2010 Grant County Public Health Potpourri
description
Transcript of 2010 Grant County Public Health Potpourri
![Page 1: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/1.jpg)
2010 GRANT COUNTY PUBLIC HEALTH POTPOURRI
Grant-Adams County Medical Society MeetingMonday, October 11th, 2010Alexander L. Brzezny, MD, MPH, FAAFPHealth Officer Grant County Health District (GCHD)
![Page 2: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/2.jpg)
TOPICS AND OBJECTIVES State of the Public’s Health in
Grant County. Is our resident’s health better than 2 years
ago? H1N1 2009-2010 Pandemic in
Numbers. Who became infected and where?
2010-2011 Influenza Season. How to diagnose, what to report, what is
new? Pertussis Resurgence in the United
States. Why now, why here, and how to fight it?
![Page 3: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/3.jpg)
GRANT COUNTY STATE OF THE PUBLIC’S HEALTH 2010
http://www.doh.wa.gov/HWS/GHS2007.shtmhttp://www.doh.wa.gov/PHIP/products/phi/indicator.htm\http://www.countyhealthrankings.org http://www.wspha.org/2010HealthChamps
![Page 4: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/4.jpg)
Notifiable Conditions, Grant County, 2010
Chlamyd.
HCV
Salmonel.
Pertussis
![Page 5: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/5.jpg)
Years of healthy life expected at age 20
(2009)
GRANT 46 years(66 years total)
Seattle-KING 55 yearsKITTITAS 54 years (74 years total)
CHELAN -DOUGLAS 51 years(71 years total)
![Page 6: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/6.jpg)
Adult physical activity (2007)
GRANT 58%
SAN JUAN 74%
ADAMS 64%
![Page 7: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/7.jpg)
Adults with diabetes (2008)
GRANT 9% (ADAMS 11%)
KITTITAS 5%Seattle-KING 6%CHELAN-DOUGLAS 7%
![Page 8: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/8.jpg)
Low birth weight rate (per 1,000)
(2009)
GRANT 6/1,000ADAMS 6/1,000
KITTITAS 3/1,000
![Page 9: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/9.jpg)
Teen birth rate (per 1,000)
GRANT 35 /1,000(ADAMS 57 /1,000)
Seattle-KING 10/1,000
![Page 10: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/10.jpg)
Teens overweight
GRANT 32% ADAMS 34%
CHELAN-DOUGLAS 23%
![Page 11: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/11.jpg)
Adult preventive cancer screening -
Colorectal
GRANT 61%
KITTITAS 70%
![Page 12: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/12.jpg)
Adult dental care
GRANT 59%
BENTON FRANKLIN 78%
![Page 13: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/13.jpg)
Food service safety
GRANT 92%
Counties with 100%
![Page 14: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/14.jpg)
Reported child immunizations
GRANT 68% (ADAMS 71%)
SPOKANE 28%
![Page 15: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/15.jpg)
Maternal cigarette smoking
GRANT 10%
SPOKANE 19%
ADAMS 2%
![Page 16: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/16.jpg)
Adults with unmet medical
needs
GRANT 13%
OKANOGAN 19%ADAMS 22%
![Page 17: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/17.jpg)
Teen physical activity
GRANT 50%
Seattle-KING 40%SNOHOMISH 41%YAKIMA 42%
ADAMS 54%
![Page 18: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/18.jpg)
QUIZ QUESTION #1 (U. OF WI) Where does Grant County rank in
health factors and outcomes among WA State counties? A. Top 10% B. Top 30% C. Just about in the middle D. Bottom 30% E. Bottom 10%
![Page 19: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/19.jpg)
Grant County Health Factors (#28 /39)
![Page 20: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/20.jpg)
Grant County Health Factors (#28 /39)
• Health Behaviors: #30 (obesity, smoking, teen birth rate, Chlamydia rate, drinking); #1 San Juan
• Clinical Care: #31 (uninsured, DM2 screening, hospice use, primary care); #1 Sea-King
