Epidemiology in Tallahassee.

Grant Writing Workshop Scheduled
for August in Miami
 

The Grant Institute's Grants 101: Professional Grant Proposal Writing Workshop will be held at the University of Miami - James L. Knight International Center, August 9-11from 8:00 a.m. until 5:00 p.m. each day. Development professionals, researchers and graduate students should register as soon as possible. All participants will receive certification in professional grant writing from the institute.  

The Grant Institute’s Grants 101 course is an intensive and detailed introduction to the process, structure, and skill of professional proposal writing. Participants will learn the entire proposal writing process and complete the course with a solid understanding of not only the ideal proposal structure, but a holistic understanding of the essential factors, which determine whether or not a program gets funded. Through the completion of interactive exercises and activities, participants will complement expert lectures by putting proven techniques into practice. This course is designed for both the beginner looking for a thorough introduction and the intermediate looking for a refresher course that will strengthen their grant acquisition skills.  

In three days, students will be exposed to the art of successful grant writing practices, and led on a journey that ends with a complete grant proposal. Grants 101 consists of three courses: Fundamentals of Program Planning, Professional Grant Writing and Grant Research.
Registration is $597.00 and includes all materials and certificates. Each student will receive:

· The Grant Institute Certificate in Professional Grant writing
· The Grant Institute's Guide to Successful Grant Writing
· The Grant Institute Grant Writer's Workbook with sample proposals, forms, and outlines  

For more information, call 888. 824.4424 or visit The Grant Institute website at http://www.thegrantinstitute.com

Salmonellosis in Collier County:
A Geographic Analysis of Rates
by Nicole Basta, M Phil Epi

Graphs associated with this article can be accessed here

Introduction
Salmonellosis is a common gastrointestinal infection caused by approximately 2000 different serotypes of Salmonella bacteria. It results in acute enterocolitis and symptoms such as fever, nausea, and abdominal pain which usually last 4 to 7 days.¹ Salmonella infection is associated with improper handling of raw foods such as chicken and eggs, consumption of food contaminated with the bacteria, contact with live infected animals, and contact with infected individuals. Some of these risk factors correlate to specific serotypes, for instance Salmonella enteritidis is associated with raw eggs. The disease is endemic worldwide, with an estimated 1.4 million cases and over 500 deaths occurring annually in the United States alone.²

Because Salmonella infection is preventable with 60%-80% of cases occurring sporadically,2 studies aimed at further understanding the trends and distribution of non-outbreak associated cases are informative when planning public health interventions intended to reduce the spread of this enteric disease.  

Background
Collier County’s reported case rate of Salmonella infections has been higher than the average statewide rate in 5 out of the last 6 years (figure 1). No contributing causes have been identified for this higher than average rate.

However, assessing rates on a county-wide level for counties that are expansive geographically and large in population hides variation within the region. To better understand the trends in salmonellosis cases within Collier County, we aimed to assess Salmonella infection rates within smaller geographic areas.

Our overall goal was to define the geographic distribution of salmonellosis rates to identify regions where individuals are at a particularly high risk of infection, so as to better plan and implement interventions that could serve to minimize future transmission.  

Methods
Cases reported from Week 1 of 2000 through Week 53 of 2004 were exported from the Merlin Electronic Reporting System into a Microsoft Excel database. As our goal was to address sporadic, local transmission of Salmonella bacteria rather than outbreak associated or restaurant/food service exposure, we excluded cases that were acquired outside of Florida, cases that were part of a known outbreak, and cases where these characteristics were unknown. Confirmed and probable cases were included.

Initial data from Merlin indicated 376 cases of salmonellosis in Collier during the 5-year period of this study. After the aforementioned exclusion and inclusion criteria were applied, 92 records were eliminated (58 were outbreak-associated, 13 were acquired outside the state, and 21 had missing information about outbreak status or acquisition location), resulting in 284 eligible cases. From this data, 10 cases (3.5%) had to be further eliminated due to unknown or incorrect addresses. As a result, 274 cases were entered into this analysis.

The surveillance data entered into Merlin comes from a variety of sources. Collier CHD utilizes Health Sentry, an electronic lab reporting system whereby all positive Diagnostic Services, Inc. (DSI) lab results are reported directly to the health department daily through downloadable, secure online databases. This system is considered an exceptionally complete lab surveillance method because an estimated 90% of all lab tests ordered in the county are processed by DSI labs. In addition, faxes and calls from hospital infection control nurses and private practitioners alert health department staff about additional cases.

