Reportable of Diseases/Conditions Narratives for SelectedNarratives for Infrequent Occurrence Infrequent Section 3

79 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

80 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

non PigFlorida.hunting likelywas of the route exposure allfor Floridathree residents.Exposure thefor Volusiaand Lucie, Allcounties. three caseswere interviewed, allinfectionsand three were acquired in and thepotentialmonths) causechronic illness.to were Cases in reported ofSt.residentsOsceola, year, throughout asthe expected isdisease a for incubation extended an with (uptoperiod several Floridathreeresidentcaseswere innon counts). case ofTwotheFlorida three residents werenohospitalized, were deathsbut reported.All non identifiedina wastwo caseswereprobable. The confirmed both culture 2014, residents. In threecaseswere reportedsporadic inFlorida residents; twoonewere confirmed, thepast10Over years, 17and betweenbrucellosiswere3 reported cases annually inFlorida toa responding bioterrorist event. productsincluding contaminated transfusion,andfood, organtransplant products;and detectingand preventprophylaxis laboratoryto exposure earlierawareness diagnosisand offor infected treatment persons; intervening early providing and atidentifyingpopulations toallow targeted preventionoutreach;increasing for health careprovider actionsthat health be can takentohelpincidence .reduce ofthis actionsinclude These Brucellosisinfections.is toreportablepublic health authorities because aretherea of publicnumber and cattleinfected sheep, with withassociatedcommonly them.U.S.,Outside the unpasteurized productsmilk frominfected , suis swine to feral infectedwith oranimal human cultures. Humaninfections in Floridaare most commonly with exposureassociated thewithbacteria. Laboratorians be can atrisk to exposurefor exposedwhenbe into theycan contact withcome infectedanimals orproductsanimal contaminated pain, andjoint fatigue. bacteriaare primarilyThese among reservoirs,animaltransmitted but people Brucellosisweakness. can alsocause long symptoms inof humans that includemay ,sweats,back , loss, weightand pain, systemicBrucellosisa is byillnessof several caused historical trends. NewMassachusetts (2), Hampshire (2), (2), and Wisconsin Arkansas(1) withwhichconsistentis Pinellas,Sumtercounties.and Allsevencaseswere interviewed. werein acquired Cases werewasyears). 64 in reported residentsBrevard, Broward,of Collier, Hillsborough,Manatee, one person.unknown for Ages 55 ranged from oldyearsto 83 age(average was years, 67 median werethreewomen, in Sixweremen. innoncases resultsavailable.test Twocaseswere buthospitalized,no weredeaths reported.Four caseswere in in2014; reported fiveconfirmedwere casesand two based were probable, on the typeoflaboratory distribution.In Florida, lessthan 12 cases are reported each year. Seven caseswere FloridaMorbidity2014 StatisticsReport was Anaplasmosis groupedwith inpreviousbut is reports, summarized separatelyinthe species,and targeteach areasofhighincidence preventionfor education. tomonitorintended overincidencetime, estimate burdenofillness, understand epidemiology the of toinfectionsdue acquired intheNortheastern and Midwestern U.S.Surveillance anaplasmosis for is pacificus transmittedhumans to by bites primarilytick from aches. Anaplasma granulocyticanaplasmosis(HGA)when thewasbacterium genus changed from humanpreviously as known granulocytotropic ehrlichiosis but (HGE), later wasrenamed human ais tickAnaplasmosis Anaplasmosis

- . . Although dogsand dolphins be may infected with owntheir residentcase was attributed to ingesting rawmilk productswhile Mexico. in Narratives for Selected Reportable Diseases/ConditionsNarratives Reportable ofInfrequent forSelected Occurrence

Moresevere infections can seenbe in those whoimmunosuppressed.are Anaplasmosisis , , the westernblack . Typical . symptomsof anaplasmosis include fever,, chills,and muscle

- Florida resident Mexicofrom (note thatthis report only includes Florida residentsin - borne bacterialborne disease caused by Brucellasuis - legged tick.Unlike ehrlichiosis,mostHGA cases reportedin Florida are B. melitensis

