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CDC Health Alert Network (HAN) Advisory

CDC HAN 412: Outbreak of Hepatitis A Virus (HAV) Infections among Persons Who Use Drugs and Persons Experiencing Homelessness

June 11, 2018: This HAN alerts public health departments, healthcare facilities, and programs providing services to affected populations about these outbreaks of hepatitis A infections and provides guidance to assist in identifying and preventing new infections.

Read the full HAN Advisory here.

CDC HAN 411: Update – CDC Recommendations for Managing and Reporting Shigella Infections with Possible Reduced Susceptibility to Ciprofloxacin

June 7, 2018: This HAN provides current recommendations on management and reporting ofShigella infections that have been treated with ciprofloxacin or azithromycin and resulted in possible clinical treatment failure. This is a follow-up to HAN 401: CDC Recommendations for Diagnosing and Managing Shigella Strains with Possible Reduced Susceptibility to Ciprofloxacin.

Read the full HAN Update here.

Infectious, Vector-Borne, and Zoonotic Diseases

Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus Infection, Puerto Rico, 2016

The objective of the study is to identify specific clinical features of GBS associated with ZIKV infection. During the ZIKV epidemic in Puerto Rico, prospective and retrospective strategies were used to identify patients with GBS who had neurologic illness onset in 2016 and were hospitalized at all 57 nonspecialized hospitals and 2 rehabilitation centers in Puerto Rico. Guillain-Barré syndrome diagnosis was confirmed via medical record review using the Brighton Collaboration criteria. Specimens (serum, urine, cerebrospinal fluid, and saliva) from patients with GBS were tested for evidence of ZIKV infection by real-time reverse transcriptase-polymerase chain reaction; serum and cerebrospinal fluid were also tested by IgM enzyme-linked immunosorbent assay. In this analysis of public health surveillance data, a total of 123 confirmed GBS cases were identified, of which 107 had specimens submitted for testing; there were 71 patients with and 36 patients without evidence of ZIKV infection. Follow-up telephone interviews with patients were conducted 6 months after neurologic illness onset; 60 patients with and 27 patients without evidence of ZIKV infection participated.

In this study, GBS associated with ZIKV infection was found to have higher morbidity during the acute phase and more frequent cranial neuropathy during acute neuropathy and 6 months afterward. Results indicate GBS pathophysiologic mechanisms that may be more common after ZIKV infection.

Read the full JAMA article here.

Study on Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico

The objective of the study is to describe patients younger than 18 years who were infected with ZIKV and were enrolled in the Sentinel Enhanced Dengue and Acute Febrile Illness Surveillance System (SEDSS). Children infected with ZIKV with 7 or fewer days of fever or emancipated minors aged 14 to 17 years with a generalized maculopapular rash, arthritis or arthralgia, or nonpurulent conjunctivitis were eligible for enrollment on or before December 31, 2016, in Puerto Rico. Patients were evaluated using ZIKV polymerase chain reaction testing at 7 or fewer days after the onset of symptoms. Available ZIKV polymerase chain reaction-positive specimens were evaluated to determine viral loads.

This study represents the largest study to date of ZIKV infection in the pediatric population. Most children infected with ZIKV had fever, rash, and conjunctival hyperemia. The children usually presented for evaluation at fewer than 3 days after the onset of symptoms. Viral loads for ZIKV were higher in serum vs urine specimens. Median viral loads in serum specimens differed significantly according to the number of days after the onset of symptoms.

Read the full JAMA article here.

Multistate Outbreaks of SalmonellaInfections Linked to Contact with Live Poultry in Backyard Flocks

CDC and multiple states are investigating several multistate outbreaks of Salmonella infections linked to contact with live poultry in backyard flocks. Epidemiologic, traceback, and laboratory findings link these outbreaks to contact with live poultry, such as chicks and ducklings, which come from multiple hatcheries.

As of June 1, 2018, 124 people infected with the outbreak strains of Salmonella have been reported from 36 states. Several different types of Salmonella bacteria have made people sick:Salmonella Seftenberg, Salmonella Montevideo, Salmonella Infantis, Salmonella Enteritidis,Salmonella Indiana, and Salmonella Litchfield.

Read the full report here.

Seasonal Influenza

Update: Influenza Activity in the United States During the 2017–18 Season and Composition of the 2018–19 Influenza Vaccine

The severity and duration of the 2017-2018 influenza season underscores the tremendous burden seasonal flu can cause and the importance of influenza countermeasures including influenza vaccination and antiviral treatment. While flu vaccination can vary in how well it works, effectiveness in the range of 20 percent to 50 percent may still prevent tens of thousands of hospitalizations during seasons with high severity. Also, flu vaccination has been shown to be life saving for children. Prompt treatment with influenza antiviral medications can shorten duration and severity of symptoms and prevent serious flu complications.

While CDC and partners are working to improve existing flu countermeasures, increases in flu vaccine uptake and the appropriate use of antiviral drugs for treatment could further reduce the burden of influenza in the United States. Influenza activity in the United States during the 2017-18 season began increasing in November followed by an extended period of high activity nationally during January and February and remained elevated through March. Influenza A(H3N2) viruses were most common through February and predominated overall but influenza B viruses, especially B/Yamagata lineage, were most common from March through May. This was a high-severity season: severity indicators (e.g., hospitalization, mortality rates) were higher than what has been observed during previous influenza A(H3N2) predominant seasons.

Studies are underway to better understand the reasons for this high severity. In addition, a high number of influenza-associated pediatric deaths were reported this season.

Read the full MMWR report here.

