Download The Year of Living Dangerously - Spokane Regional Health District

Hope is the thing with feathers—That perches in the soul—
And sings the tune without the words—And never stops—at all—
And sweetest—in the Gale—is heard—And sore must be the storm
That could abash the little Bird That kept so many warm—
I've heard it in the chillest land—And on the strangest Sea—
Yet, never, in Extremity, It asked a crumb—of me.
--Emily Dickinson, American Poet, 1830-1886
Communicable Disease News
March 2015
EDITOR: Dorothy MacEachern, MS, MPH
The Year of Living Dangerously
There is controversy about whether
the Surgeon General of the United
States (US) from 1965-1969, Dr.
William Stewart, ever uttered the
statement “it is time to close the book
on infectious diseases.” Infectious
diseases have long influenced the
course of history, and the present is
no exception. Advancements in
understanding as well as science and
technology are continually tested by
emerging and re-emerging agents of
disease.
Climate chaos resulting in habitat
change for many disease vectors,
availability of worldwide travel for
millions of earth inhabitants,
increasing interaction with exotic
environments and creatures, antibiotic
resistance, vaccine hesitancy/refusal,
providers being less familiar with
conditions long unseen, and
emergence of new viruses are among
the challenges to human health.
During the last six months, many
healthcare providers, along with the
Spokane Regional Health District
(SRHD) and government at all levels
have prepared for Ebola, influenza,
avian influenza, mumps, and measles,
in addition to our routine surveillance
of dozens of more common
infectious diseases. Middle Eastern
Respiratory Syndrome (MERS) has
danced in and out of our sights in the
last few years as well. A brief synopsis
of these diseases, dates when SRHD
first alerted the medical community,
and some of the significant
prevention/control efforts are
described here.
MERS –
First alert from SRHD sent on 3/8/2013;
primary effort was to generate awareness of
the condition in symptomatic travelers from
the Arabian Peninsula (AP).
MERS is caused by a corona virus,
aptly called MERS Coronavirus
(MERS-CoV), which affects the
respiratory system. Most MERS
patients develop severe acute
respiratory illness with symptoms of
fever, cough and shortness of breath.
About 3-4 out of every 10 patients
reported with MERS have died.
It is unclear exactly how people
become infected with this
coronavirus. MERS-CoV spreads
from ill people to others through
close contact, such as caring for or
living with an infected person, but
there is no evidence of sustained
spread in community settings. MERSCoV has also been found in some
camels, and some MERS patients
have reported contact with camels.
Of the 67 cases reported since the
beginning of February 2015, ten gave
a history of animal exposure, 18 gave
a history of contact with a case(s) in
the healthcare environment, five gave
a history of contact with a case(s) in
the community and 34 (51%) cases
did not have an identifiable high risk
exposure. Of note, 56/67 cases (84%)
had a history of pre-existing comorbidities.
Health officials first reported the
disease in Saudi Arabia in September
2012. Through retrospective
investigations, health officials later
identified cases of MERS which
occurred in Jordan in April 2012. So
far, all cases of MERS have been
linked to countries in and near the
AP. Countries on the AP that have
had cases are: Saudi Arabia, United
Arab Emirates, Qatar, Oman, Jordan,
Kuwait, Yemen, Lebanon and Iran.
Since MERS-CoV emerged, more
than 1,026 laboratory-confirmed cases
of MERS including at least 376 deaths
have been reported. More than 85%
of these have been occurred in Saudi
Arabia.
Ebola –
First alert sent from SRHD on
7/30/2014. Many materials for healthcare
providers as well as the public have been
developed and distributed since then.
Undoubtedly, Ebola takes top billing
for a disease which emerged rapidly
and created significant changes in the
manner in which public health as well
Spokane Regional Health District | Communicable Disease Epidemiology | 1101 West College Avenue,
Room 360 | Spokane, WA 99201-2095
PH (509) 324-1442 | TDD (509) 324-1464 | EMAIL [email protected]
Page 2
March 2015
as healthcare providers and
institutions approach infectious
disease. Ebola is an extremely
contagious virus that causes an acute,
often fatal hemorrhagic fever.
The 2014 Ebola epidemic is the
largest in history, affecting primarily
Guinea, Sierra Leone and Liberia in
West Africa. Apart from its
devastating impacts in resource poor
West Africa, Ebola strained
communities from coast to coast in
the US after transmission to two
healthcare workers incited fear and
uncertainty. Protocols painstakingly
developed at all levels of government
and healthcare properly addressed
risk, and no further transmissions
have occurred within the US. Dozens
of hospitals have been certified as
Ebola treatment centers and hundreds
of others are now able to assess at-risk
individuals. In our own community,
Providence Sacred Heart Medical
Center has undergone rigorous review
by the Centers for Disease Control
and Prevention (CDC) and has been
designated as a treatment facility for
Ebola patients, one of three in
Washington.
