Weekly flu season reports resumed last week in the United States and Europe. Reporting covered October 1 through October 7. According to the Centers for Disease Control and Prevention (CDC), flu activity in the U.S. is low. MESH will continue weekly surveillance of Influenza Like Illness trends locally, regionally, and nationally as flu season resumes.
FEMA has released a new set of resources to aid families and individuals in preparing for disasters.
"The guide has been designed to help the citizens of this nation learn how to protect themselves and their families against all types of hazards. It can be used as a reference source or as a step-by-step manual. The focus of the content is on how to develop, practice, and maintain emergency plans that reflect what must be done before, during, and after a disaster to protect people and their property. Also included is information on how to assemble a disaster supplies kit that contains the food, water, and other supplies in sufficient quantity for individuals and their families to survive following a disaster in the event they must rely on their own resources."
Check out this release and other resources on MESH's revamped Resources page.
The Marion County Local Emergency Planning Committee (LEPC) is teaming up with Eskenazi Health, IU Health - Methodist, Riley and University, the VA Medical Center, IUPUI, Indianapolis EMS (IEMS), Indianapolis Fire Department (IFD), MESH and other agencies for a full scale Hazardous Materials Exercise.
Event organizers are requesting volunteers from each of the hospitals and service groups to volunteer to participate. Not only are they seeking adults, but also children, ideally aged 8-18.
The MESH Coalition is helping to coordinate the volunteers. Please call 317-630-7409 or email your interest to: meshintel@meshcoalition.org
Include your name, organization, contact information, how many people are accompanying you and their ages, and if they will wear a swimsuit.
We will compile a list of volunteers and send out additional information and paperwork the week prior to the exercise.
Date: Thursday, July 13, 2017
Time: 8:00am - 12:00pm
Location: Eskenazi Health, IU Health - Methodist, Riley, & University, VA Medical Center, IUPUI Campu
"Patients with Ebola Virus Disease (EVD) were treated in five US communities during the 2014- 2016 epidemic in West Africa. Many more US communities were involved in monitoring travelers from affected countries and other individuals with various levels of possible Ebolavirus exposure. In some cases, these monitored individuals required medical care necessitating the implementation of precautions similar to those needed for actual EVD patients. Extraordinary measures were required to respond to these patients (whether actually or just potentially infected with Ebolavirus) and the potential public health threat that they posed. There are important lessons to be learned from the lived experience of individuals who were involved in the response to patients with confirmed and potential EVD in the United States, and communities that face high-consequence infectious disease (HCID) events in the future would benefit from awareness of those lessons. To that end, the purpose of this project was to develop an evidence-informed checklist that outlines action steps for medical and public health authorities, in partnership with nongovernmental organizations and private industry, to assess and strengthen the resilience of their community’s health sector in the face of EVD or other HCIDs. For the purpose of this project, we define HCIDs as having all of the following characteristics: • Novel—or at least very rare—in the affected community • Moderately to highly contagious (by whatever route), at least during some stage of the disease • Moderately to highly lethal • Not easily controllable by medical countermeasures or non-pharmaceutical interventions • Causes exceptional public concern Examples include: viral hemorrhagic fevers (e.g., Ebola, Marburg, Lassa), smallpox, SARS, MERS, and H5N1 influenza A. The checklist is intended to apply to isolated cases or limited outbreaks of HCIDs. In a pandemic or widespread outbreak, the issues and recommendations may be substantially different."
After learning of a recent human case of Powassan (POW) Virus disease in a Connecticut infant (Link 1, Link 2, Link 3), MESH has decided to update its stakeholders on this disease in preparation for a predicted heavy tick season.
POW Virus is an arboviral (any virus that is transmitted by mosquitoes, ticks, or other arthropods) flavivirus (single-stranded, enveloped RNA viruses) first discovered in 1958 in Powassan, Ontario. Two types of POW have been identified in North America; Lineage 1 and Lineage 2 (deer tick virus) POW viruses. The disease is very rare, but it has been predicted to increase in incidence due to the uncharacteristically warm winter in the United States.
The virus is transmitted by the bite of ticks infected with POW virus. In order to transfer the virus to humans, the tick must be attached for a certain amount of time that is still unknown. 6 species of tick have been identified as vectors for the virus: Ixodes cookei, Ixodes scapularis, Ixodes marxi, Ixodes spnipalpus, Dermacentor andersoni, and Dermacentor variabilis.
