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Health Alerts

The Snohomish Health District Health Officer Dr. Gary Goldbaum sends alerts via email to local health care providers. Alerts cover current local, regional or national health threats and important updates on medical care and protocols. Alerts are written as needed to cover urgent or emergent health issues.

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Measles & Influenza & Ebola virus disease (EVD) & Vaccination educational program

Today’s topics:

  • Measles
  • Influenza
  • Ebola virus disease
  • Vaccination educational program

 

Measles

Action requested: Be aware that many Snohomish County residents may have been exposed to measles recently.  Urge anyone who may be susceptible to get vaccinated now.

Background & Recommendations

An unvaccinated young adult was diagnosed with measles following travel to Snohomish County.  The case developed symptoms on 12/28/2014 and rash onset on 01/01/2015.  During the infectious period (12/28/2014 to 01/05/2015), the case traveled from and then back to California, but was mostly bedbound while in Snohomish County.  However, the case dined at Anthony’s Home Port in Edmonds on 12/30/2014, posing a risk to others who were at the restaurant from 7:30 PM to midnight.  A media release is forthcoming.

Providers should be vigilant for possible measles and should strongly encourage anyone who has not been vaccinated to do so now.  Note that children and adolescents should have two doses of MMR vaccine; adults born after 1956 who do not have evidence of immunity should get at least one dose.  For details on vaccination and disease management, see http://www.cdc.gov/measles/hcp/index.html.

 

Influenza

Action requested: Continue to vaccinate against and initiate early treatment for influenza.  Be aware of new tools to diagnose and treat influenza.

Background & Recommendations

Influenza has reached the epidemic threshold nationally and locally.  Demand on local clinics and emergency departments is high.  As of January 3rd, 62 Snohomish County residents have been hospitalized for influenza this season; two have died.  The predominant A(H3N2) strain is especially severe for older adults and the current vaccine appears not to provide full protection against this strain.  Nonetheless, vaccination remains our best strategy to limit spread and reduce complications.

All circulating influenza viruses have been susceptible to the neuraminidase inhibitor antiviral medications.  In addition to oseltamivir and zanamivir, the Food & Drug Administration (FDA) just approved a new neuraminidase inhibitor, peramivir (Rapivab, administered as a single intravenous use—see the FDA press release at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm427755.htm).  Treatment with these medications is worth considering to reduce complications.  For detailed guidance on the use of oseltamivir and zanamivir, see http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#modalIdString_CDCTable_0.  (Note that this site is being updated to include use of peramivir.)

The FDA has also just granted a CLIA waiver to allow a rapid nucleic acid-based test, the Alere i Influenza A & B test, to be used in physicians’ offices, emergency rooms, health department clinics, and other health care facilities. The test was previously only available for use in certain laboratories (see the FDA press release at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm429127.htm?utm_source=01%2F09%2F2015%3A+New+Tools+for+a+Harsh+Flu+Season&utm_campaign=ptyson%40upmc.edu&utm_medium=email).  Although this test appears to be more sensitive and specific than previous rapid tests, it remains expensive and likely most useful when clinical management will be affected.  When clinical suspicion and potential for complications are high, treatment should not be delayed until test results are available.  Treatment is most effective if initiated within 48 hours of symptom onset, but may be beneficial for some patients up to 5 days after symptom onset.

For more details about influenza management, see http://emergency.cdc.gov/han/han00375.asp.

 

Ebola Virus Disease (EVD)

Action requested: Contact public health before referring suspected cases of EVD to an assessment hospital.

Background

Three Washington hospitals have been designated as Ebola treatment facilities: Harborview Medical Center (Seattle), Seattle Children’s Hospital, and Providence Sacred Heart Medical Center & Children's Hospital (Spokane).  Treatment facilities will manage the care of persons with confirmed EVD.  Other hospitals, including Providence Regional Medical Center Everett (PRMCE), have been identified as assessment facilities.  Assessment facilities are prepared to care for persons with suspected EVD, pending confirmation of EVD.  All other hospitals and clinics are frontline facilities that should be prepared to hold a person with suspected EVD until transport can be arranged to an assessment facility.

Recommendations

  1. If EVD is suspected, immediately isolate the patient.
  2. Call the Health District at 425-339-5278.
  3. If the Health District determines that the patient should be transported to PRMCE, then the provider should call 911 to arrange transport.  If the Health District determines that the patient should be transported to another hospital, then the Health District will notify the appropriate hospital and arrange transport.

 

Vaccination Educational Program

Action requested: Consider attending an educational update about vaccines generally & pertussis specifically.

Background & Recommendations

Sanofi Pasteur is sponsoring a free educational program (“A Timely Combination Vaccination for Infants and Toddlers & An Update on Strategies in Pertussis Prevention”) at 6:30 p.m. on Thursday, January 15, 2015, at the Tulalip Resort Casino Hotel (10200 Quil Ceda Blvd, Tulalip, WA 98271). James Cherry, MD (Attending Physician at Mattel Children’s Hospital at UCLA and Professor of Pediatrics at David Geffen School of Medicine at UCLA) will discuss:

  • Current recommended dosing schedules for pediatric vaccines
  • Epidemiology of pertussis and invasive Haemophilus influenza type b disease
  • Current recommendations for use of Tdap vaccines
  • Strategies for improving Tdap vaccination coverage

RSVP to Nick Fisher at nick.fisher@sanofipasteur.com by January 12, 2015.

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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.