COCA Digest - CDC Clinician Outreach and Communication Activity

Emergency Preparedness and Response


Health Alert Network (HAN) Advisory


HAN Health Advisory logo

Severe Pulmonary Disease Associated with Using E-Cigarette Products

On August 30, 2019, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) advisory to provide: 1) background information in the forms of e-cigarette products, 2) information on the multistate outbreak of severe pulmonary disease associated with using e-cigarette products (devices, liquids, refill pods, and cartridges), and 3) clinical features of patients with severe pulmonary disease. This health advisory also provides recommendations for clinicians, public health officials, and the public based on currently available information.

Please visit HAN 421 for the full HAN Advisory. 


Measles Cases and Outbreaks 


From January 1 to August 29, 2019, 1,234 individual cases of measles have been confirmed in 31 states. This is an increase of 19 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1992.

  • More than 75% of the cases this year are linked to outbreaks in New York. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.
  • The majority of cases are among people who were not vaccinated against measles.
  • Measles can cause serious complications. As of August 29, 2019, 125 of the people who got measles this year were hospitalized, and 65 reported having complications, including pneumonia and encephalitis.
  • All measles cases this year have been caused by measles wild-type D8 or B3.


States with Reported Measles Cases

As of September 5, 2019, the states that have reported cases to CDC are Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia, and Washington. 


Please visit Measles Cases and Outbreaks for more information.


CDC Public Health Matters Blog: Protecting our Future: Emergency Preparedness and Children


Written by Jessica Franks, MPH, CHES, Health Communications Fellow, National Center on Birth Defects and Developmental Disabilities; Rebecca Leeb, PhD, Acting Team Lead, Children*s Preparedness Unit, National Center on Birth Defects and Developmental Disabilities; Amy Wolkin, DrPH, MSPH, Vulnerable Populations Officer, Center for Preparedness and Response 


a young child sitting against a wall with his head in his hands

Among the many lessons learned during the 2017 Hurricane season, it was recognized that children*s mental health and behavioral health needs are a major concern in hurricane-affected areas. CDC*s At Risk Task Force (ARTF) was established in 2017 to ensure identification and prioritization of the mental and physical health needs of at-risk populations, including children. ARTF*s first Emergency Operations Center activation was August 31, 2017, in response to Hurricane Harvey, the first of three consecutive hurricanes to hit the United States and its territories in a five-week period. ARTF*s mission was to address the needs of at-risk populations in affected areas throughout response and recovery phases. 


What does CDC*s At Risk Task Force do for children*s mental health during a hurricane response? 


During the 2017 hurricane season, the ARTF collaborated with federal and non-government partners to monitor behavioral health in affected areas and disseminate key messages and coping resources for children in schools and vulnerable populations in other contexts. During October 2017, ARTF coordinated with COCA to conduct a COCA Call for primary care physicians that focused on identification of common adjustment difficulties in children, provided strategies to promote effective coping skills in children and their parents, and explained the importance of self-care for professionals. Free CE is available until November 2019. 


Public health professionals also play an important role in addressing short-term and enduring mental health needs of the population. Timely and accurate mental and behavioral health surveillance data, that includes specific information on children, could inform intervention efforts to improve developmental outcomes for children in the longer-term aftermath of disasters. It is important that mental health surveillance be incorporated into preparedness planning so that surveillance systems can be established or leveraged immediately when emergency response begins. 


Additional Resources: 

Please visit the blog for more information. 


Other CDC Emergency Preparedness and Response Public Health Matters Blogs are available in CDC*s Public Health Media Library. Requests for content syndication, resources for web developers, and the ability to sign up to receive new postings may also be made from this page.


Health and Safety Concerns for All Disasters 


See below for information about a variety of health and safety concerns for all disasters, including〞 


.Resources for Emergency Health Professionals 


CDC offers a variety of resources and educational materials for clinicians, communicators, laboratorians, emergency planners and responders, and disaster relief volunteers to help prepare and respond to a public health emergency. Free educational materials, such as flyers, posters, stickers, and public service announcements in various languages that are suitable for printing and sharing are also included.


Emerging Health Threat Literature


Vital Signs: Pharmacy-Based Naloxone Dispensing〞United States, 2012每2018

August 6, 2019


Background: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends considering prescribing naloxone when factors that increase risk for overdose are present (e.g., history of overdose or substance use disorder, opioid dosages ≡50 morphine milligram equivalents per day [high-dose], and concurrent use of benzodiazepines). In light of the high numbers of drug overdose deaths involving opioids, 36% of which in 2017 involved prescription opioids, improving access to naloxone is a public health priority. CDC examined trends and characteristics of naloxone dispensing from retail pharmacies at the national and county levels in the United States. 


