#Rabies in a #Dog Imported from #Egypt with a Falsified Rabies Vaccination Certificate — #Virginia, 2015 (@CDCgov, MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Rabies in a Dog Imported from Egypt with a Falsified Rabies Vaccination Certificate — Virginia, 2015 [      ]

Weekly / December 18, 2015 / 64(49);1359-62

Julie R. Sinclair, DVM1; Ryan M. Wallace, DVM2; Karen Gruszynski, DVM3; Marilyn Bibbs Freeman, PhD4; Colin Campbell, DVM5; Shereen Semple, MS5; Kristin Innes, MPH5; Sally Slavinski, DVM6; Gabriel Palumbo, MPH1; Heather Bair-Brake, DVM1; Lillian Orciari, MS2; Rene E. Condori, MS2; Adam Langer, DVM1; Darin S. Carroll, PhD2; Julia Murphy, DVM3

_____

Canine rabies virus variant has been eliminated in the United States and multiple other countries. Globally, however, dogs remain the principal source for human rabies infections (1). The World Health Organization recommends that when dogs cross international borders, national importing authorities should require an international veterinary certificate attesting that the animal did not show signs of rabies at the time of shipment, was permanently identified, vaccinated, or revaccinated, and had been subjected to a serologic test for rabies before shipment (1). On June 8, 2015, an adult female dog that had recently been picked up from the streets of Cairo, Egypt, and shipped by a U.S. animal rescue organization to the United States was confirmed to have rabies by the Virginia Department of General Services Division of Consolidated Laboratory Services (DCLS). This dog was part of a large shipment of dogs and cats from Egypt that rescue organizations had distributed to multiple states for adoption. During the investigation, public health officials learned that the rabies vaccination certificate used for entry of the rabid dog into the United States had intentionally been falsified to avoid exclusion of the dog from entry under CDC’s current dog importation regulations. This report underscores the ongoing risk posed by U.S. importation of domestic animals that have not been adequately vaccinated against rabies.

(…)

Keywords: US CDC; USA; Updates; Viriginia; Dogs; Rabies.

——–

#Taiwan #CDC warns #travelers to pay attention to Mainland #China #H7N9 and #H9N2 #birdflu viruses situation (CDC, Dec. 15 ‘15, edited)

[Source: Centre for Disease Control and Prevention, Taiwan, full page: (LINK). Automatic translation, edited.]

#Taiwan #CDC warns #travelers to pay attention to Mainland #China #H7N9 and #H9N2 #birdflu viruses situation [      ][      ]

(December 15 2015)

______

As weather turns cold, please implement respiratory and hand hygiene to prevent influenza infection; China mainland recently detected H7N9 and H9N2 avian influenza virus infection cases, travelers that go to endemic areas, please be vigilant (2015-12-15)

____

Recently the weather starting to turn cold, publicly funded influenza vaccine will be exhausted soon, please seize the opportunity as soon as possible vaccinated people; in line with publicly funded influenza antiviral drug target agents also asked for medical treatment and medication as soon as possible to protect themselves and their families healthy.

China mainland recently discovered H7N9 and H9N2 influenza virus infection cases, people go to endemic areas be sure to do self-protection, to avoid contact with live poultry birds classes and access to markets, to prevent infection.

(…)

In addition, China added one case of H7N9 flu infection in Zhejiang Hangzhou, a 60-year-old male farmer, who had contact with live poultry, and that was currently in critical conditions.

China mainland reported this autumn so far a total of six cases of H7N9 influenza virus infection cases: Zhejiang, five cases; one case in Guangdong Province, was a 50 years old patient having had a history of exposure to poultry.

So far a total of 683 cases of H7N9 avian influenza virus infection have been reported worldwide since 2013, including 663 cases in mainland China, Hong Kong 13 cases, 4 cases of Taiwan, Canada two cases, one case of Malaysia, according the most recent WHO update; of these, 275 cases died.

Mainland China’s Anhui and Hunan provinces recently added four cases of avian influenza virus H9N2 infection.

The cases are 3 female and 1 male, date of onset is between April to October this year, with mild clinical course, one case he joined the family to the market to buy food, no live poultry remaining exposure history or exposure history is unknown.

Since 2013 the Chinese mainland and Hong Kong from a cumulative total of six cases of H9N2 flu, including four cases in Hunan Province, Anhui Province, one case and one case of Hong Kong (Guangdong Province moved).

Currently tourism against human bird flu epidemic proposal, mainland China, Zhejiang, Guangdong, Anhui and Hunan Provincial Tourism epidemic proposal as a warning (Alert), other provinces (excluding Hong Kong and Macao) as a note (Watch).

The Programme disease called people not to overlook the severity of influenza, usually should routinely wash their hands, good respiratory hygiene and cough etiquette; visit mainland China should avoid contact with live poultry birds classes and access to markets; edible chickens, ducks, geese and eggs to cooked to avoid infection. Such as fever or flu-like symptoms should wear a mask as soon as possible for medical treatment, in addition to travel and contact history inform physicians and medication according to doctor’s orders, at home recuperating. Information available to the illness UNDCP WWW (http://www.cdc.gov.tw), or call toll-free vaccination Line 1922 (or 0800-001922 FREE) contact.

Keywords: Taiwan; Updates; H7N9; H9N2; Avian Influenza; Human, China.

——-

#COP21: #UN chief hails new #climatechange #agreement as ‘monumental #triumph’ [updated] (UN News Centre, Dec. 13 ‘15)

[Source: United Nations News Centre, full page: (LINK).]

COP21: UN chief hails new climate change agreement as ‘monumental triumph’ [  INTL / ENVR  ]

12 December 2015

Following the adoption of the new Paris Agreement on climate change, United Nations Secretary-General Ban Ki-moon said government representatives made history today.

“The Paris Agreement is a monumental triumph for people and our planet,” said Mr. Ban in a tweet, immediately following its adoption. “It sets the stage for progress in ending poverty, strengthening peace and ensuring a life of dignity and opportunity for all.”

Gaveling the Agreement with a green hammer, the French Foreign Minister and President of COP21, Laurent Fabius, announced the historic news – a moment greeted with loud applause and cheers, as the room stood up. Many delegates hugged, while others had tears in their eyes.

For the first time today, 195 Parties to the UN Framework Convention on Climate Change (UNFCCC) – pledged to curb emissions, strengthen resilience and joined to take common climate action. This followed two weeks of tireless negotiations at the United Nations climate change conference (COP21).

