Rounds to Offer Insight on Palm Beach Malaria Outbreak|
September 30, 2003
MSW, Professional Training Coordinator, Bureau of Epidemiology
of Plasmodium vivax Malaria – Palm Beach County, Florida, 2003
M.D., M.S.P.H., Palm Beach County Health Department, Division of
Epidemiology & Disease Control
The incidence of
indigenous malaria in the USA has decreased since 1957 but may
re-emerge due to the development of
chloroquine resistance, changes in environmental conditions and
increased international travel.
Seven cases of
introduced malaria were investigated in Palm Beach County during the
months of July and August 2003. Six of the seven patients had no risk
factors for malaria and denied any international travel. Patients 1
and 2 live four houses apart and both reported having attended the
same 4th of July block party that evening in their
neighborhood. All of the patients denied previous history of malaria,
blood transfusion, organ transplantations, or IV drug use.
While the index case has not been
identified, several possible sources were considered. Palm Beach
County has a large immigrant population including many migrant farm
laborers from Mexico and Central and South America. Returning
international travelers were also considered.
Notices were sent
to all local physicians and hospitals, informing them of the presence
of malaria in the area and requesting information and testing on
anyone with a history of unexplained fever or other malaria symptoms.
public education were implemented, such as door-to-door home visits
and reverse 911 calls to residents in the targeted area. The public
was educated through news media and postal mailings detailing the
symptoms of malaria, modes of transmission and preventive measures.
Mosquito traps were placed in the area around the homes of the patient
cases. Larvicide and insecticide were applied in surrounding
With the increase
in international travel, imported cases of malaria pose a threat,
especially to those living in warmer climates. Medical providers
should provide malaria chemoprophylaxis for travelers to countries
where malaria is indigenous. They should also consider malaria a
differential diagnosis for persons with unexplained fever, and perform
a thick peripheral blood smear to diagnose malaria.
Proper Use of Antibiotics Unveiled
The Department of Health and Human
Services has a message for parents: Lay off the Antibiotics!
Referred to as antimicrobial drugs
because they fight infections caused by bacteria, they revolutionized
medical care after the 1940s and saved millions of lives.
Everyone agrees antibiotics are a good thing but when, a decade ago,
it was discovered that overuse was leading to a host of new resistant
bacteria, health officials began warning physicians to be
more firm with patients who expected to be issued antibiotics to treat
common ailments such as sore throats and the flu.
that antibiotics are effective only against bacterial infections, but
the pressure to yield to patient demands is one of the reasons
frequently cited for over prescribing antibiotics. Dr. Michael Fleming
of Shreveport, LA and president-elect of the American Academy of
Family Physicians said “You can’t imagine on a daily basis the
pressure on a physician to write(a prescription for) that antibiotic.” After an
aggressive campaign by professional public health organizations,
however, the trend has slowly begun to reverse, and physicians are
beginning to counsel patients with a “wait and see” method of
treatment for viral infections rather than reaching for the
Curriculums at medical schools are
under development to provide the new generation of physicians with the understanding
relationships between antibiotic resistance, mechanisms of resistance,
diagnosis judiciousness and techniques and prophylaxis. The next phase
of the educational effort is a national media campaign directed
towards parents with messages aired by the FDA, CDC and other health
agencies. One Public Service Ad, released this month, reads, “Snort.
Sniffle. Sneeze. No antibiotics, please.” The intent of the ads is to
make it clear to parents and others that antibiotics are powerful
drugs intended for treatment of bacterial, not viral infections and,
if overused, they may be unresponsive when needed for treatment of
stronger infections that could develop in future.
The CDC has developed several programs
to address the problem, and the information can be accessed at the
following web sites:
Active Bacterial Core Surveillance
Division of Healthcare Quality
National Antimicrobial Resistance
Monitoring System for Enteric Bacteria
►Cure for the
Common Cold One Step Closer
Annual Interscience Conference on Antimicrobial Agents and
Chemotherapy convened in Chicago this week, and one of the most
talked-about topics at the conference was a research project which
actually began two years ago.
pneumovirus called human metapneumovirus (HMPV), a
Paramyxovirus which may be the source of the common cold, has
excited the scientific community because it could also be the cause
of several severe respiratory illnesses affecting children and
infants who are hospitalized each year.
In 2001, a Dutch
scientist named van den Hoogen cultured nasal swabs submitted during
the winter season from young children with respiratory tract disease.
