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Florida Department of Health - Hillsborough County Disease Surveillance Newsletter
July 2017
1
Mission: To protect, promote & improve the health of all people
in Florida through integrated state & community efforts. Vision: To be the Healthiest State in the Nation
Rick Scott Governor
Celeste Philip, MD, MPH State Surgeon General & Secretary
EpiNotes
Director Douglas Holt, MD 813.307.8008
Medical Director (HIV/STD/EPI) Charurut Somboonwit, MD 813.307.8008
Medical Director (TB/Refugee) Beata Casanas, MD 813.307.8008
Medical Director (Vaccine Outreach) Jamie P. Morano, MD, MPH 813.307.8008
Community Health Director Leslene Gordon, PhD, RD, LD/N 813.307.8015 x7107
Disease Control Director Carlos Mercado, MBA 813.307.8015 x6321
Environmental Administrator Brian Miller, RS 813.307.8015 x5901
Epidemiology Warren R. McDougle Jr., MPH 813.307.8010 Fax 813.276.2981
TO REPORT A DISEASE:
Epidemiology 813.307.8010
After Hours Emergency 813.307.8000
Food and Waterborne Illness Patrick Rodriguez 813.307.8015 x5944 Fax 813.272.7242
HIV/AIDS Surveillance Erica Botting 813.307.8011
Lead Poisoning Cynthia O. Keeton 813.307.8015 x7108 Fax 813.272.6915
Sexually Transmitted Disease Sophia Hector 813.307.8045 Fax 813.307.8027
Tuberculosis Irma B. Polster 813.307.8015 x4758 Fax 813.975.2014
Articles and Attachments Included This Month
Zika Fever Update 1 Florida Food Recalls 2 Health Advisories and Alerts 2 Epi in the News 2 Searching Florida CHARTS for Reportable Disease Data 3 Reportable Disease Surveillance Data 5 Hillsborough Provider Awareness Letter: Mumps 8 Reportable Diseases/Conditions in Florida, Practitioner List 9 FDOH, Practitioner Disease Report Form 10
Zika Fever Update (July 31, 2017)
The total number of Zika Cases reported in the state of Florida Infection Type Infection
Count 2016 Infection
Count 2017
Travel-Related Infections of Zika 1,122 88
Locally Acquired Infections of Zika 285 6
Undetermined 49 22
Pregnant Women with Lab-Evidence of Zika 299 81
Note, these categories are not mutually exclusive and cannot be added together. Please visit our website to see the full list of travel-related cases by county.
The total number of Zika Cases reported in Hillsborough County Infection Type Hillsborough County
2016 Hillsborough County
2017
Travel-Related Infections of Zika
46 4
There are no areas of ongoing, active transmission of Zika by mosquitoes in Florida. All previous Zika zones in the following areas of Miami-Dade County have been lifted after 45 days with no evidence of active transmission and no additional people infected. It is not uncommon, however, for there to be isolated incidents of locally acquired Zika.
EpiNotes July 2017
2
Brand Names Food Date of
Recall Health Risk
Link to
Recall Bush Brothers &
Company®
Baked Beans in 28 Ounce Cans Due to a Can
Seam Issue 7/28/2017
Packaging defect may
cause spoilage Details
Grande Produce Papaya “Caribeña” 7/27/2017 Salmonella Details
Bhu Foods Protein Bars 7/21/2017 Listeria Details
Garden of Light Inc. Woodstock Organic Matcha Vanilla Oats 7/18/2017 Listeria Details
Bestherbs Coffee
LLC
New Kopi Jantan Tradisional Natural Herbs
Coffee 7/17/2017
Undeclared Active
Pharmaceutical
Ingredients & Milk
Details
Publix Publix Tropical Medley Mix 6/26/2017 Listeria Details
House of Thaller Selected Pine Nut Hummus Products 6/21/2017 Listeria Details
United Natural
Trading LLC
Products Containing Organic and Natural Chopped
Dates 6/20/2017 Listeria Details
Florida Food Recalls (June 20 – July 31)
CDC Health Alert Network HAN 404: Eculizumab (Soliris®) recipients have a 1,000 to 2,000-fold greater risk of invasive meningococcal disease compared to the general U.S. population. The Food and Drug Administration (FDA)-approved prescribing information for eculizumab includes a black box warning for increased risk of meningococcal disease, and the Advisory Committee on Immunization Practices (ACIP) recommends meningococcal vaccination for all patients receiving eculizumab.
