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ABOUT
EPIDEMIOLOGY:
Epidemiology has been defined as the study of the distribution and determinants of disease and injury in human populations. Epidemiologists study variations of disease in relation to such factors as person (who), place (where), and time (when). Also of concern are temporal distributions of disease, disease trends, and the interval between the exposure to causative factors and onset of disease. The scope of the field extends from study of the patterns of disease to the causes of disease to the control or prevention of disease.
Epidemiologists are involved in a wide range of activities. These activities include:
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The health needs of the population
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Investigation and control of disease outbreaks
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Study of environmental and industrial hazards
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Evaluation of preventive or curative programs or treatments
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Evaluation of the effectiveness of the interventions or control strategies
The Indian River County Health Department Division of Epidemiology offers the following services to our community:
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Surveillance of mandatory reportable diseases
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Prevention of disease through contact follow-up and health education
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Educational materials
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Bioterrorism preparedness
MRSA INFORMATION
On October 17th, 2007, the Journal of the American Medical Association (JAMA) published an article and an editorial that stated that the annual number of severe, invasive MRSA cases in the U.S. is approximately 90,000. Among these severe cases, there are as many as 19,000 deaths per year. Also published in the news at the same time was a report of an MRSA death of a Virginia teenager. There was an unusually strong reaction by the local school district, which closed 21 schools for one day for cleaning. The combination of these two events prompted a wave of public concern throughout Florida.
In response to the public concern, the Florida Department of Health and Department of Education have been working together to provide the public with a consistent message addressing their concerns.
The following are points and recommendations from the Florida Department of Health:
Some important points:
- MRSA is primarily transmitted person to person through close contact.
- Rates of MRSA are lowest in school-age children, compared to persons of all other ages.
- There is no current epidemic in Florida of Staph infections in general, nor of MRSA, as judged by hospitalization and mortality data.
- We are seeing a long-term increase (over several years) in the proportion of Staph aureus that are antibiotic resistant, along with an increase in the aggressiveness of these infections, and there maybe some increased morbidity as a result.
- As stated in the JAMA article, 85% of the MRSA infections are in people who have had contact with a heath care facility and only 15% are in people that have not been sick lately.
- Many people can carry the MRSA bacteria without knowing it. Focusing on individuals with an infection is not sufficient to address the problem and halt transmission.
- Transmission of MRSA can occur both within and outside of the school setting. MRSA is a community problem and not confined to the school setting.
- MRSA infections are not new. The county health departments and school health nurses have been working with this problem for several years.
- The typical classroom environment is not a high risk environment for the transmission of MRSA. Sports, where there is a lot of physical contact, potential for skin abrasions and cuts, and sharing of equipment between players, is where transmission can occur. Sharing of towels, uniforms, razors and other equipment should be avoided. Routine cleaning of locker rooms and sports equipment with a disinfectant is recommended.
- MRSA has been reported from a number of schools in Florida. While it is mainly found in sports teams, especially football teams, anyone can get MRSA.
Concerning the issue of school closures and Florida Department of Health recommendations:
The Florida Department of Health does not recommend closing schools for cleaning. Rather it recommends that schools have an emphasis on good hand hygiene among students and staff. This includes making sure opportunities for hand hygiene are readily available. Schools should have a scheduled cleaning program which emphasizes areas that are most likely to get contaminated such as locker rooms, weight rooms, whirlpools, and other sports equipment that are shared.
We do not normally exclude students from school that have a MRSA infection, but they may be prevented from participating in activities that would increase the chance for spreading the infection. This would primarily be physical education and sports.
School staff should receive basic education about MRSA and other infections and know when to refer a student for health screening or medical care. School health coordinators can facilitate discussion and link school officials, school nurses, and local public health officials for prevention, referral, treatment and public education related to MRSA.
Please read these Center for Disease Control and Prevention's (CDC) articles on MRSA for more information:
Questions and Answers about Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools
Have you been diagnosed with a Staphylococcus aureus or MRSA infection? (Adobe Acrobat file, Size: 211Kb)
In addition, here are some more useful resources for the Florida Department of Health's and Department of Education's MRSA response:
Florida Department of Health Web Site
Florida Get Smart Program, which promotes the appropriate use of antibiotics among the school community
Florida Department of Education Web Site
MORE INFORMATION ON MRSA
Disease Control and Prevention: Community Acquired-MRSA
CDC Background and General Information
CDC Information for the Public
2002 Article from Morbidity and Mortality Weekly Report (MMWR)
Centers for Disease Control and Prevention: Healthcare Associated-MRSA
CDC Background and General Information
MRSA in Schools - The EPA provides a list of EPA-registered products effective against MRSA
MRSA in Athletics
MRSA in Jails/Correctional Facilities
Federal Bureau of Prisons
MMWR Report on Facilities in Georgia, California, and Texas
MMWR Report on Facilities in Mississippi
Florida Department of Health Antibiotic Resistance Programs
Florida Department of Health Infection Control Guidelines 1999
Outpatient Staphylococcal Infections in Florida: Descriptive Epidemiology of Methicillin Sensitive and Resistant Infections
Florida Department of Health 5th Guy
Hand Hygiene
Important Information for Healthcare Providers Regarding the Administration of the Tdap Vaccine:
Requirement for Tetanus/Diphtheria/Pertussis (Tdap) for Entry and Attendance in 7th Grade
The Florida Department of Health Bureau of Immunization would like to remind all immunization partners about the upcoming school immunization requirement effective for the 2009/2010 school year for students entering 7th grade.
Effective School Year 2009/2010:
Students entering, repeating or transferring into 7th grade will need to provide documentation for the Tdap vaccine. This requirement is in addition to the previous immunization requirements that are grade-appropriate.
Students who received a dose of Td vaccine 2 to 5 years prior to entering 7th grade should be given a Temporary Medical Exemption (TME) and immunized at the appropriate time. The timeline for the TME must be no longer than 5 years from the last tetanus diphtheria containing vaccine. Please note: that a dose of Tdap can be given within 2 years of receiving a dose of Td vaccine, regardless of a child?s TME status, when there is a risk of exposure to pertussis.
The Tdap can be administered to students 10 years of age and above if prior Td booster was given at least 2 years ago. Recommendations for provision of the Tdap vaccine are in accordance with the recommendations of the Advisory Committee on Immunization Practices (ACIP).
For more information regarding the vaccine recommendations, contact Phyllis Yambor at 850-245-4342. | 
