Hot Topics R7 HCC March 16, 2017 Jackie Dawson, PhD Public Health Epidemiologist Chelan, Douglas, Grant, Kittitas and Okanogan Counties 509-886-6428 Jacqueline.dawson@cdhd.wa.gov

ILI week 9 ending Mar 4, 2017

ILI = • Flu and • Non- flu respiratory viruses ID by UW: • respiratory syncytial virus • coronavirus • rhinovirus • human metapneumovirus • parainfluenza • adenovirus

Humans and Germs • https://www.youtube.com/watch?v=xOFH57Do2EM

Around the World

Severe Acute Respiratory Syndrome

Ebola

Bird (Avian) Flu

World Organization for Animal Health (OIE) • 13 strains of Avian flu were detected in 77

countries from January 2014 through the end of 2016

• Bird flu must viewed as a global public health threat

Bird Flu x 2?

Highly Pathogenic and Low Pathogenic Avian Influenza A Viruses

• Wild aquatic birds - particularly certain wild ducks, geese, swans, gulls, shorebirds and terns - are the natural hosts for all known influenza type A viruses.

• Infection of poultry with highly pathogenic avian influenza A (HPAI) virus infection can cause disease that affects multiple internal organs with mortality up to 90-100% in chickens, often within 48 hours. However, ducks can be infected without any signs of illness.

• Infection of poultry with low pathogenic avian influenza A (LPAI) viruses may cause no disease or mild illness (such as ruffled feathers and a drop in egg production) and may not be detected.

https://www.cdc.gov/flu/avianflu/influenza-a-virus-subtypes.htm

Waterfowl Migration

USDA kills 73,500 Tyson chickens

because of bird flu- March 2017 • Should we be concerned?

• Are we prepared?

Tennessee bird flu • 4 years in a row, highly pathogenic H7 avian flu

has struck birds the US.

• 30 farms within a 10-mile radius are under quarantine.

• In addition to testing, strict movement controls are in place within an established control zone to prevent the disease from spreading.

• H7 avian “bird flu” in Tennessee is of the North American wild bird lineage, a virus that is genetically distinct from the China H7N9 lineage that has infected both poultry and people in Asia

• Tyson stock take a $1.61 hit.

• Japan, Singapore, Hong Kong, South Korea, Taiwan halt U.S. poultry imports www.aphis.usda.gov/wcm/connect/APHIS_Content_Library/SA_Newsroom/SA_News/SA_By_Date/SA-2017/hpai-tn-update?presentationtemplate=APHIS_Design_Library%2FPT_Print_Friendly_News_release

https://www.cdc.gov/flu/pdf/avianflu/avian-flu-transmission.pdf

A lower pathogenic H5N8 bird flu has also been confirmed in WI

http://www.healthmap.org/en/#!d=68,283,289,292,287,271

Bird Flu alerts in the last month

Egg Farms

• Moses Lake

• https://www.youtube.com/watch?v=M6iUN1mBzd0

https://www.nass.usda.gov/Charts_and_Maps/Poultry/eggmap.php

Backyard Bird Flocks • Live poultry, such as chickens,

ducks, geese, and turkeys, often carry harmful germs.

• After you touch a bird, or anything in the area where they live and roam, wash your hands so you don't get sick!

H7N9 bird flu patient is treated at Chinese hospital

Signs and symptoms:

• Fever (temperature of 100ºF [37.8ºC] or greater) or feeling feverish, cough, sore throat, runny or stuffy nose, muscle or body aches, fatigue, headaches, eye redness (or conjunctivitis), and difficulty breathing.

• Other possible symptoms are diarrhea, nausea, and vomiting.

• As with seasonal flu, some people are at high risk of getting very sick from bird flu infections, including pregnant women, people with weakened immune systems and people 65 and older.

https://www.cdc.gov/flu/pdf/avianflu/avian-flu-transmission.pdf http://www.nbcnews.com/health/health-care/new-gop-health-care-bill-would-cut-fund-fight-killer-n730391

Flu A/H7N9 recent changes • About a week ago, health officials from Guangdong

province and Taiwan reported the detection of mutations in samples from a trio of human cases suggesting that H7N9 has transitioned from a low-pathogenic to a highly pathogenic form of the virus in poultry.

