Friday, July 11,
"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."
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| This Week in the News|
► Polk County Health Department Increases Outreach
Government grants and a change in their approach to certain area residents should boost the ability of health department officials to prevent the spread of infectious diseases in one Central West community.
► 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.
► Trends in Tobacco Use Among New Mothers Unveiled
A statistical study ties results of data from the Florida Youth Tobacco Survey and Behavioral Risk Factor Surveillance System, to trends in smoking among Florida's new mothers.
► Salmonella Outbreak Traced to Tampa BBQ Restaurant
An outbreak of Salmonella poisoning brought Hillsborough County Health Department authorities to a Tampa restaurant to examine food practices.
► Officials Say Japanese Encephalitis Epidemic in China Under Control
The outbreak, first detected in April, has peaked, and authorities say the worst is over.
► Pre-Pregnancy Study Among Florida Women Finds Links Between BMI and Health
Healthy pre-pregnancy weight is an essential element for a healthy baby, according to a study by bureau epidemiologists.
► Arboviral Disease Report
Statistics through the week ending July 7, 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).
A R T I C L E S
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology
Curt Miller, BS, and Youjie Huang, MD, DrPH, Bureau of Epidemiology, Chronic Disease, Surveillance and Evaluation Section
David Atrubin, MPH, EIS Officer, Bureau of Epidemiology and Michael Friedman, MPH, Bureau of Community Environmental Health
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Marie A. Bailey, MA, MSW, BRFSS Coordinator and Curt Miller, BS, Epidemiologist, 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
County Health Department Increases Outreach
According to Dr. Daniel Haight, director of the Polk County Health Department, some groups are difficult to reach with messages concerning infectious diseases. Migrant farm workers may have language or transportation problems preventing access to health care, while drug users may use poor hygiene or lack health insurance. Other hard-to-reach individuals are alien residents, runaway youths, or illiterates who can’t read the information handed out by health department workers.
Jose Lojo, a Florida EIS Officer, was recently assigned to the health department after leaving the CDC in Atlanta. As an epidemiologist, he's interested in breaking down barriers that may exist between groups of people who “from our perspective, are under the public health radar.” He's now part of a team of health professionals whose mission it is to meet with members of the underserved community living in Polk County.
To ensure future efforts will reach segments of the population that don’t speak English and to assist health department staff in gaining an understanding of the difficulties encountered by other cultures, the team of Spanish-speaking doctors, epidemiologists, disaster planners and others has been assembled to visit areas in which the underserved reside. There are also plans to produce a field manual which can help other health providers deal with hard-to-reach populations.
The effort to reach out will involve building trust, making presentations on good health practices, and letting people know about the health department and what it can do for them. For more information about the Florida EIS or the Polk County programs, contact Alan Rowan at 850.245.4444, ext. 4404 concerning EIS, or Daniel Haight at 863.519.7900, ext. 1002 in Polk County.
Bioterrorism Syndromic Surveillance: A Dual-Use Approach with Direct
Application to the Detection of Infectious Disease Outbreaks
Important: While 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.
for this report are based on data from three sources: the Florida Pregnancy Risk
Assessment Monitoring System (Florida PRAMS), for 1993 through 2000; the FYTS,
for 1998 through 2001; and the Florida BRFSS, for 1990 through 2000. Florida
PRAMS is a joint surveillance project between the Florida Department of Health
and the CDC, designed to
monitor the physical, economic, and social health of Florida’s mothers and
newborns. The project was designed as a mail survey with telephone follow-up of a
random sample of recent mothers of live-born infants, completed when the infant
is approximately three to six months old.
Statistically significant declines from 1993 to 2000 in
overall prevalence of smoking during the three months before pregnancy and during
the last three months of pregnancy suggest that some tobacco control and
reduction efforts might be having an impact on new mothers in Florida.
efforts to prevent or reduce tobacco use of pregnant women and new mothers should
be continued at the high school level, at programs for low-income women such as
Women, Infants, and Children (WIC), and at primary physicians’ offices. Even in
cases where a health care worker may be confident that the new mother-to-be does
not smoke, counseling on how babies may be affected by second-hand smoke is still
critical, especially given that Florida PRAMS data indicate a possible increase
in infant exposure to second-hand smoke across all age groups. Infant
exposure to second-hand smoke has been associated with SIDS and respiratory illnesses in children.
When ascertaining the smoking status of a new mother-to-be, the physician,
nurse, or health care worker should also inquire whether anyone in the
and Background: On June 25, 2003 the Hillsborough County Health
Department was informed that two persons who had eaten lunch on June 20, 2003 at
a local BBQ restaurant in Tampa experienced gastrointestinal illness
approximately 24 hours after their meal. Reported symptoms included vomiting,
abdominal cramps and diarrhea. One of the two affected persons was hospitalized
and placed on kidney dialysis. Thirteen additional ill individuals, who all
shared similar food histories involving the same BBQ restaurant, have been
identified. All fifteen persons ate food from this restaurant during the period
of June 18-21, 2003, with BBQ sauce being the only common food among them. Five
of the fifteen illnesses were confirmed Salmonella group B cases (with matching
strains identified by PFGE). Two of these five cases had not been previously
linked to this BBQ restaurant, but were only done so after matching strains were
identified by the Jacksonville DOH Laboratory. Upon re-interview, it was learned
that these two persons did consume food from the implicated restaurant during the
June 18-21 time period.
