April 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

January-March 2019 Reportable Disease Summary 2

Florida Food Recalls 5

CDC & FDOH Measles Update 5

County Influenza Report 6

Reportable Diseases/Conditions in Florida, Practitioner List 7

FDOH, Practitioner Disease Report Form 8

• CDC Investigation Notice: Listeria Outbreak Linked to Deli-sliced Meats and Cheeses

• CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain

• CDC Media Statement: Measles cases in the U.S. are highest since measles was eliminated in 2000

• Measles Case Reported in a Pinellas County Resident

• CDC Travel Notices:

• Rubella in Japan

• Drug-Resistant Infections in Patients Who Had Weight-Loss

Surgery in Mexico (Updated)

• Ebola in Democratic Republic of the Congo (Updated)

Health Advisories, News, and Alerts

2 April 2019

0.0

16.3

8.7

0.7 0.3 0.3 2.71

21

13

03

0

3

Mumps Pertussis Varicella Listeriosis Meningitis(Bacterial,

Cryptococcal,Mycotic)

MeningococcalDisease

Legionellosis

January-March Reportable Disease Summary - Other Common Reportable Infections

March YTD 2016-2018Average

March YTD 2019

65.7

12.78.0

17.0

53.3

17.7

1.0

83

149

25

50

8

2

Campylobacteriosis Cryptosporidiosis Escherichia coli,Shiga toxin-

producing (STEC)

Giardiasis Salmonellosis Shigellosis Vibriosis

January-March Reportable Disease Summary - Enteric Infections

March YTD 2016-2018 Average

March 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

CDC is currently investigating a multistate

outbreak of E. coli O103 infections. Preliminary

information suggests that ground beef is the

source of this outbreak. At this time, no common

supplier, distributor, or brand of ground beef has

been identified. See more from CDC here:

https://www.cdc.gov/ecoli/2019/o103-04-

19/index.html

3 April 2019

January 2018 to Feb 2019 Case Summary

Total Number of cases 143

Number of cases acquired in Florida or Unknown 132

Age

Mean 38

Median 37

Min-max 7-71

Cases by Age Category Number (%)

0-18 1 (1)

19-29 28 (21)

30-39 47 (36)

40-49 37 (28)

50-59 14 (11)

60+ 5 (4)

Gender Number (%)

Female 37 (28)

Male 95 (72)

Unknown gender 0

Race Number (%)

White 113 (86)

Black 7 (5)

Other 11 (8)

Unknown race 1 (1)

Ethnicity Number (%)

Non-Hispanic 116 (88)

Hispanic 15 (11)

Unknown ethnicity 1 (1)

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.

2.3

7.7 6.3

75.3

372.7

58

16

6

87

315

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

January-March Reportable Disease Summary - Viral Hepatitis

March YTD 2016-2018 Average

March YTD 2019

58%29%

13%

Cases Who Report Drug Use as a Risk Factor

Yes No Unknown

4 April 2019

January-March 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 0.7 0.7

4.7

01

0

2

0

Chikungunya Dengue Lyme Disease Malaria Zika Fever

March YTD 2016-2019 Average

March YTD 2019

5 April 2019

Ongoing Measles Outbreaks and Risk During Passover Posted in the Florida EpiCom System April 12, 2019

As you may know, there have been multiple outbreaks of measles in the U.S. So far this year there have been 695 cases in 22 states. This is the greatest number of cases reported in the U.S. since measles was eliminated in 2000. The majority of measles cases are in New York City and New York state, which are primarily among unvaccinated people in Orthodox Jewish communities and associated with travelers who brought measles back from Israel.

With the current Passover holiday, which begins the evening of Friday April 19 and ends the evening of Saturday, April 27, we anticipate there may be more opportunities for measles to spread.

Please be aware that many people celebrating Passover do not stay at home. Families may travel to resorts, hotels, or take cruises for the holiday. And there will likely be an influx of international travelers before Passover, including many from Israel where measles is circulating. Popular destinations include New York, New Jersey, Florida, Las Vegas, Arizona, and Washington, D.C.

Many metropolitan areas of FL have large Jewish populations. Please maintain a high index of suspicion for rule out measles infections in among persons that may have connections to persons traveling from impacted areas. As always, ask patients about recent travel internationally or to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.

Internationally - Top 10 Countries with highest reported measles cases in the past 6 months

Madagascar: 59,388 Ukraine: 40,031 India: 14,304 Brazil: 9,198 Philippines: 8,212 Venezuela: 5,668 Thailand: 4,871 Pakistan: 4,775 Yemen: 4,057 Israel: 3,146

Florida Food Recalls (March 23, 2019 – April 26, 2019)

Brand Name Food Date of Recall Health Risk

Henry Avocado Corporation Whole Avocados 3/23/2019 Listeria Details

K2D Foods, doing buisness as (DBA)

Colorado Premium Foods

Raw Ground Beef Products 4/23/2019 E. coli O103 Details

6 April 2019

Hillsborough County Weekly Influenza Report (Week 16, 2019)

Flu Trend:

Stable

Flu Level:

Mild Flu Activity This Week (April 14 – April 20)

• Influenza like illness (ILI) activity continues to remain at low levels (Figure 1).

• There was little change in the number of positive flu labs from week 15 to

week 16 (Figure 2).

• No influenza or ILI outbreaks were reported in the previous week.

• No pediatric mortalities were reported in the previous week.

Flu Activity This Season (September 30 – April 20)

• Total Outbreaks: Eighteen 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 16, 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).

Comments: