FDOH-Escambia 2020 Infectious Disease

Infectious Diseases

Our infectious disease service staff members identify and monitor infectious disease outbreaks in the community. Working with area physicians and other community partners, our staff investigate outbreaks of food-borne illness, as well as locate and refer people who have been potentially exposed to tuberculosis (TB), HIV, or other sexually-transmitted diseases to local services. Staff also monitor disease outbreaks in the community, such as flu and other respiratory illnesses.

Epidemiology

The Epidemiology program seeks to prevent disease transmission in the community through surveillance, contact investigations, and education. Staff investigate reportable diseases to determine the source of the disease, the time and mode of transmission, and the number of people potentially exposed or impacted. There are currently more than 80 reportable diseases.

2020 Cases of Reportable Diseases in Escambia County

Animal Bite (PEP recommended) 142

Animal Rabies 1

Campylobacteriosis 55

Carbon Monoxide Poisoning 12

Crytosporidium 1

Cyclosporiasis 1

E. Coli (O157:H7) 6

Giardiasis (acute) 3

Haemophilus Influenzae 9

Hepatitis A 126

Hepatitis B (acute) 10

Hepatitis B (chronic) 54

Hepatitis C (acute) 32

Hepatitis C (chronic) 317

Lead Level (greater than or equal to 5 μg/dL ‡) 57

Legionellosis 11

Listeriosis 2

Lyme Disease 5

Meningitis (Bact, Cryto, Mycotic) 2

Pertussis 5

Rocky Mountain Spotted Fever 1

Salmonella 54

Shigella 15

Streptococcus Pneumoniae (invasive) 29

Varicella (Chickenpox) 8

Vibrio (vulnificus) 3

Vibrio (other) 3

Total Reported Cases 969

Florida Department of Health, Bureau of Epidemiology

Reportable diseases in Escambia County excludes HIV, AIDS, TB, gonorrhea, chlamydia, and syphilis, and any reportable diseases with no reported cases. The current data is provisional and subject to change. Counts reflect reported cases and have not necessarily been confirmed. Many cases might not meet case definition criteria upon further investigation or may be unconfirmable. This document is meant to surveil broad trends.

Area 1 STD

The Area 1 STD program provides many services to persons in Escambia, Santa Rosa, Okaloosa, and Walton counties in Northwest Florida, including prevention services, disease surveillance, education, testing, and treatment. Disease Intervention Specialists (DIS) serve as front-line defense in contact investigations and partner elicitation to intervene in the spread of STDs. Staff also collaborate with public and private health care providers regarding diagnosis and treatment of all reportable STDs.

12 MONTHLY OUTREACHES TO TEEN CHALLENGE

9 EDUCATIONAL TRAINING ACTIVITIES PROVIDED

DISEASE INTERVENTION SPECIALISTS (DIS)

DIS continued providing interviews/ investigations for positive individuals and partner services without interruption.

Resumed the After-Hours HIV/Syphilis clinic as quickly as possible so it was only canceled from April – August for a total of 7 Night clinic outreaches.

2020 Reported STDs

Chlamydia 2,224

Gonorrhea 1,209

Total: 3,573 new cases

Syphilis 101

39

HIV

STD Age Breakdown

0-4 3 cases

10-14 48 cases

15-19 1,053 cases

20-24 1,117 cases

25-29 626 cases

30-34 314 cases

35-39 193 cases

40-44 82 cases

45-54 83 cases

55-64 47 cases

65-120 7 cases

STD Gender Breakdown

Female 2,091

Male 1,482

STD Race Breakdown

White 1,072 cases 30%

Black 2,112 cases 59.11%

Asian 26 cases 0.73%

Native Hawaiian/ Pacific Islander 10 cases 0.28%

American Indian/ Alaskan Native

7 cases 0.20%Other 63 cases 1.76%

Unknown 283 cases 7.92%

Area 1 HIV/AIDS

The Area 1 HIV/AIDS program provides disease surveillance, prevention services, education, counseling and testing, referral, contract management, technical assistance, and support to community-based organizations. Services for HIV positive individuals who are uninsured or under-insured are provided through the AIDS Drug Assistance Program (ADAP), which offers life-saving medications and adherence counseling. In addition, the HIV/AIDS program oversees Ryan White Part B contracted providers for direct care and support services such as HIV specialty care, health insurance premium and cost sharing assistance, oral health, and others depending on needs assessment results and funding.

