Developed as a primary method to share information with federal, state, territorial, and local public health practitioners, clinicians, and public health laboratories, CDC’s Health Alert Network (HAN) is the primary method to share information on urgent public health incidents. The State of West Virginia has a similar system (WV-HAN) designed to share information on urgent public health incidents specific to West Virginia as well.
Below you will find information on the latest Health Alerts, both nationally and specific to West Virginia, as they occur.
HEALTH ADVISORY #159 Vector-borne Disease Season
With the spring season comes an increase in mosquito and tick activity in West Virginia. Vector-borne diseases occur annually beginning in early spring and peaking in August and September when people and arthropod vectors are most active outdoors. Health providers can educate patients on preventive measures, including use of recommended insect repellents with DEET and permethrin, to prevent bites and control diseases spread by mosquitoes and ticks.
HEALTH ADVISORY #157 Measles
The Centers for Disease Control and Prevention (CDC) has identified an increased number of measles cases and outbreaks in the United States since January 1, 2019. The last case of measles reported in West Virginia was in 2009 following international travel. Clinicians are encouraged to continue vigilance for cases of measles among all age groups and to report suspected cases of measles immediately to their local health department (LHD) as per the West Virginia Reportable Disease Rule (64 CSR 7). Additionally, clinicians should take this opportunity to ensure patients are up-to-date on measles vaccination (MMR). MMR information can be found at https://www.cdc.gov/vaccines/vpd/measles/index.html.
HEALTH ADVISORY #155 Increase in New HIV infections Among Persons Who Inject Drugs
The West Virginia Bureau for Public Health is investigating an increase in newly diagnosed human immunodeficiency virus (HIV) cases in the state among persons who inject drugs (PWID). Historically, male-to-male sexual contact has been the predominant reported risk factor for becoming infected with HIV. Since 2018, we have seen an increase in the number of newly diagnosed cases of HIV with injection drug use (IDU) reported as a risk factor statewide.
Continue Reading Here
Update—Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use
The Centers for Disease Control and Prevention (CDC) is providing information on: 1) the current status of a multistate outbreak of coagulopathy from exposure to synthetic cannabinoid products containing a vitamin K-epoxide cycle antagonist, brodifacoum; 2) the emergence of 2 new clinical scenarios; and 3) recommendations to help clinicians make decisions related to these 2 new clinical scenarios.
This is an update to the Health Alert Network (HAN) advisory released on May 25, 2018 titled Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use (https://emergency.cdc.gov/han/han00410.asp).
HEALTH ADVISORY #153 Update on Supply of Hepatitis A Vaccine, Prioritization for State- Supplied Vaccine, and Clinical Considerations
The supply of adult hepatitis A vaccine continues to be constrained nationally due to the hepatitis A outbreak among adults in several states resulting in substantially increased demand for adult hepatitis A vaccine. There are, however, adequate supplies of the pediatric formulation of hepatitis A vaccine, so routine vaccination of all children is strongly encouraged to prevent transmission of hepatitis A virus (HAV) to children.
Continue Reading Here
HEALTH ADVISORY #152 Cluster of Legionnaire’s Disease in Northern Panhandle
Since late September 2018, six (6) cases of confirmed Legionella pneumonia (also known as Legionnaire’s Disease) have been reported among persons that work at a facility in the Northern Panhandle. These cases are tightly clustered in time and there may be potentially associated cases that have not yet been identified. To date, the common occupational exposure remains the only epidemiologic link between cases. Federal, state and local public health officials are closely working to identify potential sources of exposure and to mitigate risk of additional cases.
HEALTH ADVISORY #151 Influenza Season 2018-2019
September 30, 2018 officially began the 2018-2019 influenza season. Since the 2017-2018 influenza season was one of the most severe seen in several years, it is important to be prepared for the upcoming season. The West Virginia Bureau for Public Health would like to remind stakeholders of the mandatory reporting requirements for the 2018-2019 season.
Continue Reading Here
HEALTH ADVISORY #150 Vigilance for Cases of Acute Flaccid Myelitis
Since acute flaccid myelitis (AFM) was first recognized in the United States in 2014, only two confirmed cases have been reported in West Virginia (both in 2016). Though no cases have been reported since then, healthcare providers are encouraged to continue vigilance for cases of AFM among all age groups and report suspected cases of AFM to their local health department (LHD) as per the WV Reportable Disease Rule (64 CSR 7).
AFM is characterized by a sudden onset of weakness in one or more limbs following a respiratory or febrile illness. Magnetic resonance imaging (MRI) reveals distinct abnormalities of the spinal cord gray matter.
