Friday, July 18,
"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."
Foege WH et
| This Week in the News|
► Viral Meningitis Outbreak Investigated in Alachua County
A report of clinical cases of non-polio viral meningitis took investigators to schools, day care centers and households in Alachua County.
► Bioterrorism Surveillance to be Focus of July Grand Rounds
A new biodefense surveillance system will be the topic of discussion at the Grand Rounds teleconference scheduled for 11:00 a.m. on July 29th.
► July 25th CHD Conference Call Set
Mark your calendar to participate in the next county health department/Bureau of Epidemiology conference call, slated for 10:00 - 11:00 a.m. A variety of subjects will be discussed.
► Changes to Notifiable Disease Reporting in Florida
A roster of changes finalized during the past month, as well as changes to come, are explained. Stay tuned, as more are on the way.
► Conference Call Attendance on the Rise
Last week's conference call between statewide health departments and the Florida Bureau of Epidemiology provided some much-needed information sharing and a welcome number of participants.
► Merlin Frequency Reports Available to Public
A data sharing initiative between two state health department offices has resulted in creation of a better tool for production of high-level reports.
► Managing Public Health Threats Topic of Upcoming Conference
The Florida Public Health Association and The Florida Association of Public Health Nurses are planning a joint annual education conference at the PGA National Resort & Spa at Palm Beach Gardens.
► New HIV Quick Test Available at Non-traditional Venues
In a bold move to reach high-risk populations, the FDA has allowed OraQuick tests to be conducted at places that go beyond traditional clinical settings.
► Influenza Season Summary Now on Web
The 2002-03 Influenza Season Summary is completed and available for perusal.
► Arboviral Disease Report
Statistics through the week ending July 14, 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).
Anyone interested in accessing the full text, including charts and graphs, of three articles which appeared in last week's Epi Update, can do so by clicking on the links below:
For Salmonella Outbreak Traced to Tampa BBQ Restaurant, David Atrubin, MPH, EIS Officer, Bureau of Epidemiology and Michael Friedman, MPD, Bureau of Community Environmental Health
For Trends in Tobacco Use Among New Mothers Unveiled, Marie A. Bailey, MA, MSW, BRFSS Coordinator and Curt Miller, BS, Epidemiologist, Bureau of Epidemiology
For Pre-Pregnancy Study Among Florida Women
Finds Links Between BMI and Health, Curt Miller, BS, Epidemiologist and
Youjie Huang, MD, DrPH, Bureau of Epidemiology
A R T I C L E S
Jerne Shapiro, MPH, Florida Epidemic Intelligence Service, Bureau of Epidemiology
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Kathryn Teates, MPH, Communicable Disease Surveillance & Reporting Manager, Bureau of Epidemiology
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Pete Garner, Surveillance Systems Section Administrator, Bureau of Epidemiology
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Kathryn Teates, MPH, Surveillance & Reporting Section Administrator, 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
Meningitis Outbreak Investigated in Alachua County
Non-polio enteroviruses are the second most common viral infections in humans,
surpassed only by common cold viruses. Echovirus 9 is an identified serotype of
enterovirus and known to be associated with high incidences of viral meningitis.
Symptoms of viral meningitis include headache, fever, neck and back stiffness,
photophobia, vomiting, nausea, and diarrhea. Symptoms usually last seven to ten
days; however, the virus may present in the body for up to 7 days after symptoms
have resolved. The incubation period is two to seven days. Less severe and
asymptotic cases can occur. The virus is spread from an infected person via
respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool.
Enteroviruses are most likely to occur during summer and fall. Secondary spread
often occurs in households, day care centers and group facilities. No vaccine is
On May 27, 2003, the Alachua County Health Department (ACHD), Department of
Epidemiology received two reports from concerned schools of suspect viral
meningitis, one high school student and one a kindergartener. The high school
student’s date of onset was May 23, 2003. The following day (day 2), two cases
from the same elementary school, one kindergartener (same classroom) and one
first grader, were admitted to the hospital for suspect viral meningitis. On day
3 a first grader from a second elementary school was admitted. A sixth case from
a third elementary school was added on day 4. The outbreak has continued to
spread throughout day cares, households, and schools. The ACHD developed
educational information for the families and schools and began implementing a
policy not allowing students to return to school until 10 days after symptoms
following case definition was established: Confirmed: A clinically
compatible case (2 or more symptoms) from which Echovirus 9 or Enterovirus had
been isolated either from CSF, stool, or respiratory samples. Probable: A
clinically compatible case (2 or more symptoms) that had a lumbar puncture with a
high WBC and no growth on the culture. Suspect: A clinically compatible
case (2 or more symptoms) and was a resident of Alachua County or a
clinically compatible case (2 or more symptoms) who was epidemiologically linked
to a known probable or confirmed case.
