Friday, July 25,
"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
► Broward County Study Shows Increase in Shigella Cases
A recent study shows unanticipated increases in separate, simultaneous outbreaks throughout Broward Country, causing concern among health officials there.
► Bureau of Immunization Videoconference Offers CEUs
Topics will include discussion of the influenza vaccine including recommendations for use of the new live attenuated intranasal vaccine, pneumococcal conjugate vaccine, and the hepatitis B vaccine.
► July 29th Grand Rounds to Feature Bioterrorism Study
Scheduled for 11:00 a.m. until noon, the presentation will feature details of a surveillance study performed earlier this year in Florida.
► FDA Proposes Provisions to Enhance Bioterrorism Act of 2002
Proposed as a enhancement to the Public Health Security and Bioterrorism Preparedness and Response Act (Bioterrorism Act) signed by President Bush last June, the provisions would cover all consumables currently under FDA regulation, including alcoholic beverages, baby formulas, animal feed and dietary supplements.
► Immunization Awareness Month Approaching
The medical community is laying preparations now for upcoming flu season. Find out how to become involved in your area.
► Arboviral Disease Report
Statistics through the week ending July 21, 2003. Confirmed cases only.
► Weekly Disease Table
Florida Department of Health, Bureau of Epidemiology Weekly Morbidity Report for the current week only includes selected diseases and conditions for confirmed cases.
Submissions to Epi Update should be emailed to Jaime Forth at email@example.com. Articles must be submitted as a Word document attachment in plain 10-point Arial font with no boxes, centering or other elements added to the text. Please clearly identify the author. Only final documents (not drafts) are accepted. If you have questions, call 245.4444, ext. 2440. We look forward to hearing from you!
A R T I C L E S
Soni Schulze, MPH, Florida EIS Officer, Bureau of Epidemiology
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
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
Nature of Outbreak: There has
been an increase in the number of reported* shigella cases in Broward County
beginning in June 2002. Since that time the county has been well above the
anticipated 6.7 cases per month, based upon the three year average, 1999-2001.
For the period June 2002 – May 2003, the average number of cases per month was
approximately 17.7 cases, which is more than 2.6 times higher than the 1999-2001
three year average. It appears that this increase is attributable to separate
outbreaks that are occurring simultaneously. The larger of the outbreaks is in
children aged ten and under with 73 % (154/211) of the cases. Case reviews have
not shown any particular day care center or elementary school linked to a high
proportion of cases. In fact, there were 65 day care centers and elementary
schools identified with shigellosis infections within their organization. On
average, there have not been more than two cases reported at any one facility. In
instances where an outbreak is identified, Broward County Health Department
provides educational in-servicing and sends educational materials to the facility
to control further spread of the illness.
smaller outbreak appears to be among men who have sex with men.
Communicable Disease Nursing has made possible links to circuit parties through
case investigations. There were 2.25 times more reported shigella cases in men >
25 years than in women in the same age group. Additional educational outreach may
be necessary among this population to identify cases and prevent further disease
clinic is scheduled to open in August this year in the Wilton Manor area through
grant funding, to deal specifically with the syphilis outbreak Broward County is
experiencing. However, attempts are being made to coordinate other services such
as hepatitis and HIV screening. Screening for enteric pathogens will be added for
codes (33311 and 33023) have been identified with a significant number of
shigella cases. There appear to be two possible clusters and further
investigations will continue, particularly in these areas. Contact has been made
with Child Care Enforcement (regulatory agency for day care centers). A current
list with mailing labels has been obtained from this agency. An updated Shigella
Facts Sheet will be distributed to some (or possibly all) day care centers.
Agent Identification: Of the
cases reported between June 2002 – May 2003, 202 lab reports were received with
the species identified. The species which predominates in Broward County is shigella
sonnei with approximately 92.6% (187/202) of the cases with species
identified, shigella flexneri with 6.4% (13/202) and shigella boydii with 1.0%
(2/202) as identified by the Merlin reporting and analysis system, Case Management
Symptoms: Watery or
bloody diarrhea, abdominal pain, fever, and malaise are the common clinical
features of shigellosis infection1. Severe infection may occur in young children
and the elderly, and seizures have been associated with infection in children
under the age of two1. Reiter’s syndrome can be a late complication of
infection with shigella flexneri, especially in those who are genetically
predisposed with the genetic marker HLA-B271. The following are identified risk
groups according to the CDC; children in child-care centers, persons in custodial
institutions where personal hygiene is difficult to maintain, international
travelers, men who have sex with men, and those in homes with inadequate water
for hand washing.
