►Medical Defense Against Biological and Chemical Agents to Air August 27th
This live satellite broadcast sponsored by the U.S. Army and presented by the Uniformed Services University of Health Sciences will take a look at present-day clinical protocols which were learned from past battlefield experience.


►Public Health Grand Rounds: Disease, Disaster and Detection Program for Laboratory Infrastructure
Designed by Minneapolis/St. Paul to protect and improve its laboratory infrastructure, this program may give you ideas for improving your own community laboratory sturcture. CEUs are being offered.


►Changes to CDC Information and Guidance
The CDC has released updated information and guidance concerning SARS and West Nile virus applicable to reporting, control, prevention and surveillance.


►Adult Tobacco Survey Now Available Online
This telephone survey of adults was completed in May and results regarding behavior, attitudes and beliefs are now available online.
 

►Florida Behavioral Risk Factor Surveillance System Study Now Available Online
Three summary data reports have been released as part of a collaboration with the CDC, and are now available online.


►This Week on EpiCom
If you haven't logged on recently, you've missed some important details concerning the malaria cases reported in Palm Beach County.


►Arboviral Disease Report
Statistics through the week ending August 18, 2003 for 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.

A R T I C L E S

Michael Lo, MSPH, Florida Epidemic Intelligence Officer, Bureau of Epidemiology

Marie A. Bailey, MA, MSW, BRFSS Coordinator, Bureau of Epidemiology

Marie A. Bailey, MA, MSW, BRFSS Coordinator, Bureau of Epidemiology

Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology

Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, DMV, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health

Please note that numbers are subject to change with confirmatory information

►August Grand Rounds to Examine Collier County Vehicular Mortality Rates

Tuesday, August 26, 2003  11:00 a.m. - 12:00 p.m. EST
Melanie Black, M.S.W., Professional Training Coordinator, Bureau of Epidemiology

Presenter: Michael Lo, M.S.P.H., Florida Epidemic Intelligence Service, Bureau of Epidemiology, Florida Department of Health 

The dial in number will be posted on the Bureau of Epidemiology intranet website.

Abstract

Statistics from the Florida Department of Health’s CHARTS data system show that Collier County has been consistently higher than the state average on age-adjusted death rates and years of potential life lost due to fatal motor vehicle crashes. Additional data from death certificate records show that motor vehicle traffic accidents were the leading cause of injury death among Collier County residents between1997–2001. As a result, the Collier County Health Department’s injury prevention task force, formed in 2002 to address the problem of unintentional injuries in the county, decided to make motor vehicle traffic injuries a focus area for intervention. 

Death certificate data from the Florida Department of Health’s Office of Vital Statistics and crash data from the Florida Department of Highway Safety and Motor Vehicles (DHSMV) were obtained for analysis to better inform the preventive efforts of the task force. Frequencies on a variety of demographic and crash variables related to fatal traffic accidents were tabulated and cross-tabulated, and traffic accident death rates and adjusted odds ratios of death determined from logistic regression modeling were calculated for the various demographic strata. It was found that males, residents ages 15–24, Hispanics, Immokalee residents, and combinations thereof were more likely to have died from motor vehicle traffic accidents between 1997–2001. Lack of safety belt use, alcohol use, and locations at or near intersections were found to have been factors in fatal motor vehicle crashes in Collier County during the same time period. On the basis of these findings, the demographic groups identified will be targeted for a traffic safety education campaign in partnership with other agencies and community-based organizations in Collier County. 

Additional Information

Further details regarding the audio-conference call and the PowerPoint files will be posted on the Bureau of Epidemiology Intranet web site. CEU’s will be provided for nursing. Information about upcoming topics and presenters will also be posted in the Epi Update. If either of these access points is unavailable to you, please email Melanie Black (Melanie_Black@doh.state.fl.us) or telephone (850) 245-4444 ext. 2448 (SunCom 205-4444 ext. 2448) to request presentation materials.

