May 2019 Florida Department of Health - Hillsborough County

Disease Surveillance Newsletter

1

EpiNotes

Ron Desantis

Governor Mission: To protect, promote & improve the health of all

people in Florida through integrated state & community

efforts.

Vision: To be the Healthiest State in the Nation

Director

Douglas Holt, MD

813.307.8008

Medical Director (HIV/STD/EPI)

Charurut Somboonwit, MD

813.307.8008

Medical Director (TB/Refugee)

Beata Casanas, MD

813.307.8008

Medical Director (Vaccine Outreach)

Jamie P. Morano, MD, MPH

813.307.8008

Community Health Director

Leslene Gordon, PhD, RD, LD/N

813.307.8015 x7107

Disease Control Director

Carlos Mercado, MBA

813.307.8015 x6321

Environmental Administrator

Brian Miller, RS

813.307.8015 x5901

Epidemiology

Michael Wiese, MPH, CPH

813.307.8010 Fax 813.276.2981

TO REPORT A DISEASE:

Epidemiology

813.307.8010

After Hours Emergency

813.307.8000

HIV/AIDS Surveillance

Erica Botting

813.307.8011

Lead Poisoning

Cynthia O. Keeton

813.307.8015 x7108 Fax 813.272.6915

Sexually Transmitted Disease

Sophia Romeus

813.307.8045 Fax 813.307.8027

Tuberculosis

Irma B. Polster

813.307.8015 x4758 Fax 813.975.2014

Articles and Attachments Included This Month

Health Advisories and Alerts 1

May 2019 Reportable Disease Summary 2

Florida Food Recalls 5

CDC Pink Book Webinar Series 5

Healthy Summer Press Release 7

DOH-Pinellas Identifies Case of Hepatitis A in a Food Service Worker 9

County Influenza Report 6

Reportable Diseases/Conditions in Florida, Practitioner List 15

FDOH, Practitioner Disease Report Form 16

• CDC Food Safety Alert: E. Coli O26 Outbreak Linked to Flour

• CDC Investigation Notice: Multistate Outbreak of Salmonella Infections Linked to Contact with Live Poultry

• CDC Investigation Notice: CDC Foodborne Outbreak Investigations Updates: Raw Oysters and Raw Tuna

• CDC Foodborne Outbreak Updates: Tahini and Pre-Cut Melons

• CDC Travel Notices:

• Monkeypox in Nigeria: There is an ongoing outbreak of

monkeypox in Nigeria. Travelers to Nigeria should protect

themselves from monkeypox by washing hands often with

soap and water, and avoiding contact with animals or people

that may be sick.

• Ebola in Democratic Republic of the Congo: There is an

outbreak of Ebola in the North Kivu (Kivu Nord) and Ituri

provinces in the Democratic Republic of the Congo (DRC).

Health Advisories, News, and Alerts

2 May 2019

0.0

19.7

14.3

1.0 2.7 1.04.7

0.71

23

19

0

3

0

32

Mumps Pertussis Varicella Listeriosis Meningitis(Bacterial,

Cryptococcal,Mycotic)

MeningococcalDisease

Legionellosis Vibriosis

January-April Reportable Disease Summary - Other Common Reportable Infections

April YTD 2016-2018 Average

April YTD 2019

89.7

20.09.3

25.0

74.0

25.7

0.7

119

16 14

30

67

122

Campylobacteriosis Cryptosporidiosis Escherichia coli,Shiga toxin-

producing (STEC)

Giardiasis Salmonellosis Shigellosis Vibriosis

January-April Reportable Disease Summary - Enteric Infections

April YTD 2016-2018 Average

April YTD 2019

These vaccine reportable diseases are summarized monthly in the state Vaccine

Preventable Disease Report, which is available online at:

http://www.floridahealth.gov/diseases-and-conditions/vaccine-preventable-

disease/vaccine-preventable-disease-report-archive.html

Cryptosporidium is a parasite that we see more

cases of during summer, since people can be

infected while swimming or playing in recreational

water venues. This parasite is not killed by normal

levels of chlorine in pools, and people can shed the

parasite for up to two weeks after their symptoms

end. https://www.cdc.gov/parasites/crypto/

3 May 2019

56%25%

19%

Cases Who Report Drug Use as a Risk Factor

Yes No Unknown

January 2018 to April 2019 Case Summary

Total Number of cases 166

Number of cases acquired in Florida or Unknown 154

Age

Mean 40

Median 38

Min-max 7-71

Cases by Age Category Number (%)

0-18 1 (1)

19-29 30 (19)

30-39 54 (35)

40-49 44 (29)

50-59 18 (12)

60+ 7 (5)

Gender Number (%)

Female 45 (29)

Male 109 (71)

Unknown gender 0

Race Number (%)

White 131 (85)

Black 9 (6)

Other 13 (8)

Unknown race 1 (1)

Ethnicity Number (%)

Non-Hispanic 136 (88)

Hispanic 17 (11)

Unknown ethnicity 1 (1)

3.3

12.38.7

104.3

496.3

82

1814

113

418

Hepatitis A Hepatitis B (Acute) Hepatitis C (Acute) Hepatitis B (Chronic) Hepatitis C (Chronic)

January-April Reportable Disease Summary - Viral Hepatitis

April YTD 2016-2018 Average

April YTD 2019

Hillsborough County is currently

experiencing a large increase in

infections of hepatitis A, which is

a viral infection transmitted

through the fecal-oral route.

There is a vaccine available to

prevent hepatitis A.

4 May 2019

January-April Reportable Disease Summary – Arboviral Infections

Cases of any infection are reported based on the county where the person’s home

address is. Hillsborough County has reported infections of imported mosquito-borne

diseases every year, which means the individual was infected while traveling outside

of the county. Hillsborough County has not had any infections of chikungunya,

dengue, zika, or malaria acquired through mosquitos in our county in 2018 or 2019.

The Florida Department of Health releases a weekly arboviral surveillance report that

is available here: http://www.floridahealth.gov/%5C/diseases-and-

conditions/mosquito-borne-diseases/surveillance.html

The data in these charts represent the most common reportable diseases investigated by

the Epidemiology Program. All of the state’s reportable disease data is available for the

public to search on FL CHARTS here:

http://www.flhealthcharts.com/charts/CommunicableDiseases/default.aspx To build your

own search, click on the link for “Reportable Diseases Frequency Report”.

The case numbers for 2018 and 2019 are provisional and subject to change until the

yearly database is closed, usually around April of the following year. Once the numbers

are finalized, the state puts together a comprehensive Florida Annual Morbidity Statistics

Report that details case trends and notable outbreak investigations. The report for 2017

and previous years are available at: http://www.floridahealth.gov/diseases-and-

conditions/disease-reporting-and-management/disease-reporting-and-surveillance/data-

and-publications/fl-amsr1.html

0.7 0.7 1.0 1.0

5.3

0 1 0

2

1

Chikungunya Dengue Lyme Disease Malaria Zika Fever

April YTD 2016-2019 Average

April YTD 2019

5 May 2019

CDC: 2019 Pink Book Webinar Series

CDC is offering a weekly series of 15 one-hour webinars that will provide an overview of vaccination principles, general recommendations, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each webinar will explore a chapter from the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (the “Pink Book”) and will also include updated information from recent Advisory Committee on Immunization Practices (ACIP) meetings and votes. The webinars start on June 5, 2019, and will air live most Wednesdays from 12–1 p.m. EDT through September 25, 2019. Please visit https://www2.cdc.gov/vaccines/ed/pinkbook/ for the schedule and additional information. Continuing Education (CE) will be available for each event.

It's Summertime, Florida! Keep It Safe and Healthy at the Beach, Lake,

River or Spring

Tallahassee, Fla. — In 2018, Florida set a tourism record for the eighth consecutive year

drawing 126.1 million out-of-state visitors, and this year AAA ranks Orlando as the number one

summer destination in the world! With Florida poised to break another tourism record and many

residents looking forward to holiday weekends and vacations, the Florida Department of Health

(FDOH) encourages everyone to maximize the health benefits and fun of days spent in and

around Florida’s waters: play it safe and keep it healthy.

Read the rest of the press release from the Florida Department of Health here.

DOH-Pinellas Identifies Case of Hepatitis A in a Food Service Worker;

Encourages Vaccination

The Florida Department of Health in Pinellas County (DOH-Pinellas) has identified a case of

hepatitis A in a food service worker in Madeira Beach. Following laboratory confirmation on

May 22, DOH-Pinellas immediately began conducting an epidemiological investigation and

today (May 24) determined the individual worked at Friendly Fisherman located at 150

John’s Pass Boardwalk Place between May 7 – 20 while infectious.

