►October Marks Beginning of Respiratory Syncytial Virus Season

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract illness among infants and children worldwide and each year approximately 125,000 children are hospitalized in the United States with RSV. In Florida, RSV infections typically peak during the months of October through February, although onset and conclusion months vary by region. The Florida Department of Health’s RSV Surveillance System monitors seasonal and geographic patterns associated with the detection of RSV. Sentinel providers report weekly the total number of RSV tests performed and the total number positive to the Department of Health. Based on data reported by sentinel providers in previous years, the 2003-2004 RSV season is expected to begin this month. Statewide and regional RSV seasons by month of onset and month ending in October and concludes in January. However, regional RSV seasons can begin as early as August (Southeast Region) or as late as December (Northwest Region). Seasonal trends by region are further illustrated in Figure 1 (provided at the link below).
Full article with graphs and tables

The data obtained from the RSV Surveillance System is significant because it alerts public health officials and physicians to the timing of seasonal RSV activity in Florida and it provides information used to guide physicians about when to initiate prophylaxis to high-risk children. Although a standard preventive immunization does not exist for RSV, prophylaxis can be given during the RSV outbreak season to prevent serious complications of infection in infants and children at high risk for RSV infection. Additionally, large outbreaks in hospitals may be reported during the RSV season. Control measures for hospital outbreaks should include laboratory screening of patients for RSV infection, cohorting infected patients and staff, excluding visitors with respiratory tract infections, excluding staff with respiratory tract illness or RSV infection from caring for susceptible infants, and use of gowns, gloves, goggles, and perhaps masks. Avoiding contagious settings, practicing hand hygiene, and maintaining a smoke fee environment can also prevent exposure to and transmission of RSV.

Regional and statewide RSV data are available to public health professionals, health care providers, and the public via web or email request on a monthly basis. For more information on RSV or if you are interested in being a sentinel provider for your region please contact Karen Wheeler at 850-245-4444 ext. 2401 or visit the Department of Health’s RSV website at http://www.doh.state.fl.us/disease_ctrl/epi/RSV/rsv.htm.

References

American Academy of Pediatrics. Red Book: 2003 Report of the Committee on Infectious Diseases. American Academy of Pediatrics. Elk Grove Village, Il, 2003.
CDC. Respiratory Syncytial Virus Activity—United States, 2000-01 Season. MMWR 2002; 51 (02); 26-8.

To access the complete text, including chart and graph mentioned in this article, click on this link:

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►Influenza Sentinel Surveillance Program Off to Good Start

Sunday, September 28, marked the beginning of influenza surveillance in Florida for the year 2003-2004. During August and September, local county health departments assisted in recruiting 90 sentinels from 77 public clinics and private medical practices. Sixty-one of these sentinels participated last year and agreed to continue serving throughout the upcoming year. Seventy of the 90 sentinels also agreed to participate in the laboratory component of surveillance. At present, these sentinels represent 28 counties: Alachua (1 sentinel), Brevard (3), Broward (3), Charlotte (1), Citrus (1), Collier (2), Dade (6), Duval (13), Hillsborough (6), Indian River (8), Lake (2), Lee (2), Leon (2), Marion (1), Martin (1), Monroe (1), Okaloosa (3), Orange (7), Osceola (1), Palm Beach (4), Pinellas (9), Polk (6), St. Johns (3), St. Lucie (1), Santa Rosa (1), Sarasota (1), Suwannee (1), Volusia (1).

Additional recruiting efforts will continue in eight counties that have less than the CDC’s recommended number of sentinels (one sentinel per 250,000 population). These counties are listed in Table 1.

Table 1 – Counties with less than the recommended number of sentinels
County	Sentinels Needed to Meet Recommended Coverage	Recommended Coverage	Sentinels Recruited to Date
Broward	3	6	3
Dade	3	9	6
Escambia	1	1	0
Manatee	1	1	0
Palm Beach	1	5	4
Pasco	2	2	0
Seminole	2	2	0
Volusia	1	2	1

Recruiting efforts are based on recruiting a minimum number of sentinels for each county, then attempting to match sentinels with demographic or geographic characteristics as determined by county health departments. Recruiting in some counties which have met the recommended number of sentinels may continue until these additional goals are met.

Sentinel providers begin collecting data on influenza-like illness (ILI) this week and many will submit their first weekly report next week. Reporting materials for some sentinels are still being processed; these sentinels will begin to report when their reporting materials arrive. Additionally, both the Tampa Laboratory and the Jacksonville Central Laboratory have shipped lab kits to most of the sentinel providers who agreed to submit nasal or throat swabs taken from a small sample of their patients with influenza-like illness.