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►Medical Defense Against Biological and Chemical Agents to Air August 27th

Advanced Topics on Medical Defense against Biological and Chemical Agents

Chemical Threat Agents:  What Has History Taught Us
Course No. 03.USAMRICO. A Live Satellite Broadcast

27 August 2003 1:00 - 3:00 p.m. EST (Test Signal from 12:30 -1:00 p.m. EST)

Sponsored by The U.S. Army Medical Command and the Department of Veterans Affairs Employee Education System and the Emergency Management Strategic Healthcare Group

Unlike the situation with biological warfare agents, there is an extensive historical experience in dealing with chemical warfare agents which are still threats both on the battlefield and in a civilian terrorist scenario.  In planning to respond to any chemical warfare agent attack, we must rely to a surprising extent on the historical record of previous encounters with chemical warfare agents. This program will explore what we have learned from history and how we must apply these lessons to planning today. This live, interactive, two-hour satellite broadcast will provide didactic discussion on a variety of topics. A live question and answer session will follow. Experts from the US Army Medical Research Institute of Chemical Defense, Uniformed Services University of the Health Sciences, and other organizations will present this program. The US Army Medical Research and Materiel Command will host the program at no charge to the viewer.

Agenda/Objectives: Briefly describe the US military's experience with chemical warfare agents in World War I and the use of chemical warfare agents in the Iran-Iraq War (1984-1987). Describe some of the ways in which modern clinical protocols derive directly from battlefield experience in history with chemical warfare agents. Explain how many of the issues posed by the modern chemical warfare threat are not new and how the study of history can inform our response today. Live Q & A session included. 

Target Audience: Military and civilian medical care providers; eergency and intensive care workers; rehabilitation medical care providers; first responders and others who would assist in recognizing and managing casualties from a biological and chemical agent attack. 

Accreditation/Approval: The VA Employee Education System (VA EES) is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The VA EES takes responsibility for the content, quality and scientific integrity of this CME activity. The VA EES is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation.

Continuing Education Credit: The VA Employee Education System designates this educational activity for a maximum of 2 hours in category 1 credit towards the American Medical Association Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. The VA Employee Education System designates this educational activity for 2.4 contact hours in continuing nursing education. A certificate of attendance will be awarded to participants and accreditation records will be on file at the Employee Education System. To receive a certificate from EES, you must sign in/register at the beginning of this activity, complete an evaluation/critique, and attend 100% of the satellite broadcast.

Faculty Disclosure Statement: The Employee Education System (EES) must insure balance, independence, objectivity, and scientific rigor to all EES sponsored educational activities. The intent of this disclosure is not to prevent faculty with a significant financial or other relationship from presenting materials, but rather to provide the participant with information on which they can make their own judgments. It remains for the participant to determine whether the faculty interests or relationships influence the materials presented with regard to exposition or conclusion. When an unapproved use of a FDA approved drug or medical device, or an investigational product not yet FDA approved for any purpose is mentioned, EES requires disclosure to the participants. Faculty reports regarding disclosable relationships or FDA issues are not complete at this time.

Individual Registration Instructions: Individuals should register on-line at the web-site www.biomedtraining.org. You will be able to review and choose from a list of viewing sites available in your state. You must confirm your registration at a specific viewing site by using e-mail or telephone information indicated for your site facilitator. If you do not have Internet access or cannot complete your registration on-line, please call RegisterAmerica.net at (850) 784-6002, Ext 16 for assistance.

Specific Satellite Coordinates: Are currently posted at www.biomedtraining.org.

Test Signal: The test signal for the live satellite broadcast will be from 12:30 - 1:00 p.m. EST on the same day of the program in August. Broadcast of the program begins promptly at 1:00 p.m. on 27 August 2003.

Site Facilitator Instructions: Ensure your organization or installation has assigned one person to act as the local site facilitator who will register your facility at www.biomedtraining.org. If you do not have access to the Internet or cannot complete your site registration on-line, please call RegisterAmerica.net at (850) 784-6002, Ext. 16 for assistance. They will help you register or determine if your organization or installation has been registered as a downlink site. The local site facilitator must reserve a classroom and obtain a local technical point of contact (POC), and should be prepared to be the main POC for information regarding their facility (i.e., satellite downlink capability, GETN site code/ID, and/or VTC system dial-in number).