Transmission and Incubation: Transmission
of shigella is mainly by direct or indirect fecal-oral contact. This may be
through contaminated food or water, or person-to-person contact2. Hand washing
is the key to preventing the spread of shigellosis. As few as 10-100 organisms
are needed to cause shigella infection. The incubation period is 12-96 hours with
an average of 1-3 days2.
Preventive Measures: Broward
epidemiology staff will continue to conduct case investigations and identify
possible risk factors. Educational materials and outreach will be provided as
appropriate. The goal will be to identify new cases and prevent further
transmission of the disease to others. A copy of the Shigella Facts Sheet is
available at the Broward County website, http://www.browardchd.org./
* Data depicted for 2002 and 2003 are considered preliminary and reported cases are subject to change. Reported cases include both “reported” and “not yet reported” cases within the guidelines of the Merlin reporting system.
The Grand Rounds scheduled for July 29th will commence at 11:00 a.m., with guest speaker Kristin Uhde, surveillance director at the Center for Biological Defense, College of Public Health at the University of South Florida presenting the outcome of a bioterrorism study which tested BioDefendTM as a new method of syndromic surveillance. The call in number is 850.478.8587 or SunCom 277.8587. Please be sure to dial in by 11:10 a.m. and place your phone on mute so others will not be disturbed. If you have questions, contact Melanie Black at firstname.lastname@example.org.
four provisions would be contained in Title III, Subtitle A (Protection of the
Food Supply). The proposal includes registration of food facilities by
December 12th of this year. This would be applicable to foreign or domestic facilities which manufacture, pack,
process, distribute, hold or receive food for consumption by humans and animals in
December 12th, 2003, the FDA would receive advance notice of each
shipment of food into the United States. The formal notice would include a description of all
articles in the shipment including the manufacturer, shipper and grower,
country of origin, anticipated port of entry and the country from which each
article is shipped.
proposed stipulation would authorize the FDA to administratively detain food if
the FDA holds credible information that the food poses a threat of serious
adverse health to humans or animals in the U.S.
fourth proposal would enable the FDA to investigate credible threats of serious health
impacting humans or animals by tracing the food back to its source, by requiring
persons that pack, transport, distribute, receive, hold, import and/or
manufacture food to create and maintain records which clearly identify the
immediate previous sources and immediate subsequent recipients of food.
Although these regulations have not yet been approved, they would apply to all facilities for all foods and animal feed products regulated by the FDA, including dietary supplements, infant formulas, beverages, including alcoholic beverages, and food additives. For more information or to track the progress of this proposal, log on to http://www.fda.gov/oc/bioterrorism/bioact.html.
virus activity in animals: Ten horses were confirmed with EEE
virus infections, bringing the YTD total for horses infected with EEE virus to
168 in 45 counties, with three new counties added this week. This year so far,
there are nearly seven times the number of horses than were reported with EEE in
all of last year. Seventeen seroconversions to EEE virus were confirmed in
sentinel chickens. Two dead birds were reported positive with EEE (Alachua and Leon). Two live
wild birds were found EEE-positive, both juveniles in Walton County suggesting
recent infection. Of Florida’s 67 counties, 46 have reported EEE activity,
compared to 19 last year by this time. EEE activity appears to be spreading out
from the central region.
Nile (WN) virus activity: Ten seroconversions to WN virus were confirmed in
sentinel chickens, for a YTD total of 67 WN seroconversions in 20 counties
(Martin, St. Lucie and Walton with new sentinel WN activity this week).
Six dead birds were reported positive for WN virus. Thirty-three
counties have reported WN virus activity this year, with sporadic distribution
around the state, compared to 21 last year by this time.
complete report can be viewed at: http://www.doh.state.fl.us/Environment/hsee/arbo/weekly_summary2003.htm