CDC Travel Notices: o Measles in France o Measles in Democratic Republic of the Congo o Polio in Syria o Polio in Democratic Republic of the Congo o Polio in Nigeria o Yellow Fever in Brazil
Health Advisories and Alerts
Medscape & CDC: New Cholera Vaccine for Adult Travelers
CDC reminds travelers to Europe: Protect against measles
Texas Department of State Health Services: Recommendation to test patients with consistent symptoms for Cyclospora
Epi in the News
EpiNotes July 2017
3
Searching Florida CHARTS for Reportable Disease Data Search
What is Florida CHARTS? Florida CHARTS is a convenient way to view data and statistics from many health indicator data sources. It is available here: http://www.flhealthcharts.com/charts/default.aspx
There are nearly 3,000 health indicators available from more than 25 different programs. An overview tutorial is available to explain key features.
Figure 1.
What infectious disease data are available?
Reportable disease data for infectious diseases reported to Epidemiology are available to search by county, disease, and age group (See Figue 1). Data is available to search for the current reporting year, although numbers displayed are preliminary and will fluctuate up or down over time as case reports undergo further investigation and validation. Data can be viewed in table (Figure 2, pg 4) or chart (Figure 3, pg 4) format.
EpiNotes July 2017
4
Figure 2. Select enteric disease data for 2017 for Hillsborough and Pinellas in table format.
Figure 3. Salmonella data for 2017 for Hillsborough, by age group, in chart format.
EpiNotes July 2017
5
Disease Category
Annual Totals
3 Year Average
Year-To-Date
2014 2015 2016**
Jan-June 2016
Jan-June 2017
Vaccine Preventable Diseases
Diphtheria 0 0 0 0.00 0 0
Measles 0 0 0 0.00 0 0
Mumps 1 1 2 1.33 0 3
Pertussis 65 41 72 59.33 37 26
Poliomyelitis 0 0 0 0.00 0 0
Rubella 0 0 1 0.33 1 0
Smallpox 0 0 0 0.00 0 0
Tetanus 0 0 0 0.00 0 0
Varicella 59 74 70 67.67 34 14
CNS Diseases & Bacteremias
Creutzfeldt-Jakob Disease 1 3 3 2.33 2 0
H. influenzae (Invasive Disease in children <5) 3 2 4 3.00 1 2
Listeriosis 2 2 0 1.33 0 0
Meningitis (Bacterial, Cryptococcal, Mycotic) 12 16 9 12.33 3 6
Meningococcal Disease 2 2 2 2.00 2 0
Staphylococcus aureus (VISA, VRSA) 0 0 0 0.00 0 0
S. pneumoniae (Invasive Disease in children <6) 5 2 3 3.33 1 0
Enteric Infections
Campylobacteriosis 155 152 261 189.33 129 177
Cholera 0 0 0 0.00 0 0
Cryptosporidiosis 351 101 62 171.33 39 20
Cyclospora 4 1 1 2.00 0 1
Escherichia coli, Shiga toxin-producing (STEC) 6 16 12 11.33 6 9
Giardiasis 64 55 105 74.67 56 37
Hemolytic Uremic Syndrome 1 2 1 1.33 1 3
Salmonellosis 343 287 308 312.67 135 128
Shigellosis 66 216 76 119.33 16 105
Typhoid Fever 0 0 1 0.33 1 1
Viral Hepatitis
Hepatitis A 5 5 5 5.00 2 3
Hepatitis B (Acute) 59 62 55 58.67 18 33
Hepatitis C (Acute) 29 48 32 36.33 21 11
Hepatitis +HBsAg in Pregnant Women 35 27 23 28.33 21 6
Hepatitis D, E, G 0 1 0 0.33 0 1
Reportable Disease Surveillance Data
EpiNotes July 2017
6
Disease Category
Annual Totals
3 Year Average
Year-To-Date
2014 2015 2016**
Jan-June 2016
Jan-June 2017
Vectorborne, Zoonoses
Chikungunya 33 10 1 N/A 1 0
Dengue 6 7 2 5.00 2 0
Eastern Equine Encephalitis 0 0 0 0.00 0 0
Ehrlichiosis/Anaplasmosis 2 0 0 0.67 0 0
Leptospirosis 0 1 0 0.33 0 0
Lyme Disease 11 12 7 10.00 0 1
Malaria 11 2 6 6.33 1 2
Plague 0 0 0 0.00 0 0
Psittacosis 0 0 0 0.00 0 0
Q Fever (Acute and Chronic) 0 0 0 0.00 0 0
Rabies (Animal) 4 3 3 3.33 2 4
Rabies (Human) 0 0 0 0.00 0 0
Rocky Mountain Spotted Fever 0 0 0 0.00 0 1
St. Louis Encephalitis 0 0 0 0.00 0 0
