Friday, November 5, 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."
of Salmonellosis in Florida 2000-2003
Abuse During Pregnancy in Florida
A recent study of data from the Florida Pregnancy Risk Assessment Monitoring System (PRAMS) shows the prevalence of physical abuse during pregnancy is significantly higher among non-Hispanic Black women than among both non-Hispanic White women and Hispanic women.
Microchip Moves from Animals to Humans
Conference Call Devoted to Influenza|
This bi-weekly conference call between state county health departments and Bureau of Epidemiology staff was planned to provide the most current and encompassing information available about influenza.
|Epi Update Managing Staff:||
Chief for Science Joins Bureau of Epi Staff|
After a three-year absence, Dr. Richard Hopkins returns to Tallahassee in a new role. We'll introduce and explain what he'll be doing now that he's back.
MD, MBA, MPH,
Secretary, Department of Health
Response in a Medical Environment|
Designed for medical administrators, planners, and clinicians and first responders, this two-day conference will be held in Arlington Virginia in December and feature instruction on medical planning through intelligence, threat assessment, and defense measures.
Division of Disease
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,
A report outlining confirmed cases and other activities for the week October 24 - 30, 2004.
The Florida Department of Health Bureau of Epidemiology Weekly Morbidity Report for the current week. The report includes disease and conditions for confirmed cases.
|The editor notes with regret that this is the final issue over which editor-in-chief Don Ward will preside. Epi Update would not have come this far without his vision and firm support, so this issue is to you, Don, with gratitude and all good wishes. J. Forth, et al.|
A R T I C L E S
|Lilian Kigonya, MB.Ch.B, MPH; Joann Schulte, DO, MPH, Bureau of Epidemiology; Robert Hammond, Ph.D., Bureau of Community Environmental Health||
Epidemiology of Salmonellosis in Florida 2000-2003
Salmonella bacteria is a major cause of illness in the United States; each year an estimated 3 to 5 million cases occur in humans. Although many of these cases are mild and self-limiting, serious sequelae and death may occur. The human health bill for salmonellosis is estimated at $4 billion per year1. Detection and control of Salmonella is complicated by the fact that there are over 2,0002 serotypes of Salmonella species. Due to under-reporting and lack of information on disease severity, surveillance data only allows estimation of incidence and trends. The State of Florida, in an effort to strengthen its capacity to detect, investigate and mitigate illness due to Salmonella, has put several programs in place. One of these is the Food and Waterborne Disease Program which has a unique structure for surveillance and investigation. This program is designed to address tasks at the county, regional, and state levels5. There are nine regional environmental epidemiologists that assist county health departments in the investigation of disease outbreaks. In addition to the knowledge and experience regional epidemiologists bring to the program, they provide technical expertise during outbreak investigations and report writing, questionnaire development, and statistical analysis. County health departments maintain food and waterborne illness complaint logs and perform outbreak investigations using epidemiological teams composed of an environmental health professional, a nurse and an epidemiologist. The Bureau of Epidemiology tracks salmonellosis cases in Merlin, its Web-based electronic surveillance system. This system has recently expanded to include an outbreak module that will aid in increased reporting of salmonellosis cases among other diseases in the state.
Data Analysis and
The census data for the year 2000 and population estimates of subsequent years for the counties and the state of Florida were used to calculate the disease rates (Graph 1). The mean age for salmonellosis cases was 20 years, with the majority (45%) of the cases in children under 5 years, 38% in those 5-45 years and 20% in those 46 years and over (Figure 1). The mean age for all the counties was calculated (Table 1). Gadsden and Madison Counties had the youngest patients while Sarasota and Hamilton counties had the oldest patients. The distribution of race, ethnicity and gender among the cases was similar to that seen in the population of the state of Florida, with the ratio of whites to blacks 5:1 (Table 2) and males to females 1:1 (Table 3).
For the year 2003, we determined the mean lag time (in days) it took for the counties to report a case to the bureau of epidemiology from the time the case was first identified (event date). Our results (Graph 2) indicated that caseload was not directly proportional to the mean lag time. There are probably many factors to explain this finding and counties have been encouraged to do their own research.