Methods: CDC analyzed 2012每2018 retail pharmacy data from IQVIA, a health care, data science, and technology company, to assess U.S. naloxone dispensing by U.S. Census region, urban/rural status, prescriber specialty, and recipient characteristics, including age group, sex, out-of-pocket costs, and method of payment. Factors associated with naloxone dispensing at the county level also were examined. 


Results: The number of naloxone prescriptions dispensed from retail pharmacies increased substantially from 2012 to 2018, including a 106% increase from 2017 to 2018 alone. Nationally, in 2018, one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. Substantial regional variation in naloxone dispensing was found, including a twenty-fivefold variation across counties, with lowest rates in the most rural counties. A wide variation was also noted by prescriber specialty. Compared with naloxone prescriptions paid for with Medicaid and commercial insurance, a larger percentage of prescriptions paid for with Medicare required out-of-pocket costs. 


Conclusion: Despite substantial increases in naloxone dispensing, the rate of naloxone prescriptions dispensed per high-dose opioid prescription remains low, and overall naloxone dispensing varies substantially across the country. Naloxone distribution is an important component of the public health response to the opioid overdose epidemic. Health care providers can prescribe or dispense naloxone when overdose risk factors are present and counsel patients on how to use it. Efforts to improve naloxone access and distribution work most effectively with efforts to improve opioid prescribing, implement other harm-reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships. 


Read the entire Vital Signs Report.


Please join us for a COCA Call with U.S. Surgeon General VADM Jerome Adams on Tuesday, September 17, to learn more about this topic.


Vital Signs: CDC Urges Clinicians to Promptly Recognize and Rapidly Report Acute Flaccid Myelitis (AFM) Cases 

Early Release / July 9, 2019 / Vol. 68 Vital Signs: Surveillance for Acute Flaccid Myelitis每每United States, 2018 


Background: Acute flaccid myelitis (AFM), a serious paralytic illness, was first recognized as a distinct condition in 2014, when cases were reported concurrent with a large U.S. outbreak of severe respiratory illness caused by enterovirus D-68 (EV-D68). Since 2014, nationwide outbreaks of AFM have occurred every two years in the United States; the cause for the recent change in the epidemiology of AFM in the United States, including the occurrence of outbreaks and a biennial periodicity since 2014, is under investigation. This report updates clinical, laboratory, and outcome data for cases reported to CDC during 2018. 


Methods: Clinical data and specimens from persons in the United States who met the clinical criterion for AFM (acute onset of flaccid limb weakness) with onset in 2018 were submitted to CDC for classification of the illnesses as confirmed, probable, or non-AFM cases. Enterovirus/rhinovirus (EV/RV) testing was performed on available specimens from persons meeting the clinical criterion. Descriptive analyses, laboratory results, and indicators of early recognition and reporting are summarized.

Results: From January through December 2018, among 374 reported cases of AFM, 233 (62%) (from 41 states) were classified as confirmed, 26 (7%) as probable, and 115 (31%) as non-AFM cases. Median ages of patients with confirmed, probable, and non-AFM cases were 5.3, 2.9, and 8.8 years, respectively. Laboratory testing identified multiple EV/RV types, primarily in respiratory and stool specimens, in 44% of confirmed cases. Among confirmed cases, the interval from onset of limb weakness until specimen collection ranged from 2 to 7 days, depending on specimen type. Interval from onset of limb weakness until reporting to CDC during 2018 ranged from 18 to 36 days, with confirmed and probable cases reported earlier than non-AFM cases. 


Conclusion: Identification of risk factors leading to outbreaks of AFM remains a public health priority. Prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention recommendations. 


Read the entire Vital Signs Report.


The current issue of CDC Science Clips: Volume 11, Issue 36, September 10, 2019 contains other articles on AFM which may be of particular interest to clinicians and public health professionals.

Seasonal and Pandemic Influenza


2019每2020 Influenza Season


Bookmark CDC's Information for Health Professionals page for updates about and recommendations for the 2019每2020 flu season. This page also offers public health and healthcare professionals key information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza. 


What viruses will the 20192020 flu vaccines protect against? 


There are many different flu viruses and they are constantly changing. The composition of U.S. flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019每2020, trivalent vaccines are recommended to contain

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
  • A/Kansas/14/2017 (H3N2)-like virus (updated) 
  • B/Colorado/06/2017-like (Victoria lineage) virus

Quadrivalent (four-component) vaccines also protect against a second lineage of B viruses. Quadrivalent (four-component) vaccines are recommended to contain the three recommended viruses above and〞  

  • The three recommended viruses above, plus B/Phuket/3073/2013-like (Yamagata lineage) virus. 

