Friday, November 19, 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."
Surveillance for Superbowl XXXIX
Our epidemic intelligence service fellows investigate a variety of cases during the course of their two years in Florida. This article is the result of one such investigation.
and Related Behavioral Factors Among Florida High School Youth
Opportunities for Florida Medical Professionals|
A demographic analysis workshop for geographic information systems and a clinical microbiology symposium for infectious disease practitioners are both coming up.
|Epi Update Managing Staff:||
Epidemic---Florida 2004 Two approaches to illness and injury
After four hurricanes hit our state this season, Dr. Dan Chertow spent weeks immersed in disaster relief work in the parts of Florida most affected by the storms. On November 30th at 11:00 a.m., he'll present his findings on field surveillance methods.
MD, MBA, MPH,
Secretary, Department of Health
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.
Division of Disease
►Mosquito-borne Disease Update
A report outlining confirmed cases and other activities for the week November 7- 14, 2004.
Dian K. Sharma,
MS, Ph.D., Bureau Chief,
The Florida Department of Health Bureau of Epidemiology Weekly Morbidity Report for the current week. The report contains diseases and conditions for confirmed cases.
A R T I C L E S
|Karen Wheeler, MPH, Bioterrorism Special Surveillance Projects Coordinator, Surveillance and Reporting Section||
Enhanced Surveillance for Superbowl XXXIX
Expanding current surveillance capabilities in Duval County has taken on a greater urgency in recent months in preparation for Super Bowl XXXIX in Jacksonville on February 6, 2005. The event will attract hundreds of thousands of visitors to the area during the two weeks at the end of January and beginning of February. The influx of visitors will increase the risk for disease outbreaks, whether natural or purposefully initiated. Therefore, an enhanced surveillance system will be implemented in the Jacksonville area and parts of St. Johns, Nassau and Clay counties that will assist public health officials in the early detection of illness and outbreaks. In addition to the early detection of naturally occurring infectious disease clusters, a potential benefit of developing an enhanced surveillance system is the possibility of detecting a bioterrorism-related incident. The timely identification of outbreaks (either naturally occurring or man-made) by public health officials is essential for the implementation of control measures to minimize morbidity in the population.
The enhanced surveillance project will involve a partnership between the Duval County, St. Johns County, Nassau County and Clay County Health Departments, the Florida Department of Health, and the U.S. Centers for Disease Control and Prevention. It will also involve close collaboration with hospitals and cruise lines throughout the region.
Participating hospitals will send chief complaint data plus limited patient geographic, demographic and clinical information electronically via an FTP file to the department of health’s secure server. The data will be electronically imported and stored in the Merlin Outbreak Module where it will be coded into syndromes and analyzed using CDC’s EARS (Early Aberration Reporting System) algorithms to generate a set of charts and graphs. The charts and graphs will be exported and posted to EpiCom.
Cruise ships will use a separate surveillance system from the hospital-based system. Participating cruise ships will report those patients that fall into a specific syndrome category. Medical personnel on the ship will determine what syndrome the patient belongs to. The completed form will be faxed or emailed to the appropriate health department and the information will be manually entered into the Merlin Outbreak module. Data analysis and dissemination methods will be the same as utilized in the hospital-based surveillance system.
The development and
implementation of this surveillance system will allow for a sustainable,
enhanced disease detection capability for the region, and allow the
Florida Department of Health the ability to evaluate the need and
utility of expanding syndromic surveillance to other areas of the state.
Robyn Kay, MPH, EIS
Fellow, Duval County
Syndrome (HUS) is a reportable medical condition in the State of
Florida. Clinical characteristics of HUS include hemolytic anemia, renal
injury, and low platelet count. HUS primarily occurs following a
gastrointestinal illness and is most commonly associated with shiga-like
toxin-producing Escherichia coli (SLTEC), including
Escherichia coli 0157:H71,2,3
In addition, HUS may be related to other types of bacteria, viruses and
Four cases of Hemolytic Uremic Syndrome in children have been reported in the Northeast Florida region between April and August 2004. These children were all administered antibiotics prior to specimen collection and no bacterial, viral or parasitic organisms have been isolated with three of the four cases. Only one of these cases has been associated with E. coli O157:H7. All cases are recovering. No epidemiological link has been established among any of the cases.
A confirmed case is defined as an acute illness diagnosed with HUS or Thrombotic thrombocytopenic purpura (TPP) in the presence of 1) anemia with microangiopathic changes on a peripheral blood smear AND 2) renal injury, evidenced by either hematuria, proteinuria, or elevated creatinine level AND 3) began within 3 weeks after onset of an episode of acute or bloody diarrhea.
A probable case is defined as an acute illness diagnosed as HUS or TPP in the presence of 1) anemia with microangiopathic changes on a peripheral blood smear AND 2) renal injury, evidenced by either hematuria, proteinuria, or elevated creatinine level in a patient who does not have a clear history of acute or bloody diarrhea in the preceding 3 weeks. A probable case is also defined as an acute illness diagnosed as HUS or TPP in the presence of 1) anemia with microangiopathic changes that have not been confirmed AND 2) renal injury, evidenced by either hematuria, proteinuria, or elevated creatinine level AND 3) began within 3 weeks after onset of an acute or bloody diarrhea.
