Friday, October 8, 2004

         This Week in the News

Foege, WH, et al., 
International Journal of Epidemiology
1976; 5:29-37

►Epi Teams Contribute to Hurricane Recovery Efforts
Division of Disease Control Bureau of Epidemiology employees contribute their skills through deployments and in other vital ways.

►Disease Table Returns With This Issue
After a long absence, the feature returns with a new look and improved data analysis. Review the new table and the valuable information it provides.

A R T I C L E S

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.

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.


     Screen capture of the Merlin GIS component

 

Disease Table Returns With This Issue

After an extended absence, the Weekly Disease Table returns this week with the publication of counts of selected diseases and comparative case tallies for previous weeks and months and for similar periods in years past.

These reports reflect the numbers of confirmed cases reported by the Bureau of Epidemiology each week to the Centers for Disease Control and Prevention. For the Weekly Disease Table, the bureau has taken a bit of "local license" in the way that some diseases are grouped, in order to make the information more meaningful to a Florida audience as opposed to groupings designed for inclusion in the CDC?s national disease reporting database.

In addition to the weekly tables made available in this publication, users will soon be able to review publications of the table for the years 2003 and 2004 at the bureau?s Website.

The source of data for published Weekly Disease Tables is Merlin, the official infectious disease reporting system of the Florida Department of Health. If you have any questions about the Merlin system of the Weekly Disease Tables, contact the Merlin helpdesk at Merlin Helpdesk.
 

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. 
 

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.
 

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.
 

This Week on EpiCom

• 19 probable or confirmed cases of pertussis reported in Santa Rosa County
• A multistate alert has been posted to be on lookout for zoonotic Salmonella typhimurium var Copenhagen outbreak associated with hamsters
• Death toll from Hurricane Jeanne is currently 14 persons

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.

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/. 

Humans: (onset month)	County					Status
September	Miami-Dade					living
Sentinel Chickens : (date of first positive bleed)	County	SLE	WN	EEE	HJ	Seroconversion Rate
9/15	Brevard		1			2.17
9/16, 9/20x3	Duval		4			8.33
9/8, 9/21x2	Hillsborough		3			3.45
9/17	Leon			1		2.86
9/11	Manatee		1			2.04
9/17	Nassau			1		2.38
9/7x2, 9/21	Osceola		3			4.35
9/20	Palm Beach		1			2.17
9/20x2	Pinellas		2			3.57
9/16	Seminole		1			3.57
9/20x2	St. Johns		2			3.51
Dead Birds :   (dead date)	None
Horses :  (onset date)	None
Wild and Captive Birds : (collection date)	None
Mosquito Pools : (collection date, species)	County	SLE	WN	EEE	HJ	Minimum Infection Rate
9/14, Cx. nigripalpus	Duval		1			1.11

See the Web for more information at www.MyFloridaEH.com. 

Weekly Disease Table

Click on the highlighted link to review the most recent disease figures provided by the Florida Department of Health Bureau of Epidemiology.

Click here to access the disease table from week 39

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