The World Health Organization (WHO) made the selection of the H1N1 and both B components for 2019-2020 Northern Hemisphere flu vaccines on February 21 and at that time decided to delay the decision on an H3N2 vaccine component. FDA*s Vaccines and Related Biological Products Advisory Committee (VRBPAC) also selected the H1N1 and B components at their first meeting on March 6, but also decided to postpone the selection of the H3N2 component. WHO selected the H3N2 component listed above on March 21, 2019. VRBPAC chose the same H3N2 component for U.S. vaccines on March 22, 2019. 


Please visit Frequently Asked Flu Questions: 2019每2020 Influenza Season for more information. 


2018每2019 Influenza Season Week 35 ending August 31, 2019 


All data are preliminary and may change as more reports are received. 


Nationwide during week 35, 1.0% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below the national baseline of 2.2%. (ILI is defined as fever (temperature of 100∼F [37.8∼C] or greater) and cough and/or sore throat.)


Additional data on medically attended visits for ILI for current and past seasons and by geography (national, HHS region, or select states) are available on FluView Interactive


An overview of CDC's influenza surveillance system, including methodology and detailed descriptions of each data component, is available. Read the full situational update. View the current United States flu activity map


Seasonal Influenza Resource Center 


Visit CDC's Seasonal Influenza Resource Center to sign up for weekly email updates from the CDC Seasonal Influenza Newsletter. Receive the latest on flu research and guidance, the current flu season, and CDC's seasonal flu vaccination campaign. In addition, you can subscribe to CDC's weekly email for technical flu season updates on this webpage. Technical flu season emails will provide weekly updates during flu season on influenza-related key points, surveillance and vaccination data, health alerts, publication notices, and other timely scientific immunization information. This page also contains communication resources including images, infographics, print materials, factsheets in multiple languages, videos, podcasts, and other communication materials about seasonal flu. 


Be sure to print and share with your colleagues a copy of CDC*s Intramuscular Influenza (Flu) Vaccination Infographic, ※You Call the Shots§ to serve as a reminder in your practice about safe intramuscular injection practices in adults.


2009 H1N1 Pandemic (H1N1pdm09 virus)〞 A Decade Later


N1H1 Flu Pandemic banner 


Ten Years of Gains: A Look Back at Progress Since the 2009 H1N1 Pandemic 

June 11, 2019


In 2009, a novel H1N1 influenza (flu) virus emerged to cause the first flu pandemic in 40 years. The 2009 H1N1 pandemic was estimated to be associated with 151,700 to 575,400 deaths worldwide during the first year it circulated. This H1N1 virus has continued to circulate seasonally to this day. CDC and its many partners have made great strides in the fields of influenza surveillance, prevention, and treatment since 2009. These advances have benefited both the annual response to seasonal flu epidemics and the global capacity to respond to the next pandemic. Key improvements are summarized on the pages below.


Read the entire article


Please visit 2009 H1N1 Pandemic and Past Flu Pandemics for more information.

Travelers' Health



The mission of CDC's Travelers' Health Branch is to reduce illness and injury in U.S. residents traveling internationally or living abroad. Applying the best science, the Travelers' Health Branch provide alerts, recommendations, education, and technical support to travelers and the healthcare providers who serve them. 


Now Available: CDC ※Yellow Book§ 2020, Health Information for International Travel 


Interested in the latest travel health recommendations? CDC*s ※Yellow Book§ 2020 (Health Information for International Travel) is now available to answer your patients*, employees*, or your own travel health questions. 


What is the ※Yellow Book§? 


CDC wants all travelers to stay healthy while enjoying the sights, activities, and cultures of countries around the world. As travelers plan the details of their itinerary, clinicians can use the ※Yellow Book§ to help inform their health protection strategy. 


The ※Yellow Book§ offers readers current U.S. government travel health guidelines, including pre-travel vaccine recommendations; destination-specific health advice; and easy-to-reference maps, tables, and charts.

Written by CDC*s travel health experts, the ※Yellow Book§ is intended as a reference for healthcare providers, including doctors, nurses, and pharmacists. Other audiences that find the ※Yellow Book§ to be a helpful resource include〞  

  • Travel industry 
  • Corporations and chief medical officers
  • Missionary and volunteer organizations
  • Americans who live abroad, and travelers taking short trips. 

The ※Yellow Book§ contains numerous resources to assist healthcare professionals in making appropriate recommendations to their patients, before, during, and after international travel.