The demographic distribution for all cases was determined. The number of cases reported during this period in each zip code was recorded, and the age-adjusted 5-year average rates of Salmonella infection were calculated for each zip code region.

To calculate the 2002 midyear population for each zip code, we extrapolated data for each zip code from the US Census (available at http://factfinder.census.gov), using the 2000 and 2002 county-wide population estimates (available from the Collier County Government Long-Term Planning Committee) and the 2000 population. This was necessary because the US Census does not estimate the zip code level population yearly. There are two possible limitations to these data. First, population growth rates may vary across the county resulting in some zip codes increasing in population more quickly than others. However, because we were only extrapolating over a 2 year period, this variation was likely to be minimal. Second, the 2000 US Census uses Zip Code Tabulation Areas (ZCTA) as an alternative to zip code regions because the boundaries are more uniform and useful for mapping purposes. In most cases, ZCTA regions are nearly identical to zip code regions, and a comparison of these two boundaries indicates that they are appropriate for this study.

Age-adjusted rates were calculated using three age categories applicable to this study (under 5 yrs, 5 – 64 yrs, and 65 yrs and older). Age classes were combined because of the small number of cases; these specific boundaries were chosen because the case rates are similar within these age groups. The calculated rates were then graphed and mapped for comparison. 95% confidence intervals (CI) were calculated using the formula: 

95% CI = (Age-adjusted Rate) +/- 1.96* (Age-adjusted Rate) /mathematical checkmark symbol (Number of Events) 

There are many alternate methods for calculating the 95% CI, but this formula is considered to be more than adequate for use in small area analysis for community health planning.³

Because studies involving geographic distributions of cases rely heavily on accurate address information, we compared archived paper records for the 5-year study period to electronic records, to ensure that the address listed in Merlin was correct at the time of diagnosis. Only 4 records could not be confirmed, as their paper records could not be located. These records were included in the analysis. Each address was then verified with MapMarker, a geo-coding program that can determine if an address actually exists. Any addresses that required further verification were checked using the Naples, Florida Cross Search Reference Directory (October 2004 edition). Only individuals with known physical addresses were included in this study.

The one case residing in zip code 34134 was not included in the geographic rate distribution analysis because no population data was available for the section of this zip code that is located in Collier County. The zip code crosses county boundaries and is partly located in Lee County; therefore, calculating the rate was not feasible.

Data was analyzed and graphs were created using Microsoft Excel. MapMarker Plus 10.2 and ArcMap 9.0 were used to map the rates within the zip code regions.  

Results
For the 274 cases included in this dataset, the age distribution showed the greatest percentage of cases occurring in the 0-4 year age range (46% of the overall cases), as was expected. There were slightly more females (54%) than males (46%), and the majority of cases were white (95%) and non-Hispanic (66%).

In cases where an infection or a disease disproportionately affects a certain age class, as is the case with salmonellosis, it can be misleading to compare crude rates. This is especially true when the underlying age distributions of the regions being compared are quite different (figure 2).           

Therefore, we calculated and graphed the 5-year average age-adjusted rate of salmonellosis cases in each zip code region along with the corresponding 95% confidence interval (figure 3). Zip code region 34120 (Golden Gate Estates) had the highest rate at 56.23 cases per 100,000 people per year. This rate was significantly higher than the rate in 11 other zip code regions of the county. Conversely, zip code 34102 (City of Naples) had the lowest rate with just 7.70 cases per 100,000. The most economically disadvantaged area and the area of the county with the largest migrant community, zip code 34142, had a rate of 26.61 cases per 100,000. No cases were reported during the 5-year time period in zip codes 34137, 34138, 34139, 34140, and 34141, all of which are very rural, sparsely populated areas of the county.

To understand the spatial relationship between these regions and identify trends, salmonellosis rates were mapped (figure 4). This representation suggests that there is a north-south region within the center of the county where rates are higher than in the rest of the county. In particular, it highlights the significantly higher rate of Salmonella infections in 34120.  

Discussion
Here we present a straightforward methodology for assessing disease rates within counties using small area statistical techniques. In addition, we demonstrate a simple strategy for utilizing GIS software which is beneficial for public health practice.

This study aimed to identify regions of Collier County where unexpectedly high rates of Salmonella infections have been reported. By comparing 5-year average age-adjusted rates for each zip code, we found the Golden Gate Estates region to have the highest reported case rate. This region’s rate was significantly higher than the rate for 11 other zip codes in the county where cases have been reported.  

