COCA Digest: May 7, 2018

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COCA News and Announcements

Upcoming COCA Call

Title: Recommendations for the Use of Herpes Zoster Vaccines

Date: Thursday, May 10, 2018

Time: 2:00-3:00 PM ET

Herpes zoster, also referred to as shingles, is a common viral disease with approximately one million cases occurring each year in the United States. In October 2017, the Food and Drug Administration (FDA) approved a 2-dose, recombinant zoster vaccine ([RZV], Shingrix), for the prevention of herpes zoster in adults aged ≥50 years. CDC recommends RZV for use in immunocompetent adults age ≥50 years. During this COCA Call, clinicians will learn about CDC recommendations for herpes zoster vaccines and the clinical guidelines for the new vaccine.

Recent COCA Call

Topic: A Leopard without Spots: Clinical Diagnosis and Treatment of Rocky Mountain Spotted Fever

Date: Thursday, April 12, 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

Confronting Opioids

Confronting the Opioid Epidemic: What Can be Done?

CDC continues to fight the opioid overdose epidemic, working to save lives and prevent negative health effects of this epidemic, such as opioid use disorder, hepatitis and HIV infections, and neonatal abstinence syndrome. It will take coordinated efforts by communities, healthcare providers, public health, law enforcement, and other sectors to address this ongoing epidemic.

Improving the way opioids are prescribed can ensure patients have access to safer, more effective pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. Providers and the health systems in which they work are critical when it comes to promoting safer and more effective opioid prescribing. Providers and health systems can use the CDC Guideline for Prescribing Opioids for Chronic Pain to help address patient-centered clinical practices such as conducting thorough assessments, considering non-opioid treatments, monitoring risks, and safely discontinuing opioids as needed. Supporting healthcare providers and health systems with data, tools, and guidance for evidence-based decision-making related to opioid prescribing is an important component to patient safety.

For more information about CDC's multi-tiered public health approach to address key aspects of the epidemic, click here.

Teen substance use and risks

Teen Substance Use & Risks

Substance use by teens can have a big impact on their health and well-being. The American Academy of Pediatrics (AAP), through a cooperative agreement with CDC, developed a guide for implementing substance use screening in pediatric practices to help pediatricians address substance use concerns. The AAP recommends screening for substance use in children, starting at 9 years of age.

Pediatricians can help teens avoid and reduce substance use by talking with them about their use. The guide, Substance Use Screening and Intervention Implementation Guide: No Amount of Substance Use Is Safe for Adolescents, provides helpful information for pediatricians to implement substance use screening and brief counseling in their practices. In addition, it provides guidance on protecting patient privacy and other key issues, as well as highlights the most commonly used substances, the extent of the problem, and the risks of substance use among teens.

Read the full CDC Feature here. Read the AAP Substance Use Screening and Brief Intervention for Youth here.


Containing Unusual Resistance: Early, Aggressive Action Can Prevent Spread

More than 23,000 Americans die each year from infections caused by germs resistant to antibiotics. While antibiotic resistance (AR) threats vary nationwide, AR has been found in every state. Unusual resistance germs, which are resistant to all or most antibiotics tested and are uncommon or carry special resistance genes, are constantly developing and spreading. Lab tests uncovered unusual resistance more than 200 times in 2017 in “nightmare bacteria” alone. With new resources nationwide, early and aggressive action—when even a single case is found—can keep germs with unusual resistance from spreading in health care facilities and causing hard-to-treat or even untreatable infections.

The CDC Vital Signs report highlights the importance of rapid detection by laboratorians, the critical first step in the Containment Strategy. The report also includes data from CDC’s AR Lab Network, a new resource that can help identify and characterize resistance in threats like “nightmare bacteria” carbapenem-resistant Enterobacteriaceae (CRE), emerging fungal threats like Candida auris, and even food and community pathogens. Using the AR Lab Network, nationwide testing uncovered unusual resistance genes in “nightmare bacteria” more than 220 times in 2017.

Learn more about what healthcare facilities, state and local health departments, and labs can do to help prevent spread of unusual AR here. Read CDC's latest feature on stopping spread of unusual AR here. Find out more about AR laboratory testing and resources here.

Read the transcript from the April 3 press briefing, VitalSigns Teleconference: Antibiotic Resistant Germs, here.


Vaccines For Children (VFC) Program

The Vaccines for Children (VFC) program offers vaccines at no cost to eligible children through a national network of participating health care providers. The VFC program helps ensure that all children have a better chance of getting their recommended vaccinations on schedule. These vaccines protect babies, young children, and adolescents from 16 diseases.

Healthcare Providers can find out how the VFC can benefit their patients and their practice as well as how to become a VFC provider.

Find out more about the VFC Program here and here. For information specific for healthcare providers, click here.


    Did You Know?

     Adverse Childhood Experiences

    Childhood Immunizations

    Visit CDC's Did You Know? page here.

    Infectious, Vector-Borne, and Zoonotic Diseases


    Illnesses from Mosquito, Tick, and Flea Bites Increasing in the US: Cases Triple; Better Tools Needed to Fight Mosquitoes, Ticks, and Fleas

    Illnesses from mosquito, tick, and flea bites have tripled in the U.S., with more than 640,000 cases reported during the 13 years from 2004 through 2016.  Nine new germs spread by mosquitoes and ticks were discovered or introduced into the United States during this time.

