Disease Trends and Events in Idaho

*

Christine Hahn, MD10/23/2015

Syphilis outbreak, Treasure Valley

Ebola preparations

Assessment Hospitals prepared to receive and isolate a Person under Investigation for Ebola

Virus Disease (EVD)

decision on which hospitals to designate will be made between state and local health authorities and the hospital administration

prepared to transport patients with confirmed EVD to an Ebola treatment center, informed by discussions among public health authorities and referring and accepting physicians on a case-by-case basis

should be able to provide up to 96 hours of evaluation and care until the diagnosis is either confirmed or ruled out and discharge or transfer is completed

Source: http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html

Idaho: progress to date Dec 11, 2014– survey sent to all Idaho acute care hospitals

Sent to CEO, COO and CNO level staff, asked for the survey to be completed by December 26

12 hospitals indicated interest initially; now 7

CDC site visit August 3-5

CDC Team

Results and Next Steps

Visits were very productive and well received

Both hospitals are considered assessment hospitals for planning purposes, although a few gaps remain (eg, laboratory protocols)

Additional hospitals are being contacted to determine interest in visit by Idaho team

Tularemia gram negative coccobacillus, Francisella tularensis, causes infection naturally found in animals, especially rodents, rabbits, and hares transmitted by multiple routes to humans:

– tick bite– deer fly bite (“deer fly fever”)– skinning infected rabbits (“rabbit fever”), muskrats, prairie dogs and other rodents– handling sick cats, pet hamster– eating under-cooked meat of infected animals– inhaling dust or aerosols during farming or landscaping activities, especially when

machinery (e.g. tractors or mowers) runs over infected animals or carcasses– drinking contaminated water (rare in US)

risk to laboratorians

Idaho tularemia 2015

9/2015, Valley County: – 77-yr old male– Patient reported possible yellow jacket sting on lower leg

but did not see it– MRSA suspected in leg ulcer– 3 laboratorians received prophylaxis

10/17/2015, Twin Falls County: – 79-yr old male– Finger wound that appeared infected– Patient reported gardening, possible puncture by thorn

Tularemia … a long recognized hazard to laboratorians

Source: Public Health Reports, Feb 24, 1922

Tularemia exposure to laboratorians

Lab personnel should be informed if tularemia is suspected clinically

BSL-2 practices recommended for handling clinical materials BSL-3 practices recommended for manipulations of positive

cultures Francisella tularensis is a Select Agent; notify public health of

suspected isolations even before confirmed if possible

Highly Pathogenic Avian Influenza outbreaks in the United States

Designation of highly pathogenic avian influenza (HPAI) is based on molecular characteristics of the virus and the ability of the virus to cause disease and mortality in chickens in a laboratory setting.

Between 1997 and 2014, the U.S. experienced one incident of HPAI in poultry.– 2004: H5N2 in Texas

• An outbreak of HPAI (H5N2) virus was reported in a flock of 7,000 chickens in south-central Texas.

• At that time, this was the first outbreak of HPAI in the United States in 20 years.

• No transmission to humans was reported.

Highly Pathogenic Avian Influenza (HPAI) 2015

Idaho Summer Preparedness Summit 2015

Kris Carter, DVM, MPVMCareer Epidemiology Field Officer

IDHW DPH

Initial noticeMay 19: Idaho Dept. of Fish and Game (IDFG) wildlife veterinarian informs IDHW DPH State Public Health Veterinarian about several ground squirrel mortality events

– earliest report May 12– several locations in Snake

River Birds of Prey National Conservation Area south of Boise

– IDFG sent specimens to CDC for testing for plague

Source: EID 2015: Jan; 21 (1): 16-22

Epidemiology of Plague in Western US: 1970-2009

Source: USGS Circular 1372

Confirmation

• May 20 — CDC reports carcasses are presumptive positive for Yersinia pestis by direct fluorescent antibody (DFA) test on tissue

• May 22 — CDC confirmed Yersinia pestis by bacterial culture

Source: CDC Public Health Image Library

Informing the Public: Posting

Informing the Public: Websites

Vaccine news 2015

HPV news 2015

Idaho and U.S.-- HPV

HPV – dose reduction coming?

