COCA Call – 2018-2019 Influenza Season and Recommendations for Clinicians

Calendar Reminder To Get A Flu ShotInfluenza activity in the United States is increasing and is expected to continue at elevated levels for several more weeks. Influenza A(H1N1)pdm09 viruses have been most common this season; influenza A(H3N2) and influenza B viruses are also circulating. In the southeastern part of the country, influenza A(H3N2) viruses have been most commonly reported this season. Annual influenza vaccination is recommended for all people 6 months and older and is the best way to prevent influenza and its potentially serious complications. Available evidence consistently indicates that antiviral treatment initiated as early as possible can be a useful second line of defense to treat influenza illness when indicated and can reduce severe outcomes of influenza.

During this CDC Clinician Outreach and Communication Activity (COCA) Call, clinicians will learn about 2018 –2019 influenza activity and hear an overview of CDC’s recommendations for health care providers regarding influenza vaccination and the use of influenza antiviral medications for the 2018-2019 influenza season, including a new antiviral medication approved by the FDA in October 2018. View complete info at: https://content.govdelivery.com/accounts/USCDC/bulletins/228a59b.

Date: Tuesday, January 29, 2019
Time: 2:00-3:00 PM ET
A few minutes before the webinar begins, please click the link below to join the webinar:
https://zoom.us/j/862187873

Or iPhone one-tap:
US: +16468769923,,862187873#  or +16699006833, 862187873#

Or Telephone:
US: +1 646 876 9923  or +1 669 900 6833

Webinar ID: 862 187 873
International numbers available here: https://zoom.us/u/afuFnVK9Q
The recordings (audio, slides, and transcript) for this call will be posted on the webpage a week after the COCA Call.
Free Continuing Education (CE) is available for most COCA Calls. Please see below for instructions on how to receive CE.

Activity Specific Objectives

At the conclusion of this COCA Call, the participant will be able to accomplish the following:

  • Summarize the current status of influenza activity in the United States.
  • Discuss the circulating influenza strains seen this season and the implications for clinicians.
  • Describe antiviral treatment recommendations for patients with influenza.

COCA Call Objectives

At the conclusion of the session, the participant will be able to accomplish the following:

  1. Cite background information on the topic covered during the presentation.
  2. Discuss CDC’s role in the topic covered during the presentation.
  3. Describe the topic’s implications for clinicians.
  4. Discuss concerns and/or issues related to preparedness for and/or response to urgent public health threats.
  5. Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional team of health care providers.

Presenters

  • Alicia P. Budd, MPH
    Epidemiologist
    Influenza Division
    National Center for Immunization and Respiratory Diseases
    Centers for Disease Control and Prevention
  • Angela Campbell, MD, MPH
    Medical Officer
    Influenza Division
    National Center for Immunization and Respiratory Diseases
    Centers for Disease Control and Prevention

Instructions for Obtaining Continuing Education (CE)

To receive continuing education (CE) for WC2922-012919 – (Webcast) Clinician Outreach and Communication Activity (COCA) Calls/Webinars – “2018-2019 Influenza Season and Recommendations for Clinicians” – January 29, 2019, please visit TCEO and follow these 9 Simple Steps by March 4, 2019.

To receive continuing education (CE) for WD2922-012919 – Clinician Outreach and Communication Activity (COCA) Calls/Webinars – “2018-2019 Influenza Season and Recommendations for Clinicians” – January 29, 2019, (Web on Demand), please visit TCEO and follow these 9 Simple Steps by March 5, 2021.

Wegmans recalls cauliflower rice, stir-fry mixes due to E. coli concerns

Wegmans Food Markets is recalling cauliflower rice and vegetable stir-fry mixes sold this month in its stores in six states due to E. coli concerns. The move came just five days after a California farm involved in a recent E. coli outbreak that sickened nearly 60 people said it was recalling cauliflower and red and green lettuce. The Wegmans recall involves fresh Cauliflower Rice, Veggie Cauliflower Rice Blend and Stir-Fry Mix with Cauliflower sold between Dec. 7 and Dec. 18 at its 98 stores in New York, New Jersey, Pennsylvania, Maryland, Virginia and Massachusetts. All contain “use by” dates of Dec. 11 through Dec. 22, the company said. Learn more: https://www.fda.gov/Safety/Recalls/ucm628826.htm.