There were very few deaths (14) reported as due to salmonellosis from 1998 to 2002 (Table 4). All except 3 were above 75 years of age, with only one less than 5 years. Twelve of the deaths were white. Gender was available for 11 cases; 7 of these were female.
Prevention and control of Salmonellosis
To view all the charts and graphs referenced in this article, click here.
Helen Marshall, PRAMS
Coordinator, Chronic Disease Surveillance and Epidemiology Section; Curt
Miller, BS Data Analyst, Bureau
Abuse During Pregnancy in Florida
Physical abuse against women during pregnancy is
a serious health concern with implications for both the mother and
infant. Adverse health outcomes can include, low birth weight, poor
maternal weight gain, infection, anemia, injury, and death. Physical
abuse is associated with adverse behaviors, such as, cigarette smoking,
alcohol abuse, and drug use.
Jaime Forth, Managing
Microchip Moves From Animals to Humans
We already use these chips in other objects; in the security badges which allow us access to certain areas at work, or in the push button keys that unlock our cars before we physically reach them. For humans, a 20-minute procedure would result in insertion of an FDA-approved microchip about the size of a pen point or a grain of rice in the fatty tissues of a person's forearm.
The application of such technology would have a profound effect on our medical community. Emergency room personnel could use information stored on microchips in unconscious patients to gain access to important medical data. Because the microchip is portable, insurance records could also be stored with the medical information. Another kind of microchip could be embedded to record vital signs and assist physicians in monitoring chronic problems or aid epidemiologists in disease surveillance. Researchers note that the microchip technology could create a chip designed to deliver drugs or vaccines in precise dosages.
Although produced in Florida, the technology has sold better internationally than in the U.S., where privacy issues are an important concern. Enabling an entity to monitor the movements of an individual for any reason is something that causes many Americans to deliberate, and although the speed and efficiency of the information superhighway will increase due to technological breakthroughs such as extreme ultraviolet wafer chips and embedded chips, these sophisticated improvements will certainly make future dialogues between physicians and their patients more complex and interesting.
For more information on this topic, click on the following links:
Jaime Forth, Managing
Call Devoted to Influenza
The bi-weekly conference call attended by county health departments around the state and Bureau of Epidemiology staff experienced a record number of callers interested in influenza. A summary is presented here for those who were unable to call in.
Announcements. Don Ward introduced Dr. Richard Hopkins, senior science advisor, who has rejoined the Florida Department of Health after working for the CDC for the past few years. He also announced November 8 as the starting date for Dr. Dian Sharma, who was selected as the new chief of the Bureau of Epidemiology replacing Don, whose last day in office will be November 5.
Influenza surveillance and reporting. Angela Fix directed attention to written guidance provided earlier in the week and emphasized that each county will determine the appropriate level of influenza activity to report to DOH. The report should then be posted to EpiCom by 5:00 p.m. each Monday. Following receipt of the information, Angela will prepare a color-coded GIS map for use by the Secretary of Health and CDC. The five items each CHD should report are influenza outbreaks; influenza-associated deaths; encephalitis infections; suspected respiratory infections; and flu testing results. All report forms are posted on the bureau Website.
Influenza Incident Command. Alan Rowan reported that of the two manufactures of influenza vaccine, Chiron is no longer shipping and Aventis is, but its supplies are limited. On October 19, Governor Bush contacted the secretary of the Department of Health and formally tasked him with providing a statewide response to the pending vaccine crisis. Dr. Agwunobi formed an incident command team comprised of Alan Rowan as its commander, Phyllis Yambor as the operations chief, Meade Grigg as the planning chief, Charles McArthur as logistics chief and Jackie DiPietre as the public information officer.
The team contacted all county health departments and other governmental agencies associated with the DOH to ask what their needs were, and to propose that representatives of the other agencies join a task force to ensure that no one in need of a vaccine will go without. The task force will emphasize a public health message and create an ad hoc Website featuring flu prevention tips and links to other flu-related sites.
