Fall 2003

ROLLOUT OF THE MICHIGAN DISEASE SURVEILLANCE SYSTEM Jim Collins, R.S., M.P.H. and Brad Carlson, M.P.H.

ublic health surveillance is the for a system to replace the existing health capacity. Electronic laboratory cornerstone of public health electronic system (LHDSURV). While a disease reporting and reporting from P decision-making and practice. At functional system for many years, it was a variety of other data sources are also the federal, state and local levels there clear that LHDSURV was inadequate supported within this framework. are in existence more that 100 systems to address several surveillance realities, The system can receive disease reports for public health surveillance. However, including the fact that it was one of through manual entry via on-line web these existing systems were developed the multitude of incompatible disease submission of case referral/intake reports, with little or no coordination or thought specific systems that currently existed, or importation of HL7 laboratory toward data sharing. The Michigan data in the system was consistently reports. The demographic data contained Disease Surveillance System (MDSS) is incomplete and delayed, it was not in each potential case is de-duplicated an initiative that avails itself of the use of designed to minimize the burden on to ensure the system contains a set data and information system standards to health care system to report disease and of unique patient demographic. The advance the development of an efficient, it lacked state-of-the-art information individual rather than the condition integrated, and interoperable surveillance technology resources. reported is now the hub of the system’s system that will communicate data model. The MDSS geocodes all effectively at federal, state and local The MDSS has been designed to encountered addresses with Geographical provide a web-based disease surveillance levels. A primary goal of the MDSS is Continued on page 7 the ongoing, automatic capture and application that allows for electronic analysis of data that are already available capture of disease data, case assignment electronically. and tracking, addition of public health TABLE OF CONTENTS case investigation data, and data export. In the fall of 2001, staff at the Michigan This system will improve the medical Tuberculosis in Michigan...... 2 Department of Community Health and epidemiological management of the Rabies in Michigan...... 3 (MDCH) began gathering requirements case investigations and enhance public Newborn Screening...... 4 Conferences ...... 5 Locally-Acquired QRNG ...... 5 Presentations ...... 5 Employee Focus: Gabe Palumbo...... 6 Influenza in Children and Young Adults ...... 6 Staff Changes...... 7 New CDC Fellow...... 7 Preparations for Flu Season ...... 8 New Grants ...... 8 SARS Response ...... 9 Publications...... 9 Dr. Henry Falk Visits MDCH...... 10 New EIS Officer Arrives...... 10 New Employees...... 11

DCH-0709 (Rev. 8/02) Tuberculosis in Michigan By: Gabe Palumbo, M.B.A., M.P.H., and Sue Spieldenner, R.N.

hile tuberculosis (TB) over the five-year period from 1998 remains a major threat to - 2002 (Figure 1). The City of Detroit W the health and well being of continues to report the highest number people around the world with more than of TB cases in the State with 93 cases 2 million deaths each year, case rates in of TB and an incidence rate of 9.3% the U.S. have been declining steadily cases per 100,000 population reported for the past decade. The decrease in TB in 2002. The City of Detroit accounts incidence to historic low levels creates for approximately 30% of the State’s TB challenges for public health officials who morbidity with two-thirds of Michigan’s Figure 2 are working to sustain programs and TB cases residing in the greater Detroit systems, especially when low incidence metropolitan area encompassing regard to race-specific case rates, Asian fails to indicate the full efforts required Macomb, Oakland, Washtenaw, and /Pacific Islanders case rates were the for comprehensive TB control. As a low Wayne counties. highest in Michigan in 2002 with 30.7 incident state, Michigan must strive cases per 100,000 population, followed to retain the skills needed to detect, Although TB cases continue to decline by Black, Non-Hispanic with 9.6 cases investigate, and treat TB in spite of here in Michigan and across the per 100,000 population, Hispanic falling case rates. U.S., this decline is masking some all races with 7.1 cases per 100,000 disturbing trends. In 2002, the burden population and White, Non-Hispanic In 2002, the State of Michigan TB of TB disease continued to be felt with 1.2 cases per 100,000 population Control Program reported 315 TB disproportionately in Michigan by (Figure 2). cases and a case rate of 3.2 per 100,000 minority racial and ethnic groups and population. This represented a 4.5% the foreign born. As case rates continue to decline, the decrease in the number of cases reported state program has become more focused in 2001 and maintains Michigan’s status With regard to foreign birth, 120 on TB prevention activities through as one of 22 low-incidence states in the (38.0%) of reported cases in the state in education and training. Over the past country. Overall, TB cases in the State 2002 were foreign born. This represented two years, three TB trainings approved of Michigan have decreased by 18.1% a 1.5% increase in foreign born cases by the Michigan Nurses Association from year 2001 and a 13% increase for (MNA) have been developed for the period 1998 – 2002. health care professionals, both public With regard to race and ethnicity, 136 and private. They include; Contact (43.1%) were Black, Non-Hispanic, Investigation, Case Management, and 99 (31.4%) of TB cases in 2002 were Tuberculin Skin Testing. To date, the White, Non-Hispanic, 55 (17.4%) were state TB Program has provided trainings Asian or Pacific Islander, 23 (7.3%) were to nearly all of Michigan’s 84 local health Hispanic and 2 (0.6%) were unknown. departments. The trainings have allowed There were no cases of tuberculosis in local public health nurses to strengthen the American Indian/Alaskan Native their knowledge, skills and abilities in Figure 1 populations in Michigan in 2002. With conducting identification and prevention activities.

