Friday, July 30, 2004
Week in the News
"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."
of Epidemiology Hosts EpiCom Satellite Broadcast
of Depression and Injury Among Florida's High School Students
A poster abstract from the statewide epidemiology seminar in May explains the association between drug and alcohol use among teens and suicide.
Welcomes Medical Epidemiologist
|Epi Update Managing Staff:||
The latest news on recommendations made by the CDC, the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics on the national shortage of pneumococcal conjugate vaccine.
MD, MBA, MPH,
Secretary, Department of Health
►Sensor Shields Combine Medicine and Technology
An emergency room physician with an interest in analyzing breath to diagnose illness and a biomedical laboratory engaged in innovative homeland defense concepts will begin a study this summer.
Division of Disease
and Surveillance of Escherichia coli (E. coli)|
Clarification on this notifiable condition and when and how it should be reported may help to minimize false positive reports and identify newly emerging EHEC serogroups.
Acting Bureau Chief,
Week on EpiCom|
Log on regularly to access information that could be vital to your organization if you're in the middle of an investigation. Someone else could be experiencing an outbreak that may be similar to yours.
Copy Editor / Writer
A report outlining activities for the week July 18 - 24, 2004 for confirmed cases.
A R T I C L E S
|Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology||
Bureau of Epidemiology Hosts EpiCom Satellite Broadcast
The Bureau of Epidemiology will be hosting a satellite broadcast on EpiCom and ER Census on Wednesday, August 25, 2004 from 10:00 –11:00 a.m. EST.
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.
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
Melissa Murray, MS, Coordinator of
Statistical Research, Bureau of Epidemiology; Youjie Huang, MD, MPH,
Administrator, Chronic Disease Surveillance and Epidemiology, Bureau of
Epidemiology; Zhaohui Fan, MPH, Epidemiologist
Prevalence of Depression and Injury Among Florida's High School Students
|Jaime Forth, Copy Editor / Writer, Bureau of Epidemiology||
Bureau Welcomes Medical Epidemiologist
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
Chief, Bureau of Immunization, Department of Health
This is a follow-up to earlier notices sent to county health departments and immunization partners regarding the national shortage of pneumococcal conjugate vaccine (PCV7), and the suspension of the administration of the third and fourth dose of PCV7. Due to improved vaccine supplies, new recommendations have been issued and are published in Notice to Readers: Updated Recommendations for Use of Pneumococcal Conjugate Vaccine: Reinstatement of the Third Dose, July 9, 2004/53(26);589-590. The entire text can be found online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a7.htm
Effective immediately, the Centers for Disease Control and Prevention, in consultation with the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics, recommends that providers administer 3 doses of pneumococcal conjugate vaccine. The fourth dose should still be deferred for healthy children until further production and supply data demonstrate that a 4-dose schedule can be sustained. The full 4-dose series should continue to be administered to children at increased risk for pneumococcal disease because of certain immunocompromising or chronic conditions (e.g., sickle cell disease, anatomic asplenia, chronic heart or lung disease, diabetes, cerebrospinal fluid leak, and cochlear implant).
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
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.
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
|Jaime Forth, Copy Editor / Writer, Bureau of Epidemiology||
Combine Medicine and Technology
When sensor shields to detect chemical components were first used in the Soviet Union 20 years ago, they were large and unwieldy appliances. Now, years later, scientists from the Draper Laboratory in the U.S. have realized the impact such an apparatus could have on our country's ability to respond quickly to terrorist attacks, and have teamed with researchers from the Center for Integration of Medicine and Innovative Technology (CIMIT) in Boston, Massachusetts to design miniature technology capable of identifying bioterrorism agents.
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.
|Carmela Mancini, MPH, Administrator, Surveillance and Reporting Section, Bureau of Epidemiology||
Reporting and Surveillance of
Escherichia coli (E. coli)
Pathogenic E. coli is a notifiable condition in the state of Florida. Pathogenic strains of E. coli include enterohemorrhagic E. coli O157:H7 (EHEC); E. coli shiga toxin positive, serogroup non-O157; and E. coli shiga toxin positive, not serogrouped. A lab result stating only, “E. coli positive” does not indicate infection with a pathogenic strain and should not be reported to the state health office. In such cases, county health department staff should conduct follow up to determine the shiga toxin status and/or serogroup.
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.
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
|Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology||
This Week on EpiCom
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.
|Arbovirus Surveillance Team: Samantha Rivers, MS, Caroline Collins, Kristen Payne, Calvin DeSouza, and Carina Blackmore, MS Vet. Med., PhD., State Public Health Veterinarian||
West Nile (WN) virus activity: A human case of WN infection was confirmed in a fifth Miami-
Dade County resident. There were 12 seroconversions to WN virus in sentinel chickens from Brevard, Hillsborough, and Palm Beach counties. Eight dead birds from Miami-Dade County and one from Hillsborough County were confirmed positive for WN virus. So far this year, 22 counties have reported WN activity.
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.