Virginia Secure Commonwealth Panel Health and Human Resources

Virginia Secure Commonwealth Panel Health and Human Resources Subpanel December 13, 2016 Epidemiology Updates Zika status update Hepatitis A Outbreak Influenza General Zika Virus Updates On November 18, 2016, the World Health Organization declared the end of the Public Health Emergency of International Concern stating that Zika remains a significant enduring public health challenge requiring intense action. As of December 7, 2016, there have been 4,575 cases of Zika virus disease in the United States and DC. there has been one case of locally acquired Zika virus disease

reported in Texas. All other locally acquired cases (N=184) have been reported in Florida. Zika Virus Updates in Virginia Virginias local health districts ceased targeted mosquito surveillance for Zika virus on October 31, 2016. On November 30, 2016, the Virginia Department of Health adopted CDCs new definition of Zika virus disease cases. Zika Virus Clinician Forum scheduled for May 2017 Continued response efforts to focus on Pregnancy registry coordination Infant testing criteria Travelers going to Zika-affected areas Testing Virginia Residents for Zika Virus 2,022 Virginia Residents being Tested for Zika Virus

Infection between 1/29/2016 and 12/03/2016* Virginia Residents being Tested by Region Disease Case Status Num % Confirmed/Probable Case 105 5 1,645 81

272 13 Not a case 3.56% 8.95% 15.38% Test results pending Central 14.74% 57.37% Eastern Sex and Pregnancy Status

Num % Northern Male Northwes t 239 12 Female 1,783 88

1,548 87 235 13 Southwes t Pregnant Non-pregnant * This excludes 76 (4%) Virginia residents who were approved for, but then declined testing Disease case status is based on 2016 CDC/CSTE Zika Virus Disease and Zika Virus Infection Case Definition If pregnancy status was unknown, then pregnancy status was classified as non-pregnant.

Mosquito Surveillance and Testing Figure 1: Zika Virus Testing in Mosquitoes by Jurisdiction Updated: December 12, 2016 County/City Accomack Co. Alexandria Chesapeake Chesterfield Co. Fairfax Co. Hampton Hanover Co. Henrico Co. Newport News Norfolk Northampton Co. Orange Co. Portsmouth Prince William Co. Richmond City

Suffolk Virginia Beach Winchester York Co. Total Ae. albopictus tested Total Pools Tested 3 272 98 18 529 72 2 144 38 135 1

2 19 201 29 146 111 1 37 1,858 Total Mosquitoes Zika Positive Tested Pools 103 0 7,814 0 3,675 0 770

0 13,994 0 2,571 0 58 0 6,454 0 1,512 0 5,582 0 25 0 66 0 745 0 8,130

0 1,223 0 7,151 0 3,676 0 28 0 1,158 0 64,735 0 0 64,735 Zika positive Aedes albopictus pools

Total Aedes albopictus tested Figure 2: Mosquito Surveillance Conducted for Flagged Cases 06/01/2016 - 10/31/2016 54% 46% Yes No Zika Planning-Epidemiology Web-based testing approval tool Data management, reclassification of cases Planning for Summer 2017 (Mosquito Season) Virginia Zika Task Force

November 30, 2016 Office of the Governor Commissioner VDH Virginia Zika Task Force VDEM Clinician Outreach Task Group Governors Office Representative VDH OEP Communications Task Group Human

Surveillance Task Group Lead: VDH OEPI LEGEND: BHDS: Virginia Department of Behavioral Health and Developmental Services DCLS: Division of Consolidated Laboratory Services DCR: Virginia Department of Conservation and Recreation DGS: Virginia Department of General Services DOE: Virginia Department of Education DVS: Virginia Department of Veterans Services OEP: Office of Emergency Preparedness OEPI: Office of Epidemiology ORCE: Office of Risk Communications and Education SCHEV: State Council of Higher Education for Virginia VACO: Virginia Association of Counties VCU Health: Virginia Commonwealth University Medical Center VDEM: Virginia Department of Emergency Management

VDH: Virginia Department of Health VDOF: Virginia Department of Forestry VDGIF: Virginia Department of Games and Inland Fisheries VHHA: Virginia Hospital and Healthcare Association VML: Virginia Municipal League Mosquito Control Task Group Blood/Tissue Safety Task Group Others DVS Lead: VDH ORCE

Input from all Task Groups Maternity Health Task Group Lt. Governors Office Representative DGS DCLS Lead: VDH OEPI VDH Office of Family Health Services Lead: Virginia Mosquito Control

Association Lead: American Red Cross Virginia Blood Services VDACS VDH OEPI DGS VDGIF VDOF DCR DBHDS

DOE SCHEV VHHA MSV VACO State agency Private Sector Non-governmental organization VML HEPATITIS A OUTBREAK Hepatitis A Outbreak Associated with Smoothies

70 cases as of 9/6/2016; 39 Northern, 10 Northwest, 14 Eastern, 7 Central, 0 Southwest Investigation Steps Case reporting and interviews Confirmation of smoothie exposure and description of ingredients from each person Collaborations: within VDH (epidemiology, environmental health, risk communication, districts), with VDACS on product identification and withdrawal and with DCLS on specimens, with CDC on outbreak tracking and with FDA on product tracing and food testing (no positive food yet) with the corporation on locations and recommendations Influenza Influenza-Laboratory Data

