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Florida Department of Health - Hillsborough County Disease Surveillance Newsletter

July 2017

1

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 Warren R. McDougle Jr., MPH 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

Zika Fever Update 1 Florida Food Recalls 2 Health Advisories and Alerts 2 Epi in the News 2 Searching Florida CHARTS for Reportable Disease Data 3 Reportable Disease Surveillance Data 5 Hillsborough Provider Awareness Letter: Mumps 8 Reportable Diseases/Conditions in Florida, Practitioner List 9 FDOH, Practitioner Disease Report Form 10

Zika Fever Update (July 31, 2017)

The total number of Zika Cases reported in the state of Florida Infection Type Infection

Count 2016 Infection

Count 2017

Travel-Related Infections of Zika 1,122 88

Locally Acquired Infections of Zika 285 6

Undetermined 49 22

Pregnant Women with Lab-Evidence of Zika 299 81

Note, these categories are not mutually exclusive and cannot be added together. Please visit our website to see the full list of travel-related cases by county.

The total number of Zika Cases reported in Hillsborough County Infection Type Hillsborough County

2016 Hillsborough County

2017

Travel-Related Infections of Zika

46 4

There are no areas of ongoing, active transmission of Zika by mosquitoes in Florida. All previous Zika zones in the following areas of Miami-Dade County have been lifted after 45 days with no evidence of active transmission and no additional people infected. It is not uncommon, however, for there to be isolated incidents of locally acquired Zika.

EpiNotes July 2017

2

Brand Names Food Date of

Recall Health Risk

Link to

Recall Bush Brothers &

Company®

Baked Beans in 28 Ounce Cans Due to a Can

Seam Issue 7/28/2017

Packaging defect may

cause spoilage Details

Grande Produce Papaya “Caribeña” 7/27/2017 Salmonella Details

Bhu Foods Protein Bars 7/21/2017 Listeria Details

Garden of Light Inc. Woodstock Organic Matcha Vanilla Oats 7/18/2017 Listeria Details

Bestherbs Coffee

LLC

New Kopi Jantan Tradisional Natural Herbs

Coffee 7/17/2017

Undeclared Active

Pharmaceutical

Ingredients & Milk

Details

Publix Publix Tropical Medley Mix 6/26/2017 Listeria Details

House of Thaller Selected Pine Nut Hummus Products 6/21/2017 Listeria Details

United Natural

Trading LLC

Products Containing Organic and Natural Chopped

Dates 6/20/2017 Listeria Details

Florida Food Recalls (June 20 – July 31)

CDC Health Alert Network HAN 404: Eculizumab (Soliris®) recipients have a 1,000 to 2,000-fold greater risk of invasive meningococcal disease compared to the general U.S. population. The Food and Drug Administration (FDA)-approved prescribing information for eculizumab includes a black box warning for increased risk of meningococcal disease, and the Advisory Committee on Immunization Practices (ACIP) recommends meningococcal vaccination for all patients receiving eculizumab.

CDC Travel Notices: o Measles in France o Measles in Democratic Republic of the Congo o Polio in Syria o Polio in Democratic Republic of the Congo o Polio in Nigeria o Yellow Fever in Brazil

Health Advisories and Alerts

Medscape & CDC: New Cholera Vaccine for Adult Travelers

CDC reminds travelers to Europe: Protect against measles

Texas Department of State Health Services: Recommendation to test patients with consistent symptoms for Cyclospora

Epi in the News

EpiNotes July 2017

3

Searching Florida CHARTS for Reportable Disease Data Search

What is Florida CHARTS? Florida CHARTS is a convenient way to view data and statistics from many health indicator data sources. It is available here: http://www.flhealthcharts.com/charts/default.aspx

There are nearly 3,000 health indicators available from more than 25 different programs. An overview tutorial is available to explain key features.

Figure 1.

What infectious disease data are available?

