Washtenaw County Public Health Influenza Surveillance – 12/16/14

Lab-confirmed Cases: Reports of confirmed influenza in Washtenaw County are very high. The predominant strain being reported locally is A/H3N2, with a few cases of influenza B reported as well. The age range of confirmed flu cases is 1 to 100 years old.

Please see the local flu curve:

http://www.ewashtenaw.org/government/departments/public_health/disease_control/flu-graph-16dec2014


Hospitalizations and Deaths:
New flu-related hospitalizations reported in Washtenaw residents last week were higher than at any time in the past 5 years. The majority of local hospitalizations (68%) are in individuals 65 years and older. The first hospitalized cases in Washtenaw children have been reported, representing 5% of the total flu hospitalizations to date. The age range of hospitalized children is 7 to 16 years; none received flu vaccine this season.

Hospitalizations and Deaths in Washtenaw Residents with Confirmed Influenza

Total Hospitalizations (starting September 28)
76

Hospitalizations Week of 12/7 – 12/13/14
39

Child Deaths
0
(0 – 17 years)

Adult Deaths
(18 years and older)
0

Flu Vaccine Availability

Currently, vaccine supply is good. Washtenaw County Public Health still has flu vaccine available for all ages. Please call (734) 544-6700 for an appointment.

For local influenza information: http://www.ewashtenaw.org/flu

For Michigan influenza information: http://www.michigan.gov/flu

For national information: http://www.cdc.gov/flu

Health Care Providers: New Childhood Immunization Guidelines will Mean Healthier, Safer Michigan

LANSING, MI – Dec. 11, 2014 – Physician, nurse and health care leaders from across Michigan issued the following joint statement in support of new childhood immunization guidelines developed by the Snyder Administration and approved today by the Legislature’s Joint Committee on Administrative Rules:

“Childhood immunizations protect our kids from dangerous infectious diseases such as measles, mumps and whooping cough, but more and more Michigan kids are at risk as non-medical exemption rates rise and immunization rates fall. In fact, Michigan unfortunately boasts the nation’s 4th highest rate of vaccination exemptions. This puts everyone at risk.

“Today’s update to state regulations regarding immunizations is about information and education and ensuring parents have enough of both as they make critical health decisions that impact their families and communities. Families choosing not to immunize their children will still be able to do so, but they will be supported with a consistent, detailed assessment of the personal and public health implications of their choices. We commend the Snyder Administration, state Senator Jim Marleau, and lawmakers for their leadership on this essential issue and for making this important update to state rules.”

The Michigan Academy of Family Physicians, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Chapter of the American Academy of Pediatrics, the Michigan Association of School Nurses, the Michigan Council for Maternal and Child Health, the School Community Health Alliance of Michigan, the Michigan Association of Health Plans, and the Michigan Association for Local Public Health are working together to protect Michigan children by increasing immunization rates and immunization awareness across the state.

Two Cases of Measles Confirmed in NW Michigan

Please share the following with all primary care personnel, urgent/emergency care clinicians,
and infection control/prevention specialists.

Two cases of measles have been confirmed in northwest Michigan. Both cases lacked a vaccination history against measles and recently had traveled to the Philippines where they were exposed. These are the first measles cases in Michigan in 2014. The public health investigation and response is currently ongoing.

Since late 2013 the Philippines has been experiencing a measles outbreak, exceeding 50,000 cases and over 100 deaths. Other Western Pacific Region countries have also been reporting measles outbreaks. In addition measles is endemic in many other parts of the world. This year the U.S. has experienced considerably more measles cases than usual with over 600 confirmed measles cases, the most in the U.S since 1994.

Many healthcare providers in the United States have never seen a patient with measles and may not recognize the signs and symptoms.

Michigan healthcare providers should consider measles in the initial differential diagnosis of patients who
a. present with febrile rash illness and clinically compatible measles symptoms [cough, coryza (or runny nose) or conjunctivitis (pink eye)]
b. recently traveled internationally or were exposed to someone who recently traveled
c. have not been vaccinated against measles

If you suspect measles in a patient, do the following immediately:

1.Promptly isolate patients to avoid disease transmission; measles is highly communicable.
2.Immediately report the suspect measles case to their health department.
3.Obtain specimens for testing from patients with suspected measles, including viral specimens – recommended specimens are 1) serum and 2) throat swab (place swab in viral transport media)

All international travelers should be protected against measles. Persons uncertain of their measles vaccination history or immunity status should receive measles-containing vaccine, such as MMR, preferably 2 or more weeks prior to start of travel.

CDC guidance for healthcare providers can be found at http://www.cdc.gov/measles/hcp/index.html and http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html.

Additional Michigan guidance (Key Facts about Measles) is available at

http://www.michigan.gov/documents/mdch/KeyFacts_Measles_392862_7.pdf

Washtenaw County Flu Update

Lab-confirmed Cases: Reports of confirmed influenza in Washtenaw County are climbing quickly. The predominant strain being reported locally is A/H3N2, with a few cases of influenza B reported as well. The age range of confirmed flu cases is 2 to 99 years.

· 0 – 4 yrs = 7%

· 5 – 17 yrs = 26%

· 18 – 29 yrs = 12%

· 30 – 49 yrs = 15%

· 50 – 64 yrs = 15%

· 65 and older = 25%

Please see the local flu curve:

http://www.ewashtenaw.org/government/departments/public_health/disease_control/flu-graph-3dec2014

Hospitalizations and Deaths: Flu-related hospitalizations in Washtenaw residents are increasing. The great majority of local hospitalizations are in individuals 70 years and older (76%). No reported hospitalizations have occurred in children (0 – 17 years) to date. 81% of cases are female. Influenza A was detected in all hospitalized patients (except for one influenza B), with H3N2 the only A subtype found. No deaths in Washtenaw residents have been reported.