Farewell to Bao-Ping Zhu

ao-Ping Zhu, M.D., M.S., was Before coming to MDCH, Zhu where he taught epidemiology and a familiar face in the Bureau completed his EIS fellowship in Utah. conducted research. of Epidemiology until recently His primary work, while at MDCH, B Zhu, his wife Jinwei Yan, and their three when he accepted a job as the State focused on describing the health status Epidemiologist and Chief of the Office of maternal and child health population, sons recently relocated to Columbia, of Epidemiology in Missouri. Zhu was especially in terms of the racial disparities Missouri where they are adjusting to assigned to MDCH by the CDC as of maternal and infant mortality their new surroundings. The Bureau of the Chief Maternal and Child Health rates between African-American and Epidemiology wishes them luck in this Epidemiologist five years ago. While Caucasian women. In addition, he was new endeavor! here, he oversaw the growth of this area an adjunct faculty at Michigan State and supervised several epidemiologists. University, College of Human Medicine, Page 2 Rabies In Michigan By: Kimberly Signs, D.V.M.

abies, a disease of mammals 5000 children that occurs in a variety of and adults who R animals worldwide, but occurs visited the farm in primarily in wildlife in the United States, the 30 days prior continues to present a risk to animal to the diagnosis and human health in Michigan. The of rabies, and Michigan Department of Community approximately Health’s Bureau of Laboratories (MDCH 200 of them BOL) tests over 2700 specimens underwent rabies annually, with the peak testing occurring post-exposure in late summer. As of September of prophylaxis. The 2003, over 2000 specimens have been cost of rabies tested, with 39 positives identified, post-exposure including 36 bats, 2 skunks, and 1 cat. prophylaxis, which includes Bats a dose of rabies Bats are the species most at risk for rabies immune globulin, infection in Michigan, and of all the and a series of species tested, they are the most likely to five vaccines, is be positive. Due largely to widespread approximately vaccination of domestic dogs, human $3,000 dollars per cases of rabies in the United States are person. Proper now rare. Typically one to two cases vaccination occur each year. Of all the human rabies of the pony cases that have occurred in the United • If dead bats are found and there against rabies would have prevented this States since 1991, 75% have been due to has been no known pet or human situation from occurring. exposure to rabid bats. The other 25% exposure, they should be collected Case #2: have resulted from exposure to rabid by scooping them up with a shovel, dogs in developing countries, where dog placing them in a plastic bag, and A barn cat that had been living on a farm rabies remains a concern. Although it disposing of them in the trash to go for 5 years suddenly became aggressive is estimated that fewer than 1% of the to a landfill. and attacked the property owner and a bats in Michigan carry rabies, a higher neighbor who was trying to help confine proportion (average of 6%) of those Rabies in Domestic Animals/ the cat. The cat was killed and its brain tested at the BOL are rabid. This reflects Recent Cases of Interest was submitted for rabies testing. The the fact that sick bats are more likely Most rabies in Michigan occurs in results were positive. The owner and to exhibit abnormal behavior, have an bats. However, domestic animals neighbor underwent post-exposure rabies encounter with a human or another such as a horses, sheep, or cats are prophylaxis, and other animals on the animal, and be submitted for rabies occasionally discovered to be rabid. farm were quarantined or destroyed due testing. Abnormal behaviors include In most situations, these events are to possible contact with this rabid cat. being active during the day, being found entirely preventable with proper rabies This cat was infected with skunk-strain in a place where bats are not usually seen vaccination. The following examples of rabies, and lived in an area of Michigan (such as inside a home), or inability to situations that have occurred recently in where skunk rabies was known to occur. fly. Recommendations with regard to Michigan will illustrate this point. This cat had never received a rabies bats are as follows: vaccination, although it had lived on the Case #1: same farm for 5 years. • Never handle a bat with bare hands. A 20-yr-old pony, part of a petting A new website is being developed in zoo animal display at a farm run by a • Any dead, sick, or injured bat should Michigan for zoonotic and emerging local school district, became ill with be collected and tested for rabies if diseases, including rabies. This website neurologic signs and was euthanized. exposure to people, pets, or livestock is a multi-agency effort to provide a The brain was submitted for rabies has occurred. single site that contains comprehensive testing and found to be positive for information about all aspects of these • Prevent bats from entering occupied skunk-strain rabies. Health records types of diseases, as well as links to spaces in any building where contact for the pony were incomplete, and a other useful sites. Because of its wildlife with people, pets, or livestock might history of rabies vaccination could not occur. be confirmed. There were approximately Continued on page 4 Page 3 “Rabies in Michigan” Newborn Screening in Michigan continued from page 3 By: William Young, Ph.D. For almost 40 years, the Michigan The initial newborn screening test reservoirs, rabies will continue to be a Newborn Screening Program has been should be completed when the infant is concern for Michigan citizens. The key helping to improve the lives of children 24-36 hours of age. Just a few drops of to prevention of disease in humans and around the state. The program is blood from a heel stick are needed. All domestic animals is the appropriate use designed to provide rapid identification specimens are forwarded to the MDCH of available vaccines, as well as education of newborns with rare and serious, but Newborn Screening Laboratory for of the public about the risks that wild treatable, disorders. These disorders analysis. Positive test results are either animals can pose. could cause mental retardation, physical repeated or the newborn is referred In general, the following precautions disability, severe illness or death. to one of three medical management should be taken to reduce your risk of However, early diagnosis and treatment centers (metabolic, endocrine, sickle exposure to animals that may be carrying of infants affected with these disorders cell) funded by the program. The rabies: can result in normal growth and medical management centers provide development. confirmatory testing and long-term • All pets and domestic livestock for treatment to affected children identified which a licensed vaccine exists should The Newborn Screening Program by the program. Epidemiological be vaccinated. This includes dogs, benefits affected children through evaluation of current screening cats, ferrets, horses, cattle, and sheep. improved health by offering them the methodologies and medical outcomes is Vaccines should be administered by opportunity to achieve the best possible a recent addition to the program. a licensed veterinarian, and boosters outcome. In addition, the program given according to the manufacturers significantly reduces financial costs both A significant advance in newborn directions. for families and for society through early screening technology has occurred identification. This allows for treatment with the application of tandem mass • Do not approach or handle to be initiated before the development spectrometry (MS/MS) for the detection unfamiliar or wild animals. of symptoms that require costly of a wide range of inherited disorders interventions. using a single spot of blood. The state • Thoroughly wash any wound caused laboratory is currently using MS/MS by an animal with soap and water and The current program has expanded to detect PKU, MSUD, and MCAD seek medical attention immediately. to include eight disorders: PKU, deficiency. The latter disorder is one • Rabies Post-exposure Prophylaxis Galactosemia, Maple Syrup Urine of a group of fatty acid oxidation (PEP) is highly effective in preventing Disease (MSUD), Medium Chain disorders characterized by severe, rabies in people possibly exposed to a Acyl-CoA Dehydrogenase Deficiency metabolic symptoms following periods rabid animal, if administered before (MCAD), Congenital Hypothyroidism, of prolonged fasting. The department’s symptoms develop. Congenital Adrenal Hyperplasia Newborn Screening Advisory Committee (CAH), and Sickle Cell Anemia. With is now evaluating the expansion of MS/ • There is no post-exposure prevention the exception of Hypothyroidism, the MS screening to include an additional treatment available for animals. As a disorders are inherited. Although each 15-20 amino, organic and fatty acid result, unvaccinated domestic animals of the disorders is rare the combined disorders. Cystic fibrosis is also being that are exposed to a potential incidence is approximately 1/500 for all considered. It is anticipated that DNA rabies carrier may be required to be Michigan newborns. technology will increasingly be applied euthanized. There are currently one hundred to newborn screening, which will greatly • It is illegal to have wild animals as birthing hospitals and over one hundred expand the potential for early detection pets. midwives that participate in this state of a large number of inherited disorders. It is already a part of second tier CAH mandated program. The program is • Many exotic species make poor pets, funded by a fee for the initial newborn and cystic fibrosis dry blood spot testing to improve specificity without reducing and no rabies vaccine is licensed for screening cards (all or a portion of this use in these species. fee may be covered by insurance or sensitivity of the screening tests. Medicaid and thus reimbursable to the If you have any questions about hospital). The revenue obtained from the the MDCH Newborn Screening fees allows the state to offer laboratory, Program, contact William Young at follow-up, and medical management [email protected]. services to all Michigan families of affected newborns. The current cost of the initial newborn screening card is $54.84.