• Social and economic factors: #27 (HS graduation, income inequality, single-parent, children in poverty); #1 Whitman
• Physical environment: #7 (pollution, healthy foods access; liquor stores density); #1 Garfield
![Page 21: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/21.jpg)
Grant Morbidity & Mortality (#28 /39)
![Page 22: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/22.jpg)
Grant MORBIDITY and MORTALITY
• Mortality: #28 (premature death); #1-#3 Whitman, San Juan, King
• Morbidity: #27 (poor physical or mental health days (DAYS /YEAR), low birth weight, poor health (%)); #1-#3 San Juan, Douglas, Kittitas
![Page 23: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/23.jpg)
QUIZ QUESTION #1 Where does Grant County rank in
health factors and outcomes among WA State counties? A. Top 10% B. Top 30% C. Just about in the middle D. Bottom 30% E. Bottom 10%
![Page 24: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/24.jpg)
BAD NEWS (GRANT COUNTY) Population growth with socioeconomically
challenged in-migration Grant ranks at the bottom 30% for health
in WA Several indicators demonstrate a
persistent lack of improvement: lower life expectancy, less physical activity, higher rates of DM2, high teen overweight, lower preventative services utilization, low birth weight, and alarming teen pregnancy rate.
![Page 25: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/25.jpg)
SOME GOOD NEWS (GRANT COUNTY) Grant Co. residents enjoy open spaces,
low traffic and pollution, proximity to healthy foods and outdoor recreation.
CHILD PROFILE utilization is high. Maternal smoking rate is low and
overall smoking rate is dropping (cost?).
Grant Co. teens are more active than those in most of the state.
Access to healthcare services is good.
![Page 26: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/26.jpg)
PUBLIC HEALTH FUNDING AND STAFFING
2009: Budget ~$2.2mln (final) Staff ~27.0+ FTE
2011 (projected) Budget ~$1.7+mln (in 1999: $1.86mln) Staff ~22.0+ FTE (in 1999: 25.6 FTE) (Grant Co. population in 2000: 74,698) (Grant Co. population in 2010: ~90,000)
![Page 27: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/27.jpg)
GRANT PUBLIC HEALTH, 20052011
2011 1,787,310
2010 1,876,259
2009 2,107,274
2008 2,072,423
2007 1,854,956
2006 1,820,951
2005 1,932,706
050000
100000150000200000250000300000350000400000450000500000550000600000650000
Revenue Sources
Permits Fed Grants State Grants County / CityMvet & McaidFees & Other
2011 & 2010 Budgeted 2009 - 2005 Actual Revenues
Reve
nue
In D
olla
rs
20052011
DRAFT DOCUMENT, GCHD, 10/11/2010
H1N1
![Page 28: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/28.jpg)
GRANT COUNTY AND WASHINGTON STATE 2009-2010 H1N1 PANDEMIC IN NUMBERS
http://www.doh.wa.gov/notify/other/H1N1SummRpt.pdf
![Page 29: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/29.jpg)
QUIZ QUESTION #2 (DOH) Which County in Washington experienced
the second highest severe pan-H1N1 disease rate during 2009-2010 season? Which one the highest?
A. Whatcom County (Bellingham) B. King County (Bellevue) C. Grant County (here) D. Adams County (near here) E. Pend Oreille County (Newport)
![Page 30: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/30.jpg)
20
2009-2010 INFLUENZA A H1N1 VIRUS
A/Mexico/4108/2009 (H1N1)
neuraminidasetype of nuclear material
hemagglutinin
virus type geographicorigin
strain number
year isolated virus subtype
![Page 31: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/31.jpg)
AvianInfluenza viruses
Pandemic H1N1 2009 Pedigree, 1979-2009Eurasian Swine
A/H1N1(1979-present)
Human “seasonal”A/H3N2
(1968-present)
North American SwineA/H1N1
(1918-present)
“Triple reassortant”Swine A/H1N2(1998-present)
2009 HumanA/H1N1
(2009-??)?