The Paris Agreement and the outcomes of COP21 cover all the crucial areas identified as essential for a landmark conclusion:

–> mitigation – reducing emissions fast enough to achieve the temperature goal;

–> a transparency system and global stock-take – accounting for climate action;

–> adaptation – strengthening ability of countries to deal with climate impacts;

–> loss and damage – strengthening ability to recover from climate impacts; and

–> support – including finance, for nations to build clean, resilient futures.

“In the face of an unprecedented challenge, you have demonstrated unprecedented leadership,” the UN chief said taking the COP21 stage just minutes later. “You have worked collaboratively to achieve something that no one nation could achieve alone. This is a resounding success for multilateralism.”

Recalling that he made climate change one of the defining priorities of his tenure as Secretary-General, Mr. Ban said that most of all, he has listened to people – the young, the poor and the vulnerable, including indigenous peoples, from every corner of the globe.

“They seek protection from the perils of a warming planet, and the opportunity to live in a safer, more bountiful world,” he underlined. “They have demanded that world leaders act to safeguard their well-being and that of generations to come.”

Turning to the agreement itself, the Secretary-General said negotiators reached “solid results on all key points,” with an agreement that demonstrates solidarity and “is ambitious, flexible, credible and durable.”

“All countries have agreed to hold global temperature rise to well below 2 degrees Celsius. And recognizing the risk of grave consequences, you have further agreed to pursue efforts to limit temperature increase to 1.5 degrees,” he announced.

In addition, a review mechanism has been established whereby every five years, beginning in 2018, Parties will regularly review what is needed in line with science.

“Governments have agreed to binding, robust, transparent rules of the road to ensure that all countries do what they have agreed across a range of issues,” Mr. Ban added.

Meanwhile, highlighting the role of the private sector, the UN chief said business leaders came to Paris in unprecedented numbers and that “powerful” climate solutions are already available while many more are to come.

“With these elements in place, markets now have the clear signal they need to unleash the full force of human ingenuity and scale up investments that will generate low-emissions, resilient growth,” he said, adding that “what was once unthinkable has now become unstoppable.”

“When historians look back on this day, they will say that global cooperation to secure a future safe from climate change took a dramatic new turn here in Paris,” Mr. Ban stated. “Today, we can look into the eyes of our children and grandchildren, and we can finally say, tell them that we have joined hands to bequeath a more habitable world to them and to future generations.”

Ending his remarks, the UN chief said that all Parties should be proud of the Paris Agreement and that “the work starts tomorrow.”

“For today, congratulations again on a job well done,” he concluded. “Let us work together, with renewed commitment, to make this a better world.”

Addressing the hundreds of delegates, Christiana Figueres, the Executive Secretary of UNFCCC, said “we did it in Paris.”

“We have made history together. It is an agreement of conviction. It is an agreement of solidarity with the most vulnerable. It is an agreement of long-term vision, for we have to turn this agreement into an engine of safe growth,” she exclaimed.

Several other top UN officials joined the Secretary-General in welcoming the new Agreement. This included the President of the UN General Assembly, Mr. Mogens Lykketoft.

“Today’s agreement signals nothing less than a renaissance for humankind as we collectively embrace the global challenge of climate change and endeavor to transition to a more sustainable way of living that respects the needs of people and our planet,” Mr. Lykketoft said in a statement.

Echoing this message, the President of the UN Economic and Social Council (ECOSOC), Oh Joon, said the world has reached a key milestone in collective action for sustainable development.

“Bold action against climate change will contribute to poverty reduction. The United Nations Economic and Social Council will take part in follow-up efforts,” he added.

Earlier today, at a meeting of the Committee of Paris [Comité de Paris] – the body which is overseeing the negotiations at COP21 – the UN chief spoke alongside the President of France, François Hollande as well Minister Fabius.

“The end is in sight. Let us now finish the job. The whole world is watching. Billions of people are relying on your wisdom,” the Secretary-General had told delegates.

In an emotional address during which he held back tears, Laurent Fabius said the agreement “will serve meaningful causes, food safety and security, public health, the fight against poverty and for essential rights, and therefore peace.”

“People worldwide, our citizens, our children, wouldn’t understand if we didn’t adopt it and wouldn’t forgive us,” he insisted.

“It is rare to be given the opportunity to change the world,” said President François Hollande, wrapping up the meeting. “You have the opportunity to do that.”

Keywords: Worldwide; UN; Updated; Climate Change; Global Warming; International Cooperation.

——–

#COP21: ‘Monumental #triumph’ in #Paris as #world adopts new #climatechange #agreement, says #UN chief (UN News Centre, Dec. 12 ‘15)

[Source: United Nations News Centre, full page: (LINK).]

COP21: ‘Monumental triumph’ in Paris as world adopts new climate change agreement, says UN chief [  INTL / ENVR  ]

12 December 2015

Following the adoption of the new Paris Agreement on climate change, United Nations Secretary-General Ban Ki-moon said government representatives made history today.

“The Paris Agreement is a monumental triumph for people and our planet,” said Mr. Ban in a tweet. “It sets the stage for progress in ending poverty, strengthening peace and ensuring a life of dignity and opportunity for all.”

Gaveling the agreement with a green hammer, the French Foreign Minister and President of COP21 Laurent Fabius announced its adoption—a moment greeted with loud applause and cheers, as the room stood up. Many delegates hugged, while others had tears in their eyes.

Earlier today, the Secretary-General told delegates that the world had been presented a “historic” document which promises to set it on a new path to a low-emissions, climate-resilient future.

“I would like to take this opportunity to commend the commitment, engagement and leadership of all the Heads of State, Government ministers and negotiators who have brought us so far in this very difficult negotiation,” Mr. Ban said as all COP21 stakeholders prepared to receive the final draft outcome.

At this morning’s plenary meeting of the Committee of Paris [Comité de Paris]—the body which is overseeing the negotiations at COP21—the UN chief spoke alongside the President of France, François Hollande and the President of COP21 and French Foreign Minister, Laurent Fabius.

“The end is in sight. Let us now finish the job. The whole world is watching. Billions of people are relying on your wisdom,” the Secretary-General declared.

At the opening session of the conference on the last day of November, the UN chief had told 150 world leaders—an unprecedented number to have shown up for such an occasion—that “a political moment like this may not come again.” Today, he said leaders have listened.

“They want a flexible, robust, meaningful, universal agreement that will help us rise as one to the climate challenge. The issues are many and complex. But we must not let the quest for perfection become the enemy of the public good,” he warned.

