Transcript Immunization Update

Influenza-like Illness Visits
& Influenza Labs
as of December 10, 2012
Percent of Flu Doses Administered
by Public and Private Sectors, Virginia
Influenza Season 2012-13
Source: VIIS and WebVISION data through week ending 12/7/2012, as of 12/11/2012.
• Doses given by the private sector reflect private sector participation in VIIS.
U.S. Influenza Vaccine Virus Strains,
2012-2013
Changes in the A(H3N2) and B strains, compared with last
season’s vaccine:
• A/Victoria/361/2011 (H3N2)- replaces
A/Perth/16/2009
• B/Wisconsin/1/2010 -Yamagata lineage; replaces
previous Victoria lineage (B/Brisbane/60/2008)
Same: A/California/7/2009 (H1N1)pdm09
• This strain was in in the 2009 monovalent vaccine
and the 2010-2011 and 2011-2012 seasonal vaccines
Vaccines Available for 2012-2013
No new vaccine products anticipated this season
Options similar to last season:
• Trivalent inactivated vaccine (TIV/traditional shot) - 6
mos. and older
• High dose TIV - 65 yrs. and over
• Intradermal TIV - 18 through 64 yrs.
• LAIV - healthy, non-pregnant persons 2 through 49 yrs.
Influenza Vaccination Recommendations
• Everyone 6 months of age and older is
recommended to get the flu vaccine
every year
• Children 6 months - 8 years of age require 2
doses (administered 4 weeks apart) their
first season of vaccination
• Vaccination is especially important for
people at higher risk of serious influenza
complications, or people who live with or
care for them
Seasonal Flu Surveillance
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ED/urgent care visits for influenza-like illness (ILI)
Laboratory surveillance
Sentinel physicians; DFA/PCR/culture by labs
Influenza Incidence Surveillance Project (IISP)
Weekly activity level reporting (Oct – May)
Outbreaks
School absenteeism
Influenza-associated pediatric deaths
Novel Influenza Surveillance
Districts notified of any
suspect novel influenza
occurrences should
contact DSI immediately.
• Notify Regional Epi
• Novel influenza cases are
reportable in VA
• Special case report form
• Submit specimens for
testing; alert DCLS that a
novel virus is suspected
Novel Influenza Surveillance: H3N2v
Enhanced surveillance for cases of H3N2v this season
Patients meeting both of the following criteria should be
tested:
• Fever with cough and/or sore throat (usual ILI definition)
• Direct contact with swine within the 7 days preceding onset OR
an epidemiologic link to a confirmed case of influenza A H3N2v
infection
If provider interested in testing and/or patient meets
criteria:
• Ask provider to collect NP swab, place in viral transport media
(or provide a DCLS flu test kit to them) and complete DCLS
specimen submission form
• Note outbreak ID: RES989H3N2vSurv12 on the DCLS form
• Confer with DSI, through regional epidemiologist to be sure there
is agreement patient warrants testing and ensure that DCLS
knows a specimen is on the way
• Submit the specimen to DCLS
West Nile Virus (WNV) Update
• Nationwide WNV disease activity is greater than it has
been since the mid 2000s
• As of Dec. 10th, WNV disease has been reported in 29
Virginians from all five health regions of the state
• Three WNV-related deaths in Virginia
• Neuroinvasive disease reported in 21/29 (72%)
• Last year, 9 reports of WNV disease in Virginians
• For 2006 to 2010, 1-5 WNV reports annually
• Best way to avoid WNV is to prevent mosquito bites
• Use insect repellent, consider staying indoors during
dusk and dawn, use good screens on windows, empty
containers/pools with standing water
Other Human Arbovirus Activity, 2012
• Eastern Equine Encephalitis (EEE) reported in one
Virginian
• Portsmouth HD
• Not a death
• First human case of EEE reported in Virginia since
2003
• La Crosse Encephalitis (LAC) reported in two Virginians
• Both Lenowisco HD
• No deaths
• Virginia reported one case of LAC disease in 2011 and
two cases in 2008
Fungal Meningitis Investigation –
First Steps
• Notified by CDC on evening of September 29, 2012 of
cases of fungal meningitis potentially associated with
exposure to contaminated epidural steroid injections
• Steroids were from three recalled lots of product
manufactured by the New England Compounding Center
• Two locations received these products in Virginia – New
River Valley Surgery Center and Insight Imaging Roanoke
• Facilities gave VDH patient lists so that each could be
contacted to inform them of their potential exposure and
ask about symptoms. Facilities also contacted patients
themselves.
• Letter sent to SW physicians on October 1.
Fungal Meningitis Investigation –
Two Key Categories of Response
• Surveillance of Exposed
• 680 exposed to recalled lots of MPA in VA facilities
• ~95% at Roanoke facility
• Reside in 10 VA health districts plus 4 other states
• Health departments called weekly unless the person
under doctor’s continuing care for this outbreak
• Case Finding and Reporting
• 51 cases, 2 deaths as of December 10, 2012
• Median age 64 years; all hospitalized
• Working closely with hospitals – infectious disease
specialists, laboratories, infection prevention
Fungal Infections among Patients Exposed in Virginia by Date of Onset
(as of December 10, 2012, n=51)
Number of Cases
6
5
4
3
2
1
0
Date of Initial Symptom Onset
Fungal Meningitis Investigation –
Key Public Health Activities
• Coordination and communication
• Local, state, and federal health agencies
• Public health and clinical community
• Local health department surveillance and case
reporting
• Regional/central office epidemiologists compiling &
verifying detailed information, working with DCLS, and
reporting to CDC
• Central office staff deployed to the region
• CDC Epi-Aid deployed to Virginia – clinical assessment
• Clinician letters and conference calls