The COVID-19 pandemic created challenges for the Area 1 HIV/AIDS Program. The number of HIV tests conducted by our Area 1 network of registered test sites in 2020 (6,117) was down by 39% from 2019 (10,042). The number of condoms distributed to various locations throughout Area 1 during 2020 (166,000) was also down from 2019 (283,4000).

1,365 PERSONS LIVING WITH HIV OR AIDS IN ESCAMBIA COUNTY

*Number reflects December 31, 2019. Year end 2020 numbers were unavailable at the time of publishing.

93.89% VIRALLY SUPPRESSED

Test and Treat Initiative

The Test and Treat (TnT) initiative is a key component of Florida’s plan to eliminate HIV transmission and reduce HIV-related deaths. Testing is available on-site at FDOH-Escambia’s clinic or during various outreach events where rapid tests provide results within minutes. The TnT initiative is a clinical program providing immediate linkage to HIV care and initiation of antiretroviral treatment (ART) during that first visit, if both patient and physician agree.

Patients are then referred to local infectious disease physicians for follow-up and continued care.

In 2020, the TnT initiative provided 12 uninsured or under-insured patients with immediate access to HIV medications in an effort to achieve viral suppression and better health outcomes.

PrEP and PEP Program

PrEP (Pre-exposure Prophylaxis) became a full-service program in 2019. PrEP is treatment with medications that may prevent infection before being exposed to HIV. PEP (post-exposure prophylaxis) became a full-service program in 2020. PEP is an immediate treatment that may prevent infection after being exposed to HIV. PEP treatment must start within 72 hours of the exposure, ideally, within the first 24 hours. PEP treatment involves taking HIV medications for 28 days and is most effective (up to 99%) if taken within 2-3 hours after exposure. In a single visit, a new PrEP/PEP client can receive comprehensive counseling and education from the PrEP/PEP Navigator, required lab work, a medical visit with a clinician, and leave with medication. PrEP patients return every three months for follow-up lab work, risk reduction education, and assistance with Patient Assistance Program requirements. PEP patients return a month later to have another HIV test performed and discuss the possibility of becoming a PrEP patient.

Most patients are able to receive services and medication for $0 out-of-pocket. In addition to HIV prevention, the benefit of being a patient in the PrEP/PEP program includes early detection and treatment of STDs, increased immunization rates for at-risk patients and routine medical visits to improve overall health. FDOH-Escambia partners with Curant Health Florida, a Specialty Pharmacy, to provide home delivery of medications and access to rebates to increase funds available for the program.

Referrals for the PrEP/PEP program come from FDOH-Escambia’s STD program, Family Planning Clinic and other community-based organizations involved in outreach HIV testing. The PrEP program maintains an active patient roster of 32+ low-income uninsured individuals and follows each for compliance with quarterly requirements for participation. The PEP program provided services to 8 clients in 2020. Additionally, the program conducts trainings with local Physician offices, Emergency Departments and Urgent Care Centers to increase access to PrEP and PEP throughout the county.

HIV SURVEILLANCE

Since January 2020, FDOH-Escambia’s Area 1 HIV program office has held a total of 5 “night clinics” conducting a total of 38 rapid HIV screenings. HIV education presentations and high impact prevention outreach events were also held throughout this year conducting 99 rapid HIV screenings.

14 HIGH IMPACT PREVENTION EVENTS REACHING 340+ PEOPLE

42 NEW HIV CASES REPORTED IN ESCAMBIA IN 2019*

27.6% lower FOUR-YEAR TREND IN NEW CASES FROM 2015-2019

26.2% BETWEEN THE AGE OF 25-29

73.8% WERE MALE

26.2% WERE FEMALE

*Number reflects December 31, 2019. Year end 2020 numbers were unavailable at the time of publishing.

