niman Posted September 5, 2016 Report Posted September 5, 2016 On Thursday, September 1 the Florida Department of Health pulled all of the metrics on the Zika investigations. The number of local transmission investigations had grown to 12 (10 of which were active) by August 29, the date of the last update ( 2 new investigations announced on August 30 and another on August 31 were not added to the Active Investigation page), and the postings in 5 of the final 7 days prior to the pull had numbers that were internally inconsistent (the number of designated samples - positive, negative, or pending did not match the number of samples collected). However, it was the absence of any samples (or minimal collections) in four of the active investigations, coupled with samples pending for 10 or more days in four additional investigations, that raised serious transparency issues and questions regarding the Florida DoH “belief” that there were only two active areas of local Zika transmission in Florida. Although the media actively ignored these inconsistencies, the problems were becoming increasingly obvious as the number of local transmissions continued to increase, along with the time frame associated with no or limited sample collections. Moreover, the Florida MoH began to claim CDC failures to confirm Florida DoH positive antibody data, which was problematic. The data/transparency issues began their dramatic slide on August 23 when Florida DoH announced four confirmed cases for Wynwood. As cited in the press release, these four cases had been symptomatic in mid-July, but were considered pending until the CDC confirmed that the Zika antibody positive data showed that the Zika positive was not due to cross reactivity due to a current or prior infection with Dengue or Chikingunya. The use of a “pending “ designation was in contrast to initial contacts, which were also positive in the DoH test, but were reported as positives (with the caveat that the CDC had not yet confirmed). These cases were dependent on the antibody test because urine samples were not collected when they were symptomatic in mid-July, and reliable positives based on PCR testing of urine are limited to collection of samples within two weeks of symptoms. The conversion of the four pending Wynwood samples to positive raised significant questions about samples in other investigations, which had been pending for 10 or more days. Like the Wynwood samples, these appeared to be positives awaiting CDC confirmation, and the CDC confirmation would create additional areas of active transmission, leading to a map of the area and pressure to collect additional samples in the active transmission area. Moreover, CDC would be forced to issue more travel warnings, to the designated areas, Miami Dade County, or a larger portion of Florida. On the following day, August 24, the DoH added an asterisk to the pending column for Active Investigation #2 (AI 2) where 21 samples had been collected and 2 had been pending since August `15. The asterisk was designated as “*Awaiting confirmatory testing from CDC to rule out infection." indicating the two pending samples had been Zika antibody confirmed by the DoH, and like the four pending Wynwood samples, were pending CDC confirmation. Moreover, there were 5 samples in Active Investigation #5 (AI 5) that had been pending since August 17 (out of 6 collected), which was also true for 2 samples in Active Investigation #6 (AI 6). These pending samples in 3 active investigations strongly suggested that there were at least 5 areas in Miami Dade County that had active Zika transmission in contrast to the DoH “belief” that active Zika transmission was limited to two areas (Wynwood and Miami Beach). However, in the August 25 update the two pending samples in AI 2 where updated to negative and the pending samples were reduce to 0, although the asterisk on the pending column and explanation remained. The press release provided no explanation for the failure of the CDC to confirm the DoH positive result. In the August 29 update the number of pending samples in AI 5 was reduced from 5 to 0, while the number of negative samples was increased from 1 to 5, creating an internal inconsistency between the 6 samples collected and the 5 samples designated. Thus, on September 1 Florida DoH pulled the Zika active investigation detail because the widespread transmission was becoming very obvious.
niman Posted September 5, 2016 Author Report Posted September 5, 2016 Current "data" on Active Investigations http://www.floridahealth.gov/diseases-and-conditions/zika-virus/index.html?utm_source=flhealthIndex ACTIVE INVESTIGATIONS The department is conducting 13 active investigations, including 10 in Miami-Dade, one in Pinellas and two in Palm Beach counties. The department continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties and mosquito abatement and reduction activities are also taking place around the locations that are being investigated. The department has closed out three investigations including two in Miami-Dade County and one in Broward County. These cases were determined to be single cases with no additional transmission or linkage to areas of active transmission.
