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CIDRAP - News Scan for September 10, 2019

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  • CIDRAP - News Scan for September 10, 2019

    News Scan for Sep 10, 2019

    California vaccine exemption law
    ; 'Presenteeism' in health workers
    ; H5N6 avian flu in Vietnam

    California bill toughening medical vaccine exemptions signed into law

    California Governor Gavin Newsom yesterday signed two bills that limit medical exemptions for vaccines in schoolchildren.
    One of the bills directs the California Department of Public Health (CDPH) to investigate doctors who grant five or more medical exemptions in a year, CNN reported today. The state will also investigate schools with an overall immunization rate of less than 95% and has new authority to revoke medical exemptions that are deemed inappropriate by a physician or public health officer.
    The companion bill includes some changes that Newsom proposed, which includes allowing a child with a medical exemption issued before Jan 1, 2020, to be allowed to continue going to school until he or she reaches the next grade level.
    California is among a few states that don't offer personal, philosophical, or religious exemptions from school vaccination requirements. According to CNN, the number of unvaccinated California schoolchildren declined after it outlawed nonmedical exemptions.
    The state's actions come during a year when US measles cases have reached their highest level since 1992. About 75% of the cases have occurred in New York, primarily reflecting outbreaks in Orthodox Jewish communities. According to the CDPH, the state has recorded 67 measles cases as of Sep 4, of which 38 were part of five outbreaks that have now ended.
    Sep 10 CNN report
    CDPH measles page

    New studies suggest presenteeism common in health workers ill with flu

    Two new studies, one from the United States and one from Australia, suggest a substantial percentage of healthcare providers report to work when sick with influenza-like illnesses (ILIs).
    Iowa investigators published in the Antimicrobial Resistance & Infection Control a survey of 127 medical students, resident physicians, and faculty physicians about presenteeism (working while sick). They found that 60% felt obligated to work while sick and 33% felt obligate to work with ILI symptoms.
    Many participants (83%) in the study said they worked out of fear of creating more work for colleagues. Despite that perception—which was even stronger in medical student and residents—81% still recognized the need to avoid spreading infections to patients, and 75% noted the goal of not infecting coworkers.
    "The results of our study demonstrate an ethical tension between an obligation to work and an obligation not to harm," the authors concluded. They note that Centers for Disease Control and Prevention guidelines state that healthcare workers who have fever and respiratory symptoms should not work with patients and should be excluded from work until they are afebrile for at least 24 hours.
    In a second study based in Queensland, Australia, researchers found 14.1% of healthcare workers worked while ill with influenza, including about a quarter of physicians. Physicians were also more likely to take a shortened sick leave compared with other healthcare personnel.
    The study was published in the American Journal of Infection Control and is based on laboratory-confirmed influenza cases and history of sick leave among health workers in Queensland from 2009 through 2015.
    Sep 5 Antimicrob Resist Infect Control study
    Sep 9 Am J Infect Control study
    Vietnam reports H5N6 avian flu outbreak in poultry

    Vietnam's agriculture ministry reported a highly pathogenic H5N6 outbreak at in village birds in Ben Tre province in the southern part of the country, according to a Sep 8 notification from the World Organization for Animal Health (OIE).
    The outbreak began on Aug 18, killing 138 of 1,026 susceptible birds. The survivors were culled, and authorities also increased surveillance and disinfected the affected areas.
    The country's last H5N6 outbreak occurred in the middle of August, striking village birds in Vung Tau province, also in southern Vietnam. H5N6 has been identified in poultry outbreaks in China and a handful of other Asian nations, but China is the only country that has reported human cases, which are often severe or fatal.
    Sep 8 OIE report