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University at Buffalo Libraries

2003 Monthly Epidemiology Reports


Erie County Health Department (ECHD)

(Provided with the permission of the ECHD)


January 2003

Update on Influenza Activity 2002-3

The Influenza activity in New York State, as well as Western New York is sporadic at best. There are confirmed cases of Influenza A in the area. There is still a supply of Influenza Vaccine 2002-3 available to private medical providers from Kalieda Health Systems at no charge. You may obtain a supply
of influenza vaccine by calling ECHD Disease Control at 858-7698.

Meningococcal Vaccine Shortage

There is no change in the unavailability of Single Dose Menomune Vaccine. This was due to the voluntary recall of single dose Menomune Vaccine by the producers. The multi-dose (10 dose vial) is still in adequate supply. College bound boarding students are strongly recommended to receive this vaccine. As
an interim measure these students may be referred to their respective college health centers or to various travel clinics. For questions on this matter you may contact ECHD, Disease Control at 858-7698.

During January 2003, there were 17 reports of illness involving food establishments. Ten were referred to Environmental Health for further investigation. One additional one was referred to NYS Agriculture and Markets.


February 2003

Update on Influenza Activity 2002-3 The Centers for Disease Control and the New York State Health Department have made health care providers aware of the appearance of the new strain of aviary Influenza (H5N1) in Asia. The carry over to humans has already occurred. If you have a patient presenting with influenza-like illness and has recently traveled to Asia, influenza testing would be warranted. Specimens may be forwarded to NYSDOH, Wadsworth Laboratories. If you plan on sending specimens, please call the ECHD, Disease Control at 858-7697 for tracking purposes.

Severe Acute Respiratory Syndrome (SARS)

The NYSDOH issued an ALERT to all Emergency Departments, Infectious Disease Specialists, Family Practice and Infection Control Staff to be watching for patients with recent travel to Asia who develop fever and acute respiratory disease syndromes. These patients should be moved rapidly to an airborne isolation room with airborne and contact precautions.

Case Definition:
1. high fever (38 degreesC or 101.4F)
AND
2. one or more respiratory signs or symptoms, including cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of pneumonia or respiratory distress syndrome.
AND
3. either - recent travel to areas reporting cases of SARS within 7 days of symptom onset.
OR - close contact with a person with respiratory illness having the above travel history. (Close contact is living with or caring for)

Note: Any suspect or probable cases should be IMMEDIATELY reported to the Local Health Department at 858-7697 or After hours 898-4225 (MERS).

During February 2003, there were 13 reports of illness involving food establishments. Six were referred to Environmental Health for further investigation.


March 2003

Update on Influenza Vaccine 2003-4

Health Care Providers should be aware of the age restrictions for Influenza Vaccine 2003-4. Some brands of Influenza Vaccine are for 6 Y.O. or older. Other brands are for infants and children less than 6 years of age. The ACIP for the Prevention and Control of Influenza will be published later this month or during May.

Severe Acute Respiratory Syndrome (SARS)

The NYSDOH has issued its latest Update on SARS dated April 10, 2003. According to this update Toronto, Canada area has been removed from the "High Risk Countries" for infection with SARS. The high risk areas are: Mainland China and Hong Kong Special Administrative Region; Hanoi, Vietnam; and Singapore. Persons returning from those areas should be monitored for a full 10 day period looking for fever 100.5 (F) or higher, AND One or more clinical findings of respiratory illness (e.g. cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of pneumonia or acute respiratory distress syndrome.

Note: Any Suspect Cases of SARS should be IMMEDIATELY reported to the Local Health Department at 858-7697 or After Hours 898-4225 (MERS).

Update on Pre Event Smallpox Immunization

The NYSDOH temporarily halted the Smallpox Immunization Program to address the concerns of myocardial infarction and other heart problems. At the end of March, the program was restarted. CDC recommends, as a precautionary measure, that persons with known cardiac disease (e.g. cardiomyopathy, previous myocardial infarction, history of angina, or other evidence of coronary artery disease) not be vaccinated as response team members in the smallpox pre-event vaccination program at this time.

During March 2003, there were 13 reports of illness involving food establishments. Seven were referred to Environmental Health for further investigation. One was referred to the Seneca Nation American Indian Affairs.