niman Posted September 5, 2016 Author Report Posted September 5, 2016 August 23 Active Investigations page showing Wynwood (AI #!) reduced pending samples from 4 to 0 and increased positives from 23 to 29 creating internal inconsistency (521 classified samples when only 519 were collected) ACTIVE INVESTIGATIONS The department is currently conducting eight active investigations. 1) Identified one-square mile in Miami-Dade – Two (2) original cases Total # of Samples Collected Negative Samples Positive Samples Pending Results 519 492 29 0 Door to door outreach and sampling continue. Mosquito abatement and reduction activities are on-going. The department has cleared three portions within the one-square mile as no additional people tested positive in those areas. The CDC continues to monitor the area per their guidelines. 2) First Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 21 19 0 2 3) One (1) case in Palm Beach County: Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 3 0 0 4) Second Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 5) Third Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 6 1 0 5 6) Fourth Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 26 6 0 20 7) Sixth Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest 8) Miami-Beach Investigation: Five index cases, 3 are out of state The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest 9) Pinellas Investigation: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 0 0 3 CLOSED INVESTIGATIONS The department has closed out the investigations into the first cases in Miami-Dade and Broward County (two cases). On Aug. 23, the department had enough information to close two of the ongoing investigations in Miami-Dade County, both were determined to be single cases with no additional transmission or linkage to areas of active transmission. Data as of Aug. 23, 2016 - 8:05pm EST
niman Posted September 5, 2016 Author Report Posted September 5, 2016 August 23 press release explaining why 4 pending samples in Wynwood were reclassified to positive: There are five new non-travel related cases today, including four in Miami-Dade and one in Pinellas County. The four individuals in Miami-Dade were identified within the Wynwood area and experienced symptoms of Zika in mid-July. However, the cases are being announced today following confirmatory antibody testing to rule out other mosquito-borne illness such as Dengue and Chikungunya. http://www.floridahealth.gov/newsroom/2016/08/082316-zika-update.html
niman Posted September 5, 2016 Author Report Posted September 5, 2016 Aug 24 update with asterisk for AI 2 pending column with definition ACTIVE INVESTIGATIONS The department is currently conducting 10 active investigations. 1) Identified one-square mile in Miami-Dade – Two (2) original cases Total # of Samples Collected Negative Samples Positive Samples Pending Results 519 492 27 0 Door to door outreach and sampling continue. Mosquito abatement and reduction activities are on-going. The department has cleared three portions within the one-square mile as no additional people tested positive in those areas. The CDC continues to monitor the area per their guidelines. 2) First Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results* 21 19 0 2 *Awaiting confirmatory testing from CDC to rule out infection. 3) One (1) case in Palm Beach County: Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 3 0 0 4) Second Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 5) Third Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 6 1 0 5 6) Fourth Miami-Dade investigation outside of Wynwood: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 27 24 0 3 7) Sixth Miami-Dade investigation outside of Wynwood: One (1) case The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 8) Miami-Beach Investigation: Five index cases, 3 are out of state The investigation is beginning in this area in Miami-Dade County. Mosquito abatement and reduction activities will take place around the area of interest. 9) Pinellas Investigation: One (1) case Total # of Samples Collected Negative Samples Positive Samples Pending Results 3 0 0 3 10) Second Palm Beach County Investigation: One (1) case The investigation is beginning in Palm Beach County. Mosquito abatement and reduction activities will take place around the area of interest. CLOSED INVESTIGATIONS The department has closed out the investigations into the first cases in Miami-Dade and Broward County (two cases). On Aug. 23, the department had enough information to close two of the ongoing investigations in Miami-Dade County, both were determined to be single cases with no additional transmission or linkage to areas of active transmission. Data as of Aug. 24, 2016 - 12:58pm EST
niman Posted September 6, 2016 Author Report Posted September 6, 2016 The latest press release (Sept 1) includes link to testing procedures, which notes that samples that are PCR negative but antibody positive samples are send to CDC for PRNT assay (neutralization test using multiple flavivirus targets) http://www.floridahealth.gov/diseases-and-conditions/zika-virus/_documents/zika-testing-process-final.pdf.
niman Posted September 10, 2016 Author Report Posted September 10, 2016 On Sept. 7, the state health department, in response to questions from the Herald, said eight out-of-state residents have contracted Zika in Florida but are not included in the total count. The agency also has stopped issuing details of active investigations into local Zika cases. On Sept. 1, the health department began reporting only a summary of the total number of investigations in each county. Previously, the agency had listed each investigation by county, with the number of people tested for Zika and the results of those tests. Gambineri explained the change in an email: “The department is working to ensure the information is easy to understand. It had become confusing.” Read more here:http://www.miamiherald.com/news/health-care/article100939277.html#storylink=cpy http://www.miamiherald.com/news/health-care/article100939277.html
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