Human “seasonal”A/H1N1
(1977-present)
![Page 32: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/32.jpg)
PANDEMIC H1N1 INFLUENZA VIRUS - TIMELINE
April 15 – first U.S. case confirmed by CDC (CA)
April 26 – U.S. Government declares a “public health emergency”
May – CDC provides prototype vaccine virus to manufacturers
June 11 – WHO raises pandemic level to 6 June 19 – H1N1 reported in all 50 states October 6 – first H1N1 vaccine doses
admin’d April 2010 – first confirmed H1N1 death in
Grant
![Page 33: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/33.jpg)
Extrapolation ’08‘09 season
![Page 34: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/34.jpg)
WASHINGTON LABORATORY SURVEILLANCE, 2009-2010
First WaveSecond Wave
![Page 35: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/35.jpg)
NUMBER OF SEVERE H1N1 CASES (WA) (N=1667)
First Wave
Second Wave
?Third Wave
![Page 36: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/36.jpg)
NUMBER OF SEVERE H1N1 (BY WA REGION)
![Page 37: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/37.jpg)
NUMBER AND RATE OF H1N1 (1ST WAVE)
![Page 38: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/38.jpg)
NUMBER AND RATE OF SEVERE 2009 H1N1 BY AGE GROUP, APRIL–AUGUST 2009 (N=188)
8.9
![Page 39: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/39.jpg)
NUMBER AND RATE OF CRITICAL H1N1 BY AGE, APRIL–AUGUST 2009 (N=63); (2ND WAVE)
0.9 0.9
![Page 40: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/40.jpg)
NUMBER AND RATE OF SEVERE FLU A BY AGE, SEPT 2009–APRIL 2010 (N=1479), (2ND WAVE)
![Page 41: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/41.jpg)
NUMBER AND RATE OF CRITICAL INFLUENZA A BY AGE, SEPT 09–APRIL 10 (N=360); (2ND WAVE)
8.2
![Page 42: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/42.jpg)
NUMBER AND RATE OF FATAL FLU A BY AGE GROUP, SEPT 09–APRIL 10 (N=81); (2ND WAVE)
2.32.2
0.2
1.2
![Page 43: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/43.jpg)
NUMBER OF FATAL 2009 H1N1 BY COUNTY, APRIL–AUGUST 2009 (N=17)
![Page 44: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/44.jpg)
NUMBER OF FATAL INFLUENZA A BY COUNTY, SEPTEMBER 2009–APRIL 2010 (N=81)
![Page 45: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/45.jpg)
RATE OF SEVERE 2009 H1N1 BY WA COUNTY, APRIL–AUGUST 2009 (N=188)
![Page 46: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/46.jpg)
RATE OF SEVERE INFLUENZA A BY WA COUNTY, SEPTEMBER 2009–APRIL 2010 (N=1479)
![Page 47: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/47.jpg)
QUIZ QUESTION #2 Which County in Washington experienced the
second highest severe pan-H1N1 disease rate during 2009-2010 season? A. Whatcom County (Bellingham) B. King County (Bellevue) C. Grant County (here) D. Adams County (near here) 2nd
highest E. Pend Oreille County (Newport)
highest
![Page 48: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/48.jpg)
SUMMARY OF THE 2009-2010 H1N1 (I.) Two distinct pandemic waves. Grant County: 1 fatality, 31 severe cases. Grant County severe disease rate: 36 /100,000 WA State: at minimum confirmed 1,650
hospitalizations and deaths in WA were due to this novel influenza virus (4,459 CDC estimate).
Severe disease rate greater in E. Washington (especially 2nd Wave).
Pre-school children: highest hospitalization rate. 5-24 y.o. age group had highest attack rate.
