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Summer Influenza Surveillance and Increased RSV Activity June 28, 2021

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Summer Influenza Surveillance and Increased RSV Activity June 28, 2021 Main Office Phone: (937) 390-5600 529 East Home Road Fax: (937) 390-5625 Springfield, OH 45503 Email: [email protected] Clark County Combined Health District- Health Advisory Summer Influenza Surveillance and Increased RSV Activity June 28, 2021 PART 1: Summer Influenza Surveillance: Information for Clinicians The Ohio Department of Health (ODH) Bureau of Infectious Diseases (BID) and Clark County Combined Health District (CCCHD) are asking for your support in strengthening summer influenza viral surveillance by partnering with CCCHD to increase influenza-positive specimen submissions to ODH laboratory throughout the summer months. Please contact CCCHD at 937-390-5600 to report suspect novel influenza cases and to coordinate specimen submissions from any RT- PCR or rapid molecular tests which are positive for influenza A or B to ODH Laboratory for confirmatory testing and subtyping. This increased surveillance will continue through September 30, 2021. Although there is minimal influenza activity in Ohio at this time, the Centers for Disease Control and Prevention (CDC) is requesting continued testing of influenza specimens at state public health laboratories in order to maintain situational awareness and ensure adequate novel influenza surveillance. As Ohio’s agricultural fair season begins, it is important to be mindful of potential human infections with swine variant influenza (e.g. H3N2v, H1N1v, H1N2v) and avian influenza viruses. When animal influenza viruses infect people, they are considered novel influenza A infections, a Class A notifiable condition, and should be reported immediately by telephone to the local health department of residence. Novel influenza A should be considered in people with influenza-like illness (ILI) and recent contact to swine or poultry during the summer months. Specimens should be collected promptly, and you should contact CCCHD to arrange for specimen submissions to ODH Laboratory for any suspected novel influenza A infections. Please note that nasopharyngeal (NP) OR oropharyngeal (OP) swabs, bronchoalveolar lavages (BAL) and tracheal aspirates are all appropriate specimen types for submission to ODH laboratory. For each specimen to be sent, please include a completed ODH Laboratory Microbiology Submission Form with "INFLUENZA SUMMER SURVEILLANCE" written in the comments section. This form (with comments section note pre- populated) and ODH Collection and Submission of Influenza Specimens guidelines are attached to this message. PART 2: Increased Interseasonal Respiratory Syncytial Virus (RSV) Activity Summary The Centers for Disease Control and Prevention (CDC) is issuing this health advisory to notify clinicians and caregivers about increased interseasonal respiratory syncytial virus (RSV) activity across parts of the Southern United States. Due to this increased activity, CDC encourages broader testing for RSV among patients presenting with acute respiratory illness who test negative for SARS-CoV-2, the virus that causes COVID-19. RSV can be associated with severe disease in young children and older adults. This health advisory also serves as a reminder to healthcare personnel, childcare providers, and staff of long-term care facilities to avoid reporting to work while acutely ill – even if they test negative for SARS-CoV- 2. Background RSV is an RNA virus of the genus Orthopneumovirus, family Pneumoviridae, primarily spread via respiratory droplets when a person coughs or sneezes, and through direct contact with a contaminated surface. RSV is the most common cause of bronchiolitis and pneumonia in children under one year of age in the United States. Infants, young children, and older adults with chronic medical conditions are at risk of severe disease from RSV infection. Each year in the United States, RSV leads to on average approximately 58,000 hospitalizations with 100-500 deaths among children younger than 5 years old and 177,000 hospitalizations with 14,000 deaths among adults aged 65 years or older. In the United States, RSV infections occur primarily during the fall and winter cold and flu season. In April 2020, RSV activity decreased rapidly, likely due to the adoption of public health measures to reduce the spread of COVID- Clark County Combined Health District 1 of 3 Health Alert: Summer Influenza Surveillance_6.24.21 Main Office Phone: (937) 390-5600 529 East Home Road Fax: (937) 390-5625 Springfield, OH 45503 Email: [email protected] Clark County Combined Health