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Florida Department of Health - Hillsborough County Disease Surveillance Newsletter

February 2018

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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

Rick Scott Governor

Celeste Philip, MD, MPH State Surgeon General & Secretary

EpiNotes

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

Food and Waterborne Illness Patrick Rodriguez 813.307.8015 x5944 Fax 813.272.7242

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 Hector 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

Pesticide Related Illness & Farmworkers 1 Florida Food Recalls 2 Health Advisories and Alerts 2 Vaccine Preventable Disease Update 2 Seasonal Influenza Update 3 Reportable Disease Surveillance Data 4 Rabies Prevention Flyer 7 Surgeon General Letter to Providers and Insurance Providers 8 Reportable Diseases/Conditions in Florida, Practitioner List 14 FDOH, Practitioner Disease Report Form 15

Pesticide Related Illness & Farmworkers

Farm workers are at higher risk of pesticide poisoning compared to other workers, due to high usage of pesticide in the agriculture industry. Even though acute pesticide-related illness and injury is a reportable condition in Florida, there is underreporting from the farmworkers community. More information can be found through a publication co-authored by the Florida Department of Health, Acute Pesticide-Related Illness Among Farmworkers: Barriers to Reporting to Public Health Authorities. The Florida Department of Health has created informational videos to educate farmworkers and providers within the community regarding reporting and prevention. These videos are available in English and Spanish. Additional information on pesticide poisoning and surveillance in Florida is available on the DOH website.

EpiNotes February 2018

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Brand Names Food Date of

Recall Health Risk

Link to

Recall

Arrow Reliance Inc.

Certain Raw Pet Foods; Darwin’s

Natural Pet Products and

ZooLogics Pet Food

2/13/2018 Salmonella Details

Panera Bread All 2 oz. and 8 oz. Cream Cheese

Products 1/29/2018 Listeria Details

Rich Products

Corporation Beef Products 1/24/2018 Listeria Details

National Frozen

Foods Corporation

Frozen Green Beans and Frozen

Mixed Vegetables 1/24/2018 Listeria Details

Arthri-D, LLC Dietary Supplement Arthri-D

Lot#1701-092 1/21/2018 Salmonella Details

Break

Ventures/California

Basics

Dietary Supplement Zero For Him

150ct Lot#1710-638 1/21/2018 Salmonella Details

Evershing

International Trading

Company

Recalls Frozen Shredded Coconut

Because of Possible Health Risk 1/4/2018 Salmonella Details

T. Marzetti Company Frozen Biscuit Dough Packed

Under Various Brands 1/2/2018 Listeria Details

Florida Food Recalls (January 1 – February 15)

Transcript for CDC Update on Widespread Flu Activity

Update: Multistate Outbreak of E. coli O157:H7 Infections

Study of Flu-Related Deaths in Children Shows Healthy Children at Risk

CDC Travel Notices:

Measles in Italy, Ukraine, Romania, Democratic Republic of Congo, Indonesia, England, Greece, and Serbia

Malaria and Yellow Fever in Brazil

Listeriosis in South Africa

Yellow Fever in Nigeria

2018 Winter Olympics in PyeongChang

Health Advisories and Alerts

Vaccine Preventable Disease Update

The Florida Department of Health has created a new report for select vaccine-preventable disease surveillance information. The report can be found on our website. Below is the January 2018 summary information for the state of Florida:

Pertussis activity is low, which is consistent with previous months.

Varicella activity remains elevated.

Mumps activity remains elevated, and at levels not seen since the 1990s.

EpiNotes February 2018

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2017-2018 Seasonal Influenza Update, Hillsborough County

Influenza activity in Hillsborough County is elevated. Although activity decreased in some surveillance systems in week 6, it is too early to know if influenza activity has peaked for the season. Activity remains elevated above peak levels seen in previous seasons. So far this season, forty outbreaks of influenza or influenza-like illness have been reported in Hillsborough County. The most important prevention measure you can take to prevent influenza infection is to receive your yearly influenza vaccine. It is not too late to receive the vaccine this year. You can receive the vaccine for free at the DOH-Hillsborough Immunizations Clinic while supplies last. Call (813) 307-8077 for more information. Other important ways to prevent the spread of illness include covering your cough or sneeze, frequent handwashing with soap and water, and staying home from work or school until 24 hours fever free without the use of medication. See the most recent state Florida Flu Review on our website.

Figure 1. Data are from participating Urgent Care Center (UCC) and Hospital Emergency Departments (ED) in Hillsborough County. Visits are searched for key terms related to influenza-like illness (ILI), which includes report of fever and cough or sore throat. This graph is not inclusive of all influenza diagnoses and may include visits not related to influenza.

