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#Update: Interim #Guidance for the #Evaluation and #Management of #Infants with Possible Congenital #Zika Virus #Infection — #USA, August 2016 (CDCgov, MMWR)

  Title : #Update: Interim #Guidance for the #Evaluation and #Management of #Infants with Possible Congenital #Zika Virus #Infection — #USA...

26 Aug 2016

Influx of #Fentanyl-laced #Counterfeit #Pills and #Toxic Fentanyl-related Compounds Further Increases #Risk of Fentanyl-related #Overdose and #Fatalities (@CDCgov, HAN)

 

Title: Influx of #Fentanyl-laced #Counterfeit #Pills and #Toxic Fentanyl-related Compounds Further Increases #Risk of Fentanyl-related #Overdose and #Fatalities.

Subject: Illicit and Counterfeit drugs overdose risk.

Source: US Centers for Disease Control and Prevention (CDC), Health Alert Network (HAN), full page: (LINK).

Code: [ ]

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Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds Further Increases Risk of Fentanyl-related Overdose and Fatalities

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Health Alert Network logo.

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This is an official HEALTH UPDATE

Distributed via the CDC Health Alert Network / August 25, 2016, 15:15 ET (3:15 PM ET) / CDCHAN-00395

 

Summary

  • On October 26, 2015, CDC issued HAN 384 (http://emergency.cdc.gov/han/han00384.asp) that alerted:
    • (1) public health departments, health care professionals, first responders, and medical examiners and coroners of the increase in fentanyl-related unintentional overdose fatalities in multiple states primarily driven by illicitly manufactured fentanyl (IMF) (i.e., non-pharmaceutical fentanyl);
    • (2) provided recommendations for improving detection of fentanyl-related overdose outbreaks; and
    • (3) encouraged states to expand access to naloxone and training for administering naloxone to reduce opioid overdose deaths.
  • The purpose of this HAN update is to alert public health departments, health care professionals, first responders, and medical examiners and coroners to new developments that have placed more people at risk for fentanyl-involved overdoses from IMF and may increase the risk of non-fatal and fatal overdose.
  • These developments include the following:
    • (1) a sharp increase in the availability of counterfeit pills containing varying amounts of fentanyl and fentanyl-related compounds (e.g., labeled as Oxycodone, Xanax, and Norco),
    • (2) the potential for counterfeit pills containing fentanyl and fentanyl-related compounds to be broadly distributed across the United States which could impact states not previously impacted by IMF and persons using diverted prescription pills (i.e., licit drugs diverted for illicit purposes and involves the diversion of drugs from legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary)[1],
    • (3) the widening array of toxic fentanyl-related compounds being mixed with heroin or sold as heroin, including extremely toxic analogs such as carfentanil, and
    • (4) continued increases in the supply and distribution of IMF (http://www.cdc.gov/drugoverdose/data/fentanyl-le-reports.html).

 

Background

  • In July 2016, the Drug Enforcement Administration (DEA) issued a nationwide report indicating that hundreds of thousands of counterfeit pills have been entering the U.S. drug market since 2014, some containing deadly amounts of fentanyl and fentanyl analogs [2].
  • Traditionally, fentanyl and fentanyl analogs in the illicit market have been mixed into heroin or sold as heroin, often without the knowledge of the consumer, and have primarily impacted areas where white powder heroin is prevalent, including the Northeast, Midwest, and Southeast regions of the United States.
  • The influx of counterfeit pills, which closely resemble oxycodone [2,3], Xanax [3], and Norco [4,5], has increased the chance of fentanyl-involved overdoses among persons misusing prescription opioids or benzodiazepines who seek diverted medications on the illicit market [2], in addition to persons who inject, sniff, or snort drugs.
  • Persons who misuse prescription pills are geographically widespread; thus, the potential risk for fentanyl overdose has spread beyond those regions previously known to be impacted by IMF, and could intensify the impact in regions already affected by IMF.
  • The supply, distribution, and potency of illicitly manufactured fentanyl and fentanyl-related compounds in the U.S. drug market is evolving.
  • Carfentanil, an extremely potent fentanyl analog, has been detected in at least one state [6,7] and is currently being investigated as a possibility in a few other locations [8].
  • Designed in 1974, carfentanil was previously used exclusively for veterinary use with large animals and is not approved for use in humans, as it has been shown to be 100 times more potent than fentanyl in animal studies.
  • Other fentanyl-related compounds have been reported by the DEA National Forensic Laboratory Information System (NFLIS), which systematically collects drug identification results from drug cases submitted for analysis to forensic laboratories (referred to as drug submissions).
  • From 2014 to 2015 the number of drug submissions testing positive for acetyl fentanyl increased substantially, rising from 463 in 2014 to 1,870 in 2015[9,10,11], and in 2016, NFLIS reported increasing drug submissions testing positive for furanyl fentanyl (244 drug submissions from January to July 2016) [9].
  • States should be vigilant about the possibility of highly toxic fentanyl-related compounds becoming available in the illicit drug market, as well as other highly toxic synthetic opioid derivatives, such as U47700 [2,12].
  • NFLIS has reported that the overall supply of illicitly manufactured fentanyl appears to have substantially increased from 2014 to 2015, with the number of drug submissions testing positive for illicitly manufactured fentanyl doubling during this period (from 5,343 to 13,882).
  • The number of states reporting more than 100 fentanyl submissions also increased during this period from 11 to 15 (http://www.cdc.gov/drugoverdose/data/fentanyl-le-reports.html [9]).
  • Recently, according to NFLIS and National Seizure System (NSS) reports, the amount of fentanyl seized in the United States has nearly doubled; from October 2014 to September 2015, federal, state, and local law enforcement agencies seized a total of 167.7 kilograms of fentanyl, and through June, 2016, they seized 363.8 kilograms of fentanyl [9].

