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State of the State

State of the State. APIC Meeting January 25, 2013. Agenda. 1:35 – 1:45 pm   Introduction and MEDSIS – Shoana/Sara 1:45 – 1:55 pm   Vaccine Preventable Disease – Karman Tam 1:55 – 2:05 pm   Cocci –Clarisse Tsang 2:05 – 2:15 pm   Flu – Shane Brady

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State of the State

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  1. State of the State APIC Meeting January 25, 2013

  2. Agenda • 1:35 – 1:45 pm   Introduction and MEDSIS – Shoana/Sara • 1:45 – 1:55 pm   Vaccine Preventable Disease – Karman Tam • 1:55 – 2:05 pm   Cocci –Clarisse Tsang • 2:05 – 2:15 pm   Flu – Shane Brady • 2:15 – 2:25 pm   HAI – Jason Lempp/Vinita Oberoi • 2:25 – 2:40 pm   Vector/RMSF – Selam Tecle and Erica Weis • 2:40 – 2:50 pm   Foodborne – Evan Henke • 2:50 – 3:05 pm   STD – Roxanne Ereth • 3:05 – 3:20 pm   HIV – Rick DeStephens • 3:20 – 3:35 pm   TB – Eric Hawkins • 3:35 – 4:00 pm   Questions

  3. New Year, New MEDSIS • Please remember to sign your new user agreement • For questions or MEDSIS access, please contact: • medsishelpdesk@siren.az.gov

  4. Meaningful Use • Public Health Objectives • Electronic Laboratory Reporting – currently accepting • Immunization Registry – currently accepting • Syndromic Surveillance – will be contacting hospitals shortly

  5. Vaccine Preventable DiseasesAPIC State of the StateJanuary 25, 2013 Karman Tam, MPH Office of Infectious Disease Services Arizona Department of Health Services

  6. *confirmed and probable cases

  7. Pertussis in Arizona 2012 (preliminary) 2011 867 cases 160 confirmed 707 probable • 962 cases 507 confirmed 455 probable

  8. *confirmed and probable cases

  9. Pertussis Testing http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html

  10. Mohave County Pertussis Outbreak 92 cases (72 confirmed, 20 probable) to date

  11. Calling All Health Care Workers! Get Vaccinated Against Pertussis! • Only 20% of HCW’s in the U.S. have received the adult vaccine for pertussis (Tdap) • Only ONE dose of Tdap is needed! Protect yourself Protect your patients and their families Protect infants under <1 year old • According to the CDC, Tdap vaccination in adults: • Reduces incidence of pertussis in infants • Reduces complications in high-risk individuals

  12. Arizona Partners Against Pertussis (APAP) www.WhyImmunize.org/APAP Goal: Achieve 100% pertussis vaccination rate by April 1, 2013 Prize: Certificate of Participation, recognition on the website, and prizes/money

  13. H. flu type B (Hib) in children <5 years 2012 2011 1 confirmed case • 2 confirmed cases - 3 year old: fully immunized - 4 month old: not vaccinated

  14. Meningococcal Invasive Disease 2012 2011 16 confirmed cases • 5 confirmed cases 3 serogroup C 1 serogroup Y 1 serogroup W135

  15. Measles 2012 2011 2 confirmed cases • 2 confirmed cases (siblings) 7 year old: PCR positive, not vaccinated 5 year old: IgM positive, not vaccinated

  16. Mumps 2012 2011 0 cases • 3 confirmed cases (siblings) 9 year old: IgM and PCR positive, not vaccinated 12 year old: epi-linked, not vaccinated 13 year old: epi-linked, not vaccinated

  17. Resources 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf Guideline for infection control in health care personnel, 1998 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

  18. Arizona Vaccines For Children (VFC) Program2012 Arizona Immunization Program Office (AIPO) Arizona Department of Health Services Patty Gast, M.S., Office Chief (602)364-3639

  19. Vaccines Distributed in 2012 • The Arizona VFC Program provided 1,596,867 vaccines ($81,119,566) to more than 850 private and public immunization providers statewide in AZ • VFC vaccine is for children who are on AHCCCS, Native American or uninsured • 317 vaccine is used in AZ for non-VFC eligible children, such as for insured children who present at County Health Departments

  20. Vaccine Policy Changes in 2012 Important federal vaccine policies changes were instituted in October 1, 2012, as required by VFC: • Federal vaccine may no longer be used for PRIVATELY insured children. • Most county health departments are trying to develop a private stock of vaccine and insurance billing programs in order to continue serving privately insured children. County health departments are encountering significant challenges in developing these programs, and we are concerned about where these children can get immunized in the meantime.

  21. Vaccine Policy Changes • Upcoming mid-year 2013 – our federal vaccine can not be used for underinsured children in private provider offices. • However, a safety net for these children is being established: county health departments and 24 providers statewide are being deputized with authority from a Federally Qualified Health Center (FQHC) to use VFC vaccine on underinsured children. FQHCs and Rural Health Centers (RHCs) already have this authority. • This means that starting in July 2013 (approximately) underinsured children will have to pay out of pocket at their private provider’s office or go to a county, deputized provider, FQHC or RHC to receive free vaccine. • For now, in the first half of 2013, all providers should continue using our vaccine on underinsured children. • As the Affordable Care Act rolls out in 2014, there will hopefully be fewer and fewer underinsured children.

  22. Vaccine Policy Changes • These policies have affected hospitals’ ability to participate in the Arizona VFC Program, as we previously supplied the Hepatitis B birth dose universally, but now we are not able to do so. Several hospitals have dropped out of the VFC Program, but are offering the birth dose to privately insured children at their own expense. • There will always be sufficient vaccine for VFC eligible children.

