|
►CDC's Site Visit
Deemed a Success
The Florida Pregnancy Risk Assessment Monitoring System (PRAMS) team
hosted a CDC team for its annual site assessment on October 8th and
9th.
Each year the
team visits the Chronic Disease Epidemiology, Surveillance and
Evaluation PRAMS staff to review the program operations component,
data analysis, data dissemination, and impact on state program
planning and policy development. The CDC is most interested in state
adherence to procedures listed in its official protocol.
Many
organizations in the Florida Department of Health and the Governor’s office
use Florida PRAMS data to track the impact of new health initiatives
in the state. Florida’s Healthy Start coalitions used the data
for its Back to Sleep program in an effort to reduce the
incidence of SIDS. The Birth Defects Registry used PRAMS statistics
to detect trends in folic acid usage before and during pregnancy.
Tobacco and alcohol programs use the data to track whether teen
girls stop smoking and drinking during pregnancy. The data Florida
PRAMS staff gather on the effects of second hand smoke on infants
may tie in with the high incidence of SIDS in some counties. The
bureaus in the Division of Family Health Services use PRAMS information for family
planning and access to prenatal care in first trimester. Health
departments or other entities desiring to access this information
should contact Helen Marshall at helen_marshall@doh.state.fl.us.
or access the Department of Health website at
http://www.doh.state.fl.us/disease_ctrl/epi/prams/prams.htm
to read PRAMS reports.
We’re pleased to
report the inspection team pronounced Florida PRAMS a model state
program that is achieving success with high response rates and
powerful results from data dissemination.
Currently, 32
states participate in the PRAMS project. The data each state
collects are compiled at the CDC and used to track trends in
maternal and infant health in the United States.
Back to top
►October 28th
Grand Rounds Will Review Operation Vaccinate Florida I
Part I
Smallpox Vaccine Adverse Events Statewide
Presenter: Dr. Fermin Arguello, CDC Fellow, EIS Officer,
Bureau of Epidemiology
Part 2
Smallpox Vaccine Surveillance for Eighteen Counties in North Central
Florida:
Assessing All Medical Reactions, Stage Development of the Vaccine
Site, and Demographics of the Population Vaccinated
Presenter: Jerne Shapiro, MPH, Florida Epidemic Intelligence
Service Fellow, Bureau of Epidemiology, Florida Department of
Health
Abstract:
Based on the directive from President
George W. Bush to better prepare our nation for possible terrorist
attacks, Florida enacted Operation Vaccinate Florida: Stage I (OVF
I). Beginning February 10, 2003, and continuing through March 31, 4,434 individuals
were vaccinated against smallpox.
During this time, the Bureau of Epidemiology worked directly with
the counties to provide medical and epidemiological consultation and
support and to document all adverse events from the vaccine for the
State. A total of 14 adverse events including one death were
evaluated during OVF I based on CDC case definitions.
During this same
time period a smallpox vaccine surveillance study was conducted in
eighteen counties in North Central Florida. The study was conducted
via journal log that all participants completed daily recording
demographic information, vaccine site stage development, and all
symptoms experienced that day. The study included 345 vaccinees from
Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Hamilton,
Gilchrist, Lafayette, Levy, Flagler, Marion, Nassau, Putnam, Union,
St. Johns, and Suwannee County.
Additional
Information:
The grand rounds presentation will begin promptly at 11:00 a.m., EST
on Tuesday, October 28, 2003. PowerPoint slides and the dial-in
number will be available on the Bureau of Epidemiology intranet
website on Monday, October 27. If additional information is needed,
contact Melanie Black, MSW, professional training coordinator at
(850) 245-4444, ext. 2448 or at
Melanie_black@doh.state.fl.us.