. . and domesticlivestock mayalsoinfected be with due itsto differentvectors, ecology, and geographic - Hispanicwhite aged men, 23, 65, and 70. Cases occurred - - relatedinfections developing;from detecting potentially lastingor chronic symptoms thatinclude recurrent ,

and B. abortusB. Ixodes scapularis - Hispanicwhite people;race and ethnicity were Anaplasmaphagocytophilum - positive for areimportant sourcesof human Brucella Brucella , black, the B.suis bacteriathatcan cause a range species whileworkingwith

species,human illness is not

. A . fourth wascase - legged tick,and

Ehrlichia .wasIt to I. B.

81 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

82 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

source of source mercuryleadingto healthadverse effectsin populationcanthe general causeand impaired environment andinthe accumulate in and fish marineMethylmercurymammals. is likelythe most microorganismsintheenvironment convert inorganic mercuryintoorganic its which build up form, can preservatives),inorganicmedical some and mercury(mercuricsalts). Methylmercury whencreatedis insomevapor(found thermometersanddental amalgam), methylmercury,ethylmercury in(found Forms vapors. ofmercury likely most encountered by publicinclude the general elemental mercury threats. health Mercury areexposurestypically toofingestion mercuryorinhalationdue of mercury mercurycompounds,inorganicwith each compounds),characteristics unique potentialand man Mercurynaturallya isoccurringelement distributed intheenvironment asof a result bothnaturaland MercuryPoisoning seveninfections wasremaining unknown. with contact armadillos;people three reported butnotseeing armadillos. touching origin ofThe the including Italy), one personwho inwasEcuador. born Oneofthe infected directpeople recalled 10 people withthe travel only history, internationalknown two reported travel andIceland, (Ecuador, asacquired reported inFlorida Polk,(in Volusia, MiamiClay, betweencaseswere linkages identified.the Eight ofthe caseswere interviewed. were Five infections ofresidentsBrevard (3), Volusia Polk (2), Clay (2), Miami(1), yearsto75 45 old(average wasyears,age 63 medianwerewasyears).reportedCases 67 in were innon cases were outbreakcases diagnosis. prior None peoplewereto of hospitalized the tobe known weredeaths no reported. and No laboratorydiagnosis was 38 months,including twocases with symptoms reported more 10than years all ofwhich 2014, were laboratory Florida, In less Hansen’s than12 casesarereported disease each year. caseswere Ten reported in toorderminimize permanentnerve damageand prevent further . intendedisdiseaseto Hansen’s earlyappropriatefacilitate diagnosisand bytreatment anin expert Asia, from thePacificAsian andAmericaIslands, Latin whereisthe disease Surveillanceendemic. for ofHansen’s inTransmission disease theU.S.is rare.Most U.S.incasesoccurimmigrants, typically . the possibleisIt to infected get through with contact armadillos, low. isbut the risk withnaturally infected it making difficult todetermine theofsourceinfection. Somearmadillos in U.S.thesouthern are infectedperson,livingan suchas in same incubationthe household. The isperiod typically years, leprae of mode oftransmissionnot is disease Hansen’s clearly investigators defined, most believe typicallydevelop symptoms relatedto the skin, peripheral nerves, and nasal mucosa.Although the whodevelop Those do wideclinicala of experience illnessrange butcan clinical manifestations, by caused nerves ,disease, commonlyHansen’s bacterialas a known is ofskindisease peripheral and the Disease(Leprosy)Hansen's withwere theassociated positive culture the . from isolates in2014culture (15high illnesseswere associatedwith dog.addition,this 26In laboratorians exposures reported to A hunters. secondevent involvedin2014 dog wasone that culture ServicesalsoConsumer identifieda childwere positive for a brucellosiscase2013, wasin1 reported addition In tohumanbrucellosis dogspositive cases, tested four for Narratives for Selected Reportable Diseases/ConditionsNarratives Reportable ofInfrequent forSelected Occurrence - made processes. Thereare three formsof mercury(i.e., elemental or metallicmercury, organic

isusually spread person - Mycobacteriumleprae Hispanicwhite people andonewas a Hispanic in white person.Ages ranged from

