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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:
-
the health needs of the
population
-
investigation and control of disease outbreaks
-
study of environmental and industrial hazards
-
evaluation of
preventive or curative programs or treatments
-
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
EPIDEMIOLOGY NEWS: 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
General MRSA
Centers for 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
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