Surgeon General’s Advisory on E-cigarette Use Among Youth

Today U.S. Surgeon General Jerome Adams issued an Advisory on E-cigarette Use Among Youth at a press conference in Washington, D.C. The advisory, prompted by recent skyrocketing rates of e-cigarette use by our nation’s youth, will alert parents, teachers and health professionals about new types of e-cigarettes and the negative health consequences of youth use of these products.

E-cigarette use has recently surged among youth, fueled by new e-cigarette types that look like a USB flash drive and other shapes. One of the most commonly sold USB flash drive shaped e-cigarettes is JUUL, and other companies are now starting to sell e-cigarettes that look like USB flash drives. Most e-cigarettes contain nicotine, which can harm the developing adolescent brain.

The Surgeon General urges immediate action to protect our nation’s young people from the addiction to nicotine. The advisory encourages many different stakeholders to take action to protect our nation’s youth from this health risk, including parents, teachers, health professionals, and states, communities, tribes, and territories.

Learn more: https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf?s_cid=OSH_email_E117

Update – Outbreak of E. coli Infections Linked to Romaine Lettuce

CDC, public health and regulatory officials in several states, Canada, and the FDA are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections. Read food safety alert.

As of December 6, 2018, 52 people infected with the outbreak strain of E. coli O157:H7 have been reported from 15 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates ranging from October 5, 2018 to November 18, 2018. Ill people range in age from 1 to 84 years, with a median age of 30. Sixty-nine percent of ill people are female. Of 45 people with information available, 19 (42%) have been hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Illnesses that occurred after November 14, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coliinfection and when the illness is reported. This takes an average of two to three weeks.

Investigation of the Outbreak

Epidemiologic and traceback evidence indicates that romaine lettuce from the Central Coastal growing regions of northern and central California is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Twenty-four (83%) of 29 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey[PDF – 787 KB] of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people reported eating different types of romaine lettuce in several restaurants and at home.

Preliminary traceback information from the FDA indicates that ill people in this outbreak ate romaine lettuce harvested from the Central Coastal growing regions of northern and central California. The specific California counties FDA identified in the traceback investigation are Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, and Ventura. At this time, no common grower, supplier, distributor, or brand of romaine lettuce has been identified.

The FDA, along with CDC and state partners, is investigating farms and cooling facilities in California that were identified in traceback. CDC collected samples of water to test for E. coli O157:H7; these test results are pending.

This investigation is ongoing, and CDC will provide more information as it becomes available.

Tris Pharma Issues Voluntary Nationwide Recall of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL, Due to Potential Higher Concentrations of Ibuprofen

Tris Pharma, Inc. has voluntarily recalled three (3) lots of Infants’ Ibuprofen Concentrated Oral Suspension, USP (NSAID) 50 mg per 1.25 mL, to the retail level. The recalled lots of the product have been found to potentially have higher concentrations of ibuprofen. There is a remote possibility that infants, who may be more susceptible to a higher potency level of drug, and therefore may be more vulnerable to permanent NSAID-associated renal injury. Adverse effects that may be experienced are nausea, vomiting, epigastric pain, or more rarely, diarrhea. Tinnitus, headache and gastrointestinal bleeding are also possible adverse effects. To date, Tris Pharma, Inc. has not received any reports of adverse events related to the lots of product that are the subject of this recall. Read More

New and Invasive Tick Species in Virginia

In November of 2017, a tick species previously unknown to the US called Haemaphysalis longicornis, or the Asian longhorned tick, was discovered both on a sheep and in a pasture in New Jersey.  Since then, this new tick species has been found in eight additional states, including 17 counties and one city in Virginia.