“The solutions to climate change are on the table. They are ours for the taking. Let us have the courage to grasp them,” he said ending his remarks, adding that he looks forward to joining delegates later today to celebrate the new agreement.

Opening the floor in an emotional address during which he held back tears, Foreign Minister Fabius said if the world doesn’t adopt the agreement, it is the “credibility of multilateralism” that would be in play.

“The agreement will serve meaningful causes, food safety and security, public health, the fight against poverty and for essential rights, and therefore peace,” he insisted. “People worldwide, our citizens, our children, wouldn’t understand if we didn’t adopt it and wouldn’t forgive us.”

He announced that the document presented today as the final draft is “differentiated, just, dynamic, balanced and legally binding.” It calls for global temperature rise to be limited to “well below 2 degrees Celsius,” and “endeavored to reach 1.5 degrees.” It also provides for a transparency framework, monitoring progress every five years.

“It is rare to be given the opportunity to change the world,” said President François Hollande, wrapping up the meeting. “You have the opportunity to do that.”

MORE TO FOLLOW

Keywords: UN; Updates; Worldwide; Climate Change; Interntional Cooperation; Global Warming.

——-

#Michigan, Suspect #deer confirmed #positive for chronic wasting disease [#CWD] (DNR, December 11 2015, edited)

[Source: Michigan Department of Natural Resources, full page: (LINK).]

Suspect deer confirmed positive for chronic wasting disease [      ]

Contact: Chad Stewart, 517-641-4903, ext. 263  / Agency: Natural Resources / Dec. 11, 2015

Deer was harvested in Dewitt Township; Eaton County hunters urged to voluntarily check deer and stop baiting and feeding of deer

As of Thursday, the Michigan Department of Natural Resources reports a total of 3,695 deer in Michigan this year have been tested for chronic wasting disease (CWD). Four deer have been confirmed positive for the disease, with the fourth positive just recently found.

During the firearm deer season, a hunter from Dewitt Township (Clinton County) in the Core CWD Area brought a 1 1/2-year-old buck into the DNR’s Rose Lake deer check station. The U.S. Department of Agriculture’s National Veterinary Services Laboratory in Ames, Iowa, confirmed the deer as CWD positive.

Because the deer was harvested within 10 miles of the Eaton County border, the DNR strongly encourages all hunters within Eaton County to voluntarily stop baiting and feeding, continue hunting and, most importantly, bring harvested deer into a DNR check station.

“Deer hunters in DMU 333 have been a great help by bringing in their deer to be tested. We couldn’t be more thankful or impressed with their dedication to the resource,” said Chad Stewart, DNR deer specialist. “We continue to need their help and are also asking Eaton County hunters to join our efforts. In addition, we have begun conversations with DeWitt Township, and they, too, are becoming great partners in this fight against CWD.”

There will be no mandatory regulation changes from now through the end of the deer season, as the DNR conducts CWD surveillance and decides what additional steps might be needed for the 2016 season.

CWD is a fatal neurological disease that affects white-tailed deer, mule deer, elk and moose. It is caused by the transmission of infectious, self-multiplying proteins (prions) contained in saliva and other body fluids of infected animals. Susceptible animals can acquire CWD by direct exposure to these fluids, or from environments contaminated with these fluids or the carcass of a diseased animal.

Some chronically CWD-infected animals will display abnormal behaviors, progressive weight loss and physical debilitation; however, deer can be infected without showing internal or external symptoms for many years. There is no cure; once a deer is infected with CWD, it will die.

To date, there is no evidence that chronic wasting disease presents any risk to non-cervids, including humans, either through contact with an infected animal or from handling venison. However, as a precaution, the U.S. Centers for Disease Control and the World Health Organization recommend that infected animals not be consumed as food by either humans or domestic animals.

The DNR provides weekly CWD updates at mi.gov/cwd. Announcements of additional CWD-positive deer also will be posted online.

The Michigan Department of Natural Resources is committed to the conservation, protection, management, use and enjoyment of the state’s natural and cultural resources for current and future generations. For more information, go to www.michigan.gov/dnr.

Keywords: USA; Updates; Michigan; Deer; Chronic Wasting Disease; Prions.

—–

#USDA Issues Final #Environmental #Impact #Statement to Help Reduce Potential #Risks during an #Animal #Health #Emergency (USDA, December 11 2015, edited)

[Source: US Department of Agriculture, full page: (LINK).]

USDA Issues Final Environmental Impact Statement to Help Reduce Potential Risks during an Animal Health Emergency [      ]

Published: Dec 11, 2015

WASHINGTON, Dec. 11, 2015— The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) is issuing a final environmental impact statement (EIS) for carcass management alternatives that could be implemented during an animal health emergency.

Livestock carcasses in large numbers can present a potential environmental risk. The agency must effectively manage carcasses in a mass animal health emergency to reduce potential risks to humans, livestock, and the surrounding environment.

In the EIS, the agency evaluated three alternatives, including:

  • Taking no action, under which APHIS would manage carcasses in a mass animal health emergency in accordance with the existing regulations in 9CFR53.4, using either unlined burial or open-air burning.
  • Using standard procedures, which would consider four additional carcass-management options – landfill, rendering, fixed incineration, and composting – in addition to those listed in the no action alternative.
  • Adaptive management, chosen as the preferred alternative, which allows for all high-capacity, widely-available carcass management options – including unlined burial, open-air burning, landfill, rendering, incineration, composting, and other nonstandard options – to be considered and potentially used during a mass animal health emergency.  This chosen alternative is expected to provide greater flexibility for using the best available resources in such an event.

The EIS finds that carcasses resulting from an animal health emergency can be disposed of safely using a variety of available methods.  The EIS is not specific to any one animal disease.  The findings of the EIS will be used to support animal health emergency planning and decision-making.

The final EIS is available at: http://www.aphis.usda.gov/stakeholders/downloads/2015/eis_carcass_management.pdf

The notice of availability for the final EIS is expected to be published in the Federal Register on Friday, December 18.

###

Keywords: USA; USDA; Updates; Infectious Diseases.

——–

#HK, CHP notified of two #human cases of #avian #influenza A(#H7N9) in #Zhejiang & #Guangdong Provinces (CHP, Dec. 11 ‘15)

[Source: Centre for Health Protection, Hong Kong PRC SAR, full page: (LINK).]

CHP notified of two human cases of avian influenza A(H7N9) on Mainland [      ]

The Centre for Health Protection (CHP) of the Department of Health (DH) today (December 11) was notified of two human cases of avian influenza A(H7N9) in Zhejiang and Guangdong by the National Health and Family Planning Commission (NHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the NHFPC, the cases comprise a male farmer aged 60 in Hangzhou, Zhejiang, and a male farmer aged 74 in Meizhou, Guangdong. They had poultry exposure history and are currently in serious condition.

“Based on previous seasonal patterns, it is likely that the activity of avian influenza viruses will increase in winter. Heightened vigilance is warranted. Locally, we will work closely with the World Health Organization and relevant health authorities to monitor the latest developments,” a spokesman for the DH said.

So far, six cases have been reported by the NHFPC since October 2015 (five in Zhejiang and one in Guangdong).

From 2013 to date, 663 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities.

The DH’s Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcast of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

Travellers, especially those returning from avian influenza-affected areas with fever or respiratory symptoms, should wear masks, seek medical attention and reveal their travel history to doctors. Healthcare professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas.

The public should remain vigilant and take heed of the advice against avian influenza below:

* Do not visit live poultry markets and farms. Avoid contact with poultry, birds and their droppings;
* If contact has been made, thoroughly wash hands with soap;
* Avoid entering areas where poultry may be slaughtered and contact with surfaces which might be contaminated by droppings of poultry or other animals;
* Poultry and eggs should be thoroughly cooked before eating;
* Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment (including escalator handrails, elevator control panels and door knobs); and when hands are dirtied by respiratory secretions after coughing or sneezing;
* Cover the nose and mouth while sneezing or coughing, hold the spit with a tissue and put it into a covered dustbin;
* Avoid crowded places and contact with fever patients; and
* Wear masks when respiratory symptoms develop or when taking care of fever patients.

The public may visit the CHP’s pages below for more information:

* The avian influenza page (www.chp.gov.hk/en/view_content/24244.html);
* The weekly Avian Influenza Report (www.chp.gov.hk/en/view_content/3879.html);
* Global statistics and affected areas of avian influenza (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf);
* The Facebook Page (www.fb.com/CentreforHealthProtection); and
* The YouTube Channel (www.youtube.com/c/ChpGovHkChannel).

Keywords: HK PRC SAR; Updates; China; Zhejiang; Guangdong; H7N9; Avian Influenza; Human.

——-

#Update: #Influenza #Activity — #USA, October 4–November 28, 2015 (@CDCgov / MMWR Morb Mortal Wkly Rep., edited)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Edited.]

Update: Influenza Activity — United States, October 4–November 28, 2015 [      ]

Weekly / December 11, 2015 / 64(48);1342-8

Sophie Smith, MPH1; Lenee Blanton, MPH1; Krista Kniss, MPH1; Desiree Mustaquim, MPH1; Craig Steffens, MPH1; Carrie Reed, DSc1; Anna Bramley, MPH1; Brendan Flannery, PhD1; Alicia M. Fry, MD1; Lisa A. Grohskopf, MD1; Joseph Bresee, MD1; Teresa Wallis, MS1; Rebecca Garten, PhD1; Xiyan Xu, MD1; Anwar Isa Abd Elal1; Larisa Gubareva, PhD1; John Barnes, PhD1; David E. Wentworth, PhD1; Erin Burns, MA1; Jacqueline Katz, PhD1; Daniel Jernigan, MD1; Lynnette Brammer, MPH1

______

CDC collects, compiles, and analyzes data on influenza activity year-round in the United States. The influenza season generally begins in the fall and continues through the winter and spring months; however, the timing and severity of circulating influenza viruses can vary by geographic location and season. Influenza activity in the United States remained low through October and November in 2015. Influenza A viruses have been most frequently identified, with influenza A (H3) viruses predominating. This report summarizes U.S. influenza activity* for the period October 4–November 28, 2015.†

 

Viral Surveillance

World Health Organization (WHO) collaborating laboratories and National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories, which include both public health and clinical laboratories located throughout the United States, participate in virologic surveillance for influenza.

Beginning with the 2015–16 influenza season, data for public health and clinical laboratories are presented separately because influenza testing practices differ.

Clinical laboratories test respiratory specimens for diagnostic purposes, and data from these laboratories provide useful information regarding the timing and intensity of influenza activity.

Public health laboratories primarily test specimens for surveillance purposes to understand which influenza viruses are circulating throughout their jurisdictions and which population groups are being affected. The age group distribution of influenza positive tests reported from public health laboratories is summarized.

Clinical laboratories in the United States tested 102,675 respiratory specimens collected during October 4–November 28, 2015, for influenza viruses. Among these, 1,268 (1.2%) tested positive for influenza (Figure 1); 772 (60.9%) were influenza A viruses, and 496 (39.1%) were influenza B viruses.

Public health laboratories in the United States tested 8,488 respiratory specimens collected during October 4–November 28, 2015, for influenza viruses.

Among these, 404 tested positive for influenza (Figure 2); 333 (82.4%) were influenza A viruses, and 71 (17.6%) were influenza B viruses.

Of the 333 influenza A viruses, 317 (95.2%) were subtyped; 55 (17.4%) were influenza A(H1N1)pdm09 (pH1N1), and 262 (82.6%) were influenza A (H3) viruses.

Of the 71 influenza B viruses, 21 (29.6%) had lineage determined; 13 (61.9%) belonged to the B/Yamagata lineage, and eight (38.1%) belonged to the B/Victoria lineage.

Since October 4, influenza-positive test results have been reported from all 50 states, the District of Columbia, Guam, and Puerto Rico, representing all 10 U.S. Department of Health and Human Services (HHS) regions.§ Influenza A viruses have predominated nationally and in all 10 HHS regions.

During October 4–November 28, 2015, age data were available for 370 positive influenza test results, including 31 (8.4%) in children aged 0–4 years, 96 (26.0%) in persons aged 5–24 years, 130 (35.1%) in persons aged 25–64 years, and 113 (30.5%) in persons aged ≥65 years.

Influenza A (H3) viruses were predominant in all age groups, accounting for a proportion of influenza positives ranging from 41.9% (ages 0–4 years) to 84.1% (ages ≥65 years).

The largest number of influenza A pH1N1 viruses were reported in persons aged 25–64 years. The largest number of influenza B viruses were reported in persons aged 5–24 years and 25–64 years.

 

Influenza Virus Characterization

WHO collaborating laboratories in the United States are requested to submit a subset of influenza-positive respiratory specimens to CDC for further virus characterization.