Fifteen persons (including one employee) were identified as either
confirmed or probable Salmonella group-B cases associated with dining at the same
BBQ restaurant during the period of June 18-21, 2003. All persons identified ate
in the restaurant or consumed carryout food from the restaurant during the
specified time period. At this point, extended data are available for 10 of the
fifteen cases. The mean onset of the symptoms was 25.6 hours with a range of
15-36 hours. Symptoms experienced by
the ill restaurant patrons were diarrhea (100%) and vomiting (60%) being the
predominant symptoms. Duration of illness ranged from a couple of days to over
environmental field investigation was performed at the BBQ restaurant in Tampa on
June 27, 2003. Preparation of all identified common foods consumed by the ill
persons was reviewed and the kitchen facility was inspected by the DBPR
representative. Large numbers of sanitation, employee hygiene and temperature
control violations were identified. Some of the most significant problems
identified included roast pork hot held at 95 degrees, roast chicken at 110
degrees, no hand wash sink in the kitchen area, inadequate sanitizing of work
surfaces and equipment and live roaches observed in the kitchen. In addition, one
food worker who had experienced gastrointestinal symptoms was identified. A
warning was issued by the DBPR inspector to correct all violations. Repeat visits
by the Health Department and DBPR were attempted; however, the restaurant
facility had been vacated and the present location of the owners is not
It is recommended that before the implicated restaurant is allowed to re-open, another
inspection of the facility be conducted, and educational food safety training be
provided for existing staff involved in all aspects of food preparation and
sanitation. All new kitchen staff should also undergo a similar training program.
In addition, ongoing monitoring of the facility’s operation should be
Encephalitis B, the leading cause of viral encephalitis in Asia with 30-50,000 cases reported each year, usually occurs seasonally and peaks in August. Since a vaccine was developed in the mid 1970s; however, countries which have experienced major epidemics in the past have been able to control the disease. Another major factor in the decrease of cases is an intensified effort to control the mosquito population.
The virus is
transmitted by mosquitoes which breed in rice paddies, and can spread further through domesticated pigs and wild birds. Case fatality rates range from 0.3% to
60%, and it is known to kill over 10,000 people each year in rural Asia. Japanese
encephalitis usually does not occur in urban settings.
Pre-Pregnancy Study Among Florida Women
Finds Links Between BMI and Health
The goal of this study was to document associations between
pre-pregnancy BMI (Body Mass Index) and pregnancy outcomes and health factors
among women in Florida. This report describes pre-pregnancy BMI and its
relationship to pregnancy outcomes and health conditions. This is the first PRAMS
report published nationally on pre-pregnancy weight. Other similar reports focus
on maternal weight gain during pregnancy. We approached this study from quite a
unique perspective, as we focused on pre-pregnancy BMI as a risk factor, and its
associations with birth outcomes and adverse health conditions during prenancy.
The report also describes the
socio-demographics of women who were at risk of pre-pregnancy underweight,
overweight, or obesity among Florida women in 2000.
Methods: The data analyzed were from the 2000 Florida Pregnancy
Monitoring System (PRAMS). Maternal pre-pregnancy weight-for-height status was
measured by BMI, which is weight in kilograms divided by height in meters squared
The following pregnancy outcomes were analyzed for this report:
1) preterm births, 2) delivery by Cesarean Section, 3) low birth-weight births,
and 4) length of infant’s stay in hospital. The following health conditions
were analyzed for the report: 1) diabetes, 2) hypertension, 3) urinary tract
infection, and 4) premature rupture of membranes (PROM).
Results: The prevalence of pre-pregnancy underweight was highest among non-Hispanic White women aged 19 years and under. On the other hand, the prevalence of pre-pregnancy obesity was higher among non-Hispanic Black women and women aged 35 and older than among their counterparts. Non-Hispanic Black women had the highest prevalence of pre-pregnancy obesity (20.6%). Pre-pregnancy weight was associated with health outcomes: The prevalence of Cesarean Section (30.9%), diabetes (20.3%) and hypertension (26.9%) during pregnancy was the highest among obese women. The prevalence of newborns who spent more than two nights in the hospital was significantly higher among those born to obese mothers than among those born to non-obese mothers. The prevalence of urinary tract infections during pregnancy was highest among underweight women (25.2%). Prevalence of low-birth-weight births (9.8%) was significantly higher among underweight women than among their normal-weight counterparts (6.8%).
Higher levels of poor birth outcomes and health conditions are present among
women who are either underweight or obese prior to pregnancy. Underweight mothers
had higher levels of preterm delivery, low birth-weight infants, and urinary
tract infections. On the other hand, obese mothers had higher prevalence of other
diseases and complications such as C-sections, diabetes, hypertension, PROM, and
infants who had longer hospital stays.
The full report can be found
seroconversions to EEE virus were confirmed in sentinel chickens. Twenty-seven horses were confirmed
with EEE virus infections in 16 counties, bringing the YTD total for
horses infected with EEE virus to 140 in 35 counties.
Two dead birds were
reported positive with Highlands J virus, a close relative to EEE but not as
pathogenic in humans. Five
live wild birds in Santa Rosa County and three in Okaloosa County were found to
be EEE-positive. Most of these birds were
hatchling-year birds indicating a recent infection. Of Florida’s 67 counties, 42 have reported EEE activity, compared to
16 this time last year. EEE activity is
documented primarily in the central, northern and panhandle regions.
Three seroconversions to WN virus were confirmed in sentinel chickens, for a YTD
total of 54 WN seroconversions in 16 counties. Seven dead birds were reported positive for WN virus.
counties have reported WN virus activity this year, with sporadic distribution
around the state, compared to 12 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|