COCA Digest: January 8, 2018

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CDC Health Alert Network (HAN) Advisory


Early Season Influenza A(H3N2) Activity and Treatment of Patients with Influenza Antiviral Medications

On December 27, 2017, CDC issued HAN 409 to provide: 1) a notice about increased influenza A (H3N2) activity and its clinical implications; 2) a summary of influenza antiviral drug treatment recommendations; 3) an update about approved treatment drugs and supply this season; and 4) background information for patients about influenza treatment. This CDC Health Advisory was issued to:                  

  • Remind clinicians that influenza should be high on their list of possible diagnoses for ill patients because influenza activity is increasing nationwide, and
  • Advise clinicians that all hospitalized patients and all high-risk patients (either hospitalized or outpatient) with suspected influenza should be treated as soon as possible with a neuraminidase inhibitor antiviral. While antiviral drugs work best when treatment is started within 2 days of illness onset, clinical benefit has been observed even when treatment is initiated later.

Read the full health advisory on the CDC HAN webpage.

Seasonal Influenza

CDC Press Release: Seasonal Flu Death Estimate Worldwide

According to new estimates published on December 13, 2017, between 291,000 and 646,000 people worldwide die from seasonal influenza-related respiratory illnesses each year, higher than a previous estimate of 250,000 to 500,000 and based on a robust, multinational survey.The new estimate, from a collaborative study by CDC and global health partners, appeared in The Lancet. The estimate excludes deaths during pandemics. Read the entire press release here.


2017-2018 Information for Healthcare Professionals

This page offers public health and health care professionals key information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza. It also includes information about recommendations from the Advisory Committee on Immunization Practices (ACIP) for the prevention and control of seasonal influenza for the 2017-18 influenza season. Other resources are also provided.

CDC's seasonal flu vaccination campaign materials are available to assist partners in communicating about the importance of vaccination. This digital toolkit includes details on events/activities, sample social media and newsletter content, graphics, web assets, and media prep material. This material is downloadable, shareable, and some of the material is customizable.

Weekly U.S. Influenza Surveillance Report: Flu View - Influenza Season Week 51 ending December 23, 2017: Flu View is a weekly influenza surveillance report prepared by CDC’s Influenza Division. All data are preliminary and may change as CDC receives more reports.

Update: Influenza activity - October 1 - November 25

Influenza activity in the United States was low during October 2017, but has been increasing since the beginning of November. Influenza A viruses have been most commonly identified, with influenza A(H3N2) viruses predominating. This CDC Morbidity and Mortality Weekly Report (MMWR) summarizes U.S. influenza activity during October 1–November 25, 2017.

Cancer Flu

Cancer and Flu

CDC recommends that people with cancer or a history of cancer, and people who live with or care for cancer patients and survivors, should get a seasonal flu shot. Immune defenses become weaker with age, which places older people at greater risk of severe illness from flu. Also, aging decreases the body’s ability to have a good immune response after getting a flu shot. Healthcare providers should be aware of the two vaccines designed specifically for people 65 and older. For more information, go here.

COCA News and Announcements


Recent COCA Call

Topic: The Changing Distribution of Ticks and Tick-borne Infections
Date: Thursday, December 7, 2017

Archived COCA conference calls are available here. Free continuing education (CME, CNE, ACPE, CEU, CECH, and AAVSB/RACE) is available for most calls. More information about free CE is available here.

CDC News and Announcements


Opioid Crisis in Rural America

The rate of drug overdose deaths in rural areas has surpassed rates in urban areas, and it is a huge public health concern. Understanding how rural areas are different when it comes to drug use and drug overdose deaths, including opioids, can help public health professionals identify, monitor, and prioritize their response to this epidemic. Read the CDC Public Health Matters Blog post Rural America in Crisis: The Changing Opioid Overdose Epidemic.

For additional information about illicit drug use and overdose in rural areas, read the CDC MMWR. CDC offers resources for healthcare providers, including the current CDC Guidelines for prescribing opioids for chronic pain as well as training programs to help providers apply the recommended guidelines.


Thorough Clean Up Helps Prevent Norovirus Outbreaks

This month, CDC's Public Health Matters Blog focuses on the importance of preventing the spread of norovirus. Cleaning-up immediately after someone with norovirus vomits or has diarrhea protects others from getting sick, and prevents norovirus outbreaks. It’s important for everyone to know the clean-up steps and other ways to prevent norovirus.

CDC and state and local health departments help to raise awareness among healthcare providers and the general public about norovirus and how to prevent it. Learn more about how health departments, CDC, and other agencies work to prevent and stop norovirus outbreaks.

