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Health Notice for District of Columbia Health Care Providers

Updates on Zika Virus Disease and Testing

SUMMARY

To date, there have been 36 cases of laboratory-confirmed Zika virus disease (ZVD) in the District of Columbia (DC), all of which have been travel-associated or sexually transmitted. As of August 23, 2017, states had reported a total of 5,423 cases of ZVD to the Centers for Disease Control and Prevention (CDC). Of these, 5,150 were travel-associated, 224 were locally acquired mosquito-borne cases, 47 were sexually transmitted, 1 was laboratory acquired, and 1 was person-to-person through an unknown route.  Locally acquired mosquito-borne transmission in the United States has only been documented in Florida and Texas. In DC, ZVD spread by local mosquitoes or through the use of blood or tissue products (e.g., blood transfusion, sperm donation) has not been reported.

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Complications of “chronic Lyme disease" reported

Cases have reported in which treatment for "chronic Lyme disease" resulted in the development of septic shock, osteomyelitis, Clostridium difficile colitis, or paraspinal abscess. [Marzec NS and others. Serious bacterial infections acquired during treatment of patients given a diagnosis of chronic Lyme disease—United States. MMWR 66:607-609, 2017]  "Chronic Lyme disease" is not a valid diagnostic entity. Lyme disease infections are usually cured by 2 to 4 weeks of antibiotic treatment. However, a small network of physicians and their patients have been barraging the public with claims that thousands of people being maimed, killed, and bankrupted each year by chronic Lyme disease. They incorrectly assert that Lyme is a deadly, chronic disease that requires long-term antibiotic therapy even though clinical trial evidence shows no advantage over placebo treatment. [Melia TM, Auwaerter PG. Time for a different approach to Lyme disease and long-term symptoms. New England Journal of Medicine 374:1277-1278, 2016]

(from Dr. Barrett's Quackwatch newsletter)

Two more: )
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From Medscape Internal Medicine

NDM-1 -- Making Resistant Bugs in New Ways

Carol Peckham

Posted: 09/13/2010

Introduction

A report in Lancet Infectious Disease has described the New Delhi metallo-beta-lactamase 1 (NDM-1), a unique genetic mechanism identified in India, Pakistan, and the United Kingdom that has produced antibiotic-resistant gram-negative Enterobacteriaceae. [1] The strain was identified by the Centers for Disease Control and Prevention (CDC) in 3 isolates in the United States. To determine what threat this might pose, Medscape interviewed Alex Kallen, MD, and Brandi M. Limbago, PhD, both in the Division of Healthcare Quality Promotion, who provided perspective from Centers for Disease Control and Prevention (CDC). Alex Kallen, MD, is a Medical Officer and Brandi M. Limbago, PhD, is Lead of the Antimicrobial Resistance and Characterization Laboratory at the CDC.

The Interview

 

Read the interview transcript: )
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  • Pa. hospital patient is found to have rare staph infection
    A patient at Pennsylvania Hospital has been found to have the vancomycin-resistant Staphylococcus aureus, a rare form of staph infection possibly caused by the overuse of the antibiotic vancomycin. The VRSA case is the first reported since 2007, according to CDC data. Eleven VRSA infection cases have so far been reported nationally. The Philadelphia Inquirer (4/7)
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CDC H1N1 Flu Website Situation Update, April 2, 2010 

Key Flu Indicators

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of March 21-27, 2010, nationally most key flu indicators remained about the same as during the previous week; however, increasing activity has been reported in certain areas. Below is a summary of the most recent key indicators:

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Continued H1N1 in Southeast is cause for concern, CDC says
CDC officials said continuing H1N1 influenza cases in the Southeast, especially in Georgia, may indicate a third wave of the flu and urged people to get vaccinated. H1N1 activity is low in most of the country, but flu-related hospitalizations in Georgia have been higher since February than they were last October during the second wave of the flu. Los Angeles Times/Booster Shots blog (3/29)
med_cat: (progress notes notebook)