For more information or to sign up as a sentinel provider, contact Melissa Covey at mcovey@unf.edu or call her at 904.791.1789 on Mondays and Fridays.

On September 19th the Bureau of Epidemiology mailed to all county health department epidemiology offices a selection of textbooks designed to complement their existing reference materials. The packages consisted of the following titles:

These books were provided to assist epidemiology staff in furthering their knowledge in regards to disease surveillance, field investigations and diseases that can be associated with bioterrorism. Funding for this project was made possible through the CDC bioterrorism cooperative agreement/epidemiology and surveillance program (Focus Area B).

If you have not received the books and believe you should have, please contact Melanie Black or her assistant, Linea Sundbye at 850.245.4444, ext. 2436 or via e-mail at linea_sundbye@doh.state.fl.us.

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►Grand Rounds at A.G. Holley Will Focus on TB Case Conference

A.G. Holley State Hospital will be the site for a Grand Rounds based on a statewide TB conference on October 29th from 10:00 a.m. to 12:00 p.m. EST. The sponsors of the program are Florida AHEC Network and Everglades Area Health Education Center, Inc., and support is provided by the hospital, the American Lung Association of Florida, Inc., Florida Bureaus of TB and Refugee Health and Laboratories.

The intent of the course is to prepare participants to apply principles of transmission and pathogenesis of TB; describe the role of the mycobacteriology culture in the diagnosis of the disease; discuss risk factors and clinical conditions; understand the significance of a positive smear in patient care and follow-up, and describe the rate and incidence of TB in correctional al facilities in Florida. Continuing Education Credits will be granted from the Bureau of Laboratories.

For information concerning registration and call-in participation, e-mail affette_mcintosh@doh.state.fl.us. Registrations must be confirmed by October 17th if attending in person, and lunch will be provided.

►Bureau of Epidemiology Regional Training Seminar Scheduled for Daytona October 29th and 30th

The Regional Epidemiology Training Seminar, sponsored by the Bureau of Epidemiology will be held in Daytona Beach at the Volusia County Health Department on Wednesday, October 29^th and Thursday, October 30^th, 2003. Target audiences for the regional training programs are county health department staff members who conduct epidemiologic investigations.

This program will address public health surveillance and communicable disease outbreak investigations. 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 the 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. For those county health department staff who plan to attend and have not registered, please do so as soon as possible. The class is limited and filling quickly.

Additional information will be provided in future Epi Updates and on the Bureau of Epidemiology web page. We intend to offer additional 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 take advantage of these opportunities for professional growth.

With over 25 million Americans, one in every 10, affected by some form of liver disease, the goal of the Department of Health this month is to educate people on the function of the liver, and to explain health problems associated with the liver. To that end, October has been designated Liver Awareness Month.

“The liver is one of the most important organs in the body and it is essential for survival,” said Department of Health Secretary John O. Agwunobi, M.D., M.B.A. “The liver performs many varied and complex functions. It cleans and purifies the blood supply, in addition to breaking down and manufacturing certain chemical substances in the blood.”

Some of the most frequently diagnosed liver diseases are hepatitis, cirrhosis, and fatty liver. Hepatitis is characterized by inflammation of the liver. Hepatitis A, B, and C are the most common types of viral hepatitis in the United States. Symptoms include nausea, fever, weakness, loss of appetite, and jaundice.

All year, but especially during the month of October, county health departments and DOH’s Hepatitis Program promote prevention activities, including free hepatitis A and B vaccines and free laboratory testing for hepatitis B and C for adults at increased risk for infection or the serious consequences of infection.

It is estimated that over 270,000 Floridians are infected with the hepatitis C virus, also known as a silent epidemic because most people have no symptoms and therefore don't know they're infected. It often lies undetected for 20-30 years, and is a leading cause of cirrhosis and liver failure.

Throughout October all Floridians will be encouraged through an ad campaign to learn more about the liver, how to keep this vital organ healthy, and to know their hepatitis status. For more information, visit www.myflorida.com or call Bill Parizek at 850.245.4111.

The Centers for Disease Control and Prevention's (CDC) National Immunization Program (NIP), has recently released the Influenza Vaccine Bulletin #3 for the 2003-2004 season. Bulletin #3 addresses such issues as the timing of the administration of influenza vaccine during the 2003-2004 flu season, Medicare billing information for influenza and pneumococcal vaccines, and influenza vaccine distribution. Influenza Vaccine Bulletin #3 can be accessed on-line at: http://www.cdc.gov/nip/Flu/bulletins-flu/2003-04/bulletin3_091103.htm.