Satellite Technical Specifications: The broadcast will be available as C-band, Ku-band, and digital (GETN:  i.e. Air Warrior, AETC, ATN, etc.) satellite signals, as well as a VTC signal via the U.S. Army Medical Command's (MEDCOM) VTC Bridge. Arrangements can be made to use the MEDCOM Bridge by sending an email to vtc.usamissa@cen.amedd.army.mil or by calling 210-637-2256 or DSN 471-9706 extension 2256. Please have your Site ID # available.

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►Public Health Grand Rounds: Disease, Disaster and Detection Program for Laboratory Infrastructure

"Disease, Disaster and Detection: Partnering with Public Health Laboratories" will air Friday, September 26, 2003, at 2:00 - 3:00 p.m. Eastern Standard Time. This program will focus on the laboratory network in the Twin Cities area of Minneapolis/Saint Paul, Minnesota, and how this system works to strengthen public health infrastructure to protect and improve the health of the community.

Continuing education credit for various health professions will be offered based on one hour of instruction. To be eligible, you must complete an online registration and evaluation.

This broadcast may be viewed at a satellite downlink site near you or online. Online registration, program information, and a list of currently available sites are located at our web site: http://www.PublicHealthGrandRounds.unc.edu. If you don't find a site near you on our website, please contact us by emailing grand.rounds@sph.unc.edu or phone 919.843.9261. 

Remember! Your nearest site facilitator may need a request from you before registering a viewing site for the broadcast.  For more information contact Donna E. Davis, MPH, Project Director, Public Health Grand Rounds or Reid S. Jaffe, Public Health Preparedness Coordinator at (850) 245-4444 ext 3393.

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►Changes to CDC Information and Guidance

The following changes or additions were made to CDC guidance and/or information during the period August 1 to August 15, 2003.  If you have any questions on these or other clinical issues, please call our Clinician's Information Line at 877-554-4625: 

West Nile Virus -  www.cdc.gov/ncidod/dvbid/westnile/index.htm

The following document describes surveillance, laboratory diagnosis, prevention, control, and reporting for West Nile virus: Guidelines for Surveillance, Prevention, and Control http://www.cdc.gov/ncidod/dvbid/westnile/resources/wnv-guidelines-aug-2003.pdf.

A US map showing the distribution of animal and human cases of West Nile virus infections: West Nile Virus in the United States as of August 14, 2003*
http://www.cdc.gov/ncidod/dvbid/westnile/surv&control03Maps.htm.

As of today, August 15, there have been 470 cases of West Nile virus infections in humans reported to the CDC in 25 states and 10 deaths. This web page is updated daily with human case counts: West Nile Virus 2003 Human Cases
http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount03.htm.

SARS - www.cdc.gov/ncidod/sars/ 

There has been an outbreak of an acute respiratory illness in a residential care facility for the elderly in North Surrey, British Columbia, Canada, involving 97 residents and 46 staff members since July 3, 2003.  Preliminary test results indicate a virus similar to SARS coronavirus; however, the illness in most patients has been mild (i.e., cold-like symptoms). Outbreak Notice: Respiratory Illness in Long-term Care Facility in British Columbia, Canada: August 14, 2003 http://www.cdc.gov/ncidod/sars/sarsupdatecan.htm. The fact sheet on SARS has been revised to include a retrospective on the management of the SARS outbreak that occurred earlier this year. Fact Sheet: Basic Information About SARS
http://www.cdc.gov/ncidod/sars/factsheet.htm.

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►Adult Tobacco Survey Quality Control Report Now Available Online

The Florida ATS (Adult Tobacco Survey) Quality Control Report is now on available online at:  http://www9.myflorida.com/disease_ctrl/epi/Smoking/FL_ATS_Summary_Tables.pdf

The ATS is a telephone survey of adults 18 and older, developed by the CDC.  The survey is designed to collect detailed data on cigarette use behavior, attitudes and beliefs about cigarette use, and attitudes and beliefs about the health risks of second-hand smoke. The ATS was implemented for the first time in Florida in May of 2003 with the achieved goal of collecting 1,300 completed interviews. These data will be sufficient for providing overall estimates at the state level.