To learn more about norovirus, see CDC’s norovirus website and infographics, videos, and other resources, and state and local health department websites.


CDC DentalCheck Mobile App

CDC DentalCheck is now available on Android and iOS devices! Dental health care personnel can use this app to periodically assess infection prevention and control practices in their facility and ensure they are meeting the minimum expectations for safe care. The infection prevention coordinator and other staff are encouraged to use this app at least annually to review policies and observe patient-care practices. CDC’s DentalCheck app is developed directly from the Infection Prevention Checklist for Dental SettingsFor more information and to download the free app, go here.

Public Health Preparedness

Emergency Responders: Tips for Taking Care of Yourself

Responding to disasters is both rewarding and challenging work. Sources of stress for emergency responders may include witnessing human suffering, risk of personal harm, intense workloads, life-and-death decisions, and separation from family. Stress prevention and management is critical for responders to stay well and to continue to help in the situation. There are important steps responders should take before, during, and after an event. To take care of others, responders must be feeling well and thinking clearly.

CDC provides tips for coping with a disaster or traumatic event. Additional information can be found at the Substance Abuse and Mental Health Services Administration (SAMHSA) website and here.

Emergency Preparedness and Response for Health Professionals
Find preparedness resources for health professionals.

Emergency Preparedness and Response Training Resources for Clinicians
Find online and in-person training resources.

CDC Science Clips

Each week, select science clips are shared with the public health community to enhance awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health now.

Volume 9, Issue 50, December 19, 2017

Volume 9, Issue 49, December 12, 2917

Volume 9, Issue 48, December 5, 2017

Natural Disasters and Severe Weather


2017 Hurricane Response

CDC continues to work efficiently in responding to public health needs in the aftermath of Hurricanes Harvey, Irma, and Maria.

For information used to improve safety and reduce exposure risks during the emergency response in the U.S. Virgin Islands and Puerto Rico, see Guidance for Emergency Responders in U.S. Virgin Islands and Puerto Rico,

For information on vaccines, controlling infections, drug safety, and reopening healthcare centers after a disaster, see Safety Information for Health Care Professionals.

See Coping with a Disaster or Traumatic Event for tips you, as an emergency responder, can take to ensure you are able to do your job and cope with challenging situations.

For facts on safety, cleanup, and health recommendations for volunteers and cleanup workers, see Safety Information for Response and Cleanup Workers.

Public Service Announcements (PSAs) for Disasters are available to help the media and other professionals get information to the public about preparing for hurricanes and staying safe during and after.

For a collection of the most up-to-date, cleared information on the ongoing hurricane season, see the recently updated CDC Hurricane 2017 Key Messages in English and Spanish. In addition, see CDC's recently updated Hurricane 2017 Key Messages: For Employers, Workers, and Volunteers, available in English, Spanish, Chinese, and Vietnamese.

Winter Weather

Winter Weather

When temperatures drop significantly below normal, staying warm and safe can be a challenge. Please remind patients to prepare for winter storms, prevent cold-related health problems, and protect themselves before, during, and after a storm. Some serious health problems that can result from prolonged exposure to cold include hypothermia and frostbite.

When power outages occur during winter storms and other emergencies, the use of alternative sources of fuel or electricity for heating or cooking can cause carbon monoxide (CO) to build up in a home, garage, or camper and potentially cause sudden illness and death to those exposed. For more information, see CDC's clinical guidance for CO poisoning after a disaster.

Infectious, Vector-Borne, and Zoonotic Diseases

Multidrug-resistant Candida auris continues to spread in U.S., updated clinical guidance available

Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections associated with high mortality, spread in healthcare settings, and cause outbreaks. The first U.S. cases were reported in November 2016. As of November 30, 2017, CDC has identified 174 cases of C. auris infection in 10 states. CDC has found an additional 257 patients colonized with C. auris through targeted screening in those states. To prevent further spread of this organism, CDC published guidance for healthcare professionals on identification, treatment, and infection control.

CDC released updated recommendations based on recent findings that C. auris has been identified in patients who received healthcare outside of the United States in countries with known C. auris transmission; and that in approximately half of C. auris cases, the organism was isolated from non-invasive sites such as urine and wounds. The recommendations include testing Candida isolates from non-sterile, non-invasive sites to determine species. Testing should be conducted in certain situations, including when Candida is isolated from patients who have had an overnight stay in a healthcare facility in the previous year in a country other than the U.S. with documented C. auris transmission.