Maurice Moody at an outreach promoting HIV prevention.

10 EXPOSED BABIES BORN TO HIV POSITIVE MOTHERS IN AREA 1

9 OF THOSE BABIES WERE BORN IN ESCAMBIA

29 WAS THE AVERAGE AGE OF MOTHERS. AGES RANGED FROM 22 TO 40

FDOH-Escambia’s HIV/AIDS team members celebrating Halloween on October 30, 2020.

SPOTLIGHT-HEPATITIS A

Hepatitis A is a contagious liver disease that results from infection with the hepatitis A virus (HAV). It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter—even in microscopic amounts—from contact with objects, food, or drinks contaminated by feces (stool) of an infected person. Vaccination is the best way to prevent hepatitis A.

2020 saw an increase in the number of Hepatitis A cases in Escambia County in an outbreak which was first identified in 2017. Statewide, reported cases of Hepatitis A decreased from 3,408 in 2019 to 1,028 in 2020. In Escambia County, the number of cases rose from 9 in 2019 to 126 in 2020. Vaccination and education initiatives were expanded to prevent the spread of the HAV. FDOH-Escambia implemented a targeted communications campaign and vaccination effort aimed at reaching persons at greatest risk for contracting the virus. Staff collaborated with local homeless shelters and resources such as clinics, food pantries, etc. to reach populations of persons experiencing homelessness, addiction, and other high-risk lifestyle situations known to increase a person’s chance for HAV infection. Our team administered 2,176 Hepatitis A vaccinations in adults in Escambia County in 2020, an increase from 1,458 Hepatitis A vaccinations administered in 2019.

Hepatitis A Outreach in Pensacola FDOH-Escambia held a Hepatitis A Outreach event on November 7, 2020 at the Charity Chapel Church in Pensacola, Florida. The event featured Hepatitis A prevention and vaccinations. In addition to providing Hepatitis A information, rapid HIV test kits were available along with the Florida Breast and Cervical Cancer Early Detection Program information. In total, the team administered 7 Hepatitis A vaccinations and delivered prevention information to approximately 75 homes, 1 mobile home community, 2 churches, and 10 businesses in the Bellview area.

FDOH-Escambia staff at the Hepatitis A Outreach on November 7, 2020.

Tuberculosis Prevention and Control

The Tuberculosis (TB) Prevention and Control program staff collaborate with clinicians throughout Escambia County, Florida to ensure that persons diagnosed with TB receive effective and timely treatment and additional contacts who are potentially exposed to the disease are evaluated and treated as needed.

The TB case rate for the State of Florida had an unprecedented 26% drop in TB cases from 2019 to 2020. In 2019, the State of Florida reported 558 TB cases and in 2020, 413 TB cases were reported. The state TB office in Tallahassee is suspecting that the huge drop in TB cases is related to the COVID-19 pandemic.

In 2020, the TB program created a presentation for World TB Day that targeted Shelters and the clinic that serves this very vulnerable population. Additionally, FDOH- Escambia had a very large contact investigation involving Escambia

County’s homeless population. We tested 64 individuals that were contacts to an active Pulmonary TB case in our homeless population. This investigation was difficult, and many challenges were faced with the COVID-19 pandemic. Many community services were limited or shut down which made it difficult to locate and test contacts.

10 ACTIVE TB CASES REPORTED AND TREATED

We had two inter-jurisdictional transfers from Georgia. We had a total of six TB cases that were transferred to Shands Hospital in Jacksonville, FL for medical stability. Registered Nurse, Pamela Nelson, completed 683 nursing assessments. There was a total of 1,277 directly observed or video observed therapies completed with majority in the field. Twelve Tuberculin Skin Tests were administered and 160 IGRA blood tests were collected.

Tuberculosis Morbidity Graph.