Friday, August 29,
"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 et al.
International Journal of Epidemiology
Epi Update Managing Staff:
John Agwunobi, MD, MBA, Secretary, Department of Health
Landis Crockett, MD, MPH, Director, Division of Disease Control
Acting Bureau Chief,
Epi Update Managing Editor
Jaime Forth, Copy Editor/ Writer
| This Week in the News|
►Malaria Outbreak in Palm Beach County Strikes Seven
Seven persons in Palm Beach County have tested positive for locally-acquired Plasmodium vivax infection since July. Local hospitals have been alerted to the possibility of potential new cases.
as the Next Bioweapon?
A R T I C L E S
Barbara F. Johnson, RN, BSN, JoEllen Alvarez, RN, MPH, Savita Kumar, MD, MSPH, Palm Beach County Health Department, Division of Epidemiology and Disease Control
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Kathryn Teates, MPH, Communicable Disease Surveillance & Reporting Manager, Bureau of Epidemiology
Jaime Forth, Copy Editor/Writer, Bureau of Epidemiology
Carina Blackmore, DVM, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health
Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology
Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, DVM, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health
Please note that numbers are subject to change with confirmatory information
The Palm Beach County Health Department has investigated seven cases of locally acquired Plasmodium vivax malaria. All seven cases are Palm Beach County residents and are males ranging in age from 17 to 45 years. Onset dates range from July 12 through August 19, 2003. The first case was reported to the Palm Beach County Health Department on July 25, 2003.
Symptom onset in the first four cases occurred in July and for the last three cases in August. The first five cases sought medical care repeatedly, but malaria was not considered in their diagnosis until subsequent medical visits.
The case with onset of illness in August was a blood donor who donated platelets and whole blood in the months of June, July and August 2003. Trace forward investigations of recipients of his blood products are ongoing.
Countywide education to residents in English and Spanish has focused on
prevention and control of mosquito borne illness. A countywide malaria
alert was issued. Reverse 911 calls were made to educate residents living
in a geographic area selected to include residences of all cases and
incorporate mosquito flight distance. A malaria medical directive went to
hospitals and private practitioners alerting healthcare providers to
consider malaria as a possible diagnosis in patients presenting with fever
of unknown origin or high fever, headache and chills, and to consider
ordering a thick blood smear for malaria testing.
With influenza the cause of 20,000 deaths in the U.S. alone each year, flu has potential for use as a biological weapon should it be transmitted in aerosol form. The theory was presented by a team of U.S. scientists from the University of Texas Health Science Center at Houston, Texas writing in the Journal of the Royal Society of Medicine in July.
Their research showed that many people die from influenza-related myocardial infarction, which goes unreported as influenza mortality. With the link between cardiovascular mortality and influenza now established, mortality rates in the U.S. due to flu are probably 90,000 rather than the previously estimated 20,000, according to Dr. Mohammad Madjid, the team leader.
During their search for a link between influenza and cardiovascular disease, the team studied a series of flu epidemics which spread through Spain, Russia and Hong Kong, killing 20 to 40 million during the last century as the virus naturally mutated. They became concerned about ways in which would-be terrorists and scientists might misuse information about the virus, once the sequencing of the genome for the 1918 Spanish pandemic is completed. It is estimated that mapping of the genome will be accomplished within two years.
In their report to the Royal Society of Medicine, the team wrote that “unlike anthrax or smallpox, influenza is available, can be aerosolized, the incubation period is short and ….moreover, if an epidemic starts, it may look natural because flu happens every year. And, whether man-made or natural, it can rapidly overwhelm and paralyze the whole health-care system.” Terrorists need only spray an aerosolized virus inside a bus, train or airplane compartment to start a global infection.
According to Klaus Stohr, a project leader at World Health Organization, the theory merits consideration. “The tools to create a virulent strain are readily available.” He says that reverse genetics are there to readily produce the surface proteins and other proteins needed to assemble viruses on demand.
Instead of waiting for such an event to occur, Madjid suggests implementing preventative measure now, such as increasing security at laboratories, vaccine manufacturers and distributors; encouraging more widespread use of vaccine programs; stockpiling antiviral drugs; expanding disease surveillance; and installing filters and detectors in buildings.
The influenza season is rapidly approaching and with it some changes in the Influenza Surveillance Program. The Bureau of Epidemiology has sent updated recruitment brochures and letters to each of the county health department epi contacts in preparation for recruitment. The Bureau of Epidemiology will also be hosting a conference call for the county health departments on September 8th from 11 a.m.-12 p.m. EST to introduce the Influenza Surveillance Program, methods for recruitment and details about how to sign up community providers to the sentinel physician network. An email invitation will be going to each county health department epi contact as well as key laboratory personnel. Information about the program will also be posted to the Bureau of Epidemiology website at the conclusion of the conference call.
next scheduled conference call between Bureau of Epidemiology staff and county
health departments will be held on Friday, September 5th from 10:00 -11:00 a.m.
The recent malaria outbreak in Palm Beach County indicates a need for enhanced malaria surveillance across the state.
Seven cases of locally transmitted Plasmodium vivax malaria have been confirmed in Palm Beach County. All patient cases are males with a median age of 37 years and onset dates ranging from July 12th through August 19th. Anopheline mosquitoes, the malaria vector, have a short (~1-2 mile) flight range; although all cases live within a 5 X 8 mile area, it is likely there are multiple transmission foci in the county.
Malaria (both P. vivax and P. falciperum) used to occur throughout Florida but because of improved agricultural drainage techniques and improved housing and mosquito control, the number of human cases began to decrease in the late 1930’s. The state has been considered malaria free since the late 1940’s. With large populations of malaria vectors and people visiting or immigrating from countries where malaria is endemic, however, the likelihood of local transmission of malaria in Florida is great, especially during late summer months. Despite this, reports of locally acquired malaria are rare. The last case cluster (with 2 cases) was reported from Palm Beach County in 1996. However, symptoms (particularly vivax malaria) can be mild and rare reports of locally transmitted malaria may, in part, be a result of undiagnosed and underreporting of cases.
ensure we won’t have other locally transmitted malaria in the state, we encourage epidemiologists in all county health departments to
disseminate information about malaria and the outbreak in Palm Beach County to
their local health care providers. It is also important that a detailed travel
history is obtained on each reported case. Please don’t hesitate to call (850-245-4732, SC 205-4732) or email me (Carina_Blackmore@doh.state.fl.us)
with any further questions on malaria or other vector-borne and zoonotic
- More Malaria Cases in Palm Beach County
- A request for information regarding emerging infections/VRSE in Kansas
For further information concerning the EpiCom program, send an email to EpiCom_Administrator@doh.state.fl.us.
Two WN virus infection cases were reported this week from Broward County, with onset dates 8/2 and 8/8. The following 12 counties are under medical alert: Bay, Brevard, Broward, Collier, Escambia, Gilchrist, Lee, Miami-Dade, Okaloosa, Orange, Palm Beach and Santa Rosa. Human WNV infections total 15 so far this year, and Eastern Equine Encephalomyelitis (EEE) infections remain at two. Last year by this time, 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.
EEE virus activity in animals: Four new EEE virus infections were reported in horses this week. In sentinel chickens, 4 seroconversions to EEE virus were reported from 4 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: Eight WN virus infected horses were reported. In addition, 76 seroconversions to WN virus were confirmed in sentinel chickens from 24 of the 31 counties that collected samples. Thirty-two dead birds from 14 counties were reported positive for WN virus. Fifty counties have reported WN virus activity, compared to 43 at this time last year.
Mosquito Pools: Three mosquito pools from Monroe 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