Hospitalizations and Deaths in Washtenaw Residents with Confirmed Influenza

Total Hospitalizations*
21

Hospitalizations
Week ending 11/29/14
3

Child Deaths*
(0 – 17 years)
0

Adult Deaths*
(18 years and older)
0
*Starting Sept 28, 2014

The Washtenaw hospitalization graph is available on our website:

http://www.ewashtenaw.org/government/departments/public_health/disease_control/flu-hospitalizations-3dec2014

Facility outbreak: On November 13, an outbreak of influenza was reported on a memory care unit in Washtenaw County. Nine residents were confirmed with influenza A/H3 and at least 3 were hospitalized.

Flu Vaccine Information

Vaccine match: The Centers for Disease Control and Prevention (CDC) announced on December 3 that of the A/H3N2 strains tested nationally, about half had drifted from the strain in the vaccine. This will likely mean reduced effectiveness of the vaccine. However, other circulating flu strains in the U.S. continue to match the vaccine formulation. Vaccination remains our best tool to prevent influenza infection.

CDC press release: http://www.cdc.gov/media/releases/2014/p1204-flu-season.html

Vaccine availability: Currently, vaccine supply is good. Washtenaw County Public Health still has flu vaccine available for all ages. Please call (734) 544-6700 for an appointment.

For local influenza information: http://www.ewashtenaw.org/flu

For Michigan influenza information: http://www.michigan.gov/flu

For national information: http://www.cdc.gov/flu

Housing & Harm Reduction Training Series Begins December 10, 2014

Housing & Harm Reduction:
Understanding and Implementing Harm Reduction Strategies in the Context of Supportive Housing

Training #1:
Wednesday, December 10, 2014, 8:00AM to 4:00PM
Saint Joseph Mercy Hospital Education Center
5305 Elliott Drive, Ypsilanti, MI

Morning Keynote Speaker:
“The Diagnosis of Destitution: Pain, Addiction, & the Complicated Patient”
Dr. Corey Waller

Center for Integrative Medicine
Spectrum Health, Grand Rapids, MI

    Afternoon Panelists:

Steve Aslum, The Grand Rapids Red Project
Lemont Gore, HIV/AIDS Resource Center
Pamela Lynch, MIWhoSoEver Collaborative

This training series is free! Intended for staff at:

 Housing and Homeless service providers
 Substance use disorder treatment providers
 Mental health providers
 Hospitals and clinics
 Law enforcement

Training #1 has been approved by the Michigan Social Work Continuing Education Collaborative for 4 CE hours.
*CAADC credits for MCBAP pending.*

register online:

http://bit.ly/1pjSKIk

Washtenaw County Flu Update

Washtenaw County Public Health has reported that since November 1, almost 40 cases of lab-confirmed influenza A have been reported in Washtenaw residents. Of the cases that have been subtyped, all have been A/H3. Six Washtenaw adults had flu-related hospitalizations last week; ages ranging from 57 – 93 years old.

On November 14, the first influenza outbreak in a long-term care facility in Washtenaw for this season was confirmed. Influenza A was detected in multiple residents on the same unit and three individuals were hospitalized. Samples have been sent to the State Lab for confirmation and subtyping.

Actions for Clinicians:

· Continue to promote vaccination in all persons 6 months and older.

· Consider antivirals for symptomatic individuals, especially if they are at high risk for complications from influenza infection. See the CDC webpage for current recommendations: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

See the Washtenaw County Flu Activity webpage for more details on local flu surveillance: http://www.ewashtenaw.org/government/departments/public_health/disease_control/ph_flusurveillance.html

Washtenaw County Medical Society Continues to Hold Ebola Preparedness Meetings

Ann Arbor, Mich, November 13, 2014 – The Washtenaw County Medical Society held its second Ebola Preparedness meeting for health and medical leaders within Washtenaw County. Over 40 representatives from Washtenaw County Public Health, The Michigan Department of Community Health, University of Michigan Health System, Saint Joseph Mercy Health System, Michigan Department of Community Health, EMS, and independent physician association Integrated Healthcare Associates (IHA) were present to discuss Ebola preparedness at all levels.

The group reviewed the Ebola virus situation worldwide and in the U.S. Representatives from Saint Joseph Mercy Health System and the University of Michigan Health System gave updates on their patient screening process, isolation plan for persons exposed to the virus, and training of clinical care teams. Also, Dr. Matt Davis, the Chief Medical Executive at MDCH, discussed the state preparations and answered questions from the group. The recently updated CDC Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure was reviewed and is currently being followed by Washtenaw County Public Health.

The group will meet again in 1-2 months (or sooner if necessary) to review Ebola preparedness efforts in Washtenaw County. “These meetings will help us all be on the same page regarding what we’ll do when, and if, a confirmed case of Ebola appears in Washtenaw County,” said Charles Koopmann, Jr., MD, Washtenaw County Medical Society President. Ebola has infected more than 13, 000 and killed more than 4,950 people since it broke out in West Africa earlier this year, according to the World Health Organization. The majority of the cases and deaths have occurred in Sierra Leone, Liberia and Guinea.

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