January 2019 Florida Department of Health - Hillsborough County EpiNotes Disease Surveillance Newsletter

Director Douglas Holt, MD 813.307.8008 Articles and Attachments Included This Month

Medical Director (HIV/STD/EPI) Charurut Somboonwit, MD 813.307.8008 Health Advisories and Alerts 1

Medical Director (TB/Refugee) 2018 Reportable Disease Summary 2 Beata Casanas, MD 813.307.8008 Florida Food Recalls 6

Medical Director (Vaccine Outreach) CDC Update on Contaminated Stem Cell Products 6 Jamie P. Morano, MD, MPH 813.307.8008 County Influenza Report 7

Reportable Diseases/Conditions in Florida, Practitioner List 8 Community Health Director Leslene Gordon, PhD, RD, LD/N FDOH, Practitioner Disease Report Form 9 813.307.8015 x7107

Disease Control Director Carlos Mercado, MBA 813.307.8015 x6321 Health Advisories, News, and Alerts

Environmental Administrator Brian Miller, RS

813.307.8015 x5901 • CDC HAN 417: Third Case of Rifampin/Penicillin-Resistant

Strain of RB51 Epidemiology Michael Wiese, MPH, CPH 813.307.8010 Fax 813.276.2981 • CDC Food Safety Alert: Final CDC update on the outbreak of E. coli O157:H7 infections linked to romaine lettuce TO REPORT A DISEASE: Epidemiology • CDC Provides First In-Season Estimates of Flu Illnesses,

813.307.8010 Medical Visits, and Hospitalizations

After Hours Emergency 813.307.8000 • CDC Investigation Notice: Outbreak of Salmonella Infections Linked to Pet Hedgehogs HIV/AIDS Surveillance Erica Botting • CDC Travel Notices: 813.307.8011 • Drug Resistant Infections in Mexico: Recently, some US

Lead Poisoning residents returning from Tijuana, Baja California, Mexico, Cynthia O. Keeton were diagnosed with infections caused by an antibiotic- 813.307.8015 x7108 Fax 813.272.6915 resistant form of Pseudomonas aeruginosa bacteria after receiving an invasive medical procedure. Sexually Transmitted Disease • Sophia Romeus Measles in Kazakhstan 813.307.8045 Fax 813.307.8027 • Yellow Fever in Nigeria

Tuberculosis Irma B. Polster 813.307.8015 x4758 Fax 813.975.2014

Mission: To protect, promote & improve the health of all Ron Desantis people in Florida through integrated state & community 1 Governor efforts. Vision: To be the Healthiest State in the Nation

2018 Reportable Disease Summary – Enteric Infections

Shiga-toxin producing E. Coli infections were almost 3x higher than the previous three-year average. Three national

outbreaks of E. Coli infections were reported in 2018, two related to romaine lettuce and one related to ground beef.

2015-2017 Average 2018 338 336 303.0

242.7

152.3

72.7 76 77.7 32 18.7 54 62 14.3 11

Shigellosis cases tend to be Cases of campylobacteriosis have been cyclical with peaks every 3-5 increasing in Florida as the use of culture- years. In 2015 Hillsborough independent diagnostic testing increases. The County saw a large increase case definition has changed a few times in recent in cases of shigellosis, with years to allow for reporting these newer type of a smaller increase in 2017. laboratory results as probable cases. From 2015- This year cases were well 2017 the number of culture confirmed cases of below the previous three- campylobacteriosis has remained steady (range year average. 79-87) while the number of probable cases has increased each year (165 in 2015 to 252 in 2018).

2 January 2019

2018 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 did not have any infections of chikungunya, dengue, zika, or malaria acquired through mosquitos in our county this year. 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

2015-2017 Average 25.0* 2018

10.3 9 6 4.0 1 3.0 4 5.0 5

Chikungunya Dengue Lyme Disease Malaria Zika Fever

Cases of Lyme disease are Zika fever emerged as a new infectious usually reported in persons disease in South/Central America and who have traveled to other the Caribbean in 2015, with the first states or countries, but cases reported in Florida residents in infections do occur in Florida. 2016. *The average number of cases for In 2018 two of our nine cases Zika includes only 2016-2017 numbers. of Lyme disease were Additional information on Zika in Florida acquired in Florida. is available at: https://zikafreefl.org/