![Page 49: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/49.jpg)
SUMMARY OF THE 2009-2010 H1N1 (II.) Pregnant 8-11x more likely to be
hospitalized and 3-4x more likely to be admitted to an ICU.
Fatal and critical cases treated later than those with less severe disease.
Most hospitalized and fatal cases had an ACIP-recognized high risk medical condition (asthma, chronic lung disease, and diabetes).
Overall, H1N1 less severe than anticipated.
![Page 50: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/50.jpg)
SUMMARY OF THE 2009-2010 H1N1 (III.) 1.4 influenza deaths per 100,000. 24.7 severe influenza cases per 100,000. 5% of severe cases died in the 1st Wave
compared to 9% deaths among the severe cases in the 2nd Wave.
GRANT COUNTY HEALTH DISTRICT Cost: $360,000 (or $4.50 per resident) 70 volunteers augmenting 28 staff (100 individuals) 8,920 vaccines given in 8 weeks (11% population) WSPHA recognized GCHD for “exemplary public
service”.
![Page 51: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/51.jpg)
Estimates of child and adult state-specific seasonal influenza vaccination coverage, 2009-2010
MMWR April 30, 2010 / 59(16);477-484
![Page 52: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/52.jpg)
NUMBER OF PERSONS REPORTING SEASONAL FLU VACCINE (2008-2010); BRFSS
MMWR April 30, 2010 / 59(16);477-484
![Page 53: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/53.jpg)
PRACTICE-CHANGING KNOWLEDGE 20% influenza cases are ASYMPTOMATIC. Surgical face masks decrease transmission. Early treatment improves outcomes. Pregnancy is a major risk factor for influenza. You can get fooled (infected) TWICE with the
same virus during the same season /pandemic.
Emergency declaration proved useful in increasing the number of “public health workers.”
![Page 54: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/54.jpg)
GRANT COUNTY 2010-2011 INFLUENZA SEASON
http://www.phac-aspc.gc.ca/fluwatch/index-eng.phphttp://www.who.int/csr/disease/influenza/influenzanetwork/en/index.html
http://gamapserver.who.int/maplibrary/
![Page 55: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/55.jpg)
QUIZ QUESTION #3 (WHO) So where is the avian H5N1 influenza
now??? A. Mutated into the pandemic H1N1 B. Affecting only birds C. Doing well and infecting humans D. Doing well and infecting humans in
China only E. Already in Washington
![Page 56: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/56.jpg)
![Page 57: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/57.jpg)
![Page 58: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/58.jpg)
SO WHAT HAPPENED TO THE H5N1?
![Page 59: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/59.jpg)
QUIZ QUESTION #3 So where is the “avian” H5N1 influenza
now??? A. Mutated into the pandemic H1N1 B. Affecting only birds C. Doing well and infecting
humans D. Doing well and infecting humans in
China only E. Already in Washington
![Page 60: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/60.jpg)
H1N1, SEASONAL FLU, WHERE ARE THEY? Pandemic influenza A(H1N1) 2009 virus:
Widespread activity in India and New Zealand. Regional outbreaks in Australia, Bangladesh,
Cambodia, Costa Rica, Cuba, Honduras, Laos, Malaysia, Panama, Peru, Singapore and Thailand.
Seasonal flu (non-pandemic H1N1, H3N2, and influenza B): Sporadic H1 was reported only in China and Pakistan. Regional outbreak of H3 in China Local outbreaks of H3 in Mexico and South Africa Regional and local outbreaks of influenza B:
Argentina, China, El Salvador, Australia, France - New Caledonia, South Africa.