Ten persons have been treated for
Ebola in the US to date. Travelers
from affected countries are monitored
upon entry into the US and for the
duration of their possible incubation
period. SRHD has monitored a total
of six travelers, all of whom were
regarded as having had low risk
exposures while in West Africa. None
has needed medical treatment during
their monitoring period.
Significant progress has been made in
controlling the epidemic in West
Africa. As of March 17, 2015, almost
25,000 cases have been recorded and
more than 10,000 people have died.
Enterovirus D68 (EV-D68) –
First alert sent on 9/12/2014
From mid-August 2014 to January 15,
2015, CDC and state public health
laboratories confirmed a total of 1,153
people, mostly children, in 49 states
and the District of Columbia (DC)
with EV-D68 caused respiratory
illness. EV-D68 infections are
thought to occur less commonly than
infections with other enteroviruses,
but these infections are not
reportable, and it is unknown how
many cases and deaths from EV-D68
occur each year in the US. CDC
confirmed ten cases of EV-D68 in
Washington and many children were
hospitalized due to enteroviral
infection.
Mild symptoms of enteroviral
infection may include fever, runny
nose, sneezing, cough, body and
muscle aches. Severe symptoms may
include difficulty breathing and
wheezing. People with asthma may
have a higher risk for severe
respiratory illness.
CDC is continuing to investigate a
possible association between
neurologic illnesses, including
paralysis, in a small group of children
who were infected with EV-D68. This
association has yet not been
substantiated and a clear etiology for
the neurologic illness has not been
identified.
Mumps –
First alert sent on 11/24/2014, followed
by parotitis testing recommendations
01/24/2015.
Mumps began to circulate in
September 2014 among students at
the Moscow campus of the University
of Idaho and an outbreak was
declared in late November. Two cases
were detected in western Washington
in late 2014, but none have been
reported in eastern Washington. At
last report (February 6, 2015) Idaho
had 21 confirmed and probable cases.
Speaking of parotitis, since early
December 2014, SRHD has received
more than six reports of parotitis in
children fully vaccinated with MMR.
Those who were serologically tested
were negative for mumps IgM,
indicating they were not acutely
infected. During the same time
period, the CDC was notified of
parotitis in some persons with labconfirmed influenza in multiple states,
but those tested locally did not have
influenza or respiratory symptoms.
Seasonal Influenza –
Use of antivirals for influenza alert sent on
1/9/2015. Weekly respiratory illness
updates began 10/17/2014. The first flu
case in Spokane Co. was reported on
October 1, 2014.
Nipping at the heels of Ebola and
parotid issues, influenza, the annual
epidemic, has kept public health and
healthcare providers unusually busy
this season, due to the circulation of
influenza A (H3N2) viruses. In past
seasons when these virus have
predominated, higher overall and
higher age-specific hospitalization
rates and more mortality have been
observed, especially among older
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March 2015
people, very young children, and
persons with certain chronic medical
conditions. Nearly 94% of all adults
hospitalized for flu this season had at
least one reported underlying medical
condition; the most commonly
reported conditions were heart
disease, and metabolic disorders
including diabetes and obesity. In
addition, the available flu vaccine
viruses were not well matched to the
circulating strains.
As of March 7, flu activity had been
elevated for 16 consecutive weeks
nationally; but is decreasing. (The
average length of a flu season for the
past 13 seasons has been 13 weeks.
However, because this season started
relatively early, it is expected to last
longer.) In Spokane County, where
persons hospitalized due to influenza
are reportable to SRHD, over 367
people had been admitted as of March
16. This is more than the combined
total of those hospitalized in the past
two seasons.
CDC continues to emphasize the
importance of prompt antiviral
treatment for those who are severely
ill and those who are at high risk of
flu complications. A meta-analysis
published in the Lancet in February
reports on the benefits of antiviral
treatment, including reducing the risk
of hospitalization by 63%.
Researchers analyzed individual
patient data from nine published and
unpublished randomized controlled
clinical trials which compared
oseltamivir with placebo for treatment
of seasonal influenza in adults. This
study joins a growing body of
observational data which indicates
that these drugs have benefit beyond
the treatment of uncomplicated
influenza and can reduce serious
complications from flu including
hospitalizations.
Avian Influenza –
Spokane county residents have not been
impacted by this concern, so no health alert
has been sent out on this issue to date.
In late December 2014, highly
pathogenic avian influenza (HPAI)
was detected in wild birds in
northwest Washington. Since that
time HPAI H5N2, H5N8, and a new
H5N1 re-assortant virus have been
identified in wild and domestic flocks
in California, Idaho, Oregon, Utah,
Washington, and Nevada. The
diversity and geographical distribution
of influenza viruses currently
circulating around the world in wild
and domestic birds is unprecedented.
