EPIDEMIOLOGY SURVEILLANCE REPORT NORTHEAST REGION FALL Namitha Reddy Regional Coordinator North/Central West Region NJDOH/EEOH/CDS

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1 EPIDEMIOLOGY SURVEILLANCE REPORT NORTHEAST REGION FALL 2014 Namitha Reddy Regional Coordinator North/Central West Region NJDOH/EEOH/CDS

2 Overview Purpose/Objectives State and Regional Highlights Select Disease Trends and Activity Outbreak / Cluster Reporting Investigations Note: This report provides a snapshot of communicable disease activity in the Northeast region. Included in this report are data from the various surveillance systems utilized by the New Jersey Department of Health Communicable Disease Service. It is intended for use by Public Health Officials and is not intended for public distribution. All data are provisional and are subject to change.

3 Purpose/Objectives Purpose To provide relevant information and updates to public health partners on communicable disease activity and trends within their Public health region. Objectives Provide an overview of communicable disease activity. Describe quarterly trends in select communicable diseases. Highlight interesting and/or notable outbreaks/clusters and/or investigations.

4 STATE AND REGIONAL HIGHLIGHTS NORTHEAST REGION

5 State and Regional Highlights Salmonella Clusters Multi state : NJDOH in coordination with CDC and other State health departments is currently investigating several multi state Salmonella clusters (Newport, Javiana & Typhimurium). Newport NJ has 18 cases with matching PFGE pattern. No cases in the Northeast (09/29/2014). Javiana NJ has 6 cases with matching PFGE pattern. No cases in the Northeast (09/29/2014). Typhimurium NJ has 4 cases with matching PFGE pattern. No cases in the Northeast (09/29/2014). In State : Salmonella Norwich (rare serotype) currently under investigation. Most cases are in the Southern region (4/5). The State is working with impacted counties to re interview cases and identify common exposures.

6 State and Regional Highlights Enterovirus D68 (EV D68) National: In August 2014, hospital officials in Midwest notified CDC of an increase in severe respiratory illness among children seen in the emergency rooms and admitted to the hospitals. Specimens initially tested positive for Rhinovirus and Enterovirus. CDC did further testing and identified Enterovirus D68 (EV D68). Regional/State: Overall there has been an increase in reporting in the Region and specimens meeting testing criteria are being sent to CDC for identification. As of 09/30/2014, of the results received from CDC, one sample in the region has tested positive for EVD68.

7 State and Regional Highlights Ebola National: To date, no confirmed Ebola cases have been reported in the United States. Regional/State: NJDOH has conducted (7) Investigations of suspect cases of Ebola in travelers from affected countries. We have had 4 investigations in the Central Region, 3 in the North Region and none in South region.

8 SELECT DISEASE ACTIVITY/TRENDS NORTHEAST REGION

9 Select Enteric Diseases State reports for Salmonella continued to increase from April, surpassing those for Campylobacter in June. In the Northeast region, reports for Shigellosis increased through March and there were general increases for both Campylobacter and Salmonella Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Select Enteric Diseases by Month New Jersey Jan 01, 2013 Sep 25, 2014 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 CAMPYLOBACTERIOSIS GIARDIASIS SALMONELLA NON TYPHOID SHIGELLA VIBRIO INFECTIONS (OTHER THAN V.CHOLERAE SPP.) Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Dec 13 Jan 14 Feb 14 Mar 14 Select Enteric Diseases by Month Northeast Region Jan 01, 2013 to Sept 25, Aug 13 Sep 13 Oct 13 Nov 13 CAMPYLOBACTERIOSIS GIARDIASIS SALMONELLOSIS NON TYPHOID SHIGELLOSIS VIBRIO INFECTIONS (OTHER THAN V.CHOLERAE SPP.) Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 Apr 14 May 14 May 14 Jun 14 Jun 14 Jul 14 Jul 14 Aug 14 Aug 14 Sep 14 Sep 14 CDRSS Reports of Select Enteric Diseases by Month, January 2013 September 25, 2014

10 State/Regional Reports Select Vaccine Preventable Diseases Select Vaccine Preventable Diseases State: A general decline in State reports for Meningococcal disease, Measles, Mumps and Rubella was seen from July to September Similar trends were observed for Pertussis and Varicella. Region: During the same period (July September 2014) in the Northeast Region there were three (3) reports of Meningococcal disease, seven (7) reports of Rubella two (2) of Mumps and one(1) report of Measles.

