This Health Advisory serves as a reminder to all healthcare providers and laboratorians to report outbreaks, communicable diseases, and unusual conditions or emerging infectious diseases during the National Boy Scout Jamboree as required by the West Virginia Legislative Rule for Reportable Diseases, Events and Conditions (64CSR7). West Virginia will host the 2017 National Boy Scout Jamboree from July 19-28, 2017 at the Summit Bechtel Family National Scout Reserve in Mount Hope, West Virginia
HEALTH ADVISORY #137 Legionnaire’s Disease in West Virginia
During the months of May and June 2017, West Virginia experienced more cases than expected of Legionnaire’s Disease (Legionella pneumonia).
Patients Receiving Eculizumab (Soliris®) at High Risk for Invasive Meningococcal Disease Despite Vaccination
Summary
Eculizumab (Soliris®) recipients have a 1,000 to 2,000-fold greater risk of invasive meningococcal disease compared to the general U.S. population. The Food and Drug Administration (FDA)-approved prescribing information for eculizumab includes a black box warning for increased risk of meningococcal disease, and the Advisory Committee on Immunization Practices (ACIP) recommends meningococcal vaccination for all patients receiving eculizumab. Recent data show that some patients receiving eculizumab who were vaccinated with the recommended meningococcal vaccines still developed meningococcal disease, most often from nongroupable Neisseria meningitidis, which rarely causes invasive disease in healthy individuals.
Potential for Falsely Low Blood Lead Test Results from LeadCare Analyzers
Children are particularly vulnerable to lead exposure due to the effect on their developing brains and organ systems. The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are warning Americans that certain lead tests manufactured by Magellan Diagnostics may provide inaccurate results for some children and adults in the United States. FDA is now warning that M age llan Dia gn ostics’ Le adC are® ana l yzer s (LeadCare, LeadCare II, LeadCare Ultra and LeadCare Plus) should no longer be used with venous blood samples due to the potential for falsely low test results.
Potential for Falsely Low Blood Lead Test Results from LeadCare® Analyzers
The U.S. Food and Drug Administration (FDA) has issued a safety communication warning about the use of Magellan Diagnostics’ LeadCare® analyzers (LeadCare, LeadCare II, LeadCare Ultra and LeadCare Plus) with venous blood samples because they might result in falsely low test results. FDA is now advising that Magellan Diagnostics’ LeadCare® analyzers should no longer be used with venous blood samples. The safety alert does not apply to capillary blood lead test results collected by fingerstick or heelstick. The purpose of this Health Advisory is to notify state and local health departments, healthcare providers, and laboratories about CDC’s re-testing guidance in light of the safety alert.
Mosquito-Borne Disease Season
Mosquito-borne diseases occur annually in West Virginia beginning in early spring and peaking in August and September, coinciding with mosquito activity. Arboviral infections, particularly La Crosse encephalitis (LAC) and West Nile virus (WNV), are endemic mosquito-borne diseases identified in West Virginia. In 2016, eight LAC cases and one WNV case were reported in West Virginia. Persons with severe arboviral infections will often have symptoms of encephalitis. Please be vigilant in identifying such cases, and ensure that all hospitalized patients with encephalitis undergo appropriate arboviral disease testing during mosquito 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.
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