 

Recommendations

CDC suggests the following actions in response to the increased risk of fentanyl overdose from IMF due to the influx of fentanyl-laced counterfeit pills, the widening array of highly toxic fentanyl-related compounds, and the continued expansion and geographic spread of the IMF supply:

  1. Improve detection of fentanyl outbreaks to facilitate effective response.
  • Public health departments:
    • Explore methods for rapidly identifying drug overdose outbreaks through use of existing surveillance systems such as medical examiner data, emergency medical services data, near-real time emergency department data, and poison center data [13].
    • Consider engaging local poison centers to assist with treatment of patients (toll free phone number is 800- 222-1222).
    • Track and monitor geographic trends in fentanyl and heroin supply using DEA's National Forensic Laboratory Information System (NFLIS) reports (see NFLIS Report http://www.deadiversion.usdoj.gov/nflis/spec_rpt_opioids_2014.pdf). National Heroin Threat Assessment Summaries (see NHTA Summary https://www.dea.gov/divisions/hq/2016/hq062716_attach.pdf) and alerts on the DEA website [2] to inform prevention and response efforts.
    • Raise awareness among key partners and stakeholders to the widening profile of those at risk for fentanyl overdose, which increasingly includes persons misusing diverted prescribed oral pain and sedative medications [2].
    • Track decedent demographics and known risk factors (e.g., drug type, recent release from an institution, previous overdose) to inform prevention efforts [14].
    • Develop general public health messaging about fentanyl, including fentanyl-laced counterfeit pills and fentanyl-related compounds that emphasizes the toxicity and potential lethality of the drug versus its high "potency. The messaging should include warnings of the highly variable content of fentanyl present in illicit products, which further elevates risk of overdose [12,15].
  • Medical examiners and coroners:
    • Screen for fentanyl in suspected opioid overdose cases in regions reporting increases in fentanyl seizures, fentanyl-related overdose fatalities, or unusually high spikes in heroin or unspecified drug overdose fatalities.
    • Screen specimens using an ELISA test that can detect fentanyl. Confirmatory gas chromatography mass spectrometry (GC-MS) of positive screens for fentanyl may either confirm the presence of fentanyl or suggest the presence of a fentanyl analog. [16]. When fentanyl screening is negative, or confirmatory testing is inconclusive, yet opioid or fentanyl overdose is highly suspected, consider specialized testing for fentanyl analogs, particularly if an increase in overdoses is occurring.
  • Law Enforcement: Law enforcement plays an important role in identifying and responding to increases in the distribution and use of illicitly manufactured fentanyl.
    • Use extreme caution when handling suspected illicitly manufactured fentanyl, white powders, and unknown substances (see DEA warning https://www.dea.gov/divisions/hq/2016/hq061016.shtml). Use appropriate safety precautions and personal protective equipment (see NIOSH Emergency Response Card http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750022.html)
    • Prioritize and expedite laboratory testing of drug samples taken from drug overdose scenes, if possible.
    • Share data on fentanyl and fentanyl analog drug seizures with local health departments, medical examiners, and coroners.
    • Carry a supply of naloxone so that it can be administered immediately to mitigate the effects of the overdose. (See Recommendation 2 below.)
  • Laboratories: The following government forensic laboratories supporting law enforcement can provide assistance with reference materials or reference data on a case-by-case basis.
  1. Expand Use of Naloxone and Treatment
  • Health Care Providers:
    • Multiple dosages of naloxone may need to be administered per overdose event, because of fentanyl's increased potency relative to other opioids. Orally-ingested counterfeit pills laced with fentanyl may require prolonged dosing of naloxone in the ED/hospital setting due to a delayed toxicity that has been reported in some cases [15].
    • Facilitate access to Medication-Assisted Treatment (MAT). MAT is a comprehensive approach to addressing the needs of persons with opioid use disorders that combines the use of medication with counseling and behavioral therapies.  Providers should discuss treatment options with persons who have an opioid use disorder, and persons who have experienced an opioid-related overdose once they are stabilized.
  • Harm reduction organizations:
    • Expand naloxone access to persons at risk for opioid-related overdose and to their friends and family members [17].
    • Train those using drugs how to effectively administer naloxone and emphasize the importance of calling 911 immediately after recognition of an overdose, because naloxone that is available in the field may be insufficient to reverse the overdose.