- associated. Three ofthe cases werein womenand sevenwere nine in men; B. suis M.leprae byserology in 2014.Florida The Department Agriculture of and

- ; it is;it not clear armadillosif aresimply sentinels or truereservoirs of - to risk exposuresrisk and 9 low - - confirmedcases. Themedian time symptomfrom onset to person inperson respiratory droplets followingextended close contact with Brucella . Approximately . 95% of people are resistantto infection. -

year - positiveat the andfarm both parents were avid hog - old childPolk in County. Threedogs linked to that

- risk exposures).risk - - Dade,and Orangecounty residents).Of Dadeand (1), Orange (1)counties. No - positive for B. suis

Fourof those exposures in 2014. DecemberIn

B.suis .No human B.suis thatM.

reported in2014,all reported ofwhich andwerelaboratory sporadic Typically, theemergencetrack ofa relatively rareclinically and neworganism. important patient transmittinginfection others, to prevent and such to Additionally, transmission. importantisit to identifyintendedis infectedpeople,to evaluate theirrisk infection,assessfactors for ofathe risk hastransmission.everNo VRSAbeen infection detected inFlorida. Surveillance andVISA VRSA for transferable to susceptibleorstrainsorganisms, sopotential isthere person for vancomycin to necessary.exposure not is typeofThis gene aureus not is mechanism transferrablesusceptible strains.to contrast, VRSAIn emerges when strainofa vancomycinto and repeated the use vancomycin.emergesVISA when patientwitha MRSA preexisting orcolonization infection exposed is vancomycin available the options MRSA.treatment for patientswithtreatingfor seriousMRSA infections inlast Consequently,common decade. the physicians rely primaryheavily as vancomycin the on Methicillin with contaminated body containingfluids health careworkersof the themselves;ordevices, items, orother environmental surfaces contaminatedbecome by withinfectedpatients; contact or colonized colonizedinfectedbody sites or direct contact. orwho procedures haveindwelling devices.medical associated infections,especially chronicallyamong whoillpatients haverecently had invasive orpneumoniawound can occur. infections, Mostpeople. aureus Staphylococcus aureusStaphylococcus possibleanother as ofsourcemercury exposure. consumption fish within ofillnessmonth a identification. dentalpeople reportedhavingTwo amalgam people wereFourteen exposedinFlorida and one Allwas people exposedinMassachusetts. reported interviewed,riskand data were factor collected from physicianthe reporting person.the for remaining Miami (1), Gadsden wasyears).Cases median 63 were reported ofinresidentsPalm Beach (6),Collier Pinellas (2), (2), and ethnicitywererace unknown.Ages ranged 37years from to78 old(average age wasyears, 58 wereinnon were inwomenandcases sevenwere Nine inmen. caseswere innon [µg/L])liter µg/L).orwhole (≥10 was No one hospitalizeddeathswereblood no and Eightreported. in2014.All reported 15 caseswere laboratory sporadic and reported2009since been (ranging 21 casesin2009 from in to caseswerefive 15 cases 2013); numberso poisoning,of the casesdecreased in2009.startingAn average casesperofyear have10 mercurypoisoningThe case definition changed in 2008late to require symptoms related to mercury exposure. elimination whenof sources and possible, toinform thepublic abouthow ofto reduce the risk dental thermometer, amalgams), prevent continued exposure further or through remediationor determine ifto isthere ofa source mercuryofexposurepublic health concern (e.g.,broken fish, hearing, walking;speech, and and muscleSurveillanceweakness. is mercurypoisoning for important usually hands,feelings” and aroundinthe feet, thelackmouth); ofcoordinatedimpaired movements; development; neurological impairedvision; peripheral disturbed sensations and(e.g.,“pinsneedles Narratives for Selected Reportable Diseases/ConditionsNarratives Reportable ofInfrequent forSelected Occurrence acquires the - between oneandseven VISA cases are reportedin Florida annually.Four cases were