His seroprevalence studies showed that 25% of the children aged 6-12
months had detectable antibodies to HMPV and that by age 5, every
child showed indication of past infection. Subsequent studies by
researchers in the U.S., Israel, England and Australia supported his
initial findings and further implied that HMPV is capable of causing
clinically important reinfection in late childhood or adult life.
of the pathogen is still fairly recent, it is estimated that the virus
has existed for centuries but has been difficult to find because it
does not grow capably in cell cultures. And since the human body
doesn’t remember the metapneumovirus after contracting an illness from
the virus, it doesn’t develop immunity. The result, of course, has
been miserable colds and those terrible tasting cold medicines ever
since most of us can remember. However, those days may soon be behind
us, now that scientists know which virus to attack in their war on the
►Regional Training Set for Volusia County in October
The Bureau of
Epidemiology is pleased to announce the next regional training for
county health department staff members, which will be held in
Daytona Beach at the Volusia County Health Department on Wednesday,
October 29th and Thursday, October 30th, 2003.
The target audiences for the regional training programs are county
health department staff members and partner agencies who conduct
will address public health surveillance and communicable disease
outbreak investigations. Specific topics such as principles of
public health surveillance, improving provider reporting, principles
of field epidemiology, historical overview of emerging pathogens and
an outbreak scenario will be covered in this training. On-line
registration is now available through Friday, October 17, 2003 and
can be accessed through the Bureau of Epidemiology Internet web
Space is limited to 45 participants, so register as soon as
information will be provided in the Epi Update and on the
Bureau of Epidemiology web page. We also intend to offer training
programs in other regions of the state. If you are interested in
hosting one of the training sessions or have questions related to this
program, please feel free to contact Professional Training Coordinator
Melanie Black, Bureau of Epidemiology at (850) 245-4444, ext.2448 or
SunCom 205-4444,ext. 2448.
We are truly
excited about the potential this program offers for improving disease
prevention in Florida and encourage you to pass this information along
to colleagues who may be interested.
Healthcare Research and Quality Announces Bioterrorism
The Agency for
Healthcare Research and Quality will present the fourth event in its
series of bioterrorism health system preparedness seminars on
Tuesday, October 21 via audiocast.
audio conference, entitled, “The Role of Information/Communication
Technology and Monitoring/Surveillance Systems in Bioterrorism
Preparedness” will air from 2 – 3:30 p.m. EDT. There is no charge for
registration or participation, but registration is a must. For
detailed information, contact Cheryl Bell at
firstname.lastname@example.org or phone her at 202.828.5100.
include John Loonsk, M.D., director of CDC’s Information Resources
Management Office, U.S. Department of Health and Human Services.
Dr. Loonsk will present strategies for improving coordination of
activities between the systems and organizations involved in public
health surveillance. Dr. Michael Wagner, Ph.D., assistant professor of
medicine and intelligence systems at the Center for Biomedical
Informatics at the University of Pittsburgh will discuss innovative
surveillance systems and the information they can offer policymakers
as well as public health providers. Chief of the Department of
Emergency Services, Children’s Hospital, Harvard University Michael
Shannon, M.D., M.P.H., will highlight the role played by information
technology in improving syndromic surveillance and decision-making.
►This Week on EpiCom
On the EpiCom web site this
- A suspect case of infant botulism
in Broward County
- Two malaria outbreak conference
calls among eight Florida counties were held
For further information regarding the
EpiCom program, send an email to
Three WN virus cases were reported this week in residents of Lee
(onset 8/29), Santa Rosa (onset 8/20) and Washington (onset 8/6)
counties, bringing the number of cases reported this year in Florida
to 31. The following 18 counties are under medical alert: Bay,
Brevard, Broward, Collier, Duval, Escambia,
Lafayette, Lee, Miami-Dade, Nassau, Okaloosa, Orange, Palm Beach,
Santa Rosa, St. Johns, Union and Washington. Malaria has been
reported in seven Palm Beach County residents. The total number of
EEE cases remains at two.
activity in animals: Five new
infections were reported in horses this week. In sentinel chickens,
2 seroconversions to EEE virus were reported. One dead bird from
Walton County was reported positive for EEE virus. To
date, 52 of Florida’s 67 counties have reported EEE virus activity,
compared to 23 counties reporting EEE last year at this time.
WN virus activity in animals: Seven
WN virus infected horses were reported this week; one in Dixie County
being the first WN report from that county this year. In addition, 45
seroconversions to WN virus were confirmed in sentinel chickens from
18 of the 33 counties that collected samples. Six dead birds were reported positive for WN virus. Fifty-six
counties have reported WN virus activity, compared to 48 at this time
The complete report can be viewed
to TopWeekly Disease
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