CDC characterizes influenza viruses through one or more laboratory tests including genome sequencing, or hemagglutination inhibition (HI), or neutralization assays. These data are used to compare how similar currently circulating influenza viruses are to the influenza vaccine reference viruses, and to monitor for changes in circulating influenza viruses.

Most viruses tested are propagated in mammalian cell cultures because isolation rates of human influenza viruses are higher in mammalian cell cultures than in eggs. However, egg-propagated vaccine viruses are used widely for production of influenza vaccines because most influenza vaccines are egg-based. Propagation of influenza viruses in eggs can lead to isolation of viruses that differ genetically and antigenically from corresponding clinical specimens isolated in mammalian cell cultures. In addition, mammalian cell-propagated viruses are genetically more representative of viruses present in original clinical specimens (1,2). Antigenic and genetic characterization of circulating viruses is performed using both mammalian cell- and egg-propagated reference viruses.

Historically HI data have been used most commonly to assess the similarity between reference viruses and circulating viruses. Although vaccine effectiveness field studies must be conducted to actually determine how well the vaccine is working, these laboratory data are used to determine whether changes in the virus have occurred that could affect vaccine effectiveness.

Beginning with the 2014–15 season and to date, however, a proportion of influenza A (H3N2) viruses have not yielded sufficient hemagglutination titers for antigenic characterization by HI.

For all viruses characterized at CDC laboratories, whole genome sequencing is performed to determine the genetic group identity of these circulating viruses. For the subset of viruses that do not yield sufficient hemagglutination titers, antigenic properties of those viruses are inferred using results from viruses within the same genetic group that have been characterized antigenically.

Since October 1, 2015, CDC has antigenically or genetically characterized 62 specimens (18 influenza A (H1N1)pdm09, 43 influenza A (H3N2), and one influenza B/Yamagata lineage).

A total of 43 H3N2 viruses have been genetically sequenced and all 43 viruses belonged to genetic groups for which a majority of antigenically characterized viruses were similar to the cell-propagated reference virus A/Switzerland/9715293/2013 representing the influenza A (H3N2) component of the 2015–16 Northern Hemisphere vaccine.

A total of 35 viruses (18 influenza A (H1N1)pdm09, 16 influenza A (H3N2), and one B/Yamagata lineage) collected since October 1, 2015, have been antigenically characterized.

All A(H1N1)pdm09, all B viruses, and 15 of the 16 A(H3N2) viruses were similar to the reference viruses representing the 2015–16 Northern Hemisphere influenza vaccine components.

 

Antiviral Resistance of Influenza Viruses

The WHO Collaborating Center for Surveillance, Epidemiology, and Control of Influenza at CDC tested 56 influenza virus specimens (11 influenza A (H1N1)pdm09, 33 influenza A (H3N2) and 12 influenza B) collected since October 1, 2015, in the United States for resistance to the influenza neuraminidase inhibitor antiviral medications oseltamivir, zanamivir, and peramivir, which are the drugs currently approved for use against seasonal influenza.

All 56 influenza viruses tested were sensitive to all three antiviral medications. High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A (H1N1)pdm09 and (H3N2) viruses. Adamantane drugs are not recommended for use against influenza at this time.

 

Outpatient Illness Surveillance

Since October 4, the weekly percentage of outpatient visits for influenza-like illness (ILI)¶ reported by approximately 1,800 U.S. Outpatient ILI Surveillance Network (ILINet) providers in 50 states, New York City, Chicago, the U.S. Virgin Islands, Puerto Rico, and the District of Columbia, has ranged from 1.3% to 1.9% and has remained below the national baseline** of 2.1% (Figure 3).

Peak weekly percentages of outpatient visits for ILI ranged from 2.4% to 7.6% from the 1997–98 through 2014–15 influenza seasons, excluding the 2009 pandemic.

Data collected in ILINet are used to produce a measure of ILI activity†† by jurisdiction.

During surveillance week 47, Puerto Rico and two states (Oklahoma and South Carolina) experienced moderate ILI activity, and four states (Arizona, Mississippi, New Jersey, and Virginia) experienced low ILI activity.

Minimal ILI activity was experienced in New York City and 44 states (Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming).

Data were insufficient to calculate an ILI activity level for the District of Columbia.

 

Geographic Spread of Influenza Activity

For the week ending November 28 (week 47), Guam reported widespread geographic spread of influenza,§§ Puerto Rico reported regional spread, and seven states (Iowa, Maryland, Massachusetts, New Hampshire, North Carolina, Oregon, and Utah) reported local spread.

The District of Columbia, the U.S. Virgin Islands, and 38 states (Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas, Vermont, Washington, West Virginia, Wisconsin, and Wyoming) reported sporadic spread.

Five states (Alabama, Mississippi, Rhode Island, Tennessee, and Virginia) reported no influenza activity.

 

Pneumonia- and Influenza-Associated Mortality

CDC tracks pneumonia and influenza (P&I)–associated deaths through two systems, the National Center for Health Statistics (NCHS) Mortality Surveillance System and the 122 Cities Mortality Reporting System.

Beginning during the 2015–16 season, data from the newer NCHS system will be the principal component of the U.S. mortality surveillance system.

NCHS mortality data are presented by the week that the death occurred, whereas the 122 Cities Mortality Reporting System data are reported the week that the death certificate was registered. The length of time from the occurrence of a death until registration of the death certificate in the vital statistics office can vary considerably; therefore, these two data sources produce different percentages.

Presenting data by the week of the death, rather than the date of filing of the death certificate more accurately reflects the timing of P&I mortality. The percentage of P&I deaths from each system should be compared with the corresponding system-specific baselines and thresholds.

Through the NCHS Mortality Surveillance System, the percentages of deaths associated with P&I are released 2 weeks after the week of death to allow for collection of sufficient data to produce a stable P&I mortality percentage.

Based on NCHS data available December 3, 5.9% (1,370 of 23,191) of all U.S. deaths occurring during the week ending November 14, 2015 (week 45) were classified as resulting from P&I. This percentage is below the epidemic threshold¶¶ of 6.8% for week 45.

Since October 4, the weekly percentage of deaths attributed to P&I ranged from 5.9% to 6.2% and has not exceeded the epidemic threshold this season. Peak weekly percentages of deaths attributable to P&I during the previous five influenza seasons ranged from 8.7% during the 2011–12 season to 11.1% during the 2012–13 season.

