July 2017 Volume 8, Issue 7 Points of Interest: Dengue Outbreak in Sri Lanka Zoonotic Transmission of Campylobacter Epidemiology Monthly Surveillance Report Contents Dengue Outbreak in Sri Lanka 1 Influenza Surveillance 3 Emerging Disease Surveillance - Zika 4 Gastrointestinal Illness Surveillance 5 Arboviral Surveillance 6 Outbreaks 7 Reportable Diseases Table 8 Zoonotic Transmission of Campylobacter 9 Resources 10 Florida Department of Health in Orange County Dengue Outbreak in Sri Lanka As mosquito season is under way in various parts of the world, the Florida Department of Health in Orange County (DOH-Orange) advises clinicians to consider testing travelers for arbovirus/febrile illnesses for travelers returning from endemic areas, especially Sri Lanka, as there is currently a large active dengue outbreak. In Florida, the majority of reported cases are travel associated which have been imported from dengue-endemic countries. Most people present with mild symptoms that include: fever, headache, retro-orbital pain, joint and muscle pain, and rash. Many other febrile illnesses (e.g. Zika, Chikungunya, malaria, etc.) present with the similar symptoms and it may be hard to differentiate among illnesses without laboratory evidence. Current Dengue Outbreak in Sri Lanka According to the World Health Organization (WHO), Sri Lanka has seen a 4-fold increase in dengue cases this year, compared to the same time period during 2010-2016. As of July 28, 2017, there have been 110,372 dengue cases and 301 deaths reported to the Ministry of Health, Nutrition and Indigenous Medicine (MoH) Sri Lanka for the 2017 year, with the most cases reported from June 30, 2017- July 7, 2017 in the Western province. Interestingly, DENV-2 is reportedly over 50% of current specimens which have been serotyped, but it has not been the main strain identified in individuals since 2009, which was the genotype of DENV-1. Immunity to dengue through previous infection is specific by serotype, so previous infection with DENV-1 does not provide immunity to DENV-2, DENV- 3, or DENV-4.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
July 2017
Volume 8, Issue 7
Points of Interest:
Dengue Outbreak in Sri Lanka
Zoonotic Transmission of Campylobacter
Epidemiology Monthly Surveillance Report
Contents
Dengue Outbreak
in Sri Lanka
1
Influenza
Surveillance
3
Emerging Disease
Surveillance - Zika
4
Gastrointestinal
Illness
Surveillance
5
Arboviral
Surveillance 6
Outbreaks 7
Reportable
Diseases Table
8
Zoonotic
Transmission of
Campylobacter
9
Resources 10
Florida Department of Health in Orange County
Dengue Outbreak in Sri Lanka
As mosquito season is under way in various parts of the world, the Florida Department of Health in Orange County (DOH-Orange) advises clinicians to consider testing travelers for arbovirus/febrile illnesses for travelers returning from endemic areas, especially Sri Lanka, as there is currently a large active dengue outbreak. In Florida, the majority of reported cases are travel associated which have been imported from dengue-endemic countries. Most people present with mild symptoms that include: fever, headache, retro-orbital pain, joint and muscle pain, and rash. Many other febrile illnesses (e.g. Zika, Chikungunya, malaria, etc.) present with the similar symptoms and it may be hard to differentiate among illnesses without laboratory evidence.
Current Dengue Outbreak in Sri Lanka
According to the World Health Organization (WHO), Sri Lanka has seen a 4-fold increase
in dengue cases this year, compared to the same time period during 2010-2016. As of July
28, 2017, there have been 110,372 dengue cases and 301 deaths reported to the Ministry
of Health, Nutrition and Indigenous Medicine (MoH) Sri Lanka for the 2017 year, with the
most cases reported from June 30, 2017- July 7, 2017 in the Western province.
Interestingly, DENV-2 is reportedly over 50% of current specimens which have been
serotyped, but it has not been the main strain identified in individuals since 2009, which
was the genotype of DENV-1. Immunity to dengue through previous infection is specific by
serotype, so previous infection with DENV-1 does not provide immunity to DENV-2, DENV-
3, or DENV-4.
The outbreak is concurrent with the monsoon season which brings heavy rain and flooding. With heavy rain and standing
water in urban areas, ideal mosquito (Aedes aegypti and Aedes albopictus) breeding sites are created allowing adult
mosquitos and larvae to thrive and transmit disease. The primary method of prevention has focused on eliminating
mosquito breeding sites in order to reduce the number of mosquitos present resulting in a lower number of new cases.
Residents were also encouraged to use a bed net when sleeping and practice mosquito control in and around their
home.
Geographic Distribution
Dengue is endemic in many subtropical and tropical areas of the world including Central America, South America,
Caribbean, Africa, Asia and Oceania, shown in the map below.
Prevention
All individuals traveling to endemic areas should be advised of recommended prevention methods. Clinicians should
encourage travelers to prevent dengue by avoiding mosquito bites by wearing mosquito repellent with DEET, using a
bed net when sleeping, and wearing long sleeved shirts and long pants. Patients should also be educated on the mode
of transmission and to seek medical attention if symptoms occur.
The first tetravalent dengue vaccine, Dengvaxia, was registered in Mexico in December 2015 and there are currently 5
other vaccine candidates under evaluation. The WHO recommends that countries with high burden of disease consider
introducing the vaccine into their countries. It is currently recommended for residents of endemic areas and is not
recommended for travelers.
Treatment
There is no specific treatment for dengue, so prevention is of utmost importance. Severity of symptoms will vary by patient depending on many factors including previous infection status. Symptoms can range from mild to severe, but re-infection of dengue can cause more severe symptoms including dengue hemorrhagic fever and dengue shock syndrome. Successful management of patients with dengue is attained by timely and appropriate use of supportive care by keeping the patient hydrated and using acetaminophen to control fever, avoiding aspirin and other nonsteroidal anti-inflammatory drugs because of their anticoagulant properties.
Page 2
CDC Dengue Clinical Guidance CDC Dengue Disease Information
2017 Dengue Outbreak– Sri Lanka FDOH Dengue Fever Dengue Fever World Map
Epidemiology Monthly Surveillance Report
Page 3 Epidemiology Monthly Surveillance Report
Influenza Surveillance (data from Florida Flu Review)
Florida
In weeks 27-28, Influenza and ILI activity remained low, which is typical for this time of the year.
In weeks 27-28, one outbreak of ILI was reported.
No influenza-associated pediatric deaths were reported in weeks 27-28.
Orange County
Orange County influenza activity level for weeks 27-28 has decreased.
No influenza outbreaks were investigated in Orange County in July.
Influenza Resources: Florida Department of Health Influenza
Center for Disease Control and Prevention Weekly Influenza Activity Report
Influenza-like Illness from Emergency Department Visits in Orange County, 2013 to 2017
Influenza and ILI Outbreaks by County Week 40, 2016
through Week 28, 2017
Page 4
Zika Virus Surveillance
Zika Virus Resources:
Florida Department of Health Latest Travel Notices
Orange County Mosquito Control CDC Healthcare Guidance
Centers for Disease Control and Prevention Local Health Department Contact Information
Epidemiology Monthly Surveillance Report
Clinician Guidance
Clinicians who suspect a patient has a Zika virus infection should:
1) Test for dengue and chikungunya viruses also due to similar geographic spread of diseases and clinical
presentation;
2) Contact their local county health department to report the disease upon suspicion. The local health department
will be able to provide consultation for laboratory testing recommendations. Local health department contact
information is available here.
National
CDC travel recommendations regarding Zika virus can be viewed here.
Differences in case counts can be attributed to surveillance reporting time lags between agencies.
On November 28, 2016, the first local Zika virus mosquito-borne case in Brownsville, TX was reported.