For more information

 

References

  1. "Drug Diversion in the Medicaid Program: State Strategies for Reducing Prescription Drug Diversion in Medicaid," Centers for Medicare & Medicaid Services (Baltimore, MD: January 2012), p.1, https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrityProgram/downloads/drugdiversion.pdf
  2. Drug Enforcement Administration. Counterfeit pills fueling U.S. fentanyl and opioid crisis. July 22, 2016. https://www.dea.gov/divisions/hq/2016/hq072216.shtml
  3. Florida Department of Law Enforcement. Buyer beware - deadly super pill found in Central Florida. http://www.fdle.state.fl.us/cms/News/2016/April/Buyer-Beware-%E2%80%93-deadly-super-pill-found-in-Central.aspx
  4. Drug Overdose Health Alert. Counterfeit Norco containing fentanyl. http://www.dhhs.saccounty.net/PUB/Documents/AZ-Health-Info/ME-Fentanyl+Alert_20160401.pdf
  5. Vo KT, van Wijk XM, Lynch KL, Wu AH, Smollin CG. Counterfeit Norco poisoning outbreak - San Francisco Bay Area, California, March 25-April 5, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:420-423. DOI: http://dx.doi.org/10.15585/mmwr.mm6516e1
  6. Ohio Hamilton County Heroin Coalition: heroin adulterant creating deadly combination. http://www.hamiltoncountyhealth.org/files/files/Press%20Releases/Carfentanil_7_15_2016.pdf
  7. Medical Examiner Public Health Warning Deadly Carfentanil Has Been Detected in Cuyahoga County [news release]; Cuyahoga County Medical Examiner; August 17, 2016.http://executive.cuyahogacounty.us/en-US/ME-Public-Health-Warning.aspx
  8. Unpublished data, based on communications with DEA; August, 2016
  9. National Forensic Laboratory Information System. Data query; accessed August 15, 2016.
  10. NFLIS Special Report. Opiates and related drugs reported in NFLIS, 2009-2014, Revised February 2016. https://www.nflis.deadiversion.usdoj.gov/DesktopModules/ReportDownloads/Reports/NFLIS-SR-Opioids-Rev.pdf
  11. NFLIS 2015 Midyear Report. https://www.nflis.deadiversion.usdoj.gov/DesktopModules/ReportDownloads/Reports/NFLIS_MidYear2015.pdf
  12. Canadian Center on Substance Abuse Bulletin. Novel synthetic opioids in Counterfeit pharmaceuticals and other illicit street drugs. June 2016. http://www.ccsa.ca/Resource%20Library/CCSA-CCENDU-Novel-Synthetic-Opioids-Bulletin-2016-en.pdf
  13. Jones TS, Krzywicki L, Maginnis J, et al. Nonpharmaceutical fentanyl-related deaths-multiple states, April 2005-March 2007. MMWR Morb Mortal Wkly Rep [serial online]. July 26, 2008; 57(29):793-796. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a1.htm.
  14. Levy B. Undetermined risk factors associated with drug overdose deaths, New Mexico. February 2014 (Epi-Aid 2012-022).
  15. Sutter ME, Gerona R, Davis MT, et al. Fatal fentanyl: one pill can kill. Acad Emerg Med. [Epub ahead of print June 20, 2016] http://onlinelibrary.wiley.com/doi/10.1111/acem.13034/abstract
  16. Centers for Disease Control and Prevention. Recommendations for laboratory testing for acetyl fentanyl and patient evaluation and treatment for overdose for synthetic opioids. HAN Health Advisory. June 20, 2013. https://stacks.cdc.gov/view/cdc/25259
  17. Jones CM, Logan J, Gladden RM, Bohm MK. Vital signs: demographic and substance use trends among heroin users - United States, 2002-2013. MMWR Morb Mortal Wkly Rep 2015; 64(26); 719-725. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a3.htm

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Keywords: US CDC; USA; Updates; Drugs Safety.

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#USA, #Florida: Department of Health Daily #Zika #Update (August 25 2016)

 

Title: #USA, #Florida: Department of Health Daily #Zika #Update.

Subject: Zika Virus, US State of Florida daily epidemiological update.

Source: US State of Florida Department of Health, full page: (LINK).

Code: [     ]

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Department of Health Daily Zika Update

By Florida Department of Health, Office of Communications / August 25, 2016 / Press Release / Contact: Communications Office, NewsMedia@flhealth.gov - (850) 245-4111

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Tallahassee, Fla.

In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus,  the department will issue a Zika virus update each week day. Updates will include a Zika case count by county and information to keep Floridians informed and prepared.

There are 11 new travel related cases today, three in Miami-Dade, two in Alachua, two in Orange, one in Duval, one in Monroe, one in Osceola and one in Polk.

Please visit our website to see the full list of travel-related cases.

 

Number of Zika cases by county

[County - Number of Cases (all travel related)]

  1. Alachua – 8
  2. Bay – 3
  3. Brevard – 12
  4. Broward – 93
  5. Charlotte – 1
  6. Citrus – 2
  7. Clay – 3
  8. Collier – 5
  9. Duval – 8
  10. Escambia – 2
  11. Hernando – 4
  12. Highlands – 1
  13. Hillsborough – 15
  14. Lake – 3
  15. Lee – 8
  16. Leon – 2
  17. Manatee – 3
  18. Marion – 2
  19. Martin – 2
  20. Miami-Dade – 159
  21. Monroe – 2
  22. Okaloosa – 2
  23. Okeechobee – 1
  24. Orange – 63
  25. Osceola – 24
  26. Palm Beach – 30
  27. Pasco – 7
  28. Pinellas – 13
  29. Polk – 20
  30. Santa Rosa – 1
  31. Sarasota – 1
  32. Seminole – 18
  33. St. Johns – 3
  34. St. Lucie – 5
  35. Volusia – 8
  • Total cases not involving pregnant women – 534
    • Cases involving pregnant women regardless of symptoms – 70

Data as of Aug. 25, 2016 - 3:55pm EST

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There are no new non-travel related cases today.

DOH continues door-to-door outreach and targeted testing in Pinellas, Palm Beach and Miami-Dade counties and mosquito abatement and reduction activities are also taking place around the locations that are being investigated.