3 January 2019

2018 Reportable Disease Summary – Other Common Reportable Infections

The data in these 2018 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 are provisional and subject to change until the 2018 database is closed. 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

68 2015-2017 Average 66 59.7 2018 52.7

27 21.3 14.3 3.7 1 2.0 3 10.3 4 1.3 2 11 Mumps Pertussis Varicella Listeriosis Meningitis Meningococcal Legionellosis Vibriosis (Bacterial, Disease Cryptococcal, Mycotic)

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

4 January 2019

2018 Reportable Disease Summary – Viral Hepatitis

2015-2017 Average 1578.3 1760 2018 323.7 341 84 57.3 50 38.3 16 6.7

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

Hepatitis A Case Summary - 2018 Hillsborough County is currently Total Number of cases 84 Number of cases acquired in experiencing a large increase in Florida or Unknown 77 infections of hepatitis A, which is Age a viral infection transmitted Mean 39 through the fecal-oral route. Median 38 Min-max 19-71 There is a vaccine available to Cases by Age Category Number (%) prevent hepatitis A. 0-18 0 (0) 19-29 15 (19) 30-39 32 (42) 2018 Hepatitis A cases- Drug use 40-49 20 (26) 50-59 7 (9) as reported risk factor 60+ 3 (4) Gender Number (%) Female 23 (30) Male 54 (70) 4% Unknown gender 0 Race Number (%) 34% White 71 (92) Black 2 (3) 62% Other 3 (4) Unknown race 1 (1) Ethnicity Number (%) Non-Hispanic 70 (91) Hispanic 6 (8) Yes No Unknown Unknown ethnicity 1 (1)

5 January 2019

Florida Food Recalls (December 21, 2018 – January 25, 2019)

Brand Name Food Date of Recall Health Risk Satur Farms Baby Spinach and Mesclun 1/23/2019 Salmonella Details Oskri Organics Tahini Butter and 1/2/2019 Listeria Details Corporation of Lake Mills Sunflower Butter Eat Smart Salad Shake Apio, Inc. 12/26/2018 Listeria Details Ups Single-Serve Bowls Jennie-O Turkey Store Raw Ground Turkey Salmonella 12/21/2018 Details Sales, Inc. Products Reading

CDC Update on Contaminated Stem Cell Products

Bacterial infections after use of stem cell products – January 28, 2019 CDC is investigating bacterial infections in patients who have received stem cell products from the ReGen Series® (distributed by Liveyon, LLC). Most of these patients developed symptoms such as pain, swelling, or chills within a few days of receiving the stem cell products. Liveyon, LLC, recalled these products on September 28, 2018. A Food and Drug Administration (FDA) inspection of Genetech, the company that processed these products (which is not related to the biotechnology firm Genentech), found problems with the manufacturing process. FDA also found that the facility did not determine if donors of the umbilical cord blood used to make these products were eligible by appropriately screening them for diseases such as human immunodeficiency virus (HIV), hepatitis B, and hepatitis C.

CDC is not currently aware of any HIV, hepatitis B, or hepatitis C infections linked to the ReGen Series® products, and transmission risk is very low. However, as a precaution, we recommend that patients talk to their healthcare provider about getting tested for HIV, hepatitis B virus, and hepatitis C virus. There are treatment options for patients who undergo testing and test positive for any of these three infections. Patients should discuss with their healthcare provider if they should be evaluated for bacterial infection or communicable diseases other than HIV, hepatitis B virus, or hepatitis C virus. Continue reading this CDC update here: https://www.cdc.gov/hai/outbreaks/stem-cell- products.html

6 January 2019

Hillsborough County Weekly Influenza Report (Week 3, 2019)

Flu Level: Flu Activity This Week (January 13 - January 19) Moderate • Influenza like illness (ILI) activity slightly increased this week and is above levels seen at this time during previous seasons. (Figure 1) • Positive influenza labs received electronically increased slightly and are mostly influenza type A. • One influenza outbreak in a charter school was reported in week 3. Flu Trend: • No pediatric mortalities were reported in Hillsborough County in week 3. Increasing Flu Activity This Season (September 30-January 19)

• Total Outbreaks: Eight outbreaks of influenza or ILI have been reported during the 2018-2019 flu season. For statewide data • Total Deaths: Hillsborough County has reported no pediatric mortalities in the see the Florida Flu current flu season. Review.