Back to top
►Rapid HIV Tests
Now In Use in Florida
In
Florida, there are approximately 100,000 individuals living with
HIV, with 25,000 of them unaware they are infected. To ensure HIV
testing is available and accessible to all Floridians, the Bureau of
HIV/AIDS has begun to incorporate a new rapid HIV test into its
current testing program. The OraQuick Rapid HIV-1 Antibody Test uses
whole blood specimens that can be obtained through venipuncture or a
fingerstick, with results ready in about 20 minutes. OraQuick is
extremely accurate, though a confirmatory test, such as the Western
Blot (blood or oral), must be used to confirm all positive test
results.
In the past, new testing
technologies have greatly advanced Florida’s HIV testing program,
providing services to individuals who were either unlikely or unable
to be tested. In 1998, OraSure was introduced as a viable
alternative to blood-based testing and in 2002, just a few years
later, almost one quarter of all HIV tests performed in Florida
(294,494) were administered using the OraSure test (67,743).
Likewise, the rapid test should provide individuals who are either
unlikely to learn their status, or unwilling to wait two weeks for
their test results, with the opportunity to do so quickly and
painlessly. The bureau is piloting OraQuick at seven sites in
Florida. These sites were chosen because they met several criteria,
including a high prevalence of HIV in their catchments area;
provision of services to a priority population; services conducted
in a venue of interest (e.g., jail, substance abuse treatment
center, mobile unit, STD clinic); ability to conduct a waived test;
minimal start-up time; and willingness to participate.
Sites interested in providing the
rapid test must first meet several federal and state requirements.
Federal requirements include obtaining a CLIA waiver, adhering to
the manufacturer’s instructions when performing the test, and being
subject to either announced or unannounced visits from the
Department of Health and Human Services. The Department of Labor has
set forth safety requirements through Occupational Safety and Health
Administration for sites that manipulate blood. These requirements
include providing employees with the hepatitis B vaccine and
vaccination series, developing and following a detailed exposure
control plan, providing protective clothing and equipment to
employees using the test, providing post-exposure follow-up to
employees who have been exposed to potentially contaminated blood,
and ensuring all biohazardous materials are disposed of in
accordance with state and federal laws. State requirements include
obtaining a laboratory license to perform waived testing,
developing/adhering to a detailed quality assurance plan and
complying with Florida statute throughout the testing process. In
addition to these state requirements, the Department of Health
recommends that all sites wishing to offer the rapid test do so in a
confidential manner and have the ability to obtain a confirmatory
specimen.
Several other
states have also begun integrating the rapid test into their current
HIV testing programs. While initially progressing quickly,
lack of communication, cooperation, and trust between state agencies
and providers has caused some of these programs to stall. Florida’s
diligence providing a strong foundation for rapid testing has begun
to see fruit, as we are already one of the nation’s leaders in
providing rapid HIV testing. We began in mid-July and by December
31, 2003, approximately 5,500 rapid tests will have been performed
in Florida. By continuing with rapid HIV testing in a responsible
manner, this new tool will greatly aid us in identifying people who
are unaware of their HIV status, and linking them to care.
Back to top
►PRAMS Survey
Shows Pregnancy Intendedness Data
Florida
Pregnancy Risk Assessment Monitoring System (PRAMS) is a joint
surveillance project between the Florida Department of Health and
the U.S. Centers for Disease Control and Prevention (CDC), designed
to monitor the physical, economic, and social health of Florida
mothers and newborns. PRAMS is a mail survey with telephone
follow-up of non-responders using a random sample of recent mothers
of live-born infants completed when the infant is approximately
three to six months old. Florida PRAMS 2001 personnel surveyed 2,006 new
mothers with a response rate of 75.3%.
During 2001 there were 205,800 live
births among Florida residents. Over one-third (36.5%) of these live
births were conceived of pregnancies that were wanted later
(mistimed). The prevalence of mistimed pregnancy was:
-
Higher
among both non-Hispanic black women (41.5%) and Hispanic women (43.4%) than among non-Hispanic white women (30.4%).
