COCA Digest: April 2, 2018

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COCA News and Announcements

Recent COCA Call

Topic: Joint Webinar: Vital Signs Town Hall Teleconference and COCA Call – Coordinating Clinical and Public Health Responses to Opioid Overdoses Treated in Emergency Departments

Date: Tuesday, March 13, 2018

Archived COCA conference calls are available here. Free continuing education (CE) is available for most calls. More information about free CE is available here.

CDC News and Announcements


National Infant Immunization Week is April 21-28, 2018

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities.

Since 1994, hundreds of communities across the United States have joined together to celebrate the critical role vaccination plays in protecting our children, communities, and public health.

NIIW, set for April 21-28, 2018, will be celebrated as part of World Immunization Week (WIW), an initiative of the World Health Organization (WHO). During WIW, all six WHO regions, including more than 180 Member States, territories, and areas, will simultaneously promote immunization, advance equity in the use of vaccines and universal access to vaccination services, and enable cooperation on cross-border immunization activities.

For information for healthcare professionals such as resources for vaccine conversations with parents, go here. To access the NIIW digital media Toolkit as well to get information about CDC's NIIW activities, resources, social media content, and materials, click here.


Advisory Committee on Immunization  Practices (ACIP) Updates Hepatitis A Vaccine and Influenza Vaccine Resolutions

In February 2018, ACIP updated influenza vaccine and hepatitis A vaccine resolutions for the Vaccines for Children (VFC) Program. The changes are:

  • Hepatitis A: Added vaccine recommendations for infants 6-11 months of age traveling to countries outside the United States and revised the language regarding post-exposure prophylaxis
  • Influenza: Added live attenuated influenza vaccine (LAIV) to the VFC program

For more information, see the full hepatitis A and influenza vaccine resolutions at the ACIP-VFC Vaccine Resolutions page here. For additional information for healthcare providers about the VFC Program, see the VFC page here.


Emergency Department Data Show Rapid Increases in Opioid Overdoses

Data from emergency departments (EDs) show that the U.S. opioid overdose epidemic continues to worsen, according to the latest CDC Vital Signs report.

The report examines the timeliest data available to CDC on ED visits for opioid overdoses across multiple states. Overall, ED visits (reported by 52 jurisdictions in 45 states) for suspected opioid overdoses increased 30 percent in the U.S., from July 2016 through September 2017. Opioid overdoses increased for men and women, all age groups, and all regions, but varied by state, with rural/urban differences. The findings highlight the need for enhanced prevention and treatment efforts in EDs and for greater access to evidence-based opioid use disorder treatments, including medication-assisted treatment and harm reduction services.

“Long before we receive data from death certificates, emergency department data can point to alarming increases in opioid overdoses,” said CDC Acting Director Anne Schuchat, M.D. “This fast-moving epidemic affects both men and women, and people of every age. It does not respect state or county lines and is still increasing in every region in the United States.”

Read the full press release here and the MMWR report here. For more information about opioid overdose and prevention including guidance to healthcare providers, click here. To read the March 12 Transcript for VitalSigns Teleconference: Opioid Overdoses Treated in Emergency Departments Telebriefing from Acting CDC Director RADM Anne Schuchat, click here.

Travelers' Health


CDC Warns of Deadly Outbreak of Yellow Fever in Brazil

In response to a large, ongoing outbreak of yellow fever in multiple states of Brazil, including near large urban areas and popular tourist destinations, CDC is recommending travelers to the country protect themselves from yellow fever by getting the yellow fever vaccine at least 10 days before travel, and taking steps to prevent mosquito bites during their travel.

CDC recommends that people who are unable to get yellow fever vaccine or aren’t recommended to get it should avoid traveling to areas of Brazil where yellow fever vaccination is recommended. Travelers going to areas with ongoing outbreaks may consider getting a booster dose of yellow fever vaccine if it has been 10 or more years since they were vaccinated.

Yellow fever vaccine is available at a limited number of clinics in the United States, so travelers should plan ahead to get the vaccine. For more on yellow fever vaccination clinics, click here.

Read the media statement here. For more information about yellow fever in Brazil, click here.


Clinical Update: Interim CDC Guidance for Travel to and from Countries Affected by the New Polio Vaccine Requirements

The World Health Organization (WHO) declared the international spread of wild poliovirus (WPV) a public health emergency of international concern in 2014. In February 2018, WHO released updated polio vaccine recommendations. Temporary polio vaccine recommendations affect the following countries: Afghanistan, Democratic Republic of the Congo, Nigeria, Pakistan, and Syria. Clinicians are encouraged to err on the side of caution by ensuring patients are properly prepared for any requirements they may face when leaving countries affected by the polio vaccine requirements.