Figure 1: In week 3, the percent of emergency department and urgent care center visits for ILI* in Hillsborough County increased, and is comparable to 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.”

7 January 2019

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

! Report immediately 24/7 by phone upon initial suspicion or laboratory test order www.FloridaHealth.gov/DiseaseReporting Report immediately 24/7 by phone  Report next business day www.FloridaHealth.gov/CHDEpiContact + Other reporting timeframe

! Outbreaks of any disease, any case, ! Haemophilus influenzae invasive  Pesticide -related illness and injury, cluster of cases, or exposure to an disease in children <5 years old acute infectious or non-infectious disease,  Hansen ’s disease (leprosy) ! Plague condition, or agent found in the general Hantavirus infection Poliomyelitis community or any defined setting (e.g., ! hospital, school, other institution) not Hemolytic uremic syndrome (HUS)  Psittacosis (ornithosis) listed that is of urgent public health Hepatitis A  Q Fever significance  Hepatitis B, C, D, E, and G Rabies, animal or human Acquired immune +  Hepatitis B surface antigen in pregnant deficiency syndrome (AIDS) ! Rabies, possible exposure women and children <2 years old Amebic encephalitis ! Ricin toxin poisoning Herpes B virus, possible exposure ! Anthrax  Rocky Mountain spotted fever and other  Herpes simplex virus (HSV) in infants spotted fever rickettsioses  Arsenic poisoning <60 days old with disseminated Rubella infection and liver involvement; ! ! Arboviral diseases not otherwise listed  encephalitis; and infections limited to St. Louis encephalitis  Babesiosis skin, eyes, and mouth; anogenital HSV  Salmonellosis Botulism, foodborne, wound, and ! in children <12 years old  Saxitoxin poisoning (paralytic shellfish unspecified + Human immunodeficiency virus (HIV) poisoning)  Botulism, infant infection ! Severe acute respiratory disease ! Brucellosis  HIV-exposed infants <18 months old syndrome associated with coronavirus  California serogroup virus disease born to an HIV-infected woman infection  Human papillomavirus (HPV)-   Shigellosis Campylobacteriosis associated laryngeal papillomas or + Cancer, excluding non-melanoma recurrent respiratory papillomatosis in ! Smallpox skin cancer and including benign and children <6 years old; anogenital Staphylococcal enterotoxin B poisoning borderline intracranial and CNS papillomas in children ≤12 years old Staphylococcus aureus infection, tumors ! Influenza A, novel or pandemic strains intermediate or full resistance to  Carbon monoxide poisoning vancomycin (VISA, VRSA) Influenza-associated pediatric mortality  Chancroid in children <18 years old  Streptococcus pneumoniae invasive disease in children <6 years old  Chikungunya fever  Lead poisoning (blood lead level ≥5 µg/dL)  Syphilis Chikungunya fever, locally acquired  Legionellosis Syphilis in pregnant women and  Chlamydia  Leptospirosis neonates ! Cholera (Vibrio cholerae type O1)  Tetanus Listeriosis  Ciguatera fish poisoning  Trichinellosis (trichinosis)  Lyme disease + Congenital anomalies  Tuberculosis (TB)  Lymphogranuloma venereum (LGV)  Conjunctivitis in neonates <14 days old Tularemia  !  Malaria Creutzfeldt -Jakob disease (CJD) Typhoid fever (Salmonella serotype ! Measles (rubeola)  Cryptosporidiosis Typhi) ! Melioidosis  Cyclosporiasis ! Typhus fever, epidemic  Meningitis, bacterial or mycotic Vaccinia disease ! Dengue fever ! ! Meningococcal disease  Varicella (chickenpox) ! Diphtheria  Mercury poisoning  Eastern equine encephalitis ! Venezuelan equine encephalitis  Mumps  Vibriosis (infections of Vibrio species  Ehrlichiosis/anaplasmosis and closely related organisms, Escherichia coli + Neonatal abstinence syndrome (NAS)  infection, Shiga toxin- excluding Vibrio cholerae type O1) producing Neurotoxic shellfish poisoning ! Viral hemorrhagic fevers  Giardiasis, acute Paratyphoid fever (Salmonella serotypes Paratyphi A, Paratyphi B, and  West Nile virus disease ! Glanders Paratyphi C) ! Yellow fever  Gonorrhea Pertussis ! Zika fever  Granuloma inguinale

*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…”

Practitioner Disease Report Form

Complete the following information to notify the Florida Department of Health of a reportable disease or condition. This9 can be filled in electronically.