Signs and Symptoms:
Each case was interviewed to
establish epidemiological links, symptoms, date of onset and contacts.
Information obtained from charts included lumbar puncture, CBC analysis and gram's
stain. Isolates from CSF, stool, and respiratory samples were cultured and all
labs testing positive for enterovirus were sent to the state lab for strain
typing. Viral meningitis is not a reportable disease in the state of Florida;
however, due to the outbreak nature of this organism the ACHD asked all local
hospitals and physicians to report any suspected cases. To analyze the data a
database was created in Epi Info 2002.
To educate the community the
ACHD mass mailed an information pamphlet on viral meningitis to all schools,
churches, day cares, summer camps and pools in Alachua County. Daily updates were
reported to the local press along with personal protection information. Each
patient case was personally instructed on necessary hygiene practices for the
protection of others. In addition, each patient case was mailed a personal letter
reiterating necessary hygiene practices. All group activities the patient was
involved with were subsequently contacted and sent an information pamphlet to
pass out to all possibly exposed individuals.
samples from cerebrospinal fluid (CSF), stool, or throat cultures were sent to
the state lab and tested positive for Enterovirus Echo 9 as the causative
The ongoing investigation has
revealed a total of 24 confirmed, 22 probable, and 1 suspect case since May 23,
2003 (See Table). All 47 cases were seen in local emergency rooms and 93.6% were
admitted to the hospital. All cases have recovered fully with no sequela. A total
44.7% of the cases have been epidemiologically linked to each other with
siblings, family members, and classmates subsequently becoming ill. The ages of
cases range between 4 weeks to 41 years old with a total of 71.7% of the cases
between ages 5-10yrs. A total of 58.7% are male and 73.9% black.
outbreak is ongoing, thus the nature of the outbreak may change in the future.
This outbreak of Echovirus 9 is following the known pattern occurring in the
summer months and appears to be spread via contact with stool or respiratory
secretion from infected individuals. The ACHD will continue to work with cases,
contacts, schools, day cares, employers, media, laboratories and hospitals to
provide the most up to date information and education.
Bioterrorism Syndromic Surveillance: A Dual-Use Approach with Direct
Application to the Detection of Infectious Disease Outbreaks
The surveillance system was evaluated by comparing regional,
state and national surveillance data to equivalent syndromic data reported from
BioDefend™. After comparing these data, it was determined that the BioDefend™
system detected two epidemics of public health importance more than one month
before they were identified through routine regional and state surveillance
methods. The specific syndromes identified earlier than the State of Florida
surveillance were “gastroenteritis” and “influenza-like illness.” This
study has examined whether or not the BioDefend™ surveillance system is useful
in the context of the above referenced surveillance sites, and whether it could
serve as a national model for syndromic surveillance.
we realize you may not be able to call at precisely 11:10 a.m., it can be distracting to
the speaker and others in the audience when participants dial in throughout the
hour. Please try to call in on time, and remember to put your phone on mute so as
not to disturb others. Thank you for your cooperation.
of Epidemiology will be hosting its bi-weekly conference call with county health
department staff on Friday, July 25, 2003. The purpose of the call is to update
CHD staff on Bureau activities and to discuss issues of mutual interest. Each
week’s agenda will be determined by input from the CHDs and Bureau staff. While
the majority of agenda topics will probably be directed to surveillance and
investigations, any other CHD/Epi topics are appropriate. 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” will 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 Wednesday, July 23, 2003. Please
e-mail suggestions for agenda items and any presentation materials you may have
to Melanie Black at Melanie_black@doh.state.fl.us
or Don Ward at firstname.lastname@example.org.
The revised copy of
the surveillance case definitions should be posted by July 18th. The
updated list of reportable conditions sent to community providers is already
posted on the Epidemiology and Surveillance web site. Melanie Black in the Bureau
of Epidemiology is currently working with the Public Information Office to get
these lists printed and sent to each county health department. Updated alphabetic
and numeric lists of Florida disease codes are already posted on the Web.
These lists are for epidemiology program internal use only; please do not
send the disease code lists to community providers. The list of reportable
laboratory findings is currently being revised for approval. Any questions
regarding notifiable conditions in Florida should be directed to the Communicable
Disease Surveillance and Reporting Section, Bureau of Epidemiology at
Epi Update. Jaime Forth, editor of the weekly publication, affirmed that articles from all medical professionals are welcome for inclusion in the Epi Update. Writers might consider sending abstracts concerning unusual outbreaks or occurrences; interesting studies or activities in which individuals or their staff participated; information about noteworthy upcoming conferences; reports on new medical treatments or investigations [in] which the individual has been involved or has written. For information concerning submission guidelines, email Jaime, at email@example.com.
