CDC has simplified COVID-19 vaccine recommendations for most people including additional doses for certain higher risk populations.

CDC actions follow an earlier recommendation by the U.S. Food and Drug Administration that amended the emergency use authorizations (EUAs) of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines.

With the authorization, the fact sheets have been updated and consolidated for the Moderna COVID-19 Vaccine, Bivalent and the Pfizer-BioNTech COVID-19 Vaccine, Bivalent. Each vaccine now has one fact sheet for healthcare providers and one fact sheet for recipients and caregivers, rather than different fact sheets for the various authorized age groups.

 for different age groups for both Moderna and Pfizer vaccines at the end of this message.

Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States

are expected to be updated soon at this link.

LDH reminds providers to report possible vaccine-related adverse events to the FDA/CDC Vaccine Adverse Event Reporting System (VAERS) at 

Any possible severe adverse events (those resulting in hospitalization, death, or persistent disability) should be immediately reported to the LDH Office Public Health (OPH) Infectious Disease/Epidemiology Hotline at 1-800-256-2748.

Simplified Uses for COVID-19 Vaccines

Simplified Uses for Covid-19 Vacccine

This Health Alert Network Advisory is from the CDC  regarding a 

CDC and Louisiana Department of Health (LDH) Update: Marburg Virus Disease Outbreaks in Equatorial Guinea and Tanzania. 

Please see the message below and share/distribute any/all of this information to all partners and stakeholders as deemed appropriate.

CDC and Louisiana Department of Health (LDH) Update: Marburg Virus Disease Outbreaks in Equatorial Guinea and Tanzania

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and public health departments in the United States about two confirmed outbreaks of Marburg virus disease (MVD)—one in Equatorial Guinea and one in Tanzania. Currently, there is no evidence to suggest that these two outbreaks are related; most experts agree that these represent two independent animal-to-human spillover events. To date, 

no confirmed cases of MVD related to these outbreaks have been reported in the United States or other countries outside Equatorial Guinea and Tanzania 

. This Health Advisory provides information about these outbreaks to increase awareness of the risk of imported cases in the United States. It also summarizes CDC’s recommendations for case identification, testing, and clinical laboratory biosafety considerations in the United States.

 is a rare but highly fatal viral hemorrhagic fever caused by two zoonotic viruses, Marburg virus and Ravn virus, that are closely related to ebolaviruses within family 

 were reported in Equatorial Guinea and Tanzania. These outbreaks mark the first time that Marburg virus has been identified in either Equatorial Guinea or Tanzania, though the virus has been identified previously in neighboring countries and the reservoir, the Egyptian fruit bat, is known to be present in both countries. Available information suggests that these outbreaks may have originated separately in each country. To date, there is no evidence that these two outbreaks are epidemiologically linked. Viral genetic sequencing from Tanzania is in process; these results, along with sequence data available from Equatorial Guinea, will further inform whether the outbreaks emerged separately through distinct animal-to-human spillover events.

A person with MVD is not contagious until 

 may include fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. 

(through broken skin or mucous membranes) with the blood or other body fluids (including urine, saliva, sweat, feces, vomit, breast milk, amniotic fluid, or semen) of a person who is sick with or has died from MVD, with the body fluids of infected animals, or with needles or other fomites that are contaminated with the virus. Marburg virus is 

There is currently no Food and Drug Administration (FDA)-approved vaccine or treatment for MVD. In the absence of early diagnosis and appropriate supportive care, MVD has a high mortality rate of 23%–%With early intensive supportive care and fluid replacement, mortality rates may be lower.

On February 7, 2023, the Ministry of Health and Social Welfare of Equatorial Guinea reported a cluster of deaths suspected to be caused by a viral hemorrhagic fever. The deaths occurred in early January among people in two villages in the district of Nsok-Nsomo, in the eastern province of Kié-Ntem, Río Muni Region.