Page 4 Locally-Acquired Quinolone-Resistant Neisseria Upcoming Gonorrhoeae in Michigan Conferences By: Dara Ganoczy, M.P.H. s of the end of September, 12 too, should be treated with a non- What DO They Really DO cases of quinolone-resistant quinolone regimen. In Kent County, the in Lansing? A gonorrhea (QRNG) had been Health Department sent out an advisory identified in Michigan this year. Seven recommending that providers culture An introduction to MDCH/ were Ingham County residents, three all MSM who are being evaluated for Division of Communicable Disease were from Kent County, and the other gonorrhea and submit cultures to the and Immunization for NEW Local two were from Washtenaw and Wayne state lab in Lansing for susceptibility Health Department Staff counties. Ten of the cases were male, testing. No changes in treatment of three were men who had sex with men MSM in Kent County are recommended December 4th (MSM), and their ages ranged from 16 at this time. Providers in all counties 9:30-3:00 to 42 years. Six of the cases were Black, are encouraged to culture patients whose four were White, one was Asian, and one symptoms do not resolve and send MDCH/ Division of Communicable Hispanic. Only two cases (Washtenaw cultures to the state lab in Lansing for Disease and Immunization is hosting and Kent counties) reported travel to susceptibility testing. an orientation titled “What DO They areas with endemic QRNG; the others Really DO in Lansing?” for new local appear to have acquired their infections Several areas of the country are seeing health department communicable locally. In recent years, Michigan has increases in reported cases of QRNG, disease staff. You may recall that we had one or two QRNG cases each year, and the CDC recommended in their hosted a similar day in September all of whom reported recent travel to 2002 STD Treatment Guidelines 2002. The orientation will provide an Asia. that states track gonococcal resistance introduction to: to assist providers in prescribing the • The organization of MDCH/ Following identification of the first most effective antibiotics for their Communicable Disease and QRNG cases in Ingham County, the patients. The Michigan Department Immunization and its various STD program notified all local health of Community Health has been sections departments of changes in treatment conducting a gonococcal resistance recommendations for patients in Ingham surveillance project in conjunction with • Who to contact in each section and adjoining counties (Clinton, Eaton, sentinel labs around the state since July for specific questions Jackson, Livingston, and Shiawassee). 2002. In addition, the Detroit STD Patients in these counties are to receive Clinic joined the national Gonococcal • Completing investigation forms a non-quinolone regimen for the Isolate Surveillance Project in January • How to submit lab specimens treatment of gonorrhea. Providers in 2003. We will continue to monitor other counties are advised to obtain a reports of QRNG and as additional • What MDCH can do for you! travel history for patients being treated cases are detected, treatment guidelines for gonorrhea, and if they had sex may be revised as necessary. For more • …And Much Much More!! partners from Asia, Hawaii, California, information contact Dara Ganoczy, To register, contact Jennifer Beggs at or Ingham or adjoining counties, they, M.P.H., STD Epidemiologist, at 517- 517-335-8165 by November 21st. 335-9007 or [email protected]. On November 6th, the Michigan Cancer Surveillance Program will be hosting a one-day conference Recent Presentations on benign brain/CNS tumors and collaborative staging. The conference rik Janus, M.S., recently Lori Cameron M.P.H., Ph.D., Martha will be held in the Auditorium at the presented “Michigan’s Drinking Stanbury, M.S.P.H., and Shevon Desai, Michigan Historical Library/Museum E Water: Toxicology Health Risks along with others recently presented in Lansing from 8:00-5:15 p.m. and Potential for Chemical Terrorism” in “Outreach and Coalition Building The conference is targeting hospital November at the Michigan State Medical for Agricultural Safety and Health in and laboratory personnel that report Society Annual Meeting. Janus is a Michigan-A One-Year Pilot Project” cancer cases and will cover new toxicologist for the chemical terrorism at the Challenges in Agricultural requirements and procedures that group in the Division of Environmental Health and Safety Conference in San will take effect on January 1, 2004. and Occupational Epidemiology Francisco, September 7-9. All are from If you have any questions contact the Division of Environmental and [email protected]. Occupational Epidemiology