Trichinellosis 0 0 0 0.00 0 0
Tularemia 0 0 0 0.00 0 0
Typhus Fever (Epidemic) 0 0 0 0.00 0 0
Venezuelan Equine Encephalitis 0 0 0 0.00 0 0
West Nile Virus 0 2 0 0.67 0 0
Western Equine Encephalitis 0 0 0 0.00 0 0
Yellow Fever 0 0 0 0.00 0 0
Others
Anthrax 0 0 0 0.00 0 0
Botulism, Foodborne 0 0 0 0.00 0 0
Botulism, Infant 0 0 0 0.00 0 0
Brucellosis 0 0 1 0.33 0 0
Glanders 0 0 0 0.00 0 0
Hansen's Disease (Leprosy) 0 0 1 0.33 0 0
Hantavirus Infection 0 0 0 0.00 0 0
Legionellosis 7 20 25 17.33 4 11
Melioidosis 0 0 0 0.00 0 0
Vibriosis 7 11 11 9.67 5 8
Reportable Disease Surveillance Data
EpiNotes July 2017
7
Disease Category
Annual Totals
3 Year Average
Year-To-Date
2014 2015 2016**
Jan-June 2016
Jan-June 2017
Chemicals/Poisoning
Arsenic 0 0 0 0.00 0 0
Carbon Monoxide 18 20 20 19.33 14 6
Lead 208 246 154 202.67 75 110
Mercury 0 13 0 4.33 0 0
Pesticide 2 1 2 1.67 0 2
Influenza
Influenza, Pediatric Associated Mortality 1 0 0 0.33 0 5
Influenza, Novel or Pandemic Strain 0 0 0 0.00 0 0
HIV/AIDS*
AIDS 167 177 160 172.00 NA NA
HIV Infection 332 361 330 341.00 NA NA
STDs
Chlamydia 7304 7423 8097 7608.00 4220 4321
Gonorrhea 1848 1991 2345 2061.33 1152 1331
Syphilis, Congenital 4 4 2 3.33 0 2
Syphilis, Latent 166 199 210 191.67 NA NA
Syphilis, Early 141 147 198 162.00 112 84
Syphilis, Infectious 208 222 223 217.67 118 104
Tuberculosis
TB 49 41 43 44.33 19 11
Food and Waterborne Illness Outbreaks
Food and Waterborne Cases 58 27 1 28.67 NA NA
Food and Waterborne Outbreaks 3 2 1 2.00 NA NA
Reportable Disease Surveillance Data
“Current HIV Infection data by year of report reflects any case meeting the CDC definition of ‘HIV infection’ which includes all newly reported HIV cases and newly reported AIDS cases with no previous report of HIV in Florida. If a case is later identified as being previously diagnosed and reported from another state, the case will no longer be reflected as a Florida case and the data will be adjusted accordingly. Data from the most recent calendar years (2016 and 2017) are considered provisional and therefore should not be used to confirm or rule out an increase in newly reported cases in Florida. The final year-end numbers are generated in July of the following year, after duplicate cases are removed from the dataset, as is customary of HIV surveillance in the US. **Includes confirmed and probable cases reported in Florida residents (regardless of where infection was acquired) by date reported to the Bureau of Epidemiology in Merlin. Data for 2016 and 2017 are provisional and subject to change until the database closes. Counts are current as of the date and time above, but may change. Please note that counts presented in this table may differ from counts presented in other tables or reports, depending on the criteria used. Changes in case definitions can result in dramatic changes in case counts. Please see Florida Surveillance Case Definitions on the Bureau of Epidemiology for information on case definition changes (http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/case-def-archive.html). Reportable Diseases Frequency Report – Also Available in Florida CHARTS The frequency report is based on reportable disease information received by the Florida Department of Health as mandated under Section 381.0031, Florida Statutes, and Rule 64D-3.029, Florida Administrative Code. Depending on report criteria, counts include confirmed and/or probable cases that have occurred in Florida among Florida residents. This report does not include cases of AIDS, HIV infection, sexually transmitted diseases, or tuberculosis.
Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.
Rick Scott Governor
Celeste Philip, MD, MPH State Surgeon General and Secretary
Vision: To be the Healthiest State in the Nation
Florida Department of Health in Hillsborough County Division of Community Health • Office of Epidemiology P.O. Box 5135 • Tampa, FL 33675-5135 PHONE: 813-307-8010 • FAX 813-276-2981 www.FloridaHealth.gov
June 23, 2017 To The Hillsborough County Medical Community: We would like to inform the medical community that the Department of Health in Hillsborough County is investigating a cluster of mumps cases in immunized family members. The Hillsborough County Epidemiology program is in the process of identifying direct contacts to the cases. Please remember that mumps is a reportable condition. Should you diagnose a case of mumps, even without laboratory confirmation, the illness should be reported to the county health department. Mumps is a viral illness caused by a paramyxovirus. Mumps occurs worldwide; humans are the only known hosts. The virus is spread from person to person via droplets of saliva or mucus from the mouth, nose, or throat from an infected person, usually when they cough, sneeze or talk. The risk of spreading the virus increases the longer and closer the contact a person has with someone who has mumps. Mumps is less contagious than measles or chickenpox. In recent years numerous mumps outbreaks have been identified nationally in vaccinated persons on college campuses. The average incubation period for mumps is 16 to 18 days (range 12-25 days); when ill with mumps a person should avoid contact with others from the time of symptom onset/diagnosis until 5 days after the onset of parotitis. The most common signs include:
Fever Headache Muscle aches Tiredness Loss of appetite Swollen and tender salivary glands under ears on one or both sides (parotitis) lasting 2 or more
days Orchitis/oophoritis (less commonly)
Recommended Laboratory Testing Mumps testing is available at commercial laboratories. Due to the unreliable nature of serology testing in persons that have been immunized, RT-PCR testing on a buccal swab collected within 7 days of onset of parotid swelling is recommended and preferred. A buccal swab or oral swab is best obtained by massaging the parotid gland for 30 seconds prior to swabbing. Please contact the Hillsborough County Epidemiology program at 813-307-8010 for consultation or to report suspected cases. For additional information on Mumps please refer the CDC’s site: https://www.cdc.gov/mumps/hcp.html
Birth Defects
+ Congenital anomalies
+ Neonatal abstinence syndrome (NAS)
Cancer
+ Cancer, excluding non-melanoma skin cancer and including benign and borderline intracranial and CNS tumors
HIV/AIDS
+ Acquired immune deficiency syndrome (AIDS)
+ Human immunodeficiency virus (HIV) infection
HIV, exposed infants <18 months old born to an HIV-infected woman
STDs
Chancroid
Chlamydia
Conjunctivitis in neonates <14 days old
Gonorrhea
Granuloma inguinale
Herpes simplex virus (HSV) in infants <60 days old with disseminated infection and liver involvement; encephalitis; and infections limited to skin, eyes, and mouth; anogenital HSV in children <12 years old
Human papillomavirus (HPV), associated laryngeal papillomas or recurrent respiratory papillomatosis in children <6 years old; anogenital papillomas in children <12 years old
Lymphogranuloma venereum (LGV)
Syphilis
Syphilis in pregnant women and neonates
Tuberculosis Tuberculosis (TB)
All Others
! Outbreaks of any disease, any case, cluster of cases, or exposure to an infectious or non-infectious disease, condition, or agent found in the general community or any defined setting (e.g., hospital, school, other institution) not listed that is of urgent public health significance
Amebic encephalitis
! Anthrax
Arsenic poisoning
Arboviral diseases not otherwise listed
! Botulism, foodborne, wound, and unspecified
Botulism, infant
! Brucellosis
California serogroup virus disease Campylobacteriosis
