Health Advisory

October 12, 2018

Summary

October 1 marks the beginning of influenza season surveillance. The 2017-2018 influenza season was one of the most severe non-pandemic influenza seasons on record. To strengthen surveillance and preventive interventions in our community, FCHD reminds providers of the following reporting requirements.

• Health care facilities are required to report influenza by number of cases per week to the local health department. Please report weekly case counts of influenza online to FCHD at http://bit.ly/2f5rz94.
• In some circumstances, influenza needs to be reported immediately to the health department to enable urgent public health actions. The following should be immediately reported (24/7) to the Fairfax County Health Department by calling the Acute Communicable and Emerging Disease Program at 703-246-2433.
  • A case of influenza caused by a novel influenza virus.
  • Influenza-associated death of a child 18 years of age.
  • Suspected influenza outbreak.

Suggested Actions

Reporting Influenza Numbers

• Per Virginia Regulations for Disease Reporting and Control, physicians and directors of medical care facilities in Fairfax County should report to the Fairfax County Health Department the aggregate number of influenza cases per week, by influenza type, if known (e.g., “4 cases of influenza A, 2 cases of influenza B, 2 cases of influenza type unknown”). No patient demographics need to be reported for weekly summary counts of influenza.
• This information will help to strengthen our capacity to monitor influenza activity in our community. Virginia Department of Health (VDH) releases weekly influenza activity reports for the state. These reports are available at: http://www.vdh.virginia.gov/epidemiology/influenza-flu-in-virginia/influenza-surveillance.

Immediately Reportable Influenza Cases/Outbreaks

• The scenarios listed in the second bullet of the summary above all need to be reported immediately to FCHD per Virginia Regulations.
• Immediate reporting to public health will allow for quicker follow-up testing at the state lab as well as more rapid public health interventions, such as exclusion of ill individuals from work and/or school, earlier notification to those who are high risk for complications, and the recommendation for prophylaxis, as appropriate, further limiting the spread of disease in our community.

Additional Information

What Will Flu Season Be Like This Year?

It is not possible to predict the severity of the influenza season, but you can stay up to date on what’s circulating, and the timing, severity and length of the season by signing up to receive the Fairfax County Health Department’s weekly influenza update. The first report of the 2018-2019 season will be released October 18, 2018. To sign-up, please visit https://redcap.vdh.virginia.gov/redcap/surveys/?s=MKDRNXDHT7.
Information on influenza diagnostic testing, infection control and patient education can be found on the Centers for Disease Control and Prevention’s (CDC) “Seasonal Influenza” website: www.cdc.gov/flu. 

Influenza Vaccination

• For the 2018-2019 season and every influenza season, CDC recommends routine annual influenza vaccination for all persons aged ≥6 months who do not have contraindications.
• Following two seasons (2016–17 and 2017–18) during which ACIP recommended that LAIV4 not be used, ACIP voted in February 2018 to recommend that for the 2018–19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). 
• Vaccination of people at high risk of developing influenza-related complications is especially important to decrease their risk of severe illness from influenza, as is vaccination for health care workers and those who care for high-risk persons. 
• Health care workers should be vaccinated annually against influenza. The Healthy People 2020 goal is to achieve >90% of influenza vaccine coverage among health care personnel. Strategies to achieve high vaccination coverage among health care workers can be found at https://www.cdc.gov/flu/toolkit/long-term-care/strategies.htm. 
• To review the full CDC recommendation, please see “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2018–19 Influenza Season” MMWR 2018; August 24, 2018 / 67(3);1–20 https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid=rr6703a1_w. 

Influenza Antiviral Drugs

Influenza antiviral prescription drugs can be used to treat influenza or as prophylaxis. CDC will soon provide updated clinical guidance on appropriate antiviral use for influenza at https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

2017-2018 Influenza Summary

In Fairfax, influenza activity peaked in early February with 13.7% of emergency department and urgent care center visits for influenza-like illness, which was significantly higher compared with national activity which peaked the same week at 7.5%. Per CDC, the number of hospitalizations attributed to influenza this season was record-breaking, exceeding end-of-season hospitalization estimates for 2014-2015, a high severity, H3N2-predominant season. Virginia reported widespread activity level for 18 consecutive weeks whereas during the past 5 flu seasons, Virginia remained at the widespread activity level for an average of 12 weeks. The Health Department investigated 18 outbreaks of suspected or confirmed influenza, also higher than in prior seasons.

Questions?

If you have questions, contact the Communicable Disease Unit by phone at 703-246-2433.