DOH believes ongoing transmission is only taking place within the small identified areas in Wynwood and Miami Beach in Miami-Dade County, see maps below.

One case does not mean ongoing active transmission is taking place. DOH conducts a thorough investigation by sampling close contacts and community members around each case to determine if additional people are infected. If DOH finds evidence that active transmission is occurring in an area, the media and the public will be notified.

For a complete breakdown of non-travel and travel-related Zika infections to-date, please see below.

 

[Infection Type - Infection Count]

  • Travel-Related   Infections of Zika - 534
  • Non-Travel   Related Infections of Zika - 43
  • Infections   Involving Pregnant Women70

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The department is currently conducting 10 investigations. Information regarding the investigations can be found here. If investigations reveal additional areas of active transmission, the department will announce a defined area of concern.

 

Active Investigations

The department is currently conducting 10 active investigations.

  1. Identified one-square mile in Miami-Dade – Two (2) original cases
    • [Total # of Samples Collected - Negative Samples - Positive Samples - Pending Results]
      • 519 – 492 – 270
    • Door to door outreach and sampling continue.
    • Mosquito abatement and reduction activities are on-going.
    • The department has cleared three portions within the one-square mile as no additional people tested positive in those areas. The CDC continues to monitor the area per their guidelines.
  2. First Miami-Dade investigation outside of Wynwood: One (1) case
    • [Total # of Samples Collected - Negative Samples  Positive Samples - Pending Results*]
      • 21 – 21 – 00
    • *Awaiting confirmatory testing from CDC to rule out infection.
  3. One (1) case in Palm Beach County:
    • [Total # of Samples Collected - Negative Samples - Positive Samples - Pending Results]
      • 3 – 3 – 00
  4. Second Miami-Dade investigation outside of Wynwood: One (1) case
    • The investigation is beginning in this area in Miami-Dade County.
    • Mosquito abatement and reduction activities will take place around the area of interest.
  5. Third Miami-Dade investigation outside of Wynwood: One (1) case
    • [Total # of Samples Collected - Negative Samples - Positive Samples - Pending Results]
      • 6 – 1 – 05
  6. Fourth Miami-Dade investigation outside of Wynwood: One (1) case
    • [Total # of Samples Collected - Negative Samples - Positive Samples - Pending Results]
      • 27 – 24 – 03
  7. Sixth Miami-Dade investigation outside of Wynwood: One (1) case
    • The investigation is beginning in this area in Miami-Dade County.
    • Mosquito abatement and reduction activities will take place around the area of interest
  8. Miami-Beach Investigation: Five index cases, 3 are out of state
    • The investigation is beginning in this area in Miami-Dade County.
    • Mosquito abatement and reduction activities will take place around the area of interest
    • [Total # of Samples Collected - Negative Samples - Positive Samples - Pending Results]
      • 97 – 0 – 097
  9. Pinellas Investigation: One (1) case
    • [Total # of Samples Collected - Negative Samples - Positive Samples - Pending Results]
      • 3 – 0 – 0 – 3
  10. Second Palm Beach County Investigation: One (1) case
    • The investigation is beginning in Palm Beach County.
    • Mosquito abatement and reduction activities will take place around the area of interest.

 

CLOSED INVESTIGATIONS

  • The department has closed out the investigations into the first cases in Miami-Dade and Broward County (two cases).
  • On Aug. 23, the department had enough information to close two of the ongoing investigations in Miami-Dade County, both were determined to be single cases with no additional transmission or linkage to areas of active transmission.

Data as of Aug. 25, 2016 - 6:15pm EST

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The department has conducted Zika virus testing for more than 4,020 people statewide. Florida currently has the capacity to test 6,381 people for active Zika virus and 3,124 for Zika antibodies. At Governor Scott’s direction, all county health departments now offer free Zika risk assessment and testing to pregnant women.

(…)

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Keywords: USA; Updates; Zika Virus; Florida.

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25 Aug 2016

#CTV #News #Team on the #ground in #Amatrice, #Italy, where an #earthquake took many lives (August 25 2016)

 

Title: #CTV #News #Team on the #ground in #Amatrice, #Italy, where an #earthquake took many lives.

Subject: Italy, earthquake with mass casualties.

Source: CTV, full page: (LINK). via Instagram.

Code: [  ! 

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Keywords: Italy; Earthquakes; Mass Casualty Events.

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#Zika #situation #report, 25 August 2016 (@WHO, summary)

 

Title: #Zika #situation #report, 25 August 2016.

Subject: Zika Virus, weekly global epidemiological update.

Source: World Health Organization (WHO), full page: (LINK). Summary.

Code: [     ]

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Zika situation report, 25 August 2016

Zika virus, Microcephaly and Guillain-Barré syndrome:  |-- Read the full situation report |--

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Key updates

  • Countries and territories reporting mosquito-borne Zika virus infections for the first time in the past week:
    • None
  • Countries and territories reporting microcephaly and other central nervous system (CNS) malformations potentially associated with Zika virus infection for the first time in the past week:
    • Costa Rica, Dominican Republic and Haiti
  • Countries and territories reporting Guillain-Barré syndrome (GBS) cases associated with Zika virus infection for the first time in the past week:
    • None
  • The 2016 Summer Olympics held in Rio de Janeiro ended on 21 August.
    • From the reports WHO received from national health authorities, there have so far been no laboratory confirmed cases of Zika virus in anyone associated with the Olympics.
  • Operational measures updates from the WHO Regional Office for the Americas:
    • WHO provided technical advice on integrated vector management in Puerto Rico, molecular diagnosis of Zika in the Bahamas, and clinical management of GBS in the context of the Zika emergency in Chile.