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

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 If female, Yes Date admitted: Date discharged: Female pregnant: No Unknown Unknown Insurance: Yes No Unknown Birth date: Death date: Treated:

Race: American Indian/Alaska native White Specify Asian/Pacific islander Other treatment: Black Unknown Laboratory Ethnicity: Hispanic Yes No Unknown Attach laboratory Non-Hispanic testing: result(s) if available Unknown 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 Gonorrhea Melioidosis Staphylococcus aureus infection, intermediate or full resistance to Anthrax Granuloma inguinale Meningitis, bacterial or mycotic vancomycin (VISA, VRSA) Streptococcus pneumoniae Arsenic poisoning Haemophilus influenzae invasive Meningococcal disease invasive disease in children <5 years old disease in children <6 years old Arboviral diseases not otherwise listed Mercury poisoning Hansen’s disease (leprosy) Syphilis Babesiosis Mumps Hantavirus infection Syphilis in pregnant women and Botulism, foodborne, wound, and neonates Neurotoxic shellfish poisoning unspecified Hemolytic uremic syndrome (HUS) Paratyphoid fever (Salmonella Tetanus

Botulism, infant Hepatitis A serotypes Paratyphi A, Paratyphi B, Trichinellosis (trichinosis) and Paratyphi C) Brucellosis Hepatitis B, C, D, E, and G Tuberculosis (TB) Pertussis California serogroup virus disease Hepatitis B surface antigen in pregnant women and children <2 years old Pesticide-related illness and injury, Tularemia Campylobacteriosis Salmonella Herpes B virus, possible exposure acute Typhoid fever ( serotype Typhi) Carbon monoxide poisoning Herpes simplex virus (HSV) in infants Plague Typhus fever, epidemic Chancroid <60 days old with disseminated Poliomyelitis infection and liver involvement; Vaccinia disease Chikungunya fever encephalitis; and infections limited to Psittacosis (ornithosis) Varicella (chickenpox) Chikungunya fever, locally acquired skin, eyes, and mouth; anogenital HSV Q Fever in children <12 years old Venezuelan equine encephalitis Chlamydia Human papillomavirus (HPV)- Rabies, animal or human Vibriosis (infections of Vibrio species associated laryngeal papillomas or Cholera (Vibrio cholerae type O1) Rabies, possible exposure and closely related organisms, recurrent respiratory papillomatosis in excluding Vibrio cholerae type O1) Ciguatera fish poisoning children <6 years old; anogenital Ricin toxin poisoning papillomas in children ≤12 years old Viral hemorrhagic fevers Conjunctivitis in neonates <14 days old Rocky Mountain spotted fever and Influenza A, novel or pandemic strains other spotted fever rickettsioses West Nile virus disease Creutzfeldt-Jakob disease (CJD) Influenza-associated pediatric mortality Rubella Yellow fever in children <18 years old Cryptosporidiosis St. Louis encephalitis Lead poisoning (blood lead level Zika fever Cyclosporiasis ≥5 ug/dL) Salmonellosis Outbreaks of any disease, any case, Dengue fever Legionellosis Saxitoxin poisoning (paralytic shellfish cluster of cases, or exposure to an poisoning) infectious or non-infectious disease, Diphtheria Leptospirosis Severe acute respiratory disease condition, or agent found in the Eastern equine encephalitis Listeriosis syndrome associated with coronavirus general community or any defined infection setting (e.g., hospital, school, other Ehrlichiosis/anaplasmosis Lyme disease institution) not listed above that is of Escherichia coli Shigellosis infection, Shiga toxin- Lymphogranuloma venereum (LGV) urgent public health significance. producing Smallpox Specify in comments below. Malaria Giardiasis, acute Staphylococcal enterotoxin B poisoning

Glanders Measles (rubeola) Comments: