COCA Digest: June 4, 2018

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CDC Health Alert Network (HAN) Advisory


CDC HAN 410: Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use

May 25, 2018: This HAN provides information on 1) the current status of a multistate outbreak of coagulopathy from exposure to synthetic cannabinoid products containing a vitamin K-dependent antagonist agent, such as brodifacoum; 2) signs and symptoms of presenting patients from this outbreak and which patients are at risk; 3) laboratory testing options that are available to help identify and classify cases; 4) available resources that may help clinicians make decisions; and 5) to whom to report possible cases.

Read the full Health Advisory here. Read a related MMWR article here.

COCA News and Announcements

Recent COCA Call

Title: Recommendations for the Use of Herpes Zoster Vaccines

Date: Thursday, May 10, 2018

During this COCA Call, clinicians learned about CDC recommendations for herpes zoster vaccines and clinical guidelines for the newly FDA-approved 2-dose, recombinant zoster vaccine ([RZV]), Shigrix), for the prevention of herpes zoster in adults aged ≥50 years.

In case you missed it, this and other previous COCA 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


Alcohol Screening and Brief Intervention for People Who Consume Alcohol and Use Opioids

Health care providers can use alcohol screening and brief intervention (ASBI) before prescribing opioids to reduce opioid overdose deaths involving alcohol. ASBI is an evidence-based strategy for reducing excessive drinking.

How can health care providers integrate ASBI into their practices to reduce excessive drinking among patients using prescription opioids?

  • Routinely screen patients who are seeking care for acute or chronic pain for excessive alcohol use using an approved screening method (see the following recommendations).
  • Consider collaborating with other health professionals to perform specific components of ASBI. These include in-depth assessment of drinking behavior, brief intervention, or both.
  • Identify substance use disorder specialists to refer the small percentage (about 10%) of excessive drinkers with severe alcohol use disorders (see step 5 in CDC’s guide for planning and implementing ASBI).7,9
  • Consider involving a pain management specialist in the care of acute and chronic pain in patients with alcohol use disorders.

For more information click here.

CDC Childhood Immunization Schedule Catch-up Job Aids

The Centers for Disease Control and Prevention (CDC) has released updated job aids that compliment figure 2 of the childhood immunization schedule.  These job aids will help health care providers navigate four of the vaccines in the childhood immunization catch-up schedule by looking at the current age of the child, the number of previous dose they have had and then directing the provider when the next dose will be due.

The job aids are available for the following vaccines:

  • DTaP for children 4 months through 6 years of age
  • Tdap/Td for children 7 through 18 years of age
  • Pneumococcal (PCV13) for healthy children 4 months through 4 years of age
  • Haemophilus influenzae type b for healthy children 4 months through 4 years of age
  • Hib vaccine products: ActHIB, Pentacel, Hiberix, or unknown
  • Hib vaccine products: PedvaxHIB vaccine only

The job aids are available online as PDFs and can be printed out in color.


Update on Ebola Virus Disease Outbreak in Democratic Republic of Congo, 2018

On May 8, 2018, the Ministry of Public Health (MoPH) of Democratic Republic of the Congo (DRC) declared an outbreak of Ebola virus disease (EVD) in Bikoro Health Zone, Equateur Province, in Northwest DRC. The declaration was made after lab confirmation of two cases by Institut National de Recherche Biomedicale in Kinshasa, DRC. This is the ninth outbreak of EVD in DRC since 1976, when the virus was discovered. The current outbreak is in a remote, forested area of DRC, which makes it difficult to access the region.

Numbers of cases reported in this outbreak have been changing rapidly. According to The World Health Organization (WHO), as of May 27, 2018, there have been 53 Ebola cases reported (37 confirmed, 13 probable, 3 suspected), including 25 deaths. Most of these cases have been in Bikoro. Four cases have been reported in Mbandaka, a city of about 1.2 million people. Nine neighboring countries, including Congo-Brazzaville and Central African Republic, have been advised by WHO that they are at high risk of spread and have received equipment and personnel support from WHO.

CDC advises healthcare providers in the United States to continue to obtain a travel history from all patients seeking care. Providers should promptly isolate patients that have symptoms compatible with EVD and a recent (within 21 days) history of travel to the affected areas in the Equateur Province of DRC, pending diagnostic testing. Providers should also consider other infectious disease risks that are much more common in returning travelers, including malaria.

For more information about Ebola and for updates related to the Ebola outbreak in DRC, please visit CDC’s Ebola virus disease website.


New Rapid Rabies Test Could Revolutionize Testing and Treatment

A new rabies test developed at CDC could mean people exposed to potentially rabid animals could forego the weeks-long regimen of shots to prevent the deadly disease.

The new test, designed for use in animals, can more easily and precisely diagnose rabies infection, according to a study published today in PLOS One. The new LN34 test is simpler and easier to use than current tests. During the pilot study, it produced no false negatives, fewer false positive, and fewer inconclusive results. It could allow doctors and patients to make better informed decisions about who needs treatment for rabies, which is nearly always fatal once symptoms start.

CDC is working with the Association of Public Health Laboratories (APHL) to develop rabies testing guidance that will help clinicians and laboratory staff decide which tests to run in different scenarios and which tests can be used to confirm rabies, either singly or in combination with other tests.

Read the full press release here. For more information on rabies, click here.