CDC recommends that travelers to any country with WPV or cVDPV circulation in the past 12 months protect their health by being fully vaccinated against polio, including a single lifetime polio vaccine booster for adults. For  information for clinicians, and to read the full update, click here.

Yellow Book App

CDC Yellow Book 2018 App

CDC Health Information for International Travel (commonly called the Yellow Book) is published every two years by CDC as a reference for those who advise international travelers about health risks. The Yellow Book is written primarily for health professionals, although others will find it useful. Now travelers and clinicians can access the Yellow Book any time, any where. It is currently available in print, online, and as an app for your mobile device!

Get the CDC Yellow Book 2018 app here.

Infectious, Vector-Borne, and Zoonotic Diseases


Tuberculosis continues to decline in the U.S., but progress toward elimination is slowing

New data released by CDC show tuberculosis (TB) cases declining in the United States, but at a rate too slow to achieve TB elimination in this century. In 2017, 9,093 new cases of TB were reported in the U.S., a 1.8 percent drop from the prior year. However, the current TB rate (2.8 cases per 100,000 persons) remains at levels 28 times higher than the TB elimination target rate.

Read the full press release, CDC Fact Sheet, and audio clips here. Read the March 23 Morbidity and Mortality Weekly Report (MMWR) here.

Zika Travel

Update: Noncongenital Zika Virus Disease Cases — 50 U.S. States and the District of Columbia, 2016

Although most cases in residents of U.S. states were travel-associated, local transmission has been reported. According to the March 9 MMWR, in 2016, a total of 5,168 confirmed or probable cases of noncongenital Zika virus disease with symptom onset during January 1–December 31, 2016, were reported to ArboNET from U.S. states and the District of Columbia. Most (95%) cases were travel-associated. Locally acquired disease accounted for 4% of cases, with transmission occurring in Florida (218) and Texas (six). Forty-seven cases (1%) were acquired through other routes, including sexual transmission (45), laboratory transmission (one), and person-to-person through an unknown route (one).

CDC recommends that health care providers continue to test patients with a clinically compatible illness who live in or recently traveled to areas with ongoing Zika virus transmission or had unprotected sex with someone who lives in or traveled to those areas. Although the risk for travel-associated Zika virus disease appears to be decreasing, it is important that persons traveling to areas with a risk for Zika virus transmission continue to take precautions, including using strategies to prevent mosquito bites and sexual transmission.

To read the full update, click here. For more information about CDC's testing guidance, click here.

2017 – Outbreaks of hepatitis A in multiple states among people who are homeless and people who use drugs

Since March 2017, CDC's Division of Viral Hepatitis (DVH) has been assisting several state and local health departments with hepatitis A outbreaks, spread through person to person contact, that have occurred primarily among persons who are homeless, persons who use injection and non-injection drugs, and their close direct contacts. Information on local hepatitis A case counts and outbreak response is available on web pages for the locations affected by the outbreak (California, KentuckyMichigan, Utah).

In response to these and all hepatitis A outbreaks, CDC provides ongoing epidemiology and laboratory support as well as support on vaccine supply and vaccine policy development. CDC alerts public health jurisdictions of any increases in disease. On August 25, 2017, CDC notified all state and local health departments about the investigation of a cluster of hepatitis A, genotype IB infections in people who are homeless and/or use injection and non-injection drugs. All U.S. jurisdictions were encouraged to be watchful for increases in hepatitis A cases and consider submitting recently confirmed hepatitis A virus (HAV) specimens to CDC’s Division of Viral Hepatitis Laboratory. CDC’s DVH Laboratory uses advanced molecular detection to confirm and monitor outbreaks and has tested over 1,000 specimens related to various outbreaks this year. CDC also works with state and local health officials to ensure hepatitis A vaccine is targeted to the correct at-risk populations and that supply is adequate.

To read the CDC article on the 2017 outbreak and advice to public health officials, go here. On this page, healthcare providers can access various tools and resources that CDC provides, such as the Healthcare Investigation Checklist, Healthcare Investigation Guide, Healthcare Investigation Letter, and Healthcare Notification and Testing Toolkit.

To read CDC's interim outbreak-specific guidance on hepatitis A vaccine administration, go here.