• The WHO said though the H7N9 changes may have implications for poultry surveillance and control strategies, so far there is no evidence of epidemiologic changes in human infections or that the evolution from a low-pathogenic to highly pathogenic virus in birds has any impact on pathogenicity and transmissibility in humans.

http://www.cidrap.umn.edu/news-perspective/2017/02/who-analysis-spotlights-resistance-h7n9-gene-changes

China: H7N9 antiviral resistance likely arose after treatment • The hemagglutinin mutation seen

in 3 human samples and one environmental specimen involves changes that make the virus highly pathogenic in birds, but there is no evidence that they affect pathogenicity and transmissibility in humans

http://www.cidrap.umn.edu/news-perspective/2017/03/who-h7n9-antiviral-resistance-likely-arose-after-treatment

www.cidrap.umn.edu/sites/default/files/public/downloads/topics/cidrap_h7n9_update_080414.pdf

Number of confirmed human A(H7N9) cases and deaths reported to the WHO by week of onset, China

http://virologydownunder.blogspot.com/2014/11/influenza-ah7n9-virus-detection-numbers.html

Bird Flu around the world

• France has been battling outbreaks of A/H5N8, along with other strains, since November. The area targeted for preemptive culling produces 25% of France's foie gras. The same region was hit by similar outbreaks in the winter of 2015-16.

• Germany: A/H5N8 outbreaks, mainly involving wild birds, but 3 of the locations were poultry farms, 3 were backyard holdings, and 1 was a city zoo. The outbreaks began from Feb 7 to Feb 20 and affected locations throughout a large portion of Germany. The virus killed 631 poultry and led to the stamping out of 138,142 more.

• Spain reported detecting A/H5N8 in a white stork found dead on Feb 20 at a nature park.

• Nigeria reported A/H5N1

http://www.cidrap.umn.edu/news-perspective/2017/02/china-confirms-high-path-h7n9-market-poultry

Taiwan: A/H5N6 bird flu Feb 15, 2017

• Taiwan is killing tens of thousands of chickens, ducks and turkeys since discovering its first case of bird flu

www.nbcnews.com/health/health-care/new-gop-health-care-bill-would-cut-fund-fight-killer-n730391

Region 7 Epi Response Plan

• What’s our plan?

Epidemiology Response Plan Region 7 Public Health Public Health

North Central Washington State (Chelan, Douglas, Grant, Kittitas and

Okanogan Counties) Revised December 2017

Region 7 Epi Response Plan

Washington State Guidelines on Notifiable Diseases Reporting

• Public Health Surveillance is the collection, investigation and distribution of data about illness and death.

• This surveillance helps prevent and control disease in WA State.

• Surveillance is used to protect and improve the health of the public by:

• describing disease trends;

• identifying and controlling the sources of infection;

• educating the public and;

• preventing disease.

R7 Epi Response Plan

General Public or Self reporting

In WA, health care providers, health care facilities, laboratories, veterinarians, food service establishments, child day care facilities, and schools are legally required to notify public health authorities at their local health jurisdiction of suspected or confirmed cases of selected diseases or conditions. These are referred to as notifiable conditions.

Table 2 Regional Contact Information-

• See annual update of:

• Regional Healthcare System Plan for All Hazards Preparedness and Response-REGION 7 Appendix A

Notifiable Conditions in WA

http://www.doh.wa.gov/Portals/1/Documents/5100/210-001-Poster-HCP.pdf

http://www.doh.wa.gov/Portals/1/Documents/5100/420-057-Guideline-Influenza.pdf

Electronic reporting to DOH

http://www.doh.wa.gov/Portals/1/Documents/5100/420-019-ReportForm-Influenza.pdf

http://www.doh.wa.gov/Portals/1/Documents/5100/210-001-Poster-HCP.pdf

Surveillance

Protocol for Activating Emergency Surveillance Emergency Surveillance will be implemented within Region 7 Public Health LHJs under the following conditions: • Upon receiving notification of a confirmed or suspected disease significance or

of a bioterrorism nature from the following sources: • US Centers for Disease Control (CDC) • Washington State Department of Health (WSDOH) • British Columbia Centers for Disease Control (BCCDC) • Upon the discretion and direction of the Region 7 Health Officers. • Evidence of an epidemic occurring in Washington State • A significant increase in key signs/symptoms among patients within either

Region 7 or Washington State

XIII. Regional Coordination of Surveillance Activities

• In keeping with the mutual aid agreements among Region 7

Public Health LHJs and to coordinate notifiable condition reporting surveillance within Public Health Emergency Response Planning Region 7, participants will cooperate and coordinate with the Region 7 Public Health Epidemiologist in the event of a disease outbreak within Region 7.

TERMINATION OF SURVEILLANCE

Emergency Surveillance may be terminated by Region 7 Public Health following consultation with the Health Officer, Epidemiologist, Communicable Disease Program Manager, Environmental Health Director or the Administrator.

Questions?