resistant - - Hispanic people, black one wasin a non resistant S.aureus S.aureus - S.aureus vanA Dade (1),Dade Pasco and(1), Sarasota (1)counties. Fourteen people weredirectly S. aureus

infectionsare minor, but sometimes serious or fatalbloodstream infections, isa type ofbacteria commonly onfound the skin andthe in noses of healthy ,commonly among found health care workers,isspread byhands that Infection,Intermediate Resistanceto Vancomycin gene afrom vancomycin (MRSA)istypically resistant to manyantibiotics and has become more (VRSA)have acquiredintermediate or complete resistance to S.aureus S. aureus Vancomycin S.aureus strain developsa thicker wall. This resistance

- .

resistant - S.aureus Hispanic person ofother race, and one person’s is also analsois important of health care cause - intermediate - confirmed.All fourcases were hospitalized and thus,resistance tovancomycin limits - - confirmedin urine(≥10 microgramsper mediatedresistance istheoretically Enterococcus istransmitted person S.aureus - Hispanicwhite people,two (VRE)organism. Recent

(VISA)and -

to - person person - to - person byperson - S.

83 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

84 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

illness. preventionto target educationpublic, the for overincidencetime,monitor estimateand theburden of Surveillance infected. diseaseimportant is identifyfor areaswhereto WNV is transmittedbeing WNV ornot usinghomelessness) insectrepellant orotherofprevention forms areathigher of becoming risk exposure. after Peoplethe amountslarge ofspending timeoutside(due tohobbies occupation, or theforpresencescreened of prior to transfusion.Symptoms WNV typicallyappear142 daysto from and less transfusions frequentlyorganthroughtransplantation. Since2003,all donationsbloodare infectedmosquitowith be also can humanstransmitted WNV. WNV to via contaminated areall documentedhumans hosts People for infectedwhenbecome theyarebitten by a WNV. ordeath. Severalcoma species of involveandmay encephalitisand irreversible can neurological cause damage,paralysis, pain, (headache, lessfever, and than1%fatigue), suffer from theneuroinvasive ofillness, whichform Approximatelyofthoseinfectedshow clinical 80% no 20%have symptoms, mildsymptoms inallFloridacounties. 67 Peopleinfectedwith experience a can wide rangeof symptoms.WNV and detectedinfirst1999 inFloridain 2001. Since initialits detection, activitybeen reported WNV has NileWest (WNV)is a mosquito NileVirusWestDisease (1), and the interviewed;infectionswereoutside12 acquired U.S.in of the India (7), Bangladesh (2), (1), Nassau (1), Dade (1), (1),Orange andPasco (1), (1)counties.Sarasota Allcaseswere 13 ofresidentsBroward (2),Beach Palm (2), Alachua (1), Brevard Collier (1), (1), ManateeMiami (1), from8 to 75 years old (average age was 34 years, median was35 years). Caseswere reported in PacificIslanders,two white, were twoand were werethree black, people ofother races. Ages ranged were incases andwerefemales eight in males. wereAll innon cases laboratory isdisease where endemic.the caseswere reportedThirteen in2014,all of whichwere sporadic, insummerpeakingincidence andTypically,between10 20 typhoidcases in Floridaare fever reported annually,residents with preventand suchothers identifytransmission,unrecognizedand other cases. transmissionstop from source,sucha assess the risk ofinfectedpeople transmittinginfection to (e.g.,anconcern or infectedhandler contaminatedfood commercially product)and distributed food to Surveillancetyphoid determine intended is for feverif to aisthere sourceinfection ofpublicof health case follow as theCanada,U.S.,such Europe, ,and GoodJapan. and aggressiveWestern washing food. Typhoid feveriscommon in most parts of the world except in industrialized regions contaminated withwhen sewage havethatbeverages beenbyperson whohandled a sheddingis pains, headache,stomach weakness, ofappetite,loss orrash. be severe. can feverTyphoid Peoplewithbacteria. typhoidtypically sustainedhighfever a andexperiencehavefever alsomay ais Typhoid systemic illnessfever causedby TyphoidFever Lucie counties.St. (1) All caseswere investigated,only casewasthough one abletobe interviewed. was wasyears, years). 60 median 64 were Cases reported ofinresidents ManateeClay (2), and (1), two werepeople and innon wasmorbidities). womanandinOnecase a werethree inmen; two cases were innon persondied,one and thoughnotnecessarily infectionVISA from personhad (the multipleco Narratives for Selected Reportable Diseases/ConditionsNarratives Reportable ofInfrequent forSelected Occurrence

