Friday, October 8, 2004
This Week in the News
"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.,
►Epi Teams Contribute to Hurricane Recovery Efforts
|►GIS Technology Makes Disease Surveillance More Practicable|
The technology can make work a little easier for public health epidemiologists analyzing particular outbreak data.
►Disease Table Returns With This Issue
|►Merlin Hits Milestones
Since its inception over a four years ago, this system has revolutionized the way disease reporting has been performed within the department, and the future looks even better.
|Epi Update Managing Staff:||►Scientists Crack DNA Code of Legionella Pneumophila
The Columbia Genome Center, at the Columbia University College of Physicians and Surgeons, lead a four-year research project into the genomic sequence of the bacterial agent of Legionnaires' Disease.
MD, MBA, MPH,
Secretary, Department of Health
|►Surge Capacity Course Offered via Internet
Designed specifically for policymakers, this free, 2.5 hour course is provided by the U.S. Department of Healthcare Research and Quality to prepare public health officials for bioterrorism and surge capacity incidents.
|Landis Crockett, MD,
Division of Disease
|►This Week on EpiCom
Log on regularly to access information that could be vital to your organization if you're in the middle of an investigation. Another entity may be experiencing an outbreak that could be linked to yours.
Acting Bureau Chief,
|►Mosquito-borne Disease Update
A report outlining confirmed cases and other activities for the week September 26 - October 2, 2004.
|►Weekly Disease Table
The Florida Department of Health Bureau of Epidemiology Weekly Morbidity Report for the current week. The report includes disease and conditions for confirmed cases.
A R T I C L E S
|Joann Schulte, DO, MPH, Medical Epidemiologist, Bureau of Epidemiology|
Epi Teams Contribute to Hurricane Recovery Efforts
During the recent hurricane activity in Florida, the Bureau of Epidemiology was responsible for staffing surveillance and outbreak teams that monitored the post hurricane events after hurricanes Charlie, Frances, Ivan, and Jeanne. In each case, the teams consisted of Florida EIS fellows and epidemiologists from the Division of Environmental Health, the Bureau of Epidemiology, and county health departments. These teams set up surveillance in hospitals and clinics and at disaster medical sites to gather information about injury, poisoning, and infectious diseases. The teams also visited local shelters and reported on outbreaks, and set up appropriate measures to prevent outbreaks.
The Office of Planning and Evaluation's Vital Statistics section also furnished updates on the number of deaths attributed to each hurricane. Doing so required modification of how deaths are registered in Florida so that funeral directors could register in adjacent counties.
Results of these efforts can be found on www.flepicom.net under the headings of hurricanes Charlie, Frances, Ivan and Jeanne. We encourage you look at them. Bureau of Epidemiology staff provided many hours of work in direct contact with victims of the hurricanes, and also in other areas such as the state emergency operations center in Tallahassee and in supporting roles, covering for those who were in the field at disaster sites. We?re proud of their willingness to serve their fellow Floridians and are grateful for their leadership during a critical time in our state.
|D'Juan Harris, MSP, GIS Specialist, Surveillance Systems Section, Bureau of Epidemiology
|GIS Technology Makes Disease Surveillance More Practicable
Geographic Information Systems (GIS) continue to grow as an effective resource in statewide and local public health applications. GIS maps, in paper or electronic format, provide valuable insight to researchers and epidemiologists in disease surveillance when they evaluate the degree to which a reportable disease, such as campybacteriosis, is geographically clustered. Geographic clustering of reportable disease cases may provide crucial evidence in determining the initial cause of the disease, and therefore link the agent to a definitive disease core.
GIS maps are a more intuitive method of analyzing epidemiological data to reveal trends and interrelationships than merely examining and calculating statistical data in a tabular format. It is relatively easy for epidemiologists to visualize problem areas and effectively target resources so they can intervene in at-risk regions using a geographic information system map.
To make GIS technology for disease surveillance more accessible, the Florida Department of Health Bureau of Epidemiology, with assistance from Information Systems of Florida, has developed an interactive GIS application that will be integrated into the Bureau of Epidemiology?s Merlin reportable disease system. The new GIS component will enable Merlin users to query reportable disease data and display maps on demand, utilizing the most up-to-date data entered. These maps will include ?spot? geo-referenced maps, which include geocoded address data as well as graduated shading maps showing the various range of occurrence and case rates of a disease per 100,000 population. Merlin GIS maps will display reportable disease data from statewide to individual county scale. There will also be an export feature allowing users to export the map image as a jpeg file or export the disease parameter data into an Microsoft Excel file. The Merlin GIS component will utilize a user-friendly interface, and should not require extensive training to produce interactive on-demand disease surveillance maps.
|Pete Garner, Surveillance Systems Section Administrator, Bureau of Epidemiology
Disease Table Returns With This Issue
|Carmela Mancini, MPH, Surveillance and Reporting Section Administrator, Bureau of Epidemiology
|Merlin Hits Milestones |
Merlin, the state?s Web-based disease reporting, surveillance and analysis system, has reached significant milestones since its deployment in 2001. The Bureau of Epidemiology is pleased to share some recent highlights.
A comprehensive disaster recovery fail-over plan has been established and implemented for the Merlin system. In the event that the primary Merlin server crashes, fails or becomes otherwise unavailable, an automatic transfer to an off-site server will occur, allowing for disease surveillance, reporting and analysis to be accomplished as usual, with no, or minimal interruptions. This endeavor was accomplished cooperatively by the Merlin team and the Information Technology Office.
The Outbreak Module, one of many Merlin features, has enabled state and CHD users to effectively manage, investigate and analyze information from outbreaks of reportable and non-reportable diseases, as well as clusters of symptoms/syndromes and other events of public health importance. The module has been used for managing and analyzing data collected during the hurricane response efforts; methicillin-resistant staphylococcus aureus cluster investigations; and, most recently, a suspected increase in pertussis cases. These cases will not be reported to the state health office, however, the data will be available for review, analysis and program planning. The Pinellas CHD can now track all disease control, reporting and investigation activities using one system.
The outbreak module was recently selected as an exhibit for the 2004 Quality Management Showcase. The showcase, scheduled for February 2005, will provide an opportunity for conference attendees to view Merlin's capabilities through a live demonstration of the outbreak module.
The Bureau of Epidemiology and the Division of Environmental Health (DEH) have established a data sharing agreement whereby Merlin data will be electronically transferred to a food, waterborne and arbovirus database being piloted by the DEH. The Merlin team has created a stored procedure to extract data directly from the Merlin tables, placing the data in a ?staging table? where another automated program will pull the data and enter it into the DEH database.
The Merlin system continues to increase in user size, while maintaining a high level of customer service. In the third quarter 2004, 30 new users registered on the Merlin system, bringing the total number of users to 793. Four trainings were conducted, representing eight county health departments and the Pensacola Branch Laboratory. Additionally, over 400 questions and requests were answered by the Merlin Helpdesk.
We look forward to providing you future articles highlighting the Merlin system and its utility in managing investigation, surveillance and analysis activities. For additional information please contact the Merlin Helpdesk at Merlin_Helpdesk@doh.state.fl.us or 850.245.4401.
|Jaime Forth, Editor, Epi Update, Bureau of Epidemiology||Scientists Crack DNA Code of Legionella Pneumophila|
The genomic sequencing of Legionella pneumophila, or the bacterial agent which causes Legionnaires' disease, has been discovered by a team of researchers at the Columbia University College of Physicians and Surgeons in New York. Their findings were presented in the September 24, 2004 issue of Science magazine.
Legionnaires' Disease, so named because of its identification during a 1976 American Legion convention in Philadelphia, is a potentially fatal disease infecting macrophages in lung tissue. Although it's primarily associated with the public outbreak at the hotel three decades ago, the disease normally occurs as an isolated case and is not transmitted from person to person. Once in the lungs, it causes pneumonia in approximately 30% of cases and has a mortality rate of 5-30%. The disease affects an estimated 8 to 18,000 persons in the U.S. each year.
Legionella organisms are most commonly found in water systems, and persons are exposed by breathing mists that come from water sources such as air conditioning or showers, or from direct contact with water contaminated with the bacteria. The incubation period is between two and 10 days followed by symptoms of headache and general muscle ache. Patients will also experience chills, fever and nausea, vomiting and coughing. The current remedy is erythromycin or, in severe cases, rifampin in addition to the erythromycin.
