Local Updates in Vaccine-Preventable Diseases

Anna HalloranEpidemiologist

Spokane Regional Health DistrictFebruary 2016

Overview

Pertussis: Local Increase in CasesFlu Season 2015-16New Varicella Vaccine RequirementsZika Virus Vaccine DevelopmentMiscellaneous Updates

PERTUSSISLocal increase in cases

Pertussis: Increase in CasesBackground• Highest incidence occurred in 1934, rate of 162/100,000• By the late 1970s, only 1,000 cases per year nationwide• Statewide epidemic in 2012, rate of 73/100,000• Highest incidence in infants (428/100,000)• Elevated in 13 and 14 year olds (rates of 342 and 336)• Nearly 80% of adolescent cases were up to date

Pertussis: Increase in Cases2015 situation• 1,402 cases reported in 2015 (compared to 601 in 2014)• Highest rates in Jefferson (105.8), Clark (77.6), Columbia

(72.3), and Walla Walla (62.1)• Overall incidence rate was 20.8/100,000; infant rate 117.5• 104 infants reported• 21 hospitalized (76% of hospitalized were 3 months

of age or younger)• Spokane had 44 confirmed cases, overall rate 9.4/100,000

Recent Pertussis Activity by County

Pertussis: Current Local SnapshotSpokane County 2016 YTD

• Outbreak at St. Thomas More school - current• Nine cases in students• Control measures: ill students isolated, prophy for

family members, exposure letters sent home to parents, prophy instructions for some students

• Fourteen cases reported in January, 3 to date in February• Ages 1-41

FLU 2015-16

Influenza 2015-16: Low low low

Influenza 2014-15: Comparison

0-4 5-17 18-49 50-64 65+0

50

100

150

200

250

300

2014-15 Hospitalizations for Flu in Spokane County

Flu BFlu A

Patient Age

Patie

nt C

ount

Influenza 2014-15: Comparison

Sep Oct Nov Dec Jan Feb Mar Apr May Jun0

50

100

150

200

250

2014-15 Flu Hospitalization Epi Curve for Spokane County

Flu BFlu A

Month of Admission

Num

ber o

f Pati

ents

Influenza Hospitalizations by Season

2014-15: 402 hospitalizations, 17 deaths (state – 150 deaths)2013-14: 183 hospitalizations, 8 deaths (state – 79 deaths)2012-13: 152 hospitalizations, 2 deaths (state – 54 deaths)2011-12: 118 hospitalizations, 3 deaths (state – 11 deaths)

Sep Oct Nov Dec Jan Feb Mar Apr May Jun July0

50

100

150

200

250

Influenza Hospitalizations for Spokane County

2015-162014-152013-142012-132011-12

Num

ber o

f Hos

pita

lizati

ons

A Reminder About Flu’s Seriousness

Kitsap County reported a pediatric flu death in an otherwise healthy school-aged child in January

NEW VARICELLA VACCINE REQUIREMENTS

New Varicella Vaccine RequirementsWAC 246-105-090

• K-12: two doses received on or after the child’s first birthday and at least 28 days apart, or

• Provider diagnosis or verification of a history of varicella disease or herpes zoster*, or

• Serologic proof of immunity, or• Certificate of exemption for a medical, religious or

personal reason

Protects teens who are at higher risk of complications from varicella

* As of September 1, 2014, parent report of illness is no longer acceptable

HOT TOPICS: ZIKA VIRUS

What is Zika Virus?• Mosquito-borne virus• Symptoms are fever, rash, joint pain, and conjunctivitis

(however, only 1 in 5 infected become ill)• Mild illness• Transmitted via Aedes mosquitoes – the same

mosquitoes that spread chikungunya and dengue• Also mother to baby

• No vaccine, treatment

Zika Virus Outbreak• Prior to 2015, outbreaks in Africa, Southeast Asia, and

the Pacific Islands• First cases confirmed in Brazil in May 2015• Possible correlation between microcephaly (serious birth

defect), other poor pregnancy outcomes, and Guillain Barre Syndrome

• In January 2016, CDC recommended postponing travel to Zika outbreak areas for pregnant women or women trying to become pregnant

Countries with Active Zika Virus Transmission

Approximate Distribution of Aedes Mosquitoes in the US

Zika Vaccine Development• Two vaccine makers, Sanofi Pasteur and NewLink

Genetics, announced efforts to develop vaccines• Sanofi Pasteur already has licensed vaccines for

flaviviruses such as dengue• Other small biotech companies have also announced

plans to develop a vaccine• Two key prospects that won’t be available for several

years – some experts predict it will take 5-15 years

MISCELLANEOUS UPDATES

SRHD Update• Dr. Joel McCullough, Health Officer, leaving SRHD for

position with Providence• Last day is February 16, though will be our interim Health

Officer for limited activities until replacement is found• New role in overseeing epidemiology and community

health efforts at Providence

New HPV Vaccine• Gardasil 9 (Merck) granted FDA approval in December• Indicated in females 9 through 26 years of age and males

aged • Types of HPV prevented: 6, 11, 16, 18, 31, 33, 45, 52, 58

(new)• No recommendation to re-vaccinate those who were

vaccine with the quadrivalent; however, those who choose to be vaccinated with the 9 can proceed and VFC will cover the cost

Anna Halloranahalloran@srhd.org509-324-1655