Quick viewing(Text Mode)

Hamburger Mary's in Ybor City

Hamburger Mary's in Ybor City

Florida Department of Health - Hillsborough County Disease Surveillance Newsletter October 2018

EpiNotesDirector

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 Florida Recalls 2 Medical Director (TB/Refugee) Beata Casanas, MD Preventable Disease Update 2 813.307.8008 Epi in the News 2 County Report 3 Medical Director (Vaccine Outreach) Jamie P. Morano, MD, MPH A Surveillance Summary 4 813.307.8008 Reportable Disease Surveillance Data 5

Community Health Director Hepatitis A Updated Press Release 8 Leslene Gordon, PhD, RD, LD/N Reportable Diseases/Conditions in Florida, Practitioner List 10 813.307.8015 x7107 FDOH, Practitioner Disease Report Form 11

Disease Control Director Carlos Mercado, MBA 813.307.8015 x6321

Environmental Administrator Health Advisories and Alerts Brian Miller, RS 813.307.8015 x5901

Epidemiology • DOH-Hillsborough Identifies Case Of Michael Wiese, MPH, CPH Hepatitis A in Food Service Worker – 813.307.8010 Fax 813.276.2981 Hamburger Mary’s in Ybor City TO REPORT A DISEASE: Epidemiology 813.307.8010 • Updates on Red Tide

After Hours Emergency 813.307.8000 • Flaccid in U.S. Children CDC continues to receive reports of children with acute flaccid Food and Waterborne Illness Patrick Rodriguez myelitis (AFM), a rare but serious condition. CDC is working 813.307.8015 x5944 Fax 813.272.7242 hard to find the causes of these AFM cases.

HIV/AIDS Surveillance Erica Botting • CDC Travel Notices: 813.307.8011 • Earthquake and Tsunami in Indonesia

Lead Poisoning • Ebola in Democratic Republic of the Congo (North Kivu Cynthia O. Keeton and Ituri provinces) 813.307.8015 x7108 Fax 813.272.6915 • Rubella in Japan Sexually Transmitted Disease • Monkeypox in Nigeria Sophia Hector 813.307.8045 Fax 813.307.8027

Tuberculosis Irma B. Polster 813.307.8015 x4758 Fax 813.975.2014

Rick Scott Mission: To protect, promote & improve the health of all people Governor in Florida through1 integrated state & community efforts. 1 Celeste Philip, MD, MPH Vision: To be the Healthiest State in the Nation 1 State Surgeon General & Secretary EpiNotes October 2018

Florida Food Recalls (September 30 – October 25)

Date of Link to Brand Names Food Health Risk Recall Recall Bakkavor Meat and Poultry Products 10/21/2018 / Details USA, Inc. Ruiz Food Beef and Poultry Products 10/19/2018 Salmonella/Listeria Details Products, Inc. Chicken and Beef Products Envolve Foods 10/19/2018 Salmonella/Listeria Details Containing Vegetables Chicken Wrap Products SK Food Group 10/19/2018 Salmonella/Listeria Details Containing Vegetables Working Cow Ice Cream Products - 10/18/2018 Listeria Details Homemade, Inc. Expanded Salads Containing Meat GHSE, LLC 10/17/2018 Salmonella/Listeria Details Product with Corn Ingredient Malone's Fine Pork Head Cheese Products 10/10/2018 Listeria Details Sausage, Inc. JBS Tolleson, Inc. Raw Beef products 10/4/2018 Salmonella Details Callie's Charleston Country Ham Biscuits and 10/4/2018 Listeria Details Biscuits, LLC Cocktail Ham Biscuits No Added Vanilla and Working Cow No Sugar Added Chocolate 10/4/2018 Listeria Details Homemade, Inc. Ice Cream

Vaccine Preventable Disease Update

In Hillsborough County, cases of varicella (chickenpox) decreased from eight in August to six in September, which is within numbers seen in previous years. Cases of pertussis (whooping cough) decreased to four in September from fourteen in August. No confirmed or probable cases of have been reported in 2018 in Hillsborough County.

Statewide data for vaccine preventable diseases is compiled into a monthly surveillance report, available online here.

Epi in the News

• Liveyon, LLC Issues a Voluntary Nationwide Recall of the Regen Series ® Product, Manufactured by Genetech, Inc.

• Hepatitis A outbreak reported in Orange County among homeless, drug users

• DOH-Pinellas Urges Prevention and for Hepatitis A

2 EpiNotes October 2018

DOH-Hillsborough Weekly Influenza Report Week 42 (October 14 – October 20)

Hillsborough County Influenza Summary: Influenza activity in Hillsborough County was reported as mild and sporadic during week 42 according to the state activity report. Influenza has remained at levels typically seen during the beginning of flu season. • The number of laboratory confirmed influenza cases reported by Hillsborough County medical providers remains at levels normally seen in the beginning of flu season. Very low numbers of positive flu tests were seen during week 42. • Emergency Department and Urgent Care Center visits have remained at low levels. See graph below.*

• In week 42, no outbreaks of influenza or ILI were reported. Two outbreaks of influenza or ILI have been reported in Hillsborough County during the 2018-2019 influenza season. • No influenza-associated pediatric mortalities were reported in week 42 in Hillsborough County. Hillsborough County has reported no pediatric mortalities during the current influenza season.