11 State/Regional Reports Vector Borne and Zoonotic Diseases WEST NILE VIRUS SURVEILLANCE Mosquito WNV Positive Human Positive Samples submitted to Total WNV Avian WNV PHEL Positive NJ Bergen Hudson Essex New Jersey West Nile Virus Surveillance September 17, 2014

12 Vector Borne and Zoonotic Diseases CHIKUNGUNYA AND DENGUE Mosquito Dengue Mosquito pools Positive Human Dengue (Travel Related) Confirmed and Probable Mosquito CHIKV Mosquito pools Positive Human CHIKV (Travel Related) Confirmed and Probable NJ Bergen Hudson Essex

13 State/Regional Trends CDRSS Reports of Legionellosis by Month, January 2013 September 25, 2014 Legionellosis Statewide: General Increases observed since April 2014 statewide. Multiple investigations ongoing statewide. Regional: Peaks observed in May and July Two (2) outbreaks were reported in the Northeast region this quarter JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY MARCH APRIL MAY JUNE STATE NE REGION Includes total number of reports entered into the Communicable Disease Reporting and Surveillance System (CDRSS) each month for select diseases. Excludes merged and deleted reports. Includes all case statuses (i.e. CONFIRMED, PROBABLE, POSSIBLE, REPORT UNDER INVESTIGATION (RUI), NOT A CASE). Data reflect the reporting burden of disease and does not reflect the number of cases that are confirmed. JULY AUGUST SEPTEMBER

14 OUTBREAKS/CLUSTERS NORTHEAST REGION

15 Outbreak/Cluster Type Twelve(12) outbreaks reported and investigated in the Northeast region from Jul 1, 2014 to date. An increase of 20% from the previous quarter Northeast Region N=12 Scabies 8% Gastroenteritis 17% Four of these outbreaks(33%) were Hand Foot & Mouth disease (Coxsackie virus), followed by Respiratory (25%), GI and Legionella, both 17% and Scabies (8%). Respiratory 25% Legionellosis 17% Hand foot and mouth disease 33%

16 Outbreak/Cluster Setting Northeast Region N=12 Most of the reported outbreaks, 43% occurred in LTCF s followed by Daycares, which had 25% of outbreaks Restaurant 8% School or university 8% Long term care facility 42% Camp 9% Entertainmen t venue 8% Day care facility 25%

17 INVESTIGATION OF INTEREST

18 Investigation of Interest Coxsackie A6 (CVA6) August 27, 2014: Call from a resident wanting to send a sample to CDC for Coxsackie A6 nuclear sequencing by PCR. Background on Coxsackie virus infections: Coxsackie virus most frequently causes Hand, foot, and mouth disease and Coxsackie A16 is the most commonly implicated strain in the United States. It usually affects infants and children younger than 5 years of age who generally present with fever, blister like sores in the mouth, and a skin rash. HFMD can also be caused by other viruses from the Enterovirus group. Coxsackie virus A6 : Relatively new, was identified in Scandinavia in 2008 and was first reported in the US in Nov More severe rash often extending to the trunk.

19 Investigation of Interest Investigation: An inpatient 65y/o male, symptom onset 10 days prior(8/18/2014). S/S: Fever, chills, blisters on the palm of hands and soles of his feet, scalp, face, back of his neck as well his abdominal area. Testing NJDOH approved the sample for testing on 08/28/2014 and the necessary paperwork was requested to be completed before submission to the CDC. Brief mention about a Coxsackie outbreak at the patients grandson s daycare.

20 Investigation of Interest Outbreak Unreported outbreak of Coxsackie at the daycare. Symptom onset 08/04/2014 (?), first confirmed case on 08/08/2014. Cases seen until 08/22/2014. Outbreak described as atypical and severe. The outbreak was longer (average 7 days as compared to other outbreaks that lasted an average of 2 3 days). 2 students presented with rash on the trunk and torso, and one staff member had had 2 prior Coxsackie infections. The patients grandson was also symptomatic and was diagnosed with Coxsackie during this time.

21 Investigation of Interest Conclusion Test results from CDC identified this to be CVA6. Unable to link the Daycare outbreak to the CVA6 strain due to lapse in reporting. What worked well Judicious physician noting the atypical presentation. Seamless work by all involved in identifying the case and following up on the outbreak. Kudos to the LHD and the NW and CE Regional Epidemiologists for their astute investigation and response.

22 Questions?