Humans do not develop high enough concentrations of POW virus in their bloodstreams to infect feeding ticks. Humans are therefore considered to be “dead-end” hosts of the virus. POW virus is maintained in a cycle between ticks and small-to-medium-sized rodents. In North America, three main enzootic cycles occur: Ix. cookei and woodchucks, Ix. marxi and squirrels, and Ix. scapularis and white-footed mice. Ix. cookei and Ix. marxi rarely bite humans. Ix. scapularis often bite humans and is the primary vector of Lyme disease.
For the purpose of surveillance and reporting, based on their clinical presentation, arboviral disease cases are often categorized into two primary groups: neuroinvasive disease and non-neuroinvasive disease.
Neuroinvasive disease: Many arboviruses cause neuroinvasive disease such as aseptic meningitis, encephalitis or acute flaccid paralysis (AFP). These illnesses are usually characterized by the acute onset of fever with headache, myalgia, stiff neck, altered mental status, seizures, limb weakness or cerebrospinal fluid (CSF) pleocytosis. AFP may result from anterior (“polio”) myelitis, peripheral neuritis or post-infectious peripheral demyelinating neuropathy (i.e., Guillain-Barré syndrome). Less common neurological manifestations, such as cranial nerve palsies, also occur.
Non-neuroinvasive disease: Most arboviruses are capable of causing an acute systemic febrile illness (e.g., West Nile fever) that may include headache, myalgia, arthralgia, rash or gastrointestinal symptoms. Some viruses can also cause more characteristic clinical manifestations, such as severe polyarthralgia or arthritis due to chikungunya virus or other alphaviruses (e.g., Mayaro, Ross River, O’nyong-nyong)
Many infected persons may have no symptoms or only mild symptoms. Symptoms of POW virus usually appear within 1-4 weeks of a tick bite. Signs and symptoms may include: Fever, Headache, Vomiting, Weakness, Seizures, Speech difficulties, Encephalitis (swelling of the brain), and Meningitis (swelling of the membranes that surround the brain and spinal cord.) Approximately half of survivors have permanent neurological symptoms, such as recurrent headaches, muscle wasting and memory problems. Approximately 10% of POW virus encephalitis cases are fatal.
Currently, there are no vaccines or medicines to treat or prevent POW infection; therefore, reducing exposure to ticks is the most effective way to avoid POW virus infection. Persons with severe POW illnesses often need to be hospitalized. Treatment may include respiratory support, intravenous fluids, and medications to reduce swelling in the brain.
The distribution of one of the primary human-infecting vectors for POW virus, Ix. scapularis, includes large portions of the Southern U.S., Eastern states, the Midwest, and the Great Lakes region. Much of Northern Indiana as well as parts of Central and Southern Indiana are also common areas where Ix. scapularis live. Climate change is expected to expand the natural distribution of arboviral vector species and increase the incidence of arboviral diseases. Additionally, an increase in deer populations and a warmer winter have been indicated as potential routes for increases in the incidence of human POW viral disease.
Reducing exposure to ticks is the best defense against POW virus disease and other tickborne infections. While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.
Avoid Direct Contact with Ticks
Repel Ticks on Skin and Clothing
Find and Remove Ticks from Your Body
Dogs are very susceptible to tick bites and tickborne diseases. Vaccines are not available for all the tickborne diseases that dogs can get, and they don’t keep the dogs from bringing ticks into your home. For these reasons, it’s important to use a tick preventive product on your dog.
Tick bites on dogs may be hard to detect. Signs of tickborne disease may not appear for 7-21 days or longer after a tick bite, so watch your dog closely for changes in behavior or appetite if you suspect that your pet has been bitten by a tick.
To reduce the chances that a tick will transmit disease to you or your pets:
Resources
Centers for Disease Control and Prevention: Link 1, Link 2, Link 3, Link 4
Minnesota Department of Health: Link
United States Geography Services: Link
Greer, A., Ng, V., & Fisman, D. (2008). Climate change and infectious diseases in North America: the road ahead. Canadian Medical Association Journal, 178(6), 715-722 Link
MESH thanks and acknowledges Mr. Todd Stalbaum, Paramedic, LHRM, CQM, Disaster Health & Medical Manager, ESF-8, Orange County Health Services/Office of the EMS Medical Director, Orlando, Florida for delivering and sharing this vital presentation.
MESH also thanks the Indiana Blood Center (IBC) for hosting and filming the presentation. Mr. Stalbaum conducted three presentations while in Indianapolis. One was to MESH partners from across Indiana; Another was to IBC staff and laboratory partners; The third was held at Moore Restoration and was presented to a Critical Incident Stress Management class.
Please contact MESH for more information about this and upcoming Grand Rounds events!
Click below to play the video.