During the week ending November 28 (week 47), P&I was reported as an underlying or contributing cause of 6.1% (524 of 8,634) of all deaths reported to the 122 Cities Mortality Reporting System. This percentage is below the epidemic threshold of 6.5% for the week. Since October 4, the weekly percentage of deaths attributed to P&I ranged from 5.2% to 6.1% and has not exceeded the epidemic threshold so far this season. Peak weekly percentages of deaths attributable to P&I in the previous five seasons ranged from 7.8% during the 2011–12 season to 9.9% during the 2012–13 season.

 

Influenza-Associated Pediatric Mortality

As of November 28 (week 47), two influenza-associated pediatric deaths have been reported to CDC during the 2015–16 influenza season, both of which occurred during week 44 (the week ending November 7, 2015). One death was associated with an influenza A virus for which no subtyping was performed, and one death was associated with an influenza B virus. The number of influenza-associated pediatric deaths reported to CDC in the previous three seasons ranged from 111 during the 2013–14 season to 171 during the 2012–13 season. During the 2009 pandemic, 358 pediatric deaths were reported from April 15, 2009, through October 2, 2010 (historically, influenza seasons include data from October [week 40] through September [week 39] of the following year).

 

Discussion

Influenza activity in the United States for the 2015–16 season remained low during October 4–November 28, 2015. Although the timing of influenza activity can vary, peak activity in the United States most commonly occurs during December–March; however, substantial influenza activity can be observed in November and activity can last as late as May. During the 2014–15 influenza season, activity increased in November and peaked in December; however during the current 2015–16 season, activity remains low. During October 4–November 28, 2015, influenza A (H3N2) viruses were identified most frequently in the United States, but pH1N1 and influenza B viruses also were reported.

Antigenic and genetic characterization of influenza-positive respiratory specimens submitted to CDC indicate that the majority of influenza virus isolates recently examined in the United States are similar to the 2015–16 influenza vaccine reference viruses. Although antigenic and genetic characterization of circulating influenza viruses can indicate whether antigenically different (i.e., “drifted”) viruses have emerged, vaccine effectiveness studies are needed to determine how much protection has been provided to the community by vaccination. Last season, laboratory data indicated that most influenza A (H3N2) viruses had drifted from the 2014–15 influenza A (H3N2) vaccine reference virus. During that season, reduced vaccine effectiveness against the predominant influenza A (H3N2) viruses was noted (3). During other seasons, however, antigenic differences between circulating and reference vaccine viruses that suggested reduced vaccine effectiveness were not shown to have resulted in reduced protection in community studies undertaken during the season (35). Predicting which influenza viruses will predominate during a season is challenging. Although no significant drift has been identified in influenza viruses circulating recently, it is possible that drift may still occur.

Vaccination remains the most effective method of preventing influenza and its complications. Even during seasons when vaccine effectiveness is reduced, substantial public health impact can still be observed (6). CDC previously developed a model to estimate the illnesses and hospitalizations averted by influenza vaccination in the United States. During 2010–2014, annual vaccination prevented an estimated 1.7–7.8 million cases and 34,000–114,000 hospitalizations per season, or 9.4%–22.3% of hospitalizations associated with influenza (6). For the 2014–15 influenza season, updated estimates of vaccination coverage, vaccine effectiveness, and rates of influenza were used in the same model to estimate that influenza vaccination resulted in an estimated 1.9 million (95% confidence interval [CI] = 707,000–4.4 million) fewer illnesses, 966,000 (CI = 344,000–2.2 million) fewer medically attended illnesses, and 67,000 (CI = 15,000–208,000) fewer hospitalizations associated with influenza (6).

As of December 4, 2015, vaccine manufacturers have reported that approximately 140 million doses of influenza vaccine have been distributed. Health care providers should offer vaccine to all unvaccinated persons aged ≥6 months now and throughout the influenza season as long as influenza viruses are circulating. Vaccination coverage typically declines markedly after November, prompting CDC to annually observe a National Influenza Vaccination Week (December 6–12 this year) to promote influenza vaccination beyond November. Although the timing of influenza activity can vary, little influenza activity has occurred to date this season; thus, vaccination at this time should still offer substantial public health benefit. Past and current vaccine coverage estimates highlight low influenza vaccination coverage in the United States, despite a universal vaccination recommendation that has been in place since 2010. For the 2015–16 season, the Advisory Committee on Immunization Practices (ACIP) recommends that healthy children aged 2 years through 8 years who have no vaccine contraindications or precautions receive either live attenuated influenza vaccine (LAIV) or inactivated influenza vaccine (IIV), with no preference expressed for either vaccine when one is otherwise appropriate and available (5). For the 2015–16 season, ACIP recommends that children aged 6 months through 8 years who have previously received ≥2 total doses of trivalent or quadrivalent influenza vaccine at any time before July 1, 2015, require only 1 dose of 2015–16 influenza vaccine (5). The 2 previous doses do not need to have been given during the same or consecutive seasons (5). Children in this age group who are being vaccinated for the first time or who have not previously received a total of ≥2 doses before July 1, 2015, require 2 doses of 2015–16 influenza vaccine, administered ≥4 weeks apart (7).

Although influenza vaccination is the first and best way to prevent influenza, antiviral medications continue to be an important adjunct to vaccination for reducing the health impact of influenza. Treatment is most effective when given early during illness, and providers should not delay treatment until test results become available or rely on insensitive assays such as rapid antigen detection influenza diagnostic tests to determine treatment decisions (8). Treatment with influenza antiviral medications as early as possible is recommended for patients with confirmed or suspected influenza (either seasonal influenza or novel influenza virus infection) who have severe, complicated, or progressive illness; who require hospitalization; or who are at high risk for serious influenza-related complications*** (8). Antiviral treatment should not be withheld from severely ill patients or those at high risk with suspected influenza infection pending confirmatory influenza test results or based on illness onset††† (8).

Influenza surveillance reports for the United States are posted online weekly and are available at http://www.cdc.gov/flu/weekly. Additional information regarding influenza viruses, influenza surveillance, influenza vaccine, influenza antiviral medications, and novel influenza A virus infections in humans is available at http://www.cdc.gov/flu.

 

Acknowledgments

State, county, city, and territorial health departments and public health laboratories; U.S. World Health Organization collaborating laboratories; National Respiratory and Enteric Virus Surveillance System laboratories; U.S. Outpatient Influenza-Like Illness Surveillance Network sites; National Center for Health Statistics, CDC; 122 Cities Mortality Reporting System; World Health Organization FluNet; Angie Foust, Wendy Sessions, Elisabeth Blanchard, Priya Budhathoki, Thomas Rowe, Lizheng Guo, Ewelina Lyszkowicz, Shoshona Le, Malania Wilson, Juliana DaSilva, Alma Trujillo, Michael Hillman, Thomas Stark, Samuel Shepard, Sujatha Seenu, Ha Nguyen, Vasiliy Mishin, Margaret Okomo-Adhiambo, Michelle Adamczyk, Juan De la Cruz, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.