Page 5 Severe Morbidity and Mortality Associated with Influenza in Children and Young Adults By: Shelley Stonecipher, D.V. M., M.P.H.

n January of 2003, the Michigan noninfectious disease processes. Further of cases or are the result of increased Department of Community Health investigation focused on unexplained surveillance. The results of this ongoing I (MDCH) received reports of deaths and severe illnesses associated investigation indicate the need for unexplained deaths and severe illnesses with influenza in children, considered further studies to better define the and mortality associated with influenza low risk for influenza complications, and frequency of serious complications from among Southeast Michigan residents. By young adults less than 21 years of age. influenza in children. February 6th, seven unexplained deaths were reported ranging in age from 7-48 The results of the investigation identified For the complete Morbidity and years and one death due to neurological 14 lab-confirmed cases of influenza: Mortality Weekly Report complications of influenza in a 5- 4 deaths and 10 severe illnesses, with onset during January 17–February CDC. MMWR Severe Morbidity and year-old child. Increased surveillance Mortality Associated with Influenza in for unexplained deaths and for severe 21 among children and young adults aged <21 years in Michigan. Ten Children and Young Adults–Michigan, illnesses associated with influenza began 2003. MMWR 2003; 52(35); 837-840. in the State of Michigan. MDCH children with severe illnesses were likely complications of influenza. The performed case finding with assistance *Current vaccination recommendations four fatalities associated with influenza from local health departments and for influenza is for groups of people who occurred in previously healthy children other health care personnel throughout are at increased risk for complications for whom influenza vaccination was Michigan. from influenza. Young, otherwise not encouraged or recommended.* The healthy children aged 6–23 months are cases were similar with the onset of fever, MDCH investigated cases with at increased risk for influenza-related and rapid progression of severe illness to assistance from the Centers for Disease hospitalization. For this reason, influenza death. All tested positive for influenza Control and Prevention. Epidemiological vaccination of healthy children aged and none were vaccinated for influenza. and clinical information was obtained 6–23 months is encouraged when In addition, four other unexplained and submission of clinical specimens feasible (1). for diagnostic testing was facilitated. deaths among children remain under Explanations for the unexplained deaths investigation to date. 1. CDC. Prevention and control of influenza: among the adults were ultimately recommendations of the Advisory Committee It is unknown whether these cases identified, all of which were determined on Immunization Practices (ACIP). MMWR represent an increase in the number to be due to other infectious or 2003;52 (No. RR-8). Employee Focus: Gabe Palumbo

abe Palumbo, M.B.A., M.P.H., Although in the Infectious Disease Tuberculosis (MI-ACET). He worked currently serves as a Center for Epidemiology section, Palumbo has with them to draft the 2003 MI-ACET G Disease Control and Prevention much broader duties in addition to TB Recommendations in addition to helping (CDC) Senior Public Health Advisor surveillance and epidemiology. Much of to create the new MI-ACET website. in the Infectious Disease Epidemiology his job involves program management, The website, www.michigantb.org, section. He was relocated to MDCH including assisting with the federal has comprehensive information on TB in August 2001 after serving in a similar grant and progress report writing, testing, treatment, and epidemiology. position in Honolulu, Hawaii. and maintaining contracts with local The website is a great resource for health departments and the American health care professionals, local health Palumbo joined the CDC in 1993 Lung Association. Along with the TB departments, and the general public. after being recruited into the Public coordinator, he also supervises two Health Associates Program. He received regional TB nurses. In addition to Palumbo received a B.S. in two years of training as a TB disease these programmatic duties, Palumbo, Communications for Medaille College investigation specialist with the New along with other TB staff, manage the in Buffalo, NY. He received an M.B.A. York City Health Department. After surveillance database and interact with from California Lutheran University and this training, he became a Senior Public the laboratory to report TB cases. an M.P.H. from Emory. He lives with Health Advisor in tuberculosis and his wife, Jackie, and their children Jessica has remained in this position, acting One of Palumbo’s major and Matthew in Grand Ledge. In their as a consultant to various state health accomplishments since joining spare time, the Palumbo family enjoys departments. MDCH is working with the Michigan many outdoors activities, especially Advisory Committee for Elimination of kayaking and hiking. Page 6 “Rollout of the Michigan Disease Surveillance System” continued from page 1