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Influenza Vaccine Recommendations, 2015-2016

Influenza Vaccine Recommendations, 2015-2016

• Routine annual influenza vaccination is recommended for all persons age 6 months and older who do not have a contraindication

• Special effort should be made to vaccinate- infants and young children and their

contacts- persons age 65 years and older and their

contacts- persons with underlying medical

conditions (including pregnancy) and their contacts

- healthcare providers

• Routine annual influenza vaccination is recommended for all persons age 6 months and older who do not have a contraindication

• Special effort should be made to vaccinate- infants and young children and their

contacts- persons age 65 years and older and their

contacts- persons with underlying medical

conditions (including pregnancy) and their contacts

- healthcare providers

MMWR 2015;64:818-25

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What’s New for Influenza 2015-2016What’s New for Influenza 2015-2016

• H3N2 and B virus strains changed

• New vaccines (Flublok age now 18+ years, Fluzone Intradermal now quadrivalent)

• Removal of preference for LAIV for children 2 through 8 years of age

• H3N2 and B virus strains changed

• New vaccines (Flublok age now 18+ years, Fluzone Intradermal now quadrivalent)

• Removal of preference for LAIV for children 2 through 8 years of age

MMWR 2015;64:818-25

35

Fluzone High-DoseFluzone High-Dose

• Available since December 2009• Trivalent formulation only• Contains 4 X amount of influenza

antigen than regular Fluzone• Approved only for persons 65 years

and older• Produces higher antibody levels• Local reactions more frequent than

with standard dose vaccine

• Available since December 2009• Trivalent formulation only• Contains 4 X amount of influenza

antigen than regular Fluzone• Approved only for persons 65 years

and older• Produces higher antibody levels• Local reactions more frequent than

with standard dose vaccine

MMWR 2011;60:1128-32

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Fluzone High Dose Clinical TrialFluzone High Dose Clinical Trial

• Multi-center randomized clinical trial

• 32,000 persons 65 years or older

• Compared to standard Fluzone- 24.2% reduction in laboratory-

confirmed influenza- effective against both influenza A

and B- reduction in risk of pneumonia and

hospitalization

• Multi-center randomized clinical trial

• 32,000 persons 65 years or older

• Compared to standard Fluzone- 24.2% reduction in laboratory-

confirmed influenza- effective against both influenza A

and B- reduction in risk of pneumonia and

hospitalization

N Engl J Med 2014;371:635-45

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Adult Immunization Coverage Rates 2010 - 2013 Adult Immunization Coverage Rates 2010 - 2013

Zoster, age ≥60

Pneumococcal, age 19-64 at high risk

Pneumococcal, age ≥65

Tetanus past 10y, age 19-64

Tetanus past 10y, age ≥65

0 10 20 30 40 50 60 70 80 90 100

2013201220112010

Source: National Health Interview Surveys : Healthy People 2020 target

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Pneumococcal Conjugate Vaccine (PCV13) and Adults

Pneumococcal Conjugate Vaccine (PCV13) and Adults

• FDA approved PCV13 for use among adults 50 years of age and older in December 2011

• Immunogenicity of PCV13 was found to be non-inferior to PPSV23

• ACIP recommended 1 dose of PCV13 for adults at high risk of invasive pneumococcal disease* in October 2012

• FDA approved PCV13 for use among adults 50 years of age and older in December 2011

• Immunogenicity of PCV13 was found to be non-inferior to PPSV23

• ACIP recommended 1 dose of PCV13 for adults at high risk of invasive pneumococcal disease* in October 2012

*immunocompromised, functional or anatomic asplenia, cochlear implant, CSF leak

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Pneumococcal Vaccines for Persons Age 65 Years and Older