 

Summary

  • 70 countries and territories (Fig. 1, Table 1) have reported evidence of mosquito-borne Zika virus transmission since 2007 (67 with reports from 2015):
    • 53 with a first reported outbreak from 2015 onward.
    • 4 with having possible endemic transmission or evidence of local mosquito-borne Zika infections in 2016.
    • 13 with evidence of local mosquito-borne Zika infections in or before 2015, but without documentation of cases in 2016, or with the outbreak terminated.
  • Since February 2016, 11 countries have reported evidence of person-to-person transmission of Zika virus.
  • 20 countries or territories have reported microcephaly and other CNS malformations potentially associated with Zika virus infection or suggestive of congenital infection.
    • 4 of the 20 countries reported microcephalic babies born from mothers in countries with no endemic Zika virus transmission but who reported recent travel history to Zika affected countries.
  • Outcomes of pregnancies with laboratory evidence of possible Zika virus in the United States of America:
    • 16 total liveborn infants with birth defects
    • 5 total pregnancy losses with birth defects
  • Outcomes of pregnancies with laboratory evidence of possible Zika virus in territories of the United States of America:
    • 1 total liveborn infant with birth defects
    • 1 total pregnancy loss with birth defects
  • 18 countries and territories have reported an increased incidence of GBS and/or laboratory confirmation of a Zika virus infection among GBS cases.
  • In Guinea-Bissau, the gene sequencing results of the four confirmed Zika cases sent on 1 July are still pending.
    • The investigation of the 5 cases of microcephaly detected since April 2016 is ongoing.
    • Additional WHO deployments in entomology, epidemiology and laboratory are being planned.
  • The 2016 Summer Olympics held in Rio de Janeiro ended on 21 August.
    • From the reports WHO received from national health authorities, there have so far been no laboratory confirmed cases of Zika virus in spectators, athletes or anyone associated with the Olympics.
    • The situation is being closely monitored; a few cases may still occur, especially given the approximately one-week incubation period of the virus.
  • WHO has developed advice and information on diverse topics in the context of Zika virus.

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Keywords: WHO; Worldwide; Zika Virus; Updates; Pregnancy; GBS; Microcephaly; Zika Congenital Infection; Zika Congenital Syndrome.

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#Prevention and #Control of Seasonal #Influenza with #Vaccines–#Recommendations of the #ACIP — #USA, 2016–17 Influenza Season (@CDCgov, MMWR)

 

Title: #Prevention and #Control of Seasonal #Influenza with #Vaccines–#Recommendations of the #ACIP — #USA, 2016–17 Influenza Season.

Subject: Seasonal Influenza, US CDC update on prevention with vaccines.

Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Summary.

Code: [     ]

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Prevention and Control of Seasonal Influenza with Vaccines - Recommendations of the Advisory Committee on Immunization Practices — United States, 2016–17 Influenza Season

Recommendations and Reports / August 26, 2016 / 65(5);1–54

Format: [ PDF [608 KB] ]

Lisa A. Grohskopf, MD1; Leslie Z. Sokolow, MSc, MPH1,2; Karen R. Broder, MD3; Sonja J. Olsen, PhD1; Ruth A. Karron, MD4; Daniel B. Jernigan, MD1; Joseph S. Bresee, MD1

1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; 2Battelle Memorial Institute, Atlanta, Georgia; 3Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Johns Hopkins University, Baltimore, Maryland

Corresponding author: Lisa A. Grohskopf, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC. Telephone: 404-639-2552; E-mail: Lkg6@cdc.gov.

Suggested citation for this article: Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016;65(No. RR-5):1–54. DOI: http://dx.doi.org/10.15585/mmwr.rr6505a1.

 

Summary

  • This report updates the 2015–16 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015–16 influenza season. MMWR Morb Mortal Wkly Rep 2015;64:818–25).
  • Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications.
  • For the 2016–17 influenza season, inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations.
  • Recombinant influenza vaccine (RIV) will be available in a trivalent formulation (RIV3).
  • In light of concerns regarding low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013–14 and 2015–16 seasons, for the 2016–17 season, ACIP makes the interim recommendation that live attenuated influenza vaccine (LAIV4) should not be used.
  • Vaccine virus strains included in the 2016–17 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)–like virus, an A/Hong Kong/4801/2014 (H3N2)–like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage).
  • Quadrivalent vaccines will include an additional influenza B virus strain, a B/Phuket/3073/2013–like virus (Yamagata lineage).
  • Recommendations for use of different vaccine types and specific populations are discussed.
  • A licensed, age-appropriate vaccine should be used.
  • No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate.
  • This information is intended for vaccination providers, immunization program personnel, and public health personnel.
  • Information in this report reflects discussions during public meetings of ACIP held on October 21, 2015; February 24, 2016; and June 22, 2016.
  • These recommendations apply to all licensed influenza vaccines used within Food and Drug Administration–licensed indications, including those licensed after the publication date of this report.
  • Updates and other information are available at CDC’s influenza website (http://www.cdc.gov/flu). Vaccination and health care providers should check CDC’s influenza website periodically for additional information.

(…)

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Keywords: US CDC; USA; Updates; Seasonal Influenza; Vaccines.