Pre-travel resources include: 

  • How to conduct a pre-travel consultation
  • Travel-related disease information: causes, global distribution, prevention measures
  • Vaccines: updated vaccine requirements and recommendations
  • Clinical guidance: an in-depth look at the specific travel health needs of infants and children, pregnant travelers, and those with chronic medical conditions or weakened immune systems
  • Overviews of popular tourist destinations and itineraries
  • Recommendations for expatriates, travelers visiting friends and relatives overseas or participating in study abroad, travel for work, adventure travel. 

During-travel resources

  • Conditions: including travelers* diarrhea, altitude illness, jet lag, motion sickness, and respiratory infections. 

Post-travel resources

  • How to conduct a post-travel evaluation 
  • Post-travel evaluation and management: fever in the returned traveler, sexually transmitted infections, skin and soft tissue infections, persistent diarrhea, screening newly arrived immigrants and refugees. 


Did you know?


The ※Yellow Book§ is 52 years old! CDC*s first ※Yellow Book§ (1967) was actually a small pamphlet entitled Immunization Information for International Travel. It was about the size of an index card and contained information about a few diseases, like cholera, smallpox, yellow fever, and malaria. 


What*s New for 2020? The 2020 edition of the ※Yellow Book§ offers a variety of new sections and information, including: 

  • Henipaviruses 
  • Recommendations for practicing travel health remotely, via telemedicine
  • Updated vaccine recommendations
  • Updated road and traffic-safety advice 
  • Emerging travel-related illnesses, including Zika, Ebola, and sarcocystosis 
  • New FDA-approved drugs 
  • Rapid diagnostic tests for tropical infectious diseases 
  • Recommendations for travelers with severe allergies 
  • Use of the ※One Health§ approach to manage zoonotic diseases 
  • Treating infectious diseases in the face of increasing antimicrobial resistance
  • Legal issues facing clinicians who provide travel health care 


Want a copy of Yellow Book 2020 for your practice?


The entire Yellow Book 2020 is available for free on the CDC Travelers* Health website. It is available for purchase through Oxford University Press, other major online booksellers, at most major bookstores, or as an eBook.


General Vaccine Information 


Pre-travel Care Tools 


Disease-specific Resources 

  • Zika Interactive Map: search by location to find out if Zika is in a particular destination. 
  • Yellow Fever Travel Information: a one-stop shop for yellow fever information, including risk areas, travel notices, and vaccine availability.
  • Yellow Fever & Malaria Information by Country: country-specific information and maps on yellow fever vaccine requirements and recommendations, as well as malaria transmission information and prophylaxis recommendations. 
  • Disease directory: information concerning specific diseases that can affect travelers. 
  • Travel Notices for International Travelers: travel notices inform travelers and clinicians about current health issues related to specific international destinations. These issues may arise from disease outbreaks, special events or gatherings, and natural disasters affecting travelers' health.

Food, Drug, and Device Safety


MedWatch: The FDA Safety Information and Adverse Event Reporting Program


MedWatch is your FDA gateway for clinically important safety information and reporting serious problems with human medical products. Reports of FDA and USDA Food Recalls, Alerts, Reporting, and Resources

(HHS/USDA/FDA/CDC/NIH) lists notices of recalls and alerts from both FDA and USDA. Visitors to the site can report a problem, make inquiries, and sign up to receive email updates about the content on this page. You can also embed the Food Safety Alerts and Tips widget on your website, blog, or other platform. 

CDC Current Outbreak List


Stay up-to-date on the infectious disease outbreaks that CDC is currently reporting. CDC's Current Outbreak List provides a complete list of U.S. and international outbreaks, travel notices affecting international travelers, food recalls, and further sources for content about specific outbreaks.


The Emergency Risk Communication Branch in the Division of Emergency Operations, Center for Preparedness and Response is responsible for the management of all COCA products.

For information about this update or other clinical issues, or to send your feedback, please contact us at

CDC Clinician Outreach and Communication Activity Facebook page〞connect with COCA on Facebook

Clinician Outreach and Communication Activity〞resources for healthcare providers

COCA RSS Feed〞subscribe to be notified of conference calls, updates, and CDC guidance for health providers

Crisis & Emergency Risk Communication Training〞training program that draws from lessons learned during public health emergencies, and incorporates best practices from the fields of risk and crisis communication

Health Alert Network〞CDC's primary method of sharing cleared information about urgent public health incidents with public information officers; federal, state, territorial, and local public health practitioners; clinicians; and public health laboratories


CDC logoCDC and HHS logos are the exclusive property of the Department of Health and Human Services and may not be used for any purpose without prior express written permission. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Links to non-federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organizations.


Centers for Disease Control and Prevention

1600 Clifton Rd   Atlanta, GA 30333   1-800-CDC-INFO (800-232-4636)   TTY: 888-232-6348
Questions or Problems  |  Unsubscribe