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1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC.

Corresponding author: Sophie Smith, ssmith11@cdc.gov, 404-639-3747.

 

References

  1. Schild GC, Oxford JS, de Jong JC, Webster RG. Evidence for host-cell selection of influenza virus antigenic variants. Nature 1983;303:706–9.
  2. Katz JM, Wang M, Webster RG. Direct sequencing of the HA gene of influenza (H3N2) virus in original clinical samples reveals sequence identity with mammalian cell-grown virus. J Virol 1990;64:1808–11.
  3. Flannery B, Clippard J, Zimmerman RK, et al. Early estimates of seasonal influenza vaccine effectiveness—United States, January 2015. MMWR Morb Mortal Wkly Rep 2015;64:10–5.
  4. Ohmit SE, Victor JC, Rotthoff JR, et al. Prevention of antigenically drifted influenza by inactivated and live attenuated vaccines. N Engl J Med 2006;355:2513–22.
  5. Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2015–16 influenza season. MMWR Morb Mortal Wkly Rep 2015;64:818–25.
  6. CDC. Estimated influenza illnesses and hospitalizations averted by vaccination—United States, 2015–16 influenza season. Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/flu/about/disease/2014-15.htm.
  7. Neuzil KM, Jackson LA, Nelson J, et al. Immunogenicity and reactogenicity of 1 versus 2 doses of trivalent inactivated influenza vaccine in vaccine-naive 5–8-year-old children. J Infect Dis 2006;194:1032–9.
  8. Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM. Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60(No. RR-1).

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* CDC collects five categories of surveillance data from nine data sources: 1) viral surveillance (World Health Organization collaborating laboratories, the National Respiratory and Enteric Virus Surveillance System, and novel influenza A virus case reporting); 2) outpatient illness surveillance (U.S. Outpatient Influenza-Like Illness Surveillance Network); 3) mortality (the National Center for Health Statistics Mortality Surveillance System, 122 Cities Mortality Reporting System, and influenza-associated pediatric mortality reports); 4) hospitalizations (Influenza Hospitalization Surveillance Network [FluSurv-NET], which includes the Emerging Infections Program and surveillance in three additional states); and 5) summary of the geographic spread of influenza (state and territorial epidemiologist reports). Additional information available at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

† Data reported as of December 4, 2015.

§ Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Region 2: New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands. Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia. Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Region 7: Iowa, Kansas, Missouri, and Nebraska. Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. Region 9: Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau. Region 10: Alaska, Idaho, Oregon, and Washington.

¶ Defined as a temperature of ≥100°F (≥37.8°C), oral or equivalent, and cough or sore throat, without a known cause other than influenza.

** The national and regional baselines are the mean percentage of visits for ILI during noninfluenza weeks for the previous three seasons plus two standard deviations. A noninfluenza week is defined as periods of ≥2 consecutive weeks in which each week accounted for <2% of the season’s total number of specimens that tested positive for influenza. National and regional percentages of patient visits for ILI are weighted on the basis of state population. Use of the national baseline for regional data is not appropriate.

†† Activity levels are based on the percentage of outpatient visits in a jurisdiction attributed to ILI and are compared with the average percentage of ILI visits that occur during weeks with little or no influenza virus circulation. Activity levels range from minimal, corresponding to ILI activity from outpatient clinics at or below the average, to high, corresponding to ILI activity from outpatient clinics much higher than the average. Because the clinical definition of ILI is very nonspecific, not all ILI is caused by influenza; however, when combined with laboratory data, the information on ILI activity provides a clearer picture of influenza activity in the United States.

§§ Levels of activity are 1) no activity; 2) sporadic: isolated laboratory-confirmed influenza case(s) or a laboratory-confirmed outbreak in one institution, with no increase in activity; 3) local: increased ILI, or at least two institutional outbreaks (ILI or laboratory-confirmed influenza) in one region of the state, with recent laboratory evidence of influenza in that region and virus activity no greater than sporadic in other regions; 4) regional: increased ILI activity or institutional outbreaks (ILI or laboratory-confirmed influenza) in at least two but less than half of the regions in the state with recent laboratory evidence of influenza in those regions; and 5) widespread: increased ILI activity or institutional outbreaks (ILI or laboratory-confirmed influenza) in at least half the regions in the state, with recent laboratory evidence of influenza in the state.

¶¶ The seasonal baseline proportion of P&I deaths is projected using a robust regression procedure, in which a periodic regression model is applied to the observed percentage of deaths from P&I that were reported by the National Center for Health Statistics Mortality Surveillance System and the 122 Cities Mortality Reporting System during the preceding 5 years. The epidemic threshold is set at 1.645 standard deviations above the seasonal baseline. Users of the data should not expect the NCHS mortality surveillance data and the 122 Cities Mortality Reporting System to produce the same percentages and the percent P&I deaths from each system should be compared to the corresponding system specific baselines and thresholds.

*** Persons at higher risk include 1) children aged <2 years; 2) adults aged ≥65 years; 3) persons with chronic pulmonary conditions (including asthma); cardiovascular disease (except hypertension alone); renal, hepatic, hematologic (including sickle cell) disease; metabolic disorders (including diabetes mellitus); or neurologic and neurodevelopmental conditions (including disorders of the brain, spinal cord, peripheral nerves, and muscles, such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); 4) persons with immunosuppression, including that caused by medications or by human immunodeficiency virus infection; 5) women who are pregnant or postpartum (within 2 weeks after delivery); 6) persons aged ≤18 years who are receiving long-term aspirin therapy; 7) American Indians/Alaska Natives; 8) persons who are morbidly obese (i.e., body mass index ≥40); and 9) residents of nursing homes and other chronic care facilities.

††† Additional information on antiviral use and treatment of influenza is available at: http://www.cdc.gov/flu/antivirals.

Keywords: USA; US CDC; Updates; Seasonal Influenza; H1N1pdm09; H3N2; Flu B; Vaccines; Antivirals.

