Johnson County Health Department - EPI Update Newsletter

The Kansas Department of Health and Environment (KDHE) released the Kansas Pandemic Influenza Preparedness and Response Plan on October 10. The document, which includes strategies to decrease morbidity, mortality, and social disruption from pandemic influenza, centers on a strain of avian influenza that has swept through poultry populations in Southeast Asia and killed at least 65 people in Southeast Asia since 2003.

Influenza poses a unique biologic threat in part from the reservoir of different virus types – primarily in birds, ability to mutate quickly, and transmissibility among vulnerable species. Avian flu, an H5N1 strain of type A influenza, does not pass easily from person to person, but a mutation could increase the virus’s ability to transmit between humans. The majority of the 65 people killed in the past 2.5 years from avian influenza have had close contact with poultry or wild birds.

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Influenza vaccine distribution delays or vaccine supply shortages have occurred in the United States in three of the last five influenza seasons (1,2). In response, prioritization has been implemented in previous years to ensure that enough vaccine is available for those at the highest risk for complications from influenza (3). The information in this report updates projections of influenza vaccine supply and previous recommendations for priority use of trivalent inactivated influenza vaccine (TIV) during the 2005--06 influenza season (4).

Four manufacturers now expect to provide influenza vaccine to the U.S. population during the 2005--06 influenza season (Table). Sanofi Pasteur, Inc., projects production of 60 million doses of TIV. Chiron Corporation projects production of 18--26 million doses of TIV. GlaxoSmithKline (GSK), Inc., whose license application was approved by the Food and Drug Administration on August 31, 2005, projects production of 8 million doses of TIV. MedImmune Vaccines, Inc., producer of live attenuated influenza vaccine (LAIV), projects production of approximately 3 million doses. However, because of the uncertainties regarding production of influenza vaccine, the exact number of available doses and timing of vaccine distribution for the 2005--06 influenza season remain unknown.

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The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are alerting consumers and health care providers to five reports of Guillain Barre Syndrome (GBS) following administration of Meningococcal Conjugate Vaccine A, C, Y, and W135 (trade name Menactra), manufactured by Sanofi Pasteur. It is not known yet whether these cases were caused by the vaccine or are coincidental. FDA and CDC are sharing this information with the public now and actively investigating the situation because of its potentially serious nature.

Guillain Barre Syndrome (GBS) is a serious neurological disorder that can occur, often in healthy individuals, either spontaneously or after certain infections. GBS typically causes increasing weakness in the legs and arms that can be severe and require hospitalization.

Meningococcal infection, which Menactra prevents, is a major cause of bacterial meningitis, affecting approximately 1 in 100,000 people annually. The infection can be life threatening:

10-14 percent of cases are fatal and 11-19 percent of survivors may have permanent disability.

According to Jesse Goodman, MD, Director of FDA’s Center for Biologics Evaluation and Research, at the present time there are no changes in recommendations for vaccination; individuals should continue to follow their doctors' recommendations. FDA and CDC are not able to determine if any or all of the cases were due to vaccination. The current information is very preliminary and the two agencies are continuing to evaluate the situation.

Because of the potentially serious nature of this matter, FDA and CDC are asking any persons with knowledge of any possible cases of GBS occurring after Menactra to report them to the Vaccine Adverse Event Reporting System (VAERS) to help the agencies further evaluate the matter. Individuals can report to VAERS on the web at www.vaers.hhs.gov or by phone at 1-800-822-7967.

The five cases of GBS reported following administration of Menactra occurred in individuals living in NY, OH, PA, and NJ. All five patients were 17 or 18 years of age and developed weakness or abnormal sensations in the arms or legs, two-four weeks after vaccination. All individuals are reported to be recovering or to have recovered. More than 2.5 million doses of Menactra vaccine have been distributed to date. The rate of GBS based on the number of cases reported following administration of Menactra is similar to what might have been expected to occur by coincidence, that is, even without vaccination. However, the timing of the events is of concern. Also, vaccine adverse events are not always reported to FDA so there may be additional cases of which we are unaware at this time.

