Transcript Slide 1

Emerging Diseases of Concern
Health and Human Resources Subpanel
Governor’s Secure Commonwealth Initiative
October 2014
1
Enterovirus D68
• Enterovirus D68 (EV-D68) is one of more than
100 non-polio enteroviruses
• EV-D68 can cause mild to severe respiratory
illness.
• EV-D68 likely spreads from person to person
when an infected person coughs, sneezes, or
touches contaminated surfaces.
2
Enterovirus D68 in United States
From mid-August to
October 15, 2014, CDC
or state public health
laboratories have
confirmed a total of
780 people in 46
states and the District
of Columbia with
respiratory illness
caused by EV-D68.
3
Enterovirus D68 in Virginia
• As of October 15, EV-D68 lab-confirmed in the
Central, Northern and Eastern Regions
• 66 patients tested for EV-D68 (72 specimens)
• 35 patients confirmed EV-D68 by CDC or DCLS labs
• 18 patients had rhinovirus or other enteroviruses
• 8 hospitals reported increases in ED visits
and/or admissions in children presenting with
possible EV-D68
• St Mary's Hospital – 50% of children admitted
required PICU
4
Enterovirus D68
• VDH continues to
work with any
facilities reporting a
cluster of illness to
facilitate lab testing
where appropriate.
• VDH will continue
traditional and
enhanced surveillance
to characterize the
nature of the illness
and these clusters.
5
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
6
Virginia’s 2013-14 Flu Season_Insert
Updated Slide
Peak activity week ending 1/18/2014,
widespread for 11 weeks, 30 outbreaks
Recent uptick in Flu B
7
8
Flu vaccine composition unchanged…
2014-2015 trivalent influenza vaccines protect against the
following three viruses:
• A/California/7/2009 (H1N1)pdm09-like virus
• A/Texas/50/2012 (H3N2)-like virus
• B/Massachusetts/2/2012-like virus
Quadrivalent vaccines also protect against:
• B/Brisbane/60/2008-like virus
9
Flu vaccine recommended for…
• All persons aged 6 months and older should be vaccinated
annually.
• Vaccination of persons at high risk is especially important to
decrease their risk of severe flu illness.
• People at high risk of serious flu complications include young
children, pregnant women, people with chronic health conditions
like asthma, diabetes or heart and lung disease, and people 65
years and older.
• Vaccination also is important for healthcare workers, and other
people who live with or care for people at high risk to keep from
spreading flu to those at high risk.
• Children younger than 6 months are at high risk of serious flu
illness, but are too young to be vaccinated. People who care for
them should be vaccinated instead.
10
Other Emerging Infections
• Middle East Respiratory Syndrome Coronavirus
(MERS-CoV)
• May 2, 2014 – first U.S. imported case (IN)
• May 11, 2014 – second U.S. imported case (FL)
• Unrelated cases; both from Saudi Arabia
• Avian Influenza A H7N9 in China
Both diseases still need to be considered in ill
travelers from affected countries.
DCLS has ability to test in-house.
11
Virginia’s Preparedness for
Ebola Virus Disease (EVD)
Health and Human Resources Subpanel
Governor’s Secure Commonwealth Initiative
October 2014
12
Ebola: The Basics
• Ebola virus is a type of viral hemorrhagic fever.
• Virus spread person to person mainly by direct contract
with bodily fluids (blood, feces, vomit), less commonly
by contaminated items (needles).
• Ebola is a severe and often fatal disease; begins with
acute fever, progressing to multi-organ involvement.
• Infected person is contagious only after symptoms
develop (usually 8-10 days (range 2 to 21 days) after
exposure).
• Persons (healthcare workers, household members)
caring for person acutely ill with Ebola are at highest
risk of being infected.
13
Ebola in Africa and the United States
14
• Mar 2014: Outbreak began in Guinea
• Aug 8: WHO declared international
public health emergency
• Sep 30: First case diagnosed in US
(Texas); traveler left Liberia Sep 19,
arrived US Sep 20, and became
symptomatic Sep 24
Image source: CDC (October 10, 2014)
• Ongoing outbreaks in Guinea, Liberia,
Sierra Leone. Limited but now
contained spread in Nigeria. Now
limited spread in the U.S. Sporadic
detection in 2 other countries.
• 8,997 total reported cases and 4,493
deaths (Oct 12)
EVD Control Measures: Based on
Established Core Public Health Actions
• Surveillance
• Disease reporting
• Communication
• Investigation
• Implementation of control measures
• Risk communication
15
16
Statewide Hospital Preparedness Program
VDH provides the framework for statewide administration of HPP
VDH works through the Virginia Hospital and Healthcare Association
(VHHA) to coordinate governance and initiatives to 6 Healthcare
Coalitions with 300+ participating facilities
• Regional Healthcare Coordinators
develop their regional plans, polices and
governance structure under the
oversight of their Regional Healthcare
Coalition
• Regions operate Regional
Healthcare Coordination Centers
(RHCC)
17
Three EVD Scenarios to Consider
in Virginia
I.
Individual arrives at Virginia airport (Dulles most
likely) with symptoms consistent with EVD (or likely
exposure) and travel history to affected areas
II. Individual presents to Virginia hospital with symptoms
consistent with EVD and a travel history to the
affected areas
III. Individual with EVD identified in another state but had
contact with Virginians
18
I. Person Arrives at Airport
• Active planning over many years with CDC’s Division of
Global Migration and Quarantine (DGMQ) for arrival of
person with communicable condition
• Airlines trained to notify DGMQ of ill passengers.
Captains have a legal responsibility.
• Entry screening will begin at Dulles 10/16/14.
• Initial protocols developed
• Includes communication with local and state
public health, EMS and hospitals
19
Dulles Scenario, continued:
Four scenarios:
1. Person has fever and symptoms consistent with EVD
• Transport by Airport EMS to accepting hospital
2. Person has no history of EVD exposure but is
febrile/symptomatic
• Assessment and, if appropriate, hospital evaluation
3. Person has history of EVD exposure but no symptoms
• CDC would provide a conditional release. State
may issue quarantine order.
4. No exposure history AND no symptoms
• Released with information sheet
20
II. Person Presents to Virginia Hospital
• Hospital staff perform assessment and implement
isolation
• Hospital staff report to and consult with local health
department and follow the steps for testing approval
within VDH and with Virginia’s State Lab, DCLS
• DCLS would test patient samples and forward portions
to CDC for additional testing
21
If Patient Tests Positive
• Case patient remains in isolation at hospital.
• VDH initiates investigation
• includes contact tracing - something we do very
regularly.
• On a daily basis, VDH staff would assess contact’s
compliance with monitoring.
• If activities of well contacts need to be restricted, the
VDH district health director would make that
recommendation to the Commissioner.
• Commissioner would need to decide on quarantine
order issuance
22
Layers of Offense and Defense
• Public health and health care efforts in West
Africa to get the outbreaks under control
• Exit screening at airports in West Africa
• Entry screening at airports in the United States
• Early identification and isolation of persons
presenting with EVD in the United States
• Aggressive contact investigations and measures
to prevent the spread of EVD infection in the
United States
23
Quarantine Orders
• Legal authority exists for State Health Commissioner to
issue orders of quarantine for disease threats
• If non-compliant with voluntary agreement, or
• If such order is necessary to control the disease
• Letters for EVD-related voluntary quarantine and orders
for the two mandatory quarantine scenarios have been
drafted
24
Quarantine (continued)
• For persons under order:
• law enforcement help with delivery
• least restrictive setting (home quarantine wherever
possible)
• daily monitoring for compliance
• assurance that essential needs are met
• will require support and leadership from local
jurisdiction, particularly local DSS.
• Ex parte court review required and person has right to
challenge the order
25
III. If Virginia resident is exposed to a
case in another state
• Once VDH receives such notification, efforts will begin
immediately to locate the exposed person(s)
• Once located, the person will be asked about exposures
and any symptoms of illness
• if well and exposure confirmed,
• VDH will actively monitor symptoms daily
• determine need for Order of Quarantine
• if ill, VDH will take actions as previously described
• isolation and testing of patient, assurance of protection of
healthcare workers, identification of contacts, interviewing and
monitoring health of contacts, providing recommendations for
disease control
26
State Health Commissioner Actions
• Maintain full situational awareness at local, state,
national and international levels.
• Inform and regularly update public, healthcare
community, legislators and Executive Branch leadership
about significant events/developments
• Promote hygienic practices and influenza
vaccination
• Evaluate each potential EVD case/contact as a
Communicable Disease of Public Health Threat
• Determine need for individual orders of isolation or
quarantine
27
Commissioner (continued)
Coordinate efforts with neighboring jurisdictions
Direct agency resources to meet local needs
Identify need for interagency assistance
Declare Public Health Emergency if situation warrants
enhanced awareness and communication
• Request Governor declaration of emergency if an
affected area needed to be isolated or quarantined
•
•
•
•
28
Other Issues Addressed to Date
•
•
•
•
•
•
•
•
29
Laboratory testing and transportation of samples
Personal protective equipment (PPE) stockpile
Emergency medical services’ transportation of patients
Medical waste disposition
Fatality management
Healthcare coalition preparedness and response
Decontamination of a home
Planning for a call center
Summary
Ebola is a very serious disease that has not been
diagnosed in humans in Virginia before
VDH and our health care partners are as ready to respond
as we can be today
• Our staff are trained and capable in the necessary
core public health services
• We will continue learning and sharing as new
information is obtained
We will assure effective communication within our
organization, to Executive Branch leadership, with our
partners across the state and in other states and with
the public
30
Resources
VDH Home Page
• http://www.vdh.virginia.gov/
VDH Ebola Information for Healthcare Providers and
Facilities
• http://www.vdh.virginia.gov/epidemiology/ebola/index.htm
VDH FAQs
• http://www.vdh.virginia.gov/news/pdf/Ebola%20FAQ.pdf
CDC Ebola Information
• http://www.cdc.gov/vhf/ebola/
31
32
High risk exposures
Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or
body fluids of EVD patient
Direct skin contact with, or exposure to blood or body fluids of, an EVD
patient without appropriate personal protective equipment (PPE)
Processing blood or body fluids of a confirmed EVD patient without
appropriate PPE or standard biosafety precautions
Direct contact with a dead body without appropriate PPE in a country where
an EVD outbreak is occurring
Low risk/some risk exposures
Household contact with an EVD patient
Other close contact with EVD patients in health care facilities or community
settings. Close contact is defined as
• being within approximately 3 feet (1 meter) of an EVD patient or
within the patient’s room or care area for a prolonged period of time
(e.g., health care personnel, household members) while not wearing
recommended PPE for standard, droplet, and contact precautions
• having direct brief contact (e.g., shaking hands) with an EVD patient
while not wearing recommended PPE
33