US: sporadic activity of H3N2 and influenza B
![Page 61: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/61.jpg)
ILI=INFLUENZA-LIKE ILLNESS
Influenza-like illness (ILI): Fever>100F (37.8C) AND
Cough AND/OR Sore Throat
Many other symptoms Absence of other obviously known cause
![Page 62: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/62.jpg)
ILI VS. SARI (SEVERE RESP. DISTRESS SY)
Causes two respiratory disease syndromes ILI (upper respiratory tract)
Fever (100F) plus cough or sore throat Lots of other symptoms
Severe acute respiratory illness (SARI) ILI + progressive SOB/ tachypnea/ hypoxia
Lower lung involvement ILI or SARI not specific to influenza virus
infections (parainfluenza, coronaviruses [SARS], adenovirus, HMP virus, rhinovirus, RSV)
![Page 63: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/63.jpg)
LABORATORY CRITERIA FOR DIAGNOSIS Influenza virus in respiratory cell culture; RT-PCR testing of respiratory specimens; Immunofluorescent antibody staining (direct or
indirect); Rapid influenza diagnostic testing; Immunohistochemical (IHC) staining for influenza
viral antigens in respiratory tract (autopsy); Four-fold rise in influenza hemagglutination
inhibition (HI) antibody titer in paired acute and convalescent sera.
![Page 64: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/64.jpg)
WHAT IS THE BEST TEST? WELL, THAT DEPENDS…
Viru
s co
ncen
trat
ion
Days from infection
0 4 5 6 7 8 91 2 3
Symptoms onset Detection thresholds
rtPCR
Virus cell culture
Direct fluorescentantibody assays (DFA)
Antigen detect (“RDT /RIT”)
![Page 65: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/65.jpg)
INFLUENZA CONTROL: FOUR NUMBERS + 2 6 (feet of separation) 100 (Fahrenheit) 7 (days of exclusion) 24 (hours w/o fever) Influenza vaccine Surgical face mask+handwashing
![Page 66: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/66.jpg)
INFLUENZA HIGH-RISK INDIVIDUALS Pregnant women, People with asthma and other lung disease, Diabetics, Morbidly obese person, People with blood disorders (sickle cell, etc.) People with compromised immune systems, People with heart disease, stroke or similar, Those with neuromuscular diseases (CP,
etc.), Hemodialysis patients (and other ESRD), Infants, elderly, nursing home residents, Individuals with a recent illness.
![Page 67: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/67.jpg)
2010-2011 INFLUENZA VACCINE 11 trivalent vaccines: A/California/7/2009
(H1N1), A/Perth/16/2009 (H3N2), and B/Brisbane/60/2008
Annual influenza vaccination is recommended for every person in the United States 6 months of age and older (“almost universal”)
MMWR 2010;59 (early release)
![Page 68: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/68.jpg)
![Page 69: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/69.jpg)
SEASONAL INFLUENZA VACCINE IN PREGNANCY
In 2000-2003 a total of 2 million influenza vaccines administered to pregnant women: 20 VAERS reports received (9 injection site reactions; 8 systemic reactions; 3 unrelated miscarriages).
2 studies (N=2,252): no adverse events. Influenza more severe in pregnancy. ACIP: Seasonal Inactivated Influenza
Vaccine (TIV) INDICATED in pregnancy (not LAIV).
![Page 70: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/70.jpg)
IMMEDIATELY REPORTABLE TO GCHD IN 2010-11
(Pediatric) influenza deaths are currently reportable in Washington (death resulting directly or indirectly from a disease clinically compatible and laboratory-proven as influenza).
Suspected and laboratory-confirmed infections with a novel influenza including avian influenza A (H5N1) virus (excluding 2009 H1N1).
Unexplained critical illnesses and deaths in persons <50 years old
Laboratory-confirmed influenza hospitalizations are not legally reportable statewide, HOWEVER, CDC requested.