In this analysis, several years’ data were pooled in an attempt to increase the sample size in each region. In addition, by calculating the 95% CI for comparison, the issue of small sample sizes and variability in the rates was directly addressed. It is possible that confounding factors could lead to a higher rate in one region compared to another. The greatest source of confounding would be due to age, since salmonellosis is an infection that disproportionately affects young children. In this study, we accounted for this fact by comparing age-adjusted rates only.

In addition, it is possible that reporting frequencies differ between the zip code regions of the county. This could occur if, for instance, physicians serving one area were more vigilant about reporting positive lab results to the county health department. However, since Collier CHD utilizes the electronic lab reporting system Health Sentry, there is minimal variation in reporting activity within the county. 

On the other hand, it is possible that individuals in one area of the county seek out health care for salmonellosis-like symptoms more often then those living in other areas, perhaps due to the cost of health care. If this were the case, we would expect to see the highest rates in the most affluent areas of the county. Instead, we found that the most affluent area, the city of Naples, had the lowest rate, thereby refuting this theory.  

This study has the advantage of utilizing a reliable dataset, of having minimized confounding based on age and reporting frequency, and of clearly identifying an area where further interventions aimed at reducing the transmission of Salmonella bacteria could benefit the community. Of course, all communities could benefit from educational information about adequate hand-washing, proper food handling protocols, and infection control measures to minimize person-person transmission. However, if certain high-risk regions are identified based on studies such as this one, efforts should be made to ensure that useful, timely information about how to reduce the risk of transmission is made available. 

Recommendations
Based on the results of this report, we suggest steps that could be taken to identify the source and reduce the transmission of Salmonella in areas where rates are unusually high. Currently, all salmonellosis cases are investigated by a phone interview conducted by Collier CHD staff in English or Spanish. However, the following proposals may be more effective in minimizing the spread of this enteric disease:

A home visit, which includes a face-to-face meeting where educational materials can be provided and discussed in greater depth, may prove to be more beneficial way to identify risk factors. This strategy has been used in other areas of the state and anecdotal evidence suggests that more detailed information about transmission can be gathered. Once specific risk factors are identified in this area, educational campaigns or could be planned and/or regulations could be enacted to address specific issues.

A case-control study is an excellent way to utilize data about case exposures to identify risk factors in a specific population. An individual with epidemiology experience, an adequate sample size, and a detailed questionnaire would be needed in order to obtain valid results.

Attending health fairs and presenting to community groups would also serve to educate communities about ways to prevent Salmonella and food-borne illness in general. 

These interventions could educate the community and identify behaviors leading to exposure to Salmonella bacteria that may be more common in certain areas, such as keeping yard chickens, or consuming raw or undercooked eggs. These suggestions will require greater time and resources than the current case investigation methods, but the high rate of salmonellosis cases warrants the attention and could ultimately reduce the case rates in areas where they are higher than expected. 

Conclusion
Often, infection with Salmonella bacteria is not considered a serious public health threat, but high rates of any disease that causes significant morbidity should be examined, and strategies to reduce these rates should be utilized. Using reported salmonellosis case data, we have identified a region of our county where the rate is significantly higher than in the majority of the rest of the county. Based on this information, Collier County Health Department epidemiology staff are addressing this issue to reduce infection rates in the future. 

References
(1) Heymann, DL, ed. Control of Communicable Diseases. 18th Edition. Washington, DC: American Public Health Association, 2004, pp.469-472.
(2) Centers for Disease Control, Division of Bacterial and Mycotic Diseases, Salmonellosis Technical Information, http://www.cdc.gov/ncidod/dbmd/diseaseinfo/salmonellosis_t.htm
(3) National Center for Health Statistics, Applied Statistics Training Institute, 1994 Course Binder, pp. 68-69.

Nicole Basta is a Florida Epidemic Intelligence Service fellow assigned to the Collier and Hendry/Glades County Health Departments. She can be reached by calling 239.774.8234.

 

CDC Guidance on Who Should be Tested for Influenza A (H5N1) Virus in Florida
as of June 8, 2006 

For consultation on testing or management of possible human cases of avian influenza, contact your country health department or the Bureau of Epidemiology at 850.245.4401

 
CDC Health Update
This update provides revised interim guidance for testing of suspected human cases of avian influenza A (H5N1) in the United States and is based on the current state of knowledge regarding human infection with H5N1 viruses. The epidemiology of H5N1 human infections has not changed significantly since February 2004. Therefore, CDC recommends that H5N1 surveillance in the United States remain at the enhanced level first established at that time. 