The Asian longhorned tick is native to East Asia and has also been well described in New Zealand and Australia. In the tick’s native range, it has been known to cause Theileriosis disease in cattle, as well as a frequently fatal viral disease called “Severe Fever with Thrombocytopenia Syndrome” (or SFTS) in humans;  the SFTS virus resembles Heartland virus, a pathogen that may be found in Virginia’s environment. There is also some research from this tick’s native territory in Asia showing that the Asian longhorned tick might be capable of transmitting Lyme disease (from an Asian Borrelia species), as well as Human Anaplamsosis and Ehrlichiosis pathogens, and a Spotted fever Rickettsiosis.  However, more time will be needed to assess the tick’s ability to acquire and transmit these various pathogenic agents found in the United States.

An interesting feature of this tick and a major factor enabling its rapid spread, is the ability to reproduce asexually, a process known as parthenogenic reproduction. To date, no males of this species have been confirmed among the many thousands of females that have been discovered. This tick also boasts a broad host range and has been found on birds, rodents, terrestrial mammals, livestock, domestic pets, and even humans. Also, this species of tick has been found in both field and forested environments in Virginia and may be common in pasturelands where livestock might be found grazing. This is atypical of Virginia’s most common human-biting tick species, as they are more likely to be found in a forested environment.

For safety purposes, it is important to take precautionary measures to help reduce your risk of tick bites year round. Here are some steps you can take to avoid being bitten:

  • Use EPA registered repellents, such as permethrin, to treat your shoes, socks, pants, and shirts, and ALWAYS follow the product label for use.
  • Ticks typically start to climb onto people from the ground, or from low vegetation, so the use of repellents and protective clothing should also be from the ground, up. Tuck your pant legs into your socks and shirt into your pants when in forest or pasture environments.
  • Avoid any unnecessary walks in brushy or wooded environments, or grassy fields, especially when not using repellents.

For more information regarding ticks and tick-borne illnesses, visit our ‘Bugs’ and Human Health page on the Virginia Department of Health website under Environmental Epidemiology at http://www.vdh.virginia.gov/environmental-epidemiology/bugs-human-health

H. longicornis adult (left), nymph (center), and larva (right). (Photo credit: Manigandan Lejeune, Cornell Animal Health Diagnostic Center)

FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely Linked to Romaine Lettuce Grown in California

Update: November 26, 2018

The FDA, along with CDC, state and local agencies, is investigating a multistate outbreak of E. coli O157:H7 illnesses likely linked to romaine lettuce grown in California this fall. The Public Health Agency of Canada (PHAC) and Canadian Food Inspection Agency are also coordinating with U.S. agencies as they investigate a similar outbreak in Canada.

The FDA has been conducting a traceback investigation, reviewing shipping records and invoices to trace the supply of romaine from the place where ill people were exposed to the place where that romaine was grown.

Preliminary traceback information indicates that ill people in several areas across the country were exposed to romaine lettuce harvested in California. Specifically, current evidence indicates this romaine was harvested in the Central Coast growing regions of northern and central California.

Romaine harvested from locations outside of the California regions identified by the traceback investigation does not appear to be related to the current outbreak. Read More>>

Acute Flaccid Myelitis Virginia Update

Acute flaccid myelitis or “AFM” is a condition that affects the nervous system, specifically the spinal cord. Most patients have sudden onset of limb (arm and leg) weakness. AFM is thought to be caused by infections with different types of viruses. The infections most commonly mentioned with AFM include polio or West Nile virus and related infections. Most patients with AFM have a respiratory illness or fever before their limbs are affected. Other causes of AFM are still being explored and may include environmental toxins or genetic disorders. Learn More

CDC: Outbreak of E. coli Infections Linked to Romaine Lettuce

CDC, public health and regulatory officials in several states, Canada, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections linked to romaine lettuce. CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until they learn more about the outbreak. This investigation is ongoing and the advice will be updated as more information is available. Learn more