Prelicensure studies conducted by Sanofi Pasteur of more than 7000 recipients of Menactra showed no GBS cases. CDC conducted a rapid study using available health care organization databases and found that no cases of GBS have been reported to date among 110,000 Menactra recipients.

A new, highly contagious strain of influenza that jumped from horses to dogs has infected dogs in kennels, dog tracks, and household dogs in several states. The virus was first detected in January 2004 at a Florida greyhound racetrack, where 8 of 24 infected animals died. Testing indicates that the same virus likely was responsible for outbreaks of respiratory disease at six racetracks in Florida, Texas, Alabama, Arkansas, West Virginia and Kansas in 2004, then at 20 tracks in Florida, Texas, Arkansas, Arizona, West Virginia, Kansas, Iowa, Colorado, Rhode Island and Massachusetts earlier this year. Recent positive tests for four dogs in Los Angeles and one dog in Oregon show that the virus has spread from its East Coast origin to the West Coast.

Canine influenza, or “dog flu,” is difficult to distinguish from a common respiratory illness called kennel cough, caused mainly by the Bordetella bronchiseptica bacteria, related to whooping cough in humans. Initial symptoms for kennel cough and for canine influenza include a dry, hacking cough, runny nose and fever. About 80% of infected dogs have a mild illness with cough and nasal discharge that resolves over one to two weeks without treatment.

The mortality rate of canine influenza is unknown, but it may kill between 5% and 8% of infected dogs. Infected dogs can be free of symptoms, yet able to transmit the virus to other dogs. Canine influenza is believed to be spread through droplets in the exhalations, coughs and sneezes of infected animals.

Owners of dogs with cough or other kennel cough or influenza symptoms are asked to keep their animals away from other dogs. Most dogs will recover on their own, but dogs that become depressed or stop eating and playing should be taken to a veterinarian as soon as possible. There is no evidence of the virus being transmitted to humans.

“Dog flu arrives in Oregon,” The Associated Press, 10/1/05
“Dog flu jumped from horses,” The Washington Post, 9/27/05
“A new deadly, contagious dog flu virus is detected in 7 states,” The New York Times, 9/22/05 - (registration required)
Crawford PC, et al, Transmission of Equine Influenza Virus to Dogs, Science, September 26, 2005
“Is doggie flu epidemic overblown?” The Roanoke Times

To see upcoming workshops, satellite broadcasts, and more at the Johnson County Health Department, check out the What’s New? page of our website to see our calendar of events.

September Communicable Disease Report:

Disease Category	Sept 2005	Sept 5yr Avg	YTD 2005	2004 Total	2003 Total	2002 Total
Enteric Diseases:
Shigella	5	1.4	32	11	6	30
Salmonella	10	5.6	73	85	50	38
Central Nervous System:
Meningitis, Aseptic (including viral and fungal meningitis)	5	4.2	10	29	14	26
West Nile Encephalitis/Meningitis	0	0.8	1	2+	5	2
West Nile Fever	0	0	0	1+	0	0
Sexually Transmitted Infections:
Infection Numbers (excluding HIV/AIDS - see below)	116	59.6	799	981	849	876
Vaccine Preventable Diseases:
Influenza, A&B	0	0	4	1	7	1
Measles	0	0	0	0	0	0
Pertussis	3	1.6	15	19	5	4
Varicella	10*+	n/a	156*+	51*+	*	*
M. tuberculosis:
Confirmed Cases	1!	1	7	7	14	12
Rare Diseases (other than listed):
Brucellosis	0	0	0	2	0	0
HIV and AIDS	Apr-June 2005	June 5yr avg	YTD 2005	2004 Total	2003 Total	2002 Total
HIV	5	4.4	14	17	18	19
AIDS	4	4	14	26	15	8

* Became reportable in June 2004
+ Includes probable as well as confirmed cases
! 15 cases under investigation
n/a not applicable

Communicable disease reporting is the cornerstone of public health surveillance and disease control. Please remember to maintain an index of suspicion for bioterrorism and reportable disease, and give us a call if you have any questions or concerns (913-826-1303). On behalf of the Disease Containment Staff, thank you for your continued support.

Johnson County government does not discriminate on the basis of race, color, national origin, gender, religion, age and handicapped status in employment or the provision of programs and services.