Epidemiology Update HEALTH AND HUMAN RESOURCES SUB-PANEL, - PowerPoint Presentation

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Epidemiology Update

HEALTH AND HUMAN RESOURCES SUB-PANEL,

GOVERNOR’S

SECURE COMMONWEALTH

INITIATIVE

October 16, 2017

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Epidemiology Updates

Influenza/Respiratory Conditions

Opioid Indicators

Viral Hepatitis

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Influenza

Influenza season is typically defined as early October to mid-May (

MMWR

weeks 40 to 20)

2017-2018: reporting starts October 1, 2017

Influenza activity usually peaks in January or February in VirginiaVirginia conducts surveillance year-roundWeekly activity level relies on three data sources:Influenza-like illness (ILI) visits to healthcare providersViral laboratory specimens (DFA, PCR, and/or culture)Outbreaks

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Why Conduct Influenza Surveillance?

Determine which, when, and where influenza viruses are circulating

Determine intensity and impact of influenza activity

Detect unusual events

Infection by unusual viruses

Unusual syndromes caused by influenza virusesUnusually large/severe outbreaksGoal: build a system that is useful on the local level and builds up to national level surveillance4

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Data Sources

Influenza-like illness (ILI) data

Electronic data feeds from hospital emergency departments (ED) and urgent care (UC) facilities

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facilities reporting data dailyUses chief complaint (free text)ILI case definition: Fever with cough and/or sore throatLaboratory reportsLab specimens collected through sentinel sites and other providersConfirmatory labs (e.g., PCR, DFA, culture)Summary counts of rapid tests

Results of laboratory specimens are entered into VEDSS

Electronic laboratory reports (

ELRs

) into VEDSS

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Positive Specimens by Type;

A Comparison of VA and US: 2016-2017 Influenza Season

Subtype

Virginia

US

Influenza A

80%

78%

H3N2

69%

97%

2009 H1N1

2%

3%

H1

1%

--

Subtyping Not Performed

28%

--Influenza B20%22%

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Flu Near You

Participatory disease surveillance system for ILI

symptoms

Users

report their health information using a brief weekly survey

Also features a “Vaccine Finder” toolGenerate early signal of ILI Provide insights to the public and stakeholders

www.flunearyou.org

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Posted on VDH flu surveillance website:

http://www.vdh.virginia.gov/epidemiology/influenza-flu-in-virginia/influenza-surveillance/

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Novel Influenza Viruses & Terminology

Novel influenza A virus infection

:

Human infection

with any influenza A virus different from current seasonal influenza A viruses

Variant influenza virus: Human infection with a swine-origin influenza virusAbbreviated with a lower case “v” following subtype (e.g., H3N2v, H1N1v, H1N2v)Avian influenza virus: Human infection with an avian-origin influenza A virusOnly swine-origin and avian-origin influenza A viruses have been identified in humans globally

Canine, equine, and other non-human animal influenza viruses have not been identified in humans

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Avian Influenza

Avian influenza (AI) is a disease of birds caused by influenza type A viruses that can infect poultry and can be found in waterfowl

Designated as highly pathogenic (HPAI) or low pathogenic avian influenza (LPAI) due to ability to cause disease in chickens

Although these viruses usually do not infect humans, rare cases of human infection have been reported

Human infections with HPAI or LPAI viruses have resulted in a wide range of illness, from mild to fatal

VDH Avian Influenza Response Plan

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Avian Influenza (H5N2) Update

Avian influenza (H5N2) detected in wild mallard duck in Montana in January 2017

Part of on-going, routine surveillance for avian influenza viruses

No human infections or mortality among domestic poultry associated with this finding

This strain is similar to the H5N2 strain associated with the multistate outbreak of HPAI in the U.S. in 2014-15

This was the first state to report HPAI in 2017The risk to the public from these H5 HPAI infections is low; no human infections have occurred in the U.S.