-
The
highest among younger women: 61.7% among women aged 19 and under;
52.8% among those aged 20 to 24 years; 29.3% among those aged 25 to
34 years, and 14.6% among women aged 35 years and over.
-
Higher
among women with less than 12 years education (49.8%) than among
those with over 12 years education (29.6%).
-
Higher
among women who received Medicaid (47.6%) than among those who
received no Medicaid (27.8%).
-
Higher
among women who were not married (56.6%) than among their married
counterparts (25.2%).
One in ten (10.2%) live births to
Florida residents during 2001 were conceived of pregnancies that
were not wanted then or at any time in the future (unwanted). The
prevalence of unwanted pregnancy was:
-
The
highest among non-Hispanic black women (21.5%) in contrast to
non-Hispanic white women (7.0%) and Hispanic women (7.8%).
-
Higher
among women with less than 12 years education (13.9%) than among
those with more than 12 years education (7.0%).
-
Higher
among Medicaid recipients (14.5%) than among non-Medicaid recipients
(7.1%).
-
Higher
among women who were not married (13.7%) than among those who were
married (8.3%).
Findings from
this study showed that Florida women who were non-Hispanic black or
of Hispanic ethnicity, aged 24 years and under, with less than 12
years education, recipients of Medicaid, and not married had the
highest prevalence of mistimed pregnancy. This study also found that
the prevalence of unwanted pregnancy was the highest among Florida
women who were non-Hispanic black, had less than 12 years education,
had received Medicaid, and were not married. Women with these
socio-demographic characteristics should be viewed as being at
greater risk for experiencing pregnancies that are either mistimed
or unwanted than women of other socio-demographic backgrounds.
Back to top
►Scombroid
Foodborne Outbreak Investigated at Cancer Treatment Center in
Hillsborough County
Investigation
Team:
Warren McDougle, MPH, Environmental Specialist III, Hillsborough Co.
Health Dept., Michael Friedman, MPH, Bureau of Community Environmental
Health and Roberta Hammond, PhD, Bureau of Community Environmental
Health
Introduction and Background
On October 3, 2003, the Hillsborough County Health Department was
contacted regarding four diagnosed cases of scombroid food poisoning
among employees at a local cancer treatment center in Tampa. The
employees had eaten grilled tuna steaks for lunch that had been served
at the facility’s cafeteria and became ill with facial flushing,
itching and headaches within three hours. A physician at the treatment
center promptly diagnosed and reported the cases to the health
department. Additional case finding was conducted by the cancer
center’s epidemiology nurse and the local health department. Traceback
of the implicated yellow-fin tuna steaks identified that this product
had been imported from Indonesia.
Methodology
A joint field visit was performed by the Hillsborough County
Environmental Health, Bureau of Community Environmental Health and
an investigator from the Tampa office of the Food and Drug
Administration (FDA) on October 6, 2003. Epidemiological data had
confirmed that grilled tuna fish had been consumed at lunch on
October 3 by the ill employees at the cancer center. This product
is available to visitors and staff through the cafeteria and also is
found on various patient menus. Approximately 120 orders of grilled
tuna are served daily. Sanitation, food temperatures, product
thawing procedures and employee hygiene in kitchen area were found
to be excellent. The grilled tuna is yellow-fin that is received by
the facility on a monthly basis. The product was a frozen fillet
that had been cryovacked. Cooked and raw product from the same batch
served on October 3 had been saved by the facility's food service
manager. While a case of frozen tuna was also available, invoices
showed that this product was not from the same batch of yellow-fin
tuna.
Traceback information from invoices and product packaging identified
that the yellow-fin tuna steaks were originally from Indonesia. They
were imported through New York and Orlando and locally distributed
by a seafood supplier in Tampa. The FDA investigator collected all
the cooked and raw tuna steaks available and packed them for
shipping to the FDA laboratory.
