Emerging Infections of Concern

Health and Human Resources SubpanelGovernor’s Secure Commonwealth Initiative

March 2015

INFLUENZA

Influenza Vaccine

• WHO recommends that influenza vaccines for use in the 2015-2016 northern hemisphere influenza season contain the following: – an A/California/7/2009 (H1N1)pdm09-like virus,

which is the same as 2014-2015– an A/Switzerland/9715293/2013 (H3N2)-like virus,

which is different from 2014-2015– a B/Phuket/3073/2013-like virus, which is

different from 2014-2015

Influenza Vaccine

• Early estimates (January 2015) of vaccine effectiveness (VE) indicated that vaccination reduced a person’s risk of having to go to the doctor for flu illness by 23% across all ages.

• In late February, updated estimates indicated that VE was 18%.

• VE against influenza B viruses was 45%.

Highly Pathogenic Avian Influenza H5

• Federal agencies continue to detect and report the presence of highly pathogenic avian influenza (HPAI) H5 viruses in US domestic poultry, captive wild birds, and wild birds.

• No human infections with these viruses have been reported worldwide; however, genetically similar viruses have infected people in the past

Measles• Highly contagious• Can cause serious health

complications• Prior to vaccination programs

in the US, 3-4 million people in the US got measles each year.

• Measles was declared eliminated from the US in 2000

• Measles is still commonly transmitted in many parts of the world.

Measles in Virginia

• There have been no cases of measles in 2015 to date.

• In previous seasons:– 2011: 7 cases– 2012: 0– 2013: 0– 2014: 2

• 88.6% of children in Virginia ages 19-35 months received 1 dose of MMR (2013, NIS)

• The HP2020 goal is 90%

Measles in the United States, 2015

•170 cases reported from 17 states

•125 (74%) considered to be part of California amusement park outbreak

•Outbreaks•California – 125 cases•Illinois – 15 cases•Nevada – 8 cases•Washington – 7 cases

These 4 outbreaks represent 89% of the cases reported in 2015.

U.S. Multi-state Measles OutbreakDecember 28, 2014 – February 27, 2015

State Case Count*

Arizona 7

California 124

Colorado 1

Nebraska 2

Oregon 1

Utah 3

Washington 2

Total 140

*Provisional data reported to CDC’s National Center for Immunization and Respiratory DiseasesSource: http://www.cdc.gov/measles/multi-state-outbreak.html

Impact of US Measles Outbreak in Virginia• There have been NO measles cases in Virginia linked to this US Outbreak• Heightened Concern

• Providers• Public• Facilities

• Information Requests• Data• Materials to help answer questions• Clinician’s Letter distributed on Feb 13, 2015

• Other Health Department Activities• Investigation of suspected cases• 20% increase in MMR doses administered

MERS-CoV• MERS CoV: Middle East Respiratory Syndrome coronavirus-

– Presents a very LOW risk to general public in the US– As of January 23, 2015, WHO has confirmed 956 laboratory-

confirmed cases of MERS-CoV infection, which include at least 351 deaths.

– All reported cases have been directly or indirectly linked through travel or residence to nine countries: Saudi Arabia, the United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Yemen, Lebanon, and Iran.

– In the United States, two patients tested positive for MERS-CoV in May 2014, each of whom had a history of fever and one or more respiratory symptoms after recent travel from Saudi Arabia (2).

– No further cases have been reported in the United States despite nationwide surveillance and the testing of 514 patients from 45 states to date.

Ebola – Cumulative Cases through

03/18/15

Mar-14

Mar-14

Mar-14

Apr-14

Apr-14

May-14

May-14

May-14

Jun-14

Jun-14Jul-1

4Jul-1

4

Aug-14

Aug-14

Aug-14

Sep-14

Sep-14

Oct-14

Oct-14

Nov-14

Nov-14

Nov-14

Dec-14

Dec-14Jan

-15Jan

-15

Feb-15

Feb-15

Feb-15

Mar-15

0

2000

4000

6000

8000

10000

12000

14000

Total Cases, GuineaTotal Cases, LiberiaTotal Cases, Sierra Leone

Confirmed weekly Ebola virus disease cases reported from Sierra Leone (WHO)

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% children in kindergarten who have been exempted from 1+ vaccinesUS 2013-2014 School Year

Ebola – Virginia Traveler Active Monitoring

Risk Category Num %Low but not zero risk 752 97.9Some risk 15 2.0High risk 1 0.1

Travelers entered Virginia’s active monitoring program between 10/27/2014 and 3/22/2015

Current Status Num %

Completed monitoring 492 64.1

Transferred out 185 24.1

Released from monitoring 7 0.9

Under monitoring (as of 2/28/15) 84 10.9

659

3833 33 3

Health Planning Region*

Northern Northwest Eastern

Central Southwest

768

*2 travelers were transferred out of Virginia prior to being assigned to a region/health district