Projected production and distribution schedules should allow for sufficient supply of influenza vaccine during October and November. Therefore, influenza vaccination can proceed for all high-risk and healthy persons, individually and through mass campaigns, as soon as vaccine is available.

A Vaccine Information Statement has been published for the live intranasal flu vaccine (FluMist) with an edition date of 9/4/03. Providers are required to give a vaccine informational statement to each patient or his guardian prior to the administration of a vaccine. As with other vaccine information statements, the Live Intranasal Influenza VIS describes the use of the vaccine, indications, contraindications, administration timing, as well as any possible risks involved with the use of FluMist. Printable copies of the FluMist VIS can be accessed at the CDC, National Immunization Program website at: http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf.

There has been a minor change to the Inactivated Influenza VIS. The change, which involves only one sentence in Part 4, is a result of the Advisory Committee on Immunization Practice's recent decision to rescind their recommendation for staged administration of the influenza vaccine and allow everyone to get the vaccine as soon as it is available (see "Notice to Readers: Supplemental Recommendations About the Timing of Influenza Vaccination, 2003-04 Season"; MMWR, August 22, 2003/52(33); 796-797). The entire recommendation can be accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a6.htm. The edition date did not change, and the current edition stocked in the DOH Forms Warehouse should be used for the remainder of the 2003-2004 flu season.

The Centers for Disease Control and Prevention National Immunization Program has made the "NIP Flu Gallery" available for the 2003-2004 influenza season. The Flu Gallery is your one-stop resource for influenza health education materials, which can be downloaded to your desktop and office printer.

Materials are available in English and Spanish, and can be printed on your black and white or color office printer, or by a professional (offset) printer. The National Immunization Program has improved the instructions for downloading print materials and has categorized materials for quick and easy access. Be sure to visit the Flu Gallery at http://www.cdc.gov/nip/flu.

The Centers for Disease Control and Prevention has selected ten metropolitan areas throughout the United States to participate in an enhanced influenza awareness campaign. Five of the ten areas are in the state of Florida (Jacksonville, Miami-Dade, Tampa/St. Petersburg and Ft. Lauderdale). These cities will receive promotional packets tailored to the specific cities and will be mailed to 1,000 private providers in each area. Additionally, area-specific public service announcements will be available for each locality that will include local footage, messages from area personalities and messages from CDC Director Dr. Julie Gerberding that are specific to each region. The CDC hopes to kick-off its campaign with a media rollout in one of the Florida sites sometime in October.

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►This Week on EpiCom

Hillsborough County CHD is investigating reports of illness in students at a local high school. Illness reportedly involves wheezing upon inhalation, numbness and tingling of mouth or fingers, chest pain and anxiety.

►Mosquito-borne Disease Update

Nine WN virus cases were reported this week in Florida residents: Bay (2), Citrus (1), Gulf (3), Miami-Dade (2) and Walton (1) counties, bringing the number of cases reported this year in Florida to 48. The following 21 counties are under medical alert: Bay, Brevard, Broward, Citrus, Collier, Duval, Escambia, Gilchrist, Gulf, Lafayette, Lee, Miami-Dade, Nassau, Okaloosa, Orange, Palm Beach, Santa Rosa, St. Johns, Union, Walton and Washington. Indian River County is under medical advisory. Malaria has been reported in eight Palm Beach County residents; no new cases this week. 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: One sentinel seroconversion to EEE virus was confirmed in Walton County. In addition, two out of 8 wild birds captured in Walton County were found EEE positive; one of 9 trapped in Washington County tested positive for EEE. 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: Fifteen WN virus infected horses were reported this week, three of them in counties reporting WN positive horses for the first time this year: Gadsden, Gilchrist and Polk; this was the first report of WN activity for Gadsden County. The other 12 were in Alachua (2), Bay (1), Levy (1), Marion (4), Palm Beach (2), St. Johns (1) and Volusia (1) counties. In addition, 99 seroconversions to WN virus were confirmed in sentinel chickens from 25 of the 32 counties that collected samples. Sixteen dead birds were reported positive for WN virus from Escambia (1), Gilchrist (1), Jackson (1), Okaloosa (11), Palm Beach (1) and Walton (1) counties. One wild captured bird was found flavivirus (St. Louis Encephalitis or WN) - reactive in Walton County. Fifty-eight counties have reported WN virus activity, compared to 49 at this time last year.

A mail-out of the updated Mosquito-borne Disease in Florida brochure was sent to every county health department, in English, Spanish and Creole translations. If you did not receive your shipment or if you need to request more, please email caroline_collins@doh.state.fl.us. See the web page for maps and more information: http://www.doh.state.fl.us/Environment/hsee/arbo/index.htm