    Did You Know?


    • The rate of new hepatitis B virus infections has increased since 2014, likely due to rising rates of injection drug use.
    • Getting vaccinated helps prevent infection with the hepatitis B virus; chronic infection can lead to serious liver problems.
    • Healthcare professionals can follow new recommendations for a 2-dose hepatitis B vaccine for adults, which provides another option to the existing 3-dose series. 

    Visit CDC's Did You Know? page here.

    Infectious, Vector-Borne, and Zoonotic Diseases


    Mosquito, tick, and flea bites: Disease cases have tripled in the U.S. from 2004 to 2016

    Almost everyone has been bitten by a mosquito, tick, or flea. These can be vectors for spreading pathogens. Between 2004 and 2016, more than 640,000 cases of these diseases were reported, and 9 new germs spread by bites from infected mosquitoes and ticks were discovered or introduced in the US. State and local health departments and vector control organizations are the nation’s main defense against this increasing threat. Yet, 84% of local vector control organizations lack at least 1 of 5 core vector control competencies. Better control of mosquitoes and ticks is needed to protect people from these costly and deadly diseases.

    Learn more about vector-borne diseases here.


    FDA Investigates Multistate Outbreak of B. cepacia Complex Linked to Medline Remedy Essentials No-Rinse Cleansing Foam

    As of May 21, 2018, CDC reports that there are 15 confirmed cases of the Burkholderia cepacia complex (Bcc) associated with use of Medline Remedy Essentials No-Rinse Cleansing Foam. There are seven cases in Pennsylvania, one case in New Jersey and seven cases in California. These patients were already hospitalized for acute conditions and acquired the infections while hospitalized.

    On March 28, 2018, Shadow Holdings dba Bocchi Laboratories of Santa Clarita, CA, announced a voluntary recall of 4oz and 8oz bottles of Medline Remedy Essentials No-Rinse Cleansing Foam lots that had been identified as positive for Bcc. The FDA is currently investigating this matter further to determine whether any additional products or lots may present a risk to consumers.

    Health care professionals and patients should discard all recalled lots of Remedy Essentials No-Rinse Cleansing Foam.

    FDA will continue to work with CDC and state and local health departments in affected states to gather additional information.

    To read the full press release, click here.

    Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant

    Hepatitis B (HepB) vaccination is the primary means of preventing infections and complications caused by hepatitis B virus (HBV). On February 21, 2018, the Advisory Committee on Immunization Practices (ACIP) recommended Heplisav-B (HepB-CpG), a yeast-derived vaccine prepared with a novel adjuvant, administered as a 2-dose series (0, 1 month) for use in persons aged ≥18 years.

    The ACIP Hepatitis Vaccines Work Group conducted a systematic review of the evidence, including data from four randomized controlled trials assessing prevention of HBV infection and six randomized controlled trials assessing adverse events in adults. Seroprotective antibody to hepatitis B surface antigen (anti-HBs) levels were achieved in 90.0%–100.0% of subjects receiving HepB-CpG (Dynavax Technologies Corporation), compared with 70.5%–90.2% of subjects receiving Engerix-B (GlaxoSmithKline Biologicals). The benefits of protection with 2 doses administered over 1 month make HepB-CpG an important option for prevention of HBV.

    Read the full report here.

    Seasonal Influenza


    Weekly U.S. Influenza Surveillance Report

    Influenza activity in the United States continued to decrease, and is below the national baseline for the seventh consecutive week since late November according to the latest FluView report. Influenza-like illness (ILI) decreased slightly to 1.2%. Current data indicate that the 2017-2018 flu season peaked at 7.5% in early February (during week 5). However, 2 states, 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 1 flu-related pediatric death during week 20, bringing the total number of flu-related pediatric deaths this season to 169. Localized or 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.

    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 (6/1/2018)

    Since the last update on May 9, 2018, 23 more ill people were added to this outbreak.

    As of May 15, 2018, 172 people infected with the outbreak strain of E. coli O157:H7 have been reported from 32 states.Illnesses started on dates ranging from March 13, 2018 to May 2, 2018. Ill people range in age from 1 to 88 years, with a median age of 29. Of 157 people with information available, 75 (48%) have been hospitalized, including 20 people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California.. This investigation is ongoing.

    Multistate Outbreak of Salmonella Typhimurium Infections Linked to Dried Coconut (5/18/2018)

    CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Salmonella Typhimurium infections. This outbreak appears to be over. However, recalled dried coconut products have a long shelf life and may still be in people’s homes. Consumers unaware of the recall could continue to eat these products and potentially get sick.

    As of May 18, 2018, this outbreak appears to be over.


    Multistate Outbreak of Salmonella Braenderup Infections Linked to Rose Acre Farms Shell Eggs (5/11/2018)

    Since the last update on April 16, 2018, 12 more ill people were added to this outbreak.

    As of April 16, 2018, 35 people infected with the outbreak strain of Salmonella Braenderup have been reported from 9 states. Illnesses started on dates ranging from November 16, 2017 to April 14, 2018. Ill people range in age from 1 to 90 years, with a median age of 65. Fifty percent of ill people are female. Of 28 people with information available, 11 (39%) have been hospitalized and no deaths have been reported. This investigation is 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 that CDC, other federal agencies, and COCA partners offer, 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.