Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology

Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology

Melissa Covey, Influenza Surveillance Coordinator

Jaime Forth, Copy Editor/ Writer, Bureau of Epidemiology

Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology

Pete Garner, Surveillance Systems Manager, Bureau of Epidemiology

Caroline Collins, Arbovirus Surveillance Coordinator and Carina Blackmore, DVM, Ph.D., Acting State Public Health Veterinarian, Bureau of Community Environmental Health

►October 28th Grand Rounds to Review Adverse Events During Operation Vaccinate Florida Phase I

Part I
Smallpox Vaccine Adverse Events Statewide
Presenter: Dr. Fermin Arguello, CDC EIS Officer, Bureau of Epidemiology, Jerne Shapiro, MPH

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, Secretary of Health Agwunobi enacted Operation Vaccinate Florida: Stage I (OVF I). The objective for OVF I was to vaccinate the key public health staff who would play a major role in expanded vaccination programs. 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 provide medical and epidemiologic consultation for 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.

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►Bi-Weekly Conference Call Introduces New Staff, New Reporting Guidelines

A brief summary of the October 17^th conference call among county health departments and Bureau of Epidemiology staff is recounted here for those who were unable to take part last week. Just a reminder that if you would like to participate, the agenda is posted on our Website a few days prior to the scheduled call, which is on alternating Fridays throughout the year. To be placed on the agenda, simply email melanie_black@doh.state.fl.us or donald_ward@doh.state.fl.us.

Surveillance and Epidemiology Bioterrorism Issues. Melanie Black announced the CDC will soon require certification for staff who spend 100% of their time on bioterrorism grant work, so be prepared for this eventuality.  

A new staffmember has been added to the Surveillance and Reporting Section; Angela Fix is the new respiratory disease coordinator and will work with the SARS team which has just reconnected. 

Determining Residency for Reportable Diseases. Kathryn Teates read the new guidelines for determining residency for reportable diseases proposed at the CSTE annual conference in June. The current guidelines will be in effect until the end of December, where the patient’s residency at the time of diagnosis will determine which state or county reports the case.  

Beginning January 1, 2004, however, where the patient sleeps most of the year will determine their residency. This is a major change which has been made to accurately reflect Florida’s disease rates that are based on resident population. The importe code will be used to clarify the geographic location where infection or exposure happened. For example, if a Florida resident falls ill in Georgia the case would be reported by Florida as acquired in the U.S. but not in Florida. Questions regarding ambiguous determinations of residency can be directed to the Communicable Disease Surveillance and Reporting Section in the Bureau of Epidemiology. 

PRAMS CDC site visit. Helen Marshall reviewed the CDC annual site visit to Tallahassee offices to ensure protocols were consistent with CDC guidelines. They’re very satisfied with our performance and pleased with our response rates, which are higher than those of other PRAMS states. Our staff are preparing to place our databook on our Website and they also appear pleased with that.  

New Phase Five surveys will begin with January births. Florida personnel conducted a field test of Phase Five questions for the CDC with Spanish-speaking new mothers in Ruskin recently. 

Chronic Disease Reports: Analysis and Data Conclusions. Dr. Huang discussed a number of surveys currently underway that will provide whole new sets of data for us. Health care access, overweight issues, HIV/AIDS and other data samples from three urban and rural counties will give us more variables to analyze.  

Another series of BRFSS reports concerning people with diabetes and hypertension is currently under review.  

Dynamic Data Exchange is a function our staff uses to analyze collective information.  Anyone interested in obtaining this software can contact Dr. Huang at youjie_huang@doh.state.fl.us. 

A new question which will be added to the cancer report concerns the stage of the disease, since this is an important indicator of health disparities. 

Training Announcements. Melanie Black reminded participants that Grand Rounds on adverse events related to OVF I will air on October 28^th from 11 a.m. – 12:00 p.m. Nursing CEUs have been approved; other CEUs are pending approval.  

Regional training slots in Volusia County are filled. The next regional training course will occur around the end of January or early February. 

There will be a satellite broadcast on SARS and quarantine presented by Dr. Joann Schulte, Tom Belcuore and Mort Laitner on November 6^th. More information will be posted to our Intranet site as it becomes available.  

The next conference call is slated for Friday, October 31^st at 10:00 a.m. EST.

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►Malaria Cases on the Rise Worldwide

Though most laymen may presume malaria is a disease all but eradicated many years ago, world health experts know that a serious resurgence began in the 1970s and that it has continued to spread. The advent of worldwide travel, growing resistance to antimalarial drugs, changes in the behavior of vectors from being outdoor to indoor biters and other factors have contributed to a dramatic escalation of cases in the last decade.

About 300 million people are touched by malaria each year, with between 1 and 1.5 million deaths attributed to the disease during the same timeframe. Current research is focused on the immunologic characteristics of the disease as well as development of new drugs to destroy the malaria parasite in the liver rather than the blood, since the most dangerous species, P. falciparum, takes residence in the liver and causes late-onset malaria even when travelers conscientiously take their recommended medicines.