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Avian Influenza (H7N9) Update

March 5, 2017– USDA/APHIS reported detection of highly pathogenic avian influenza (HPAI) A virus in commercial chicken flock in Lincoln County, Tennessee

Identified as H7N9, but

not

the same as the China H7N9 virus

Low-pathogenic H7N9 found on second Tennessee farm and other southeastern states (AL, GA, KY) No human illnesses in US; no avian cases in VAPossible exposures can occur during depopulation, disposal, decontamination activities Medical monitoring for 10 days post-exposureAntivirals may be usedVDH subject matter expert: Dr. Karen Gruszynski

http://www.cdc.gov/flu/avianflu/guidance-exposed-persons.htm

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H3N2v Update

On May 5, 2017, CDC reported a human infection with a novel

influenza virus

Occurred in child in Texas who was not hospitalized; recovered

Exposure to swine was reported at an agricultural event in week preceding illness onset

September 2017: H3N2v detected in Maryland residents who reported close contacts with pigs at agricultural fairsAs of October 4, 2017 : 40 presumptive positive and confirmed cases in this Maryland clusterSince August 2011: 365 cases identified in U.S. 3 cases in 2015 (MI, MN, NJ)18 cases in 2016 (MI, OH)

1 case in 2017 (TX)

1 case with VA exposure in 2013

Associated with exposure to swine at agricultural fairs

Case

Counts:

http://www.cdc.gov/flu/swineflu/variant-cases-us.htm

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Take home message

Influenza surveillance

Importance of provider awareness and prompt reporting

Adherence to prevention strategies

Vaccination!

Stay home when you’re sickWash your handsAdherence to infection control

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MERS-

CoV

“Camel Flu”

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Middle East Respiratory Syndrome (MERS-CoV

)

Viral respiratory illness

First reported in Saudi Arabia in 2012

Linked to countries in and near the Arabian Peninsula

Caused by a coronavirusSevere acute respiratory illnessFever, cough, sore throat, chest pain, and shortness of breathApproximately 30-40% of patients with confirmed MERS-CoV infection have died

Two imported cases identified in U.S.

Travel history to Saudi Arabia

Two cases not linked

Indiana, Florida

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MERS-CoV Testing Criteria

Severe illness: Fever

AND

pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence) with history of any of the following exposures

Travel to Arabian Peninsula within 14 days of symptom onset or close contact with symptomatic traveler

History of being in a healthcare facility in the Republic of Korea within 14 days of symptom onsetMember of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated

Mild illness:

Fever AND symptoms of respiratory illness with history of being in a healthcare facility in the Arabian Peninsula within 14 days

Fever OR symptoms of respiratory illness with history of close contact with a MERS case

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Opioid Indicators and Viral Hepatitis

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Opioid Indicators Dashboard

2017 Governor’s Technology Award

Initially created in response to the Comprehensive Harm Reduction Legislation A platform for the public and health professionals to find data related to the opioid epidemic

Data included in the dashboard: HIV, HCV, Neonatal Abstinence Syndrome (NAS), Overdose data, EMS

Narcan

administration and Emergency Department data.Trends by year and age group State, Region, District, and Locality level dataOpioid Addiction Indicators Dashboard Link

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Opioid Prescriptions and Overdose Data

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State Summary

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Trends Over Time

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Rate Maps

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Hepatitis

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Rates of Newly Reported Acute and Past or Present HCV,

by County, Virginia, 2010 and 2016

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Incidence of Chronic HBV and HCV Infections

Virginia, 2010-2016

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Percentage of Past or Present HCV Cases by Age Group,

Virginia, 2010-2016

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Percentage of Past or Present HCV Cases by Age Group,

Virginia, 2010-2016

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Percentage of Past and Present HCV Cases, Persons 18-29 Years of Age, Appalachian* vs. non-Appalachian, 2010-2016

*based on event date

*Alleghany, Bath, Bland, Botetourt, Buchanan, Carroll, Craig, Dickenson, Floyd, Giles, Grayson, Henry, Highland, Lee, Montgomery, Patrick, Pulaski, Rockbridge, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe, Bristol city, Buena Vista city, Covington city, Galax city, Lexington city, Martinsville city, Norton city, Radford city)

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HCV Cases* per 100,000 Persons Aged 18-29 by County (Appalachia** vs. Non-Appalachia), Virginia 2006-2015

Year

Appalachia

(rate per 100,000)

Non-Appalachia

(rate per 100,000)

Univariate Rate Ratio (95% CI)

2006-2010

48.0

8.2

5.79 (5.04-6.65)

2011-2015

96.1

21.6

4.44 (4.04-4.87)

2006-2015

72.1

14.9

4.81 (4.45-5.20)