CDC H1N1 Flu Website Situation Update, March 27, 2010

Key Flu Indicators

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of March 14-20, 2010, nationally most key flu indicators remained about the same as during the previous week, however, increasing activity has been reported in certain areas. Below is a summary of the most recent key indicators:

  • Visits to doctors for influenza-like illness (ILI) remained stable and relatively low nationally. However, ILI is also looked at by region, and three of 10 U.S. regions reported elevated ILI for the week ending March 20. Elevated ILI was seen in Regions 4, 7 and 9. Region 4 is comprised of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. Region 7 is Iowa, Kansas, Missouri and Nebraska. And Region 9 is Arizona, California, Hawaii and Nevada. (Last week, only region 4 had elevated ILI.)
  • Laboratory-confirmed hospitalizations rates have leveled off and very few hospitalizations were reported by states during the week ending March 20, however some states in the Southeast are reporting recent increases in the number of flu-related hospitalizations.
    • The majority of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. Some influenza B viruses are circulating at low levels, and these viruses remain similar to the influenza B virus component of the 2009-10 seasonal flu vaccine.

Good news?

Dec. 8th, 2009 03:42 pm
med_cat: (progress notes notebook)
New calculations project H1N1 flu to be less severe than thought
U.S. and British researchers have come up with new estimates on the severity of the H1N1 flu pandemic. Their projection at the low end places deaths at 1,500 to 2,700, intensive care admissions at 6,600 to 11,000 and hospitalizations at 36,000 to 78,000 for every 10% of the population that show flu symptoms. The high-end scenario could see 7,800 to 29,000 deaths, 40,000 to 140,000 intensive care admissions and 250,000 to 790,000 hospitalizations for every 10% of the population with flu symptoms, according to the estimate. USA TODAY (12/7)

U.S. cancer diagnoses, mortality rates steadily decline
A report in the journal Cancer found cancer diagnosis rates for most all gender and ethnic groups in the U.S. dropped by an average of 1% per year from 1999 to 2006. Mortality rates also declined, mainly for common cancers such as lung, prostate and colorectal in men and breast and colorectal cancers in women. CNN (12/8)
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CDC: Few Serious Reactions After Swine Flu Vaccine

Chances of Neurological Disorder Seen in 1976 "Vanishingly Remote"
By Cathryn Meurer
WebMD Health News
Reviewed by Louise Chang, MD
Dec. 4, 2009 - Serious reactions after receiving the H1N1 swine flu vaccine are rare and not significantly higher than those seen from the seasonal flu vaccine, according to a briefing at the CDC today.

Director Thomas Frieden, MD, MPH, presented preliminary safety data and confidence that the H1N1 vaccine will not be dogged by Guillain-Barre syndrome, the neurological disorder that was associated with the 1976 swine flu vaccine.

“The likelihood that we’ll have a 1976-like problem with this year’s H1N1 influenza vaccine is vanishingly remote,” said Frieden.
H1N1 flu cases fell off somewhat during the Thanksgiving week, with widespread activity reported in 25 states, a drop from 32 states in the previous week. Still, 17 children died last week of laboratory-confirmed H1N1 flu, bringing the number of child deaths to 210. That’s three times the number of flu deaths expected in children at this point in a normal flu season.
“This virus is a much worse virus for younger people. The number of people, not just children, but young adults under age 50 who will get severely ill or die from this virus is much higher than it is from seasonal flu," said Frieden.
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H1N1 flu activity in the U.S. may be on downward trend
Health officials say the second wave of the H1N1 flu in the U.S. may have reached its peak after cases of the flu continued to drop over the past four weeks. However, there is a possibility of "another uptick of activity late this year or early next year" similar to what happened during the 1957 flu pandemic, said Thomas Skinner, spokesman for the CDC. The Washington Post (12/1)