Information Systems (GIS) mapping developments include an automated Departments), project developers have which is integrated into case, as well as syndromic surveillance system (The been able to gather valuable insights and reporting screens. Tabular summary and MDSS Syndromic Surveillance Project) the needs of public health participants detail reports are also available. Security that will leverage MDSS technologies from across the State. Further, the of data is of utmost importance in to incorporate the inclusion of “chief contributions of this group have been this system. To that end, the MDSS is complaint” data from Michigan’s critical in the development of the accessible only to users having signed-in emergent care facilities as well as a system training programs scheduled for release through the Michigan Single-Sign-On to monitor sales patterns of over-the- in late fall, 2003. process. Once entry to the system has counter pharmaceuticals. Both of these been gained, further access is limited to projects promise the introduction of data Ultimately, the development of the users based upon assigned programmatic streams that sacrifice specificity for much MDSS and associated projects will and geographic roles that are maintained more timely data access to emergent provide a clearer picture of public and enforced within the application. conditions than has been available via health in Michigan, and will be a traditional passive diagnoses-based resource for the early identification of At implementation, the system will reporting. emergent public health conditions and facilitate investigations for the majority a data foundation upon which we will of communicable diseases reportable By working with a user group be building for many years to come. in the State of Michigan (sexually representing a variety of Michigan’s Questions about the system should be transmitted diseases, tuberculosis Local Public Health Jurisdictions referred to the appropriate MDCH and HIV/AIDS laboratory data will (Central-Michigan District, Kent Regional Epidemiologist, Brad Carlson be accepted by the system, but case County, Macomb County, Marquette ([email protected]) or Jim Collins management will be separate during County, and Washtenaw County Health ([email protected]). the initial implementation). Parallel New CDC Fellow Staff Changes Joins MDCH Staff ennifer Beggs, M.P.H., recently National Research Council of Canada. took a new position in the She received her M.S. in epidemiology J Communicable Disease Section as a from MSU and her B.S. in Life Sciences iolanda I. Grigorescu M.D., M.S.P.H. is the CDC/HRSA Communicable Disease Epidemiologist. from the University of Toronto. Maternal and Child Health Prior to this she worked for the V Surveillance Section as a Regional Rebecca Malouin, Ph.D., M.P.H., (MCH) Epidemiologist Fellow Epidemiologist assigned to Region has recently accepted a new position who joined MDCH as the MCH as Senior Genetic Epidemiologist epidemiology team leader. She is a senior 7. She attended the University of Michigan were she received an M.P.H. in the Epidemiology Services MCH epidemiologist who worked with Division. Previously, Malouin was Georgia Division of Public Health prior She received a B.S. from Michigan State University. Her new tasks will include an Epidemiologist with the Maternal to her move to Michigan. While being and Child Health group working on a in Atlanta, she worked on different planning MDCH’s Communicable Disease Conferences; monitoring and HRSA-funded project concerning racial projects such as: perinatal indicators by disparities in maternal morbidity in perinatal regions and hospitals’ level of providing guidance for prion diseases, legionella, and hepatitis A outbreaks; Michigan. She is now responsible for care, peripartum cardiomiopathy case special studies and ongoing program reviews, and maternal morbidity among developing a scabies manual; and assisting with general communicable evaluation in the genetics and newborn Medicaid women. She also offered screening programs. assistance in improving the maternal disease follow-up. mortality surveillance system. Susan Bohm, M.S., recently took Elizabeth Hamilton, M.P.H., has a position as the new Regional accepted an expanded role within Grigorescu has a long career in women’s the Bloodborne Infections and STD health and MCH as a physician and Epidemiologist for Region 1 (based in Ingham County). She comes to Epidemiology section as an HIV then as an epidemiologist. She earned Epidemiology Specialist. She will her M.D. degree at the University of the Surveillance System section from Chronic Diseases, Epidemiology remain as the primary contact for the Medicine and Pharmacy Iasi, Romania HIV Surveillance Evaluation Project. In and her M.S.P.H. at the University of Services Division, where she worked on the Behavioral Risk Factor Survey. addition, she will give support to staff in Louisville, School of Public Health. using SAS and in writing SAS programs, She has more than 15 years of clinical Prior to coming to MDCH, she held several research assistant positions at the completing and assisting staff with the experience as an Ob/Gyn physician more complex HIV data analyzes, and in in her native country, including also Department of Epidemiology, Michigan State University and had a long career taking the lead role for Epi Profiles and Continued on page 8 in scientific journal publishing at the community planning. Page 7 “New CDC Fellow Joins MDCH Staff” continued from page 7 Preparations for the 2003-2004 Influenza Season By: Kyle Enger, M.P.H. her training and work in infertility he 2003-2004 influenza are at lowest risk for influenza-related management and treatment and surveillance season began on complications (4). It is more expensive reproductive-assisted techniques in September 28, 2003. There than the inactivated vaccine, and its Sheffield, U.K. She was also involved T are currently 39 health care providers storage and handling procedures differ in many voluntary activities as the who are enrolled as sentinel surveillance as well. vice-president and then president sites throughout the state. Their data of the Society for Education on contribute to the CDC’s influenza The composition of the 2003-04 vaccine Contraception and Sexuality funded in surveillance system, which allows is the same as the 2002-03 vaccine; 1991 in Romania with USAID and IPPF tracking of influenza activity regionally it contains A/New Caledonia/20/99- support. From 1995 until 1997, she was and nationally. In the past, surveillance like [H1N1), A/Moscow/10/99-like involved in WHO projects related to was only active from October to mid- [H3N2), and B/Hong Kong/330/01-like women and children’s health in Eastern May, since influenza usually peaks strains (5). Both inactivated and live and Central Europe. during December to March (1). attenuated vaccine will protect against However, in Michigan during 2003, the the same strains of virus. In 1999, Grigorescu became the MCH sentinel surveillance system was active epidemiologist/Healthy Start (HRSA Worldwide virologic surveillance results from mid-May through September for funded) evaluator at the Louisville/ covering May to September of 2003 (1) the first time, with about 10 sentinel Jefferson County Health Department, showed H3N2 subtypes of influenza sites providing data. As expected, only KY. She was the team leader of the A predominating, with about 70% of low levels of influenza-like illness were Data Use Institute (DUI) and Perinatal the 254 H3N2 isolates tested matching detected. Summer surveillance should Periods of Risk Practice Collaborative the vaccine strain well. All of the 91 increase our ability to detect unusual (PPOR-PC) teams. As a consequence, H1 isolates tested matched the vaccine influenza activity and may provide early she was able to develop a strong strain well. Half of the 4 influenza warning of a pandemic. Recruitment collaboration with different community B strains tested matched the vaccine of additional sentinel sites is ongoing; partners and thus to implement both strain well. Although this indicates that interested clinicians may contact Kyle PPOR and Fetal and Infant Mortality H3N2 subtypes might also predominate Enger at 517-335-8159 for more (FIMR) project as a two-step process of this winter in the U.S., neither the information. analyzing the fetal and infant mortality predominant subtype nor the severity in Louisville/Jefferson County, KY. She Influenza vaccine is the key means of the 2003-04 influenza season can be was the local CityMatCH representative available to limit influenza morbidity predicted with certainty. The best way and she worked in collaboration with the and mortality. About 85.5 million doses to be prepared is to get vaccinated in Kentucky Chapter of March of Dimes of inactivated influenza vaccine will be October or November. (MOD) as well as the MCH public available nationwide for the 2003-04 References: heath professionals at the State level, influenza season (2). According to the being involved in different activities (i.e. CDC, this quantity is sufficient for 1. CDC. Update: Influenza Activity -- - United States and Worldwide, May-- State Child Fatality Review Committee, everyone who wants vaccine to receive State MCH Conference). Grigorescu also September 2003. MMWR 2003; 52: it as early as October (2). Influenza 911-913. continued to work with the University of vaccination is particularly important for Louisville and as a result she developed persons aged 6-23 months or 50+ years, 2. CDC. Press Release: Influenza Vaccine the MCH epidemiology internship in persons with certain medical conditions, Supply Expected to Meet Demand. Aug. collaboration with the School of Public women in the 2nd or 3rd trimester of 25, 2003. http://www.cdc.gov/od/oc/ media/pressrel/r030825b.htm Health faculty. pregnancy, and persons (such as health care workers) who care for individuals 3. CDC. Prevention and Control of at increased risk for influenza-related Influenza: Recommendations of the complications (3). Although vaccination Advisory Committee on Immunization is most useful in October or November, Practices (ACIP). MMWR 2002; it may continue throughout the 51(RR-3): 1-32. influenza season until supplies are 4. Harper, SA, et al. Using Live, Attenuated exhausted (3). Influenza Vaccine for Prevention and Control of Influenza. MMWR 2003; This year, a newly approved live 52[RR-13): 1-8. attenuated influenza vaccine is also available. Its trademark is FluMist 5. CDC. Update: Influenza Activity --- and it is administered as a nasal spray. United States and Worldwide, 2002--03 Season, and Composition of the 2003-- However, it is only approved for use in 04 Influenza Vaccine. MMWR 2003; 52: healthy persons aged 5 to 49 years, who 516-521. Page 8 New Grants The SARS Response in Michigan, 2003