Discussion. Pete Garner noted that
the inventory reporting system was set up to communicate with the
Bureau of Epidemiology on the status of flu vaccine at each county
health department. Only on-hand vaccine should be recorded. Using
Saturday as the ending date, all CHDs should submit their report each
Friday. The reporting address is
|Jaime Forth, Managing Editor||
for Science Joins Bureau of Epi Staff
During the past year, Dr. Richard Hopkins made his home in Atlanta at the Centers for Disease Control and Prevention, working in applied epidemiology on projects that combined surveillance and informatics.
His move to Tallahassee a few weeks ago was a move back home of sorts.
Dr. Hopkins attended Harvard College and graduated Magna cum laude before earning his medical degree from the University of Pennsylvania. He served his internship and residency at Pennsylvania Hospital in Philadelphia. After becoming board certified in internal medicine he joined the CDC, which first assigned him to the Montana Department of Health and Environmental Sciences, where he conducted communicable disease surveillance and consulted on outbreak investigations.
His subsequent assignments took him to Colorado, where he was chief of the Communicable Disease Control Section at the Colorado Department of Health; to Ohio State University, where he performed research on the epidemiology of injuries as assistant professor at the Department of Preventive Medicine; and West Virginia, where he performed epidemiologic investigations related to communicable and chronic diseases.
Dr. Hopkins was introduced to Tallahassee in 1990 when he became deputy state epidemiologist for the state of Florida. Less than a year later, he was named state epidemiologist and held that position until 2001, when he left to accept a post in Kansas as chief scientist at the state department of health. There, he developed and implemented the state's bioterrorism preparedness and response work plan. His return to Tallahassee as deputy chief for science at the Bureau of Epidemiology will require detailed supervisory work in surveillance and electronic data systems.
With over $2,500,000 in grants and contracts funded since 1980, Dr. Hopkins has directed projects ranging from the epidemiology of consumer product-related injuries to forensic epidemiology for public health law. He has published articles on waterborne diseases, worker's compensation issues and hurricane-related recovery as well as other topics. His expertise is broad, and he comes well-prepared to rise to the challenges inherent in his newly-created position here.
To reach Dr. Hopkins, email him at
email@example.com or phone him at 850.245.4444, ext.
|Jaime Forth, Managing Editor||
Response in a Medical Environment
A two-day conference sponsored by the Homeland Defense Journal and Homeland Defense Radio.com will be held in Arlington, Virginia this December to teach participants the building blocks of crisis planning in a medical setting to enhance preparedness and risk management for catastrophic events. The course is designed specifically for medical administrators, planners, and clinicians and first responders.
Because the role of healthcare professionals has evolved within the last several years, the conference will address the impact of complex emergency events and provide guidance on improving medical planning through intelligence, threat assessment, and defense measures.
Announced exhibitors include Medical Planning Resources, Inc., the Professional Services Council, Wireless Communications Association, Int'l, Grants Office, and Venture Capital, Angel Roundtable. Registration fee for government entities is $595. For more information, including special hotel accommodations, go to www.homelanddefensejournal.com.
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 use the link to sign up for features such as automatic notification for certain events. Registered users should 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.
|D'Juan Harris, MSP, GIS Specialist, Surveillance Systems Section, Bureau of Epidemiology||
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.
|Arbovirus Surveillance Team: Samantha Rivers, MS, Caroline Collins, Kristen Payne, Calvin DeSouza, and Carina Blackmore, MS Vet. Med., PhD., State Public Health Veterinarian||
Eastern Equine Encephalomyelitis (EEE) virus activity: Six wild birds captured in three Panhandle counties were reported to be infected with EEE virus. So far this year, 33 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 still present in many areas of the state, although cooler temperatures are expected to reduce their numbers. All are urged to maintain preventive actions against mosquito bites. Dead birds should be reported to www.wildflorida.org/bird/.
See the Web for more information at www.MyFloridaEH.com.