January 4, 2017
- Influenza update
- Mumps update
- Expanded surveillance for multi-drug resistant organisms
Action requested: Anticipate increased demand for management of influenza.
Background & Recommendations
The number of cases of influenza has reached epidemic levels statewide. As of 12/31/16, Snohomish County had witnessed dramatic increases in cases hospitalized (111), outbreaks in long term care facilities (10), and deaths (4). The spike in reported cases is earlier than we experienced during the 2014-2015 season and the week’s numbers are already higher than for any week during the past three seasons. Outpatient testing for influenza is also running high at The Everett Clinic, with more than half of influenza tests being positive. This is proving to be a relatively severe season, placing high demand on hospitals (already over capacity), clinics, and the emergency medical system (which is backing up when bringing patients to emergency departments). Please discourage patients from going to the emergency department or calling 911 except for true emergencies. Everyone needs to wash hands frequently, cover coughs, stay home if ill, and get vaccinated!
For detailed clinical guidance on testing, use of antiviral drugs, and vaccine recommendations, see https://www.cdc.gov/flu/professionals/index.htm.
Action requested: Be aware that mumps continues to be reported in the state.
Background & Recommendations
Mumps continues to rise across the U.S. and our region. As of December 3, 46 states and the District of Columbia had reported 4258 cases to the Centers for Disease Control & Prevention, the highest number since 2006. As of January 3, 139 cases had been reported in Washington State, with another 62 under investigation. Most (117) cases have been in King County, with the rest in Pierce (12), Spokane (9), and Yakima (1) counties. More than 2/3 of cases are under age 20 and ¾ of cases are part of or have had close contact with someone in the Marshallese Islander community. Most have been vaccinated, raising concern about waning immunity. However, at this time, additional vaccination is not recommended. Please refer to my health alert of 12/14/16 for guidance about testing if you suspect mumps.
Expanded surveillance for multi-drug resistant organisms
Action requested: Submit to the state laboratory specimens of select multi-drug resistant organisms.
Emerging mechanisms of antibiotic resistance are a serious threat to health. Recent reports of plasmid-mediated colistin-resistant E. coli and multidrug resistant Candida auris has prompted the Centers for Disease Control & Prevention to request that these organisms be reported to public health. The Washington State Department of Health has conducted surveillance for carbapenem-resistant E. coli since October 2012 and receives approximately 15-30 isolates for resistance testing each month, of which 12% produce a carbapenemase (for details, see http://www.doh.wa.gov/DataandStatisticalReports/DiseasesandChronicConditions/CommunicableDiseaseSurveillanceData/CRESurveillance). Washington surveillance has also identified several Pseudomonas and Acinetobacter isolates with carbapenemase genes, including in 2 residents of long term care without any international travel. Consequently, the Department of Health is initiating sentinel surveillance for CR-Pseudomonas and CR-Acinetobacter in order to estimate the prevalence of carbapenemase genes in these isolates and to identify patients who require additional infection precautions. The Washington State Public Health Laboratory recently communicated with Washington clinical labs about the new multi-drug resistant organism surveillance and will be contacting select labs directly to request that they serve as sentinel labs for the CR-Pseudomonas and CR-Acinetobacter surveillance (sentinel laboratories will be asked to submit a subset of more common isolates such as CR- Pseudomonas species).
Report to the Health District (425-339-5278) confirmed plasmid-mediated colistin resistance or carbapenemase production in E. coli, Klebsiella, Enterobacter, Pseudomonas, or Acinetobacter. Continue to submit to the Washington State Public Health Laboratory carbapenem-resistant Enterobacteriaceae and also submit:
- Carbapenem-resistant (CR) Pseudomonas species and CR-Acinetobacter species
- Colistin-resistant E. coli, Klebsiella, Enterobacter, Pseudomonas, and Acinetobacter species
- Unusual Candida species, e.g., C. auris, C. glabrata, C. haemulonii, and any Candida not identified when species identification is performed (i.e., not in laboratory database)
Use Standard and Contact precautions for patients infected or colonized with these organisms and ensure appropriate daily as well as terminal cleaning and disinfection of the patient’s room.
You can find my recent health alerts posted on the Provider pages of our website, at http://www.snohd.org/Providers/Health-Alerts.
Gary Goldbaum, MD, MPH | Health Officer & Director | Administration
3020 Rucker Avenue, Ste 306 | Everett, WA 98201 | 425.339.5210 | firstname.lastname@example.org