he Infectious Disease By: Kyle Enger, M.P.H. Epidemiology section, o confirmed cases of SARS //www.cdc.gov/ncidod/sars/) and the T along with Detroit Health were found in Michigan WHO (http://www.who.int/csr/sars/ Department, has been awarded a grant during the SARS epidemic en/). to determine if the new Quantiferon N in the spring of 2003. However, References: blood test is equivalent to the tuberculin the Communicable Diseases and skin test for detection of TB infection Immunization Division responded 1. WHO. Summary of probable or disease. Michigan will enter into vigorously, communicating with local SARS cases with onset of illness a consortium with five other states to health departments (LHDs), devising from 1 November 2002 to 31 July conduct this research and CDC will and disseminating a screening tool, 2003. September 26, 2003. http: provide equipment, training, and dollars collecting data regarding cases under //www.who.int/csr/sars/country/ for enrollment incentives. investigation, and fielding calls from table2003_09_23/en/ The Bloodborne Pathogens and STD health care professionals, the media, and Epidemiology Section has received the public. Shelley Stonecipher headed Recent Publications $114,945 in funding from CDC for our SARS response, with assistance continuation of the OASIS project. from Kyle Enger, Sally Bidol, Joyce Lai, ealer, L., Marfin, A., Petersen, The OASIS project conducts enhanced Gillian Stoltman, Melinda Wilkins, and L., Lanciotti, R., Page, P., surveillance for gonorrhea, which will aid Matthew Boulton. The Virology Section Stramer, S., Stobierski, M.G., of the Bureau of Laboratories also P in characterization of the population in Signs, K., Newman, B., Kapoor, H., terms of demographics, risk factors, and assisted in the response. Goodman, J., and M. Chamberland. Transmission of West Nile Virus co-morbidities. From March through July, the Division Through Blood Transfusion in the coordinated with the LHDs to The Michigan Cancer Surveillance United States in 2002. investigate 68 Michigan residents who The New Program, in the Epi Services Division, 2003; were potential SARS cases. Three of England Journal of Medicine has received funding through the 349(13): 1236-1245. National Cancer Institute to bring these residents were classified as suspect a closer collaboration between the cases; however, they were later excluded Stanbury, M., Reilly, M., and state cancer registry and the Detroit based on laboratory evidence. A fourth K. Rosenman. Work Related Metropolitan SEER registry. This will suspect case was identified in Michigan Amputations in Michigan, 1997. include work related to data collection but resided in another state; however, American Jourinal of Industrial and data quality as well as collaborative that case was later excluded as well. Medicine. 2003; 44: 359-367. research projects. This funding is for just No probable or confirmed cases were under one million dollars for a seven year identified in Michigan. Goodwin, S., Stanbury, M., Wang, funding cycle. M., Silbergeld, E., and J. Parker. The World Health Organization Previously undetected silicosis in New The Bloodborne Pathogens and STD (WHO) issued a global health alert and Jersey decendants. American Journal Epidemiology section in the Division travel advisory on March 15, including of Industrial Medicine. 2003; 44: of Communicable Disease and reports of cases in Toronto, Canada. On 304-311. Immunization has received two grants. June 12, the last probable SARS case The section was awarded $303,972 to in Toronto was identified. There have Berger, K., Zhu, B.P., and G. continue the STARHS project, which been 251 probable cases in Canada, 43 Copeland. Mortality Through Early will develop incidence reporting of (17%) of whom died (1). One hundred Childhood for Michigan Children HIV through new laboratory methods. and nine (43%) of the Toronto cases Born with Congenital Anomalies, This funding will also provide ongoing were health care workers (1). On June 1992-1998. Birth Defects Research financial support for antiretroviral drug 15, the last probable case in the world (Part A). 2003; 67: 656-661. resistance surveillance. Also, the section was identified in Taiwan, and on July 5, the WHO announced that transmission Wilkins, M., Boulton, M., was awarded $130,699 for behavioral Stoltman, G., Bidol, S., Enger, K., surveillance for HIV. of SARS had ceased worldwide. Surveillance is continuing in order to Lai, J., Uyeki, T., Harper, S., Fischer, rapidly identify potential cases of SARS. M., Reagan, S., Jones, J., Terebuh, In Michigan, the Division is identifying P., and S. Stonecipher. Severe ways to improve our SARS response Morbidity and Mortality Associated should it return in the future. with Influenza in Children and Young Adults — Michigan, 2003. Centers Valuable resources regarding SARS for Disease Control MMWR 2003: are available from the CDC (http: 52(35): 837-840.