 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=20) electronically transmit visit data into ESSENCE-FL daily or hourly.  The ESSENCE-FL influenza-like illness (ILI) syndrome is composed of chief complaints that include the words “influenza” or “flu,” or chief complaints that include the words “” and “cough,” or “fever” and “sore throat.”

3 EpiNotes October 2018

Hepatitis A Surveillance Summary

Hillsborough County has been experiencing 2018 Case Summary an unprecedented number of hepatitis A Number of cases 38 Incidence rate (per cases in 2018. The county has reported 38 100,000 cases of hepatitis A as of October 25, 2018. population) 2.54 Age (in Years) Mean 38 Min-max 22-71 Number Gender (%) Rate Female 11 (29) 1.51 Male 27 (71) 3.91 Number Race (%) Rate White 30 (79) 2.83 Black 3 (8) 1.2 Other 3 (8) 2.84 Number Ethnicity (%) Rate Non-Hispanic 32 (84) 3.12 Hispanic 3 (8) 0.77

4

For cases reporting any type of drug use they EpiNotes October 2018

Reportable Disease Surveillance Data

Annual Totals Year-To-Date Disease Category Jan- Jan- 3 Year Sept Sept 2015 2016 2017 Average 2017 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 4 0 Pertussis 41 73 45 53.00 39 58 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 26 46 CNS Diseases & Bacteremias Creutzfeldt-Jakob Disease 3 3 2 2.67 1 1 H. influenzae (Invasive Disease in children <5) 2 4 4 3.33 3 2 Listeriosis 2 0 4 2.00 2 3 Meningitis (Bacterial, Cryptococcal, Mycotic) 16 9 6 10.33 6 4 Meningococcal Disease 2 2 0 1.33 0 2 Staphylococcus aureus (VISA, VRSA) 0 0 1 0.33 1 0 S. pneumoniae (Invasive Disease in children <6) 2 3 2 2.33 0 2 Enteric Infections Campylobacteriosis 152 197 315 221.33 250 268 Cholera 0 0 0 0.00 0 0 101 62 55 72.67 36 63 Cyclospora 1 1 12 4.67 12 3 Escherichia coli, Shiga -producing (STEC) 16 24 16 18.67 13 46 55 105 73 77.67 57 51 Hemolytic Uremic Syndrome 2 1 3 2.00 3 1 Salmonellosis 287 308 315 303.33 227 238 Shigellosis 216 76 165 152.33 148 25 0 1 3 1.33 2 5 Hepatitis A 5 5 10 6.67 6 29 (Acute) 62 53 55 56.67 43 34 (Acute) 48 31 35 38.00 26 17 Hepatitis +HBsAg in Pregnant Women 27 23 14 21.33 12 9 , E, G 1 0 1 0.67 1 2

5 EpiNotes October 2018

Reportable Disease Surveillance Data

Annual Totals Year-To-Date Disease Category Jan- Jan- 3 Year Sept Sept 2015 2016 2017 Average 2017 2018 Vectorborne, Zoonoses Chikungunya 10 1 1 4.00 0 1 Dengue 7 2 0 3.00 0 4 Eastern Equine Encephalitis 0 0 0 0.00 0 0 Ehrlichiosis/Anaplasmosis 0 0 1 0.33 1 1 Leptospirosis 1 0 1 0.67 0 2 Lyme Disease 12 6 12 10.00 11 2 Malaria 2 6 7 5.00 4 4 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 (Animal) 3 3 4 3.33 4 9 Rabies (Human) 0 0 0 0.00 0 0 Rocky Mountain Spotted Fever 0 0 1 0.33 1 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 2 1 0 1.00 0 0 Western Equine Encephalitis 0 0 0 0.00 0 0 Yellow Fever 0 0 0 0.00 0 0 Zika Fever NA 39 15 25.00 13 5 Others Anthrax 0 0 0 0.00 0 0 , Foodborne 0 0 0 0.00 0 0 Botulism, Infant 0 0 0 0.00 0 0 Brucellosis 0 1 0 0.33 0 1 Glanders 0 0 0 0.00 0 0 Hansen's Disease (Leprosy) 0 0 0 0.00 0 0 Hantavirus 0 0 0 0.00 0 0 Legionellosis 20 25 19 21.33 17 23 Melioidosis 0 0 0 0.00 0 0 Vibriosis 11 11 21 14.33 20 10