EpiNotes February 2018

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Disease Category Annual Totals**

3 Year Average

Year-To-Date**

2015 2016 2017 Jan

2017 Jan

2018

Vaccine Preventable Diseases

Diphtheria 0 0 0 0.00 0 0

Measles 0 0 0 0.00 0 0

Mumps 1 2 8 3.67 0 0

Pertussis 41 73 45 53.00 5 4

Poliomyelitis 0 0 0 0.00 0 0

Rubella 0 1 0 0.33 0 0

Smallpox 0 0 0 0.00 0 0

Tetanus 0 0 0 0.00 0 0

Varicella 74 70 35 59.67 2 5

CNS Diseases & Bacteremias

Creutzfeldt-Jakob Disease 3 3 2 2.67 0 0

H. influenzae (Invasive Disease in children <5) 2 4 4 3.33 1 0

Listeriosis 2 0 4 2.00 0 0

Meningitis (Bacterial, Cryptococcal, Mycotic) 16 9 6 10.33 1 0

Meningococcal Disease 2 2 0 1.33 0 0

Staphylococcus aureus (VISA, VRSA) 0 0 1 0.33 0 0

S. pneumoniae (Invasive Disease in children <6) 2 3 2 2.33 0 0

Enteric Infections

Campylobacteriosis 152 197 316 221.67 16 21

Cholera 0 0 0 0.00 0 0

Cryptosporidiosis 101 62 55 72.67 2 6

Cyclospora 1 1 12 4.67 0 0

Escherichia coli, Shiga toxin-producing (STEC) 16 24 15 18.33 1 6

Giardiasis 55 105 73 77.67 5 4

Hemolytic Uremic Syndrome 2 1 3 2.00 0 0

Salmonellosis 287 308 321 305.33 9 17

Shigellosis 216 76 165 152.33 11 6

Typhoid Fever 0 1 3 1.33 1 3

Viral Hepatitis

Hepatitis A 5 5 10 6.67 0 2

Hepatitis B (Acute) 62 53 72 62.33 5 8

Hepatitis C (Acute) 48 31 40 39.67 1 9

Hepatitis +HBsAg in Pregnant Women 27 23 13 21.00 0 3

Hepatitis D, E, G 1 0 1 0.67 0 0

Reportable Disease Surveillance Data

EpiNotes February 2018

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Disease Category Annual Totals**

3 Year Average

Year-To-Date

2015 2016 2017 Jan

2017 Jan

2018

Vectorborne, Zoonoses

Chikungunya 10 1 1 4.00 0 1

Dengue 7 2 0 3.00 0 0

Eastern Equine Encephalitis 0 0 0 0.00 0 0

Ehrlichiosis/Anaplasmosis 0 0 1 0.33 0 0

Leptospirosis 1 0 1 0.67 0 0

Lyme Disease 12 6 12 10.00 0 0

Malaria 2 6 7 5.00 0 0

Plague 0 0 0 0.00 0 0

Psittacosis 0 0 0 0.00 0 0

Q Fever (Acute and Chronic) 0 0 1 0.33 0 0

Rabies (Animal) 3 3 4 3.33 0 0

Rabies (Human) 0 0 0 0.00 0 0

Rocky Mountain Spotted Fever 0 0 2 0.67 0 0

St. Louis Encephalitis 0 0 0 0.00 0 0

Trichinellosis 0 0 0 0.00 0 0

Tularemia 0 0 0 0.00 0 0

Typhus Fever (Epidemic) 0 0 0 0.00 0 0

Venezuelan Equine Encephalitis 0 0 0 0.00 0 0

West Nile Virus 2 1 1 1.33 0 0

Western Equine Encephalitis 0 0 0 0.00 0 0

Yellow Fever 0 0 0 0.00 0 0

Zika Fever NA 46 16 NA 4 0

Others

Anthrax 0 0 0 0.00 0 0

Botulism, Foodborne 0 0 0 0.00 0 0

Botulism, Infant 0 0 0 0.00 0 0

Brucellosis 0 1 0 0.33 0 0

Glanders 0 0 0 0.00 0 0

Hansen's Disease (Leprosy) 0 0 0 0.00 0 0

Hantavirus Infection 0 0 0 0.00 0 0

Legionellosis 20 25 19 21.33 2 1

Melioidosis 0 0 0 0.00 0 0

Vibriosis 11 11 21 14.33 0 2

Reportable Disease Surveillance Data

EpiNotes February 2018

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Disease Category Annual Totals**