Results
Preliminary testing results by the FDA laboratory on the yellow-fin
tuna steaks identified very high levels of histamine in the cooked
product. A traceback investigation of the seafood supplier in Tampa
was conducted by the FDA. The local distributor had received five 10
lb. cases of tuna steaks from a distributor in Orlando. It appeared
that the tuna steaks had been repacked somewhere in the distribution
chain because the country of origin did not appear on the product
label. Four of the cases of tuna had been sold to the cancer center
and the remaining case was placed on hold at the local distributor.
Since the product was received and stored in a walk-in freezer, it
did not appear that temperature abuse had occurred at the local
seafood store.
Analysis and Conclusion
This outbreak of scombroid food poisoning was confirmed as being
associated with the consumption of imported yellow-fin tuna steaks
at a cancer treatment center cafeteria in Tampa on October 3, 2003.
The four ill persons had no other epidemiological associations
identified and the onset of symptoms were chronologically clustered
indicating a common source exposure. A very low attack rate (3.3
percent) among persons consuming the implicated tuna at the
treatment center indicates that only a small portion of the fish
served was spoiled. Traceback activities at the seafood distributor
in Orlando identified some major food temperature problems. The FDA
is considering a recall at this time.
Scombroid
poisoning typically causes perioral tingling and burning, facial
flushing and sweating, nausea, vomiting, headache, palpitations,
dizziness and rash within a range of immediately to 30 minutes after
consumption of foods that contain high levels of histamine and
possibly other vasoactive amines and compounds. Duration can be as
long as 3 days. Common foods include tunas (e.g., skipjack and
yellow fin), mahi mahi, bluefish, sardines, mackerel, amberjack, and
abalone as well as Swiss cheese. Neither cooking, canning, or
freezing reduces the toxic effect. Common sensory examination by the
consumer cannot ensure the absence or presence of the toxin.
Chemical testing is the only reliable test for evaluation of a
product.1
Back to top
►This
Week on EpiCom
Outbreaks of hepatitis A have
affected restaurant patrons in southern states that have been traced
to fresh green onions. Twenty-six cases have been reported from a single
restaurant in Tennessee and over 250 cases have developed in
Georgia. Similar clusters have been identified in North Carolina.
These same green onions may have been distributed to other states.
For further information regarding the
EpiCom program including how to sign up, send an email to
EpiCom_Administrator@doh.state.fl.us.
Back to top
►Mosquito-borne
Disease Update
Four WN virus cases were reported this week in Florida residents
from Bay, Holmes, Santa Rosa and Seminole counties, bringing the
number of cases reported this year in Florida to 61. The following
25 counties are under medical alert: Bay, Brevard, Broward, Calhoun,
Citrus, Collier, Duval, Escambia,
Gilchrist, Gulf,
Holmes, Jackson, Lafayette, Lee, Marion, Miami-Dade, Nassau,
Okaloosa, Orange, Palm Beach, Santa Rosa, St. Johns, Union, Walton
and Washington. Holmes and Jackson were added this week. 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 13 cases of WN and one case of EEE infection.
EEE
virus
activity in animals: None this week. To
date, 52 of Florida’s 67 counties have reported EEE virus activity,
compared to 24 counties reporting EEE last year at this time.
WN virus activity in animals: Four
WN virus infected horses were reported this week in Columbia, Levy,
Okaloosa and Palm Beach counties. In addition, 56 seroconversions to
WN virus were confirmed in sentinel chickens from 23 of the 30
counties that collected samples.
Twenty dead birds were reported positive for WN virus from
Alachua (1), Escambia (3), Hillsborough (1), Holmes (2), Jackson
(2), Jefferson (1), Leon (2), Levy (1), Okaloosa (1), Palm Beach (2)
and Santa Rosa (4) counties. Fifty-eight counties have reported WN
virus activity, compared to 52 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 Florida 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
The complete report can be viewed at http://www.doh.state.fl.us/Environment/hsee/arbo/weekly_summary2003.htm
Back
to Top
►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
Back to top
|