6 EpiNotes October 2018

Reportable Disease Surveillance Data

Annual Totals Year-To-Date Disease Category Jan- Jan- 3 Year Sept Sept 2015 2016 2017 Average 2017 2018 Chemicals/Poisoning Arsenic 0 0 0 0.00 0 0 Carbon Monoxide 20 20 32 24.00 21 7 Lead 246 154 315 238.33 247 335 Mercury 13 0 3 5.33 0 0 1 2 6 3.00 5 9 Influenza Influenza, Pediatric Associated Mortality 0 0 5 1.67 4 0 Influenza, Novel or Pandemic Strain 0 0 0 0.00 0 0 Tuberculosis TB 41 43 28 37.33 20 21

**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).

7

October 31, 2018

TIME RUNNING OUT FOR HAMBURGER MARY’S PATRONS TO GET FREE HEP A VACCINE

Contact: Kevin Watler [email protected] o: (813) 307-8044 c: (813) 298-2024

Tampa, Fla. – This Friday, November 2, the Florida Department of Health in Hillsborough County (DOH-Hillsborough) will discontinue offering the free to those who ate or drank between October 4 – 20, at the Hamburger Mary’s Ybor City.

The vaccine was offered for free by DOH-Hillsborough, to prevent those who may have been exposed to hepatitis A from getting sick. However, the vaccine must be administered within two weeks of exposure. That time is expiring soon and expired for some people already.

The hepatitis A vaccine is available at the DOH-Hillsborough Sulphur Springs location, which is at 8605 Mitchell Ave, Tampa, FL 33604. The clinic is open weekdays from 7:30 a.m. to 3 p.m.

Those who are not affected by the Hamburger Mary’s incident must pay $59 for the hepatitis A vaccine, unless they are high-risk and qualify for a free vaccine.

As of Tuesday, 574 people received the hepatitis A vaccine following the announcement last Thursday. Additionally, the 813-307-8004 hotline received nearly 400 calls.

There have been no Hepatitis A cases linked to the Hamburger Mary’s incident.

DOH-Hillsborough continues to encourage all healthcare providers, including hospital emergency departments to stay on high alert and immediately report cases to the Florida Department of Health.

Vaccination is the best way to prevent hepatitis A. People who should be vaccinated for hepatitis A include:

• All children at age 1 year • People who are experiencing homelessness • Users of recreational drugs, whether injected or not • Men who have sexual encounters with other men • People with direct contact with others who have hepatitis A • Travelers to countries where hepatitis A is common • People with chronic or long-term disease, including hepatitis B or hepatitis C • People with clotting-factor disorders • Family and caregivers of adoptees from countries where hepatitis A is common

What is hepatitis A?

Hepatitis A is a highly contagious disease that attacks the liver. People infected with hepatitis A are most contagious from two weeks before onset of symptoms to one week afterwards. Not everyone who is infected will have all the symptoms. Symptoms usually start within 28 days of exposure to the virus with a range of 15-50 days. Symptoms can include:

• (yellowing skin and whites of eyes) • Fever • • /tired • Loss of appetite • and vomiting • Stomach pain • Dark-colored • Pale or clay colored stool

How is hepatitis A treated or hepatitis A infection prevented?

• Hepatitis A vaccine is the best method of preventing infection. • No medicines can cure the disease once symptoms appear. People with hepatitis A symptoms should seek medical care immediately. • Most people get better over time but may need to be hospitalized. • Previous infection with hepatitis A provides for the rest of a person’s life. • People that are exposed to hepatitis A may be given vaccine or immune globulin within 14 days of exposure to prevent infection. ###

About the Florida Department of Health

The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

Follow us on Facebook, Instagram and Twitter at @DOHHillsborough. For more information about the Florida Department of Health please visit www.FloridaHealth.gov.

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  (HSV) in infants spotted fever rickettsioses  Arsenic poisoning <60 days old with disseminated ! Rubella ! Arboviral diseases not otherwise listed infection and liver involvement; encephalitis; and 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 ( type O1)  Tetanus Listeriosis  Ciguatera fish poisoning  Trichinellosis ()  Lyme disease + Congenital anomalies  Tuberculosis (TB)  Lymphogranuloma venereum (LGV)  Conjunctivitis in neonates <14 days old Tularemia  Malaria !  Creutzfeldt -Jakob disease (CJD) Typhoid fever (Salmonella ! Measles (rubeola)  Cryptosporidiosis Typhi) ! Melioidosis  ! 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 + Neonatal abstinence syndrome (NAS) and closely related organisms,  Escherichia coli infection, Shiga toxin- excluding Vibrio cholerae type O1) producing Neurotoxic ! Viral hemorrhagic  Giardiasis, acute Paratyphoid fever (Salmonella 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:

Birth date: Death date: Treated: Yes No Unknown

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) Arsenic poisoning Haemophilus influenzae invasive Meningococcal disease Streptococcus pneumoniae 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 Herpes B virus, possible exposure acute Typhoid fever (Salmonella 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 general community or any defined infection setting (e.g., hospital, school, other Ehrlichiosis/anaplasmosis Lyme disease Shigellosis institution) not listed above that is of Escherichia coli 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:

Top View