Florida Department of Health - Polk County Weekly Morbidity Report - Confirmed and Probable cases * Week #9 (through March 3, 2018)

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1 Florida Department of Health - Polk County Weekly Morbidity Report - Confirmed and Probable cases * Week #9 (through March 3, 2018) Weekly Cumulative (YTD) Annual Totals ICD 9 code Disease Category Yr Avg A. Vaccine Preventable Diseases Measles Mumps Pertussis Varicella B. CNS Diseases & Bacteremias H. influenzae, Invasive in children < 5 years old Meningitis, bacterial or mycotic Meningococcal Disease Strep Pneumoniae, Invasive, Resistant, < 6 years old Strep Pneumoniae, Invasive, Suscept., < 6 years old C. Enteric Infections Campylobacteriosis ** Cryptosporidiosis Cyclosporiasis Escherichia Coli Shiga Toxin + ** Giardiasis Hemolytic Uremic Syndrome Salmonella Typhi infection Salmonellosis ** Shigellosis ** Vibrio vulnificus ** Vibrio parahemolyticus ** Vibrio - others ** D. Viral Hepatitis NA Hepatitis A Hepatitis B, Acute Hepatitis C, Acute Hepatitis +HBsAg in pregnant women E. Sexually Transmitted Diseases Chlamydia Gonorrhea Infectious Syphilis - Primary or Secondary Early Non-Primary Non-Secondary Syphilis Unknown Duration or Late Syphilis Congenital Syphilis HIV AIDS F. Vector Borne, Zoonoses Brucellosis Chikungunya V Dengue Fever Eastern Equine Encephalitis Lyme Disease Malaria Post-Exposure Prophylaxis for Rabies (PEP) NA Rabid Animals Rabies, Possible Exposure Rocky Mountain Spotted Fever, other rickettsioses West Nile Virus Zika Fever G. Others Carbon Monoxide Poisoning Creutzfeldt - Jakob Disease (CJD) Lead Poisoning Legionellosis Tuberculosis * This report lists diseases reportable to the state of Florida as provided by Section (1,2), of the Florida statute on public health. Data for 2017 and 2018 are provisional. ** Suspect cases are included for these diseases due to recent changes in case definition. For information on case definitions please visit the FL DOH website. ICD 9 codes are used for all diseases except for Post-Exposure Prophylaxis (no ICD 9 code available). Cumulative no. for STD also includes monthly totals after approval and review from Tallahassee, hence weekly numbers may not add up to cumulative no. Sexually Transmitted Infections are submitted by James Hinson, HIV/ AIDS by Kat Rittichaikul, Tuberculosis by Benito Renelus, and Rabies PEP by Amber Hutchins. = values above 2 standard deviations of the YTD 3 year average = values below 2 standard deviations of the YTD 3 year average

2 Influenza Surveillance Clinicians should encourage all patients who have not yet received an influenza vaccine this season to be vaccinated against influenza. Antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative by rapid influenza diagnostic test. State influenza and influenza-like illness (ILI) activity for Week 9, 2018: In week 9, influenza activity decreased. Data indicate influenza activity peaked during week 5 (ending February 3, 2018). While decreases have been observed, activity levels were still high, indicating the season is not over yet. No new influenza-associated pediatric death was confirmed. Six influenza-associated pediatric deaths have been confirmed in Florida in the influenza season. Statewide, eight outbreaks of influenza or ILI were reported: six with laboratory confirmation of influenza and two ILI. As of week 9 (ending March 3, 2018), 456 outbreaks of influenza and ILI have been reported since the start of the season. Overall, deaths due to pneumonia and influenza were within expected levels. The Florida Department of Health is conducting enhanced surveillance of intensive-care unit (ICU) patients aged <65 with laboratory-confirmed influenza; 274 cases have been reported since February 1, The majority of these cases occurred in unvaccinated people with underlying health conditions. Please see the ILI and other respiratory illness visit data from Polk ED s in the Hospital Emergency Department Syndromic Surveillance on the following pages for additional local trends. National influenza activity: Influenza activity decreased, but remained well above the national baseline. As in Florida, influenza A (H3) has been the most common influenza identified, however, influenza B activity has increased in recent weeks. This late-season circulation of influenza B is expected. Although influenza activity has peaked, it is still not too late to get vaccinated. People who have not been vaccinated should get vaccinated as soon as possible. Flu vaccines are safe and are the best way to prevent influenza infection and serious influenza complications. Influenza vaccination has been shown to significantly reduce the risk of hospitalization for influenza among adults aged 50 years and the risk of death due to influenza among children. CDC recommends the use of antiviral treatment as soon as possible for all hospitalized, severely ill, and people who are at higher risk for complications with suspect influenza: children <2 years old, adults 65 years old, pregnant women, and those with underlying medical conditions. Treatment should be administered within 48 hours of illness onset (but treatment administered after this period can still be beneficial). A recent CDC health advisory stresses the importance of rapid and early antiviral treatment this season. For more information, visit: Clinicians should not wait for laboratory confirmation to administer antivirals for suspect influenza. For more information, please visit the FDOH flu surveillance website:

3 Hospital Emergency Department Syndromic Surveillance All five hospital emergency departments in Polk County (Bartow Regional Medical Center, Heart of Florida, Lake Wales Medical Center, Lakeland Regional Health, and Winter Haven Hospital) are providing de-identified visit data into the statewide syndromic surveillance system known as Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE). The data are reviewed daily by the Epidemiology Program within the Florida Department of Health in Polk County (FDOH-Polk) as a way to detect unusual activity that might require further investigation; these can include identifying clusters of visits related to a certain disease category, such as influenza-like illnesses or food poisoning, or individual notifiable disease cases, such as chikungunya or varicella (chickenpox). FDOH-Polk is providing a regular summary of ESSENCE data with the Weekly Morbidity Report for select disease categories by chief complaint and/or discharge diagnosis, and whenever unusual activity is detected in other categories. Please note however, that discharge diagnosis information is frequently not immediately available, and that there may be a lag of several days until charts displaying discharge diagnoses are updated. Note also that charts relying on discharge diagnosis data may show pronounced differences in activity following the implementation of ICD-10 on October 1, For more information on ESSENCE and other FDOH surveillance systems, please visit Respiratory: Where ILI = Influenza or (Fever and (Cough or SoreThroat) and not NonILIFevers)

4 Visits with discharge diagnosis = influenza and not vaccination Visits with discharge diagnosis = acute uri, or acute bronchitis, or acute pharyngitis or acute nasal pharyngitis, and not influenza

5 Visits with discharge diagnosis = acute uri, or acute bronchitis, or acute pharyngitis or acute nasal pharyngitis, and not influenza Visits with discharge diagnosis= RSV or syncytial

6 Visits with discharge diagnosis = strep pharyngitis or strep throat Where chief complaint = asthma, bronchashtma, or reactive airway disease

7 Gastrointestinal: Where NVD = Nausea or Vomiting or Diarrhea Other: Visits with discharge diagnosis = enterovir and vesicul and st or (foot and mouth) Visits with chief complaint or discharge diagnosis = conjunctivitis or conjunctitis, or pinkeye or pink eye