1. Local Updates in Vaccine- Preventable Diseases Anna Halloran Epidemiologist Spokane Regional Health District February 2016

2. Overview Pertussis: Local Increase in Cases Flu Season 2015-16 New Varicella Vaccine Requirements Zika Virus Vaccine Development Miscellaneous Updates

3. PERTUSSIS Local increase in cases

4. Pertussis: Increase in Cases Background Highest incidence occurred in 1934, rate of 162/100,000 By the late 1970s, only 1,000 cases per year nationwide Statewide epidemic in 2012, rate of 73/100,000 Highest incidence in infants (428/100,000) Elevated in 13 and 14 year olds (rates of 342 and 336) Nearly 80% of adolescent cases were up to date

5. Pertussis: Increase in Cases 2015 situation 1,402 cases reported in 2015 (compared to 601 in 2014) Highest rates in Jefferson (105.8), Clark (77.6), Columbia (72.3), and Walla Walla (62.1) Overall incidence rate was 20.8/100,000; infant rate 117.5 104 infants reported 21 hospitalized (76% of hospitalized were 3 months of age or younger) Spokane had 44 confirmed cases, overall rate 9.4/100,000

6. Recent Pertussis Activity by County

7. Pertussis: Current Local Snapshot Spokane County 2016 YTD Outbreak at St. Thomas More school - current Nine cases in students Control measures: ill students isolated, prophy for family members, exposure letters sent home to parents, prophy instructions for some students Fourteen cases reported in January, 3 to date in February Ages 1-41

8. FLU 2015-16

9. Influenza 2015-16: Low low low

10. Influenza 2014-15: Comparison

12. Influenza Hospitalizations by Season 2014-15: 402 hospitalizations, 17 deaths (state – 150 deaths) 2013-14: 183 hospitalizations, 8 deaths (state – 79 deaths) 2012-13: 152 hospitalizations, 2 deaths (state – 54 deaths) 2011-12: 118 hospitalizations, 3 deaths (state – 11 deaths)

13. A Reminder About Flu’s Seriousness Kitsap County reported a pediatric flu death in an otherwise healthy school-aged child in January

14. NEW VARICELLA VACCINE REQUIREMENTS

17. New Varicella Vaccine Requirements WAC 246-105-090 K-12: two doses received on or after the child’s first birthday and at least 28 days apart, or Provider diagnosis or verification of a history of varicella disease or herpes zoster*, or Serologic proof of immunity, or Certificate of exemption for a medical, religious or personal reason Protects teens who are at higher risk of complications from varicella * As of September 1, 2014, parent report of illness is no longer acceptable

18. HOT TOPICS: ZIKA VIRUS

19. What is Zika Virus? Mosquito-borne virus Symptoms are fever, rash, joint pain, and conjunctivitis (however, only 1 in 5 infected become ill) Mild illness Transmitted via Aedes mosquitoes – the same mosquitoes that spread chikungunya and dengue Also mother to baby No vaccine, treatment

20. Zika Virus Outbreak Prior to 2015, outbreaks in Africa, Southeast Asia, and the Pacific Islands First cases confirmed in Brazil in May 2015 Possible correlation between microcephaly (serious birth defect), other poor pregnancy outcomes, and Guillain Barre Syndrome In January 2016, CDC recommended postponing travel to Zika outbreak areas for pregnant women or women trying to become pregnant

21. Countries with Active Zika Virus Transmission

22. Approximate Distribution of Aedes Mosquitoes in the US

23. Zika Vaccine Development Two vaccine makers, Sanofi Pasteur and NewLink Genetics, announced efforts to develop vaccines Sanofi Pasteur already has licensed vaccines for flaviviruses such as dengue Other small biotech companies have also announced plans to develop a vaccine Two key prospects that won’t be available for several years – some experts predict it will take 5-15 years

24. MISCELLANEOUS UPDATES

25. SRHD Update Dr. Joel McCullough, Health Officer, leaving SRHD for position with Providence Last day is February 16, though will be our interim Health Officer for limited activities until replacement is found New role in overseeing epidemiology and community health efforts at Providence

26. New HPV Vaccine Gardasil 9 (Merck) granted FDA approval in December Indicated in females 9 through 26 years of age and males aged Types of HPV prevented: 6, 11, 16, 18, 31, 33, 45, 52, 58 (new) No recommendation to re-vaccinate those who were vaccine with the quadrivalent; however, those who choose to be vaccinated with the 9 can proceed and VFC will cover the cost

27. Anna Halloran ahalloran@srhd.org 509-324-1655