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Concurrent #Outbreaks of St. Louis #Encephalitis Virus and #WestNile #Virus #Disease — #Arizona, 2015 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Notes from the Field: Concurrent Outbreaks of St. Louis Encephalitis Virus and West Nile Virus Disease — Arizona, 2015 [      ]

Weekly / December 11, 2015 / 64(48);1349-50

Heather Venkat, DVM1,2,3,*; Elisabeth Krow-Lucal, PhD1,4,*; Morgan Hennessey, DVM1,4; Jefferson Jones, MD1,2,3; Laura Adams, DVM3,6; Marc Fischer, MD4; Tammy Sylvester, MSN2; Craig Levy, MS2; Kirk Smith, PhD5; Lydia Plante, MSPH3; Kenneth Komatsu, MPH3; J. Erin Staples, MD4; Susan Hills, MBBS4

 

Abstract

St. Louis encephalitis virus (SLEV) and West Nile virus (WNV) are closely related mosquito-borne flaviviruses that can cause outbreaks of acute febrile illness and neurologic disease. Both viruses are endemic throughout much of the United States and have the same Culex species mosquito vectors and avian hosts (1); however, since WNV was first identified in the United States in 1999, SLEV disease incidence has been substantially lower than WNV disease incidence, and no outbreaks involving the two viruses circulating in the same location at the same time have been identified. Currently, there is a commercially available laboratory test for diagnosis of acute WNV infection, but there is no commercially available SLEV test, and all SLEV testing must be performed at public health laboratories. In addition, because antibodies against SLEV and WNV can cross-react on standard diagnostic tests, confirmatory neutralizing antibody testing at public health laboratories is usually required to determine the flavivirus species (2). This report describes the first known concurrent outbreaks of SLEV and WNV disease in the United States.

(…)

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1Epidemic Intelligence Service, CDC; 2Maricopa County Department of Public Health, Phoenix, Arizona; 3Arizona Department of Health Services; 4Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 5Maricopa County Environmental Services Vector Control Division; 6Career Epidemiology Field Officer Program, CDC.

Corresponding authors: Heather Venkat, HeatherVenkat@mail.maricopa.gov, 602-531-4422; Elisabeth Krow-Lucal, ekrowlucal@cdc.gov, 970-266-3565.

Keywords: USA; US CDC; Updates; West Nile Fever; St Louis Encephalitis; Arizona.

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#Outbreaks of Acute #Gastroenteritis Transmitted by Person-to-Person #Contact, #Environmental #Contamination, and Unknown Modes of #Transmission — #USA, 2009–2013 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract.]

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission — United States, 2009–2013 [      ]

Surveillance Summaries / December 11, 2015 / 64(SS12);1-16

Mary E. Wikswo, MPH1, Anita Kambhampati, MPH1, Kayoko Shioda, DVM1, Kelly A. Walsh, MPH2, Anna Bowen, MD2, Aron J. Hall, DVM1

1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 2Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC

Corresponding author: Mary Wikswo, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC. Telephone: 404-639-0881; E-mail: ezq1@cdc.gov.

 

Abstract

Problem/Condition:

Acute gastroenteritis (AGE) is a major cause of illness in the United States, with an estimated 179 million episodes annually. AGE outbreaks propagated through direct person-to-person contact, contaminated environmental surfaces, and unknown modes of transmission were not systematically captured at the national level before 2009 and thus were not well characterized.

Reporting Period:

2009–2013.

Description of System:

The National Outbreak Reporting System (NORS) is a voluntary national reporting system that supports reporting of all waterborne and foodborne disease outbreaks and all AGE outbreaks resulting from transmission by contact with contaminated environmental sources, infected persons or animals, or unknown modes. Local, state, and territorial public health agencies within the 50 U.S. states, the District of Columbia (DC), five U.S. territories, and three Freely Associated States report outbreaks to CDC via NORS using a standard online data entry system.

Results:

A total of 10,756 AGE outbreaks occurred during 2009–2013, for which the primary mode of transmission occurred through person-to-person contact, environmental contamination, and unknown modes of transmission. NORS received reports from public health agencies in 50 U.S. states, DC, and Puerto Rico. These outbreaks resulted in 356,532 reported illnesses, 5,394 hospitalizations, and 459 deaths. The median outbreak reporting rate for all sites in a given year increased from 2.7 outbreaks per million population in 2009 to 11.8 outbreaks in 2013. The etiology was unknown in 31% (N = 3,326) of outbreaks. Of the 7,430 outbreaks with a suspected or confirmed etiology reported, norovirus was the most common, reported in 6,223 (84%) of these outbreaks. Other reported suspected or confirmed etiologies included Shigella (n = 332) and Salmonella (n = 320). Outbreaks were more frequent during the winter, with 5,716 (53%) outbreaks occurring during December–February, and 70% of the 7,001 outbreaks with a reported setting of exposure occurred in long-term–care facilities (n = 4,894). In contrast, 59% (n = 143) of shigellosis outbreaks, 36% (n = 30) of salmonellosis outbreaks, and 32% (n = 84) of other or multiple etiology outbreaks were identified in child care facilities.

Interpretation:

NORS is the first U.S. surveillance system that provides national data on AGE outbreaks spread through person-to-person contact, environmental contamination, and unknown modes of transmission. The increase in reporting rates during 2009–2013 indicates that reporting to NORS improved notably in the 5 years since its inception. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic data, might account for a substantial proportion of outbreaks without a reported etiology. During 2009–2013, norovirus accounted for most deaths and health care visits in AGE outbreaks spread through person-to-person contact, environmental contamination, and unknown modes of transmission.

Public Health Action:

Recommendations for prevention and control of AGE outbreaks transmitted through person-to-person contact, environmental contamination, and unknown modes of transmission depend primarily on appropriate hand hygiene, environmental disinfection, and isolation of ill persons. NORS surveillance data can help identify priority targets for the development of future control strategies, including hygiene interventions and vaccines, and help monitor the frequency and severity of AGE outbreaks in the United States. Ongoing study of these AGE outbreaks can provide a better understanding of certain pathogens and their modes of transmission. For example, certain reported outbreak etiologies (e.g., Salmonella) are considered primarily foodborne pathogens but can be transmitted through multiple routes. Similarly, further examination of outbreaks of unknown etiology could help identify barriers to making an etiologic determination, to analyze clinical and epidemiologic clues suggestive of a probable etiology, and to discover new and emerging etiologic agents. Outbreak reporting to NORS has improved substantially since its inception, and further outreach efforts and system improvements might facilitate additional increases in the number and completeness of reports to NORS.

Keywords: USA; US CDC; Updates; Research; Abstracts; Gastroenteritis; Food Safety.

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