Legionella sabotages the defense apparatus of the body's waste disposal structure that macrophages use for destroying any menaces with which they come into contact. Legionella pneumophila exists in chromosomal and episomal forms and is a frequent cause of hospital-acquired pneumonias.
The breakthrough research, performed over four years, showed previously unrecognized factors that could explain the bug's unusual virulence. The team discovered, for instance, that the genome for Legionnaires' holds an unusually high number of proteins that pump toxins away from the bacteria, providing a possible explanation as to why the bacterium are able to survive inhospitable environments. They also theorize that its high amount of candidate virulence factors, or proteins, may enable it to survive in protozoa and infect and kill human cells.
|Jaime Forth, Editor, Epi Update, Bureau of Epidemiology||Surge Capacity Course Offered via Internet|
On October 26, 2004 from 2:00 - 3:30 p.m. the U.S. Agency for Healthcare Research and Quality will host a Web conference for state, local and health system policymakers entitled Addressing Surge Capacity in a Mass Casualty Event.
This is third in a series of conferences designed to equip policymakers with effective planning tools to deal with bioterrorism and health system preparedness. Panelists will include Dr. Robert Claypool, deputy chief medical officer of the U.S. Department of Health and Human Services; Dr. Nathaniel Hupert, assistant professor at the Department of Public Health and Medicine at Cornell University; Dr. Michael Shannon, associate chief of the Division of Emergency Medicine of Children's Hospital at Harvard Medical School; and Dr. Gregory Bogdan, research director and medical toxicology coordinator at Rocky Mountain Poison and Drug Center in Denver, Colorado. Panelists will discuss scenario-based surge capacity models to plan for mass casualty events; explore school-based and other large-scale emergencies; examine specs and resources required to develop a public health center that can be responsive to other public health agencies; and underscore initiatives taken by the Department of Health and Human Services to deal with surge capacity priorities.
The conference format will provide attendees three ways to access the proceedings - via Internet, telephone, and Internet and phone connection.
To learn more about the event or to register, visit the Web site at www.hrsnet.net/ahrq/surgecapacity. There is no charge to participate, but participants must register. Questions about the conferences can be addressed to Maureen Ball at 202.828.5100.
The Department of Health Bureau of Epidemiology does not endorse products highlighted in this journal. To determine whether these products or services are suitable for your needs, we encourage you to investigate and use your own best judgment.
|Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology||
The Bureau of Epidemiology encourages Epi Update readers to not only register on the EpiCom system at https://www.epicomfl.net but to browse EpiCom frequently and contribute public health observations related to any suspicious or unusual occurrences or circumstances, as appropriate. EpiCom is the primary method of communication between the Bureau of Epidemiology and other state medical agencies during emergency situations.
|Arbovirus Surveillance Team: Samantha Rivers, MS, Caroline Collins, Kristen Payne, Calvin DeSouza, and Carina Blackmore, MS Vet. Med., PhD., State Public Health Veterinarian||Mosquito-borne Disease Update|
West Nile (WN) virus activity: One case was confirmed in a resident of Miami-Dade County, bringing the state-wide total to 33. There were 18 seroconversions to WN virus in sentinel chickens from Brevard, Duval, Hillsborough, Manatee, Osceola, Palm Beach, Pinellas, Seminole and St. Johns counties. A mosquito pool (Cx. Nigripalpus) collected in Duval County on 9/14 tested WN positive. So far this year, 34 counties have reported WN activity. Brevard, Broward, Duval, Gadsden, Hillsborough and Miami-Dade counties are under medical alerts for mosquito-borne disease and Pinellas is under medical advisory for mosquito-borne diseases.
Eastern Equine Encephalomyelitis (EEE) virus activity: There were two seroconversions to EEE virus in sentinel chickens from Leon and Nassau counties. So far this year, 32 counties have reported EEE activity.
St. Louis Encephalitis (SLE) virus activity: None this week. Four counties have reported SLE activity.
Highlands J (HJ) Virus activity: None this week. Twelve counties have reported HJ this year.
Mosquito populations are present in many areas of the state, especially in areas hard-hit by Hurricane Charley. All are urged to take precautions against mosquito bites. Dead birds should be reported to www.wildflorida.org/bird/.
See the Web for more information at www.MyFloridaEH.com.
|D'Juan Harris, MSP, GIS Specialist, Surveillance Systems Section, Bureau of Epidemiology||
Weekly Disease Table