However, this revised interim guidance provides an updated case definition of a suspected H5N1 human case for the purpose of determining when testing should be undertaken and also provides more detailed information on laboratory testing. Effective surveillance will continue to rely on health care providers obtaining information regarding international travel and other exposure risks from persons with specified respiratory symptoms as detailed in the recommendations below. This guidance will be updated as the epidemiology of H5N1 changes.  

CDC is revising its interim guidance for infection control precautions for avian influenza A (H5N1). These will be issued as soon as they are available. 

Current Situation
The avian influenza A (H5N1) epizootic (animal outbreak) in Asia has expanded to wild birds and/or poultry in parts of Europe, the Near East and Africa. Sporadic human infections with H5N1 continue to be reported and have most recently occurred in China, Egypt, Indonesia, Azerbaijan, Cambodia, and Djibouti. In addition, rare instances of probable human-to-human transmission associated with H5N1 viruses have occurred, most recently in a family cluster in Indonesia. So far, however, the spread of H5N1 virus from person to person has been rare, inefficient, and unsustained. 

The total number of confirmed human cases of H5N1 reported as of June 7, 2006 has reached 225. The case fatality rate for these reported cases continues to be approximately 50 percent. As of this date, H5N1 has not been identified among animals or humans in the United States.  

The epizootic in Asia and parts of Europe, the Near East and Africa is not expected to diminish significantly in the short term and it is likely that H5N1 infection among birds has become enzootic in certain areas. It is expected that human infections resulting from direct contact with infected poultry will continue to occur in affected countries. Since no sustained human-to-human transmission of influenza H5N1 has been documented anywhere in the world, the current phase of alert, based on the World Health Organization (WHO) global influenza preparedness plan, remains at Phase 3 (Pandemic Alert).*  

In addition, no evidence for genetic reassortment between human and avian influenza A virus genes has been found. Nevertheless, this expanding epizootic continues to pose an important and growing public health threat. CDC is in communication with WHO and other national and international agencies and continues to monitor the situation closely. 

Reporting and Testing Guidelines
CDC recommends maintaining the enhanced surveillance efforts practiced currently by state and local health departments, hospitals, and clinicians to identify patients at increased risk for avian influenza A (H5N1). Guidance for enhanced surveillance was first described in a HAN update issued on February 3, 2004 and most recently updated on February 4, 2005.  

Testing for avian influenza A (H5N1) virus infection is recommended for:

A patient who has an illness that:

1.       requires hospitalization or is fatal; AND

2.       has or had a documented temperature of ≥ 38°C (≥100.4° F); AND

3.       has radiographically confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness for which an alternate diagnosis has not been established; AND

4.       has at least one of the following potential exposures within 10 days of symptom onset:  

a.       History of travel to a country with influenza H5N1 documented in poultry, wild birds, and/or humans,† AND had at least one of the following potential exposures during travel: 

i.         direct contact with (e.g., touching) sick or dead domestic poultry;

ii.       direct contact with surfaces contaminated with poultry feces;

iii.      consumption of raw or incompletely cooked poultry or poultry products;

iv.      direct contact with sick or dead wild birds suspected or confirmed to have influenza H5N1;

v.        close contact (approach within 1 meter [approx. 3 feet]) of a person who was hospitalized or died due to a severe unexplained respiratory illness; 

b.       Close contact (approach within 1 meter [approx. 3 feet]) with an ill patient who was confirmed or suspected to have H5N1; 

c.       Worked with live influenza H5N1 virus in a laboratory.  

Testing for avian influenza A (H5N1) virus infection can be considered on a case-by-case basis, in consultation with local and state health departments, for: 

• A patient with mild or atypical disease‡ (hospitalized or ambulatory) who has one of the exposures listed above (criteria a, b, or c); OR
• A patient with severe or fatal respiratory disease whose epidemiological information is uncertain, unavailable, or otherwise suspicious but does not meet the criteria above (examples include a returned traveler from an influenza H5N1-affected country whose exposures are unclear or suspicious, a person who had contact with sick or well-appearing poultry, etc.)

