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►STEPS Grant
Awarded to Pinellas County
Under the
leadership of Dr. Youjie Huang, the Chronic Disease Surveillance and
Epidemiology Section at the Bureau of Epidemiology maintains an
impressive database of surveillance material based on surveys and
other methodology, which can be helpful to county health departments
should they need access to the data. This was the case
when the Pinellas County Health Department applied to the
federal government several months ago for a grant for implementation
of a community-based initiative to promote better health and prevent
diseases.
The project is one
of 12 nationally receiving a total of $13.7 million
under HHS' new Steps to a Healthier US program, which aims to
help Americans live longer, better, and healthier lives by reducing
the burden of diabetes, obesity and asthma and addressing three
related risk factors -- physical inactivity, poor nutrition and
tobacco use.
On September 18,
2003, HHS Secretary Tommy G. Thompson announced award of a $940,306 grant to
Pinellas County. The application process required cooperation from
many state and local partners, but BRFSS Coordinator Marie Bailey,
Bureau of Epidemiology was of particular assistance in providing
much of the data required on the application. Any health department
applying for grant monies should be aware that this information is just an email away. Contact Marie at
marie_bailey@doh.state.fl.us.
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►County Health
Department Conference Call Highlights
The
agenda for the bi-weekly conference call conducted on September 19th
contained two major items. The first was a presentation on morbidity
analysis/pertussis by Karen Wheeler, the bureau's bioterrorism
special surveillance coordinator. Second was an announcement and discussion by
Kathryn Teates, the bureau's communicable disease surveillance and
reporting
manager, concerning hepatitis outbreaks at outdoor concert events.
If you missed the call, here are some highlights.
Morbidity Analysis/Pertusis.
Karen Wheeler described the nature of the last pertussis outbreak in
Florida, which occurred in 1999 with 112 reported cases. A normal
year finds around 49 confirmed cases, mostly in children under five
years of age. There is a slow trend, however, toward adolescents and
adults. This trend is being monitored closely.
So far this year, there are 57
confirmed cases, which tracks similarly to the 1999 numbers. Duval
and Dade counties are showing the highest number of cases. Pertusis
outbreaks are cyclic in nature, with July the peak month.
Health care providers are advised to
scrutinize patients who present with coughing illnesses.
Currently, in addition to the 49 confirmed cases, there are
approximately 30 cases which are probable but not confirmed.
Hepatitis A Outbreaks Related to
Outdoor Concert Events. Kathryn Teates noted that the CDC is
investigating a multi-state outbreak of hepatitis A among persons
who attended outdoor concert and camping events. Poor sanitation and
hygiene are suspected causes, although food borne diseases have not
been ruled out. So far, affected states are Arizona, California,
Missouri, Colorado, Oregon, Wisconsin and New Mexico. Food service
workers in North Carolina and Maryland have also been diagnosed with
hepatitis A. (Editor's note: A related article in this issue of
Epi Update highlights efforts here in Florida to curb similar
outbreaks)
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►Grand Rounds Scheduled for
September 30th
Grand Rounds:
September 30, 2003 11:00 a.m. EDT
Coordinator: Melanie Black,
MSW, Professional Training Coordinator, Bureau of Epidemiology
Topic: Local Transmission
of Plasmodium vivax Malaria – Palm Beach County, Florida, 2003
Presenter: Savita Kumar,
MD, MSPH, 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.
Eight cases of
locally transmitted malaria were investigated in Palm Beach County during the
months of July, August and September 2003. Six of the eight 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.
Surveillance and
public education efforts 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
neighborhoods.
With the increase
in international travel, local transmission resulting from imported cases of malaria poses 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.
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►September Marks
Beginning of Influenza Season
Influenza
season officially begins September 29th. Vaccination is
an important tool in preventing community and institutional
outbreaks. Each county health department, as well as private
healthcare providers, offers flu vaccine each year. Please review
materials on the CDC National Immunization Program website to get
more information about when to get vaccinated, groups at high risk
for complications due to influenza infection and communication tools
for patients. There are several flyers available for download in the
Gallery.
CDC National
Immunization Program Influenza Gallery:
http://www.cdc.gov/nip/flu/gallery.htm
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►Group to Work on
Cutting Hepatitis Risks to Concertgoers
Always
aware of the health hazards associated with large gatherings in
outside venues, public health professionals work to minimize
potential risks to those involved. Don Windham, Regional
Environmental Epidemiologist in North Central Florida, has been
working on a hepatitis awareness information packet with staff from
the Suwannee County Health Department in Live Oak. The CDC has noted
that there has been a multi-state outbreak of hepatitis A among
young adult concert attendees, especially in the western part
of the country. Most of the cases attended multiple events in which
camping was involved. There is a large music park located a few
miles north of Live Oak specializing in concert series and
festivals, wildlife shows and similar events. The CDC is concerned
that, although the summer season has ended, fall concert
tours have begun and transmission of the virus could continue and
thrive at venues such as the one located near Live Oak.
