Resources for Medical Care Providers

2016 PWHD Communicable Disease Report

Zika

Zika virus is spread primarily through the bite of infected mosquitos and may cause a mild illness including fever, rash, joint pain, and red eyes (conjunctivitis).  The current international outbreaks have led to concerns regarding the possibility of birth defects or poor birth outcomes related to the virus. Zika virus has been reported in travelers returning to the continental U.S. from affected countries and continues to be monitored by public health. As a result, area providers are encouraged to remain vigilant and report suspected Zika virus disease cases to Prince William Health District (PWHD)/Virginia Department of Health (VDH) in order to assist with diagnosis and mitigate the potential for local transmission to occur. As more is learned about this virus, information and recommendations may change frequently. For the latest information please visit the CDC and VDH Zika websites (http://www.cdc.gov/zika/index.html and http://www.zikava.org) for more information.

Zika Clinician Forum Invitation

• Mosquito Control Prescription English
• Mosquito Control Prescription Spanish

Syphilis Morbidity Increases

• Virginia primary and secondary syphilis rates have increased from 2014 to 2015 from 3.4 cases/100,000 persons in 2014 to 4.5 cases/100,000 persons in 2015; a 32% increase.

• Nationally, primary and secondary syphilis rates increased by 15.1%, from 5.5 to 6.3 cases per 100,000 population from 2013 to 2014.  National data for 2015 is not yet unavailable.

• Virginia’s rates of total early syphilis (TES), which includes primary, secondary and early latent syphilis, have increased by 40.5% compared to the average annual rate between 2011-2014.

• Statistically significant increases in TES rates have been found in six health districts for 2015, while several others have also experienced concerning increases, although not statistically significant.  The districts most affected are located in the Eastern and Central health regions, and predominantly in more populous, urban areas .

• The majority of Virginia’s 2015 TES cases were diagnosed among men (90%); of these, 75% were among men who have sex with men (MSM).

• The rate of TES diagnoses among women has also increased 47% from the average rate between 2011-2014.  This is especially concerning due to the possibility of congenital syphilis diagnoses.

• Nationally, rates of congenital syphilis have risen 38% from 2012-2014.  In Virginia, there were eight congenital syphilis diagnoses between 2013-2015, compared to two cases diagnosed between 2010-2012. (Virginia rates for congenital syphilis are not calculated due to low case counts.)

• Ocular syphilis cases have been reported across the United States since 2015.  Five cases have been reported in Virginia in 2015, one heterosexual female and four males (all MSM).  None of these cases noted prior history of syphilis infection; three were HIV+, with a median age of 45 (range = 34–56 years). Three additional cases have been reported in 2016; two MSM and one heterosexual female.  More information on this manifestation is available in the Centers for Disease Control and Prevention’s (CDC) updated March, 2016 ocular syphilis clinical advisory.

• In 2015, 43% of TES cases diagnosed in Virginia were co-infected with HIV, raising concerns for further syndemic transmission.  Notable increases in new HIV diagnoses have also been observed in early 2016 for the Eastern region, particularly in the Hampton and Chesapeake Health Districts.

Additional issues of concern

• In May 2016, the CDC announced a national shortage of penicillin G benzathine (Bicillin L-A®), which is the recommended treatment for syphilis.  The VDH Division of Pharmacy Services has continued to evaluate and successfully order sufficient quantities of Bicillin-LA® for local health department use.  Nationally, the CDC Division of STD Prevention believes there is sufficient supply of Bicillin-LA® for treatment of syphilis cases until normal production levels resume.
• Inquiries from local healthcare providers related to Bicillin L-A® distributor supply chain issues can be directed to the Pfizer Supply Continuity Team at (844) 804-4677 to request an emergency supply.  Please alert River Pugsley, STD epidemiologist at 804.864.8039 or river.pugsley@vdh.virginia.govwith any known shortage of Bicillin L-A®.  Staff from DDP will communicate this information to CDC for continual national monitoring.
• Especially in light of this shortage, special attention to staging syphilis appropriately will aid in judicious use of the current penicillin G benzathine supply.  A one-time dose of penicillin G benzathine 2.4 million units IM is the recommended treatment for primary, secondary and early latent syphilis.  Additional doses to treat early syphilis do not enhance efficacy, including in patients living with HIV infection.
• Ocular syphilis should be managed according to treatment recommendations for neurosyphilis (aqueous crystalline penicillin G IV or Procaine penicillin IM with Probenecid for 10-14 days).
• Complete clinical management and treatment recommendations are available in CDC’s 2015 STD Treatment Guidelines.
• Questions regarding syphilis clinical management can be directed to an infectious disease specialist via the on-line National Network of STD Clinical Prevention Training Centers (NNPTC) STD Clinical Consultation Network.

Chronic Pain Training Plan Now Available on TRAIN

Epi 1 Reporting Form

Virginia Reportable Disease List

HTN and Eclampsia

Immunization Resources For Providers

Health Care Provider Toolkit, HPV

Communicable Disease Report to Providers

Personal Protective Equipment (PPE)

Reporting Acute Flaccid Myelitis (AFM) Cases