Clinicians should contact their county health department and the Florida Department of Health, Bureau of Epidemiology 850.245.4401 as soon as possible to report any suspected human case of influenza H5N1 in the United States. Advanced consultation with the Bureau of Epidemiology can be done before testing commences.  See specific guidance on the Florida Department of Health Internet site dated 6/8/06 http://www.doh.state.fl.us/disease_ctrl/epi/htopics/BirdFlu.htm. 

Specimen Collection and Testing Guidelines

• Oropharyngeal swab specimens and lower respiratory tract specimens (e.g., bronchoalveolar lavage or tracheal aspirates) are preferred because they appear to contain the highest quantity of virus for influenza H5N1 detection, as determined on the basis of available data. Nasal or nasopharyngeal swab specimens are acceptable, but may contain less virus and therefore not be optimal specimens for virus detection.
• Detection of influenza H5N1 is more likely from specimens collected within the first 3 days of illness onset. If possible, serial specimens should be obtained over several days from the same patient.
• Bronchoalveolar lavage is considered to be a high-risk aerosol-generating procedure. Therefore, infection control precautions should include the use of gloves, gown, goggles or face shield, and a fit-tested respirator with an N-95 or higher rated filter. A loose-fitting powered air-purifying respirator (PAPR) may be used if fit-testing is not possible (for example, if the person has a beard). Detailed guidance on infection control precautions for health care workers caring for suspected influenza H5N1 patients is available.||
• Swabs used for specimen collection should have a Dacron tip and an aluminum or plastic shaft. Swabs with calcium alginate or cotton tips and wooden shafts are not recommended. Specimens should be placed at 4°C immediately after collection.« Ship immediately.
• For reverse-transcriptase polymerase chain reaction (RT-PCR) analysis, nucleic acid extraction lysis buffer can be added to specimens (for virus inactivation and RNA stabilization), after which specimens can be stored and shipped at 4°C. Otherwise, specimens should be frozen at or below -70°C and shipped on dry ice. For viral isolation, specimens can be stored and shipped at 4°C. If specimens are not expected to be inoculated into culture within 2 days, they should be frozen at or below -70°C and shipped on dry ice. Avoid repeated freeze/thaw cycles.
• Influenza H5N1-specific RT-PCR testing conducted under Biosafety Level 2 conditions is the preferred method for diagnosis. All state public health laboratories, several local public health laboratories, and CDC are able to perform influenza H5N1 RT-PCR testing, and are the recommended sites for initial diagnosis.
• Viral culture should NOT be attempted on specimens from patients suspected to have influenza H5N1, unless conducted under Biosafety Level 3 conditions with enhancements.
• Commercial rapid influenza antigen testing in the evaluation of suspected influenza H5N1 cases should be interpreted with caution. Clinicians should be aware that these tests have relatively low sensitivities, and a negative result would not exclude a diagnosis of influenza H5N1. In addition, a positive result does not distinguish between seasonal and avian influenza A viruses.
• Serologic testing for influenza H5N1-specific antibody, using appropriately timed specimens, can be considered if other influenza H5N1 diagnostic testing methods are unsuccessful (for example, due to delays in respiratory specimen collection). Paired serum specimens from the same patient are required for influenza H5N1 diagnosis: one sample should be tested within the first week of illness, and a second sample should be tested 2-4 weeks later. A demonstrated rise in the H5N1-specific antibody level is required for a diagnosis of H5N1 infection. Currently, the microneutralization assay, which requires live virus, is the recommended test for measuring H5N1-specific antibody. Any work with live wild-type highly pathogenic influenza H5N1 viruses must be conducted in a USDA-approved Biosafety Level 3 enhanced containment facility. Visit http://www.cdc.gov/flu/h2n2bsl3.htm for more information about procedures and facilities recommended for manipulating highly pathogenic avian influenza viruses.

Travel Health Notice
CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1. However, CDC does recommend that travelers to these countries avoid poultry farms and bird markets or other places where live poultry are raised or kept. For details about other ways to reduce the risk of infection, see http://www.cdc.gov/travel/other/avian_influenza_se_asia_2005.htm. 