Page 9 Dr. Henry Falk Visits MDCH

DCH was honored by the cooperative agreement to conduct public relationship with MDCH in the health visit of a very prominent health assessments with ATSDR since assessment process and welcomed M public health leader in 1988 and agreed to take the lead on this dialogue with the community and the August. Dr. Henry Falk, the Assistant assessment. stakeholders. Administrator of the federal Agency for Toxic Substances and Disease Registry Dr. Falk and several ATSDR and NCEH Dr. Flak and his colleagues were given (ATSDR) in Atlanta and newly (in staff members flew into Lansing on a tour of the floodplain on both sides August) appointed head of the federal August 20th and met briefly over with of the Tittabawassee River with stops National Center for Environmental Epidemiology Bureau Director Dr. Matt in public parks where MDEQ has Health (NCEH) came to Michigan to Boulton, Division of Environmental detected levels of dioxin in surface soil discuss two prominent sites of dioxin and Occupational Epidemiology above its 90 parts per trillion direct contamination in our state. Director Dr. David Wade, Toxicology contact criteria. Following the tour, and Response Section Manager Linda the group participated in a working Dr. Falk has taken a particular interest in Dykema and staff from the Toxicology lunch with Dow at its corporate the Petitioned Health Assessment request and Response section. Dr. Falk and headquarters in Midland. Dr. Falk was ATSDR received from several Michigan his colleagues from ATSDR met with asked about health assessment project residents. ATSDR was created under MDCH Director Olszewski, upper level components such the exposure study the federal Superfund legislation and is Michigan Department of Environmental under development and the likely charged with conducting public health Quality (MDEQ) management, and epidemiological health study that would assessments at sites of environmental representatives of the Governor office follow. The group also had a tour of the contamination. Under this legislation, before departing to Midland. Dow plant facility before departing for private citizens can petition the ATSDR Atlanta. to consider whether a health assessment In Midland Dr. Falk met with citizens should be conducted at a site of public and environmental activists who Dr. Falk’s visit to Michigan coveys a concern. The presence of dioxin and composed and submitted the petition message to citizens and colleague alike other dioxin-like chemicals in the soils of to ATSDR. The group also attended a that the Midland and floodplain dioxin the city of Midland and in the floodplain public meeting in Freeland sponsored contamination are important public of the Tittabawassee River between by MDCH and featuring presentations health issues in which he has taken Midland and Saginaw was the focus by Dr. Falk and Dr. Suzanne White, a priority interest. His openness and of a 2001 petition to ATSDR. After Executive Director of the Poison Control accessibility impressed all who met with considering the available information, Center at Children’s Hospital in Detroit. him. MDCH staff involved with the ATSDR decided that the Midland and Dr. White was representing the newly public health assessment for these areas is floodplain dioxin contamination met formed American College of Medical grateful for the interest and support that the criteria the agency uses to determine Toxicologists. Her presentation centered Dr. Falk continues to provide. if a public health assessment should on the toxicity and health effects of be conducted. MDCH has had a dioxin. Dr. Falk’s explained ATSDR’s

New EIS Officer Arrives at MDCH

Darline K. El Reda, Dr.P.H., M.P.H., investigations, then as an HIV program epidemics in Michigan and elsewhere in began her Epidemic Intelligence Service evaluator and Epidemiology Teaching the United States. Her first project will (EIS) Fellowship through The Centers Assistant at the University of Texas- be to evaluate Michigan’s Early Hearing for Disease Control and Prevention Houston. More recently, Dr. El Reda was Detection and Intervention Surveillance (CDC) this summer and will be a Senior Epidemiologist at the City of System. Dr. El Reda received her B.S. spending two years at the Bureau of Houston Health Department working from Syracuse University, her M.P.H. Epidemiology. She comes to Michigan on the management of STD and HIV from California State University-Long after years of working in the field of grants for the Bureau of Epidemiology. Beach (‘98), and her Dr.P.H. from the sexually transmitted diseases. First, as a During her EIS fellowship, Dr. El Reda University of Texas Houston Health Disease Intervention Specialist for the will focus her research on maternal and Science Center School of Public Health City of Long Beach Health Department child health issues in Michigan and assist (‘02). conducting contact tracing and outbreak in investigations of disease outbreaks/ Page 10 New Employees