On February 12, 2023, clinical samples were collected from known contacts of the decedents and sent to the Institute Pasteur in Dakar, Senegal, where one sample was confirmed positive for Marburg virus by real-time polymerase chain reaction (RT-PCR). This index (first confirmed) patient presented with fever, vomiting, bloody diarrhea, and convulsions and died the same day. This patient appears to be epidemiologically linked to four deceased community members from one of the affected villages in Nsok-Nsomo district.

On March 13, 2023, two additional samples collected from people in Kié-Ntem province tested positive for Marburg virus by RT-PCR performed at a CDC-supported field laboratory at the Regional Hospital of Ebibeyin. As of April 5, 2023, 14 laboratory-confirmed MVD cases have been identified from five districts across four provinces in Equatorial Guinea. Ten of these cases were fatal. There are no known epidemiologic links between patients in one province, Centre Sur. This, taken together with the wide geographic spread of the outbreak within the country, suggests that there may be undetected community spread of the virus in the country. All suspect cases in nearby surrounding countries have been confirmed negative to date.

On March 21, 2023, the Ministry of Health of Tanzania announced an MVD outbreak. The announcement followed the identification of Marburg virus by RT-PCR in clinical samples collected from patients in several villages in the northwest Kagera region. As of April 5, 2023, 8 laboratory-confirmed MVD cases have been reported. Five of these infections were fatal. Based on currently available information, all these individuals with MVD are from Kagera Region in Tanzania and appear to be epidemiologically linked.

Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases. It is important to systematically assess patients for the possibility of viral hemorrhagic fevers (including MVD or Ebola disease) through a 

. Early identification of MVD or other viral hemorrhagic fevers is important for providing appropriate and prompt patient care and preventing the spread of infection. Recent presence in Equatorial Guinea or Tanzania should not be a reason to defer 

or other measures necessary for standard patient care.

MVD should be included as a differential diagnosis for an ill person with history of a 

concerning exposure while in a MVD affected area

 (e.g., contact with a symptomatic person with suspected or confirmed MVD or an unknown illness; attending/participating in a funeral; visiting or working in a healthcare facility; having contact with bats or non-human primates; working or spending time in a mine/cave) within 21 days before symptom onset and who have clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. Alternative diagnoses such as 

 , COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in a patient with recent international travel should be considered, evaluated, and managed appropriately. Additionally, patients with a Marburg virus infection may present with concurrent infections (e.g., co-infection with malaria) and the possibility of a concurrent infection should be considered if a patient has a clinical and epidemiologic history compatible with MVD.

If a patient is determined to meet criteria for Marburg virus testing, the patient is considered a suspect case of MVD and should be managed under isolation precautions until receiving a negative Marburg virus test result on a sample collected > 72 hours after symptom onset. 

 to monitor the patient’s clinical status and diagnostic testing for other potential causes of the patient’s illness should be pursued while Marburg virus testing is underway. Marburg virus diagnostic testing should not be delayed while awaiting results of other diagnostic testing.

Clinicians with concerns about a patient with 

 should immediately contact the Infectious Disease Epidemiology (IDEpi) 24/7 clinician hotline: 800-256-2748. If a diagnosis of MVD is considered, clinical teams should coordinate with LDH and CDC to ensure appropriate precautions are taken to help prevent potential spread.

Clinicians caring for patients with planned travel to an MVD outbreak affected area can counsel their patients on ways to 

 during their travel. This includes avoiding contact with blood and body fluids (or materials possibly contaminated with blood and body fluids) of people who are sick; funeral or burial practices that involve touching the body of someone who died from suspected or confirmed MVD; or contact with fruit bats and nonhuman primates and areas known to be inhabited by fruit bats (such as mines or caves).

combination of infection prevention and control measures

 to prevent transmission of MVD. These infection prevention and control measures include personal protective equipment (PPE), patient placement, and patient care considerations. If MVD is suspected, patients should be isolated in a private room with a private bathroom or covered bedside toilet. Healthcare personnel should follow the same 

infection prevention and control measures as recommended for Ebola disease

recommended personal protective equipment (PPE)

 and limiting the number of personnel who enter the room for clinical evaluation and management.