Enhanced Surveillance Acknowledgements Zika Epidemiology Team Foodborne Disease Team Influenza Surveillance Epidemiologist District and Regional Epidemiologists Addiction in Virginia Public Health Perspective What Public Health Data is Available? VDH: Overdose Death Data (OCME) Syndromic Surveillance Data

Naloxone Administration Data (OEMS) Reportable Disease Surveillance Data (e.g., Hepatitis C, HIV) Other Agencies/Sources: Substance Abuse Treatment Admission Data Hospital Discharge Data All Payers Claims Database (APCD) Total Number of Prescription Opioid (Excluding Fentanyl), Fentanyl, and/or Heroin, and All Opioid Overdoses by Year of Death, 2007-2016 Number of Fatalities 1100 1000 + 25.2% 900 800 700

600 + 47.0% All Opioids 500 400 Rx Opioid (excluding Fentanyl) 300 200 Fentanyl and/or Heroin 100 0 2007

2008 2009 2010 2011 2012 2013 2014 2015 2016* FIGURE 2. Percentage of all admissions to substance abuse treatment centers by

persons aged 1229 years (N = 217,789) attributed to the use of opioids, prescription opioids, and heroin, by year Kentucky, Tennessee, Virginia, and West Virginia, 20062012 MMWR Weekly: Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged 30 Years Kentucky, Tennessee, Virginia, and West Virginia, 20062012 Weekly: May 8, 2015 / 64(17);453-458 Incidence of acute hepatitis C among persons aged 30 years, by urbanicity and year Kentucky, Tennessee, Virginia, and West Virginia, 20062012 MMWR Weekly: Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged 30 Years Kentucky, Tennessee, Virginia, and West Virginia, 20062012 Weekly: May 8, 2015 / 64(17);453-458 Percent of reported hepatitis C occurring in individuals under 30 years of age (VEDSS) Reported hepatitis C per 100,000* *This map excludes results from hepatitis C testing performed at correctional facilities to prevent false clustering of cases.

Incarcerated individuals are not included in census population data for the counties where correctional facilities are located. Trends in hepatitis C in the incarcerated population are described separately Addiction: A Public Health Response Health Departments Response Primary: Declaration of a Public Health Emergency Secondary: Addiction Disease Management Sessions Tertiary: Naloxone Standing Order Surveillance of adverse health impacts of opioid addiction: Death, Injury due to Overdose, Hepatitis B and C infections, HIV Draft legislative proposal to establish Syringe Services Programs as part of comprehensive harm reduction

VDH Addiction IMT 12/12/2016 (rev 2) Incident Commander Dr. Marissa Levine PIO Maribeth Brewster Liaison Officer Joe Hilbert T F Liaison External Partners VSP, VDEM, DBHDS, VDSS Planning Chief Bob Mauskapf Operations Chief

Dr. Hughes Melton Exercise Branch Suzi Silverstein D Access/Functional Needs Planning Ofc of Health Equity (Dr.Adrienne McFadden) Primary Prevention Branch Lead: OFHS (Dr. Vanessa Walker Harris) Training Lisa Wooten Education Carole Pratt

A R Data and Intelligence Branch Dr. Laurie Forlano Disease/ED Data CHS Branch Bob Hicks 35 Local Health District Directors Secondary Prevention Branch Lead: EMS (Gary Brown) Hospital/Medical Community Kelly Parker Death Data

OCME EMS/Naloxone Data OEMS National Abstinence/ PMP Data OFHS Tertiary Prevention Branch Lead: OEPI (TBD) DDP (Diana Jordan, RN) Administration/Logistics/Finance Chief Richard Corrigan HR Rebecca Bynum IT Debbie

Condrey Finance Beth Franklin Procurement/ General Services Steve VonCanon Regional Response Branch Lead: CHS/OEP Executive Leadership Team Focuses on: resources, legislation, policy, budget, regulations, communications Co-Chairs: Secretary of Health &Human Resources William A. Hazel, Jr., MD Secretary of Public Safety & Homeland Security Brian J. Moran Coordinators: Victoria Cochran & Jodi Manz Public Safety: DCJS, DFS, VSP HHR: DBHDS, VDH, DMAS, DHP Other: DVS, DOE, SCHEV

Overview State Support Action Group Focuses on: situational awareness and recommendation development Leadership: Shannon Dion, DCJS, and Holly Morlock, DBHDS Agency membership: DBHDS, DHP, DMAS, VDH, DSS Primary Prevention / Interdiction prevent the onset of addiction Lead: DCJS Tertiary Prevention /Rehabilitation address the consequences Lead: VDH Secondary Prevention

/Incapacitation address addiction directly Lead: DBHDS Data and Surveillance Action Group Lead: VSP/Fusion Center Local Support Action Group Focuses on: Dissemination of information and assisting local communities Leadership: Major Gary Settle, VSP, and Hughes Melton, VDH Staff: Carole Pratt, VDH Agency Membership: VDH, DBHDS (CSBs), DSS, VDEM, DCJS, VSP, DJJ, DOE, SCHEV VSP Region 1 Lead:

Coalition 1: Coalition 2: Etc VSP Region 2 Lead: VSP Region 4 Lead: VSP Region 3 Lead: VSP Region 6 Lead: VSP Region 5 Lead: VSP Region 7

Lead: 33 Thank you

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