April 2003

Update on Influenza 2002-3

May 15th marks the end of the Influenza 2002-3 Season. In retrospect, this has been a very mild year. There were confirmed cases of both Influenza A and Influenza B within Erie County. The statewide and national picture were a reflection of what Erie County experienced. The Influenza 2003-4 Season
begins in October 2003

Severe Acute Respiratory Syndrome (SARS)

The NYSDOH wants medical providers to be aware of patients who may have recently returned from a SARS infected area. Protocol dictates that the person should self monitor themselves for a full ten (10) days following departure from a SARS infected area. If they become symptomatic with symptoms consistent with SARS, then they are to contact their health care provider prior to going for an appointment. If they elect to use a hospitalemergency department, they should also call ahead prior to going.

Note: Any Suspect Cases of SARS should be IMMEDIATELY reported to the Local Health Department at 858-7697 or After Hours 898-4225 (MERS).

Update on West Nile Virus

ECHD has been actively monitoring for indicators of West Nile Virus in the area Since 5/1/03. They have been requesting that persons aware of dead birds(crows, blue jays or raptors report these sighting to:

Tonawanda 874 - 1070
Lancaster-Depew 683 - 6487
Hamburg 649 - 4225
Buffalo 881 - 4052

Other dead bird sighting should be reported directly to the Dead Bird Hotline at 1-866-537-2473.

During April 2003, there were 11 reports of illness involving food establishments. Six were referred to Environmental Health for further investigation. One was referred to New York State Agriculture and Markets for further investigation.


May 2003

Update on Influenza 2002-3

The Centers for Disease Control and Prevention (CDC) has described the most recent flu season in the United States as mild. The CDC said that deaths from influenza and pneumonia has likely declined from last year, and it noted that the percentage of flu-related deaths never rose above epidemic thresholds during the
2002-3 flu season. During the previous season, deaths exceeded epidemic levels for five weeks in a row at one point.

Severe Acute Respiratory Syndrome (SARS)

CDC and WHO generally concur that the number of newly reported SARS cases are on the decrease worldwide. However, it cautions health care providers to be aware of patients who may have recently returned from a SARS infected area. Protocol dictates that the person should self monitor themselves for a full ten (10) days following departure from a SARS infected area. If they become symptomatic with symptoms consistent with SARS, then they are to contact their health care provider prior to going for an appointment. If they elect to use a hospital emergency department, they should also call ahead prior to going.

Note: Any Suspect Cases of SARS should be IMMEDIATELY reported to the Local Health Department at 858-7697 or After Hours 898-4225 (MERS).

Update on West Nile Virus

To date there have been no confirmed cases of birds infected with WNV in Erie County. In addition, there have been no pools of infected mosquitoes found in Erie County this year. Dead bird sightings may be reported directly to the Dead Bird Hotline at 1 - 866-537-2473. Health care providers have been sent a 2003 WNV protocol to assist them in testing their patients suspected of having Encephalitis or Viral Meningitis. A copy of the specimen identification form should be sent directly to the local health department.

Multistate Outbreak of Monkeypox - Illinois, Indiana, and Wisconsin 2003

The CDC, FDA, and NYSDOH have issued multiple directives as a means of preventing the spread of monkeypox beyond the known areas. Additional information about monkeypox, including an interim case definition, is available at http://www.cdc.gov/ncidod/monkeypox and http://www.cdc.gov/ncidod/monkeypox/casedefinition.htm

During May 2003, there were 7 reports of illness involving food establishments. None were referred to Environmental Health for further investigation.


June 2003

Severe Acute Respiratory Syndrome (SARS)

The NYSDOH announced last week that the Wadsworth Laboratories is working on a PCR for Coronavirus. As soon as this testing will be available protocols will be distributed regarding the collection of specimens and shipment instructions.

Note: Any Suspect Cases of SARS should be IMMEDIATELY reported to the Local Health Department at 858-7697 or After Hours 898-4225 (MERS).

Update on West Nile Virus

To date there have been no confirmed cases of birds infected with WNV in Erie County. Thirty-one aviary specimens have been submitted to Wadsworth Laboratories. Twenty-five have been reported as negative. Health care providers have been sent a 2003 WNV protocol to assist them in testing their patients suspected of having Encephalitis or Viral Meningitis. A copy of the specimen identification form is to be sent directly to the local health department.

