1. Emerging Infections of Concern Health and Human Resources Subpanel Governor’s Secure Commonwealth Initiative March 2015

2. INFLUENZA

6. Influenza Vaccine WHO recommends that influenza vaccines for use in the 2015-2016 northern hemisphere influenza season contain the following: – an A/California/7/2009 (H1N1)pdm09-like virus, which is the same as 2014-2015 – an A/Switzerland/9715293/2013 (H3N2)-like virus, which is different from 2014-2015 – a B/Phuket/3073/2013-like virus, which is different from 2014-2015

7. Influenza Vaccine Early estimates (January 2015) of vaccine effectiveness (VE) indicated that vaccination reduced a person’s risk of having to go to the doctor for flu illness by 23% across all ages. In late February, updated estimates indicated that VE was 18%. VE against influenza B viruses was 45%.

8. Highly Pathogenic Avian Influenza H5 Federal agencies continue to detect and report the presence of highly pathogenic avian influenza (HPAI) H5 viruses in US domestic poultry, captive wild birds, and wild birds. No human infections with these viruses have been reported worldwide; however, genetically similar viruses have infected people in the past

9. Measles Highly contagious Can cause serious health complications Prior to vaccination programs in the US, 3-4 million people in the US got measles each year. Measles was declared eliminated from the US in 2000 Measles is still commonly transmitted in many parts of the world.

10. Measles in Virginia There have been no cases of measles in 2015 to date. In previous seasons: – 2011: 7 cases – 2012: 0 – 2013: 0 – 2014: 2 88.6% of children in Virginia ages 19-35 months received 1 dose of MMR (2013, NIS) The HP2020 goal is 90%

11. Measles in the United States, 2015 170 cases reported from 17 states 125 (74%) considered to be part of California amusement park outbreak Outbreaks California – 125 cases Illinois – 15 cases Nevada – 8 cases Washington – 7 cases These 4 outbreaks represent 89% of the cases reported in 2015.

12. U.S. Multi-state Measles Outbreak December 28, 2014 – February 27, 2015 StateCase Count* Arizona7 California124 Colorado1 Nebraska2 Oregon1 Utah3 Washington2 Total140 *Provisional data reported to CDC’s National Center for Immunization and Respiratory Diseases Source: http://www.cdc.gov/measles/multi-state-outbreak.htmlhttp://www.cdc.gov/measles/multi-state-outbreak.html

13. Impact of US Measles Outbreak in Virginia There have been NO measles cases in Virginia linked to this US Outbreak Heightened Concern Providers Public Facilities Information Requests Data Materials to help answer questions Clinician’s Letter distributed on Feb 13, 2015 Other Health Department Activities Investigation of suspected cases 20% increase in MMR doses administered

14. MERS-CoV MERS CoV: Middle East Respiratory Syndrome coronavirus- – Presents a very LOW risk to general public in the US – As of January 23, 2015, WHO has confirmed 956 laboratory- confirmed cases of MERS-CoV infection, which include at least 351 deaths. – All reported cases have been directly or indirectly linked through travel or residence to nine countries: Saudi Arabia, the United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Yemen, Lebanon, and Iran. – In the United States, two patients tested positive for MERS-CoV in May 2014, each of whom had a history of fever and one or more respiratory symptoms after recent travel from Saudi Arabia (2).2 – No further cases have been reported in the United States despite nationwide surveillance and the testing of 514 patients from 45 states to date.

15. Ebola – Cumulative Cases through 03/18/15

16. Confirmed weekly Ebola virus disease cases reported from Sierra Leone (WHO)

17. Thank you! Questions?

18. % children in kindergarten who have been exempted from 1+ vaccines US 2013-2014 School Year

19. Ebola – Virginia Traveler Active Monitoring Risk CategoryNum% Low but not zero risk75297.9 Some risk152.0 High risk10.1 Travelers entered Virginia’s active monitoring program between 10/27/2014 and 3/22/2015 Current StatusNum% Completed monitoring49264.1 Transferred out18524.1 Released from monitoring70.9 Under monitoring (as of 2/28/15)8410.9 *2 travelers were transferred out of Virginia prior to being assigned to a region/health district