Healthcare personnel can be exposed through contact with a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (e.g., the eyes, nose, or mouth) are particularly hazardous. Procedures that can increase environmental contamination with infectious material, involve handling of potentially contaminated needles or other sharps, or create aerosols should be minimized. Separate 

 is available for managing clinically stable and clinically unstable patients.

Testing for Marburg virus and other causes of viral hemorrhagic fevers is available at CDC (Atlanta, Georgia) and within the 

 . To date, 32 geographically diverse LRN laboratories and 8 Regional Emerging Special Pathogen Treatment Centers can test using the 

 , with several more LRN laboratories working toward building testing capability. The Warrior Panel can detect marburgviruses (Marburg and Ravn viruses) and ebolaviruses (Ebola, Sudan, Tai Forest, Bundibugyo, and Reston viruses) in addition to other high-consequence pathogens.

CDC has issued travel health notices for 

 and could consider engaging traveler health clinics or other clinical and public health partners to increase awareness on MVD. There are no direct commercial flights from Equatorial Guinea or Tanzania to the United States and the number of travelers arriving in the United States from either country is low. Currently, no enhanced domestic travel measures are recommended, as the overall risk in the United States is considered low at this time

Early symptoms associated with MVD are similar to 

 associated with fever in returning travelers. MVD is rare; patients with suspected symptoms should be asked a detailed travel history and should be tested for other conditions and treated accordingly. Clinical laboratories can 

 for patients with suspected MVD by following 

Standard Precautions for All Patient Care

Universal Precautions for Preventing Transmission of Bloodborne Infections

Under the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens Standard, laboratories handling blood and body fluids must have a written 

 in place to eliminate or minimize employees’ risk of exposure to blood or other potentially infectious materials. 

 should be available and staff should be trained to properly put on and take off (don and doff) their PPE. If a facility does not have the appropriate risk mitigation capabilities, the specimen should be forwarded to another facility that does.

Marburg Virus Disease Outbreaks in Equatorial Guinea and Tanzania

 for information from the Centers for Medicare & Medicaid Services (CMS) regarding the Inappropriate Use of Antipsychotic Medications And Erroneous Diagnosis of Schizophrenia in Nursing Homes

For questions / more information, contact 

Inappropriate Use of Antipsychotic Medications And Erroneous Diagnosis of Schizophrenia in Nursing Homes

FDA’s Division of Drug Information is presenting a series of continuing education (CE) webinars targeting the needs of health care professionals. 

Cannabis and Cannabis-Derived Products – For Healthcare Practitioners

If you have comments or questions, please contact the FDA at: 1-888-INFO- FDA (1-888-463-6332) or 301-796-3400 from 8:00 am - 4:30 pm ET Monday - Friday. You can also email us at: 

FDA’s Division of Drug Information is presenting a series of continuing education (CE) webinars targeting the needs of health care professionals

This message is  from the Office of Public Health regarding the  

Please see the Colorectal Cancer Comms Toolkit 

CONTACT THE OFFICE OF PUBLIC HEALTH WITH ANY COMMENTS OR CONCERNS.

2023 Colorectal Cancer Comms Toolkit

The following Health Alert Network (HAN) notice originated from the CDC

CONTACT THE CDC WITH ANY QUESTIONS OR CONCERNS

Increase in Extensively Drug-Resistant Shigellosis in the United States

The Centers for Disease Control and Prevention (CDC) has been monitoring an increase in extensively drug-resistant (XDR) 

infections (shigellosis) reported through national surveillance systems [1]

infections reported to CDC were caused by XDR strains, compared with 0% in 2015. Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. 

strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC and the Louisiana Department of Health (LDH) ask healthcare professionals to be vigilant about suspecting and reporting cases of XDR 

infection to LDH and educating patients and communities at increased risk about prevention and transmission.