Florida
On August 1, 2017, the first case of sexually transmitted Zika infection was confirmed in Pinellas County. There are no reports of local transmission by mosquitos in Florida.
On June 2, the CDC removed the cautionary area designation for Miami-Dade County.
There are no longer travel recommendations related to Zika virus for Miami-Dade County, Florida. However, the level of risk for Zika virus transmission after a yellow area is removed remains unknown. Therefore individuals should continue to protect themselves by following CDC recommendations.
Orange County
No local transmission of Zika has been identified in Orange County.
Pregnant women (with or without exposure) can get tested for free at three Health Department locations in Orange County (Tues-Thurs 9:00AM-1:30PM).
Lila Mitchell Clinic: 5151 Raleigh St. Suite B
Southside: 6101 Lake Ellenor Dr.
Eastside: 12050 E. Colonial Dr. Building A Testing referrals will be given on a walk-in basis only.
Top 3 States Total Case Count
Florida 1143
New York 1042
California 454
Laboratory-confirmed symptomatic Zika virus
disease cases (2015-2017)
Travel-Related Zika Cases in FL by County
County Case Count
2016 Case Count
2017
Miami-Dade 350 37
Broward 182 17
Orange 167 12
Palm Beach 65 4
Hillsborough 46 4
Osceola 38 0
Polk 31 2
Seminole 28 2
Collier 28 4
Pinellas 25 2
Brevard 17 0
As of August 2, 2017
As of August 4, 2017
Page 5 Epidemiology Monthly Surveillance Report
Gastrointestinal Illness Surveillance
Enteric reportable disease cases remain within seasonally expected levels.
2 GI illness outbreaks were reported to Orange County during July.
In July, there were 15 foodborne illness complaints reported to Orange County.
Gastrointestinal Illness Resources:
Florida Online Foodborne Illness Complaint Form - Public Use Florida Food and Waterborne Disease Program Florida Food Recall Searchable Database Florida Department of Health - Norovirus Resources CDC: A-Z Index for Foodborne Illness CDC: Healthy Water
Select Reportable Enteric Diseases in Orange County, Florida, July 2016 to July 2017
Gastrointestinal Illness Points of Interest:
Arboviral Surveillance
Weekly Florida Arboviral Activity Report (Released on Mondays) Orange County Mosquito Control
Arboviral Resources:
Florida Department of Health Mosquito-Borne and Other Insect-Borne Diseases
Information
Florida Department of Health Mosquito-Borne Disease Education Materials
Florida
Additional Resources:
Four travel-associated cases of dengue have been
reported in 2017. One travel-associated case of
chikungunya was reported in 2017. No human cases of
West Nile virus (WNV) have been reported.
No counties are currently under a mosquito-borne illness
advisory or alert.
The best method of prevention is to avoid mosquito bites and to reduce mosquito breeding sites.
National
There is a CDC Level 2 (Alert) Travel Health Notice for Brownsville, TX.
International
There is a CDC Level 2 (Alert) Travel Health Notice for
multiple countries in the Caribbean, Central and South
America, Mexico, Cape Verde, Southeast Asia, and
Pacific Islands related to Zika and poor pregnancy
outcomes.
There is a CDC Level 2 Travel Health Notice for Brazil
related to the transmission of Yellow Fever virus.
There is a CDC Level 1 (Watch) Travel Health Notice for
multiple countries in the Caribbean, Central and South
America, and Mexico, related to the transmission of
chikungunya virus.
Page 6 Epidemiology Monthly Surveillance Report
Orange County
No locally acquired cases of Zika virus, West Nile virus, dengue virus, chikungunya virus, St. Louis encephalitis virus, or Eastern
equine encephalitis virus have been identified in Orange County in 2017.
Three travel-related cases of Zika virus were reported in July 2017. In total, there are 12 travel-related cases of Zika virus in
2017.
Outbreaks in Orange County, FL
*** All Data are Preliminary ***
In July 2017, there were 2 Gastrointestinal Illness outbreaks reported to Orange
County.
