December 4, 2002

"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."

Foege WH et al. 
Int. J of Epidemiology
1976; 5:29-37

Epi Update Managing Staff
John Agwunobi, MD, MBA,
Secretary, Department of Health 

Landis Crockett, MD, MPH, 
Director, 
Division of Disease Control 

Steven T. Wiersma, MD, MPH,
Bureau Chief, 
State Epidemiologist 

Don Ward, 
Deputy Bureau Chief 
Epi Update Managing Editor 

Catherine Richards, 
Web Page Designer, 
Editorial Assistant 

Elizabeth Woodsmall,
Web Page Designer

A r t i c l e s:

 
Steven T. Wiersma, MD, MPH,
Bureau Chief, 
State Epidemiologist



The Bureau
was cited
as the state’s 
Outstanding
Work Unit
with a prize
of $2,500

Don Ward,
Deputy Chief,
Bureau of Epidemiology



Epi-Com will connect
more than 800 key
public health partners
with pivotal roles
in recognition and 
intervention of
disease outbreaks.

Training component
 modules will be
presented in a two-day
 distance learning satellite
 videoconference on
 December 5-6, 2002.

Phone Numbers
for Programs
Voice:
800-793-8598

FAX:
(800) 553-6323  

TTY:
(800) 815-8152 

Carina Blackmore,
M.S. Vet. Med., Ph.D.



Higher flu activity
than expected for this
time of year (>2%)
was reported by
physicians in Duval,
Okaloosa and Polk counties

Caroline Collins,
Arbovirus Surveillance Coordinator

Lisa Conti, DVM, MPH
State Public Health Veterinarian

and D’Juan Harris,
GIS Coordinator

Disclaimer: 
Please note that 
numbers are subject 
to change with 
confirmatory information.

To report dead birds use: 
http://wildflorida.org/bird/ 
http://wld.fwc.state.fl.us/bird/ 
or call toll free 1-800-871-9703

► Bureau of Epidemiology Wins Top Award
The Davis Productivity Awards recognized the Bureau of Epidemiology with two performance awards for outstanding achievement in 2001. Together with the Bureau of Laboratories, The Bureau of Epidemiology was cited as the state’s Outstanding Work Unit with a prize of $2,500 for outbreak response efforts. The Bureau of Epidemiology also received a letter of commendation for development of the Merlin project. The Davis Awards recognize and reward state government employees in Florida whose work significantly and measurably increases productivity and promotes innovation to improve the delivery of state services and save money for Florida taxpayers and businesses. 

Rapid Response to Anthrax
The award was based in part on the rapid response of the Bureau of Epidemiology to the first case of intentionally-caused anthrax disease in the United States (Palm Beach County) that helped prevent further cases and deaths. Its investigation provided a model for response in other states and determined the source and mode of transmission within 3 and 7 days after the first case was confirmed. 

Surveillance and Prevention of West Nile Virus
For the past two summers, Florida has experienced a new mosquito-borne and potentially fatal disease, the West Nile virus. The Bureau of Epidemiology team responded rapidly and effectively, resulting in prevention of many cases of severe disease, disability and death. 

Certificate of Commendation Winner
The Bureau of Epidemiology, Merlin Development Team, won a Certificate of Commendation for creating Merlin, the state’s revolutionary disease reporting and analysis system, Merlin has replaced a slow, labor intensive paper-based reporting system with a web-based system that leads the state-of-the art for the nation. Merlin has added to the timeliness and accuracy of collecting and evaluating disease and laboratory information, enhancing the potential for rapid recognition and response to disease outbreaks, including potential bioterrorist events.
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► Epi-Com: State-of-the-Art Epidemiology Network
The State Technology Office (STO) has completed its technical review and the Bureau of Epidemiology is now cleared to complete development and activation of Epi-Com—a secure, web-based outbreak communication/information network. When completed, the system will connect more than 800 key public health partners with pivotal roles in recognition and intervention of disease outbreaks including those related to a bioterrorist attack. Key partners include county health departments, state health offices, hospital emergency and infection control departments, clinical laboratories, major primary care providers, and a variety of responder groups. 

The Epi-Com network will be similar in design to the CDC’s Epi-X, which uses a dedicated website for exchange of information among the state health departments and the CDC. Unlike Epi-X, EpiCom will extend the user community to the local level. Members will use the website to communicate about all levels of individual case, cluster, laboratory or other data related to an outbreak or to seek medical or epidemiologic consultation. Members reading notices may respond with elucidating comments, guidance, anecdotal reports or criticisms. The network also will contain a step-down communications system to locate and inform key public health and response officials using pagers, telephones and other devices. The Bureau of Epidemiology will also provide an editing interface between the Florida network and the CDC’s Epi-X, to which the system will be connected, so posting of nationwide interest can be easily migrated to the national system.
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► CDC Bioterrorism Update: 12121
Smallpox Preparedness
A National Immunization Program and
Public Health Training Network Satellite Broadcast
December 5, 2002 - Part 1 
December 6, 2002 - Part 2 
12:30 PM - 5:30 PM ET

Implementation of a vaccination plan for smallpox preparedness and response will require a variety of persons in state and local health departments, hospitals, and other healthcare settings to receive general education and training on smallpox and smallpox vaccine issues. Some personnel, e.g. smallpox vaccine clinic personnel, clinicians who may evaluate and treat adverse events, will need detailed information. 

Hospital administrators and hospital-based clinicians will need information to make informed decisions about program participation and possible vaccination sequelae. Primary care physicians will also need basic clinical information, including evaluation of patients with rash/suspected smallpox, screening issues for potential vaccinees who may seek their advice, and management and referral of adverse reactions following vaccination.

Training component modules will be presented in a two-day distance learning satellite videoconference on December 5-6, 2002. Modules of the 2-day program will be available in a variety of formats including videotape, CD-ROMs, through the Centers for Disease Control and Prevention (CDC) website and through print materials for subsequent use. Public Health Foundation will distribute videos, CDs, and selected print materials (free of charge) shortly after the program broadcast.
Target Audience: State/Local Public Health Vaccine Program Implementers, Vaccine Clinic Personnel, Clinicians/Healthcare Workers and Public Health Personnel Considering Vaccine Program Participation, Clinicians/Healthcare Workers in Hospitals Designated as Healthcare Response Teams, Front Line/Primary Care Clinicians

Components (modules) of training needed to support a smallpox vaccination program will include, but not be limited to
Day 1
- Vaccine Clinic Operations and Management
  (site selection, setting up a clinic, scheduling, staffing)
- Vaccine Distribution and Storage
 - Data and Information Management
- Laboratory Support
- Communications with Public and Stakeholders
- Considerations for Hospitals: Developing a Smallpox
  Vaccine Healthcare Response Team

Day 2
- Vaccine Contraindications and Screening
- Pre-screening of Program Participants
- Vaccine Administration
- Vaccinee Education and Follow-up Care: Evaluation of "Takes," Site Care, and Monitoring
- Vaccine Safety and Reporting Adverse Events
- Evaluation, Management and Treatment of Adverse Events of Smallpox Vaccine

Registration Information
Visit the CDC/ATSDR Training and Continuing Education Online System at http://www.phppo.cdc.gov/phtnonline to register online for these programs. Individual registration will begin on Monday, December 2, 2002. No site registration will be available for these programs. You must use the on-line system to register and complete the daily broadcast evaluations. A certificate of attendance will be awarded to participants who complete a course evaluation. Individuals who have questions about registration should call 1-800-41-TRAIN or email ce@cdc.gov.

Modules of the 2-day program will be available in a variety of formats including videotape, CD-ROMs, through the Centers for Disease Control and Prevention (CDC) website and through print materials for subsequent use.

The Public Health Foundation will distribute videotapes, CD-ROMs, and selected print materials (free of charge) shortly after these programs. Contact the Public Health Foundation at http://www.phf.org or call toll free
1-877-252-1200.

Webcast Information
These programs will each have a live webcast and will also be available for viewing after each live broadcast via the CDC website, http://www.cdc.gov/smallpox.
 
Audiobridge Information
In the event you are unable to receive the signal on program day, you may join by audiobridge. 
Bridge will open at 11:45 AM ET
- USA Toll Free Number: 888-566-6189
- USA Toll Number 1-712-257-3328
- Passcode for Dec. 5 - Part 1 broadcast:

If you have problems during your audiobridge conference, you may call 800-728-8232 or International callers dial 404-639-1289.
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► Influenza Virus Surveillance Summary Update
Week ending November 9, 2002-Week 45
Florida: During week 45 (November 3-9, 2002) influenza activity, calculated based on the proportion of patients with influenza-like illness (ILI) seeking care by physicians participating in the Florida Sentinel Physicians Surveillance Network was low 0.98%. Higher flu activity than expected for this time of year (>2%) was reported by physicians in Duval, Okaloosa and Polk counties. The third positive rapid flu test was reported from Miami-Dade County this week. Earlier this season an influenza A(H1N1) outbreak was confirmed in Holmes County. 

National Report: One influenza B virus isolation was made from 738 specimens tested by the World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories this week. Since September 29, 0.2% (n=11) of the 6,493 specimens tested nationwide have been positive. Influenza A activity has been detected in Florida, Louisiana, New York, North Carolina and South Carolina. Influenza B isolates have been identified in New York, North Carolina and South Carolina. CDC has characterized one influenza A (H1N2) isolate antigenically. Both the hemagglutinin (H) and neuraminidase (N) proteins of this reassorted strain are similar to H and N proteins in the vaccine strains. 

The proportion of patient visits to sentinel physicians for influenza-like illness (ILI) was 1.3% nationwide, which is below the national baseline of 1.9%. AN ILI outbreak was reported from Louisiana. Sporadic influenza activity was reported from 17 states (Alabama, Colorado, Florida, Georgia, Indiana, Kansas, Kentucky, Maine, Missouri, Nebraska, Nevada, New Mexico, Pennsylvania, Tennessee, Texas, West Virginia and Wyoming). The proportion of deaths attributed to pneumonia and influenza as reported by the vital statistics offices of 122 U.S. cities was 6.5% during week 45. This percentage is below the epidemic threshold of 7.2% for this time. 
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► Arboviral Activity Summary Week Ending 11/258/02

During the period of November 19, 2002 through November 25, 2002, the following arbovirus activity (St. Louis encephalitis [SLE] virus, eastern equine encephalomyelitis [EEE] virus, West Nile [WN] virus and dengue virus) was recorded for Florida:

Human:  One West Nile case was reported this week, a 49 year-old resident of Hillsborough County.

Sentinel Chickens:  Thirty-five WN seroconversions were confirmed in Bay (1), Charlotte (2), Citrus (1),  Hillsborough (1), Indian River (1), Lee (3), Manatee (3), Martin (1), Okeechobee (1), Orange (6), Osceola (3), Palm Beach (2), Pasco (2), Pinellas (1), Sarasota (2), Seminole (1), St. Johns (1), St. Lucie (1), Volusia (1) and Walton (1) counties.  This week, 792 samples were tested from 24 counties.  

Equine*:  Twenty-one WN cases were reported from the following counties: Citrus (1), Escambia (4),  Holmes (3), Jackson (8), Pasco (1),  Putnam (1), Santa Rosa (2), and Washington (1).

Bird Mortality: Fourteen dead birds were reported with WN from Bay (1), Jackson (5),  Leon (1), Okaloosa (1), Pasco (2), Putnam (1), Santa Rosa (2) and Walton (1) counties.   3,817 birds were tested and an additional 406 were too decomposed to be tested.  To date, 9,523 bird reports were logged representing 11,833 dead birds; 1,204 (10%) were crows; 1,321 (11%) were blue jays and 286 (2%) were raptors.

To report dead birds use http://wildflorida.org/bird/ or http://wld.fwc.state.fl.us/bird/ 

Online bird identification: http://www.mbr-pwrc.usgs.gov/id/framlst/framlst.html or http://data.acnatsci.org/ornithology/vireo.php 

Mosquito Pools:  No new mosquito pools were reported WN positive this week.  A  total of 3,512 mosquito pools collected during 2002 have been submitted for testing at the DOH Tampa Laboratory.  At least 982 additional pools have been tested by mosquito control agencies and 298 pools have been tested by Department of Defense installations in the state.

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► Weekly Disease Table : Week 45
Florida Department of Health – Bureau of Epidemiology
Weekly Morbidity Report Selected Diseases and Conditions
(Confirmed Cases Only) Week 46 Ending 11/16/2002

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