  23. Additional Updates • New ADHS manual for preventing perinatal hepatitis B virus infections:  with chapters specifically aimed at OBs, hospitals, pediatricians, and health departments. It can be found on the ADHS immunization website under AIPO Program Activities—perinatal hepatitis B prevention. • March of Dimes sponsoring coalition of 17 health care organizations entitled Arizona Partners Against Pertussis (APAP):  Contest to have employers get staff 100% immunized with Tdap.  Deadline April 1, 2013.  Details on TAPI’s website at www.whyimmunize.org.  • AIPO started doing a small pilot project with a rural pharmacy to see if a pharmacy can serve as a VFC vaccine provider in Arizona. • FDA has approved Varizig (varicella immune globulin) for prophylaxis in high risk individuals, and has extended use to 10 days (MMWR March 30, 2012).

  24. Additional Updates • Waiting for MMWR to publish provisional recommendations from ACIP vote on: • Tdap for every pregnant woman during every pregnancy • Measles recommendation changes, including MMR down to 6 months old for international travel and 2 doses of MMR for > 12 months old for international travel • ADHS study showed risk factors for having 1st hepatitis B vaccine >14 days versus 1st in 3 days. • Babies born to mothers with private insurance were twice as likely to miss the HBV vaccine birth dose • Babies born to mothers with complications during labor or delivery were more than twice as likely to miss the HBV vaccine birth dose than when the mother experienced no complications

  25. Additional Updates • All influenza vaccines this season are trivalent.  • Looking to the future.  New influenza vaccines will likely be available next season • Live attenuated quadrivalent vaccines: both intranasal and injection.  (H1N1, H3N2, and 2 Bs) • First influenza vaccine grown with cell culture technology (dog kidney cells). No risk for egg allergic patients.

  26. Thank you! Please contact Karman Tam for more information: karman.tam@azdhs.gov (602) 364-0246

  27. Coccidioidomycosis in Arizona Clarisse Tsang, MPH Acting Program Manager Infectious Disease Epidemiology APIC: January 25, 2013

  28. Impact of Cocci on Arizonans • 60% of all reported US cases are in Arizona • 2nd most commonly reported infectious disease • Symptoms last for a median of 4 months • In 2007, $83 million was spent on cocci for hospital visits

  29. Surveillance: Cocci Case Definition • Council for State and Territorial Epidemiologists (CSTE) • Updated in 2007 • Clinical case definition • Lab criteria* • Arizona Department of Health Services (ADHS) • Since 1997 • No clinical symptoms required • Lab criteria* *Lab criteria for diagnosis includes either detection of IgM by immunodiffusion (ID), enzyme immunoassay (EIA), latex agglutination, or tube precipitin OR IgG by ID, EIA, or complement fixation (CF) OR cultural, histopathologic, or molecular evidence of Coccispecies

  30. Rates of Reported Cocci Cases, Arizona, 1990-2012 Change in EIA Reporting Lab Reportable

  31. Reported Cocci Cases, Age and Gender *2011 Numbers are provisional and have not been finalized n/a = have not analyzed yet

  32. Reported Cocci Cases by Age, 2007-2011 Reported cases per 100,000

  33. Provider Education • Brochures and posters about cocci testing for providers • CME for the PCP: https://www.vfce.arizona.edu/clinicians/FreeOnineCME.aspx • Annual Valley Fever Awareness Week in November

  34. Public Education • Brochures with cocci info for the public • Video: “Valley Fever: The Impact on Arizonans”

  35. 1.

  36. Resources • ADHS website: www.valleyfeverarizona.org • Valley Fever Center for Excellence: www.vfce.arizona.edu

  37. Thank you! Questions? Clarisse Tsang tsangc@azdhs.gov 602-364-3817

  38. Influenza: 2012-2013 Shane Brady, MPH Influenza Epidemiologist

  39. 2012-2013 Season • Early flu season around the country • First case confirmed on October 30th, 2012 with activity intensifying in the last few weeks • Vaccine is a good match to all three circulating strains • an A/California/7/2009 (H1N1)pdm09-like virus • an A/Victoria/361/2011 (H3N2)-like virus • a B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses)

  40. Lab-confirmed influenzacases, 2009-2013

  41. Age Groups by Flu Type

  42. State Lab Data:PCR & cultures, 2012-2013

  43. Percentage of Visits for Influenza-like illness at sentinel outpatient providers, 2012-2013

  44. School surveillance • Approx. 300 schools around the state participate in an automated surveillance program that pulls data from the school nurses’ database • Analyzed weekly for influenza-like illness visits to school nurses’ office • Seeing a small increase in activity now • Some counties have additional school surveillance: • Maricopa: Has web-based system to collect information from participating schools on student absences due to ILI, respiratory diseases, GI diseases and other reasons. Plans to expand system.

  45. Pediatric Flu-Associated Mortality • One case this season: • Yavapai County child 5 years old • PCR confirmed influenza A (H3) and RSV • Underlying conditions • Not vaccinated

  46. Antiviral resistance (national) *Includes specimens tested in national surveillance and additional specimens tested at public health laboratories in four states (AZ, MD, NY, and PA) who share testing results with CDC. Neuraminidase inhibitors continue to show very little resistance (e.g., Tamiflu). Adamantanes are not usefulas high levels of resistance persist among 2009 influenza A (H1N1) and A (H3N2) viruses.

  47. Antiviral Treatment Clinical trials and observational data show that early antiviral treatment may do the following: • shorten the duration of fever and illness symptoms • reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, respiratory failure) and death • shorten the duration of hospitalization

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