    These findings are in the latest Vital Signs report by the CDC. This is CDC’s first summary collectively examining data trends for all nationally notifiable diseases caused by the bite of an infected mosquito, tick, or flea. It provides detailed information on the growing burden of mosquito-borne and tickborne illnesses in the U.S.

    CDC scientists analyzed data reported to the National Notifiable Diseases Surveillance System (NNDSS) for 16 notifiable vector-borne diseases from 2004 through 2016 to identify trends. In 2016, the most common tickborne diseases in the U.S. were Lyme disease and ehrlichiosis/anaplasmosis. The most common mosquito-borne viruses were West Nile, dengue, and Zika. Though rare, plague was the most common disease resulting from the bite of an infected flea.

    Read the full press release, including key findings and what state and local public health labs can do to help, here. Read the full MMWR article here. Get the transcript and audio recording from the May 1 telebriefing on vector-borne diseases here.

    Seasonal Influenza

    Flu Banner

    CDC Reports on Vaccine Benefits from 2016-2017 Season

    Flu vaccination prevented an estimated 5.3 million influenza illnesses, 2.6 million influenza-associated medical visits, and 85,000 influenza-associated hospitalizations during the 2016-2017 influenza season, according to an online CDC report. These findings underscore the important benefits provided by influenza vaccination, which has been recommended annually in the United States for all persons 6 months and older since 2010, but also highlights areas where improvements in vaccine uptake and vaccine effectiveness could deliver even greater benefits to the public’s health. For example, increasing vaccination coverage among adults 18 to 64 years would further reduce the burden of influenza, as this age group continues to have the lowest influenza vaccination coverage. If vaccination rates improved to 70 percent for all age groups, another 1.9 million illnesses, 822,000 medical visits, and 17,300 hospitalizations could have been prevented during the 2016-2017 flu season.

    Read the full report here. Get access to the original PloS One article here.


    Weekly U.S. Influenza Surveillance Report

    Influenza activity in the United States continued to decrease, and is below the national baseline for the fourth consecutive week since late November according to the latest FluView report. Influenza-like illness (ILI) dropped from 1.6% reported last week to 1.5%. Current data indicate that the 2017-2018 flu season peaked at 7.5% in early February (during week 5). However, 10 states and Guam and Puerto Rico continue to report widespread or regional flu activity. Hospitalization rates this season have been record-breaking, exceeding end-of-season hospitalization rates for 2014-2015, a high severity, H3N2-predominant season. CDC also is reporting an additional 3 flu-related pediatric deaths during week 17, bringing the total number of flu-related pediatric deaths this season to 163. Sporadic flu activity may continue for a number of weeks. 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. Below is a summary of the key flu indicators for the week ending April 28, 2018 (week 17).

    Read the full situational update here. View the current United States flu activity map here.

    Healthcare professionals can find additional resources, recommendations, and guidances here.

    Food, Drug, and Device Safety

    Romaine Lettuce

    Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce (4/27/2018)

    Since the last update on April 25, 2018, 14 more ill people were added to this outbreak. Three more states have reported ill people: Mississippi, Tennessee, and Wisconsin.

    Ninety-eight people infected with the outbreak strain of E. coli O157:H7 have been reported from 22 states. Forty-six people have been hospitalized, including 10 people who have developed a type of kidney failure called hemolytic uremic syndrome. No deaths have been reported.

      CDC laboratory testing has confirmed that the strain of Shiga-toxin producing E. coli O157:H7 causing this outbreak produces a type of toxin that tends to cause more severe illness, which may explain why there is a high hospitalization rate. This investigation is ongoing.


      Multistate Outbreak of Salmonella Braenderup Infections Linked to Rose Acre Farms Shell Eggs (4/19/2018)

      On April 16, 2018, Cal-Maine Foods, Inc. voluntarily recalled eggs purchased from Rose Acre Farms and produced at the Hyde County, North Carolina facility. Twenty-three people infected with the outbreak strain of Salmonella Braenderup have been reported from nine states. Six people have been hospitalized, and no deaths have been reported. This investigation in ongoing.

      Multistate Outbreak of Salmonella Typhimurium Linked to Chicken Salad (Final Update) (4/6/2018)

      On February 21, 2018, Triple T Specialty Meats, Inc. recalled all chicken salad produced from January 2, 2018 to February 7, 2018. The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores from January 4, 2018, to February 9, 2018. As of April 6, 2018, this outbreak appears to be over.

      Multistate Outbreak of Salmonella Infections Linked to Kratom (4/5/2018)

      Kratom products from several companies have been recalled because they might be contaminated with Salmonella. The list of recalled kratom products is available on the U.S. FDA website. A total of 132 people infected with outbreak strains of Salmonella I 4,[5],12:b:-, Salmonella Javiana, Salmonella Okatie, or Salmonella Thompson have been reported from 38 states. Forty percent of ill people have been hospitalized, and no deaths have been reported. This investigation is ongoing.

      Multistate Outbreak of Salmonella Typhimurium Infections Linked to Dried Coconut (4/2/2018)

      On March 29, 2018, Healthy Nut Factory recalled 7-ounce pouches of Organic Coconut Smiles. This product was distributed and sold at retail stores in New York City and Long Island. Thirteen people infected with the outbreak strain of Salmonella Typhimurium have been reported from eight states. Three hospitalizations have been reported, and no deaths.The recalled bulk dried coconut may have been repackaged into clear, plastic containers with grocery store labeling, or served in bulk bins. The list of locations and cities is available on the FDA website. This investigation in ongoing.

      Public Health Preparedness

      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.