Friday, July 30, 2004

         This Week in the News
 

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

►Bureau of Epidemiology Hosts EpiCom Satellite Broadcast
A live broadcast on August 25th will feature a discussion on the ER census feature for hospitals that allows them to track unusual trends and clusters.

►Bureau Welcomes Medical Epidemiologist
Joann Schulte, DO, MPH, returns to Tallahassee to work full time for the Bureau of Epidemiology.

A R T I C L E S

Pete Garner, surveillance systems administrator, Bureau of Epidemiology, Florida Department of Health will moderate the program. EpiCom is an outbreak communications and emergency notification system developed and managed by the Florida Department of Health, Bureau of Epidemiology. The EpiCom system allows users to post messages related to suspected and confirmed disease outbreaks, and then notifies selected users when a threat to public health has been identified.  EpiCom also contains a feature that tracks hospital emergency room admissions data and produces charts and graphs that can identify aberrant census levels. The ER census feature is designed to help hospitals and county health departments gather meaningful data so they can recognize and respond to unusual trends or clusters. 

The presenters, Christie Luce, EpiCom marketing consultant and Karen Wheeler, MPH, bioterrorism special surveillance projects coordinator, key staff at the Bureau of Epidemiology, Florida Department of Health. They will discuss the EpiCom system and its components, highlight the significance of using the EpiCom system to share disease outbreak information with internal associates and community partners, introduce  participants to the ER surveillance aspect of EpiCom (specifically the ER Census Program), and explain how county health departments can use the ER census data to monitor aberrations in emergency room numbers from hospitals in their counties.  

Further information regarding the broadcast and how to access it will be made available through the Epi Update and also sent to site coordinators. One hour of CEUs will be provided to nursing for this program. CEUs are pending for environmental health professionals and laboratorians. Questions should be directed to Melanie_Black@doh.state.fl.us or Christie_Luce@doh.state.fl.us
 

Background:
According to the 2003 Florida Youth Risk Behavior Survey (YRBS), the prevalence of depression and considering, planning, and attempting suicide was significantly higher among girls and among public high school students who were current alcohol and drug users. The purpose of this study is to highlight the subgroups within Florida's high schools that have higher prevalence of suicidal behavior and injury. 

Methods:
Data from the 2003 Florida YRBS were analyzed to show the association between current alcohol and marijuana use and depression and injury among Florida public high school students. The prevalence of students who felt depressed, considered suicide, planned suicide, attempted suicide, or were injured as a result of a suicide attempt were analyzed among four groups: Non-alcohol users, current alcohol users, non-marijuana users, and marijuana users. The data were also analyzed by gender and race/ethnicity. 

Results:
Girls were significantly more likely than boys to report feeling depressed (37.6 percent versus 22.7 percent), considering suicide (20.4 percent versus 11.3 percent), planning suicide (14.8 percent versus 10.3 percent), and attempting suicide (11.8 percent versus 6.2 percent). A significant association was found between current alcohol and drug use and potential injury. Compared to students who did not consume alcohol in the past 30 days, current alcohol users were more likely to report feeling depressed (37.3 percent versus 23.8 percent), considering suicide (20.4 percent versus 12 percent), planning suicide (16.2 percent versus 8.9 percent), attempting suicide (12 percent versus 5.4 percent), and among those students who attempted suicide, sustaining an injury from a suicide attempt (39.1 percent versus 26.3 percent). Compared to students who did not use marijuana in the past 30 days, current marijuana users were more likely to report feeling depressed (40.3 percent versus 27 percent), considering suicide (23.6 percent versus 13.3 percent), planning suicide (20.5 percent versus 10 percent), attempting suicide (16.7 percent versus 6.3 percent), and among those students who attempted suicide, sustaining an injury from a suicide attempt (45 percent versus 28.8 percent). 

Conclusion:
Although no causal relationship between drug and alcohol use and depression and suicide can be drawn from YRBS data, there is a significant association between these behaviors. Efforts to reduce injury among youth should also target drug and alcohol abuse. Also, girls are more likely than boys to feel depressed and to have considered, planned, or attempted suicide. Future efforts should focus on issues specific to girls to combat this issue.  
 

Joann Schulte is a commissioned officer of the US Public Health Service, assigned to the Centers for Disease Control and Prevention. Attached to the Florida Department of Health for the past 18 months, Dr. Schulte has worked with the Bureau of Epidemiology on a part-time basis while also serving as the maternal-child health epidemiologist assigned to the Division of Family Health Services. In August 2004, however, her role will change to that of a medical epidemiologist focusing on communicable disease issues and issues related to bioterrorism. She will work solely for the bureau.   

With typical good humor, Joann describes herself as a rehabilitated journalist who was once a medical reporter for the Dallas Morning News. She received a BA in journalism from Kent State University and went on to earn a BS in health science from Florida International University in Miami, first writing about AIDS when there was a pediatric transfusion case in Dallas. She also worked as a reporter for newspapers in Florida.  

The Texas College of Osteopathic Medicine conferred her DO degree, and she earned a masters degree in public health from Emory University. She is board-certified in pediatrics and board-eligible in preventive medicine. She was a CDC EIS officer in Atlanta and then was assigned to the Texas Department of Health by CDC to complete her preventive medicine residency. After completing her training, she was division director for STD and HIV/AIDS epidemiology at the Texas Department of Health. 

She first visited Tallahassee as a medical student working at the Division of Sexually Transmitted Diseases (STD) with CDC during a syphilis outbreak, and returned to Florida to perform a study on STD, HIV and tuberculosis among migrant farm workers. 