A disease
surveillance and education program, focused on prevention of
Hepatitis A, could help keep concert-goers healthy. Windham is
working with nursing and environmental health staff at the Suwannee
County Health Department, putting together pamphlets and posters to
be distributed to park management and food vendors. Division of
Hotels and Restaurants, Department of Business and Professional
Regulation (DBPR) staff will also participate. They have a program
aimed specifically at preventing the food borne transmission of
hepatitis A in their licensed facilities. DBPR maintains a licensed
cafeteria at this campground. The fall concert season begins in the
middle of October. A visit to the site and consultation with the
concert promoters is planned during the first week of that month.
Scheduling favorable to the Suwannee CHD unit and DBPR is currently
being coordinated.
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►Regional Training Set for October in Volusia County
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
epidemiologic investigations.
This program 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 site
http://www.doh.state.fl.us/disease_ctrl/epi/conf/conf_call.html.
Space is limited to 45 participants, so register as soon as
possible. At
least half the spaces are already reserved.
Additional
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.
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►Merlin User
Surveys to Assess Efficiency
A
Merlin User Satisfaction Survey is scheduled for statewide
distribution on Friday, September 26, 2003. All registered Merlin
users will receive the survey through their Department of Health
(DOH) email account. The survey was designed in Reciprix, an
electronic survey tool, and can be completed and submitted in
the email message in which the survey was received.
The purpose of
the User Satisfaction Survey is to assess each user’s opinion
regarding the effectiveness, efficiency and usefulness of Merlin,
Florida’s web-based disease reporting and surveillance system. Some
questions in the survey were designed specifically with the county
health department user in mind; however, the Bureau requests the
participation of all Merlin users, whether state or county, in this
important evaluative effort. If you are completing the survey as a
state health employee, please answer the questions to the best of
your ability. If you feel a specific question does not apply to you,
simply go on to the next question.
Responses will
provide integral feedback and will also guide plans for enhancements
and modifications to the Merlin system. Please send questions or
comments about this survey or the overall evaluation project to
carmela_mancini@doh.state.fl.us.
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►This Week on EpiCom
A check of the EpiCom site
this week showed:
- An 8th case of Plasmodium vivax
malaria has been
confirmed in Palm Beach County
- Infection control practitioners
were introduced to EpiCom at this week's FPIC conference. Welcome
aboard!
For further information regarding the
EpiCom program, send an email to
EpiCom_Administrator@doh.state.fl.us.
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►Mosquito-borne
Disease Update
Eight WN virus cases were reported this week in Florida residents:
Bay (2), Duval (2), Collier (1), Lee (1) and Miami-Dade (1)
counties, bringing the number of cases reported this year in Florida
to 39. The following 19 counties are under medical alert: Bay,
Brevard, Broward, Collier, Duval, Escambia,
Gilchrist,
Lafayette, Lee, Miami-Dade, Nassau, Okaloosa, Orange, Palm Beach,
Santa Rosa, St. Johns, Union, Walton and Washington. Malaria has
been reported in an additional Palm Beach County resident, bringing
the total to eight. The total number of EEE cases remains at two.
Last year by this date, there were eight cases of WN and one case of
EEE infection.
EEE
virus
activity in animals: EEE positive wild captured birds were found in
Okaloosa (6), Santa Rosa (2), Walton (3) and Washington (1)
counties. 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: Twelve
WN virus infected horses were reported this week, four of them in
counties reporting WN positive horses for the first time this year:
Leon, Madison, Wakulla and Walton. The others were in Bay (2), Lake
(1), Levy (1), Palm Beach (2) and Santa Rosa (2) counties. In
addition, 92 seroconversions to WN virus were confirmed in sentinel
chickens from 24 of the 32 counties that collected samples.
Fifty-three dead birds were
reported positive for WN virus from 13 counties, the highest numbers
being from Bay (12) and Santa Rosa (17) counties. Flavivirus (SLE or
WN) positive wild captured birds were found in Santa Rosa (2) and
Washington (3) counties. Fifty-seven counties have reported WN virus
activity, compared to 48 at this time last year.
A mail-out of
the updated Mosquito-borne Disease in Florida brochure was sent to
every county health department this week, in English, Spanish and
Creole translations. If you did not receive your shipment or if you
want to request more, please email
caroline_collins@doh.state.fl.us.
The complete report can be viewed at http://www.doh.state.fl.us/Environment/hsee/arbo/weekly_summary2003.htm
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►Weekly Disease
Table
Click on the link below to access the
latest data regarding this week's disease figures provided by the
Florida Department of Health, Bureau of Epidemiology.
Current
week's disease table
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