August 12, 2005
Epi Update Managing Staff:
"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
Clostridium difficile is the most common cause of infectious nosocomial diarrhea in the United States. Over the past couple of years increases in C. difficle-associated disease have been reported in several states, Canada and Europe. In addition, the disease has been reported to be more severe and to result in increased mortality. With these changes a new strain of C. difficile has been identified that has been associated with outbreaks in hospitals. The new strain appears to produce greater quantities of toxins A and B then previously identified strains. In Florida there have been several reports of increases in incidence, morbidity and mortality of C. difficile-associated disease from infection control professionals and physicians.
The Agency for Health Care Administration hospital discharge data show an increase of over 65% in discharges with C. diffiicle enteritis from 2001 through 2003. Based on these reports, cultures of C. difficile from a Tampa bay area hospital were sent to the Centers for Disease Control and Prevention (CDC) for strain typing. Results from the CDC were positive for the new strain referred to as the BI/NAP1. Infection control measures and treatment of the new strain are not different from those for other strains. Prevention and control measures include judicious use of antibiotics, contact precautions for patients with known or suspected C. difficile, and thorough environmental cleaning and disinfection. Treatment for C. diffficle-associated disease includes stopping antibiotics used for other conditions, if possible. The recommended first-line treatment for this infection is metronidaxole, with vancomycin a second choice. There are reports, however, that the new strain may not respond as well to metronidazole as to other strains.
The Florida Department of Health would like to determine whether the new strain is present in other areas of the state. Laboratories outside the Tampa Bay area that have or can obtain cultures for C. difficile and would like strain typing performed, should contact Roger Sanderson by phone at 813.974.6305 for further instructions.
Additional information on C. difficile and the new strain can be found at www.cdc.gov/ncidod/hip/gastro/ClostridiumDifficile.htm.
Roger Sanderson is a regional epidemiologist assigned to the investigative section of the Bureau of Epidemiology in Tallahassee. He is currently headquartered in Tampa and can be reached at 813.974.6305.
On Wednesday, July 13, 2005 the Escambia County Health Department (CHD) received a complaint from a local business about a possible foodborne outbreak. The initial call indicated that approximately 7 of 54 employees had contracted gastrointestinal illnesses following two common meals from two separate food service establishments that had been delivered to and consumed at the office on July 11 and 12. After interviewing all of the employees, it was discovered that a total of 24 out of the 54 employees had become ill.
Five stool samples were taken and sent to the Bureau of Laboratories in Jacksonville and Tampa. All samples were negative for standard enteric bacteria; however, all five stools tested were positive for Norovirus G2. Data analysis shows that five of the employees became ill between two and five hours after the July 11 meal. Due to the short incubation period, however, it is unlikely that either meal was the cause of their illness. One of the group that became ill on July 11 was confirmed positive for Norovirus G2.
Although this outbreak was initially considered to be foodborne and related to Hurricane Dennis (landfall, July 9), the investigation proved otherwise. The rest of the cases became symptomatic in the afternoon and evening of July 12 and the early morning of July 13, suggesting person-to-person secondary transmission. There were no other apparent common exposures other than working together. The Escambia CHD has stressed the importance of frequent and proper handwashing for the prevention of transmission of disease.
Rick Hutchinson is
a regional environmental epidemiologist for Northwest Florida, in the
Bureau of Community Environmental Health. He can be contacted in
Tallahassee at 850.245.4444, ext. 2928.
This data book contains detailed statistics for all maternal and child health variables available in the Florida PRAMS datasets. This publication is presented in three sections: Maternal Health and Behaviors, Prenatal and Postpartum Care, and Infant Health. To make navigation through the material as user-friendly as possible, the layout of the bookmarks follows that of the table of contents. The release of this data book marks the completed publication of the five most current years of Florida PRAMS data. Access these and other Florida PRAMS publications online at the following Florida Department of Health website
It is our goal to produce a similar data book for each Florida PRAMS dataset beginning with our most current data, 2003, working retrospectively through to our earliest data, 1993. These data books have been completed, most of which are currently in review, five of which are published online at
Anyone with questions about these special reports can contact either Helen Marshall, PRAMS coordinator, ato 850.245.4444, extension 2415 or Curt Miller, data analyst at 850.245.4444, extension 2407.
Curt Miller is a data analyst in the
Chronic Disease Surveillance and Epidemiology Section of the Bureau of
Epidemiology in Tallahassee.
The unusual characteristics of the outbreak have caught the interest of medical experts in other countries. They note that the speed and high morbidity and mortality rates in people are inconsistent with endemic swine strep. Farmers having come into contact with the infected pigs have swiftly become symptomatic with fever, nausea, vomiting and bleeding under the skin. Thirty-nine so far are reported dead. Normally, cases of the bacterial infection are rare in humans and where they do appear they are sporadic, slow to develop, and accompanied by meningitis and hearing loss.
The atypical presentation of the reported cases has caused experts outside China to ponder other possibilities. They're concerned that a cross-species infection may have occurred or, given the fact that the area is still battling avian flu, the strain has been misidentified. China's past reluctance to share investigative information, and the fact that its practitioners have not requested consultation with experts in other countries, has caused neighbors such as Hong Kong to worry about the potential for another epidemic. In recent days Hong Kong has reported eight patients with confirmed Streptococcus suis.
Streptococcus suis is a species of bacterium relatively common among pigs, although it may be found in other mammals. Its typical route of transmission is between pigs raised in unsanitary or stressful conditions. Humans can contract the virus through skin wounds and abrasions when handling the pigs without protection. Infected pigs can be treated with antibiotics. Vaccines are available, but it is not certain whether they're fully effective.
To read more about this topic, click on the
Jaime Forth is managing editor of Epi Update and can be reached at 850.245.4444, ext. 2440.
Disease Update July 31 - August 6, 2005
Gadsden, Leon, Pasco and Pinellas Counties are currently under medical alert for mosquito-borne disease. Where biting 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.
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
contribute appropriate public health observations related
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.
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.
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