 Shigellosis is an acute enteric infection that is an important cause of domestically acquired and travel-associated bacterial diarrhea in the United States. Shigellosis usually causes inflammatory diarrhea that can be bloody and may also lead to fever, abdominal cramping, and tenesmus. Infections are generally self-limiting; however, antimicrobial treatment may be indicated to prevent complications or shorten the duration of illness [2]. CDC defines XDR 

as strains that are resistant to all commonly recommended empiric and alternative antibiotics — azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole (TMP-SMX), and ampicillin. Currently, there are no data from clinical studies of treatment of XDR 

 to inform recommendations for the optimal antimicrobial treatment of these infections. As such, CDC does not have recommendations for optimal antimicrobial treatment of XDR 

 bacteria are transmitted by the fecal-oral route, directly through person-to-person contact including sexual contact, and indirectly through contaminated food, water, and other routes. 

bacteria are easily transmitted because of the low infectious dose (as few as 10 – 100 organisms), and outbreaks tend to occur among people in close-contact settings [2–6]. 

Historically, shigellosis has predominantly affected young children (age 1 – 4 years) in the United States. More recently, CDC has observed an increase in antimicrobial-resistant 

 infections among adult populations [4,5] especially

Most people with diarrheal illness require only supportive care and fluid replacement. Antimicrobial agents are not always needed for mild shigellosis, but they may be indicated to

In the United States, recommended empiric antimicrobial agents include azithromycin, ciprofloxacin, or ceftriaxone. Ampicillin or TMP-SMX are recommended as alternative treatments for susceptible strains [2].

 In the United States, the percentage of 

infections caused by XDR strains reported to CDC increased from zero in 2015 to 5% in 2022 (

). Between January 1, 2015, and January 22, 2023, CDC received reports of 239 XDR

accounting for the largest percentage (66%) followed by

(34%). The median age of patients was 42 years (range 1–83 years). Among 232 patients with available information, 82% were men, 13% were women, and 5% were children. Among 41 patients who answered questions about recent sexual activity, 88% reported male-to-male sexual contact.

isolates that showed an extensively drug resistant (XDR)* phenotype or genotype in the United States, by year, 2015–2022† (See pdf attached for Figure 1).

bacteria (n=239) are defined as resistant to azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin.

PulseNet Whole Genome Sequencing Database

 ; data are preliminary and based on broth microdilution susceptibility testing and/or presence of resistance genes and mutations found in whole genome sequences of bacterial DNA.

isolates with unique or worrisome antimicrobial susceptibility patterns and genetic resistance markers. In addition, CDC is conducting an analysis of antimicrobial-resistant 

 infections in the United States using data in the 

National Antimicrobial Resistance Monitoring System for Enteric Bacteria

Recommendations for Healthcare Professionals

 infections have been described among adult men and may be associated with transmission among MSM. Cases of 

shigellosis co-occurring with other sexually transmitted infections

 (STIs), including HIV, have been described among MSM [8].

Please counsel patients with suspected or confirmed shigellosis about measures they can take to keep others healthy. Patients taking antibiotics should continue to follow prevention measures. All patients with suspected or confirmed shigellosis should

Increase in Extensively Drug-Resistant Shigellosis in the United States. 

The Centers for Medicare and Medicaid Services (CMS) are responsible for the oversight and health and safety of 

 residents. Over the past decade, through the work of the 

 to improve dementia care, CMS has been monitoring antipsychotic medication use in nursing homes. Though steps have been taken to reduce the use of these drugs, there continue to be concerned that nursing home residents may be inappropriately prescribed antipsychotic medications as a result of being misdiagnosed and coded as having schizophrenia, see the 

 for more information. Antipsychotic medications are dangerous among the vulnerable nursing home population because of their potential side effects, including death.