Multistate Outbreak of Monkeypox - Illinois, Indiana, and Wisconsin 2003

The CDC is still investigating the multi-state outbreak of Monkeypox. CDC Advisories 00147 and 00148 contain important information about containment and handling animal species suspected of having been in contact with other animals ill with monkeypox. The following reference site may be helpful. http://www.cdc.gov/ncidod/monkeypox and http://www.cdc.gov/ncidod/monkeypox/casedefinition.htm

During June 2003, there were 7 reports of illness involving food establishments. One was referred to New York State Agriculture and Markets for further investigation.


July 2003

Severe Acute Respiratory Syndrome (SARS)

As of July 17, 2003, the CDC case definition for SARS is as follows: Confirmed:

  • Detection of antibody to SARS-CoV in a serum sample, or
  • Detection of SARS-CoV RNA by RT-PCR confirmed by a second PCR assay, by using a second aliquot of the specimenand a different set of PCR primers, or
  • Isolation of SARS-CoV.

Negative:

  • Absence of antibody to SARS-CoV in the convalescent-phase serum obtained >28 days after symptom onset. This does not apply to serum samples collected before July 11, 2003. Testing results from serum samples collected before July 11, 2003 and between 22 to 28 days after symptom onset are acceptable and will not require collection of an additional sample >28 days after symptoms onset.

Undetermined:

  • Laboratory testing either not performed or is incomplete (e.g. appropriately timed convalescent samples not submitted).

Update on West Nile Virus

To date there have been five confirmed cases of birds infected with WNV in Erie County. Forty-eight aviary specimens have been submitted to Wadsworth Laboratories. There have been no confirmed cases of WNV in humans in Western New York. One case was reported in Nassau County as of 8/18/03.

Update on Influenza Vaccine 2003-4

The CDC and NYSDOH, issued a directive regarding "Timing of Influenza Vaccination During the 2003-4 Season." As of August 11, 2003, CDC determined that vaccine production for the 2003-4 influenza
season is proceeding satisfactorily, and that projected production and distribution schedules will allow for sufficient supply of influenza vaccine during October and November. Therefore, influenza vaccination can proceed for all high-risk and healthy persons, individually and through mass campaigns, as soon as vaccine is available. The ACIP targets October 1st, as the recommended start date for immunizations.

During July 2003, there were 15 reports of illness involving food establishments. Seven were referred to ECHD Environmental Health District Offices for further investigation.


August 2003

Severe Acute Respiratory Syndrome (SARS)

WHO and CDC have issued a report concerning the reappearance of SARS during Fall 2003. There is a likelihood that persons with SARS will be residents of countries lacking a sufficient health infrastructure. WHO later announced the first suspect case in Singapore during September 2003.

CDC will be offering a teleconference on SARS for Public Health Departments and health care providers in an effort to prepare for the resurgence of SARS.

Update on West Nile Virus

There have been no confirmed cases of WNV in humans in Erie County. However, there has been one reported case of WNV in Cattaraugus County. Erie County now has three mosquito pools confirmed as having WNV. ECHD is no longer shipping any crows, blue jays or raptors, since WNV has been confirmed in the aviary population.

Update on Influenza Vaccine 2003-4

ECHD is in the process of coordinating with the private sector to assemble a consolidated listing of all "Flu Clinic Sites" within Erie County. Once completed, this list will be available through ECHD Health Information.Flu Clinics will be starting during October 2003.

During August 2003, there were 12 reports of illness involving food establishments. Two were referred to ECHD Environmental Health District Offices for further investigation. Two additional reports were referred toNew York State Agriculture and Markets for field investigations.


September 2003

Severe Acute Respiratory Syndrome (SARS)

CDC, via their teleconferences on September 23rd and the 30th focused on preparing the medical community for the likely return of SARS during Fall 2003. Containment will be most effective when control measures are implemented upon entry into the health care system. This will be achieved by educating first responders and emergency department personnel on proper isolation techniques for the patient and protection of the staff.

Update on West Nile Virus

As of 9/30/03, there have been no confirmed cases of WNV in humans within Erie County. Dead bird reports will continue until November 1st. These reports are referred directly to a toll free number: 1-866-537-2473.

Pre Exposure Rabies Clinics

ECHD has set up the Pre-Exposure Rabies Clinics at ECC South Campus on 10/22/03, 10/29/03, and 11/12/03, and at SPCA, Ensminger Road, Tonawanda on 10/23/03, 10/30/03, and 11/13/03. Blood draws and titers will be offered to high risk individuals, i.e. animal handlers, animal control officers, and veterinary personnel, who were previously immunized two or more years ago. If you have not been already notified, information is available by calling 858-7697.