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Highly pathogenic #avian #influenza #H5N1, #Togo [two new #poultry #outbreaks] (#OIE, August 25 2016)

 

Title: Highly pathogenic #avian #influenza #H5N1, #Togo [two new #poultry #outbreaks].

Subject: Avian Influenza, H5N1 subtype, new poultry epizootics in Togo.

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic avian influenza H5N1, Togo

Information received on 24/08/2016 from Dr Batawui Komla Batasse, Directeur de l'élevage et de la pêche, -, Ministère de l'Agriculture de l'Elevage et de la Pêche , Lomé, Togo

  • Summary
    • Report type Immediate notification
    • Date of start of the event 18/08/2016
    • Date of confirmation of the event 23/08/2016
    • Report date 24/08/2016
    • Date submitted to OIE 25/08/2016
    • Reason for notification Reoccurrence of a listed disease
    • Date of previous occurrence 16/01/2009
    • Manifestation of disease Clinical disease
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N1
    • Nature of diagnosis Clinical, Laboratory (advanced), Necropsy
    • This event pertains to a defined zone within the country
  • New outbreaks
    • Summary of outbreaks
      • Total outbreaks: 2
        • Outbreak Location  - RÉGION MARITIME (Adidogome, Golfe Adétikope, Agonyivé)
          • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
            • Birds  - 14372  - 11300  - 11300  - 3030  - 0
          • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
            • Birds - 78.63% - 78.63% - 100.00% - 99.71%
            • * Removed from the susceptible population through death, destruction and/or slaughter;
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
  • Control measures
    • Measures applied
      • Movement control inside the country
      • Disinfection / Disinfestation
      • Traceability
      • Quarantine
      • Surveillance outside containment and/or protection zone
      • Official disposal of carcasses, by-products and waste
      • Surveillance within containment and/or protection zone
      • Vaccination prohibited
      • No treatment of affected animals
    • Measures to be applied
      • Screening
      • Stamping out
      • Control of wildlife reservoirs
  • Diagnostic test results
    • Laboratory name and type - National veterinary laboratory (National laboratory)
      • Tests and results: Species – Test - Test date – Result
        • Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 23/08/2016 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Keywords: OIE; Updates; H5N1; Avian Influenza, Poultry; Togo.

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#Monkeypox, #Cameroon [#chimpanzee #infections] (#OIE, August 25 2016)

 

Title: #Monkeypox, #Cameroon [#chimpanzee #infections].

Subject: Monkeypox virus infection in non-human primates, Cameroon.

Source: OIE, full page: (LINK).

Code: [     ]

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Infection with Pox viruses (other than those listed by the OIE), Cameroon

Information received on 25/08/2016 from Dr Gaston Djonwe, Directeur des Services Vétérinaires, Services Vétérinaires, Ministère de l'Elevage, des Pêches & des Industries Animales, Yaoundé, Cameroon

  • Summary
    • Report type Immediate notification
    • Date of start of the event 15/08/2016
    • Date of confirmation of the event 17/08/2016
    • Report date 25/08/2016
    • Date submitted to OIE 25/08/2016
    • Reason for notification Emerging disease
    • Morbidity 1.0 %
    • Mortality 1.0 %
    • Zoonotic impact Virus de la variole du singe
    • Causal agent Monkeypox virus
    • This event pertains to the whole country
  • New outbreaks
    • Summary of outbreaks
      • Total outbreaks: 1
        • Outbreak Location  - CENTRE (Mefou Primate Sanctuary, Mfou, Mefou et Afamba)
          • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
            • Common chimpanzee: Hominidae (Pan troglodytes)  - 300  - 2  - 1  -  - 1  - 0
          • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality  rate - Apparent case fatality rate - Proportion susceptible animals lost*
            • Common chimpanzee: Hominidae (Pan troglodytes) - 0.67% - 0.33% - 50.00% - 0.67%
            • * Removed from the susceptible population through death, destruction and/or slaughter;
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
  • Epidemiological comments
    • Within the framework of wild diseases surveillance, the Cameroon network of Animal diseases epidemio-surveillance (RESCAM), Ministry of Livestock, Fisheries and Animal industries, was informed about the mortality of a chimpanzee from the Mefou Primate Sanctuary, on August, 16th.
    • Following epidemiological investigation and sampling, the Research center for Armies health (CRESAR) performed analyses and confirmed the presence of simian orthopoxvirus, which is the causal agent responsible for a zoonotic disease known as Monkeypox.
    • Poxvirus Congo basin strain was identified.
    • The group of 22 chimpanzees (1 sick + 1 dead) used to live in a 3-hectares enclosure isolated from the other compartments of the sanctuary (18 enclosures).
    • Clinical signs were:
      • lack of appetite and
      • progressive occurrence of nodules and blisters on the face.
    • The sanctuary is populated with chimpanzees, gorillas and monkeys (300 in total) over about 900 hectares.
    • It is compartmentalized and fenced.
    • Animals were introduced within the sanctuary.
    • Quarantine was applied (sick animals kept inside the enclosure) and biosecurity measures are reinforced for the staff working within the enclosure.
    • Epidemiological investigation is continuing and active surveillance of rodents and the environment is being performed within the sanctuary.
  • Control measures
    • Measures applied
      • Disinfection / Disinfestation
      • Quarantine
      • Surveillance outside containment and/or protection zone
      • Surveillance within containment and/or protection zone
      • Vaccination prohibited
      • No treatment of affected animals
    • Measures to be applied
      • No other measures
  • Diagnostic test results
    • Laboratory name and type - Army health Research center (CRESAR) (National laboratory)
      • Tests and results: Species – Test - Test date – Result
        • Common chimpanzee - gene sequencing – Pending
        • Common chimpanzee - real-time PCR - 17/08/2016 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Keywords: OIE; Updates; Monkeypox; Cameroon; Wildlife.