To increase our focus on this issue, CMS will conduct off-site nursing home audits to assess the accuracy of Minimum Data Set (MDS) data. Specifically, to determine whether or not the facility is appropriately assessing, diagnosing, and coding schizophrenia in the MDS for residents in their facility. These efforts are aligned with the latest actions under 

Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Home

If the audit reveals a pattern of inaccurate coding, this practice will negatively impact a facility’s Five-Star Quality Measure Rating on Nursing Home Care Compare. 

In addition to CMS’ actions, we believe that some of these instances may represent actions that are inconsistent with the expectations of the board of licensure. As such, if there are instances where a practitioner has not followed the expected standards for diagnosing individuals and/or prescribing medications, we believe these practitioners should be referred to their respective state boards for investigation.

See the following resources related to reducing the use of antipsychotic medications and appropriately assessing, diagnosing, and coding of schizophrenia in the MDS:

Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual

(Manual (page 2 of the Errata (v2) effective July 15, 2022)

Refer to pg. 352 for the process of appropriately assessing and coding a diagnosis of schizophrenia in the MDS for residents of your long-term care facility. Specifically, you should ensure the medical record of a resident diagnosed with schizophrenia contains documentation of a comprehensive medical and psychiatric evaluation, completed by diagnosing a Medical Director or licensed psychiatric practitioner, that meets professional standards of practice (for example, The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)), at the time of the initial diagnosis of schizophrenia. Listing of schizophrenia as a diagnosis on a medical record (i.e., problem list) is not sufficient.

State Operations Manual Appendix PP - Guidance to Surveyors for Long-Term Care Facilities

F658 - Services Provided Meet Professional Standards

F758 - Free from Unnecessary Psychotropic Meds/PRN Use

Facilities can locate their QIO by visiting Locate Your QIO | 

Humayun “Hank” Chaudhry, DO, MS, MACP, FRCP (Lon.) 

1775 Eye Street NW, Suite 410 | Washington, DC 20006

CMS Nursing Homes Misdiagnosis and Coding of Schizophrenia Education 

This Health Alert Network Advisory is from the CDC and being sent by the Louisiana Department of Health Emergency Operations Center (LDH EOC) via Louisiana Health Alert Network (LA HAN) to LA HAN Recipients regarding 

Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears. 

Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

This Health Alert Network Advisory is from the CDC about infections with an extensively drug-resistant strain of Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant 

While no cases have been identified to-date in Louisiana, the below recommendations are applicable statewide

Most patients reported using artificial tears. Patients reported more than 10 different brands of artificial tears, and some patients used multiple brands. The majority of patients who used artificial tears reported using EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles. CDC laboratory testing identified the presence of the outbreak strain in opened EzriCare bottles with different lot numbers collected from two states. Patients and healthcare providers should immediately discontinue using EzriCare artificial tears pending additional guidance from CDC and the Food and Drug Administration (FDA).

As of January 31, 2023, CDC in partnership with state and local health departments identified 55 case-patients in 12 states (CA, CO, CT, FL, NJ, NM, NY, NV, TX, UT, WA, WI) with VIM-GES-CRPA, a rare strain of extensively drug-resistant 

. Thirty-five patients are linked to four healthcare facility clusters. Dates of specimen collection were from May 2022 to January 2023. Isolates have been identified from clinical cultures of sputum or bronchial wash (13), cornea (11), urine (7), other nonsterile sources (4), blood (2), and from rectal swabs (25) collected for surveillance; some patients had specimens collected from more than one anatomic site. These specimens were collected in both outpatient and inpatient healthcare settings. Patients had a variety of presentations including keratitis, endophthalmitis, respiratory infection, urinary tract infection, and sepsis. Patient outcomes include permanent vision loss resulting from cornea infection, hospitalization, and one death due to systemic infection.

Isolates in this outbreak are sequence type (ST) 1203, harbor 

combination not previously observed in the United States) and are closely related based on analysis of whole genome sequencing (WGS) data. These isolates are not susceptible to cefepime, ceftazidime, piperacillin-tazobactam, aztreonam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, fluoroquinolones, polymyxins, amikacin, gentamicin, and tobramycin; the subset of isolates that underwent antimicrobial susceptibility testing for cefiderocol were susceptible to this agent.