Reportable disease data for infectious diseases reported to Epidemiology are available to search by county, disease, and age group (See Figue 1). Data is available to search for the current reporting year, although numbers displayed are preliminary and will fluctuate up or down over time as case reports undergo further investigation and validation. Data can be viewed in table (Figure 2, pg 4) or chart (Figure 3, pg 4) format.

EpiNotes July 2017

4

Figure 2. Select enteric disease data for 2017 for Hillsborough and Pinellas in table format.

Figure 3. Salmonella data for 2017 for Hillsborough, by age group, in chart format.

EpiNotes July 2017

5

Disease Category

Annual Totals

3 Year Average

Year-To-Date

2014 2015 2016**

Jan-June 2016

Jan-June 2017

Vaccine Preventable Diseases

Diphtheria 0 0 0 0.00 0 0

Measles 0 0 0 0.00 0 0

Mumps 1 1 2 1.33 0 3

Pertussis 65 41 72 59.33 37 26

Poliomyelitis 0 0 0 0.00 0 0

Rubella 0 0 1 0.33 1 0

Smallpox 0 0 0 0.00 0 0

Tetanus 0 0 0 0.00 0 0

Varicella 59 74 70 67.67 34 14

CNS Diseases & Bacteremias

Creutzfeldt-Jakob Disease 1 3 3 2.33 2 0

H. influenzae (Invasive Disease in children <5) 3 2 4 3.00 1 2

Listeriosis 2 2 0 1.33 0 0

Meningitis (Bacterial, Cryptococcal, Mycotic) 12 16 9 12.33 3 6

Meningococcal Disease 2 2 2 2.00 2 0

Staphylococcus aureus (VISA, VRSA) 0 0 0 0.00 0 0

S. pneumoniae (Invasive Disease in children <6) 5 2 3 3.33 1 0

Enteric Infections

Campylobacteriosis 155 152 261 189.33 129 177

Cholera 0 0 0 0.00 0 0

Cryptosporidiosis 351 101 62 171.33 39 20

Cyclospora 4 1 1 2.00 0 1

Escherichia coli, Shiga toxin-producing (STEC) 6 16 12 11.33 6 9

Giardiasis 64 55 105 74.67 56 37

Hemolytic Uremic Syndrome 1 2 1 1.33 1 3

Salmonellosis 343 287 308 312.67 135 128

Shigellosis 66 216 76 119.33 16 105

Typhoid Fever 0 0 1 0.33 1 1

Viral Hepatitis

Hepatitis A 5 5 5 5.00 2 3

Hepatitis B (Acute) 59 62 55 58.67 18 33

Hepatitis C (Acute) 29 48 32 36.33 21 11

Hepatitis +HBsAg in Pregnant Women 35 27 23 28.33 21 6

Hepatitis D, E, G 0 1 0 0.33 0 1

Reportable Disease Surveillance Data

EpiNotes July 2017

6

Disease Category

Annual Totals

3 Year Average

Year-To-Date

2014 2015 2016**

Jan-June 2016

Jan-June 2017

Vectorborne, Zoonoses

Chikungunya 33 10 1 N/A 1 0

Dengue 6 7 2 5.00 2 0

Eastern Equine Encephalitis 0 0 0 0.00 0 0

Ehrlichiosis/Anaplasmosis 2 0 0 0.67 0 0

Leptospirosis 0 1 0 0.33 0 0

Lyme Disease 11 12 7 10.00 0 1

Malaria 11 2 6 6.33 1 2

Plague 0 0 0 0.00 0 0

Psittacosis 0 0 0 0.00 0 0

Q Fever (Acute and Chronic) 0 0 0 0.00 0 0

Rabies (Animal) 4 3 3 3.33 2 4

Rabies (Human) 0 0 0 0.00 0 0

Rocky Mountain Spotted Fever 0 0 0 0.00 0 1

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 0 2 0 0.67 0 0

Western Equine Encephalitis 0 0 0 0.00 0 0

Yellow Fever 0 0 0 0.00 0 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 0 1 0.33 0 0