Pneumococcal Vaccines for Persons Age 65 Years and Older

• One lifetime dose of PCV13 for adults

• PCV13 and PPSV23 should NOT be administered at the same visit

• Administer PCV13 before PPSV23, whenever possible

• PCV13 should be administered to those who have already received PPSV23

• One lifetime dose of PCV13 for adults

• PCV13 and PPSV23 should NOT be administered at the same visit

• Administer PCV13 before PPSV23, whenever possible

• PCV13 should be administered to those who have already received PPSV23

MMWR 2014;63(No. 37):822-5

Pneumococcal vaccination for seniors

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6434a4.htm

4242

Meningococcal Incidence in Adolescents and Young Adults by Serogroup, 2009–2013

Meningococcal Incidence in Adolescents and Young Adults by Serogroup, 2009–2013

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 260.0

0.1

0.2

0.3Serogroup B Serogroups C & Y

Age (years)

Inci

den

ce p

er 1

00,0

00

Source: NNDSS data supplemented with additional serogroup data from ABCs and state health departmentsSource: NNDSS data supplemented with additional serogroup data from ABCs and state health departments

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Groups at Increased Risk for Meningococcal B Disease

Groups at Increased Risk for Meningococcal B Disease

• High-risk medical conditions: - persistent complement component

deficiencies- functional or anatomic asplenia

• Certain microbiologists

• Populations at risk during an outbreak

• NOT at increased risk: international travelers, first year college students

• High-risk medical conditions: - persistent complement component

deficiencies- functional or anatomic asplenia

• Certain microbiologists

• Populations at risk during an outbreak

• NOT at increased risk: international travelers, first year college students

CDC unpublished data

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ACIP Recommendations for Meningococcal B Vaccine of High Risk Persons

ACIP Recommendations for Meningococcal B Vaccine of High Risk Persons

• Certain persons 10 years of age or older* who are at increased risk for meningococcal disease should receive MenB vaccine

- persistent complement component deficiency

- anatomic or functional asplenia

- risk in a serogroup B meningococcal disease outbreak

- certain microbiologists

• MenB vaccines are included in VFC

• NOT routinely recommended for college students or international travelers

• Certain persons 10 years of age or older* who are at increased risk for meningococcal disease should receive MenB vaccine

- persistent complement component deficiency

- anatomic or functional asplenia

- risk in a serogroup B meningococcal disease outbreak

- certain microbiologists

• MenB vaccines are included in VFC

• NOT routinely recommended for college students or international travelers

*off-label for persons 26 years and older. MMWR 2015;64:608-12

“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”

Bexsero® (MenB-4C, 2 doses) and Trumenba® (MenB-FHbp, 3 doses) are both licensed. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses.

MenB-FHbp or MenB-4C may be administered concomitantly with other vaccines indicated for this age, but at a different anatomic site, if feasible.

7698 participants received the vaccine; 7713 participants got placebo Mean follow-up of 3.2 years Herpes zoster in 6 participants in the vaccine group; 210 participants in the

placebo group Overall vaccine efficacy against herpes zoster was 97.2% (95% confidence

interval [CI], 93.7 to 99.0; P<0.001).

Source: http://www.nejm.org/doi/full/10.1056/NEJMoa1501184

News from ACIP this week Influenza activity very low right now; over the summer, H3N2 predominated

Supply: 171-179 million doses of flu vaccine expected to be available; last 147.8 million were distributed. So far, 109.4 million have been distributed, similarly to last year.

Fluzone and FluZone High Dose distribution complete, other than prefilled syringes but expected to be complete by November

FluMist distribution ongoing but delayed

News from ACIP this week Early data showing impact of HPV vaccination

Early results of CDC Ebola vaccine trial

This week Investigations by local public health district epidemiologists at PHD3

and PHD4 of 4 campylobacter cases and 4 STEC cases, including two hospitalized patients

Raw milk consumption linked to illnesses

Thank You!