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#Areas with Current #Zika #transmission, 24 August 2016 #Update (@ECDC_EU, edited)

 

Title: #Areas with Current #Zika #transmission, 24 August 2016 #Update.

Subject: Zika Virus, weekly global activity surveillance update.

Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK).

Code: [     ]

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Areas with Current Zika transmission, 24 August 2016  Update

The information on current Zika transmission is useful to evaluate the risk for people who have recently returned from or are planning to travel to countries with active local transmission.

Countries and territories are categorised as currently experiencing active local Zika virus transmission if local Zika infections have been reported by health authorities within the last three months.

The information is updated every Friday simultaneously with the update of the epidemiological situation, also each time a country is added or removed to the list of countries who report a Zika virus transmission or a country’s transmission status changes.

Countries and territories are removed from this list if no new evidence of Zika virus transmission is provided within 9 months.

The first declaration of local Zika virus transmission in a country or territory is based on a laboratory confirmed case reported by competent health authority.

For countries outside of the intertropical range, sub-national information is presented.

As of week 17 in 2016, ECDC extended the period for classifying whether a country or territory has active local transmission from two to three months. This change is based on the fact that Zika virus outbreaks last usually for more than two months.

In addition, ECDC added a ‘countries and territories with past vector-borne transmission’ category for countries having experienced transmission since 2007 up to three months ago.

 

Countries and territories with reported confirmed autochthonous vector-borne transmission  of Zika virus infection in the past three months 

Based on data reported by 24 August 2016

  • [     ] Sporadic transmission
    • No more than 10 locally transmitted cases have been reported in a single area within this time period.
  • [     ] Increasing or widespread transmission
    • More than 10 locally transmitted cases of Zika virus are reported in a single area,
      • OR
    • at least two separate areas report locally transmitted cases of Zika virus,
      • OR
    • Zika virus transmission is ongoing in an area for more than 3 months.
  • [     ] Past transmission
    • Local Zika virus transmission has been reported since 2007 – but not in the past three months.

|-- Download in high resolution –|

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Current Zika transmission worldwide

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Countries affected in past 3 months

[Areas (non-tropical countries only) - Type of transmission]

  1. American Samoa – … - Widespread transmission
  2. Argentina - Tucumán Province - Widespread transmission
  3. Barbados – … - Widespread transmission
  4. Belize – … - Widespread transmission
  5. Bolivia – … - Widespread transmission
  6. Bonaire – … - Widespread transmission
  7. Brazil – … - Widespread transmission
  8. Cape Verde – … - Widespread transmission
  9. Colombia – … - Widespread transmission
  10. Costa Rica – … - Widespread transmission
  11. Curaçao – … - Widespread transmission
  12. Dominica – … - Widespread transmission
  13. Dominican Republic – … - Widespread transmission
  14. Ecuador – … - Widespread transmission
  15. El Salvador – … - Widespread transmission
  16. Fiji – … - Widespread transmission
  17. French Guiana – … - Widespread transmission
  18. Guadeloupe – … - Widespread transmission
  19. Guatemala – … - Widespread transmission
  20. Haiti – … - Widespread transmission
  21. Honduras – … - Widespread transmission
  22. Jamaica – … - Widespread transmission
  23. Martinique – … - Widespread transmission
  24. Mexico – … - Widespread transmission
  25. Micronesia, Federated States of – … - Widespread transmission
  26. Nicaragua – … - Widespread transmission
  27. Panama – … - Widespread transmission
  28. Paraguay – … - Widespread transmission
  29. Peru – … - Widespread transmission
  30. Puerto Rico – … - Widespread transmission
  31. Saint Lucia – … - Widespread transmission
  32. Saint Martin – … - Widespread transmission
  33. Saint Vincent and the Grenadines – … - Widespread transmission
  34. Saint-Barthélemy – … - Widespread transmission
  35. Samoa – … - Widespread transmission
  36. Sint Maarten – … - Widespread transmission
  37. Suriname – … - Widespread transmission
  38. Thailand – … - Widespread transmission
  39. Tonga – …  - Widespread transmission
  40. Trinidad and Tobago – … - Widespread transmission
  41. US Virgin Islands – … - Widespread transmission
  42. Venezuela – … - Widespread transmission
  43. ​​United States of America - ​Florida (Miami-Dade county) - Widespread transmission
  44. ​​​United States of America - ​Florida (Broward, Palm Beach and Pinellas  counties) - ​Sporadic transmission
  45. Antigua and Barbuda – … - Sporadic transmission
  46. Anguilla -  … - Sporadic transmission
  47. ​Cayman Islands – … - ​Sporadic transmission
  48. ​Cuba – … - Sporadic transmission
  49. Grenada – … - Sporadic transmission
  50. Guinea-Bissau – … - Sporadic transmission
  51. Indonesia – … - Sporadic transmission
  52. Saba – … - Sporadic transmission
  53. Sint Eustatius – … - Sporadic transmission
  54. Turks and Caicos Islands – … - Sporadic transmission
  55. ​Vietnam – … - ​Sporadic transmission

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The classification of countries above is based on: 1) number of reported autochthonous confirmed cases; 2) number of countries who report a zika virus transmission or a country’s transmission status changes; 3) duration of the circulation.