![Page 71: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/71.jpg)
GRANT COUNTY AND NATION’S HEALTH RESURGENCE OF PERTUSSIS IN UNITED STATES
http://www.cdc.gov/vaccines/vpd-vac/pertussis/default.htmhttp://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport10-6-2010.pdf
http://www.who.int/vaccines-documents/DocsPDF-IBI-e/mod4_e.pdf
![Page 72: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/72.jpg)
QUIZ QUESTION #4 (USMLE) The 3-year-old sister of an infant boy is diagnosed with
pertussis by nasopharyngeal swab. The mother gives a history of being immunized as a child. Which one is correct.
A. Mother has no risk of acquiring the disease because of her immunization status.B. Hyperimmune globulin is effective in protecting the infant.C. Erythromycin should be prescribed to the infant.D. The risk to the infant depends on the immunity of the mother E. The 3-year-old sister should be immediately immunized with an additional dose of pertussis vaccine.
![Page 73: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/73.jpg)
QUIZ QUESTION #4 The 3-year-old sister of an infant boy is diagnosed with
pertussis by nasopharyngeal swab. The mother gives a history of being immunized as a child. Which one is correct.
A. Mother has no risk of acquiring the disease because of her immunization status.B. Hyperimmune globulin is effective in protecting the infant.C. Erythromycin should be prescribed to the infant.D. The risk to the infant depends on the immunity of the mother E. The 3-year-old sister should be immediately immunized with an additional dose of pertussis vaccine.
![Page 74: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/74.jpg)
PERTUSSIS IN GRANT COUNTY 2010 TOTAL CASES: 9 ONE FATALITY (2 week old)
eight (8) laboratory proven cases, one (1) epidemiologically-linked, age 2 w.o.– 60’s y.o.
First case: 8/23/2010; Last case: 9/23/2010 Total suspects: 19 (all culture or PCR or both
NEG) Total contacts: 222 (185 case contacts: of those
58 HEALTHCARE WORKERS, 37 suspect contacts)
CLOSE CONTACTS PEP rate: 100% TOTAL COST: $24,835; staff hours:480 (9/30)
![Page 75: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/75.jpg)
Incidence increasing since the 1990s Cyclical: peaks every 2-5 years as numbers of
susceptible people increase enough to allow sustained transmission; last peak year 2005 with 25,616 U.S. cases, a 45 year high
Adults are vulnerable to pertussis 27% of reported cases are among adults Pertussis immunity wanes 5 to 10 years after DTaP* series
(immunity from disease wanes in 15 years) ONLY 25% of cough illness lasting >2 weeks is pertussis
First pertussis vaccines (Tdap)† for adolescents and adults licensed in 2005; uptake suboptimal
*Diphtheria and tetanus toxoids and acellular pertussis vaccine†Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine
PERTUSSIS: MOST POORLY CONTROLLED VACCINE-PREVENTABLE DISEASE
![Page 76: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/76.jpg)
SYMPTOMS OF INFANT PERTUSSIS Initially infant looks deceptively well:
coryza, no fever, mild cough Leukocytosis with lymphocytosis Apneic episodes Seizures Respiratory distress Pneumonia Adenovirus or RSV co-infection can
confuse picture
![Page 77: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/77.jpg)
“TYPICAL” SYMPTOMS OF PERTUSSIS Three-stage bacterial illness (catarrhal,
paroxysmal and convalescent) that lasts 4-12 weeks
“Typical” symptoms paroxysmal cough lack of fever no systemic illness coryza; no pharyngitis post-tussive vomiting post-tussive whoop absolute lymphocytosis
Adults with pertussis often report feeling as if they’re choking on something, sweating episodes
![Page 78: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/78.jpg)
Adults transmit pertussis to infants Among 264 known source-cases:
Almost 50% were parents, most often mothers 51% were adults >19 years of age
Bisgard KM, et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004; 23(11):985-989. Wendelboe AM, et al. Transmission of Bordetella pertussis to young infants. Pediatr Infect Dis J 2007; 26(4):293-299.
