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2001 Monthly Epidemiology Reports


Erie County Health Department (ECHD)

(Provided with the permission of the ECHD)


January 2001

Update on Influenza 2000-1 Activity

The first case of Influenza A was confirmed by ECMC Virology Laboratory from a specimen collected on 1/16/01, from a 46 year old male from Depew, NY. The first Case of Influenza B was confirmed by Children's Hospital Virology Laboratory from a specimen collected on 1/10/01, from a 16 year old male from Buffalo, NY. The ECHD Active Surveillance Program has noted a significant increase within Erie County in the number of persons with flu-like illness starting in Mid-January. The Centers for Disease Control and Prevention reported that 6% of the 26,789 flu specimens have been found to be positive for influenza. Seventy-three percent of those were confirmed as Influenza A and 27% were confirmed as Influenza B.

Update on Rabies in Animals in Erie County

During January 2001, there were three reports of confirmed rabies within Erie County. Two were raccoons and one was a cat. Considering the weather during January this was unexpected activity. I would like to remind the Health Care Providers that "Animal bites for which rabies prophylaxis is given" is a reportable condition in New York State. Reports should be phoned into Disease Control at 858-7698, or after hours 898-4225 (MERS).

During January 2001, there were 25 reports of food related illness. One was referred to Monroe County. Two others were sent to NYS Agriculture and Markets for further investigation. Eight others were sent to ECHD Environmental Health for on-site food illness visits .


February 2001

Update on Influenza 2000-1 Activity

The Centers for Disease Control and Prevention has released a statement claiming that to date the 2000-1 Flu Season has been the lightest in recent memory for contagion, death and other effects on health. The pattern of influenza spread was different from previous years, in that, isolations jumped around the nation erratically, instead of following the normal movement. The "flu season" will continue in Western New York until mid May.

There is still an ample supply of 2000-1 Influenza Vaccine for the private medical providers from NYSDOH at no charge. The recommendation is to continue immunizing through the end of March and beyond. If you wish to obtain the multi-dose vials call Mr. Schwartz, ECHD Disease Control at 858-7697.

Update on West Nile Virus (WNV) Plan

The NYSDOH has drafted its WNV Plan 2001 and distributed it to the LHU's for comment. In turn ECHD has completed its WNV Plan 2001. Human surveillance will start in May and will continue through October. Dead bird and mosquito surveillance will also take place simultaneously. A meeting of the directors from the hospital laboratories is scheduled for March 19, 2001 to discuss an efficient way of monitoring for suspect human cases of Encephalitis or Viral (Aseptic) Meningitis.

During February 2001, there were 16 reports of food related illness in Erie County. Six were referred to ECHD Environmental Health for field inspections.


March 2001

Update on West Nile Virus (WNV) Plan

The ECHD has started its "dead bird surveillance" on April 1st. As in previous years we are looking for fresh dead crows that have died due to a non-trauma condition. Persons are asked to notify the Environmental Health District Offices to give information and arrange for pick up. Human surveillance will start on May 1st. Health care providers and laboratories are asked to submit human specimens on only those persons who meet the specific WNV criteria. The ECHD Vector Laboratory is nearing completion and will be available for the regional identification of mosquitoes within the upcoming month.

During March 2001, there were 5 reports of food related illness in Erie County. Two were referred to ECHD Environmental Health for field inspections.


April 2001

Update on Influenza 2000-1 Activity

ECHD Active Surveillance for Influenza Season 2000-1 has ended the second week of May 2001. In retrospect, this has been a difficult year with the delay in vaccine supply. When the vaccine became available in Mid January, it was difficult to get the target group of persons to return to be immunized. We were fortunate that this was a mild year for influenza when compared to previous years.

Update on West Nile Virus (WNV) Plan

ECHD WNV Plan 2001, has been finalized and put into action. The dead bird surveillance started April 1st. Fresh dead crows or blue jays are to be reported to the respective environmental offices, so that they can be picked up and shipped to Wadsworth Laboratories for WNV testing. The ECHD Vector Laboratory was officially opened on 5/7/01. Mosquito larva sampling is underway. Control measures using larvacide will be in placed countywide.