The Florida ATS will be implemented again in spring of 2004, with a goal of collecting 3,600 completed interviews. Results from the 2004 ATS will be used to analyze cigarette use behavior, attitudes and beliefs by sex and by race/ethnicity.

Implementation of the 2003 Florida ATS has been a collaboration of the Bureaus of Epidemiology and of Chronic Disease Prevention, the Division of Health Awareness and Tobacco, the Centers for Disease Control and Prevention, and our respective vendors, Macro ORC International and Research Triangle Institute.

For more information on the 2003 Florida ATS, please contact: 

Marie A. Bailey, MA, MSW
BRFSS Coordinator
4052 Bald Cypress Way Bin #A-12
Tallahassee, FL  32399-1720
Office:  850.245.4444 extension 2434
Fax:  850.922.9299
Email:  marie_bailey@doh.state.fl.us

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►Florida Behavioral Risk Factor Surveillance System Survey Now Available Online

Three summary data reports for the 2002 Florida Behavioral Risk Factor Surveillance System (BRFSS) survey are now on available online at http://www9.myflorida.com/disease_ctrl/epi/brfss/summary_reports.htm.  As part of its collaboration with states to implement the annual BRFSS survey, the CDC provides summary data reports of each state's data. These data reports provide descriptive statistics for the BRFSS core questions, any optional modules that were supported, and estimates for calculated risk factor variables (such as "at risk for heavy drinking"). 

Specifically:

1.   The BRFSS State Data Report for Florida Statewide is a standard set of tabulations used for all states. This report provides estimates for most, if not all, of the core questions asked in 2002.

2.   The BRFSS State Prevalence Report of Risk Factors for Florida Statewide. Tabulations in this report contain prevalence estimates for health behaviors and preventive health measures by race and sex.

3.   The BRFSS Optional Modules Report for Florida Statewide provides estimates for the optional questions that Florida funded in 2002.

For more information on the 2002 Florida BRFSS, please contact Marie Bailey at marie_bailey@doh.state.fl.us.

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►This Week on EpiCom

A fourth patient case of malaria has been diagnosed in Palm Beach County.  For details, log on to https://epicomfl.net/

For further information concerning the EpiCom program, send an email to EpiCom_Administrator@doh.state.fl.us.

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►Arboviral Disease Report  

Six West Nile (WN) virus infection cases were reported this week from Broward, Escambia, Miami-Dade, Okaloosa (two) and Santa Rosa counties. Onset dates range from 6/23 to 8/11.  Bay, Brevard, Broward, Collier, Escambia, Gilchrist, Lee, Miami-Dade, Okaloosa, Orange, Palm Beach and Santa Rosa counties are under medical alert. 

Human WNV infections total 13 so far this year and EEE infection remain at two. Last year by this date, there was one human EEE infection in a Highlands County resident and one WN infection in a Sumter County resident with a travel history to Louisiana. Eastern Equine Encephalomyelitis (EEE) virus activity in animals:

No new EEE virus infections were reported in horses this week. In sentinel chickens, 14 seroconversions to EEE virus were reported from seven counties. One dead bird from Santa Rosa County was reported positive for EEE virus. 

To date, 52 of Florida’s 67 counties have reported EEE virus activity, compared to 20 counties reporting EEE last year at this time. WN virus activity in animals: Five WN virus infected horses from three counties were reported. In addition, 46 seroconversions to WN virus were confirmed in sentinel chickens from 16 counties. 

Twenty-two dead birds from eight counties were reported positive for WN virus. Forty-four counties have reported WN virus activity, compared to 35 at this time last year. Mosquito Pools: Eleven mosquito pools, ten from Palm Beach County and one from Escambia County, tested positive for WN virus this week. 

The complete report can be viewed at: http://www.doh.state.fl.us/Environment/hsee/arbo/weekly_summary2003.htm

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