Update: Recommendations for the Use of Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) — United States, 2018–19 Influenza Season

On February 21, 2018, the Advisory Committee on Immunization Practices (ACIP) recommended that intranasally administered live attenuated influenza vaccine (LAIV4) be an option for influenza vaccination of people for whom it is appropriate for the 2018–19 season. This article provides an overview of the information discussed in the decision-making process leading to this recommendation. Intranasally administered LAIV was initially licensed in the United States in 2003 as a trivalent formulation (LAIV3; FluMist, MedImmune, LLC). Quadrivalent live attenuated influenza vaccine (LAIV4; FluMist Quadrivalent, MedImmune) has been licensed in the United States since 2012 and was first available during the 2013–14 influenza season, replacing LAIV3. During the 2016–17 and 2017–18 influenza seasons, the Advisory Committee on Immunization Practices (ACIP) had recommended that LAIV4 not be used because of concerns about low effectiveness against influenza A(H1N1)pdm09-like viruses circulating in the United States during the 2013–14 and 2015–16 seasons. A description of methodology and data reviewed for the decision will be included in the background materials that will supplement the 2018–19 ACIP Influenza Recommendations, which will replace the 2017–18 ACIP influenza statement, and which will also contain guidance for the use of LAIV4.

Read the full MMWR report here.

Food, Drug, and Device Safety

Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce (6/29/2018)

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of E. coli O157:H7 infections. 210 people infected with the outbreak strain were reported from 36 states. 96 people were hospitalized, including 27 people who developed a type of kidney failure called hemolytic uremic syndrome. 5 deaths were reported from Arkansas, California, Minnesota (2), and New York. This is the final update.

Multistate Outbreak of Salmonella Mbandaka Infections Linked to Kellogg’s Honey Smacks Cereal (6/15/2018)

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella Mbandaka infections.

As of June 14, 2018, 73 people infected with the outbreak strain of Salmonella Mbandaka have been reported from 31 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates from March 3, 2018, to May 28, 2018. Out of 55 people with information available, 24 (44%) have been hospitalized. No deaths have been reported. This is an ongoing investigation.

Multistate Outbreak of Cyclosporiasis Linked to Del Monte Fresh Produce Vegetable Trays (6/15/2018)

The U.S. Food and Drug Administration (FDA) along with CDC and state and local officials have been investigating a cluster of cyclosporiasis illnesses associated with recalled Del Monte vegetable trays from Kwik Trip/Kwik Star locations in the United States, including Iowa, Indiana, Michigan, Minnesota, and Wisconsin.

As of June 15, 2018, CDC has reported 78 laboratory-confirmed cases of cyclosporiasis in persons from Iowa, Michigan, Minnesota, and Wisconsin who reportedly consumed the vegetable trays. The two cases from Michigan reportedly purchased the vegetable tray in Wisconsin and therefore Michigan is not impacted from this outbreak. This is an ongoing investigation.

Multistate Outbreak of Salmonella Braenderup Infections Linked to Rose Acre Farms Shell Eggs (6/14/2018)

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Salmonella Braenderup infections linked to Rose Acre Farms shell eggs. As of June 14, 2018, this outbreak appears to be over.

Since the last update on May 10, 2018, 10 more ill people were reported, bringing the total to 45 people from ten states. Eleven people were hospitalized. No deaths were reported. Illnesses started on dates ranging from November 16, 2017, to May 13, 2018.

Multistate Outbreak of Salmonella Adelaide Infections Linked to Pre-Cut Melon (6/8/2018)

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella Adelaide infections.

Epidemiologic and preliminary traceback evidence indicates that pre-cut melon supplied by the Caito Foods, LLC of Indianapolis, Indiana is a likely source of this multistate outbreak. As of June 7, 2018, 60 people infected with the outbreak strain of Salmonella Adelaide have been reported from five states. No deaths have been reported. This is an ongoing investigation.

Public Health Preparedness

Resources for Emergency Health Professionals

CDC offers a variety of resources for clinicians, communicators, laboratorians, emergency planners and responders, and disaster relief volunteers to prepare them to respond to a public health emergency. Included in this section are free educational materials that are suitable for printing and sharing in various languages, including flyers, posters, stickers, and PSAs.

Click here to access the resources.

Natural Disasters and Severe Weather

Natural Disasters and Severe Weather

You can take steps now to help you prepare for an emergency and cope if a public health emergency, such as a  natural disaster, act of terrorism, or disease outbreaks happens. There are step-by-step actions to help you prepare before an emergency. For information about specific types of disasters, ranging from inclement weather to tornadoes, go here.

Health and Safety Concerns

For information on health and safety concerns for all disasters, including animals and insects, food and water, carbon monoxide, illness and injury prevention, power outages, safe cleanup, and more, go here.

Food and Water Needs: Preparing for a Disaster or Emergency

For food, water, sanitation, and hygiene information for use before and after a disaster or emergency, go here.

Disaster Resources

CDC provides educational materials about a variety of topics ranging from health related illnesses to carbon monoxide poisoning. They are separated by topic or language, PSAs for disasters, resources for emergency health professionals, and social media. Go here to access these free resources, that are suitable for printing and sharing.

MedWatch: The FDA Safety Information and Adverse Event Reporting Program—(FDA)
MedWatch is your FDA gateway for clinically important safety information and reporting serious problems with human medical products.

FoodSafety.gov: Reports of FDA and USDA Food Recalls, Alerts, Reporting, and Resources—(HHS/USDA/FDA/CDC/NIH)
Foodsafety.gov lists notices of recalls and alerts from both FDA and the U.S. Department of Agriculture. Visitors to the site can report a problem or make inquiries.

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