PROTECTING THE PUBLIC 2007 Amoeba Cases

JULY 26, 2007 Volusia County Health Department issues annual PAM releaseVolusia County Health Department issues annual PAM release Orange County Health Department receives call from Fox 35 requesting interview on PAM; request fulfilledOrange County Health Department receives call from Fox 35 requesting interview on PAM; request fulfilled

AUGUST 8, 2007 OCHD issues health warning regarding 1 st PAM caseOCHD issues health warning regarding 1 st PAM case –media briefing at 3:45 pm –updated website with information

AUGUST 9, 2007 OCHD placed prevention information on main phone line (Spanish and English)OCHD placed prevention information on main phone line (Spanish and English) News release, fact sheet and water safety flyer sent toNews release, fact sheet and water safety flyer sent to –Region 5 CHD PIOs –Regional DOH PIOs –Local hospitals and partner agencies

AUGUST 15, 2007 Orange County Government placed temporary water safety signs at theOrange County Government placed temporary water safety signs at the –4 public permitted bathing areas –11 public boat docks August 24 permanent signs posted

SEPTEMBER 5, 2007 DOH, Orange and Osceola CHDs issued joint news release on 2nd PAM caseDOH, Orange and Osceola CHDs issued joint news release on 2nd PAM case News conference held at 11:30amNews conference held at 11:30am State Surgeon General issues health advisoryState Surgeon General issues health advisory OCHD disseminates advisory to major local theme parksOCHD disseminates advisory to major local theme parks

SEPTEMBER 7, 2007 OCHD collaborated with OC public schools to have prevention message sent to staff and students via telephoneOCHD collaborated with OC public schools to have prevention message sent to staff and students via telephone CDC confirms 3rd amoeba related caseCDC confirms 3rd amoeba related case DOH and OCHD immediately issue news release to the mediaDOH and OCHD immediately issue news release to the media

Primary Amoebic Meningoencephalitis Epidemiology: N. fowleri is ubiquitous worldwide in warm freshwater bodies, including lakes, ponds, rivers, minimally chlorinated pools and hot springsN. fowleri is ubiquitous worldwide in warm freshwater bodies, including lakes, ponds, rivers, minimally chlorinated pools and hot springs Enters through the nose across the cribiform plate and infects the brainEnters through the nose across the cribiform plate and infects the brain Rare, about 200 cases reported in the worldRare, about 200 cases reported in the world PAM is nearly always fatal, but case reports of survival existPAM is nearly always fatal, but case reports of survival exist Incubation period is daysIncubation period is days Water temperature greater than 80  F and low water depth can lead to increased risk for infection among swimmers in rivers, lakes and pondsWater temperature greater than 80  F and low water depth can lead to increased risk for infection among swimmers in rivers, lakes and ponds

Primary Amoebic Meningoencephalitis Clinical Findings: Same signs/symptoms as fulminant bacterial meningitis and include headache, fever, stiff neck, anorexia, vomiting, altered mental status, seizures, and coma. Anosmia may be an early signSame signs/symptoms as fulminant bacterial meningitis and include headache, fever, stiff neck, anorexia, vomiting, altered mental status, seizures, and coma. Anosmia may be an early sign Death typically in 3-7 daysDeath typically in 3-7 days Autopsy demonstrates acute hemorrhagic necrosis of olfactory bulbs and cerebral cortexAutopsy demonstrates acute hemorrhagic necrosis of olfactory bulbs and cerebral cortex

Primary Amoebic Meningoencephalitis Cases in Central Florida, 2007 FIRST CASE Orange County ResidentOrange County Resident Orange County chlorinated pool exposure in apartment complexOrange County chlorinated pool exposure in apartment complex Case reported 7/26/07 from Medical Examiner’s office of suspect amoeba case through identification of an amoeba on tissue biopsyCase reported 7/26/07 from Medical Examiner’s office of suspect amoeba case through identification of an amoeba on tissue biopsy Onset of symptoms: 6/6/07Onset of symptoms: 6/6/07 Patient expired: 6/8/07Patient expired: 6/8/07 SECOND CASE Orange County ResidentOrange County Resident Orange County lake exposureOrange County lake exposure Case reported 8/7/07 – diagnosed through identification of amoeba in Cerebral Spinal Fluid (CSF) specimen from local hospital labCase reported 8/7/07 – diagnosed through identification of amoeba in Cerebral Spinal Fluid (CSF) specimen from local hospital lab Onset of symptoms: 8/2/07Onset of symptoms: 8/2/07 Patient expired: 8/8/07Patient expired: 8/8/07

Primary Amoebic Meningoencephalitis Cases in Central Florida, 2007 THIRD CASE Osceola County ResidentOsceola County Resident Orange County lake exposureOrange County lake exposure Case reported 9/3/07 – diagnosed through identification of amoeba in Cerebral Spinal Fluid (CSF) specimen from local hospital labCase reported 9/3/07 – diagnosed through identification of amoeba in Cerebral Spinal Fluid (CSF) specimen from local hospital lab Onset of symptoms: 8/31/07Onset of symptoms: 8/31/07 Patient expired: 9/4/07Patient expired: 9/4/07 JUST ONE CASE IS ONE TOO MANY!!!…. THE HEALTH DEPARTMENT HAS AND WILL CONTINUE DO ALL IT CAN TO HELP SAVE LIVES.