3 Year Average

Year-To-Date

2015 2016 2017 Jan

2017 Jan

2018

Chemicals/Poisoning

Arsenic 0 0 0 0.00 0 0

Carbon Monoxide 20 20 32 24.00 0 1

Lead 246 154 140 180.00 8 1

Mercury 13 0 3 5.33 0 0

Pesticide 1 2 6 3.00 0 0

Influenza

Influenza, Pediatric Associated Mortality 0 0 6 2.00 1 0

Influenza, Novel or Pandemic Strain 0 0 0 0.00 0 0

Tuberculosis

TB 41 43 28 37.33 0 1

Food and Waterborne Illness Outbreaks

Food and Waterborne Cases 27 1 NA 14.00 7 NA

Food and Waterborne Outbreaks 2 1 NA 1.50 1 NA

**Includes confirmed and probable cases reported in Florida residents (regardless of where infection was acquired) by date reported to the Bureau of Epidemiology in Merlin. Data for 2017/2018 are provisional and subject to change until the 2017/2018 database closes. Counts are current as of the date and time above, but may change. Please note that counts presented in this table may differ from counts presented in other tables or reports, depending on the criteria used. Changes in case definitions can result in dramatic changes in case counts. Please see Florida Surveillance Case Definitions on the Bureau of Epidemiology for information on case definition changes (http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/case-def-archive.html).

Reportable Disease Surveillance Data

Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Rick Scott

Governor

Celeste Philip, MD, MPH

Surgeon General and Secretary

Vision: To be the Healthiest State in the Nation

Florida Department of Health

Office of the State Surgeon General

4052 Bald Cypress Way, Bin A-00 • Tallahassee, FL 32399-1701 PHONE: 850/245-4210 • FAX: 850/922-9453

FloridaHealth.gov

January 31, 2018

Dear Health Care and Health Insurance Providers,

Influenza and influenza-like illness activity levels are high statewide in people of all age groups. Florida is experiencing a moderately severe season with emergency department visits for influenza-like illness well above peak levels observed in previous seasons and more outbreaks reported than in previous seasons at this time, and we are aware of at least three pediatric deaths. With influenza activity continuing to increase, we must do everything in our power to minimize its impacts and keep Floridians safe. Plan providers play an important role in helping to ensure access to care, disease prevention and lifesaving medications. The Florida Department of Health (DOH) urges the following:

Ensuring promotion, easy access, and coverage for influenza vaccine Please assist us to ensure vaccine provision and availability. Ensure plans have provisions for covering influenza vaccinations for all patients six months and older. Remind providers to order and administer vaccine to their patients. Studies have shown that people are more likely to get vaccinated if it is recommended by their provider. DOH encourages providers to actively identify, recommend and offer flu vaccine to patients in clinics who have not received their 2017-18 influenza vaccinations.

Ensuring rapid use and availability of antivirals Centers for Disease Control and Prevention (CDC) recommends the use of antiviral treatment as soon as possible for all persons with suspected influenza for all hospitalizations, severely ill, and people who are at higher risk for complications (children under 2 years old, adults aged 65 years and older, pregnant women, and those with underlying medical conditions). Treatment should be administered within 48 hours of illness onset (but treatment administered after this period can still be beneficial). A recent CDC health advisory stresses the importance of rapid and early antiviral treatment this season (http://www.floridahealth.gov/diseases-and-conditions/influenza/_documents/cdc-han-influenza-12-27-2017.pdf).

Lifting pre-authorization requirements for antivirals DOH is aware of reports of insurers asking for preauthorization and approval for administration of antivirals. This process delays appropriate treatment and treatment within the recommended timeline. DOH encourages health insurers to lift such pre-authorization requirements. Delays in obtaining antivirals adversely impacts patient outcomes.

Suspend antiviral brand preferences CDC is aware of spot shortages of antiviral drugs in some places experiencing high influenza activity. While this is not a true shortage but a result of retail pharmacies dispensing their in-house supply quicker than they can restock, it has created situations where only certain antivirals (e.g. brand or generic forms of oseltamivir) are available in some locations. Please consider suspending any existing formulary preferences for antivirals to ensure patients get timely access to needed antiviral medications.

Page 2 Influenza Letter

Please visit https://www.cdc.gov/flu/professionals/index.htm for additional information from the CDC regarding influenza vaccination, antivirals, and chemoprophylaxis. We would also appreciate help distributing the CDC guidance document: Prevention Strategies for Seasonal Influenza in Healthcare Settings (https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm). Sincerely, Celeste Philip, MD, MPH Surgeon General and Secretary