Lyme Disease

A special service provided by the NYSDOH, Buffalo Regional Office, of identifying "ticks" has now ceased with the retirement of Dr. Jacques Berlin. The newly formed ECHD, Vector Lab will now provide that service for persons in Western New York at no charge. If you have a patient with a tick, he/she can be directed to the closest ECHD Environmental Health Office. They in turn, will forward the specimen to the Vector Lab for identification. Human surveillance will start in May and will continue through October 2001. Wadsworth Laboratories will have a stricter policy on acceptance of human specimens. Criteria of a suspect WNV case must be met before testing will be done. If an adequate specimen is submitted, testing will be done for WNV and -2- other arboviral agents. NYSDOH assures us that the turnaround time will be much better this year.

During April 2001, there were 22 reports of food related illness in Erie County. Eight were referred to ECHD Environmental Health for field inspections. Three of these reports involved larger gatherings with larger numbers of persons reporting illness.


May 2001

Pre-Planning for Influenza Vaccine Program 2001-2

Plans are already being discussed for the area wide Influenza immunization campaign. The ECHD is planning on increasing the number of immunizations for the county employees and the Medically Indigent Clinic clients. Mixed messages are being sent by the Centers for Disease Control and Prevention concerning the availability of influenza vaccine for 2001-2 Influenza Season. The NYSDOH had distributed a list of influenza vaccine vendors. It is advisable that the private sector get their orders placed as soon as possible. If they are experiencing a problem with their order, they may contact Disease Control at 858-7698 for a list of vendors.

Update on West Nile Virus (WNV)

According to the NYSDOH, there have been 15 dead crows confirmed as infected with WNV during April and May 2001: 1 - Westchester County 1 - New Haven , Connecticut 2 - Baltimore 11 - New Jersey ECHD currently has 49 bird submissions listed on the HIN and 3 human specimens submitted to Wadsworth Laboratories for WNV testing. All dead bird reports are being taken, but only fresh dead crows or blue jays are being submitted for testing.

ECHD Vector Laboratory

ECHD is offering Tick Identification through its newly formed vector laboratory located adjacent to the Public Health Laboratory at 462 Grider BB -122. A specimen must be accompanied by Tick Identification Request Form. Specimens 2 may be dropped off at any of the ECHD District Offices and they will be forwarded to the Vector Lab.

During May 2001, there were 18 reports of food related illness in Erie County. Five were referred to ECHD Environmental Health for field inspections. Three of these reports involved large numbers of persons resulting in the administration of questionnaires. One was referred to NYS Agriculture and Markets for further follow up. One additional complaint was referred to the NYSDOH.

The Biostatistics Unit completed 28 requests statistical data during May 2001. Nine were for outside agencies.


June 2001

Pre Planning for Influenza Vaccine Program 2001-2

Centers for Disease Control and Prevention have published the Advisory Committee on Immunization Practices (ACIP) for the Prevention and Control of Influenza in the MMWR Vol 50 / No RR -4 dated April 20, 2001. This document may be downloaded and printed via internet: www.cdc.gov. Optimal timing for starting vaccination programs will again be during October and November. The NYSDOH has provided an updated list of influenza vaccine vendors (6/18/01). It is advisable that the private sector get their orders placed as soon as possible. If they are experiencing a problem with their order, they may contact Disease Control at 858-7698 for a list of vendors.

Update on West Nile Virus (WNV)

Erie County Health Department has submitted 77 dead crows for testing since May 2001. Of these, 65 were found to be negative, 5 - not done, and 7 pending. To date, only three human blood specimens have been submitted to Wadsworth Center for Laboratory Research. All three are pending.

ECHD Vector Laboratory

ECHD is offering Tick Identification through is newly formed vector laboratory located adjacent to the Public Health Laboratory at 462 Grider BB -122. A specimen must be accompanied by Tick Identification Request Form. Forms are available at all the ECHD District Offices, or can be requested from Disease Control by calling 858-7698. Specimens and accompanying form may be dropped off at any of the ECHD District Offices.