- confirmedcases. Eleven people were hospitalized,no but deaths werereported. Five - Typhilives onlyin humans.People get typhoid feverafter eating food or drinking up helpup prevent becomingfrom endemicin industrializedregions.

PhilippinesOne(1). infection was acquiredin Florida(Nassau County resident).

- Hispanicpeople. black Ages ranged 34from toyears 79 old (average age months.Approximately of80%infections are acquiredin othercountries Salmonella Culex - borne flavivirus thatwas introduced first to the northeastern U.S. mosquitoes,animals (particularly wild birdsandhorses),and Typhibacteria intogets the waterused fordrinking or Salmonella Typhi( - Hispanic;six were in Asian/ Typhistoolin their or

Salmonella - Hispanicwhite - Typhi)

-

please see Section see 4:pleaseNotable Outbreaksand Case Investigations. casesofthe firstSLE reportedinFloridasince 2003.For informationmore cases,abouttheseSLE hypothesized that SLEVhave may WNV replaced otherFlorida inand parts ofthe U.S. were These inresidents2014.Similar SLE to virus a is flavivirus WNV, thewithsame vectorsitmosquito and is Alsoofinterest,definition. two casesofSt.Louis (SLE)were identifiedinDuval County screeningbloodprocess later the and developed non and(July), JohnsSt.(September) Ancounties. additional was initiallydonor blood through identified donorswerebloodAsymptomatic reported Duval from Polk (September), (November),SantaRosa Fourasymptomaticdefinitions. infections inblood donorswere identifiedin Floridainresidents 2014. infections WNV do occur, thoughthey do not meet Floridathe surveillancecase inBahamas acquired the and 16 the remaining infections were acquired in Florida. September(8), and (6), All October (2). 17 infected people wereinterviewed. infection was One Pasco(1), Polk and (1)counties. Consistent pastyears,with casesoccurred inJuly (1), August ofresidentsEscambia (4), DuvalVolusia (4), (2), Clay (1), AlachuaLeon (1), Marion Monroe(1), 7years from to80 age old(average wasyears, 46 was years). median 43 were Cases in reported innon Sixhospitalized persondied. one caseswereand elevenininwomen and were All men. caseswere supportiveprobable, meaning less that laboratory wasFifteenpeople evidenceavailable. were ofwhich were2014, 12 neuroinvasive. All16 cases werewere sporadic, confirmed one and was cases,74 with theninreported decreased2013 Seventeen tosevencases. caseswere reported in 2006 to2003; from 2009,only caseswerethree year. reported each peaked againin 2012 Incidence between consistentlypeaks JulySeptember. and largestnumber The ofcases(94)was reportedin ofincidence Thein Floridavariesdisease WNV greatly yeartoyear but from incidence the Narratives for Selected Reportable Diseases/ConditionsNarratives Reportable ofInfrequent forSelected Occurrence - Hispanicpeople; one person was black and theremaining people16 werewhite. Agesranged - neuroinvasive symptoms, meeting the case

85 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence

86 Section 3: Narratives for Selected Reportable Diseases/Conditions of Infrequent Occurrence