Seasonal Influenza


Influenza activity in the United States continued to decrease, but remained above the national baseline according to the latest FluView report. Influenza-like illness (ILI) dropped from 2.8% reported last week to 2.5%. Current data indicate that the 2017-2018 flu season peaked at 7.5% in early February (during week 5). However, 16 states plus Puerto Rico continue to report widespread flu activity and 4 states continue to experience high ILI levels. Hospitalization rates are higher than the end-of-season hospitalization rates for 2014-2015, a high severity, H3N2-predominant season. CDC also is reporting an additional 4 flu-related pediatric deaths during week 12, bringing the total number of flu-related pediatric deaths this season to 137. Flu activity is likely to remain elevated for a number of weeks.

CDC routinely recommends influenza vaccination for all persons 6 months of age and older as long as flu viruses are circulating. While H3N2 viruses remain predominant overall this season, during week 12, influenza B viruses were more frequently reported than influenza A viruses. Early vaccine effectiveness (VE) estimates through February 3, 2018 show that flu vaccine reduced the risk of having to go to the doctor due to flu by 36% overall. VE against H3N2 viruses was 25%. VE against H1N1 67% and VE against B viruses was 42%. CDC recommends prompt treatment with influenza antiviral medications for people who are severely ill and people who are at high risk of serious flu complications who develop flu symptoms.

Read the full Situational Update here. Read the FluView report for 2017-2018 Influenza Season Week 12 ending March 24, 2018 here.

Influenza surveillance data from the 1997-1998 through current season from the U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) can be accessed through the FluView Interactive website here and here.

Food, Drug, and Device Safety


CDC Report Shows Progress and Gaps in Reducing Foodborne Illnesses

Reducing foodborne illness depends in part on identifying which illnesses are decreasing and which are increasing. Yet recent changes in the use of tests that diagnose foodborne illness pose challenges to monitoring illnesses and assessing trends, according to a report published on March 23 in CDC’s MMWR.

Rapid diagnostic tests help doctors diagnose infections quicker than traditional culture methods, which require growing bacteria to determine what is causing illness. These culture-independent tests are revealing many infections that likely would not have been diagnosed in the past because of limited testing. But without a bacterial culture, public health officials cannot get the detailed information needed to detect and prevent foodborne disease outbreaks, monitor disease trends, and identify antibiotic resistance.

In 2017, FoodNet reported 24,484 infections, 5,677 hospitalizations, and 122 deaths. The most frequent causes of infection in 2017 were Salmonella and Campylobacter, consistent with previous years. Although the incidence of Salmonella infections overall did not change significantly, infections caused by Salmonella Typhimurium and Salmonella Heidelberg has been decreasing for more than a decade, with overall declines of more than 40 percent for both. Infections caused by Shiga toxin-producing Escherichia coli also have decreased during the past 10 years. These findings suggest targeted control measures are effective in reducing infections.

Read the full MMWR here. Learn more about FoodNet surveillance here.

FoodNet Fast

New Data, Search Field in FoodNet Fast

FoodNet Fast is CDC’s interactive online program for getting information on illnesses reported to the Foodborne Diseases Active Surveillance Network (FoodNet). FoodNet Fast makes it easy for healthcare providers and others to see how rates of illness have changed over the past 20 years for nine pathogens: Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia.  

CDC has updated FoodNet Fast with preliminary 2017 data. Now, healthcare providers and others can get information on illnesses reported to FoodNet from 1996 through 2017. CDC also has added the ability to search by geographic area – in addition to pathogen, year, age group, sex, and race – by selecting one of FoodNet’s 10 sites, which are the states of Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee, and selected counties in California, Colorado, and New York. Information may not be available for some sites before 2004.

Public Health Preparedness

Emergency Response

Emergency Preparedness and Response for Health Professionals

For a variety of resources for clinicians, communicators, laboratorians, emergency planners and responders, and disaster relief volunteers to prepare them to respond to a public health emergency, as well as Health Alert Network (HAN) archives, go here.

Emergency Preparedness and Response Training Resources for Clinicians

For scheduled and on-demand emergency preparedness and response training resources offered by CDC, other federal agencies, and COCA partners, go here.

Natural Disasters and Severe Weather

Natural Disasters and Severe Weather

For information about specific types of disasters and information for specific groups, go here.

Health and Safety Concerns

For information on health and safety concerns for all disasters, including animals and insects, food and water, carbon monoxide, illness and injury prevention, power outages, safe cleanup, and more, go here.

Food and Water Needs: Preparing for a Disaster or Emergency

For food, water, sanitation, and hygiene information for use before and after a disaster or emergency, go here.

Disaster Resources

For educational materials by topic or language, PSAs for disasters, resources for emergency health professionals, and social media, go here.

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.