During June 2001, there were 10 reports of food related illness in Erie County. Six were referred to ECHD Environmental Health for field inspections. One additional report was forwarded to New York State Agriculture and Markets for further investigation.


July 2001

Update on Rabies Activity

Through the end of July 2001, there have been 17 confirmed cases of rabies in animals within Erie County:

  • 2 - Cats; 9 - Raccoons; 4 - Bats, 1 - Skunk, and 1- Grey Fox

In the same timeframe 46 series of Post-Exposure Rabies were authorized for human exposure. Twenty-seven of these were for exposures to cats or dogs. Twelve were for exposure to bats. If a patient is bitten by a bat, or finds a bat in an occupied sleeping room, the bat should be kept and taken to the ECHD for rabies testing. If the bat is negative for rabies, there will be no need for post-exposure rabies series. If the incident occurs after hours or on the weekend call 898 - 4225 (Medical Emergency Relay Service (MERS) for assistance.

Update on West Nile Virus Activity

As of 8/4/01, the First 2001 Case of WNV in a human has been confirmed in a 73 year-old male from Northern Florida. Of the 160 WNV infected birds, 71 have come from Baltimore City and Baltimore County, Maryland. So far, there have been no positive crows in NYS. Erie County has submitted 111 birds to Wadsworth Laboratories for WNV Testing. One hundred and three are negative to date.

During July 2001, there were 16 reports of food related illness in Erie County. Nine were referred to ECHD Environmental Health Units for field investigations. Two additional complaints were referred to NYS Agriculture and Markets for Further investigation.


August 2001

Temporary Shortage of Meningococcal Vaccine

On August 27, 2001, CDC released a notice concerning the temporary shortage of Meningococcal Polysaccharide Vaccine (Groups A, C, Y, and W-135) . Adventis is the sole producer of the vaccine in USA, and is restricting all single dose purchases of the vaccine to three doses per month. Ten dose vials are available to health care providers.

Update on Influenza 2001 -2002 Vaccine

On August 10, 2001, the National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) state that influenza vaccine manufacturers expect that 79.1 million doses will be distributed this season. By the end of October 2001, 47.8 million doses should be available for delivery and 31.3 million doses are projected to be available in November and December.

BOTULISM ALERT

Some sheepshead fish (other common names include: croaker, thunder pumper, lake drum, grunt, bubbler, and grinder) from Lake Erie contain botulism poison. Other fish and waterfowl may be affected too. Advise patients not to eat any fish or waterfowl that act abnormally or seem sick. If dead or dying fish or waterfowl must be handled, gloves or a plastic bag should be used.

The botulism poison can cause illness and death. Symptoms of botulism usually appear 12-36 hours after ingestion but may take several days. Botulism is characterized by acute bilateral cranial nerve impairment and descending weakness or paralysis. Visual difficulty, dysphagia, and dry mouth are often the first complaints. These symptoms may extend to a symmetrical flaccid paralysis in a paradoxically alert person. Vomiting and constipation or diarrhea may be present initially. Fever is absent unless a complicating infection occurs.

For further information call:

  • State Health Department: 1-800-458-1158
  • Erie County Health Department: 716-858-6089

SYPHILIS ALERT.

This communication alerts you to the increases in infectious syphilis and other sexually transmitted diseases (STD) among men who have sex with men (MSM) in New York State.

Within the past year the frequency of STD has risen dramatically in MSM across the United States. In New York City during 1999, syphilis increased 60% to 130 cases from the 81 cases reported in 1998. Locally, in Erie County to date this year, we have recorded four cases of secondary syphilis. In 2000 we recorded one case. As has been observed elsewhere, this cluster of cases has occurred among the MSM population.

The importance of STD/HIV risk assessment and screening in MSM cannot be overemphasized. The New York State Health Department recommends the following guidelines.

STD/HIV Screening Guidelines for men who have sex with men (MSM) Summary Recommendations

These guidelines apply to both HIV-infected and HIV-negative MSM, and should be employed regardless of history of condom use.

