David H. Trump, MD, MPH State Epidemiologist & Director, Office of Epidemiology December 16, 2013

1. Public Health Issues of Interest Seasonal Influenza Seasonal Norovirus Middle East Respiratory Syndrome Coronavirus Novel Influenza (A/H7N9) David H. Trump, MD, MPH State Epidemiologist & Director, Office of Epidemiology December 16, 2013

2. Seasonal influenza • Influenza comes to Virginia every year • Season is October – May • Usually peaks December – February • This year, we can expect to see multiple flu viruses circulating • Influenza A/H3N2, 2009 Influenza A/H1N1, Influenza B • Influenza can have a large impact, especially in group residential settings

3. Flu outbreaks reported last season

4. Influenza activity this season

5. VDH’s flu-related activities • Deliver public messages about covering cough, staying home while sick, washing hands and getting the flu vaccine • Commissioner’s “Dear Colleague” letter • Monitor flu activity based on outbreaks, laboratory findings, and visits for influenza-like illness (ILI) • Give advice on outbreak control to facilities, facilitate specimen collection for testing at state lab (DCLS) • Encourage and provide vaccine

6. Influenza vaccine coverage in VirginiaPersons ≥ 6 months of age Source: CDC’s FluVaxView, http://www.cdc.gov/flu/fluvaxview/

7. Virginia flu vaccine coverage estimates, by age group and flu season 59% of Virginia women who delivered during 2010-2011 flu season had received flu vaccine (CDC, PRAMS) Source: CDC’s FluVaxView, http://www.cdc.gov/flu/fluvaxview/

8. Source: Influenza Vaccination Coverage Among Health-Care Personnel — United States, 2012–13 Influenza Season. MMWR Morb Mortal Wkly Rep 2013;62(38);781-786

9. Source: Influenza Vaccination Coverage Among Health-Care Personnel — United States, 2012–13 Influenza Season. MMWR Morb Mortal Wkly Rep 2013;62(38);781-786

10. Seasonal norovirus • At the same time influenza is circulating, we also see a seasonal increase in the activity of norovirus, a gastrointestinal virus, in the community. • Norovirus causes vomiting and/or diarrhea. • It spreads easily from person-to-person. • It can have a large impact in group settings, such as schools, daycare facilities, long-term care facilities, and social gatherings.

11. Norovirus outbreaks reported last season

12. Norovirus activity

13. VDH’s norovirus-related activities • Investigate and seek laboratory confirmation of many outbreaks • Monitor trends in outbreaks and outpatient visits for gastrointestinal illness • Give advice to facilities experiencing an outbreak • Make available information on the disease and disease prevention and control measures • Press release • Commissioner’s “Dear Colleague” letter • Guidelines for managing outbreaks in facilities

14. MERS-CoV – Update • 163 cases reported (CDC, 12/5/2013) • 71 deaths (44% fatality rate) • Cases in 10 countries: 80% in Saudi Arabia • No cases in United States • No sustained person-to-person transmission, but can spread person-to-person during close contact • Family caregivers • Healthcare settings • VDH and DCLS collaborated to test 4 people for MERS-CoV • All met screening criteria for testing • All tested negative

15. Novel influenza – Update • Influenza A H7N9 • All cases to date have been in China • 137 cases (45 deaths) reported (WHO, as of 10/25/2013) • China reporting a few cases this autumn • 1 case in Taiwan and 2 cases in Hong Kong, all associated with travel to mainland China • VDH and DCLS collaborated to test 6 people for H7N9 • All met screening criteria for testing • All tested negative

16. Tracking and responding to seasonal and emerging infections keeps VDH and DCLS staff busy and challenged. • Any questions?