Brenda Brennan, M.S.P.H., the University of Michigan. Previously, education and a Post-Baccalaureate Legal recently joined the Infectious Disease he worked as a Research Assistant Assistant Certificate and an Associate of Epidemiology Section as one of the new in the Department of Microbiology Arts degree from LCC. Communicable Disease Epidemiologists. and Immunology at the University of She received her undergraduate degree Michigan. Cassandre Celeste Larrieux, M.P.H., in microbiology from Michigan State is a new Maternal and Child Health University. After graduation, she worked Michael Hass, M.S., is the new Epidemiologist in the Epidemiology as a researcher at the Karmanos Cancer Geographic Information System Services Division responsible for the Institute and later at Pfizer Global (GIS) Specialist in the Surveillance Pregnancy Risk Assessment Monitoring Research and Development. Brennan Section. Hass attended the University System (PRAMS) and the Supplemental received a M.S.P.H. in Tropical Public of Massachusetts and Humboldt State Food Program for Women, Infants, and Health and Communicable Diseases University (CA) where he received Children (WIC) programs data analysis. from the University of South Florida. an M.S. in GIS and natural resources planning. He comes to MDCH from the She received her bachelor’s degree in While obtaining her degree, she worked chemistry/molecular biology and a at the Florida Department of Health Michigan State University Extension and Branch County GIS where he completed M.P.H. at Florida A&M University. as a virologist conducting arboserology She also worked as a chemist technician testing. numerous spatial database and analysis projects for multiple governmental for the Florida Dept. of Environmental Kim Kutzko, M.P.H., is the new partners, including Branch, Hillsdale, Protection. She has participated in a Regional Epidemiologist for Region and St. Joseph county local health variety of public health projects such 5 (based in Kalamazoo). She attended departments. as: developing a surveillance report the University of Iowa and received on the prevalence of diabetes and its a B.A. in psychology and attended Elizabeth Grant, M.H.S, is the new complications in Florida’s Hispanic the University of Michigan School of Regional Epidemiologist for Region population for 1990-99 as well as Public Health and received a M.P.H. in 6 and is based in Grand Rapids. She analyzing data for Florida’s Behavioral epidemiology. Previously, she worked as received a B.S. with honors in medical Risk Factor Surveillance System a Research Associate in the Department microbiology and immunology from (BRFSS). the University of Wisconsin - Madison of Epidemiology at the University of Michael Paustian, M.S., is a Michigan and as the Assessment and in 2000. She received a M.H.S. from Johns Hopkins Bloomberg new Maternal and Child Health Evaluation Specialist at the Kalamazoo Epidemiologist in the Epidemiology County Human Services Department. School of Public Health in infectious disease epidemiology in 2003. Prior Services Division responsible for the Paul Moffat, M.P.H., M.P.A., is a new to attending graduate school, Grant CSHCN and oral health surveillance CDC Public Health Advisor for the worked as a laboratory scientist at the data analysis. He received his B.S. in Immunization Program. For eight years, University of Wisconsin Biotechnology genetics from Iowa State University Moffat has worked for the Maine, New Center. During graduate school, Grant in 1999 and his M.S. degree in York and Ohio Immunization Programs. worked for a year with the Center epidemiology from the University of He started his career performing for Immunization at the Maryland Iowa in 2003. As a graduate research STD/HIV surveillance and disease Department of Health and Mental assistant his work included a study intervention techniques in Chicago Hygiene. on the contribution of environmental and southern California, and has also exposures, particularly arsenic exposure, managed the New Orleans, Louisiana Shelly Shinevar is the new Secretary to melanoma. He also worked on a study TB control program. Recently, he has for the Surveillance Systems Section. of the preventive aspects of selenium worked in short term assignments She has worked for MDCH since intake with regard to prostate cancer. both as the Deputy Director of January 2001 in multiple areas, He has designed and presented an Guyana’s Global AIDS Program and including Legislative Support, Analysis evaluation study on the implementation as a Technical Officer for the World & Policy Development/Certificate of motivational interviewing into Health Organization in Kishoreganz, of Need/Cardiovascular Health, and substance-abuse counseling. Bangladesh. Nutrition & Physical Activity. She has also worked as a dance director, Kory Groetsch, M.S., is the new Scott Schreiber, M.P.H., is the new teacher, and choreographer at Lansing Health Assessor/Education Coordinator Region 8 Epidemiologist for the Upper Community College (LCC), Michigan with the site assessment team in the Peninsula based in Marquette. He State University and at various dance Toxicology and Response Section received his B.S. in zoology at Michigan studios and recreation programs. She has (Division of Environmental and State University and his M.P.H. in a B.S. degree from Western Michigan Occupational Epidemiology). He has hospital and molecular epidemiology at University in english and dance more than seven years experience in Continued on page 12 Page 11 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH PRSRT STD COMMUNITY PUBLIC HEALTH ADMINISTRATION U.S. Postage BUREAU OF EPIDEMIOLOGY PAID 3423 NORTH MARTIN LUTHER KING, JR. BLVD. Lansing, MI P.O. BOX 30195 Permit No. 1200 LANSING, MICHIGAN 48909 Address Correction Requested

“New Employees” continued from page 11 the field of environmental toxicology Epidemiology. Dr. Vasiliu is a native of Paul Kramer, is a new employee in the and chemistry and currently is the Romania, where she received her medical Vital Records and Health Data Section. immediate past president of the Midwest degree; she recently received her M.S. Kramer has a degree in economics from Chapter of the Society of Environmental in epidemiology from MSU. She is the Trinity College and a degree in computer Toxicology and Chemistry. Groetsch has Project Manager for the Michigan PBB science from Wayne State. He previously worked as an environmental scientist Cohort Endocrine Disruption study that worked at Voices of Detroit as a data for the Lake Superior Chippewa Indians is a collaboration of MDCH with MPHI coordinator. He was also awarded the studying contaminant concentrations and Dr. Michele Marcus of the Rollins Spirit of Detroit Award by the Detroit in traditional native foods and issues of School of Public Health at Emory City Council last May for his work chemical exposure to tribal members. University. The study seeks to examine there. Kramer will be working on the Groetsch has a M.S. from Miami the impact of PBB exposure, as measured expansion of a new hearing screening University (Ohio). by serum levels, upon a number of reporting module in hospitals to ease the hormonally influenced conditions and burden of reporting and processing of Oana Vasiliu, M.D., M.S., is a new life events in cohort members and their newborn hearing screen results. Epidemiologist with the Division of offspring. Environmental and Occupational

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