All men who have had sex with other men in the past year:

HIV serology, if HIV-negative or if not previously tested
Syphilis serology
Pharyngeal culture for Neisseria gonorrhoeae

All men who have had receptive anal intercourse in the past year:

Rectal culture for Neisseria gonorrhoeae
Rectal culture for Chlamydia trachomatis

More frequent testing is indicated for:

MSM with anonymous or multiple partners
MSM who use crystal methamphetamine or inhaled nitrites ("poppers")
Men whose sex partners participate in these activities
MSM with symptoms of STD or HIV, regardless of when previous tests were done

Also recommend: Immunization against hepatitis A and B if unvaccinated or no history of prior infection

Also offer: Type specific serology for herpes simplex virus (HSV) infection Please address any questions regarding this matter to Cecelia Kohlmeier at 858-7687. Thank you.

During August 2001, there were 22 reports of food related illness. Nine were referred to ECHD Environmental Health for field investigations. One additional report was referred to Cattaraugus County for further investigation.


September 2001

TERRORIST ACTIVITY RESPONSE

Due to yesterday's tragic events in New York City and Washington, D.C., the CDC is on heightened alert status to monitor for any possible unusual disease patterns associated with chemical or biological terrorism. Following CDC recommendations, the Erie County Department of Health has initiated heightened epidemiologic surveillance for terrorist activity. Please be on the alert for any unusual disease pattern or occurrence, or increased numbers of illness that may be associated with a chemical or biological threat (e.g., respiratory disease with fever, gastrointestinal illness, neurological syndromes, fever with rash).

Should you suspect any such activity, please contact the office of Disease Control immediately.

Phone: (716) 858-7698
Fax: (716) 858-7964
E-mail: doh@bflo.co.erie.ny.us

Update on Rabies Activity

The ECHD Bureau of Disease Control is coordinating its annual Human Pre- Exposure Rabies Clinics. The clinics will be held at the SPCA, Ensminger Road, Tonawanda, NY on 11/7/01, 11/14/01, and 11/28/01; and at ECC South, 4041 Southwestern Blvd, Orchard Park, NY on 11/8/01, 11/15/01, and 11/29/01. As done in past years those persons requiring titers can have this service done on 11/7/01 or 11/8/01 at no cost. Persons requiring the basic series of Pre-Exposure Rabies Vaccine must pay for the full series at the time of the first immunization. To register call ECHD Disease Control at 858-6150.

Update on West Nile Virus Activity

On 9/26/01, NYSDOH Wadsworth Labs reported the first isolate of West Nile Virus in Erie County for 2001 from a crow found and submitted on 9/17/01. The preventive program will continue in Erie County through the end of October, and resume in early Spring 2002.

Update on Influenza Vaccine 2001-2

The NYSDOH has informed ECHD that although there will be an ample supply of Influenza Vaccine this year, the shipments will be received in segments throughout October, November and December. Some of the vendors that took orders for Influenza Vaccine 2001-2 are not filling the orders. If you have not been notified from you supplier, it is suggested that you contact them to see if your order has been affected. The NYSDOH has given ECHD - Disease Control a limited supply of Fluvirin Influenza Vaccine to be used as a buffer for the private medical providers until their influenza orders are received. This vaccine is to be used for high risk patients four years of age or older. Influenza Vaccine may be obtained by calling ECHD - Disease Control at 858-7698. Note: There is a 50 dose limit per health care provider.

During September 2001, there were 13 reports of illness involving food establishments. Three complaints were referred to NYS Agriculture and Markets for further investigation. Five reports were referred to ECHD Environmental Health Units.


October 2001

Update on West Nile Virus Activity

In summary, the ECHD submitted 174 dead birds to Wadsworth Lab for West Nile Virus testing. Of these, 1 was positive, 167 negative and 6 are still pending. The positive crow was submitted on 9/17/01 and reported as positive on9/26/2001. At this time, the ECHD has stopped bird submissions and will resume again in early Spring of 2002.