Medical management for HUS includes IV fluids to maintain hydration, blood transfusion, or dialysis7. Severe cases of HUS may require a renal transplant. Treating an Escherichia coli 0157:H7 with antibiotics or antimotility agents has been widely debated by researchers. Some studies have suggested that antibiotics or antimotility agents increase the risk of HUS in children with an Escherichia coli 0157:H7 infection 8.
If you suspect that a patient has HUS or an enterohemorrhagic E. coli infection and the reference laboratory does not have the ability to test for shiga toxins, please contact your health department’s epidemiology division so testing may be arranged through the state laboratory.
If you have any questions regarding the submission of laboratory specimens to the state laboratory or how to report a case of HUS or E. coli contact the Florida Department of Health Bureau of Epidemiology at 850.245.4401 for assistance.
CDC. Community Outbreak of Hemolytic Uremic
Syndrome Attributable to Escherichia coli 0111:NM—South Australia, 1995.
MMWR 1995; 44: 550-551, 557-558.
A special thank you to Roberta Hammond, PhD, Kathleen Ward, RS MSEH, Carmela Mancini, MPH, Angela Morgan, RN, BSN, Rebecca Crouse, RN, BSN, Christine Bailey, RN, BSN, MSH, and Jerne Shapiro, MPH.
Zhaohui Fan, MSPH,
Epidemiologist, Chronic Disease Surveillance and Epidemiology Section
Related Behavioral Factors Among Florida High School Youth
Jaime Forth, Managing
Opportunities for Florida Medical Professionals
Full and half-day workshops in GIS (geographic information systems) will be held at the New Horizons Computer Learning Center in Miami December 2 and 3, 2004. The workshops will teach students how to use the GIS system to download, analyze, extract and query census demographic data for Miami (or any other community). The information can be used by researchers, planners or health department personnel in disease surveillance. The workshop will also provide a discussion of GIS trends, the use of ArcExplorer, and detailed hands-on experience. Workbooks and a reference CD are included. Fee is $249 and hours are 9:00 to 4:00 for the full day or 8:15 - 12:15 or 1:00 - 5:00 for a half-day session. For more information visit www.sgtinfo.com or call 877.241.6576 toll free.
The Renaissance Resort at World Golf Village at St. Augustine, Florida will host the First Coast Infectious Disease Clinical Microbiology Symposium scheduled for February 18 - 19, 2005. Some oaf the confirmed speakers are Susan Sharp, PhD, from Kaiser Permanente at Portland, Oregon; Peter Gilligan, PhD, University of North Carolina at Chapel Hill; John Wingard, MD, University of Florida College of Medicine and Michael Miller, PhD, The Centers for Disease Control & Prevention in Atlanta. Abstracts are currently being accepted for work presented within the February 2004 - January 2005 timeframe. The conference is co-sponsored by Baptist Health, Jacksonville and the First Coast Infectious Disease/Clinical Microbiology Symposium. For details, log on to http://www.firstcoastidem.com or call Dr. Diane Halstead at 904.202.2166.
The Department of Health Bureau of
Epidemiology does not specifically endorse trainings or products
highlighted in this journal. To determine whether these services are
suitable for your particular needs, we encourage to you investigate and
use your own best judgment.
|Dan Chertow, MD, MPH, CDC EID, Bureau of Epidemiology||
Epidemic---Florida 2004 Two approaches to illness and injury
Title: Hurricane Epidemic—Florida, 2004 Two approaches to illness and injury surveillance
Presenter: Dan Chertow MD, MPH, CDC Epidemic Intelligence Service (EIS) Officer, Bureau of Epidemiology, Florida Department of Health
Date: Tuesday, November 30, 2004 11:00 a.m.– 12:00 p.m. EDT
Following hurricane Charley (8/13 to 8/31), 13,465 medical visits were recorded from the majority of hospitals, clinics, and DMATs (disaster medical assistance teams) in Charlotte, Desoto, and Hardee counties. Data were also collected from Sarasota and Lee counties. A summary of demographic and clinical data from these visits is as follows: 53% of patients were female, 78% white, and 76% non-Hispanic. The majority of visits (30%) were for reasons other than those under surveillance. Twenty-three percent of visits were for injuries, 7 % for GI illness, 7% for respiratory conditions, 6% for skin conditions, 6% for an exacerbation of a chronic illness, and 5% for chest pain. Less common were visits for fever (3%), heat illness (2%), stress (1%), dehydration (1%) and poisoning (1%). A peak in poisoning was noted early in surveillance. This peak was thought secondary to carbon monoxide. No outbreaks of infectious disease were detected. Findings from this surveillance system helped guide prevention messages and public health interventions.
With the rush of hurricanes following hurricane Charley, the original surveillance system was modified for hurricanes Frances, Ivan, and Jeanne so that data could be collected, transferred, and analyzed electronically. EARS (the early aberration detection system) was applied for the purpose of detecting outbreaks. This application of EARS was the first ever in a natural disaster setting. Although no outbreaks of infectious disease were detected, the application of EARS allowed for specificity in describing illness and injury, as well as a timely and acceptable approach to natural disaster surveillance.
|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
use the link to sign up for features such as automatic
notification for certain events.
|D'Juan Harris, MSP, GIS Specialist, Surveillance Systems Section, Bureau of Epidemiology||
Weekly Disease Table
Click here for this week's disease table. Figures are provided by the Florida Department of Health.
|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: Two wild birds captured in Washington County were reported to be infected with EEE virus. There were 4 seroconversions to EEE virus in sentinel chickens from Leon (3) and Walton (1) counties. 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.