Health Update: Reporting guidelines changed for vaping-associated lung injury

The Centers for Disease Control and Prevention (CDC) and public health agencies in Washington State continue to investigate a multi-state outbreak of vaping-associated lung injury. The latest information about the outbreak can be found on the CDC and Department of Health websites. 

Symptoms

Patients in this investigation have reported symptoms such as cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever, and/or abdominal pain. Some patients have reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks.

Healthcare providers should ask patients presenting with the above symptoms whether they have vaped or dabbed in the past 90 days.

Reporting Cases to Public Health

Healthcare providers are required to report cases of vaping-associated lung injury to their local health department within 3 days. Please report patients who meet the following criteria.

Any hospitalized patient who:

Reports vaping or dabbing in the 90 days prior to symptom onset

AND

Has a chest X-ray with pulmonary infiltrates or a chest CT scan with ground-glass opacities

AND

Has no pulmonary infection (i.e., negative respiratory viral panel, negative flu test, and other clinically-indicated respiratory infectious disease testing negative) or an infection has been identified, but you feel this is not the sole cause of the lung injury or complete infectious disease testing was not performed, but you feel an infection is not the sole cause of the lung injury

AND

There is no other alternative plausible diagnosis such as a cardiac, rheumatologic no neoplastic process.

 For more information, see the full CDC case definition.

Healthcare providers and healthcare facilities are required to report vaping-associated lung injury per an emergency rule passed by the State Board of Health on October 9th and, as a  rare disease of public health significance, per WAC 246-101-101 and WAC 246-101-301.

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Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Advisory: Severe pulmonary disease associated with using e-cigarette products

There are no confirmed or suspect cases pulmonary disease associated with using e-cigarette products in Grays Harbor County.

215 cases have been reported to the Center of Disease Control and Prevention from 25 states and others are under investigation.  E-cigarettes typically contain nicotine, most also contain flavorings and other chemicals, and some may contain marijuana or other substances. They are known by many different names and come in many shapes, sizes and device types. Devices may be referred to as “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” “mods,” “tanks,” or electronic nicotine delivery systems (ENDS). Some e-cigarette devices resemble other tobacco products such as cigarettes; some resemble ordinary household items such as USB flash drives, pens, and flashlights; and others have unique shapes. Use of e-cigarettes is sometimes referred to as “vaping” or “juuling.” E-cigarettes used for dabbing are sometimes called “dab” pens. 

 Recommendation for clinicians :

1. Report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days to your state health department. Reporting of cases may help CDC and state health departments determine the cause or causes of these pulmonary illnesses. (Hospitals only)

2. Ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness.

3. If e-cigarette product use is suspected as a possible etiology of a patient’s severe pulmonary disease, obtain detailed history.

4. Determine if any remaining product, including devices and liquids, are available for testing. Testing can be coordinated with the state health departments.

 Recommendation for the public :

1. While this investigation is ongoing, if you are concerned about the risks, stop using e-cigarette products.

2. Regardless of the ongoing investigation, e-cigarette products should not be used by youth, young adults, pregnant women, as well as adults who do not currently use tobacco products. 

3. If you are concerned about harmful effects from e-cigarette products, call your local poison control center at: 1-800-222-1222.

4. We encourage the public to submit detailed reports of any unexpected tobacco or e-cigarette-related health or product issues to the FDA via the online Safety Reporting Portal: https://www.safetyreporting.hhs.gov. 

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Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Update: New measles outbreak has 7 confirmed cases in WA State

King County has 4 cases,  Pierce County has 2 cases and Snohomish County has 1 case.  All cases were present at SeaTac International Airport on 4/25/2019.  You can view other exposure sites and dates at www.doh.wa.gov.

There are no confirmed or suspect cases of measles in Grays Harbor County. Most people in Grays Harbor County have immunity to measles through vaccination, so the risk to the general public is low.  People at highest risk from exposure to measles include those who are unvaccinated, pregnant women, infants under twelve months of age and those with weakened immune systems.

A person is considered immune to measles if any of the following apply:

· You were born before 1957

· You are certain you had the measles

· You are up-to-date on measles vaccines (1 dose age 1-3 years, 2 doses age 4 years & up.)

Testing for immunity after MMR vaccination is not routinely recommended.

 Please consider measles in patients who :

1. Present with febrile rash illness and the “three Cs”: cough, coryza, or conjunctivitis.

2. Recently traveled internationally or potentially exposed to someone with measles.

If you suspect measles, immediately mask and isolate patients to avoid disease transmission  and contact Grays Harbor County Public County Health to arrange for testing.