Advice to Clinicians about Leptospirosis in U.S. Travelers Returning from Northern Israel
The Israeli Ministry of Health is reporting an outbreak of leptospirosis in persons with exposure to natural water sources in the Golan Heights region of northern Israel after July 1, 2018. As of September 6, 2018, three persons with leptospirosis who traveled to Israel have been identified in the United States, with additional suspected cases reported and under investigation. Early symptoms of leptospirosis include fever, headache, chills, muscle aches, vomiting, diarrhea, cough, conjunctival suffusion (conjunctival redness without exudates), jaundice, and sometimes a rash. Clinicians should consider leptospirosis as a diagnosis in any patient who develops an acute febrile illness within 4 weeks of travel to one of the areas in northern Israel listed below since July 1, 2018.
HEALTH ADVISORY #149 Information for Healthcare Providers and Emergency Departments on the Hepatitis A Outbreak
The West Virginia Bureau for Public Health (BPH) continues to investigate cases of hepatitis A as part of the multi-state outbreak that is occurring nationally. Persons who use injection and non-injection drugs, persons with unstable housing or are homeless, persons with recent history of incarceration, and men who have sex with men (MSM) are at considerable risk for infection. There is continued transmission of hepatitis A in West Virginia due to increasing case counts and the long incubation period of the disease.
Suggestions offered for dealing with mosquito-borne illnesses
As summer takes hold, residents are becoming more concerned about the annual mosquito-borne illness problem. According to Christina Hinkle, RN, Kanawha-Charleston Health Department’s director of clinic services, “West Nile virus is a mosquito-borne illness that causes no symptoms in approximately 80 percent of the people who are infected.”
As many as 20 percent of those infected with West Nile virus will have symptoms including body aches, fever, headaches, nausea, vomiting and sometimes swollen lymph glands or skin rashes on the stomach or back. About 1 in 150 people develop more severe illnesses that may cause neurological impairment.
HEALTH ADVISORY #148 Voluntary NonOpioid Advanced Directive
The purpose of this Health Advisory is to provide guidance regarding the Voluntary NonOpioid Advanced Directive (VNOAD) form as established in Senate Bill 273, the Opioid Reduction Act of 2017 (“Act”), specifically W.Va. Code §16-54-2.
HEALTH ADVISORY #147 Update on the Multi-State Hepatitis A Outbreak
As of June 8, 2018, West Virginia has identified 203 cases from 11 counties. Most cases have been reported from Cabell, Kanawha, and Putnam counties. Hospitalization remains high at about 70%. BPH is working closely with local health departments to obtain the most complete epidemiologic data available on cases to prevent secondary cases among close contacts. Vaccination of high-risk groups continues to be an important strategy in preventing new cases. In early June, BPH collaborated with the Regional Jail Authority to vaccinate inmates at the Western and Southcentral Regional Jails
PCHD offers warm weather guidance
“Now is the time to prepare for hot temperatures that bring illness and even death every year,” according to Christina Hinkle, director of clinic services, at the Kanawha-Charleston Health Department and the Putnam County Health Department.
“Take measures to stay cool. Remain hydrated and keep informed. Getting too hot can make you sick. You can become ill from the heat if your body can’t compensate for it and properly cool you off,” Hinkle said.
HEALTH ADVISORY #142 Vigilance for Cases of Acute Flaccid Myelitis
Since acute flaccid myelitis (AFM) was first recognized in the United States in 2014, only two confirmed cases have been reported in West Virginia (both in 2016). Though no cases have been reported in 2017, healthcare providers are encouraged to continue vigilance for cases of AFM among all age groups and report suspected cases of AFM to their local health departments. Reporting of cases will help public health monitor the occurrence of AFM to better understand factors associated with this illness.
HEALTH ADVISORY #143 Widespread Influenza Activity and Severity in West Virginia
Influenza activity has increased significantly in the United States in recent weeks. West Virginia is characterized as having widespread activity. This influenza season is notable for the sheer volume of ill cases that has caused stress to health systems. The Centers for Disease Control and Prevention (CDC) released a Health Advisory (https://emergency.cdc.gov/han/han00409.asp) that warned of a high-severity influenza A (H3N2) season and resulting clinical implications. As of January 6, 2018, 20 pediatric influenza deaths were reported nationally, none in West Virginia.
HEALTH ADVISORY #141 Dramatic Increase in Lyme Disease Cases
West Virginia will report the highest number of Lyme disease cases on record in 2017. As of November 8, 2017, 571 confirmed and probable Lyme disease cases have been reported compared to the previous record of 368 cases in 2016. The geographic distribution of cases has also increased. As of November 8, 2017, 45 counties have reported at least one confirmed or probable Lyme disease case, up from 11 counties in 2012. This increase could be the result of increased reporting, increase in the number of Ixodes scapularis ticks infected with Borrelia burgdorferi in West Virginia, or a recent change in the national surveillance case definition for Lyme disease. Based on the change, West Virginia is considered a high incidence Lyme disease state, and the presence of an erythema migrans (EM) with known exposure in the state is sufficient for a patient to be classified as a confirmed surveillance case.
