July 22, 2005

Epi Update Managing Staff:

John A. Agwunobi, MD, MBA, MPH, Secretary, Florida Department of Health
Landis Crockett, MD, MPH, Director, Division of Disease Control
Dian K. Sharma, MS, PhD, Bureau Chief, Bureau of Epidemiology, Editor-in-Chief
Jaime Forth, Managing Editor, Bureau of Epidemiology

"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., International Journal of Epidemiology 1976; 5:29-37



Email addresses are no longer provided as a method of contact for contributing authors.
We regret this inconvenience. This is a security measure designed to prevent Internet
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FDA Approves Single Booster Vaccine
Against Pertussis, Tetanus and Diphtheria
by Joann Schulte, DO, MPH
 

On June 10, 2005 the U.S. Food and Drug Administration approved Adacel, a vaccine for single-booster immunization against pertussis, for use in persons aged 11-64. The vaccine also includes tetanus toxoid and diphtheria toxoid. Licensure of this vaccine is expected to have a major impact on efforts to control pertussis, which still occurs in cyclic epidemics every two to five years. The Advisory Committee on Immunization Practices, which is an advisory group convened by the Centers for Disease Control and Prevention to set immunization schedules, is considering how the new vaccine should be used. It is widely expected that booster doses will be recommended for some adults as a control measure for pertussis.

Pertussis, a highly communicable and potentially serious illness in adolescents and adults, can cause prolonged cough and missed days at school and work. In young infants, pertussis is more frequently severe and can be fatal, particularly in those too young to be fully vaccinated. Since 1980, the rates of reported pertussis cases have been increasing in adolescents and adults, as well as in young infants. Adolescents and adults have been implicated as the source of pertussis infection for susceptible young infants and other family members.

For further information, you can review the two articles at the links provided here:
Article 1
Article 2

Joann Schulte is administrator of the Surveillance and Reporting Section of the Bureau of Epidemiology in Tallahassee.  To reach her, call 850.245.4415.

Fall Summit to Convene on Pandemic Influenza
by Jaime Forth

The Bureau of Epidemiology and Division of Emergency Medical Operations are co-sponsoring a one-day Pandemic Influenza Leadership Summit designed to facilitate working knowledge and collaboration among first responders and others who would assume primary responsibilities in the event of a flu pandemic.  

A pandemic occurs when a novel strain of influenza is introduced and spreads widely in a population where no one has pre-existing immunity.  The expected cumulative infection rate in such a situation would be approximately half of the population.  Planning for the threat of a pandemic caused by avian influenza or other novel influenza strains is a national and state public health priority having implications for every response discipline.  Generally, the objectives in planning for an epidemic of influenza are to reduce the total number of cases and the number of deaths due to the epidemic, minimize the social disruption caused by high infection rates and minimize the overall economic impact.  Pandemic Influenza is a complex scenario and an enormous planning effort which requires all of our response partners to come together.  To that end, you are invited to join us at the leadership summit where we will begin this important cross- discipline dialogue.   

Planned objectives are to review the status of preparedness among principle partners and identify current gaps in emergency planning, as well as educate the emergency response community and state executives on the principles of epidemiology and disease control concerning pandemic influenza. County health department and regional domestic security task force leadership, federal liaisons; members of  working groups involved in emergency or catastrophic planning; leaders in medical or corrections facilities; hospital response plan regional advisory groups, and the Domestic Security Oversight Council should consider attending to ensure preparedness for a major epidemic will be at a level commensurate with what we could encounter in the near future. 

The summit will be held September 13, 2005 at the Tampa Airport Marriott from 8:00 a.m. until 4:00 p.m. To make hotel accommodations at the government rate of $99.00, call 800.228.9290 by Monday, August 29.  

Event registration can be accessed online at the Department of Health website at
http://www.doh.state.fl.us/disease_ctrl/epi/conf/training/PanFlu_Summit.htm. There is no fee for participation in this summit. Should the number of persons registering exceed the available space, priority will be given to the target audience identified in the agenda. If you have questions about conference arrangements, contact Melanie Black,  Bureau of Epidemiology, Florida Department of Health at 850.245.4444, ext. 2448.

Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.
 