If you frequented this restaurant during that period and have not previously been vaccinated

for hepatitis A, you should consider getting vaccinated. You will receive the first dose of the

hepatitis A immunization. The second dose is provided six months after the first. If you have

previously received the hepatitis A vaccine you do not need to take additional action.

Read the rest of the press release from the Florida Department of Health here.

Florida Food Recalls (April 25, 2019 – May 28, 2019)

Brand Name Food Date of Recall Health Risk

Seven Seas International LLC USA Biltmore Smoked Sockeye Salmon 5/6/2019 Listeria

monocytogenes Details

6 May 2019

Hillsborough County Weekly Influenza Report (2018 – 2019 Season)

Flu Trend:

Stable

Flu Level:

Mild

The 2018-2019 influenza season officially ended in week 20 (May 12-18).

While influenza season is over, influenza viruses remain circulating at low

levels all year in Florida. Sporadic outbreak reports during the summer are

expected. Earlier in the season, influenza A 2009 (H1N1) was reported as the

predominant strain both in Florida and in the United States. Mid-season

changes in the predominantly circulating strain have been observed in past

seasons.

Flu Activity This Season (September 30 – May 18)

• Total Outbreaks: Nineteen outbreaks of influenza or ILI have been reported

during the 2018-2019 flu season.

• Total Deaths: Hillsborough County has reported no pediatric mortalities in the

current flu season.

Figure 1: In week 20, the percent of emergency department and urgent care center visits for ILI* in

Hillsborough County remained stable and is within levels seen in previous seasons.

*Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL) measures trends in ILI

visits from emergency departments (ED) and urgent care clinics (UCC). Participating EDs and UCCs in Hillsborough County

(n=21) electronically transmit visit data into ESSENCE-FL daily or hourly. The ESSENCE-FL ILI syndrome captures visits with

chief complaints that include the words “influenza” or “flu,” or chief complaints that include the words “fever” and “cough,” or “fever”

and “sore throat.”

For statewide data

see the Florida Flu

Review.

www.FloridaHealth.gov/DiseaseReporting

www.FloridaHealth.gov/CHDEpiContact

! Outbreaks of any disease, any case, cluster of cases, or exposure to an infectious or non-infectious disease, condition, or agent found in the general community or any defined setting (e.g., hospital, school, other institution) not listed that is of urgent public health significance

+ Acquired immune deficiency syndrome (AIDS)

Amebic encephalitis

! Anthrax

Arsenic poisoning

! Arboviral diseases not otherwise listed

Babesiosis

! Botulism, foodborne, wound, and unspecified

Botulism, infant

! Brucellosis

California serogroup virus disease Campylobacteriosis

+ Cancer, excluding non-melanoma skin cancer and including benign and borderline intracranial and CNS tumors

Carbon monoxide poisoning

Chancroid

Chikungunya fever

Chikungunya fever, locally acquired

Chlamydia

! Cholera (Vibrio cholerae type O1)

Ciguatera fish poisoning

+ Congenital anomalies

Conjunctivitis in neonates <14 days old

Creutzfeldt-Jakob disease (CJD)

Cryptosporidiosis

Cyclosporiasis

! Dengue fever

! Diphtheria

Eastern equine encephalitis

Ehrlichiosis/anaplasmosis

Escherichia coli infection, Shiga toxin-producing

Giardiasis, acute

! Glanders

Gonorrhea

Granuloma inguinale

! Haemophilus influenzae invasive disease in children <5 years old

Hansen’s disease (leprosy)

Hantavirus infection

Hemolytic uremic syndrome (HUS)

Hepatitis A

Hepatitis B, C, D, E, and G

Hepatitis B surface antigen in pregnant women and children <2 years old

Herpes B virus, possible exposure

Herpes simplex virus (HSV) in infants <60 days old with disseminated infection and liver involvement; encephalitis; and infections limited to skin, eyes, and mouth; anogenital HSV in children <12 years old

+ Human immunodeficiency virus (HIV) infection

HIV-exposed infants <18 months old born to an HIV-infected woman

Human papillomavirus (HPV)-associated laryngeal papillomas or recurrent respiratory papillomatosis in children <6 years old; anogenital papillomas in children ≤12 years old

