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 2012-2013No new vaccine products anticipated this seasonOptions 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

• 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 seasonPatients 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)

7/29

/12

8/5/

12

8/12

/12

8/19

/12

8/26

/12

9/2/

12

9/9/

12

9/16

/12

9/23

/12

9/30

/12

10/7

/12

10/1

4/12

10/2

1/12

10/2

8/12

11/4

/12

11/1

1/12

0

1

2

3

4

5

6

Date of Initial Symptom Onset

Nu

mb

er

of

Cases

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