Dr. Schulte honed her medical and epidemiological skills treating and investigating cases involving risk factors for delayed measles immunization, TB transmission in pediatric settings and HIV facilities, pertussis morbidity, Group B strep, and smallpox. At the Bureau of Epidemiology she will continue to play a key role in developing recommendations, assessing trends in disease surveillance, working on bioterrorism issues and leading investigations.   

Dr. Schulte can be reached at 850.245.4415, or email her at joann_schulte@doh.state.fl.us.
 

An interim catch-up schedule is provided in the notice for children who are incompletely vaccinated. The highest priority for catch-up vaccination is to ensure that children aged <5 years at high risk for invasive pneumococcal disease are fully vaccinated. Second priorities include vaccination of healthy children aged <24 months who have not received any doses of PCV7 and vaccination of healthy children aged <12 months who have not yet received 3 doses. This recommendation reflects CDC's assessment of the existing national PCV7 supply and will be modified if needed. Updated information about the national PCV7 supply is available from CDC at http://www.cdc.gov/nip/news/shortages/default.htm. 

We ask that you share this publication with everyone who provides immunizations. The Bureau of Immunization will continue to update you with any vaccine supply information. 

The Vaccines for Children (VFC) Program will continue to monitor supply of Prevnar to ensure both public and private providers receive some vaccine. Providers that are out or nearly out of Prevnar should contact their VFC program representative at 800.483.2543. 

For additional information regarding vaccine supplies, please contact Doug Lees of the Bureau of Immunization at 800.483.2543. For questions concerning the recommendations,  contact Vivienne Treharne, RN, of the Bureau of Immunization at 850. 245.4342. Visit the following Website for more information at http://www.cdc.gov/nip/news/shortages/default.htm#
 

In another part of Boston, an emergency room physician was having similar thoughts about a sensor device, only his concept was centered on an aid to diagnosis: If doctors can sniff the breath of patients to analyze illness and lab tests can detect ketones, he reasoned, couldn't a sensor do the same? After he attended a meeting at CIMIT where researchers explained what their sensor could do, he approached them with a proposal to evaluate the breath of patients with the device to determine whether it could detect the different gases in their breath signaling heart and lung problems or diabetes. The study will become a reality this summer when Brigham and Women's Hospital commences using a sensor to detect medical problems by analyzing patients breath.

This phenomenon, in which disciplines merge to facilitate new ideas in science and medicine, has become more prevalent in the last decade and has even resulted in the partnership of government agencies with private enterprise. Government and private industries have integrated to explore methods for the detection of an organism's DNA or assess potential health risks in organisms; it was a private researcher who suggested expanding the range of analytes that could be measured in the body to make electrochemical sensors more intelligent; and today our military forces are capable of using sophisticated testing sensors for airborne bacteria and viruses.

As the medical community explores new ways to strengthen its surveillance methods, some have reached out to an environmental approach that could be used in conjunction with other data to decrease the number of false positive alerts. Additional research may show that flexible use biosensors can provide the additional security that communities have been looking for.
 

A laboratory result indicating the isolation of a pathogenic strain of E. coli will commonly be reported as:  “E. coli O157:H7,” or “E. coli O157:H7, positive for shiga toxins,” or “E. coli not O157, positive for shiga toxins,” or E. coli not serogrouped, positive for shiga toxins.” Often the complete results or interpretation of the results will be located in the “General Comments” section of a paper lab record or the “Lab Result Notes” section of an electronic lab record.   

In 2003, a total of 79 cases (confirmed and probable) of pathogenic E. coli were reported in Florida; 61% were identified as O157:H7. Adults aged 60 and older and children aged 1-4 years represented 28% and 20% of the cases, respectively. Of the 79 E. coli cases, 48 (61%) were reported in Merlin with lab results confirmed by one of the state laboratories. 

Stool samples or isolates positive for E. coli O157:H7 or E. coli shiga toxin positive should be submitted to the Jacksonville branch of the state laboratory for confirmatory analysis.  Confirmatory testing minimizes the probability of false-positive reports and can also identify newly emerging EHEC serogroups; something private labs may not be capable of.    

For questions concerning E. coli reporting requirements please call Carmela Mancini at the Bureau of Epidemiology at 850.245.4401 (Suncom 205.4401). For questions or assistance with submitting isolates to the state lab for confirmatory testing please contact Ron Baker, Jacksonville branch laboratory, at 904.791.1605. 
 

This Week on EpiCom

• Jackson County evaluating a male in 30s for Brucella
• Volusia County reports patient from another state with presumptive E Coli
• Outbreak of MRSA in Manatee County at outpatient medical practice

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.

Eastern Equine Encephalomyelitis (EEE) virus activity: Four horses from Citrus, Marion, Osceola and Pasco counties were confirmed with EEE virus infection this week. There were five seroconversions to EEE virus in sentinel chickens from Hendry, Hillsborough, Jefferson, Nassau and Orange counties. So far this year, 23 counties have reported EEE activity. 

St. Louis Encephalitis (SLE) virus activity: None this week. Two counties reported SLE this year.

Highlands J (HJ) Virus activity: None this week. Eight counties reported HJ this year. 

Mosquito populations are present in many areas of the state. All are urged to take precautions against mosquito bites. Dead birds should be reported to www.wildflorida.org/bird/.

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

Bureau of Epidemiology

 Epi Update Archives

Florida Department of Health

My Florida

Contact Us

CDC