Glanders 0 0 0 0.00 0 0

Hansen's Disease (Leprosy) 0 0 1 0.33 0 0

Hantavirus Infection 0 0 0 0.00 0 0

Legionellosis 7 20 25 17.33 4 11

Melioidosis 0 0 0 0.00 0 0

Vibriosis 7 11 11 9.67 5 8

Reportable Disease Surveillance Data

EpiNotes July 2017

7

Disease Category

Annual Totals

3 Year Average

Year-To-Date

2014 2015 2016**

Jan-June 2016

Jan-June 2017

Chemicals/Poisoning

Arsenic 0 0 0 0.00 0 0

Carbon Monoxide 18 20 20 19.33 14 6

Lead 208 246 154 202.67 75 110

Mercury 0 13 0 4.33 0 0

Pesticide 2 1 2 1.67 0 2

Influenza

Influenza, Pediatric Associated Mortality 1 0 0 0.33 0 5

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

HIV/AIDS*

AIDS 167 177 160 172.00 NA NA

HIV Infection 332 361 330 341.00 NA NA

STDs

Chlamydia 7304 7423 8097 7608.00 4220 4321

Gonorrhea 1848 1991 2345 2061.33 1152 1331

Syphilis, Congenital 4 4 2 3.33 0 2

Syphilis, Latent 166 199 210 191.67 NA NA

Syphilis, Early 141 147 198 162.00 112 84

Syphilis, Infectious 208 222 223 217.67 118 104

Tuberculosis

TB 49 41 43 44.33 19 11

Food and Waterborne Illness Outbreaks

Food and Waterborne Cases 58 27 1 28.67 NA NA

Food and Waterborne Outbreaks 3 2 1 2.00 NA NA

Reportable Disease Surveillance Data

“Current HIV Infection data by year of report reflects any case meeting the CDC definition of ‘HIV infection’ which includes all newly reported HIV cases and newly reported AIDS cases with no previous report of HIV in Florida. If a case is later identified as being previously diagnosed and reported from another state, the case will no longer be reflected as a Florida case and the data will be adjusted accordingly. Data from the most recent calendar years (2016 and 2017) are considered provisional and therefore should not be used to confirm or rule out an increase in newly reported cases in Florida. The final year-end numbers are generated in July of the following year, after duplicate cases are removed from the dataset, as is customary of HIV surveillance in the US. **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 2016 and 2017 are provisional and subject to change until the 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 Diseases Frequency Report – Also Available in Florida CHARTS The frequency report is based on reportable disease information received by the Florida Department of Health as mandated under Section 381.0031, Florida Statutes, and Rule 64D-3.029, Florida Administrative Code. Depending on report criteria, counts include confirmed and/or probable cases that have occurred in Florida among Florida residents. This report does not include cases of AIDS, HIV infection, sexually transmitted diseases, or tuberculosis.

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 State Surgeon General and Secretary

Vision: To be the Healthiest State in the Nation

Florida Department of Health in Hillsborough County Division of Community Health • Office of Epidemiology P.O. Box 5135 • Tampa, FL 33675-5135 PHONE: 813-307-8010 • FAX 813-276-2981 www.FloridaHealth.gov

June 23, 2017 To The Hillsborough County Medical Community: We would like to inform the medical community that the Department of Health in Hillsborough County is investigating a cluster of mumps cases in immunized family members. The Hillsborough County Epidemiology program is in the process of identifying direct contacts to the cases. Please remember that mumps is a reportable condition. Should you diagnose a case of mumps, even without laboratory confirmation, the illness should be reported to the county health department. Mumps is a viral illness caused by a paramyxovirus. Mumps occurs worldwide; humans are the only known hosts. The virus is spread from person to person via droplets of saliva or mucus from the mouth, nose, or throat from an infected person, usually when they cough, sneeze or talk. The risk of spreading the virus increases the longer and closer the contact a person has with someone who has mumps. Mumps is less contagious than measles or chickenpox. In recent years numerous mumps outbreaks have been identified nationally in vaccinated persons on college campuses. The average incubation period for mumps is 16 to 18 days (range 12-25 days); when ill with mumps a person should avoid contact with others from the time of symptom onset/diagnosis until 5 days after the onset of parotitis. The most common signs include:

Fever Headache Muscle aches Tiredness Loss of appetite Swollen and tender salivary glands under ears on one or both sides (parotitis) lasting 2 or more

days Orchitis/oophoritis (less commonly)

Recommended Laboratory Testing Mumps testing is available at commercial laboratories. Due to the unreliable nature of serology testing in persons that have been immunized, RT-PCR testing on a buccal swab collected within 7 days of onset of parotid swelling is recommended and preferred. A buccal swab or oral swab is best obtained by massaging the parotid gland for 30 seconds prior to swabbing. Please contact the Hillsborough County Epidemiology program at 813-307-8010 for consultation or to report suspected cases. For additional information on Mumps please refer the CDC’s site: https://www.cdc.gov/mumps/hcp.html

Birth Defects

+ Congenital anomalies

+ Neonatal abstinence syndrome (NAS)

Cancer

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

HIV/AIDS

+ Acquired immune deficiency syndrome (AIDS)

+ Human immunodeficiency virus (HIV) infection

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

STDs

Chancroid

Chlamydia

Conjunctivitis in neonates <14 days old

Gonorrhea

Granuloma inguinale

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

Lymphogranuloma venereum (LGV)

Syphilis

Syphilis in pregnant women and neonates

Tuberculosis Tuberculosis (TB)

All Others

! 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

Amebic encephalitis

! Anthrax

Arsenic poisoning

Arboviral diseases not otherwise listed

! Botulism, foodborne, wound, and unspecified

Botulism, infant

! Brucellosis

California serogroup virus disease Campylobacteriosis

Carbon monoxide poisoning

Chikungunya fever

Chikungunya fever, locally acquired

! Cholera (Vibrio cholerae type O1)

Ciguatera fish poisoning

Creutzfeldt-Jakob disease (CJD)

Cryptosporidiosis

Cyclosporiasis

Dengue fever

Dengue fever, locally acquired

! Diphtheria

Eastern equine encephalitis

Ehrlichiosis/anaplasmosis

Escherichia coli infection, Shiga toxin-producing

Giardiasis, acute

! Glanders

! 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 or children <2 years old

Herpes B virus, possible exposure

! Influenza A, novel or pandemic strains

Influenza-associated pediatric mortality in children <18 years old

Lead poisoning

Legionellosis

Leptospirosis

Listeriosis

Lyme disease

Malaria

! Measles (rubeola)

! Melioidosis

Meningitis, bacterial or mycotic

! Meningococcal disease

Mercury poisoning

Mumps

Neurotoxic shellfish poisoning

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

Tetanus

Trichinellosis (trichinosis)

! 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

! 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

*Section 381.0031 (2), Florida Statutes (F.S.), 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, Section 381.0031 (4), F.S. 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…”

Reportable Diseases/Conditions in Florida Practitioner List (Laboratory Requirements Differ) Effective June 4, 2014

Florida Department of Health, Practitioner Disease Report Form Complete the following information to notify the Florida Department of Health of a reportable disease or condition, as required by Chapter 64D-3, Florida Administrative Code (FAC). This can be filled in electronically.