The Hillsborough County Perinatal
Hepatitis B Prevention Project
by Margaret Ewen, RN, BSN, MSPH; Warren Oliver, MPH;
Sandra Morehouse, MPH; Elaine P. Thomas

Introduction
State of Florida communicable disease reports indicate that since 1990, there have been 349 pregnant women who have tested positive for the Hepatitis B surface antigen (HBsAg) in Hillsborough County, Florida. The Hillsborough County Health Department (HCHD) Perinatal Hepatitis B Prevention Program received funding for a dedicated perinatal Hepatitis B health services representative for four years, and in 2004 its personnel began to develop and promote their program and its benefits through increased education and outreach services. Some of these measures included the establishment of a Hepatitis B information phone line, development of informational posters for HCHD clinic sites, and an increase of community education programs for the general public and the professional community. The HCHD Perinatal Hepatitis B Prevention Program also received funding through the state to design and place informational ads in the interior of public buses and on bus stop benches. As a result of these efforts, the HCHD Perinatal Hepatitis B Prevention Program received additional funding from the Florida Department of Health to establish the Hillsborough County Perinatal Hepatitis B Prevention Project. This funding is being utilized to sustain these efforts and stimulate development of new initiatives. 

Objectives
The main objectives of the Hillsborough County Perinatal Hepatitis B Prevention Project are to:

• Identify strategies to reduce the morbidity and mortality of Hepatitis B in the community
• Increase public awareness of the importance of immunization through training and education
• Act as a local resource for Hepatitis B immunization questions from the general public
• Develop and provide training on Hepatitis B immunization to local health care providers, public health workers, and professional and volunteer groups
• Promote the program and its benefits through newsletters, information packets, and TV and radio commercials.

Methodology
The Hillsborough County Perinatal Hepatitis B Prevention Project has applied the concept of social marketing (the use of traditional marketing strategies to “sell” the promotion of healthy behaviors) to improve the quality and outcome of perinatal Hepatitis B prevention efforts within its community. This social marketing strategy includes the development of a marketing plan, construction of a well-defined message, and employment of mass media to deliver the message. 

Results
Implementation of the project has already begun to yield results. In the month of January 2005 the information phone line received approximately 40 calls from persons seeking additional information. Trainings for public healthcare providers and community organizations have been planned and scheduled. These include drug and alcohol treatment centers, hospital and clinical sites, and facilities serving homeless persons, pregnant women, and runaway teens. In the first quarter of 2005, 16 sites were visited, reaching nearly 200 members of the community. Two television ads have begun production, and will be followed by radio spots and billboard messages. 

Conclusion
The development of community projects by the Hillsborough County Perinatal Hepatitis B Prevention Project is an effective means to improve the health outcomes of citizens served by the health department. The HCHD Perinatal Hepatitis B Prevention Program is evaluating the effectiveness of this project through client surveys and evaluations, and monitoring the use of the information phone line and requests for community training and education.  

Margaret Ewen is a senior community health nurse working in the epidemiology program at the Hillsborough County Health Department. Warren Oliver and Sandra Morehouse are health service representatives for Closing the Gap Project and Elaine Thomas is a health service representative for the Hillsborough County Perinatal Hepatitis B Prevention Program. To reach Margaret Ewen, call 813.307.8010 at extension 6702.

This was one of many abstracts submitted for the poster session at the Bureau of Epidemiology 2005 annual seminar this spring. Look for more abstracts from the seminar in upcoming issues of Epi Update.

Links to Merlin, EpiCom
Now Easier to Find
by Richard H. Hopkins, MD, MSPH

Have you ever been in someone else's office and wanted to access Merlin but realized you don't have the web address memorized? Now, thanks to D'Juan Harris, you can access both Merlin and EpiCom from links on the front page of the Bureau of Epidemiology's internet web site. Just look for the nifty Merlin and EpiCom logos on the left hand side of the screen.  [Click here to visit the Bureau of Epidemiology Intranet Site]

Watch for the EpiCom logo on the DOH main intranet page, too.

Dr. Hopkins is administrator of the newly formed Acute Disease Section of the Bureau of Epidemiology, comprised of the Investigations, Surveillance and Reporting, and Surveillance Systems Sections. To contact him, call 850.245.4412.

An Epidemiological Study on
Inflammatory Bowel Disease
by Regan Glover, MS

During this year’s legislative session Florida legislature passed the Inflammatory Bowel Disease Research Act.  The Act requires the Bureau of Epidemiology to conduct an inflammatory bowel disease epidemiology study and submit the finished product to the legislature in January 2006. 