*Excludes persons institutionalized at the time of diagnosis

**Alleghany, Bath, Bland, Botetourt, Buchanan, Carroll, Craig, Dickenson, Floyd, Giles, Grayson, Henry, Highland, Lee, Montgomery, Patrick, Pulaski, Rockbridge, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe, Bristol city, Buena Vista city, Covington city, Galax city, Lexington city, Martinsville city, Norton city, Radford city)

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VDH Testing Site Data

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Comprehensive Harm Reduction

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Acknowledgements

Division of Surveillance and Investigation

Sarah Fenno (former Influenza Surveillance Coordinator)

Division of Disease Prevention

VDH Addiction/Opioid Data Workgroup

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Extra Slides

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Influenza A (H3N2) Variant Virus

September 2017: H3N2v detected in Maryland residents who reported close contacts with pigs at agricultural fairs

As of October 4, 2017 : 40 presumptive positive and confirmed cases

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Sentinel Influenza Surveillance

Participating providers are asked to send up to 5 specimens/week to

DCLS

for viral isolation. Provides data to:

Help characterize the level of Influenza-like Illness (ILI) activity

Track the strains of influenza virus circulating in the stateMeasure the impact of influenza on morbidity and mortality in our communities

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Results of Sentinel Surveillance

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sentinel surveillance sites recruited to collect viral specimens during the 2016-2017 season

Represented 25 health districts

Goal: up to 5 specimens per week from each sentinel site

14 sites did not submit any specimens during the season745 sentinel specimens received

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Asian H7N9 “Bird Flu” in China

Human infections with avian influenza A(H7N9) viruses were first reported in China in March 2013

Annual increases in the number of human infections in China have occurred each winter since 2013 and are called “epidemics”

Most reported poultry exposure; no sustained person-to-person transmission

Cumulative number of human infections with Asian H7N9 viruses reported by WHO between 2013 and present: 1,486

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H7N9 in China Update

H7N9

Mainland China

Smaller numbers in travelers from Hong Kong, Taiwan, Malaysia, Canada

Most hospitalized

Most reported poultry contactNo sustained person-to-person transmissionNo cases detected in U.S.43

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H7N9 Testing Criteria

New onset of severe acute respiratory infection requiring hospitalization

Recent travel (within <10 days of illness onset) to areas where human cases of avian influenza A (H7N9) are present or to areas where avian influenza A (H7N9) viruses are known to be circulating in animals (China)

Preferred specimen: NP swab; nasal aspirate or nasal wash are suitable alternatives

For patients with lower respiratory tract illness, a lower respiratory tract specimen (e.g., an

endotracheal aspirate or bronchoalveolar lavage) is preferred

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Feline Influenza (H7N2) in NYC

Over 100 cats tested positive for H7N2 across all NYC animals shelters

Only one confirmed human infection was identified in the more than 300 individuals screened

V

eterinarian

with close and prolonged contact with sick catsIllness was very mild and the individual recovered completely This was the first reported case due to exposure from an infected catOnly two other H7N2 human cases (due to exposure from infected turkeys/chickens)  Risk to humans very low and no evidence that the outbreak affected Virginia in any way

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H3N2v Testing Criteria

ILI

Recent (within 7 days of illness onset) contact with swine or recent attendance at an event (such as an agricultural fair) where swine were present

Contact with swine may be direct contact (i.e., touching or handling a pig) or indirect contact (coming within about 6 feet (2 meters) of a pig without known direct contact).

Preferred specimen: NP swab; nasal aspirate or nasal wash are suitable alternatives

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MERS Person Under Investigation: Specimen Collection and Testing

Collect multiple specimens from different sites at different times after symptom onset, if possible.

Testing for

MERS-CoV

:

Lower respiratory tract specimen (sputum, tracheal aspirate, bronchoalveolar lavage, or pleural fluid), This is a priority specimen U

pper respiratory tract specimen

(combined NP/OP swab), AND

Blood/serum

are required

Collect respiratory specimens as soon as possible after symptoms begin

Ideally within 7 days and before antiviral medications are administered

Use appropriate infection control precautions

Consult with DSI and DCLS prior to specimen submission

Outbreak ID:

RES989MERSCOV17

http://www.dgs.state.va.us/DivisionofConsolidatedLaboratoryServices/HotTopics/tabid/1531/Default.aspx

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