Vaccine Preventable Diseases. Rebecca Ward Utah Department of Health Bureau of Epidemiology October 9, 2013

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1 Vaccine Preventable Diseases In Utah: 2013 Rebecca Ward Utah Department of Health Bureau of Epidemiology October 9, 2013

2 VPD Overview H3N2v Influenza Seasonal Influenza Pertussis Haemophilus influenzae type b Hepatitis A Hepatitis B Measles Meningococcal disease Mumps Pneumococcal disease Rubella

3 H3N2v Influenza H3N2v Transmission - prolonged exposure to pigs at agricultural fairs No sustained community spread First detected in July YTD: 18 cases No cases in Utah Most cases in midwest states Same course of illness as in other strains of influenza State fairs with swine on display monitored closely

4 2013 Seasonal Influenza Activity in Utah Official influenza surveillance season October 1 - May 31 every year Updates posted weekly on Wednesday afternoons p season - minimal activity reported season was highly active 985 influenza-associated i hospitalizations ti reported 77%: Type A(H3); 20%: Type B Peaked end of December; usually ~mid-january to ~1 st week February Generally expect ~500 cases/influenza season Adult vaccination recommendation: 1 dose annually

5 Influenza-like Illness Weekly Influenza-like Illness Activity Influenza-like illness (ILI) activity as measured by the number of standard deviations from the epidemic threshold - Utah, ILI Activity /6 10/27 11/17 12/8 12/29 1/19 2/9 3/2 3/23 4/13 5/4 5/25 6/15 7/6 7/27 8/17 9/7 9/28 Week

6 Influenza Testing Influenza Positive Tests Influenza positive specimens tested by Unified State Laboratory: Public Health - Utah, Number of Positive Specimens Percent Positive B A (unknown subtype) A (H3) A (H1) A (2009 H1N1) Percent Positive /6 10/20 11/3 11/17 12/1 12/15 12/29 1/12 1/26 2/9 2/23 3/9 3/23 4/6 4/20 5/4 5/18 Week of Test

7 Pertussis 2013 YTD: same time: 1, Hospitalizations: : 1,544 cases US: 41,880 (provisional) [48,277-09/12/13] Highest case count - Washington: 4,604 Current statewide activity Highest incidence - infants <1 year and 5-14 years: 39.1 cases per 100,000 persons Adult incidence rate (18+ years): 13.7 per 100,000 persons Adult vaccination recommendation 19+ years: 1 single dose of Tdap o Pregnant women: 1 dose of Tdap during each pregnancy, irrespective of the prior history of receiving Tdap, optimally between 27 and 36 weeks gestation

8 Pertussis Totals Utah Pertussis, * YTD , *

9 Haemophilus influenzae type B (Hib) 2013 YTD: 3 cases 3 cases; 2 children <5 years; 1 adult 19 years 1 case was vaccinated 2012: 2 cases Both in children <5 years; both unvaccinated Young children <5 years of age are most affected H. influenzae vaccination - only serotype B U.S. incidence of Hib decreased by 99% since the late 1980 s/early 1990 s due to routine Hib vaccination Adult vaccination recommendation: persons with asplenia, splenectomy, or immunodeficiency

10 Haemophilus influenzae type b (HIB) Totals Utah HIB, * YTD * yrs 6-20 yrs yrs yrs 65+ yrs

11 Hepatitis A 2013 YTD: 9 cases Average age: 41 years Average range: years None were vaccinated Hepatitis A Outbreak/Frozen Berries o 4 cases 2012: 4 cases Average age 47 years Age range years 1 was unvaccinated Hepatitis A vaccination introduced 1995 Adult vaccination recommendation: 2-dose series

12 Hepatitis A Totals Utah Hepatitis A, * YTD *

13 Hepatitis B Acute Clinical Case Definition: An acute illness with 1) discrete onset of symptoms, and 2) jaundice or elevated serum levels Chronic Clinical Case Definition: No symptoms required; persons with chronic HBV infection may have no evidence of liver disease or may have a spectrum of disease ranging from chronic hepatitis to cirrhosis or liver cancer Adult vaccine recommendation: 3-dose series Acute Hepatitis B 2013 YTD 11 1 confirmed confirmed Chronic Hepatitis B 2013 YTD confirmed confirmed

14 600 Hepatitis B Totals Acute vs. Chronic Utah Hepatitis B, Acute vs. Chronic, * YTD Hepatitis B Chronic Hepatits B Acute *

15 Measles 2013 YTD: 0 cases 2012: 1 case; vaccinated No continuous spread 2011: 15 cases Index case was unvaccinated and had recent travel to Eastern Europe where measles was known to be circulating Last measles case reported in Utah case Adult vaccination recommendation: 1 2 doses if born in 1957 Adult vaccination recommendation: 1-2 doses if born in 1957 or later; varies by occupation - i.e., healthcare worker, college student

16 Meningococcal Disease 2013: 7 cases 2 cases 18 years;1 unvaccinated; 1 unknown 5 cases >18 years; all unvaccinated 2012: 4 cases 2 unvaccinated; 2 unknown Since 2005, average ~9 cases/year Higher risk individuals - underlying immune deficiencies Outbreaks typically occur in closed settings Childcare facilities, schools, colleges (dormitory living), and military training camps Adult vaccination recommendation: persons with immunodeficiency, first year college students in dorms

17 Meningococcal Disease Totals Utah Meningococcal Disease, * YTD >18 Years 18 Years *

18 Mumps 2013 YTD: 1 case; vaccination unknown 2012: 3 cases In children <8 years 2 were vaccinated 2011: 0 cases : Average ~4 cases/year Adult vaccination recommendation: 1-2 doses if born in 1957 or later; varies based on occupation - i.e., healthcare worker, college student

19 Pneumococcal Disease 2013 YTD: 62 cases 2012: 183 cases Average ~230 cases/year Majority of cases are in adults >18 years Most susceptible populations Children <1 year Adults >65 years Most common cause of bacterial pneumonia in U.S. Adult vaccination recommendation: 1 dose pneumococcal polysaccharide (PPSV23) for 65+ and others with certain risk factors; pneumococcal conjugate (PCV13) for immunocompromisedi persons 19+

20 Rubella 2013 YTD: 0 cases 2012: 1 case; vaccinated Last rubella cases reported in Utah cases Adult vaccination recommendation: 1-2 doses if born in 1957 or later; varies based on risk factors such as pregnancy, occupation - i.e., healthcare worker, college student

21 2013 YTD Cases of Reported VPDs (excluding Pertussis & Influenza)

22 DON T WAIT, VACCINATE! Utah Vaccination Locator: Utah Immunization Hotline:

23 QUESTIONS