! Influenza A, novel or pandemic strains

Influenza-associated pediatric mortality in children <18 years old

Lead poisoning (blood lead level ≥5 µg/dL)

Legionellosis

Leptospirosis

Listeriosis

Lyme disease

Lymphogranuloma venereum (LGV)

Malaria

! Measles (rubeola)

! Melioidosis

Meningitis, bacterial or mycotic

! Meningococcal disease

Mercury poisoning

Mumps

+ Neonatal abstinence syndrome (NAS)

Neurotoxic shellfish poisoning

Paratyphoid fever (Salmonella serotypes Paratyphi A, Paratyphi B, and Paratyphi C)

Pertussis

Pesticide-related illness and injury, acute

! Plague

! Poliomyelitis

Psittacosis (ornithosis)

Q Fever

Rabies, animal or human

! Rabies, possible exposure

! Ricin toxin poisoning

Rocky Mountain spotted fever and other spotted fever rickettsioses

! Rubella

St. Louis encephalitis

Salmonellosis

Saxitoxin poisoning (paralytic shellfish poisoning)

! Severe acute respiratory disease syndrome associated with coronavirus infection

Shigellosis

! Smallpox

Staphylococcal enterotoxin B poisoning

Staphylococcus aureus infection, intermediate or full resistance to vancomycin (VISA, VRSA)

Streptococcus pneumoniae invasive disease in children <6 years old

Syphilis

Syphilis in pregnant women and neonates

Tetanus

Trichinellosis (trichinosis)

Tuberculosis (TB)

! Tularemia

Typhoid fever (Salmonella serotype Typhi)

! Typhus fever, epidemic

! Vaccinia disease

Varicella (chickenpox)

! Venezuelan equine encephalitis

Vibriosis (infections of Vibrio species and closely related organisms, excluding Vibrio cholerae type O1)

! Viral hemorrhagic fevers

West Nile virus disease

! Yellow fever

! Zika fever

! Report immediately 24/7 by phone

upon initial suspicion or laboratory test order Report immediately 24/7 by phone

Report next business day + Other reporting timeframe

Reportable Diseases/Conditions in Florida Practitioner List (Laboratory Requirements Differ)

Per Rule 64D-3.029, Florida Administrative Code, promulgated October 20, 2016 Florida Department of Health

*Subsection 381.0031(2), Florida Statutes, provides that “Any practitioner licensed in this state to practice medicine, osteopathic medicine, chiropractic medicine, naturopathy, or veterinary medicine; any hospital licensed under part I of chapter 395; or any laboratory licensed under chapter 483 that diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.” Florida’s county health departments serve as the Department’s representative in this reporting requirement. Furthermore, subsection 381.0031(4), Florida Statutes, provides that “The Department shall periodically issue a list of infectious or noninfectious diseases determined by it to be a threat to public health and therefore of significance to public health and shall furnish a copy of the list to the practitioners…”

9

Patient Information Medical Information

SSN: MRN:

Last name: Date onset: Date diagnosis:

First name: Died: Yes No Unknown

Middle: Hospitalized: Yes No Unknown

Parent name: Hospital name:

Gender:

Male Female Unknown

If female, pregnant:

Yes No Unknown

Date admitted: Date discharged:

Insurance:

Birth date: Death date: Treated: Yes No Unknown

Race:

American Indian/Alaska native Asian/Pacific islander Black

White Other Unknown

Specify treatment:

Ethnicity:

Hispanic Non-Hispanic Unknown

Laboratory testing:

Yes No Unknown Attach laboratory result(s) if available

Address: Provider Information

ZIP: County: Physician:

City: State: Address:

Home phone: City: State: ZIP:

Other phone: Phone:

Emergency phone: Fax:

Email: Email:

To obtain local county health department contact information, see www.FloridaHealth.gov/CHDEpiContact. See www.FloridaHealth.gov/DiseaseReporting for other reporting questions. HIV/AIDS and HIV-exposed newborn notification should be made using the Adult HIV/AIDS Confidential Case Report Form, CDC 50.42A (revised March 2013) for cases in people ≥13 years old or the Pediatric HIV/AIDS Confidential Case Report, CDC 50.42B (revised March 2003) for cases in people <13 years old. Please contact your county health department for these forms (visit www.FloridaHealth.gov/CHDEpiContact to obtain contact information). Congenital anomalies and neonatal abstinence syndrome notification occurs when these conditions are reported to the Agency for Health Care Administration in its inpatient discharge data report pursuant to Chapter 59E-7 FAC. Cancer notification should be directly to the Florida Cancer Data System (http://fcds.med.miami.edu). All other notifications should be to the CHD where the patient resides.