- See more at: http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/zika-outbreak/Pages/Zika-countries-with-transmission.aspx#sthash.qODGTHFK.dpuf

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Keywords: ECDC; Updates; Zika Virus; Worldwide.

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#Outcomes of #Pregnancies with Laboratory Evidence of Possible #Zika Virus #Infection in the #USA, 2016 (@CDCgov, August 25 2016)

 

Title: #Outcomes of #Pregnancies with Laboratory Evidence of Possible #Zika Virus #Infection in the #USA, 2016.

Subject: Zika Virus & Zika Congenital Infection, weekly US Update.

Source: US Centers for Disease Control and Prevention (CDC), full page: (LINK).

Code: [     ]

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Outcomes of Pregnancies with Laboratory Evidence of Possible Zika Virus Infection in the United States, 2016

Language: [ English | Español | Português ]

 

Pregnancy Outcomes in the United States and the District of Columbia

  • Liveborn infants with birth defects* - 16
  • Pregnancy losses with birth defects** - 5

 

Pregnancy Outcomes in the United States Territories

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  • What these numbers show
    • These numbers reflect poor outcomes among pregnancies with laboratory evidence of possible Zika virus infection reported to these systems. Reported numbers may increase or decrease as preliminary information is clarified.
    • The number of live-born infants and pregnancy losses with birth defects are combined for the 50 US states, the District of Columbia, and the US territories. To protect the privacy of the women and children affected by Zika, CDC is not reporting individual state, tribal, territorial or jurisdictional level data.
    • The poor birth outcomes reported include those that have been detected in infants infected with Zika before or during birth, including microcephaly, calcium deposits in the brain indicating possible brain damage, excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures, abnormal eye development, or other problems resulting from damage to brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints, and confirmed hearing loss.
  • What these new numbers do not show
    • These numbers are not real time estimates. They will reflect the outcomes of pregnancies reported with any laboratory evidence of possible Zika virus infection as of 12 noon every Thursday the week prior; numbers will be delayed one week.
    • These numbers do not reflect outcomes among ongoing pregnancies.
    • Although these outcomes occurred in pregnancies with laboratory evidence of Zika virus infection, we do not know whether they were caused by Zika virus infection or other factors.
  • Where do these numbers come from?
    • These data reflect pregnancies reported to the US Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System. CDC, in collaboration with state, local, tribal and territorial health departments, established these systems for comprehensive monitoring of pregnancy and infant outcomes following Zika virus infection.
    • The data collected through these systems will be used to update recommendations for clinical care, to plan for services and support for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy.

___

These registries are covered by an assurance of confidentiality. This protection requires us to safeguard the information collected for the pregnant women and infants in the registries.

___

* Includes microcephaly, calcium deposits in the brain indicating possible brain damage, excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures, abnormal eye development, or other problems resulting from damage to the brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints, and confirmed hearing loss.

**Includes miscarriage, stillbirths, and terminations with evidence of the birth defects mentioned above

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Keywords: US CDC; USA; Updates; Zika Virus; Zika Congenital Infection; Zika Congenital Syndrome.

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#Pregnant #Women with Any Laboratory Evidence of Possible #Zika Virus #Infection in the #US and #Territories, 2016 (@CDCgov, August 25 2016)

 

Title: #Pregnant #Women with Any Laboratory Evidence of Possible #Zika Virus #Infection in the  #US and #Territories, 2016.

Subject:  Zika Virus & Pregnacy, weekly US CDC update.

Source: US Centers for Disease Control and Prevention (CDC), full page: (LINK).

Code: [     ]

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Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection in the United States and Territories, 2016

Language: [ English | Español | Português ]

 

Pregnant Women with Any Laboratory Evidence of Possible Zika Virus Infection

  • US States and the District of Columbia* - 584
    • *Includes aggregated data reported to the US Zika Pregnancy Registry as of August 18, 2016
  • US Territories** - 812

 

About These Numbers

  • What these updated numbers show
    • These updated numbers reflect counts of pregnant women in the United States with any laboratory evidence of possible Zika virus infection, with or without symptoms. Pregnant women with laboratory evidence include those in whom viral particles have been detected and those with evidence of an immune reaction to a recent virus that is likely to be Zika.
    • This information will help healthcare providers as they counsel pregnant women affected by Zika and is essential for planning at the federal, state, and local levels for clinical, public health, and other services needed to support pregnant women and families affected by Zika.
  • What these new numbers do not show
    • These new numbers are not comparable to the previous reports. These updated numbers reflect a different, broader population of pregnant women.
    • These updated numbers are not real time estimates. They will reflect the number of pregnant women reported with any laboratory evidence of possible Zika virus infection as of 12 noon every Thursday the week prior; numbers will be delayed one week.
  • Where do these numbers come from?
    • These data reflect pregnant women in the US Zika Pregnancy Registry and the Zika Active Pregnancy Surveillance System in Puerto Rico. CDC, in collaboration with state, local, tribal and territorial health departments, established these registries for comprehensive monitoring of pregnancy and infant outcomes following Zika virus infection. 
    • The data collected through these registries will be used to update recommendations for clinical care, to plan for services and support for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy.
  • What are the outcomes for these pregnancies?

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Keywords: US CDC; USA; Updates; Zika Virus; Pregnancy.

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