Review of common exposures revealed that most patients, including most patients with eye infections, used artificial tears prior to identification of VIM-GES-CRPA infection or colonization. Patients reported more than 10 brands of artificial tears, and some patients used multiple brands. The majority of patients who used artificial tears reported using EzriCare Artificial Tears, a preservative-free product dispensed in multidose bottles. This was the only common artificial tears product identified across the four healthcare facility clusters. CDC laboratory testing identified the presence of VIM-GES-CRPA in opened EzriCare Artificial Tears bottles from multiple lots; these bottles were collected from patients with and without eye infections in two states. These product-related VIM-GES-CRPA match the outbreak strain. VIM-GES-CRPA recovered from opened bottles could represent either bacterial contamination during use or during the manufacturing process. Testing of unopened bottles of EzriCare Artificial Tears is ongoing to assist in evaluating for whether contamination may have occurred during manufacturing.

Recommendations for Clinical Laboratories

Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears 

This message is from LDH re: Increase in Pediatric Invasive Group A Streptococcal Infections

The Centers for Disease Control and Prevention (CDC) and the Louisiana Department of Health (LDH) are issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections. In November 2022, CDC was notified of a possible increase in iGAS infections among children at a hospital in Colorado. Potential increases in pediatric iGAS cases in other states were subsequently noted by contributors to the Infectious Diseases Society of America’s provider-based 

and by certain jurisdictions participating in CDC’s 

Active Bacterial Core Surveillance System (ABCs) 

. A similar increase has been observed in Louisiana. The number of iGAS cases reported among pediatric patients in Louisiana remains relatively low. However, the number of cases reported year to date in 2022 is approximately 3 times higher than the average annual number of cases reported during the preceding 10 years.

This increased number of pediatric iGAS cases in some jurisdictions, including Louisiana, has occurred in the setting of increased circulation of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2, and other respiratory viruses. This Health Advisory highlights the recent rise in iGAS infections in children, the increased seasonal risk of iGAS disease for all age groups, and the importance of early recognition, diagnosis, and appropriate treatment of these diseases in children and adults.

 (GAS) bacteria can cause a range of illnesses, from pharyngitis (i.e., strep throat) and skin and soft tissue infections to uncommon but severe diseases such as sepsis, streptococcal toxic shock syndrome, and necrotizing fasciitis. These severe and invasive diseases are associated with high mortality rates and require immediate treatment, including appropriate antibiotic therapy.

Similar to other agents spread primarily by the respiratory route, cases of GAS, including both iGAS and streptococcal pharyngitis (“strep throat”), tend to have a pronounced seasonal pattern with a peak in December through April in the United States. Strep throat is most common among school-aged children (i.e., 5–15 years of age), and exposure to someone with strep throat is a risk factor for iGAS infection. In addition, increased rates of iGAS infection have been noted during times of increased influenza activity. Seasonal influenza activity is currently high in the US and above the levels seen in recent years.

People with concurrent or preceding viral infections, such as influenza and varicella (chickenpox), are at increased risk for iGAS infection. Other groups at higher risk for iGAS include:

iGAS cases reported to ABCs, CDC’s active laboratory-and population-based surveillance system for invasive bacterial pathogens, were lower than usual among all age groups during the COVID-19 pandemic. This decrease started in April 2020 and was partly due to associated respiratory disease mitigation measures. A review of preliminary ABCs data from 2022 demonstrated a monthly increase in the number of confirmed iGAS cases in children between September to November, above what was seen in the same period in 2020 and 2021. However, it is too early to determine whether this rise is beyond what would be expected for pre-COVID-19 GAS seasonal patterns.

1 Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. 

Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America 

Increase in Pediatric Invasive Group A Streptococcal Infections 

regarding Increase in Pediatric Invasive Group A Streptococcal Infections

The Centers for Disease Control and Prevention (CDC) and the Louisiana Department of Health are issuing this Health Alert Network (HAN) Health Advisory about a recently confirmed outbreak of Ebola virus disease (EVD) in Uganda caused by Sudan virus (species 

to summarize recommendations for clinicians, case identification and testing, and clinical laboratory biosafety considerations. No suspected, probable, or confirmed EVD cases related to this outbreak have yet been reported in the United States. However, as a precaution and to remind clinicians about best practices, LDH is issuing this update to raise awareness of this outbreak.

On September 20, 2022, the Ministry of Health of Uganda officially declared an outbreak of EVD due to Sudan virus (species 

in Mubende District, Central Uganda. As of October 6, 2022, a total of 44 confirmed cases, 10 confirmed deaths, and 20 probable deaths of EVD have been identified in Uganda. CDC is working closely with the Ministry of Health of Uganda, the World Health Organization (WHO), and other partners to support the response to this outbreak.

 This is the fifth outbreak of EVD caused by Sudan virus in Uganda since 2000. The current outbreak is in the same area as Uganda’s most recent EVD outbreak caused by Sudan virus, which occurred in 2012. During the 2012 outbreak, limited secondary transmission was reported, and the outbreak was effectively contained.

 As of October 6, 2022, no suspected, probable, or confirmed EVD cases related to this outbreak have been reported in the United States or other countries outside of Uganda. The geographic scope of this outbreak in Uganda is currently limited to five districts in central Uganda and not the capital Kampala or the travel hub of Entebbe. While there are no direct flights from Uganda to the United States, travelers from or passing through affected areas in Uganda can enter the United States on flights connecting from other countries.

 Starting the week of October 10, 2022, CDC and Department of Homeland Security will implement funneling of U.S.-bound air passengers who have been to Uganda in the prior 21 days. These passengers will fly into 5 U.S. airports where they will undergo entry health screenings. LDH epidemiologists will follow-up with air travelers from Uganda with a Louisiana destination, conducting health assessments, providing additional information, and doing check ins with the travelers.

 It is important for clinicians to obtain a detailed travel history from patients with suspected EVD, especially those that have been in affected areas of Uganda. Early consideration of EVD in the differential diagnosis is important for providing appropriate and prompt patient care, diagnostics, and to prevent the spread of infection. Healthcare providers should be alert for and evaluate any patients suspected of having EVD, particularly among people who have recently traveled to affected areas in Uganda.

A person infected with EVD is not contagious until 

 appear (including fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding). Sudan virus is spread through direct contact (through broken skin or mucous membranes) with the body fluids (blood, urine, feces, saliva, droplet, or other secretions) of a person who is sick with or has died from EVD, infected animals, or with objects like needles that are contaminated with the virus. EVD is not spread through airborne transmission.

There is currently no FDA-licensed vaccine to protect against Sudan virus infection. The Ebola vaccine licensed in the United States (

genus (species Zaire ebolavirus), and based on studies in animals, it is not expected to protect against Sudan virus or other viruses in the Ebolavirus genus. Also, there is currently no FDA-approved treatment for Sudan virus.

 In the absence of early diagnosis and appropriate supportive care, EVD is a disease with a high mortality rate; occasional outbreaks have occurred mostly on the African continent. With intense supportive care and fluid replacement, mortality rates may be lowered. The genus 

 but only four (Ebola, Sudan, Taï Forest, and Bundibugyo viruses) are known to cause EVD in humans. Infection with any Ebola species presents as clinically similar disease. Previous outbreaks of Sudan virus have had a mortality rate of approximately 50%.

