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: