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 Virginia Persons ≥ 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 Source: CDC’s FluVaxView, http://www.cdc.gov/flu/fluvaxview/ 59% of Virginia women who delivered during 2010- 2011 flu season had received flu vaccine (CDC, PRAMS)

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

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?