Carbon monoxide poisoning
Chikungunya fever
Chikungunya fever, locally acquired
! Cholera (Vibrio cholerae type O1)
Ciguatera fish poisoning
Creutzfeldt-Jakob disease (CJD)
Cryptosporidiosis
Cyclosporiasis
Dengue fever
Dengue fever, locally acquired
! Diphtheria
Eastern equine encephalitis
Ehrlichiosis/anaplasmosis
Escherichia coli infection, Shiga toxin-producing
Giardiasis, acute
! Glanders
! Haemophilus influenzae invasive disease in children <5 years old
Hansen’s disease (leprosy)
Hantavirus infection
Hemolytic uremic syndrome (HUS)
Hepatitis A
Hepatitis B, C, D, E, and G
Hepatitis B surface antigen in pregnant women or children <2 years old
Herpes B virus, possible exposure
! Influenza A, novel or pandemic strains
Influenza-associated pediatric mortality in children <18 years old
Lead poisoning
Legionellosis
Leptospirosis
Listeriosis
Lyme disease
Malaria
! Measles (rubeola)
! Melioidosis
Meningitis, bacterial or mycotic
! Meningococcal disease
Mercury poisoning
Mumps
Neurotoxic shellfish poisoning
Pertussis
Pesticide-related illness and injury, acute
! Plague
! Poliomyelitis
Psittacosis (ornithosis)
Q Fever
Rabies, animal or human
! Rabies, possible exposure
! Ricin toxin poisoning
Rocky Mountain spotted fever and other spotted fever rickettsioses
! Rubella
St. Louis encephalitis
Salmonellosis
Saxitoxin poisoning (paralytic shellfish poisoning)
! Severe acute respiratory disease syndrome associated with coronavirus infection
Shigellosis
! Smallpox
Staphylococcal enterotoxin B poisoning
Staphylococcus aureus infection, intermediate or full resistance to vancomycin (VISA, VRSA)
Streptococcus pneumoniae invasive disease in children <6 years old
Tetanus
Trichinellosis (trichinosis)
! Tularemia
Typhoid fever (Salmonella serotype Typhi)
! Typhus fever, epidemic
! Vaccinia disease
Varicella (chickenpox)
! Venezuelan equine encephalitis
Vibriosis (infections of Vibrio species and closely related organisms, excluding Vibrio cholerae type O1)
! Viral hemorrhagic fevers
West Nile virus disease
! Yellow fever
! Report immediately 24/7 by phone upon
initial suspicion or laboratory test order Report immediately 24/7 by phone
Report next business day + Other reporting timeframe
*Section 381.0031 (2), Florida Statutes (F.S.), provides that “Any practitioner licensed in this state to practice medicine, osteopathic medicine, chiropractic medicine, naturopathy, or veterinary medicine; any hospital licensed under part I of chapter 395; or any laboratory licensed under chapter 483 that diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.” Florida’s county health departments serve as the Department’s representative in this reporting requirement. Furthermore, Section 381.0031 (4), F.S. provides that “The department shall periodically issue a list of infectious or noninfectious diseases determined by it to be a threat to public health and therefore of significance to public health and shall furnish a copy of the list to the practitioners…”
Reportable Diseases/Conditions in Florida Practitioner List (Laboratory Requirements Differ) Effective June 4, 2014
Florida Department of Health, Practitioner Disease Report Form Complete the following information to notify the Florida Department of Health of a reportable disease or condition, as required by Chapter 64D-3, Florida Administrative Code (FAC). This can be filled in electronically.
Patient Information
SSN:
Last name:
First name:
Middle:
Parent name:
Gender: MaleFemaleUnk
Birth date: Death date:
Race: American Indian/Alaska NativeAsian/Pacific IslanderBlack
WhiteOtherUnk
Ethnicity: HispanicNon-HispanicUnk
Address:
ZIP: County:
City: State:
Home phone:
Other phone:
Emer. phone:
Pregnant: YesNoUnk
Died: Yes No Unk
Hospitalized:
Date admitted: Date discharged:
Date onset: Date diagnosis:
Physician:
Address:
City: State: ZIP:
Phone: Fax:
Email:
Medical Information
Yes No Unk
Provider Information
Hospital name:
Insurance:
Treated: Yes No Unk
Specify treatment:
Laboratory
testing:
Yes No Unk Attach laboratory result(s) if available.