H1N1 slowdown provides "window" for more people to get vaccinated
U.S. health officials said the reported slowing in the spread of H1N1 flu cases in the country will give people more time to get vaccinated. Despite the recent drop in H1N1 flu cases, experts said the flu virus is "unpredictable" and a new surge in cases still could occur. Yahoo!/Agence France-Presse (12/1)
med_cat: (progress notes notebook)
CDC estimates 4,000 U.S. deaths from H1N1 flu since April
Calculations by CDC epidemiologists put the number of U.S. deaths from H1N1 flu since April at 4,000, higher than the earlier 1,200 count. The higher figure was based on the number of deaths from laboratory-confirmed cases of flu, as well as deaths that seemed to be caused by the flu. The New York Times (11/10)

Google introduces Web-based locator of flu vaccines
Google has rolled out a flu vaccine finder service at google.com/flushot, which is designed to locate facilities that offer H1N1 and seasonal flu shots. "Given slower than expected vaccine production, we think it's important to bring together flu shot information in a coherent manner," said Roni Zeiger and Jennifer Haroon of Google. Yahoo!/Agence France-Presse (11/10)

Flu news

Oct. 31st, 2009 05:40 pm
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U.S. sees 10 million more H1N1 vaccine doses next week

Sat Oct 31, 2009 2:37pm EDT

WASHINGTON (Reuters) - Five drug companies are now increasing production of the vaccine for the H1N1 swine flu, and 10 million more doses are expected next week, Health and Human Services Secretary Kathleen Sebelius said on Saturday.

President Barack Obama on Friday expressed frustration about the slow pace of production of the vaccine, which has resulted in just 26.6 million doses as of Friday, far below earlier estimates of 40 million by the end of October.

Sebelius said those initial estimates were based on "overly optimistic" predictions by the five contracted vaccine makers for the U.S. market -- MedImmune, a unit of AstraZeneca, Sanofi-Aventis, Australia's CSL, GlaxoSmithKline and Novartis.

But production was now increasing and vaccine doses were being shipped seven days a week, Sebelius told CNN.

"The good news is that we have, as of yesterday, 26.6 million doses out and around the country. We are expecting another 10 million doses next week," Sebelius said. "So the vaccine is beginning to roll in larger volumes. And it's being distributed as quickly as it comes off the line."

 

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President Obama signed a proclamation declaring the H1N1 influenza a national emergency, giving doctors and medical facilities greater leeway in responding to the flu pandemic.

Obama signed the declaration late Friday, which the White House said allows medical treatment facilities to better handle a surge in flu patients by waiving federal requirements on a case-by-case basis.

"The foundation of our national approach to the H1N1 flu has been preparedness at all levels -- personal, business, and government -- and this proclamation helps that effort by advancing our overall response capability," the White House said in a statement.

The flu has infected millions of Americans and killed nearly 100 children in the U.S. The chief of the Centers for Disease Control and Prevention said Friday that over a thousand people have died as a result, with 46 states reporting widespread H1N1 activity.

"Since the beginning of the pandemic, we've seen more than 1,000 deaths and 20,000 hospitalizations," said Dr. Thomas Frieden, head of the CDC. "We expect it to occur in waves, but we can't predict when those waves will happen."

Sixty million Americans have been vaccinated against the seasonal flu this year, but an additional vaccine against H1N1 has been in short supply. About 120 million doses were expected to be made available by the middle of October, though only 11 million doses have been shipped to health departments for use.

med_cat: (progress notes notebook)
Production of H1N1 flu vaccine fails to meet promised pace
Only 13 million of the 120 million doses of H1N1 flu vaccine that the federal government said would be available by mid-October have been delivered. Health officials attribute the delay to the heavy burden placed on drug companies to produce vaccines for H1N1 as well as the seasonal flu, and the slowness and unreliability of the chicken-egg method used to produce the vaccines. Google/The Associated Press (10/21)

