Friday, November 5, 2004

         This Week in the News

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

►Epidemiology of Salmonellosis in Florida 2000-2003
With an estimated three to five million cases occurring annually in the nation, this is also a major cause of illness in Florida.

►Medical Microchip Moves from Animals to Humans
After a lengthy trial in pets as a way of identifying them when they get lost or stolen, some researchers say it's time to recognize the value of a microchip in humans.
 

A R T I C L E S

Materials and Methods
We analyzed surveillance data for salmonellosis from Merlin. Reported cases of salmonellosis from January 2000 to December 2003 were studied to determine the incidences, infecting serotypes, racial differences, outbreaks, and geographical distribution of the disease around the state. Salmonellosis due to Salmonella typhi was excluded from this analysis.  

Data Analysis and Results
The statistical program for the social sciences version 11.5 was used in the descriptive analysis of the surveillance data.

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.

Conclusions

• Mean age for salmonellosis cases was 20 years
• While less than 10% of the cases were outbreak related, Florida has in the past experienced unusual foodborne Salmonella outbreaks. The largest in the state's reporting history (1000+ cases) occurred in 1995 and was associated with patrons of a Mexican restaurant. Florida has also experienced several Salmonella outbreaks related to emerging vehicles; namely, fresh-squeezed orange juice, tomatoes, sprouts and frozen mamey.
• Mean lag time to report cases to the Bureau of Epidemiology was not directly proportional to the caseload for the county
• Most of the deaths were seen in white females older than 75 years of age.

 Prevention and control of Salmonellosis

• Hand wash with soap and water before you prepare or eat food and after use of the bathroom, handling of uncooked food, playing with pets, tending to a sick person and changing diapers
• Refrigerate meats and eggs. Follow the food safety principles of "Clean, Cook, Chill, Separate (see the Fight BAC Website³ for specifics).
• Avoid raw or undercooked meat including poultry and seafood, and also raw eggs and unpasteurized (raw) milk. Do not eat batter or dough, egg nog, mousse or dressings which contain raw eggs
• Meats should be cooked to the following temperatures: Poultry (including ground poultry) 165^° F; ground meats other than poultry, 155^° F; roasts, steaks, fish and egg dishes, 145^° F; cooked fruits and vegetables that will be kept hot before serving, 140^° F
• Wash fruits and vegetables in cold, running water
• Individuals with salmonellosis should not work with food, children, the elderly, or people in sensitive situations such as nursing homes, hospitals or group care facilities⁴
• Recognize the risk of infection from animals/pets especially chicks, ducklings, reptiles, iguanas, kittens and puppies.

To view all the charts and graphs referenced in this article, click here.

References:
1.  United States Department of Agriculture
2.  Pan American Health Organization. Epidemiological Bulletin, Vol. 23, no. 1, March 2002
3.  Fight Bac: http://www.fightbac.org/main.cfm(10/25/04)
4.  Section 64D-3.014, Florida Administrative Code - Sensitive Situations
5.  Roberta Hammond, Ph.D., Division of Environmental Health
 

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.

The prevalence of physical abuse among pregnant women in Florida was analyzed using the combined data from the 2000, 2001, and 2002 Florida Pregnancy Risk Assessment Monitoring System (PRAMS). The greatest number of cases of physical abuse during pregnancy is found among Black women (5.1 percent), compared to White (3.1 percent) and Hispanic women (2.7 percent). Prevalence of abuse during pregnancy is higher among women 24 years of age and younger (5.5 percent) compared to women ages 25 to 34 years of age (2.1 percent) and women ages 35 to 39 years (2.0 percent). Women with less than 12 years of education (6.3 percent) are abused more often than women with more than 12 years of education (1.5 percent).

The less income the woman has, the more likely abuse occurs (5.6 percent) compared to women with higher incomes (1.1 percent). Unmarried women are physically abused during pregnancy (6.4 percent) more than married women (1.6 percent). Women with Medicaid privileges are abused more often (5.7 percent) than non-Medicaid women (1.6 percent). Women who are abused during pregnancy are more likely to smoke (6.1 percent) than women who are not abused during pregnancy (2.6 percent). Abused women are more likely to develop bladder/kidney infections (33.8 percent) than women not abused (17.0 percent). Women abused during pregnancy are more likely to develop high blood pressure (27.0 percent) and preterm labor (48.9 percent) than women not abused during pregnancy (17.4 percent) and 28.9 percent, respectively).

Physical abuse is highly associated with behaviors and attitudes before and during pregnancy. As indicated, the more education and the higher the income, the less chance of physical abuse. Teens are more likely to be abused before as well as during pregnancy. Medicaid recipients are more likely to be abused than non-Medicaid recipients.   

The effort to decrease the number of cases in Florida is a major undertaking as it requires the cooperation of the woman, law enforcement, and the abuse counselor/investigator.

Medical Microchip Moves From Animals to Humans

After a decade of use in household pets for identification purposes, the sub dermal microchip is headed our way.

One version has already been tested by the attorney general of Mexico and bar patrons in Spain, and in the United Kingdom the item is being touted as a potential lifesaving device for thousands of heart patients. The U.S. Department of Energy already uses the technology to monitor salmon migration. Security experts cite other potential benefits as control monitors for prisoners, and tracking devices for soldiers and kidnapping victims as other possibilities. 

As worn by dogs, the microchip and its antenna are sealed in an airtight glass capsule and inserted just beneath the skin between the shoulder blades. The device is about the size of a grain of rice. Implanting the microchip is much like giving the dog a vaccination. To avoid shifting, a sheath can be used to promote bonding between fibrous tissue and the capsule. Once the implant is made, it can be read using a scanning device which emits a low-frequency radio signal, activating the microchip to send a unique identification number back to the scanner.

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:

http://www.msnbc.msn.com/id/5439055/

http://www.thestate.com/mld/thestate/2004/10/15/news/nation/9913496.htm

http://www.nature.com/news/2004/041011/full/041011-16.html

http://www.ajc.com/news/content/news/1004/14chip.html
 

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 https://www.epicomfl.net. 

The next scheduled bi-weekly conference call will be held Friday, November 19 at 10:00 a.m.

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 richard_hopkins@doh.state.fl.us or phone him at 850.245.4444, ext. 4412.
 

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.
 

This Week on EpiCom

• Approximately 50% of attendees at social function fell ill after consuming a catered luncheon in Tampa; health department is investigating
• It was announced by HHS Secretary that an additional one million doses of FluMist nasal spray will be available to treat healthy adults wishing to be immunized from influenza
• Jefferson County inmate hospitalized in ICU with confirmed Meningococcal Meningitis

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.

Mosquito-Borne Disease Update

West Nile (WN) virus activity: One human case of WN illness was confirmed in a resident of Brevard County this week, bringing the state-wide total to 40. There were five seroconversions to WN virus in sentinel chickens from Brevard, Hendry, Hillsborough, St. Johns and Volusia counties. A horse in Broward County was confirmed with WNV infection this week. 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: 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. 

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