MRN:
Email:
Revised June 4, 2014
Reportable Diseases and Conditions in Florida Notify upon suspicion 24/7 by phone Notify upon diagnosis 24/7 by phone
HIV/AIDS and HIV-exposed newborn notification should be made using the Adult HIV/AIDS Confidential Case Report Form, CDC 50.42A (revised March 2013) for cases in people 13 years old or the Pediatric HIV/AIDS Confidential Case Report, CDC 50.42B (revised March 2003) for cases in people <13 years old. Please contact your local county health department for these forms (visit http://floridahealth.gov/chdepicontact to obtain CHD contact information). Congenital anomalies and neonatal abstinence syndrome notification occurs when these conditions are reported to the Agency for Health Care Administration in its inpatient discharge data report pursuant to Chapter 59E-7 FAC. Cancer notification should be directly to the Florida Cancer Data System (see http://fcds.med.miami.edu). All other notifications should be to the CHD where the patient resides. To obtain CHD contact information, see http://floridahealth.gov/chdepicontact. See http://floridahealth.gov/diseasereporting for other reporting questions.
Amebic encephalitisAnthraxArsenic poisoning
Botulism, foodborne
Botulism, infant
Botulism, wound or unspecifiedBrucellosisCalifornia serogroup virus diseaseCampylobacteriosisCarbon monoxide poisoningChancroid
ChlamydiaCholera (Vibrio cholerae type O1)Ciguatera fish poisoningConjunctivitis in neonate <14 days oldCreutzfeldt-Jakob disease (CJD)CryptosporidiosisCyclosporiasisDengue fever
DiphtheriaEastern equine encephalitisEhrlichiosis/anaplasmosis
Giardiasis, acute
GlandersGonorrheaGranuloma inguinale
Arboviral disease not listed here
Chikungunya fever
Escherichia coli infection, Shiga toxin- producing
Hansen's disease (leprosy)Hantavirus infectionHemolytic uremic syndrome (HUS)Hepatitis AHepatitis B, C, D, E, and G
Herpes B virus, possible exposure
HSV, anogenital in child <12 years old
Influenza A, novel or pandemic strains
Lead poisoningLegionellosisLeptospirosisListeriosisLyme diseaseLymphogranuloma venereum (LGV)MalariaMeasles (rubeola)
MelioidosisMeningitis, bacterial or mycotic
Haemophilus influenzae invasive disease in child <5 years old
Influenza-associated pediatric mortality in child <18 years old
Hepatitis B surface antigen in pregnant woman or child <2 years old
Herpes simplex virus (HSV) in infant <60 days old
Human papillomavirus (HPV), laryngeal papillomas or recurrent respiratory papillomatosis in child <6 years oldHPV, anogenital papillomas in child <12 years old
Meningococcal diseaseMercury poisoningMumpsNeurotoxic shellfish poisoning
Pertussis
Pesticide-related illness and injury, acute
PlaguePoliomyelitis
Psittacosis (ornithosis)
Q Fever
Rabies, animal
Rabies, human
Rabies, possible exposure
Ricin toxin poisoning
Rubella
St. Louis encephalitis
Salmonellosis
Shigellosis
Smallpox
Severe acute respiratory disease syndrome associated with coronavirus infection
Staphylococcus aureus infection, intermediate or full resistance to vancomycin (VISA, VRSA)
Saxitoxin poisoning (paralytic shellfish poisoning)
Rocky Mountain spotted fever or other spotted fever rickettsiosis
Staphylococcal enterotoxin B poisoning
Syphilis
Syphilis in pregnant woman or neonate
Tetanus
Trichinellosis (trichinosis)
Tuberculosis (TB)
Tularemia
Typhoid fever (Salmonella serotype Typhi)
Typhus fever, epidemic
Vaccinia disease
Varicella (chickenpox)
Venezuelan equine encephalitis
Viral hemorrhagic fevers
West Nile virus disease
Yellow feverOutbreaks of any disease, any case, cluster of cases, or exposure to an infectious or non-infectious disease, condition, or agent found in the general community or any defined setting (e.g., hospital, school, other institution) not listed above that is of urgent public health significance. Please specify:
Streptococcus pneumoniae invasive disease in child <6 years old
Vibriosis (infections of Vibrio species and closely related organisms, excluding Vibrio cholerae type O1)
Comments
Chikungunya fever, locally acquired
Dengue fever, locally acquired
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