H1N1 cases spread from children to other age groups
H1N1 cases are spreading from schoolchildren to the rest of the U.S. population, according to an analysis by Quest Diagnostics, which makes a test to confirm an H1N1 flu diagnosis. While children ages 5 to 14 have had higher overall rates of H1N1 cases, with a sharp increase seen in late August and early September, the U.S. now is seeing delayed by several weeks an increase in cases among the elderly, people ages 50 to 64 and children under 5. Reuters (10/21)
med_cat: (progress notes notebook)
CDC: Most hospitalized H1N1 patients under age 25
CDC officials said that slightly more than half of the people sick enough to be hospitalized with the H1N1 flu virus are under age 25, which is very different from the seasonal flu, in which the elderly account for about 60% of hospitalizations. The CDC report also showed that 23.6% of H1N1 deaths are in people younger than 25. ABC News/Reuters (10/20)
med_cat: (progress notes notebook)

Swine flu vaccine deliveries run late

With demand far outstripping supply, state cancels clinics

Swine flu vaccine shipments to Massachusetts are running three weeks behind schedule, forcing the state to direct local health departments to cancel vaccine clinics scheduled for next month.

At the same time, shortages of the vaccine against seasonal flu strains are also being reported, as unusually high demand is outpacing the supply. Communities from Scituate to Somerville and Cambridge said they were postponing vaccine clinics aimed at protecting the public against both types of the flu.

The problems seen in Massachusetts reflect a nationwide shortage, as production facilities - pressed to make two types of vaccine at once - have been unable to churn out adequate amounts of either one.

med_cat: (progress notes notebook)
CDC officials said the H1N1 vaccine will be in short supply for the next couple of weeks because of production delays. Data showed H1N1 is widespread in 41 states, with 6% of physician visits being for flu symptoms, a rate not normally seen this early in the fall. The virus continues to hit children hard, with 11 deaths reported in the past week, health officials said. Yahoo!/The Associated Press (10/17)
med_cat: (progress notes notebook)

Key Flu Indicators

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of October 4-10, 2009, a review of the key indicators found that influenza activity continued to increase in the United States from the previous week. Below is a summary of the most recent key indicators:

  • Visits to doctors for influenza-like illness (ILI) continued to increase in the United States, and overall, are higher than what is expected for this time of the year. ILI activity now is equal to or higher than what is seen at the peak of many regular flu seasons.
  • Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and exceeds what is normally expected at this time of year. In addition, 11 flu-related pediatric deaths were reported this week; 10 of these deaths were confirmed 2009 H1N1, and one was influenza A virus, but unsubtyped. Since April 2009, there have been 86 confirmed pediatric 2009 H1N1 deaths; 39 of these have been reported to CDC since August 30, 2009.
  • Forty-one states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu.
  • Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Flu news

Oct. 17th, 2009 05:06 pm
med_cat: (Basil scientist)

More can be found at flu.gov
Cat

Flu Myths and Realities

“The federal government is running a mandatory vaccination campaign.”

The federal government’s vaccination program for H1N1 flu is VOLUNTARY.  Some hospitals and localities are requiring that health care workers get vaccinated for the flu, but that is a local decision.   HHS and the CDC have included health care workers as one of our top priority groups to receive the vaccine, and several places across the country began offering H1N1 vaccination to health care workers this week.

The petition on a few selected internet sites protesting the federal government’s “mandatory” vaccination campaign is simply false in its claims. Vaccination is highly recommended as a protective measure against the flu, but is absolutely voluntary.

 

 

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A CDC study on 1,400 adults and 500 children hospitalized with the H1N1 flu across 10 states showed that 55% of the patients who died from the flu had other medical conditions and most were younger than 65 years old. Asthma, immunosuppression, chronic lung disease and chronic heart disease were the most common underlying conditions among adults, while children had asthma, chronic lung diseases, neurological or neuromuscular diseases, and sickle cell or other blood conditions. Reuters (10/13)

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