District- Health Advisory Summer Influenza Surveillance and Increased RSV Activity June 28, 2021 19. Compared with previous years, RSV activity remained relatively low from May 2020 to March 2021. However, since late March, CDC has observed an increase in RSV detections reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS), a nationwide passive, laboratory-based surveillance network. CDC noted increases in laboratory detections and in the percentages of positive detections for both antigen and PCR testing in parts of HHS Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas). Due to limited testing outside of the typical RSV season, data are limited in some jurisdictions and may be incomplete for the most recent weeks. Since this elevated interseasonal activity is a deviation in the typical circulation patterns for RSV, at this time it is not possible to anticipate the likely spread, peak, or duration of activity with any certainty. Health officials also identified increased interseasonal RSV circulation in parts of Australia during late 2020 and in South Africa in early 2021. Still, RSV did not reach seasonal peak levels in most regions or result in widespread circulation. Due to reduced circulation of RSV during the winter months of 2020–2021, older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months. In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or apnea with or without fever. In older infants and young children, rhinorrhea and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. Symptoms in adults are typically consistent with upper respiratory tract infections, including rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. There is no specific treatment for RSV infection other than symptom management. Recommendations 1. Clinicians and caregivers should be aware of the typical clinical presentation of RSV for different age groups. 2. Clinicians should consider testing patients with a negative SARS-CoV-2 test and acute respiratory illness or the age-specific symptoms presented above for non-SARS-CoV-2 respiratory pathogens, such as RSV. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) is the preferred method for testing for respiratory viruses. 3. Clinicians should report laboratory-confirmed RSV cases and suspected clusters of severe respiratory illness to local and state health departments according to their routine reporting requirements. 4. Healthcare personnel, childcare providers, and staff of long-term care facilities should avoid reporting to work while acutely ill – even if they test negative for SARS-CoV-2. 5. Clinicians can review weekly updates to the NREVSS website and refer to surveillance data collected by local hospitals and health departments for information on RSV circulation trends in their area. For More Information • CDC – RSV Information for Healthcare Providers • CDC – RSV National Trends – NREVSS • CDC – RSV Trends and Surveillance • CDC – RSV Symptoms and Care Attachments • Collection and Submission of Influenza Specimens, ODH • ODH Laboratory Microbiology Specimen Submission For • CDC Health Alert Network (HAN) Health Alert 443 - Increased Interseasonal Respiratory Syncytial Virus (RSV) Activity in Parts of the Southern United States Clark County Combined Health District 2 of 3 Health Alert: Summer Influenza Surveillance_6.24.21 Main Office Phone: (937) 390-5600 529 East Home Road Fax: (937) 390-5625 Springfield, OH 45503 Email: [email protected] Clark County Combined Health District- Health Advisory Summer Influenza Surveillance and Increased RSV Activity June 28, 2021 If you are receiving this health advisory via fax, please visit the CCCHD website to view a digital copy with clickable links. In the future, if you wish receive health alerts electronically, please contact [email protected]. Alert Details Date: 6/28/21 Time Sensitivity: Moderate To: Medical offices, Urgent Cares, Clinics, Hospitals, Laboratories and ICPs Target Audience: Physicians, PA, NP, Nurses, Medical Staff, ICP staff, and Laboratorians From: Clark County Combined Health District Subject: Summer Influenza Surveillance and Increased RSV Activity Relevance to Public Health: High Clark County Combined Health District 3 of 3 Health Alert: Summer Influenza Surveillance_6.24.21 Collection and Submission of Influenza Specimens When to collect influenza specimens • Within three days of symptom onset, preferably as soon as possible after onset. Specimens collected up to 10 days after onset of symptoms may be submitted if necessary. How to collect influenza specimens Collect one nasopharyngeal (NP) specimen with viral transport media from each patient, using the following methods: Nasopharyngeal
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