COCA Digest: January 2, 2019

View this email as a webpage:

COCA Digest Banner

CDC Health Alert Network (HAN) Update


CDC HAN 416: Update—Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use (12/10/2018)

The Centers for Disease Control and Prevention (CDC) is providing information on: 1) the current status of a multistate outbreak of coagulopathy from exposure to synthetic cannabinoid products containing a vitamin K-epoxide cycle antagonist, brodifacoum; 2) the emergence of 2 new clinical scenarios; and 3) recommendations to help clinicians make decisions related to these 2 new clinical scenarios.

This is an update to the Health Alert Network (HAN) advisory released on May 25, 2018 titled Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use.

Read the full HAN Update here.

Sign up to receive CDC HAN messages here.

CDC News and Announcements

CDC Earns Reaccreditation for Emergency Management

The Centers for Disease Control and Prevention’s emergency management program, which includes the emergency operations center, has been accredited again by the Emergency Management Accreditation Program for excellence in emergency management.

CDC’s emergency management program was first accredited in 2013. The program led CDC’s management of numerous emergency responses, including the 2014 Ebola response and the 2016 Zika response. CDC activated its Emergency Operations Center to simultaneously manage four emergencies in 2016 (Global Polio Eradication, Ebola, Zika, and the Flint Michigan Water Contamination).

Deadly Marburg Virus Found in Sierra Leone Bats

First time this Ebola-like virus identified in West Africa

Scientists have discovered live Marburg virus in fruit bats in Sierra Leone – the first time the deadly virus has been found in West Africa.

Five Egyptian rousette fruit bats tested positive for active Marburg virus infection. Scientists caught the bats separately at locations in three health districts: Moyamba, Koinadugu and Kono. There have been no reported cases of people sick with Marburg in Sierra Leone, but the virus’s presence in bats means people nearby could be at risk for contracting Marburg virus. Marburg virus is a cousin to Ebola virus that causes a similar, often fatal disease in people.

For more information about Marburg virus, click here.

COCA Partner News

COCA would like to welcome our newest partner, the Association of Public Health Nurses (APHN)! APHN works to protect and promote the health and safety of the public by fostering high public health nursing practice standards, promoting and providing educational opportunities, and advancing the public health nursing role. Learn more about APHN by checking out their website here!

Seasonal Influenza


2018-2019 Influenza Season Week 51 ending December 22, 2018

All data are preliminary and may change as more reports are received.

An overview of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component, is available at,

Influenza activity in the United States is increasing. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continue to co-circulate. Below is a summary of the key influenza indicators for the week ending December 22, 2018:

  • Viral Surveillance: Influenza A viruses have predominated in the United States since the beginning of October. Influenza A(H1N1)pdm09 viruses have predominated in most areas of the country, however influenza A(H3) viruses predominated in the southeastern United States (HHS Region 4). The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories is increasing.
    • Virus Characterization: The majority of influenza viruses characterized antigenically and genetically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses. A comparison of gene sequences of recent influenza A(H1N1)pdm09 viruses from the U.S. and Mexico/Central America showed them to be similar.
    • Antiviral Resistance: All viruses tested show susceptibility to the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir).
  • Influenza-like Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) increased to 3.3%, which is above the national baseline of 2.2%. Nine of 10 regions reported ILI at or above their region-specific baseline level.
    • ILI State Activity Indictor Map: New York City and nine states experienced high ILI activity; Puerto Rico and seven states experienced moderate ILI activity; 11 states experienced low ILI activity; the District of Columbia and 22 states experienced minimal ILI activity; and one state had insufficient data. Among the four states along the southern U.S. border, ILI activity increased to moderate in Arizona and high in New Mexico.
  • Geographic Spread of Influenza: The geographic spread of influenza in Guam and 11 states was reported as widespread; Puerto Rico and 19 states reported regional activity; 15 states reported local activity; the District of Columbia, the U.S. Virgin Islands and three states reported sporadic activity; and two states did not report.
  • Influenza-associated Hospitalizations A cumulative rate of 3.6 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.  The highest hospitalization rate is among children younger than 5 years (10.0 hospitalizations per 100,000 population).
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths: Four influenza-associated pediatric deaths were reported to CDC during week 51.

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.    

Emergency Preparedness and Response

person shoveling snow

Winter Weather Public Service Announcements (PSAs) and Podcasts

Clinicians, remind your patients about the importance of being prepared and how they can take steps to protect themselves and their families during extreme cold. CDC has Winter Weather Public Service Announcements (PSAs) and Podcasts that you can access here.

Natural Disasters and Severe Weather

See below for information on a variety of health and safety concerns for all disasters, including:  

Resources for Emergency Health Professionals

CDC offers a variety of resources for clinicians, communicators, laboratorians, emergency planners and responders, and disaster relief volunteers to help them prepare to respond to a public health emergency. This section includes free educational materials that are suitable for printing and sharing in various languages, including flyers, posters, stickers, and PSAs.

Click here to access the resources.

Disaster Resources and Educational Materials

Be sure to check out CDC’s educational materials including a variety of hazards listed by topic or language, PSAs for disasters, resources for emergency health professionals, and social media channels with featured apps, blogs, content available for syndication, and buttons and badges. Go here to access these free resources that are suitable for printing and sharing.

Travelers' Health

photo of a man traveling on a plane

The mission of CDC Travelers' Health is to reduce illness and injury in US residents traveling internationally or living abroad. Applying the best science, we provide alerts, recommendations, education, and technical support to travelers and the healthcare providers who serve them. More Travelers' Health information.

General Resources
CDC Health Information for International Travel (the Yellow Book) contains the US government's most current travel health guidelines, including pre-travel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts. Available free online( and for iOS or  Android.

General Vaccine Information

Pre-travel Care Tools

Disease-Specific Resources

Clinical Updates

Food, Drug, and Device Safety

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. 

CDC Current Outbreak List

Stay up to date on the infectious disease outbreaks that CDC is currently reporting. For a complete list of U.S. outbreaks, travel notices affecting international travelers, food safety recalls, and further sources for content about specific outbreaks, please go here.

You can also sign up to receive email updates about U.S.-Based Outbreaks and Travel Notices Affecting International Travelers on this page.