Grays Harbor County Public Health does not provide measles immunizations or testing for immunity.

We have developed a Q & A document in response to community concerns about measles.  Please let us know if you hear commonly asked questions or concerns that would be helpful to include in the  Q & A document.  As always, we are available to discuss any questions about measles diagnosis or testing requirements.

Due to the current increase in measles cases in the United States (https://www.cdc.gov/mmwr/volumes/68/wr/mm6817e1.htm), the Centers for Disease Control and Prevention has developed a summary for vaccination of adults against measles with measles, mumps, rubella (MMR) vaccine.

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Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Advisory: Measles case confirmed in Pierce County resident

The Pierce County resident spent time in Pierce and King Counties while contagious from  May 6-11.  See https://www.tpchd.org/Home/Components/News/News/126/286?backlist=%2fhome for a  list of  known exposure locations. 

 There are no confirmed or suspect cases of measles in Grays Harbor County. Most people in Grays Harbor County have immunity to measles through vaccination, so the risk to the general public is low.  People at highest risk from exposure to measles include those who are unvaccinated, pregnant women, infants under twelve months of age and those with weakened immune systems.

A person is considered immune to measles if any of the following apply:

· You were born before 1957

· You are certain you had the measles

· You are up-to-date on measles vaccines (1 dose age 1-3 years, 2 doses age 4 years & up.)

Testing for immunity after MMR vaccination is not routinely recommended.

 Please consider measles in patients who :

1. Present with febrile rash illness and the “three Cs”: cough, coryza, or conjunctivitis.

2. Recently traveled internationally or potentially exposed to someone with measles.

If you suspect measles, immediately mask and isolate patients to avoid disease transmission and contact Grays Harbor County Public Health to arrange for testing.

Grays Harbor County Public Health does not provide measles immunizations or testing for immunity.

We have developed a Q & A document in response to community concerns about measles.  Please let us know if you hear commonly asked questions or concerns that would be helpful to include in the Q & A document.  As always, we are available to discuss any questions about measles diagnosis or testing requirements.

For questions or further information contact Lisa Leitz RN, Communicable Disease Program Coordinator at (360) 500-4044 or lleitz@co.grays-harbor.wa.us or our main line at (360) 532-8631.

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Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Advisory: Influenza season continues with an increase in influenza A (H3N2)

The Centers for Disease Control and Prevention (CDC) is issuing a health advisory to notify clinicians that influenza activity remains high in the United States, with an increasing proportion of activity due to influenza A (H3N2) viruses, continued circulation of influenza A (H1N1) viruses, and low levels of influenza B viruses.       

Influenza should be considered as a possible diagnosis for patients with respiratory illness while local  influenza activity remains elevated.  Because influenza A (H3N2) viruses may be associated with severe disease in older adults, this health advisory serves as a reminder that early empiric treatment with influenza antiviral medications is  recommended for hospitalized and high-risk patients, especially those 65 years and older. 

Antiviral treatment should be started as soon as possible after illness onset and should not wait for laboratory confirmation. CDC recommends antiviral medication for the treatment of influenza, regardless of a patient’s influenza vaccination status.  Influenza antiviral medications are most effective in treating    influenza and reducing complications when  treatment is started early (within 48 hours of illness onset). However, some studies suggest clinical benefit among hospitalized patients and young children with febrile illness even when  treatment starts three to five days after illness onset.

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EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.

Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature

Health Alert: Clark County confirms 14 cases of measles and is investigating 3 suspected cases of measles

Washington State Department of Health is supporting Clark County Public Health to limit the spread of measles through epidemiological investigation and testing. 

13 of the lab-confirmed cases are unimmunized and 1 has an unknown immunization status (this was the index patient). The index case had fever onset 12/27/18 and rash on 12/30/18.  All patients are under 18 years old.

This investigation is in the early stages and currently there is not clear evidence of linkages to a particular population. 

Please visit Clark County Public Health  website at:  https://www.clark.wa.gov/public-health/measles-investigation for the most up to date status and listing of exposure dates and locations.

Please consider measles in patients who:

1.  Present with febrile rash illness and the “three Cs”: cough, coryza (runny nose) or conjunctivitis (pink  eye).

2.  Recently traveled internationally or potentially exposed to someone with       confirmed measles..

If you suspect measles, immediately mask and isolate patients to avoid disease  transmission and contact Grays Harbor County Public Health to arrange for testing.

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EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.

Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature