Friday, August 13 2004

         This Week in the News
 

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

►Florida Breast Cancer Treatment Modalities, 2000
This abstract is another of the many presented at the spring epidemiology seminar hosted by the Bureau of Epidemiology.

►Epi Bureau, Staff Garner Awards
Staff members at the Bureau of Epidemiology are a productive group. Here's a short enumeration of what's been going on in Tallahassee.

A R T I C L E S

Methods:
The state of Florida mandates that medical facilities report cancer cases to the statewide cancer registry, called the Florida Cancer Data System (FCDS). Each case reported to FCDS provides the patient?s demographics, tumor information, diagnostic procedures and treatment methods. Cancer incidence data are collected, verified and maintained by FCDS for surveillance, prevention, control, and research. For this analysis, 2000 incidence data for female breast cancer were analyzed to evaluate the frequency of treatment (i.e., chemotherapy, radiation and surgery) by age, race and stage. 

Results:
In 2000, 19,922 female breast cancer cases were reported to FCDS. Approximately 16 percent of female breast cancer cases were in situe; 49 percent local, 25 percent regional/distant and 10 percent unstaged. In 2000, approximately 90 percent of female breast cancer patients reported using surgical treatments as a form of treatment. For chemotherapy and radiation treatments, female breast cancer patients reported 22 percent and 29 percent utilization, respectively. Among white females, 92.1 percent reported surgical procedures as an initial course of treatment compared to 87.6 percent of black females. For chemotherapy, 21.7 percent of white females reported this treatment method compared to 35.9 percent utilization. For advanced stage breast cancer, 90.1 percent of female patients used surgery as a treatment method, 26.8 percent used radiation, and 52.4 percent used chemotherapy. 

Conclusion:
Cancer reporting by medical facilities within Florida must be maintained to identify the occurrence of cancer incidence and mortality, stimulate cancer research, and enhance cancer control and surveillance activities. These efforts should result in better prevention for the population most at risk for developing cancer, and improved treatment choices for cancer patients. For female breast cancer patients regardless of age and race, surgical procedures are used more often as the first course of treatment.
 

August is National Immunization Awareness Month
The National Partnership for Immunization (NPI) has designated August as National Immunization Awareness Month (NIAM). Each year, this commemorative month increases awareness about immunization across the lifespan as parents and children plan for the return to school, and the medical community begins its preparations for the upcoming flu season. NIAM provides an opportunity to create positive messages for the media and to highlight local, grassroots immunization initiatives. County health departments are encouraged to participate in the observance of NIAM through press releases, media campaigns, health fairs and exhibits.

For further information, go to the NPI, NIAM Web site at http://www.partnersforimmunization.org/niam.html, or contact Tom Bendle of the Bureau of Immunization at 850.245.4444, extension 2391 or SunCom 205.4444, extension 2391.

Immunization Update 2004
The Department of Health, Bureau of Immunization, in conjunction with the Office of Performance Improvement, is making available the Immunization Update 2004 interactive satellite teleconference through the Department of Health Telnet Videoconference Sites. This broadcast will air on August 19, 2004 from 9:00 to 11:30 a.m. EDT. The teleconference will be re-broadcast from 12:00 noon to 2:30 p.m. that afternoon.

Anticipated topics include new recommendations for influenza vaccine, including routine vaccination of children and expanded use of live attenuated influenza vaccine; pneumococcal conjugate vaccine shortage; varicella vaccine; and vaccine safety issues. Continuing education (CEU) credits will be offered for a variety of professions, based on 2.5 hours of instruction. 

Participants must register to receive CEUs for this broadcast. Registration for the program will be handled electronically. Site registration began on June 24. Participant registration began on July 22. Each county health department should designate a site facilitator who will instruct the satellite site coordinator to register as a viewing site through the Department of Health, Office of Performance Improvement's Web page at http://www.doh.state.fl.us/hpi/WFD/registration.htm. For registration to work smoothly, viewing sites should register prior to individual participants. The facilitator will also advertise the broadcast offering to employees and local providers, and provide instructions for participants to register on-line at http://www.phppo.cdc.gov/phtn/immup04/default.asp. Applicable course material will be available through this site. Participants may register for either the morning or afternoon broadcast.

Address questions concerning registration or satellite coordinates to Shawna Goodwin, Office of Performance Improvement, at 850.245.4444, extension 2182, or SunCom 205.4444, extension 2182. For other broadcast information, please contact Tom Bendle of the Bureau of Immunization at 850.245.4444, extension 2391 or SunCom 205.4444, extension 2391.
 

Carmela Mancini, MPH, administrator of the Bureau of Epidemiology Surveillance and Reporting Section has been elected chair of the Epidemiology Lab Section of the Florida Public Health Association for the upcoming year. Her responsibilities will entail representing her section as a voting member of the board of directors, holding business meetings and planning educational programs, attendance at standing committee meetings, and contributing articles to the association newsletter.

Melissa Murray, MS, appeared in The Florida State University Everything FSU newsletter for her presentation, Associations between alcohol and Drug use and injury among Florida's high school students at the annual conference of the Council of State and Territorial Epidemiologists in Boise, Idaho in June.

Longtime staff member Cadedra Parmer graduated August 7th from Florida State University   with a BS degree in chemical science and a minor in biology. Cadedra works as a data entry operator in the Surveillance and Reporting Section at the Bureau of Epidemiology, and plans to attend the University of Central Florida to earn a master's degree in forensic science.

The bureau itself was the recipient of a Department of Health Certificate of Acknowledgement for 100% compliance in submittal of purchasing card reconciliations for the months April through June 2004. This was mainly due to the diligence of Theresa Vivas, who specializes in purchasing and requisitioning for the bureau.

The Bureau of Epidemiology is proud of the achievements of these team members and we wish them continued success in all their endeavors.
 

Persons who live in or travel to the tropics, subtropics and southern European countries where Leishmaniasis is endemic are at risk for bites by the phlebotomine sandfly, the cause of the disease. Kabul, Afghanistan accounts for about a third of all cutaneous Leishmaniasis cases in the world. This week, the World Health Organization declared it would set up emergency operations there in an effort to halt the longstanding problem.

So far, soldiers assigned to this part of the world have been diagnosed with only two forms of the epidemic:

Cutaneous Leishmaniasis (CL) is the most common and produces large numbers of lesions on exposed parts of the body. Typical lesions do not hurt and emerge slowly, evolving from papules to nodules to ulcerations. This type of infection can be asymptomatic or yield only mild, nonspecific symptoms which are felt only weeks or even months after the bites.

Visceral (VL) (which, through aggressive testing will show differently from the Viscerotropic Leishmaniasis mentioned earlier) is the most serious, and is characterized by irregular fever, excessive weight loss, and abdominal pain caused by swelling of the liver and spleen. Left untreated, the fatality rate in underdeveloped countries can reach 100%.

Mucocutaneous lesions (MCL) form around the mucous membranes of the nose, mouth and throat cavities in this third form, and destroy the surrounding tissues. No U.S. or allied soldiers are reported to have been diagnosed with this form of the disease.

Leishmanias is endemic on five continents and 88 countries around the world. An emerging concern to the WHO is the frequency with which HIV co-infections are being reported. Physicians for the organization note that VL hastens the onset of AIDS, especially since Leishmania parasites and HIV destroy the same cells. When co-infection reporting began in 1998, the number of cases represented by southwestern Europe was two-thirds of the total number. Approximately 71% of those co-infected patients are IV drug users; Leishmaniasis can be transmitted from person to person through needles.

In Afghanistan and Iraq, American soldiers are provided traditional wartime equipment but they're also given prophylaxis, permethrin-treated bed netting and insect repellent containing DEET. They know that in addition to a visible enemy they've been trained to deal with, there's another menace for whom they need to be vigilant - a tiny female sandfly.
 

The initial distribution was made to infection control practitioners at all Florida hospitals and netted a very satisfactory number of responses from non-Department of Health users.

This descriptive epidemiological analysis will encapsulate the current information known about Salmonella senftenberg infected patients including antibiotic resistance, control/prevention, surveillance, and education. In addition, patient transfers have led to the transmission of the organism to additional healthcare facilities. Salmonella senftenberg is an emerging infectious organism with significant public health implications for the state of Florida. 

Additional Information:
The grand rounds presentation will begin promptly at 11:00 a.m., EST on Tuesday, August 31, 2004. The PowerPoint slides will be available on the Bureau of Epidemiology intranet Website on Friday, August 27. CEUs will be provided for nursing, environmental health professionals, and laboratorians. Please remember you must complete the entire registration form including the evaluation and test questions. Registration for CEUs will be accepted August 31 - September 2. Registrations received prior to the beginning of the program will not be accepted.
 

This Week on EpiCom

• 3 counties reporting West Nile virus
• Shigella reported in Palm Beach County
• e. Coli reported in Pinellas County

The Bureau of Epidemiology encourages Epi Update readers to not only register on the EpiCom system at https://www.epicomfl.net but to 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.

Eastern Equine Encephalomyelitis (EEE) virus activity: There were eight seroconversions to EEE virus in sentinel chickens from Alachua, Hillsborough and Orange counties. So far this year, 25 counties have reported EEE activity. 

St. Louis Encephalitis (SLE) virus activity: None this week. Two counties reported SLE this year. 

Highlands J (HJ) Virus activity: There were five seroconversions to HJ virus in sentinel chickens from Hillsborough, Marion, Nassau, Putnam and Walton counties. Nine counties reported HJ this year. 

Mosquito populations are present in many areas of the state. All are urged to take precautions against mosquito bites. Dead birds should be reported to www.wildflorida.org/bird/. 

See the Web page for more information at www.MyFloridaEH.com. 

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