One was associated with exposure to a pet store chain.
One occurred in a daycare.
There was one outbreak of Legionnaires’ disease associated with a skilled nursing
facility.
There was one suspected streptococcal pharyngitis outbreak in a daycare.
A VIM-producing Pseudomonas outbreak occurred in a Long Term Acute Care
Hospital.
Page 7 Epidemiology Monthly Surveillance Report
Number of Outbreaks Reported in Orange County, FL, by Month from 2013 - 2017
Page 8 Epidemiology Monthly Surveillance Report
*** All Data are Preliminary ***
ORANGE All Counties
Disease July Cumulative
(YTD) July
Cumulative (YTD)
2017 Median
5YR 2017
Median 5YR
2017 Median
5YR 2017
Median 5YR
Campylobacteriosis 22 16 118 76 453 335 2648 1875
Carbon Monoxide Poisoning 4 0 10 3 20 17 131 107
Creutzfeldt-Jakob Disease (CJD) 0 0 1 0 1 1 13 14
Cryptosporidiosis 4 7 14 14 48 56 247 271
Cyclosporiasis 1 1 2 1 27 21 51 25
Escherichia coli: Shiga Toxin-Producing (STEC) Infection 3 2 16 11 80 53 406 281
Giardiasis: Acute 6 7 27 36 91 99 634 611
Haemophilus influenzae Invasive Disease 0 1 10 8 26 14 183 188
Hemolytic Uremic Syndrome (HUS) 0 0 1 0 0 1 8 4
Hepatitis A 0 0 7 2 26 12 164 74
Hepatitis B: Acute 4 1 21 8 72 32 443 229
Hepatitis B: Chronic 32 32 273 239 412 396 3260 2770
Hepatitis B: Surface Antigen in Pregnant Women 6 6 41 40 42 52 281 295
Hepatitis C: Acute 2 1 12 3 37 19 207 122
Hepatitis C: Chronic 109 123 871 860 2150 2448 15456 17286
Hepatitis C: Perinatal 0 0 0 0 0 0 7 0
Influenza-Associated Pediatric Mortality 0 0 1 0 0 0 12 3
Lead Poisoning 1 1 13 14 77 80 709 491
Legionellosis 3 2 25 9 50 32 281 178
Listeriosis 0 0 2 1 6 5 31 21
Lyme Disease 1 0 6 1 41 32 190 82
Malaria 0 1 2 4 14 7 36 40
Measles (Rubeola) 0 0 1 0 0 0 4 5
Meningitis: Bacterial or Mycotic 0 0 1 2 10 14 67 89
Meningococcal Disease 1 0 1 0 3 2 16 30
Mercury Poisoning 0 0 1 0 2 1 23 9
Mumps 0 0 1 0 12 1 46 13
Neurotoxic Shellfish Poisoning 0 0 2 0 0 0 2 0
Pertussis 1 3 20 19 48 77 250 344
Q Fever: Acute (Coxiella burnetii) 0 0 1 0 0 0 2 1
Rabies: Possible Exposure 3 5 44 53 263 299 1912 1736
Salmonellosis 38 31 163 141 662 724 3081 2940
Shigellosis 9 6 59 49 157 172 753 1203
Strep pneumoniae Invasive Disease: Drug-Resistant 2 0 13 16 12 14 163 297
Strep pneumoniae Invasive Disease: Drug-Susceptible 1 1 14 15 23 27 241 335
Typhoid Fever (Salmonella Serotype Typhi) 1 0 2 0 4 1 30 7
Varicella (Chickenpox) 2 2 37 11 52 36 416 460
Vibriosis (Other Vibrio Species) 1 0 1 0 8 2 37 6
Vibriosis (Vibrio alginolyticus) 1 0 4 2 10 8 45 36
Vibriosis (Vibrio vulnificus) 0 0 1 0 9 6 17 15
Zika Virus Disease and Infection- Non-Congenital 0 0 17 0 14 0 172 0
Total 258 249 1856 1638 4962 5096 32675 32493
Florida Department of Health: Since 2007, the Florida Department of Health has
operated the Electronic Surveillance System for the
Early Notification of Community-based Epidemics
(ESSENCE-FL), a state-wide electronic bio-
surveillance system. The initial scope of ESSENCE
was to aid in rapidly detecting adverse health events
in the community based on Emergency Department
(ED) chief complaints. In the following years,
ESSENCE capabilities have continually evolved to
currently allow for rapid data analysis, mapping, and
visualization across several data sources, including
ED record data, Merlin reportable disease data,
Florida Poison Information Network consultations,
and Florida Office of Vital Statistics death records.
The majority of the information presented in this
report comes via ESSENCE. Florida currently has
228 emergency departments and 35 urgent care
centers reporting to ESSENCE-FL for a total of 263
facilities.
Epidemiology Monthly Surveillance Report
Hospital linked to ESSENCE
Florida Hospital Centra Care Clinic linked to ESSENCE
Other Disease Resources
In the structure of DOH-Orange, tuberculosis, sexually transmitted infections,
and human immunodeficiency virus are housed in separate programs from the
Epidemiology Program. We recognize the importance of these diseases for our
community partners and for your convenience have provided links for
surveillance information on these diseases in Florida and Area 7 HIV & AIDS
Program (Brevard, Orange, Osceola, and Seminole Counties).
Page 9
Zoonotic Transmission of Campylobacter
While Campylobacter gastroenteritis is commonly associated with foodborne transmission such as
consuming raw or undercooked poultry, zoonotic transmission has also been implicated and should be
considered during patient interviews. In the US, 14 cases of campylobacteriosis per 100,000 persons are
diagnosed each year, making it one of the most common causes of diarrheal illness.
Symptomatic and asymptomatic animals such as puppies, kittens, and birds are natural carriers of Campylobacter, and therefore shed the bacteria in their stool. In humans, infection with Campylobacter bacteria may cause diarrhea which is often bloody, and vomiting, abdominal pain, and fever. Those at a greater risk for developing illness include children, older adults, and immunosuppressed individuals. Vigilant hand washing after contact with animals or animal feces is recommended to prevent illness.
Resources: https://www.cdc.gov/foodsafety/diseases/campylobacter/index.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197190/
The Epidemiology Program conducts disease surveillance and investigates, controls, and prevents
infectious diseases and conditions that are reported to DOH-Orange.
Surveillance is primarily conducted through passive reporting from the medical community as
required by Chapter 381, Florida Statutes.
Data are collected and analyzed to track disease trend, and identify outbreaks and unusual
occurrences for response and mitigation, to identify targets for prevention and reduction efforts.
In cooperation with the Office of Emergency Operations, the Epidemiology Program conducts
syndromic and influenza-like-illness surveillance activities. Syndromic surveillance was added to the
disease reporting process as an active method of determining activities in the community that could
be early indicators of outbreaks and bioterrorism.
Our staff ensure that action is taken to prevent infectious disease outbreaks from occurring in
Orange County communities and area attractions. Along with many public and private health
groups, we work for the prevention of chronic and long-term diseases in Central Florida.
Epidemiology Program
6101 Lake Ellenor Drive
Orlando, Florida 32809
Phone: 407-858-1420
Fax: 407-858-5517
http://orange.floridahealth.gov/
F l or i da D e p ar t m e nt o f H e a l th i n Or a n g e Co u n t y
ALL DATA ARE PROVISIONAL
Issue Contributors
Alvina Chu, MHS
Epidemiology Program Manager
Taylor Campion, MPH Epidemiologist
Kathy Abusager, MPH
Epidemiologist
Ashley Vineyard, MPH Epidemiologist
Sign up for
Electronic Health Alerts & Epidemiology
Monthly Surveillance Reports
Email Contact Information to:
Page 10 Epidemiology Monthly Surveillance Report
Related Documents