Inflammatory bowel disease, Crohn’s disease, and ulcerative colitis (collectively known as IBD) are chronic disorders of the gastrointestinal tract which afflict approximately 47,000 Floridians. IBD represents a major cause of morbidity from digestive illness and, although it is not fatal, IBD is often devastating. 

The Florida Department of Health is working with the University of Florida College of Public Health and Health Professions for this epidemiologic study, which goal it is to gain a better understanding of the prevalence of the disease in the state, the unique demographic characteristics of the patient population, and the role that environmental factors and family history play in the development of the disease. The Bureau of Epidemiology is currently finalizing a study group to guide the study.  The group will consist of representatives from DOH, AHCA, Crohn’s and Ulcerative Colitis Foundation of America, the Florida House of Representatives, the Florida Senate, medical providers, and other interested groups. Our bureau will also seek assistance from the Centers for Disease Control and Prevention, which is conducting a similar study at the national level.  A report on its findings is expected to be sent to the governor, the president of the senate, and the speaker of the house of representatives by February 1, 2006.

Regan Glover is the IBD project coordinator, working in the Chronic Disease Surveillance and Epidemiology Section. Contact her at 850.245.4444, extension 2424.

July Grand Rounds: A Rapid Epidemiological
 Assessment Following a Natural Disaster Using a
Random Telephone Survey
by Marie Bailey, MA, MSW

Title: “A Rapid Epidemiological Assessment Following a Natural Disaster Using a Random Telephone Survey”
Presenter: Marie Bailey, MA, MSW, Florida BRFSS Coordinator, Chronic Disease Section, Bureau of Epidemiology, Florida Department of Health
Date: Tuesday, July 26, 2005 

Abstract
During August 13, 2004–September 25, 2004, Florida experienced four major hurricanes: Category 4 hurricanes Charley and Frances, and Category 3 hurricanes Jeanne and Ivan. In October 2004, the Florida Department of Health added 30 questions to the state’s Behavioral Risk Factor Surveillance System (BRFSS) survey to assess the impact of the hurricanes on state residents. This report summarizes the results of that survey, which indicated that 48.7% of Florida residents had no plans to evacuate, 17.5% of homes used a generator after electric power outages, and residents of counties outside the direct paths of the four hurricanes had consequences (e.g., physical injuries, barriers to treatment of health conditions, and loss of work days) similar to those who lived inside the direct paths of the hurricanes. 

BRFSS is a state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged >18 years. During November–December 2004, a total of 1,706 interviews were conducted in Florida, including 919 adults living within the direct paths of the hurricanes. Response rate was 42.5%; data were weighted by sex, age, and race to represent characteristics of the 2000 Florida population.  

Among all Florida residents, 51.3% reported having evacuation plans; results were similar for residents of counties in the direct path of hurricanes (53.5%) and those living outside the direct paths hurricanes (48.5%). More than one third (37.9%) of Floridians living in the direct paths evacuated their homes for at least one hurricane, compared with 26.7% of those living outside the hurricane paths.  

Overall, 17.5% of occupied Florida residences used a generator for electric power after hurricanes; 4.6% reported operating them inside a home or garage. Among all respondents, 51.4% reported some damage to their homes, including 43.3% who were not living in counties in the direct paths of the hurricanes.  

Overall, 45.8% missed work, lost their jobs, or both, because of the hurricanes, and 39.2% were out of work for more than 5 days.  Physical injuries caused by the hurricanes were reported by 4.6% of persons in the hurricane paths and 3.8% outside the hurricane paths. Among persons with health conditions such as diabetes, asthma, or cardiovascular disease, 5.4% reported their conditions were made worse as a result of the hurricanes. Among those who said their health conditions were made worse, 13.6% reported being prevented or delayed by the hurricanes in obtaining medication, and 9.0% reported barriers to accessing essential medical equipment (e.g., dialysis or oxygen).  

Emotional and mental health conditions were assessed in the interviews to determine whether any resulted from the hurricanes. Among all respondents, 10.7% reported current feelings of nervousness, worry, or anxiety because of the hurricanes; 6.0% reported feeling sad, or having loss of appetite or difficult sleeping; 3.9% reported reduced mental ability to work or study.

The findings from these data are based, in part, on contributions by the Florida Dept of Children and Families Adult Mental Health Program; Florida Behavioral Risk Factor Surveillance System Working Group; Bureau of Epidemiology, Bureau of Chronic Disease Prevention and Health Promotion, Division of Environmental Health, Florida Department of Health.  