Advice for Health Care Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.
Rifampin/Penicillin-Resistant Strain of RB51 Brucella Contracted from Consumption of Raw Milk
The Texas Department of State Health Services, with assistance from CDC, is investigating Brucella RB51 exposures and illnesses that may be connected to the purchase and consumption of raw (unpasteurized) milk from K-Bar Dairy in Paradise, Texas. Symptoms of brucellosis can include: fever, sweats, malaise, anorexia, headache, fatigue, muscle & joint pain, and potentially more serious complications (e.g., swelling of heart, liver, or spleen, neurologic symptoms).
Hurricane Harvey – Clinical Guidance for Carbon Monoxide (CO) Poisoning
Carbon monoxide (CO) is an odorless, colorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air. During a significant power outage, persons using alternative fuel or power sources such as generators or gasoline powered engine tools such as pressure washers might be exposed to toxic CO levels if the fuel or power sources are placed inside or too close to the exterior of the building causing CO to build up in the structure. The purpose of this HAN advisory is to remind clinicians evaluating persons affected by the storm to maintain a high index of suspicion for CO poisoning. Clinicians are advised to consider CO exposure and take steps to discontinue exposure to CO. Clinicians are also advised to ask a patient with CO poisoning about other people who may be exposed to the same CO exposure, such as persons living with or visiting them so they may be treated for possible CO poisoning.
Increase in West Nile Virus Activity in Mosquitoes
Based on data collected from May 24, 2017 to July 26, 2017, the West Virginia Department of Health and Human Resources, Bureau for Public Health Mosquito Surveillance Program is reporting several West Nile virus (WNV) positive mosquito pools across West Virginia with the greatest number of infected mosquitoes from Cabell County. WNV positive mosquito pools have also been detected in Berkeley, Fayette, Kanawha, Putnam, Wayne, Wetzel, and Wood counties this season.
Prolonged IgM Antibody Response in People Infected with Zika Virus: Implications for Interpreting Serologic Testing Results for Pregnant Women
In July 2016, CDC issued Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States, July 2016 (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm) that includes Zika virus immunoglobulin M (IgM) testing of pregnant women. However, some flavivirus infections can result in prolonged IgM responses (>12 weeks) that make it difficult to determine the timing of infection, especially in testing of asymptomatic people. Emerging epidemiologic and laboratory data indicate that Zika virus IgM can persist beyond 12 weeks in a subset of infected people. Therefore, detection of IgM may not always indicate a recent infection. Although IgM persistence could affect IgM test interpretation for all infected people, it would have the greatest effect on clinical management of pregnant women with a history of living in or traveling to areas with Zika virus transmission. Pregnant women who test positive for IgM antibody may have been infected with Zika virus and developed an IgM response before conception.
Tickborne Disease Season
Tickborne diseases occur annually in West Virginia with most cases developing symptoms between April and September. Lyme disease is the most commonly reported tickborne disease in West Virginia. In 2016, West Virginia recorded 368 Lyme disease cases, the most ever in a single year. Counties in the northwestern and southwestern parts of the state have had increasing case counts in recent years. In 2016, 43 counties reported at least one confirmed or probable Lyme disease case. Based on new national reporting standards, West Virginia is considered a high incidence Lyme disease state.
CDC Recommendations for Diagnosing and Managing Shigella Strains with Possible Reduced Susceptibility to Ciprofloxacin
This Health Advisory describes the identification of emerging Shigella strains with elevated minimum inhibitory concentration values for ciprofloxacin and outlines new recommendations for clinical diagnosis, management, and reporting, as well as new recommendations for laboratories and public health officials. Current interpretive criteria provided by the Clinical and Laboratory Standards Institute (CLSI) categorize these strains as susceptible to ciprofloxacin, which is a fluoroquinolone antibiotic and a key agent in the management of Shigella infections.
Increased Screening Recommendations for HIV Outbreak Detection Among Persons Who Inject Drugs
The epidemic of non-prescription opioid addiction has led to an increase in injection drug use, hepatitis C virus (HCV) infections, and hepatitis B virus (HBV) infections in West Virginia. Though West Virginia is a low incidence state for human immunodeficiency virus (HIV) infections, several counties have been deemed at high-risk for an HIV outbreak similar to the one in Scott County, Indiana in 2015 predominantly among people who inject drugs (PWID). In order to detect an outbreak of HIV among PWID, increased screening is necessary.