The death rate from malaria is highest among persons without previous immunity, children, and visitors to malaria-endemic areas from industrialized parts of the world where malaria does not exist. According to a recent article in the New England Journal of Medicine, Americans and Europeans have been lax in their attitudes towards this infectious disease. The issue should be "one of the major concerns for travelers to the tropics," according to Dr. Eli Schwartz, director of the Center for Geographic Medicine at the Chaim Sheba Medical Center in Tel Hashomer, Israel. He estimates that for more than 70 million people traveling from Western countries to endemic areas, there are approximately 30,000 cases of malaria annually in returning travelers in Europe alone.

Malaria is endemic in 91 countries, with pockets of transmission in another eight countries.

For more information, log on to the CDC Website at http://www.cdc.gov

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►Volunteer Sentinel Influenza Providers on the Rise, More Needed

Of the 101 sentinel providers recruited to date, 57 have submitted at least one weekly report during the first two reporting weeks. Twelve of these reporting sentinel providers are new volunteers to the program and 45 returned from previous years (43 participated last year).  Twenty-three of the returning sentinel providers have also volunteered their time to report during each of the last four years. Of the remaining 44 who were recruited but who have not reported, 32 are expected to begin during the next two weeks, and 10 need additional follow-up to see if they received their reporting materials. Three declined further participation after reviewing the reporting materials. Table 1 shows the number of sentinel providers recruited so far and who among them have reported, as well as those who did not report because their paperwork is being processed or those who could not report.

Barriers to initial reporting this year have been due to either missing reporting folders or errors within the CDC’s telephone and internet reporting systems. The reporting system errors affect only those sentinel providers assigned user IDs that are greater than 12300. While the Internet reporting system is now fully functional, the CDC estimates that it may take two or more weeks before sentinel providers with IDs greater than 12300 are able to report using the phone reporting system. These sentinel providers should either use the Internet system or fax their reports directly to the CDC using the form provided in their reporting materials. We apologize for any inconvenience caused by these errors.   

Additional recruiting efforts will be carried out to attain sentinel providers in Escambia and Manatee Counties to meet the CDC’s recommended number of sentinel providers (one sentinel per 250,000 population).  Sentinel recruiting continues this week in Bay, Collier, Hernando, Orange and Nassau counties. To sign up for this program, contact Melissa Covey on Mondays and Fridays at 904.791.1789 or via email at mcovey@unf.edu.

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►As Temperatures Drop, SARS Experts Brace for Return of Virus

Health experts will meet in Geneva next week to discuss an expected return of SARS during the coming influenza season and devise a more targeted diagnosis for Severe Acute Respiratory Syndrome (SARS). Last season, medical caregivers experienced difficulties differentiating between influenza patients and deadly SARS cases.

This year, World Health Organization members will suggest dividing the world into three zones to relieve hospitals and laboratories of unnecessary testing. The first zone, where the disease originated, would be called a "zone of re-emergence," in which any case of atypical pneumonia would be tested for the SARS coronavirus. A second zone, called a zone of "nodal areas," would be a zone of no routine testing for atypical pneumonia unless a cluster of suspected cases emerged. The third zone, comprised of the U.S. and the rest of the world, would be "not normally seen," and patients would be tested as a last resort only.

The World Health Organization has also suggested imposing an international double testing standard, requiring confirmation from a second laboratory in any SARS test. The effects these suggestions would have on the U.S. remains to be seen. Parts of the U.S., and Florida in particular, currently use the double testing regime for SARS, malaria and other outbreaks.

In the U.S., campaigns for influenza vaccinations are considered a primary preventative tool and states have been actively engaged in encouraging citizens to become immunized this year especially. Surveillance is also a valuable tool and in Florida, efforts are ongoing throughout the year.  As always, Merlin and EpiCom will continue to be at the forefront of data gathering and communication should SARS reemerge this season.

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►Questions, Comments? We're Listening!

Thanks to the suggestion of one of our readers and through the efforts of Surveillance Systems staff, a great improvement will be evident in the presentation of the bureau's Weekly Disease Table soon.

When scrolling down the Weekly Disease Table, the heading row should remain at the top of your screen for quick and accurate reference from the numbers to the descriptions of each of the columns. The rapid turnaround for this enhancement to the Epi Update and to the Bureau of Epidemiology Web site is credited to Loran Tyre and D'Juan Harris of the Surveillance Systems group.

Readers are invited and encouraged to tell us what they do and don't like about Epi Update and to make suggestions about things they'd like to see. D'Juan Harris, who last week received the "Charlotte WebManager Award" of the month for professionalism, enthusiasm, initiative and maintenance of his sites, was also lauded for expanding information and utilization of a new web tool that will benefit web development efforts. We're very proud of D'Juan and so glad he's a member of the Epi Update team.