More Information
Department of Health and Human Services at www.pandemicflu.gov
World Health Organization at World Organization for Animal Health (OIE) at http://www.oie.int/eng/en_index.htm

*For the current WHO Pandemic Phase, see http://www.who.int/csr/disease/avian_influenza/phase/en/index.html.
† For a listing of influenza H5N1-affected countries, visit the CDC website at http://www.cdc.gov/flu/avian/outbreaks/current.htm; the OIE website at http://www.oie.int/eng/en_index.htm; and the WHO website at http://www.who.int/csr/disease/avian_influenza/en/.
‡ For example, a patient with respiratory illness and fever who does not require hospitalization, or a patient with significant neurologic or gastrointestinal symptoms in the absence of respiratory disease.
|| Interim recommendations for infection control in health-care facilities caring for patients with known or suspected avian influenza are available at http://www.cdc.gov/flu/avian/professional/infect-control.htm.
« Specimens can be transported in viral transport media, Hanks balanced salt solution, cell culture medium, tryptose-phosphate broth, veal infusion broth, or sucrose-phosphate buffer. Transport media should be supplemented with protein, such as bovine serum albumin or gelatin, to a concentration of 0.5% to 1%. Specimens should be placed at 4°C immediately after collection.
Information regarding Laboratory Biosafety Level Criteria can be found at http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm.

Annual Florida Professionals in Infection Control Conference to be Held in September
by Joanne Barnett, RN, BSN, CIC, LHRM
 

The 31st Florida Professionals in Infection Control Annual Conference will be held in Orlando September 12 - 15, 2006 at the Orlando Airport Marriott.   

A pre-conference seminar will be held on September 12th and is approved for 6 contact hours titled "Infection Control Basics Across the Continuum of Care" which will focus on basic infection control in all settings. 

On September 13, the conference "Expanding The Horizons" will begin with renowned keynote speaker William Jarvis, MD to address the Evolution of Infection Control across the Continuum. The conference will present state of the art information about infection control practice and disease control. The programs are designed for infection control professionals in all health care settings and are approved for 18 contact hours of continuing education for nursing and clinical laboratory personnel.       

Conference Objectives: 

• Outline basic infection control practice and principles across the healthcare continuum
• Discuss the major drivers of healthcare infection control change
• Discuss the relationship between host factors, infection control and interventions
• Provide HIV update and rule revisions in Florida
• Explain the role of ICRAs in assessing environmental hazards
• Highlight changes in the revised CDC Isolation Guidelines
• Describe practical ways to prevent transmission of resistant organisms
• Provide update on public health issues in Florida
• Discuss methods to reduce infections in intravenous therapy
• Describe practical ways to promote an infection control program and implement change
• Spotlight and reward infection control initiatives of FPIC members
• Develop infection control plan for emergencies
• Provide update on core measures reporting
• Discuss the impact of mandatory HAI reporting in Florida
• Review the scope and application of the new TB guidelines

Call for abstracts is due by July 26. Here is an excellent opportunity to present your infection control solutions/ strategies at the annual conference!  

For more information on the conference and abstract submission visit www.flpic.com.

Joanne Barnett is the infection control coordinator at Central Florida Regional Hospital. To contact her, call 407.321.4500, ext. 5242.

Mosquito-borne Disease Summary June 25 - July1, 2006
Rebecca Shultz, MPH, Caroline Collins, Daneshia Roberts, Calvin DeSouza, Carina Blackmore, PhD

During the period June 25 - July 1, 2006, the following arboviral activity (St. Louis Encephalitis virus [SLEv], Eastern Equine Encephalitis virus [EEEv], Highlands J virus [HJv], West Nile virus [WNv], California Group virus [CALv]) was recorded in Florida: 

EEE virus activity: One horse from Okaloosa County was reported positive for EEE virus infection this week. A total of 16 counties have reported EEEv activity so far this year, compared to 33 at this time last year.  

WN virus activity: There was no West Nile virus activity reported this week. So far, 10 counties have reported WNv activity this year, compared to 11 at this time last year.  

No locally-acquired human cases of arboviral infection were reported yet this year.  

Horses: One horse from Okaloosa County tested positive for EEE virus infection this week.

Dead Birds: The Fish and Wildlife Conservation Commission (FWC) collects reports of dead birds, which can be an indication of arbovirus circulation in an area. This week, 43 reports representing 76 dead birds were received from 25 counties. Of the reported birds, 5 were corvids, 3 were a type of raptor, and the remaining 68 were other birds. The FWC collects reports of birds that have died from a variety of causes, not only arboviruses. There were no positive test results this week.

See the web page for more information: www.MyFloridaEH.com. The Disease Outbreak Information Hotline offers recorded updates on medical alert status and surveillance at 888.880.5782.  Dead birds should be reported to www.myfwc.com/bird/