Pregnancy Zika

Children with Congenital Zika Virus Infection Face Serious Challenges as They Age

Most children born with microcephaly and evidence of congenital Zika virus infection face severe health and developmental challenges at ages 19-24 months, according to results from a new investigation led by the CDC in collaboration with the State Health Secretariat of Paraíba and the Ministry of Health of Brazil.

The MMWR report is the first to describe the health and developmental effects of congenital Zika virus infection in children with microcephaly through 2 years of age.

One Health graphic with animals and human hand

One Health Approach Supports Global Health Security

Diseases, including zoonotic diseases, can spread around the world very quickly, and the One Health approach can help to protect people and animals from illnesses that cross borders. CDC and its partners support One Health activities in the United States and globally, helping to prevent, detect, and respond to emerging global health threats including zoonotic diseases shared between people and animals.

CDC’s Emerging Infectious Diseases journal is featuring a special supplement on Global Health Security, which includes articles highlighting how the One Health approach plays an important role in creating a safer global community. Read the commentary here.

Travelers' Health


Hurricanes Irma and Maria in the Caribbean

Beginning on September 6, 2017, Hurricane Irma crossed the Caribbean, followed on September 16 by Hurricane Maria. These storms caused severe damage in a number of countries and territories, including Anguilla, Barbuda, the British Virgin Islands, Dominica, the Dominican Republic, Haiti, Puerto Rico, Saint Martin, Sint Maarten, and the US Virgin Islands.

Post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among persons in or recently returned from hurricane-affected areas. Contaminated drinking water and reduced access to safe water, food, and shelter in some areas may create conditions for outbreaks of infectious diseases such as leptospirosis, dengue, hepatitis A, typhoid, vibriosis, Zika, and influenza.

Potential visitors should be aware of travel notices to such severely affected areas because serious health and safety risks may be present and medical care may be limited or unavailable. Those who must travel, including those who are traveling for humanitarian aid work, should adhere to CDC recommendations here.

Food, Drug, and Device Safety

CDC Investigating Multistate E. coli Outbreak

CDC, several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections. Seventeen illnesses have been reported from 13 states. Preliminary laboratory results show that the E. coli that made people sick in the United States is closely related genetically to the E. coli making people sick in an outbreak in Canada. The Public Health Agency of Canada has identified romaine lettuce as the source of the outbreak in Canada. CDC is still collecting information to determine whether there is a food item in common among sick people, including leafy greens and romaine.

The symptoms of Shiga toxin- producing E.coli infections vary for each person but often include very bad stomach cramps, diarrhea (often bloody), and vomiting. If there is fever, it usually is less than 101˚F. Most people get better within 5–7 days. Some infections can be very mild, but others can be life threatening. Contact your healthcare provider if you have diarrhea that lasts for more than 3 days or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.

Investigation of a Salmonella Infection Linked to Rattlesnake Pills

CDC and the Kansas Department of Health and Environment have linked one person’s Salmonella Oranienburg infection to taking rattlesnake pills. Rattlesnake pills are often marketed as remedies for various conditions, such as cancer and HIV infection. These pills contain dehydrated rattlesnake meat ground into a powder and put into pill form. The CDC recommends that healthcare providers advise patients that are considering taking rattlesnake pills, especially if the are in a group that is more likely to get a severe Salmonella infection.

New Report on Foods Commonly Linked to Illness


The Interagency Food Safety Analytics Collaboration (IFSAC) released a report that helps us better understand the types of foods that contribute to foodborne illness. Each year, an estimated 9 million people get sick, 56,000 are hospitalized, and 1,300 die of foodborne diseases caused by known pathogens.

The IFSAC report relies on multi-year surveillance outbreak data to estimate the most common food categories responsible for illnesses caused by Salmonella, E. coli O157, Listeria monocytogenes, and Campylobacter in 2013. The report’s findings include:

  • Salmonella illnesses came from a wide variety of foods.
  • E. coli O157 illnesses were most often linked to vegetable row crops and beef.
  • Listeria monocytogenes illnesses were most often linked to fruits and dairy products.
  • Non-dairy Campylobacter illnesses were most often linked to chicken.

These new estimates can help inform efforts to prioritize food safety initiatives, interventions, and policies for reducing foodborne illness. IFSAC is a collaboration of CDC, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture’s Food Safety and Inspection Service.

MedWatch: The FDA Safety Information and Adverse Event Reporting Program—(FDA)
MedWatch is your FDA gateway for clinically important safety information and reporting serious problems with human medical products. Reports of FDA and USDA Food Recalls, Alerts, Reporting, and Resources—(HHS/USDA/FDA/CDC/NIH) lists notices of recalls and alerts from both FDA and the U.S. Department of Agriculture. Visitors to the site can report a problem or make inquiries.