Additional Information
The grand rounds presentation will begin promptly at 11:00 a.m. ET on Tuesday, July 26, 2005. The PowerPoint slides and dial-in number will be posted on the Bureau of Epidemiology intranet website on Friday, July 22, 2005. CEUs will be provided for nursing and environmental health professionals. If additional information is needed, contact Melanie Black, MSW, professional training coordinator, at 850.245.4444 ext. 2448.

Marie Bailey is coordinator of statistical research in the Chronic Disease Surveillance and Epidemiology Section in the Bureau of Epidemiology. She can be reached at 850.2425.4444, ext. 2434.

Regional Epidemiology Training to be
Held in Leon in August
by Melanie Black, MSW

The next Regional Epidemiology Seminar, co-sponsored by the Bureau of Epidemiology and the Leon County Health Department will be held in Leon County, Tallahassee, Florida on Thursday, August 11th and Friday, August 12th, 2005. Due to hurricane preparedness endeavors, the location is yet to be determined but negotiations are currently underway and a location will be announced next week. Target audiences for regional training seminars are county health department staff members who conduct epidemiologic investigations, and infection control practitioners.  

The August program will specifically address public health surveillance and communicable disease outbreak investigations. Topics such as principles of public health surveillance, improving provider reporting, principles of field epidemiology, using Merlin in investigations, measuring epidemiological effectiveness, and an outbreak scenario will be covered. On-line registration is now available and can be accessed through the Bureau of Epidemiology Internet web site at http://www.doh.state.fl.us/disease_ctrl/epi/conf/training/agenda.htm. The class will be limited to 45 participants. CEUs will be offered for the program; 8.5 hours for nursing, 11 hours for environmental health professionals and 4.5 hours for laboratorians. 

Additional information will be provided in the Epi Update and on the Bureau of Epidemiology web page. We intend to offer future training programs in other regions of the state. If you are interested in hosting one of these sessions or have questions related to the program, please feel free to contact Professional Training Coordinator Melanie Black at 850.245.4444, ext.2448 or SunCom 205.4444, ext. 2448. 

We are truly excited about the potential this program offers for improving disease prevention in Florida.

Melanie Black is the Bureau of Epidemiology's professional training coordinator and can be reached at 850.245.4444, ext. 2448 if you have questions related to training, Friday CHD conference calls, Grand Rounds or would like to discuss other opportunities.

Mosquito-borne Disease Update   July 10-16, 2005
Rebecca Shultz, MPH, Caroline Collins, Tasharra Kenion, Calvin DeSouza, Carina Blackmore, Ph.D.


Weekly Update: During the period July 10-16, 2005, the following arboviral activity (St. Louis encephalitis [SLE] virus, eastern equine encephalomyelitis [EEE] virus, Highlands J [HJ] virus, West Nile [WN] virus and dengue virus) was recorded for Florida: 

There are no counties currently under medical alert for mosquito-borne disease. Where mosquitoes are present, people are urged to take precautions against getting bitten.   

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

     

           This Week on EpiCom
                                      by Christie Luce

The Bureau of Epidemiology encourages Epi Update readers to not only register on the EpiCom system at https://www.epicomfl.net but to sign up for features such as automatic notification of certain events (EpiCom_Administrator@doh.state.fl.us) and contribute appropriate public health observations related to
any suspicious or unusual occurrences or circumstances. EpiCom is the primary method of communication
between the Bureau of Epidemiology and other state medical agencies during emergency situations.

• Two infant cases of pertussis in Polk County this week
• A fourth travel-related case of dengue fever in Pinellas County
• Hepatitus A in a Volusia County 2-year old child who attends day care
• Lee County reports Typhimurium in father and son linked to multistate warning concerning ice cream

Christie Luce is an EpiCom consultant in the Surveillance Systems Section of the Bureau of Epidemiology. She can be reached at 850.245.4444, ext. 2450.
 

                         Weekly Disease Table
                                                          by D'Juan Harris, MSP

Click here to review the most recent disease figures provided by the Florida Department of Health Bureau of Epidemiology.

D'Juan Harris is a GIS specialist in the Surveillance Systems Section of the Bureau of Epidemiology.
He can be reached at 850.245.4444, ext. 2435.

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