Patient Information

SSN:

Last name:

First name:

Middle:

Parent name:

Gender: MaleFemaleUnk

Birth date: Death date:

Race: American Indian/Alaska NativeAsian/Pacific IslanderBlack

WhiteOtherUnk

Ethnicity: HispanicNon-HispanicUnk

Address:

ZIP: County:

City: State:

Home phone:

Other phone:

Emer. phone:

Pregnant: YesNoUnk

Died: Yes No Unk

Hospitalized:

Date admitted: Date discharged:

Date onset: Date diagnosis:

Physician:

Address:

City: State: ZIP:

Phone: Fax:

Email:

Medical Information

Yes No Unk

Provider Information

Hospital name:

Insurance:

Treated: Yes No Unk

Specify treatment:

Laboratory

testing:

Yes No Unk Attach laboratory result(s) if available.

MRN:

Email:

Revised June 4, 2014

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

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 local county health department for these forms (visit http://floridahealth.gov/chdepicontact to obtain CHD 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 (see http://fcds.med.miami.edu). All other notifications should be to the CHD where the patient resides. To obtain CHD contact information, see http://floridahealth.gov/chdepicontact. See http://floridahealth.gov/diseasereporting for other reporting questions.

Amebic encephalitisAnthraxArsenic poisoning

Botulism, foodborne

Botulism, infant

Botulism, wound or unspecifiedBrucellosisCalifornia serogroup virus diseaseCampylobacteriosisCarbon monoxide poisoningChancroid

ChlamydiaCholera (Vibrio cholerae type O1)Ciguatera fish poisoningConjunctivitis in neonate <14 days oldCreutzfeldt-Jakob disease (CJD)CryptosporidiosisCyclosporiasisDengue fever

DiphtheriaEastern equine encephalitisEhrlichiosis/anaplasmosis

Giardiasis, acute

GlandersGonorrheaGranuloma inguinale

Arboviral disease not listed here

Chikungunya fever

Escherichia coli infection, Shiga toxin- producing

Hansen's disease (leprosy)Hantavirus infectionHemolytic uremic syndrome (HUS)Hepatitis AHepatitis B, C, D, E, and G

Herpes B virus, possible exposure

HSV, anogenital in child <12 years old

Influenza A, novel or pandemic strains

Lead poisoningLegionellosisLeptospirosisListeriosisLyme diseaseLymphogranuloma venereum (LGV)MalariaMeasles (rubeola)

MelioidosisMeningitis, bacterial or mycotic

Haemophilus influenzae invasive disease in child <5 years old

Influenza-associated pediatric mortality in child <18 years old

Hepatitis B surface antigen in pregnant woman or child <2 years old

Herpes simplex virus (HSV) in infant <60 days old

Human papillomavirus (HPV), laryngeal papillomas or recurrent respiratory papillomatosis in child <6 years oldHPV, anogenital papillomas in child <12 years old

Meningococcal diseaseMercury poisoningMumpsNeurotoxic shellfish poisoning

Pertussis

Pesticide-related illness and injury, acute

PlaguePoliomyelitis

Psittacosis (ornithosis)

Q Fever

Rabies, animal

Rabies, human

Rabies, possible exposure

Ricin toxin poisoning

Rubella

St. Louis encephalitis

Salmonellosis

Shigellosis

Smallpox

Severe acute respiratory disease syndrome associated with coronavirus infection

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

Saxitoxin poisoning (paralytic shellfish poisoning)

Rocky Mountain spotted fever or other spotted fever rickettsiosis

Staphylococcal enterotoxin B poisoning

Syphilis

Syphilis in pregnant woman or neonate

Tetanus

Trichinellosis (trichinosis)

Tuberculosis (TB)

Tularemia

Typhoid fever (Salmonella serotype Typhi)

Typhus fever, epidemic

Vaccinia disease

Varicella (chickenpox)

Venezuelan equine encephalitis

Viral hemorrhagic fevers

West Nile virus disease

Yellow feverOutbreaks 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. Please specify:

Streptococcus pneumoniae invasive disease in child <6 years old

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

Comments

Chikungunya fever, locally acquired

Dengue fever, locally acquired

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