Update on Influenza Vaccine 2001-2

The ECHD - Disease Control has disbursed all 4,300 of the initial shipment of Influenza Vaccine received from the NYSDOH to private medical doctors for their high risk patients as reported last month. A second shipment of 1,500 doses of Influenza Vaccine from the NYSDOH has been received by the ECHD - Disease Control. This shipment is also to be used as a buffer for the private medical providers until their supply of influenza vaccine is received. Again, this vaccine is to be used for high-risk patients four years of age or older. The vaccine may be obtained by calling the ECHD - Disease Control at 858-7697. Note: There is a 50 dose limit per health care provider.

Update on Td Vaccine shortage

The shortage of adult tetanus-diphtheria toxoids (Td) in the United States is expected to continue until the end of 2001. As a result, the Centers for Disease Control and Prevention (CDC) has issued further guidance for the use of available supplies of Td in the May 25, 2001 issue of the MMWR. In this report, the CDC recommends that, "to assure vaccine availability for priority indications, all routine Td boosters in adolescents and adults should be delayed until 2002." In addition, the CDC recommends that Td use should follow existing recommendations for all other indications, including:

  1. persons traveling to a country where the risk for diphtheria is high
  2. persons requiring tetanus vaccination for prophylaxis in wound management
  3. persons who have received
  4. pregnant women who have not been vaccinated with Td during the preceding 10 years.

During this shortage, private medical providers can send their patients who fall into one of the above criteria to the ECHD, 1500 Broadway Clinic for a Td booster. The doctor is required to give the patient a script requesting the Td booster and state which criteria the patient falls into, and then call the clinic at 891-7711 to schedule the booster.

During October 2001, there were 12 reports of illness involving food establishments. One complaint was referred to NYS Agriculture and Markets for further investigation. Five reports were referred to ECHD Environmental Health Units.


November 2001

Update on Influenza Activity 2001-2

According to CDC as of the end of November there is documented influenza activity in 25 states, including New York State. Isolates were found of Influenza A (H3N2), Influenza A (H1N1), and Influenza B. All the strains were antigenically similar to the Influenza Vaccine 2001-2. During November, there was a reported Influenza A outbreak at a long term care facility in Hudson Valley, New York. This was confirmed by rapid antigen testing. Erie County Health Department still has a supply of Influenza 2001-2 Vaccine for the private physician. You may obtain the vaccine by calling the ECHD - Disease Control at 858-7697. Note: There is a 50 dose limit per health care provider.

Change to List of Reportable Diseases

Effective 11/30/01, the following diseases have been added to the list of reportables:

Glanders
Q Fever
Meliodosis
Smallpox
Staph Enterotoxin B Poisoning
Viral Hemorrhagic Fevers

During November 2001, there were 6 reports of food illness involving food establishments. Two reports were referred to ECHD Environmental Health Units For further investigation.


December 2001

Update on Rabies Activity

The ECHD Bureau of Disease Control has completed its annual Human Pre- Exposure Rabies Clinics during November 2001.

392 rabies titers were drawn
76 Pre-exposure series were administered
3 rabies boosters were administered

ECHD is still awaiting the titer results from Wadsworth Laboratories to determine which persons will require boosters.

Update on Influenza Activity 2001-2

The first case of Influenza A in Western New York was identified by Rapid Antigen Testing on 12/24/01, by Childrens Hospital Virology Laboratory. The patient was a 1 month old female from Niagara Falls, New York. The culture was forwarded to ECMC Virology Laboratory for further identification.. On 1/11/02, it was identified as Influenza A Panama-like (H3N2). This strain is covered in the Influenza 2001-2 Vaccine. Physicians are reminded that they make use of the Rapid Antigen Testing for high risk patients who present with flu-like illness. For certain settings or for high risk individuals anti-viral treatment may be indicated. ECHD has a limited supply of Influenza 2001-2 Vaccine that is available for private physicians. This may be requested by calling Disease Control at 858-7698.

During December 2001, there were 10 reports of illness involving food establishments. Two complaints were referred to NYS Agriculture and Markets for further investigation. Three reports were referred to ECHD Environmental Health Units for field investigations.