During September 2003, there were 11 reports of illness involving food establishments. Nine were referred to ECHD Environmental Health District Offices for further investigation. One additional report were referred to New York State Agriculture and Markets for field investigations.


October 2003

Update on Influenza 2003-04 Activity:

The Centers for Disease Control and Prevention is tracking reports of Influenza illness nationwide. Numerous reports of Influenza A have been reported in Texas during October. There have been no reported cases of influenza in Erie County so far this Flu Season. One report of a positive Rapid Antigen Test for Influenza A and B was reported in a resident of Cattaraugus County. Retesting is currently being done for confirmation of diagnosis. Ample supply of Influenza Vaccine 2003-04 is available. Call ECHD Disease Control at 858-7697 for more information.

Pre-Exposure Rabies Clinic for Animal Handlers

ECHD is in the process of completing the Pre-Exposure Rabies Series for persons at high risk of contracting rabies due to their occupation. Sixty series are being administered. Another 420 bloods have been drawn and are being submitted to the NYS Rabies Laboratory for titer testing.

During October 2003, there were 7 reports of food illness. Three of these were referred to ECHD Environmental Health for field investigation.


November 2003

Update on Influenza 2003-4 Activity:

The Centers for Disease Control and Prevention continues to track influenza activity across the nation. As of the end of November outbreaks have been reported in 25 states. Western New York has sporadic cases throughout all age groups. Two Long Term Care Facilities in Erie County have reported small clusters of Influenza A.According to NYSDOH the Injectable Influenza Vaccines have been expended.

There is a limited supply of Intra-nasal "Flu Mist" Vaccine. However, it is recommended that persons contact their health care provider for availability.

Cluster of E.Coli 0157 Cases

The ECHD, Disease Control is currently investigating a cluster of cases of E.Coli 0157 occurring in a concentrated area of Tonawanda. The reported cases aged from 17 to 19 Y.O.. The onset of the index case was 12/4/03. All of these cases are related either by residence or association. ECHD is recommending that all health care providers and hospital emergency departments be alerted to watch for patients presenting with severe abdominal cramps, diarrhea and red blood in the stool. If so, a stool specimen should be ordered for pathogens including E.Coli 0157.

During November 2003, there were 17 reports of food illness. Seven were referred to ECHD Environmental Health for field investigations. One additional report was referred to NYS Agriculture and Markets. Another was referred to Niagara County since it involved a joint investigation.


December 2003

Update on Influenza 2003-4 Activity:

The New York State, Department of Health issued an Influenza Alert on 12/15/03, requesting "Surveillance for Severe Illness in Pediatric Patients". Health facilities are requested to report pediatric patients with laboratory confirmed influenza (rapid antigen testing or culture) who meet the following criteria:

  1. Influenza encephalopathy cases (defined as altered mental status, or personality changes in patients lasting >24 hours and occurring within 5 days of the onset of an acute febrile respiratory illness;
  2. Influenza-related deaths.
  3. Severe illness defined as admission to an intensive care unit for influenza related illness (in previously healthy children).

Influenza Vaccine Supply Update:

The CDC and influenza vaccine manufacturers and distributors have announced that all inactivated influenza vaccine has been distributed to providers. Only live attenuated nasal mist vaccine, which is recommended for healthy persons aged 5 to 49 years, is available. As a result the CDC has posted the following ecommendations:

  • Target high-risk groups for complications from influenza: healthy children 6-23 months, adults >65 years, pregnant women in 2nd or 3rd trimester during the flu season, and persons aged >2 with underlying chronic conditions.
  • All children at high risk, including those aged 6-23 months, who report for vaccination should be vaccinated with a first or second dose, depending on vaccination status. Doses should not be held in reserve to ensure that two doses will be available.

Update on SARS Activity

The suspect case of SARS in Guangdong Province, China, reported during December 2003, was confirmed as a SARS Case. The second suspect SARS case in the Philippines was ruled out. On 1/8/04, China reported a second person being treated for SARS, who also lives in Guangdong Province.

During December 2003, there were 12 reports of food illness. Five were referred to ECHD Environmental Health for field investigations.

Maintained by Pamela M. Rose, MLS