Avian influenza A(H7N9) is a subtype of influenza viruses that have been detected in birds. The first reported human infection occurred on March 31, 2013 in China. Since then, sporadic infections in both humans and birds have been observed. Most of the cases of human infection with this avian H7N9 virus have reported recent exposure to live poultry or potentially contaminated environments, especially markets where live birds have been sold. This virus does not appear to transmit easily from person to person, and sustained human-to-human transmission has not been reported.
As of April 8, 2017, the Center for Health Protection and Department of Health (China) had reported 581 human infections with Asian H7N9 virus during the 5th epidemic. This brings the total cumulative number of human infections with Asian lineage H7N9 reported by WHO to 1,381. During epidemics one through four, about 40 percent of people confirmed with Asian H7N9 virus infection died. Characteristics of the fourth epidemic included greater percentages of patients admitted to intensive care units and with diagnoses of pneumonia, identification of the virus in new areas, a greater percentage of infected persons living in rural areas, and a longer epidemic period. Genetic changes in the virus have not been sufficient to alter antigenic properties or cause mismatch with candidate vaccines.
Most human infections with avian influenza viruses, including Asian H7N9 virus, have occurred after exposure to poultry; Asian H7N9 viruses continue to circulate in poultry in China. Most reported patients with H7N9 virus infection have had severe respiratory illness (e.g., pneumonia). In most cases, infection with A(H7N9) virus is characterized by high fever, cough, shortness of breath and rapidly progressing severe pneumonia. Complications include acute respiratory distress syndrome (ARDS), septic shock and multi-organ failure requiring intensive care. Severe illness and fatal outcome have been more frequently observed in pregnant women, in older persons and those with underlying chronic conditions. Asymptomatic and mild infections with A(H7N9) virus have been detected, but the underlying rate of such infections is not well understood.
Rare instances of limited person-to-person spread of this virus have been identified in China, but there is no evidence of sustained person-to-person spread. Some human infections with Asian H7N9 have been reported outside of mainland China, but most of these infections have occurred among people who had traveled to mainland China before becoming ill. Asian H7N9 viruses have not been detected in people or birds in the United States.
While the current risk to the public’s health posed by Asian H7N9 virus is low, the pandemic potential of this virus is concerning. Influenza viruses constantly change and it is possible that this virus could gain the ability to spread easily and sustainably among people, triggering a global outbreak of disease. In fact, of the novel influenza A viruses that are of special concern to public health, Asian lineage H7N9 virus is rated by the Influenza Risk Assessment Tool (IRAT) as having the greatest potential to cause a pandemic.
It is likely that sporadic human infections with Asian H7N9 virus associated with poultry exposure will continue to occur in China. There is also a possibility of Asian H7N9 virus spreading to poultry in neighboring countries and human infections associated with poultry exposure may be detected in neighboring countries. Asian H7N9 infections may continue to be detected among travelers returning from countries where this virus is present. However, as long as there is no evidence of ongoing, sustained person-to-person spread, the public health risk assessment would not change substantially. Responding to this threat, there is a need for a national containment-control-eradication program in poultry, in addition to effective A(H7N9) virus surveillance and continued risk assessment among humans and poultry in China and neighboring countries.
Resources:
Centers for Disease Control and Prevention: Link 1, Link 2
World Health Organization: Link 1, Link 2, Link 3, Link 4
Center for Infectious Disease Research and Policy: Link
Food and Agriculture Organization of the United Nations: Link
Center for Health Protection: Link
Keep up to date with the latest surveillance information about influenza-like disease (ILI) in Marion County and beyond.
According to the Centers for Disease Control and Prevention (CDC) Drug overdose deaths nearly tripled during 1999–2014. In 2014, among 47,055 drug overdose deaths, 28,647 (61%) involved an opioid. Between 2014 and 2015, death rates increased by 15.6 percent, and 72.2 percent of deaths were from synthetic opioids, mostly fentanyl and heroin. death rates increased by 15.6 percent, and 72.2 percent of deaths were from synthetic opioids, mostly fentanyl and heroin.
To learn more about this topic, please click on the following links:
According to reports, H5N8 has now been confirmed in 14 European countries including France, Croatia, Hungary, Romania and, Serbia. Outside of the region, the virus has also turned up in Egypt, India, Iran, Israel, and Tunisia. Officials said the source of H5N8 is contact with wild species and that the affected farms are on the path of migrating birds flying from Europe to Africa. Based on the limited information obtained to date, human infection cannot be excluded. Although the likelihood is low.
To learn more about the current H5N8 outbreak, please click on the following links.