Case Definitions and Reportable Disease List. Kathryn Teates, surveillance and reporting section administrator, discussed pending changes to the Merlin reporting system. She outlined updated and completed lab findings and new codes which will go into effect next week. There will also be rule changes which necessitate a change to the reportable disease list. Be alert to other changes and email her or her staff with questions. Changes will also be listed on both our Internet and Intranet sites. There will be additional announcements in future editions of the Epi Update. Kathryn’s email address is firstname.lastname@example.org.
Chronic Disease Epi. Marie Bailey was introduced as the new BFRSS coordinator and announced that a working group will form to meet later this month. Information concerning the program is readily available and anyone seeking assistance can email her at email@example.com.
BT Grant Spending 2003-04. Don Ward, acting bureau chief, brought attendees up to date on approved budget figures for the next fiscal year. The $10 million bioterrorism grant funds for Epidemiology and Surveillance include new surveillance and epidemiology projects, training for 72 recently hired county health department epidemiologists, and quarterly regional training on preparedness on response. Don also elaborated on the type of surveillance activities for which the bureau is prepared to commit funding.
The next conference call is scheduled for July 25th. Stay tuned for details or email Professional Training Coordinator Melanie Black at firstname.lastname@example.org
Weekly, a sanitized extract of communicable disease case data is made from the Merlin Disease Reporting System and forwarded to the Planning and Evaluation internet web server where it can be queried through web forms to produce high-level reports. Users can choose from selection criteria including ICD9 codes, County Name, and a range of dates from which to request reports. The web site offers several subtotal “group by” options such as age groups, gender, and zip code.
These reports can be viewed by visiting the Florida Department of Health public website at http://www.doh.state.fl.us and clicking “Health Statistics” under the “Reports and Health Statistics heading. Then select “Communicable Disease Frequency Reports”.
The development effort as well as the ongoing enhancement and maintenance of the data and reporting capabilities are credited to staff in both offices including Kathryn Teates and Xiaobing Zhang of the Bureau of Epidemiology and to Chris Keller and Ron Humphries of the Office of Planning, Evaluation, and Data Analysis.
Managing Public Health Threats Topic of Upcoming
New HIV Quick Test Available at
There are high hopes, however, that the new rapid test, which boasts 99.6% accuracy, will bring changes to that scenario. OraQuick Rapid HIV-1 Antibody Test is a single-use qualitative immunoassay that detects antibodies to HIV-1 in a fingerstick sample of blood. Although the accuracy rate for positives is high and no false positives were found in clinical trials, follow-up confirmatory testing should still be completed, according to the FDA.
interest of reducing the number of persons who don't return to receive their test
results, the Department of Health and Human Services has granted a waiver for
non-traditional venues to act as testing sites using OraQuick. Kits cost
approximately $10-15 each. To find out more about the certificate of waiver
program administered by the Centers for Medicare and Medicaid Services, go to the
CMS CLIA website at http://www.cms.gov/clia/cliaapp.asp.
Bureau of Epidemiology and Bureau of Laboratories have completed the 2002-03
Influenza Season Summary. This final report is posted on the Internet under
Diseases and Conditions, Influenza.
summary report covers the Florida Sentinel Physician Reporting System, laboratory
surveillance, results, and future plans for influenza surveillance in Florida.
Recruitment plans and materials for the upcoming influenza season will be made
available by September. Questions or comments can be directed to Melissa Covey,
the influenza surveillance coordinator, at the Bureau of Epidemiology in
Jacksonville. To reach Melissa, call at 904.791.1567.
EEE virus activity: Eighteen horses were confirmed with
EEE virus infections, bringing the YTD total for horses
infected with EEE virus to 157 in 42 counties, with seven new counties added this
week. This year so far, there are more than six times the number of horses which
were reported with EEE in all of last year. Fourteen seroconversions to EEE virus
were confirmed in sentinel chickens. No
dead birds were reported positive with EEE. Six live wild birds were found EEE-positive, one
juvenile in Walton County suggesting a recent infection. Of Florida’s 67
counties, 46 have reported EEE activity, compared to 16 this time last year. EEE
activity appears to be spreading out from the central region.
West Nile (WN) virus activity: Three seroconversions to WN virus were confirmed in sentinel chickens, for a YTD total of 57 WN seroconversions in 17 counties. Nine dead birds were reported positive for WN virus. Twenty-nine counties have reported WN virus activity this year, with sporadic distribution around the state, compared to 18 at this time last year.
The complete report can be viewed at: http://www9.myflorida.com/Environment/hsee/arbo/weekly_summary2003.htm
|Bureau of Epidemiology|