Florida Department of Health - Hillsborough County Disease Surveillance Newsletter EpiNotes April 2018 Director Douglas Holt, MD 813.307.8008 Medical Director (HIV/STD/EPI) Articles and Attachments Included This Month Charurut Somboonwit, MD 813.307.8008 Health Advisories and Alerts 1 Medical Director (TB/Refugee) Beata Casanas, MD Florida Food Recalls 2 813.307.8008 Vaccine Preventable Disease Update 2 Medical Director (Vaccine Outreach) Arboviral Testing Fact Sheet 3 Jamie P. Morano, MD, MPH Seasonal Influenza Update 4 813.307.8008 Reportable Disease Surveillance Data 5 Community Health Director Seasonal Arboviral Update 8 Leslene Gordon, PhD, RD, LD/N Reportable Diseases/Conditions in Florida, Practitioner List 15 813.307.8015 x7107 FDOH, Practitioner Disease Report Form 16 Disease Control Director Carlos Mercado, MBA 813.307.8015 x6321 Environmental Administrator Health Advisories and Alerts Brian Miller, RS 813.307.8015 x5901 FDA Update on Ongoing Investigation into Lead Epidemiology Michael Wiese, MPH, CPH Testing Issues 813.307.8010 Fax 813.276.2981 TO REPORT A DISEASE: Multistate Outbreak of E. coli O157:H7 Infections Epidemiology Linked to Chopped Romaine Lettuce: Information 813.307.8010 collected to date indicates that romaine lettuce from the After Hours Emergency Yuma, Arizona growing region could be contaminated with 813.307.8000 E. coli O157:H7 and could make people sick. At this time, no common grower, supplier, distributor, or brand has Food and Waterborne Illness Patrick Rodriguez been identified. Unless you can confirm the romaine 813.307.8015 x5944 Fax 813.272.7242 lettuce you have is not from the Yuma, AZ region, do not consume it. HIV/AIDS Surveillance Erica Botting 813.307.8011 Outbreak Alert: Potential Life-Threatening Vitamin K- Lead Poisoning Dependent Antagonist Coagulopathy Associated With Cynthia O. Keeton Synthetic Cannabinoids Use 813.307.8015 x7108 Fax 813.272.6915 Sexually Transmitted Disease CDC Travel Notices: Sophia Hector Malaria and Yellow Fever in Brazil 813.307.8045 Fax 813.307.8027 Listeriosis in South Africa Tuberculosis Lassa Fever in Nigeria 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 April 2018 Florida Food Recalls (March 24 – April 24) Date of Link to Brand Names Food Health Risk Recall Recall NutriZone, LLC of Expanded recall of various Kratom dietary 4/18/2018 Salmonella Details Houston supplements Triangle Pharmanaturals Recalling all kratom (mitragyna speciosa) 4/17/2018 Salmonella Details LLC powder products since April 4, 2017 Boost Me Mighty Meaty Beef Topper Meal TruPet, LLC 4/17/2018 Salmonella Details Enhancer Viable Solutions, LLC Kratom-containing powder products 4/17/2018 Salmonella Details Carnivore Meat Company Limited batches of "Vital Essentials" pet food 4/16/2018 Salmonella Details Cal-Maine Foods, Inc. Shell Eggs 4/16/2018 Salmonella Details Vitakraft Sun Seed Sunseed Vita Prima Sugar Glider Food 4/14/2018 Salmonella Details Rose Acre Farms Shell Eggs 4/13/2018 Salmonella Details Bob's Red Mill Natural 2,099 cases of Organic Amaranth Flour (22 4/6/2018 Salmonella Details Foods oz.) Club 13 of St. Augustine, Kratom Maeng Da Red Powder and Capsules 4/5/2018 Salmonella Details FL Triangle Pharmanaturals All food products containing powdered kratom 4/3/2018 Salmonella Details LLC NutriZone, LLC of Multiple Dietary Supplements 3/30/2018 Salmonella Details Houston Arrow Reliance Inc. & Darwin’s Natural Pet Darwin’s Brand Dog Foods 3/26/2018 Salmonella/STEC Details Products Blue Ridge Beef BRB Complete Raw Pet Food Lot#GA0131 3/26/2018 Salmonella/Listeria Details Vaccine Preventable Disease Update In Hillsborough County, cases of varicella (chickenpox) and pertussis (whooping cough) increased slightly from February to March, but remain well within levels seen during previous years. No confirmed or probable cases of mumps have been reported in 2018 in Hillsborough County. Statewide data for vaccine preventable diseases is compiled into a monthly surveillance report, available online here. 2 EpiNotes April 2018 Arboviral Testing Fact Sheet For most arboviruses, PCR testing on serum (or CSF if applicable) is confirmatory and most useful during the first 5-8 days of illness. A negative PCR result more than 5 days from For Questions or Reporting: symptom onset does not rule out the possibility of infection. DOH-Hillsborough There may be serologic cross-reactivity between viruses of the Epidemiology Program same genus. For instance, antibody testing for West Nile virus Office: 813.307.8010 (WNV) may cross react with St. Louis encephalitis (SLE), Fax: 813.276.2981 dengue, or Zika. Depending on clinical presentation, antibody testing should be ordered for all arboviruses circulating where the patient was exposed to compare results. Suspected Cases of Endemic Arboviruses: Suspected Cases of Imported Arboviruses: (West Nile Virus, St. Louis Encephalitis, (Zika, Dengue, Chikungunya) Eastern Equine Encephalitis) Reportable upon suspicion (laboratory test Reportable by next business day order) during business hours. Cases suspected to be acquired locally, or PCR testing is available commercially cases of yellow fever, are reportable for West Nile Virus (WNV). PCR testing is immediately upon suspicion 24/7. not commercially available for SLE or EEE as these infections are less common and Testing for Zika, dengue, and chikungunya detectable viremia is generally shorter. should be ordered concurrently since all viruses have similar symptoms and are For most arboviral infections, IgM endemic in the same locations. antibodies are generally first detectable 3- 8 days after the onset of illness and PCR testing is available commercially for persist 30-90 days (or longer). Serum dengue, chikungunya, and Zika. collected within 8 days of illness onset may not have detectable IgM and testing For most arboviral infections, IgM antibodies should be repeated on a convalescent- are generally first detectable 3-8 days after phase sample. the onset of illness and persist 30-90 days (or longer). Serum collected within 8 days of IgM antibody testing for WNV, SLE, and illness onset may not have detectable IgM EEE is available commercially for serum and testing should be repeated on a and CSF. convalescent-phase sample. A single positive IgG titer with no other IgM antibody testing for dengue, laboratory results may be indicative of chikungunya, and Zika is available past infection, and a convalescent sample commercially. There may be serologic should be collected 2-4 weeks later for cross-reactivity between Zika and dengue. titer comparison. An individual with a dengue re-infection may show elevated IgG titers but no IgM titers. IgG testing for dengue is available commercially. 3 EpiNotes April 2018 2017-2018 Seasonal Influenza Update, Hillsborough County Influenza activity in Hillsborough County has been decreasing for the last eight weeks. Influenza activity peaked in week 5, 2018. Although activity has decreased, it remains elevated above off season levels. The most important prevention measure you can take to prevent influenza infection is to receive your yearly influenza vaccine. It is not too late to receive the vaccine this year as different strains of influenza tend to circulate later in the season. You can receive the vaccine for free at the DOH-Hillsborough Immunizations Clinic while supplies last. Call (813) 307-8077 for more information. Other important ways to prevent the spread of illness include covering your cough or sneeze, frequent handwashing with soap and water, and staying home from work or school until 24 hours fever free without the use of medication. See the most recent state Florida Flu Review on our website. Figure 1. Data are from participating Urgent Care Center (UCC) and Hospital Emergency Departments (ED) in Hillsborough County. Visits are searched for key terms related to influenza-like illness (ILI), which includes report of fever and cough or sore throat. This graph is not inclusive of all influenza diagnoses and may include visits not related to influenza. 4 EpiNotes April 2018 Reportable Disease Surveillance Data Annual Totals** Year-To-Date** Disease Category 3 Year Jan-Mar Jan-Mar 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 0 0 Pertussis 41 73 45 53.00 8 13 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 5 9 CNS Diseases & Bacteremias Creutzfeldt-Jakob Disease 3 3 2 2.67 0 0 H. influenzae (Invasive Disease in children <5) 2 4 4 3.33 1 0 Listeriosis 2 0 4 2.00 0 2 Meningitis (Bacterial, Cryptococcal, Mycotic) 16 9 6 10.33 1 0 Meningococcal Disease 2 2 0 1.33 0 1 Staphylococcus aureus (VISA, VRSA) 0 0 1 0.33 0 0 S. pneumoniae (Invasive Disease in children <6) 2 3 2 2.33 0 0 Enteric Infections Campylobacteriosis 152 197 315 221.33 78 59 Cholera 0 0 0 0.00 0 0 Cryptosporidiosis 101 62 54 72.33 5 14 Cyclospora 1 1 12 4.67 0 0 Escherichia coli, Shiga toxin-producing (STEC) 16 24 15 18.33 3 18 Giardiasis 55 105 73 77.67 15 13 Hemolytic Uremic Syndrome 2 1 3 2.00 2 0 Salmonellosis 287 308 315 303.33 43 52 Shigellosis 216 76 163 151.67 35 13 Typhoid Fever 0 1 3 1.33 1 3 Viral Hepatitis Hepatitis A 5 5 10 6.67 1 6 Hepatitis B