Clinicians who evaluate patients with clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding should suspect possible VHF or EVD on the differential diagnosis and clinicians should be prompted to immediately take a travel history. Healthcare providers should be alert for and evaluate any patients suspected of having VHF or EVD, particularly among people who have recently traveled to affected areas in Uganda, and place in a private room while performing clinical evaluation. If performing an aerosol generating procedure, conduct in an Airborne Infection Isolation Room (AIIR) when feasible. Testing for diseases in returning travelers which may present similarly to EVD, such as malaria, should be considered, but clinical consultation should be pursued if there is still a high index of suspicion for EVD.

 Louisiana clinicians with concerns about a patient with suspected EVD should immediately contact the Infectious Disease Epidemiology (IDEpi) 24/7 clinician hotline: 800-256-2748.

 Early recognition and identification of a suspected EVD 

 is critical. If a diagnosis of EVD is considered, clinical teams should coordinate with 

 and CDC to ensure appropriate precautions are taken to help prevent potential spread of EVD.

 As a resource for public health departments, CDC’s Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations regarding suspected VHF or EVD cases by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB’s on-call epidemiologist, or by e-mailing 

 Healthcare personnel can be exposed to Ebola virus by touching a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (for example, the eyes, nose, or mouth) are particularly hazardous. Procedures that can increase environmental contamination with infectious material or create aerosols should be minimized. CDC recommends a combination of measures to 

 with more LRN laboratories working toward the ability to test. The Warrior Panel can detect Ebola, Sudan, Tai Forest, Bundibugyo, and Reston viruses.

Clinical and Laboratory Biosafety Considerations

All personnel handling specimens from patients with suspected EVD (especially patients with travel history to Uganda three weeks before symptom onset) should adhere to recommended 

 to prevent infection and transmission among laboratory personnel. As a component of the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens Standard, laboratories handling blood and body fluids must have an 

 in place to eliminate or minimize employees’ risk of exposure to pathogens. Laboratories should conduct 

 to identify and mitigate hazards associated with handling Ebola specimens to create the safest environment.

 needs to be identified, available, and staff trained to properly don and doff their PPE. Staff need to be specially trained, have passed 

 and attended drills to safely receive, handle, and process these specimens. A laboratory should have dedicated space, equipment for handling and testing specimens from ill patients, and plans for minimizing specimen manipulation. A 

 needs to be in place for lab reagents and Category A waste, including PPE and sample material. If a facility does not have the appropriate risk mitigation capabilities, then the specimen should be forwarded to another facility that does.

General Resources for Ebola Virus Disease

Outbreak of Ebola virus disease (Sudan ebolavirus) in Central Uganda

This message is from the State Health Officer regarding 

Increasing HIV Diagnoses across Louisiana. 

 Please see the message below to share and distribute with relevant stakeholders and partners through your own distribution channels.

Medical Providers and Community Leaders in Louisiana

Joseph Kanter, MD, Louisiana State Health Officer

Increasing HIV Diagnoses across Louisiana

The rise in people newly diagnosed with HIV is alarming and, notably, this increase is occurring in both rural and urban areas of the state. The Louisiana Department of Health‘s

 Office of Public Health requests that all healthcare professionals and community leaders in the state join us in addressing the rise of new HIV diagnoses.

All community and medical providers should ensure their patients are aware of HIV prevention options.

 These include Pre-Exposure Prophylaxis (PrEP), Post Exposure Prophylaxis (PEP), and an understanding that people with HIV who take their HIV medicine as prescribed and who achieve and maintain viral suppression (undetectable) can stay healthy and will not transmit HIV to their sex partners. – this is known as undetectable equals untransmittable (or U=U). More information can be found at 

Healthcare professionals are additionally encouraged to take the following steps to help reduce the rate of new diagnoses, especially in our most vulnerable communities.

As of October 1, 2022, LSBME will no longer accept paper applications. All applications (and payments) must be made online through your 

.  If you have any questions you may contact our licensure department at 

Paper Applications

Increasing Numbers of Syphilis and Congenital Syphilis Diagnoses Across Louisiana.  

to share and distribute with relevant stakeholders and partners through your own distribution channels.

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