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►New Health Info Available From the Web

The Centers for Disease Control and Prevention

SARS
http://www.cdc.gov/ncidod/sars/sarsprepplan.htm
Draft, Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)

The Centers for Disease Control and Prevention (CDC) is making this document available in draft form to assist local and state public health and healthcare officials in their preparations for a possible reemergence of SARS during the approaching respiratory disease season. The proposed framework and strategies for SARS preparedness and response are based on lessons learned from the 2003 global SARS epidemic and the advice and suggestions of domestic and international public health and healthcare partners. The document is currently undergoing external review by partner organizations and other federal agencies and will be updated as necessary to incorporate comments from reviewers and to reflect increased understanding of SARS-CoV transmission dynamics and the availability of improved prevention tools. CDC invites interested public health partners to submit comments on the draft document to sars-plan@cdc.gov. 

SARS Webcasts
http://www.phppo.cdc.gov/PHTN/webcast/sars-return/
On September 23 and 30, CDC presented a two-part Webcast entitled "Preparing for the Return of SARS:  Are We Ready?"  This Website offers video recordings of the two Webcasts along with the speakers' slides.  The site also provides links to two new fact sheets based on the Webcasts:

Guidance for Surveillance and Early Detection of SARS
http://www.phppo.cdc.gov/PHTN/webcast/sars-return/Surv-FactSheet-9-29-03.doc
Describes the practice of surveillance as the foundation for controlling a potential re-emergence of SARS and the key components of SARS surveillance and reporting.

Guidance for SARS Preparedness for Infection Control
http://www.phppo.cdc.gov/PHTN/webcast/sars-return/Infection_Control_Fact_Sheet.doc
Describes infection-control preparedness planning for outpatient and hospital settings for an outbreak of SARS in the United States.

West Nile Virus
http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm
This Web page provides a state-by-state count of incidence and mortality from human West Nile virus infections and links to a map that details the distribution of human and animal cases.  As of October 17, there have been 7,021 cases and 152 deaths.

The Bureau of Community Environmental Health, Florida Department of Health
 The 2002 Annual Food and Waterborne Disease Report was released on Thursday, October 16. A copy can be found at the Food and Waterborne Disease website with previous annual reports http://www.doh.state.fl.us/environment/hsee/foodsurveillance/annualreports.html. The report includes a training overview, descriptive statistics on food and waterborne disease outbreaks for the 2002 calendar year with details on factors contributing to outbreaks, overviews of foodborne Norovirus and hepatitis A in Florida as well as Vibrio vulnificus in Florida. In addition, there are several case studies describing outbreaks that occurred throughout the year.
 

The Centers for Disease Control and Prevention
Health, U.S. Chartbook on Trends in the Health of Americans, 2003 at www.cdc.gov/nchs/hus/htm

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►This Week on EpiCom

A catered wedding party in Palm Beach County was the site of a gastrointestinal outbreak the weekend of October 18th. The outbreak is being investigated by the Palm Beach CHD.
 

A catered dinner in Pinellas County attended by approximately 150 persons is being investigated for foodborne outbreak. The matter is being investigated by the Pasco County CHD. 

For further information regarding the EpiCom program including how to sign up, send an email to EpiCom_Administrator@doh.state.fl.us.
 

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►Mosquito-borne Disease Update

Six WN virus cases were reported this week in Florida residents from Bay (2), DeSoto, Escambia, Monroe and Santa Rosa counties, bringing the number of cases reported this year in Florida to 67. The following 27 counties are under medical alert (new ones bolded): Bay, Brevard, Broward, Calhoun, Citrus, Collier, DeSoto, Duval, Escambia, Gilchrist, Gulf, Holmes, Jackson, Lafayette, Lee, Marion, Miami-Dade, Monroe, 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, with no new cases since mid-September. The total number of EEE cases remains at two. Last year by this date, there were 14 cases of WN, one case of EEE, and one case of St. Louis Encephalitis (SLE) infection. 
 

EEE virus activity in animals: Two sentinel seroconversions to EEE virus were reported from Putnam County 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: Seven WN virus infected horses were reported this week in Citrus, Escambia, Hernando, Marion, Orange, Suwannee and Walton counties; this is the first reported WN activity for Suwannee County. In addition, 29 seroconversions to WN virus were confirmed in sentinel chickens from 15 of the 31 counties that collected samples. Sixteen dead birds were reported positive for WN virus from Alachua, Bay (4), Escambia, Franklin, Hillsborough, Holmes, Jackson, Marion, Okaloosa (4) and Walton counties. Fifty-nine counties have reported WN virus activity, compared to 53 at this time last year. No counties have reported SLE activity this year compared to two counties at this time last year. 

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
 

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►Weekly Disease Table

Click on the link below to access the latest data on Week 42 disease figures, provided by the Florida Department of Health, Bureau of Epidemiology.

Current week's disease table

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