The risk of disease in people is low,
because these viruses do not normally
infect humans easily, and even if a
person is infected, the viruses do not
spread easily to other people.
However, because avian influenza
viruses have the potential to change
and gain the ability to spread easily
among people, monitoring for human
infection and person-to-person
transmission is extremely important
for public health.
The Washington State Department of
Health and local health jurisdictions
continue to work with our animal
health colleagues to evaluate and
minimize public health risk. After a
duck die-off, one flock in Spokane
County was tested for avian influenza
and was negative.
Measles First alert sent on 1/23/2015, followed by
the recommendations for measles vaccine in
adults on 1/30/2015 and measles in health
care settings on 2/6/2015, as well as an
outbreak update on 2/26/2015.
The latest entry to this busy period’s
infectious disease mélange is measles.
The US has been experiencing a large
multi-state measles outbreak that
started in California in December
2014 and has spread to additional
states, Canada and Mexico. The initial
confirmed cases reported visiting a
Disneyland theme park in Orange
County, California, from December
17 through December 20, 2014. From
January 1 to March 13, 2015, 176
people from 17 states and DC were
reported to have measles. (In
Washington, eight cases have been
detected, but none in eastern
Washington.) Seventy-four percent of
the cases are associated with the
theme park, and three other outbreaks
have been identified.
Measles continues to circulate worldwide with close to 200,000 cases
reported in 2013. In the last five years,
Europe has experienced a dramatic
resurgence of measles and rubella, and
several countries have reported
outbreaks. Notably, as part of an
ongoing outbreak in Berlin, Germany
more than 600 cases have already
been reported in 2015.
In 2014, 3,616 measles cases were
reported from 30 countries in Eastern
and Western Europe, not including
Russia; among those cases with
known vaccination status, 83% were
completely unvaccinated.
March 2015
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Phew! It seems as if infectious
diseases are here to stay!
public health events such as the
Influenza A (H1N1) pandemic,
MERS, and Ebola, sustaining public
health preparedness capacity must
remain a key priority. There is an
ongoing need to prepare for the next
epidemic, including assurance of
following good science and
supporting healthcare providers.
Laboratory and surveillance networks
Looking ahead, we have both a
practical and a moral responsibility to
actively participate in coordinated
responses to public health
emergencies. While knowledge and
experience with health threats has
accumulated during our responses to
must be maintained and upgraded as
necessary. Collaboration established
between human and animal health
sectors should be supported. Above
all, communication is critical. We’ll do
our best to keep you posted!
Selected Diseases Reported to Spokane Regional Health District
Includes confirmed cases only unless
otherwise noted.
NA = not available yet
Borreliosis (relapsing fever)
Campylobacteriosis
Chlamydia
Cryptosporidiosis
Giardiasis
Gonorrhea
Hepatitis A (confirmed & probable)
Hepatitis B acute
Hepatitis B chronic (confirmed & probable)
Hepatitis C acute
Hepatitis C chronic
Herpes (initial diagnosis)
HIV disease (newly diagnosed)
Legionellosis
Meningococcal disease (confirmed & probable)
Pertussis (confirmed & probable)
Salmonellosis
Shiga toxin-producing E. coli (STEC)
Shigellosis
Syphilis
2013
2014
Oct
Nov
Dec
2013
total
Oct
Nov
Dec
2014
total
0 1 174 1 2 37 0 1 6 0 53 11 0 0 0 0 2 0 1 1 1 0 3 157 0 3 31 0 3 5 0 44 17 1 1 0 1 1 0 1 3 1 0 0 125 0 1 38 0 2 3 0 55 15 1 0 0 0 1 0 1 1 0 2 42 2005 3 23 321 1 12 57 14 639 131 20 4 2 31 32 3 20 14 7 0 8 179 0 6 52 1 2 7 1 72 16 1 1 0 2 1 0 2 2 0 0 2 169 0 4 57 0 3 8 2 57 13 1 0 0 2 1 2 0 4 0 0 4 168 0 5 53 0 0 7 4 65 14 1 0 1 3 4 0 1 1 1 2 54 2128 2 42 521 2 13 66 18 777 200 9 6 2 25 30 16 11 26 5 0 / 0 3 / 3 8 / 23 Tuberculosis
Institutional Outbreaks
0 / 2 2 / 0 3 / 3 10 / 31
0 / 0 (respiratory/gastrointestinal)
Communicable Disease 24-hr Confidential Reporting: 324-1449
Epidemiology: 324-1442
HIV/AIDS: 324-1544
TB: 324-1613