Boulder County Infectious Disease Surveillance Update Community - - PowerPoint PPT Presentation

Boulder County Infectious Disease Surveillance Update

Community Infectious Disease Emergency Response Meeting 8.21.2018

Reportable Conditions Investigated by BCPH

50 100 150 200 250 100 200 300 400 500 600 700 800 2012 2013 2014 2015 2016 2017 Rate per 100,000 Number of Cases Total Cases Rate per 100,000 Pertussis Epidemic Year

Pertussis Epidemic Year

46% compared to 5 year average (2012-2016) 21% compared to pertussis epidemic year (2013)

20 40 60 80 100 120 140 160 Number of Cases 5 Year Average (2013-2017) 2018

Total Number of Reportable Conditions Investigated 2018 Compared to 5 Year Average

8% compared to 2017 YTD

2017-2018 Influenza Season Recap

• High severity, H3N2-predominant season with

record-breaking level of influenza-like illness and hospitalizations.

• Between October 1, 2017-May 26, 2018

– 4,675 hospitalizations statewide/ 260 in Boulder County – 183 outbreaks/14 in Boulder County (Assisted and Skilled Nursing) – One pediatrics death in the state – One novel influenza A variant (H1N2v)

2018-2019 Influenza Season

What communications/data going into and during the 2018-2019 Influenza season would be helpful to you/your

• rganization?

Common Reportable Conditions

(January 1, 2018-July 31, 2018)

66 43 23 22 19 17 8 7 6 4 47 57 24 17 6 9 1 17 4 8

10 20 30 40 50 60 70 Campylobacter Pertussis Giardia Salmonella Cryptosporidium Shiga-toxin producing E.Coli Cyclospora Yersinia Shigella Vibrio

5-YR Mean (2013-2017) YTD 2018 YTD

Cyclospora: 100% out of state (3)/country (5) Cryptosporidium: 56% out of state (3)/country (9) STEC: 59% out of state (1)/country (9) Campylobacter: 65% out of state (11)/country (32)

Campylobacter Surveillance

5 10 15 20 25 30 35 40 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Rate per 100,000 Boulder CO CO Healthy People 2020 Goal

Enteric Pathogen Testing in Boulder County

Colorado Rabies Update

• 277 specimens have tested positive for rabies in Colorado.

– 202 skunks, 63 bats, 3 raccoons, 1 alpaca, 8 cat/dog – Boulder County: bat (2); skunk (1)

• This number of positive animals surpasses the previous

season high of 191 in 2013.

• Of 277 rabid animals, 132 were known or strongly

suspected of exposing 277 domestic pets, 92 livestock and 86 people.

• Rabies risk assessments and rabies PEP recommendations

have been made for 24 Boulder County residents thus far this year.

West Nile Virus Activity by State, 2018

*August 7, 2018

Colorado West Nile Virus Update

• 8 cases of human West Nile Virus (WNV) have

been reported/confirmed as of August 20, 2018 in Delta (1), Larimer (4) and Weld (3) counties.

– uncomplicated fever cases (67%) – meningoencephalitis case (33%) – No fatalities have been reported

• 85 mosquito pools tested positive state-wide and

were collected from Adams (2), Boulder (10), Larimer (53), and Weld (20)

U.S.-Based Ongoing Outbreak Update

July 2018: Multistate (9) Outbreak of Salmonella (Pasta Salad) August 2018: Multistate (15) Outbreak of Cyclosporiasis (McDonalds) July 2018: Multistate (26) Outbreak of Salmonella (Ground Turkey) July 2018: Multistate (4) Outbreak of Vibrio parahaemolyticus (Crab meat) June 2018: Multistate (33) Outbreak of Salmonella (Honey Smacks) June 2018: Multistate (9) Outbreak of Salmonella (Pre-cut melon) June 2018: Multistate (44) Outbreak of Salmonella (Live poultry) Multistate (10) Outbreak

• f Hepatitis A

Hepatitis A Outbreak Continues in Multiple States Across the U.S.

• CDC and state health departments continue to investigate HAV outbreaks in

multiple states among persons reporting injection drug use and/or experiencing homelessness and their contacts.

• Colorado returned back to baseline rates of reported hepatitis A cases in November

2017 (~30/year).

• Eight cases of hepatitis A have been reported in Colorado in 2018; and one

case was both experiencing homelessness and reported injection drug use.

• No cases have been reported in Boulder County in 2018.
• BCPH continues to provide the Hepatitis A vaccines at the Boulder Shelter and at

BCPH- walk-in, appointment and during regular clinic hours.

Enterovirus A71 (EV-A71) Update

• CDPHE continues to investigate a number of cases of neurologic

disease (meningitis, encephalitis, acute flaccid myelitis) associated with enterovirus A71 (EV-A71) infection in children.

• Cases are all under age 3 years with no underlying medical
• conditions. Symptoms include fever, irritability, myoclonus, ataxia,

rash, weakness, vomiting, and diarrhea.

• Consider collecting throat, rectum and cerebrospinal fluid (CSF)

samples from children with aseptic meningitis, encephalitis, or

• ther central nervous system infections for enteroviral PCR testing.

– EV-A71 is often not detected by PCR in CSF, so CDPHE recommends simultaneous testing from all three sites.

• Please report all cases of meningitis, encephalitis, AFM, or other

neurologic complications in patients who test positive for enterovirus to CDPHE.

Antibiotic Resistant Bacteria Surveillance Updates

Recent carbapenem-resistant bacteria surveillance changes

November 2012: Carbapenem-resistant Enterobacteriaceae (CRE) statewide lab reportable condition Carbapenem-resistant Acinetobacter baummannii (CRAB) reportable in the 5-county Denver metro area November 2015: Carbapenem-resistant Pseudomonas aeruginosisa (CRPA) statewide lab reportable condition January 2016: CRE definition change July 2018: Additional CRE

• rganisms: Citrobacter,

Serratia, Raoultella, Proteus, Providencia, and Morganella; AND carbapenemase- producing CRE (CP-CRE)

• f any genus/species

reportable

Extended-spectrum beta-lactamases (ESBLs) Surveillance in Boulder

• ESBLs are enzymes that mediate resistance to

extended-spectrum (third generation) cephalosporins (e.g., cefotaxime, ceftriaxone) and monobactams (e.g., aztreonam) but do not affect cephamycins (e.g., cefoxitin and cefotetan) or carbapenems (e.g., meropenem

• r imipenem).
• ESBLs became reportable in Boulder County

starting July 15, 2018.

Antimicrobial Stewardship

• The first Colorado Antibiogram is nearly

complete.

– Publically available tool of antibiotic stewardship that will inform population level antibiotic stewardship strategy – Summary of susceptibility of bacteria cultured from clinical specimens in 2016 – Data pooled from antibiogram of individual hospitals (N=66), skilled nursing (n=86), and assisted living facilities (n=170)

Questions?