Reportable Diseases and Conditions in Florida Notify upon suspicion 24/7 by phone Notify upon diagnosis 24/7 by phone

Amebic encephalitis

Anthrax

Arsenic poisoning

Arboviral diseases not otherwise listed

Babesiosis

Botulism, foodborne, wound, and unspecified

Botulism, infant

Brucellosis

California serogroup virus disease

Campylobacteriosis

Carbon monoxide poisoning

Chancroid

Chikungunya fever

Chikungunya fever, locally acquired

Chlamydia

Cholera (Vibrio cholerae type O1)

Ciguatera fish poisoning

Conjunctivitis in neonates <14 days old

Creutzfeldt-Jakob disease (CJD)

Cryptosporidiosis

Cyclosporiasis

Dengue fever

Diphtheria

Eastern equine encephalitis

Ehrlichiosis/anaplasmosis

Escherichia coli infection, Shiga toxin-producing

Giardiasis, acute

Glanders

Gonorrhea

Granuloma inguinale

Haemophilus influenzae invasive disease in children <5 years old

Hansen’s disease (leprosy)

Hantavirus infection

Hemolytic uremic syndrome (HUS)

Hepatitis A

Hepatitis B, C, D, E, and G

Hepatitis B surface antigen in pregnant women and children <2 years old

Herpes B virus, possible exposure

Herpes simplex virus (HSV) in infants <60 days old with disseminated infection and liver involvement; encephalitis; and infections limited to skin, eyes, and mouth; anogenital HSV in children <12 years old

Human papillomavirus (HPV)-associated laryngeal papillomas or recurrent respiratory papillomatosis in children <6 years old; anogenital papillomas in children ≤12 years old

Influenza A, novel or pandemic strains

Influenza-associated pediatric mortality in children <18 years old

Lead poisoning (blood lead level ≥5 ug/dL)

Legionellosis

Leptospirosis

Listeriosis

Lyme disease

Lymphogranuloma venereum (LGV)

Malaria

Measles (rubeola)

Melioidosis

Meningitis, bacterial or mycotic

Meningococcal disease

Mercury poisoning

Mumps

Neurotoxic shellfish poisoning

Paratyphoid fever (Salmonella serotypes Paratyphi A, Paratyphi B, and Paratyphi C)

Pertussis

Pesticide-related illness and injury, acute

Plague

Poliomyelitis

Psittacosis (ornithosis)

Q Fever

Rabies, animal or human

Rabies, possible exposure

Ricin toxin poisoning

Rocky Mountain spotted fever and other spotted fever rickettsioses

Rubella

St. Louis encephalitis

Salmonellosis

Saxitoxin poisoning (paralytic shellfish poisoning)

Severe acute respiratory disease syndrome associated with coronavirus infection

Shigellosis

Smallpox

Staphylococcal enterotoxin B poisoning

Staphylococcus aureus infection, intermediate or full resistance to vancomycin (VISA, VRSA)

Streptococcus pneumoniae invasive disease in children <6 years old

Syphilis

Syphilis in pregnant women and neonates

Tetanus

Trichinellosis (trichinosis)

Tuberculosis (TB)

Tularemia

Typhoid fever (Salmonella serotype

Typhi)

Typhus fever, epidemic

Vaccinia disease

Varicella (chickenpox)

Venezuelan equine encephalitis

Vibriosis (infections of Vibrio species and closely related organisms, excluding Vibrio cholerae type O1)

Viral hemorrhagic fevers

West Nile virus disease

Yellow fever

Zika fever

Outbreaks of any disease, any case, cluster of cases, or exposure to an infectious or non-infectious disease, condition, or agent found in the general community or any defined setting (e.g., hospital, school, other institution) not listed above that is of urgent public health significance. Specify in comments below.

Practitioner Disease Report Form Complete the following information to notify the Florida Department of Health of a reportable disease or condition. This can be filled in electronically.

Per Rule 64D-3.029, Florida Administrative Code, promulgated October 20, 2016 (laboratory reporting requirements differ).

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