PERTUSSIS TRANSMISSION TO INFANTS
![Page 79: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/79.jpg)
PERTUSSIS RESURGENCE SINCE THE 1990S Genetic changes in B. pertussis; greater
virulence? Variable vaccine efficacy (acellular pertussis
vaccines licensed in 1991 for 4th/5th doses; entire series in 1996)
Waning of vaccine-induced immunity and lack of natural booster events
General availability of better laboratory tests Greater awareness of pertussis by clinicians
![Page 80: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/80.jpg)
http://www.doh.wa.gov/PHIP/products/phi/indicator.htm
![Page 81: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/81.jpg)
PERTUSSIS IN CALIFORNIA 1950-2010
![Page 82: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/82.jpg)
![Page 83: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/83.jpg)
PERTUSSIS INCIDENCE BY AGE -- CALIFORNIA, 2010
0
5
10
15
20
25
30
<1 1-6 7-9 10-18 19-64 65+age group
case
s pe
r 10
0,00
0
![Page 84: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/84.jpg)
PERTUSSIS COMPLICATIONS BY AGE*
*Cases reported to CDC 1997-2000 (N=28,187)
0
10
20
30
40
50
60
<1 1-4 5-14 15-24 >25Age group (years)
Rat
e pe
r 100
,000
pop
ulat
ion
![Page 85: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/85.jpg)
![Page 86: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/86.jpg)
PERTUSSIS INCIDENCE BY AGE GROUP (EXCLUDING INFANTS), CALIFORNIA 2005-10-- CALIFORNIA, 2005-2010
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010year
case
s pe
r 10
0,00
0
1-6
7-10
11-18
19-64
65+
All ages
![Page 87: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/87.jpg)
![Page 88: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/88.jpg)
![Page 89: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/89.jpg)
STANDARD TDAP/DTAP RECOMMENDATIONS
DTap for children at 2, 4, 6, & 15‐18 monthswith a booster at 4‐6 years Tdap for adolescents at 11‐17 years Tdap for adults 18‐64 years Tdap for all household contacts &
caregivers ofinfants; especially post‐partum mothers
Tdap should replace one dose of Td
![Page 90: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/90.jpg)
Promote the use of Tdap - particularly in those who have contact with infants Postpartum Tdap policies (standing orders for Tdap
postpartum); encourage ED use of Tdap instead of Td Tdap for grandparents, daycares, caregivers, HCW’s! Work with payers re: Tdap reimbursement
Clinician education Tdap recommendations Pertussis signs and symptoms: if you’re testing,
TREAT Exclude immediately; once antibiotic started for
a minimum of 5 days (7days in HCW’s)!Public education
Vaccination/cocooning Limitation of visits Pertussis signs and symptoms Keep ill people away from infants
PERTUSSIS MITIGATION
![Page 91: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/91.jpg)
ALTERNATIVE MITIGATION VIA VACCINATION (NOT ACIP /CDC)
Tdap workplace requirement:L&D, PEDI, daycares Off-label Tdap use:
>65 years old (very likely to be approved by ACIP late October 2010)
<10 years old (7-9 y.o.; possibly to be endorsed by ACIP with VFC annotation)
Use in pregnancy (not a contraindication, but category C; little to no risk with inactivated vaccine; important in local outbreaks or when working with children /adolescents)
DTaP changes Starting as early as 6 weeks of age, and accelerate Adding another shot at 6 y.o. (not just 4-6 range)
![Page 92: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/92.jpg)
PERTUSSIS: WHO SHOULD BE TESTED? Patients of any age with cough >2
weeks. Patients with respiratory illness of
any duration who are contacts to a pertussis or to persons with prolonged cough illness.
Infants <12 months old with any respiratory symptoms of any duration, even those immunized against pertussis or test positive for RSV.
![Page 93: 2010 Grant County Public Health Potpourri](https://reader037.fdocuments.net/reader037/viewer/2022110215/56816500550346895dd76d45/html5/thumbnails/93.jpg)