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From YouTube: CIDER Virtual Meeting Recording 05.02.23
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A
We
will
go
ahead
and
stop
the
recording
about
three
quarters
of
the
way
through
we're
going
to
go
ahead
and
get
started
today
with
the
a
presentation
with
some
of
my
colleagues
regarding
the
end
of
the
public
health
emergency.
A
What
the
bcph
transition
and
stabilization
plan
looks
like
and
what
that
might
mean
for
all
of
you
in
the
community
we'll
provide
a
covid
variant
update,
then
we're
going
to
Pivot
and
provide
a
brief
update
on
a
couple,
important
non-covid
issues
that
we'd
like
to
have
on
everyone's
radar
and
then
we'll
stop,
recording
and
open
up
the
floor
to
all
of
you.
B
So,
as
we
know,
the
public
health
emergency
is
anticipated
to
end
around
May
11th,
and
so
we
wanted
to
let
you
know
about
our
forthcoming
transition
and
stabilization
plan
and
to
find
out
if
this
group
has
any
particular
needs
or
concerns
with
regard
to
the
end
of
the
public
health
emergency.
And
so
our
response
to
the
spread
of
SARS
cov2
will
remain
a
public
health
priority.
B
Next
slide,
please
Stacy,
so
I
wanted
to
take
a
quick
moment
to
look
back
at
the
three
phases
or
plans
that
were
adopted
by
bcph
over
the
course
of
the
pandemic,
as
we
regularly
assess
challenges
faced
by
the
community
and
pivoted
actions
as
needed.
So
we
conducted
three
plans
and
the
first
one
was
in
the
summer
of
2021.
This
was
based
a
plan
based
on
the
assumption
that
the
pandemic
was
not
over
and
would
likely
continue
to
cycle
up
and
down,
as
new
variants
continue
to
emerge,
which
is
exactly
what
we
saw.
B
This
plan
was
written
when
70
percent
of
our
community
was
vaccinated
with
at
least
one
dose
of
what
was
considered
at
that
time
to
be
a
highly
effective
vaccine,
and
then,
a
year
later
in
2022,
the
state
guidance
changed
and
the
governor
issued
a
road
map
forward,
and
so
bcph
engaged
in
a
series
of
action
planning
sessions
that
helped
to
realign
our
agency
with
those
changes.
B
And
now,
with
the
the
end
of
the
public
health
emergency
occurring,
we
are
rolling
out
what
we're
calling
the
transition
and
stabilization
plan
that
recognizes
both
the
changes
in
funding
that
we're
experiencing,
as
well
as
a
move
towards
working
with
limited
priority
populations
and
specific
priority
settings
next
slide.
Please.
B
B
The
public
health
emergency
Declaration
was
intended
to
provide
resources,
waivers
and
flexibilities
to
be
enacted
and
carried
out
by
both
Public
Health
agencies
and
Health
Care
Systems,
so
that
Americans,
regardless
of
socioeconomic
status
and
other
factors,
had
access
to
care
and
resources
during
the
pandemic
and
with
the
end
of
the
public
health
emergency.
Many
of
those
directives
for
public
health
action
that
were
dictated
by
the
state
and
the
U.S
government
have
ended
or
will
be
ending.
B
This
may
and
that's
going
to
transition
many
things
back
into
our
Health
Care
Systems
and
Commercial
markets
and
our
communities
have
already
been
impacted
and
will
certainly
continue
to
be
impacted
as
a
result
of
the
end
of
the
public
health
emergency,
for
example.
Continuous
enrollment
for
Medicaid
ended
at
the
end
of
March
of
this
year,
and
it
was
projected
at
that
time
that
about
half
of
Medicaid
enrollees
in
Boulder
County
would
likely
be
ineligible
for
re-enrollment.
So
this
means
that
a
lot
of
the
eligible
beneficiaries
would
likely
need
assistance
with
the
re-enrollment
process.
B
Since
that's
something
that
had
gone
away
and
that
those
who
were
ineligible
actually
may
need
assistance,
finding
alternative
resources,
and
so
our
plan
is
to
continue
to
work
with
local
Health
Care
Partners
to
ensure
access
to
health
care
for
those
in
need.
Another
example
was
the
supplemental
nutrition
assistance
program,
SNAP
benefits
which
have
also
been
reduced
and
we're
working
with
internal
and
external
Partners
to
assist
those
with
food
security
and
housing
stability
issues.
B
So
in
this
presentation
we
are
going
to
really
focus
on
our
role
in
ensuring
Community
Access
to
things
like
testing,
Therapeutics
and
vaccinations
for
community
members,
and
we
admit
that
we
don't
have
all
the
answers.
We're
going
to
continue
efforts
with
Partners
to
promote
Health
Equity
next
slide.
Please.
B
But
the
good
news
is
that
on
April
18th
of
2023
Health
and
Human
Services
and
the
US
government
announced
a
program
to
maintain
access
to
covid-19
vaccines
and
Therapeutics
for
uninsured
Americans
in
this
program
is
going
to
dedicate
over
a
billion
dollars
and
work
partnering
with
pharmacies
and
public
health
infrastructure,
federally
qualified
Health
Centers
to
promote
that
access
to
care
for
uninsured
next
slide.
Please.
B
And
while
we
can
identify
some
areas
where
community
members
may
be
impacted
with
the
end
of
the
public
health
emergency,
we
also
acknowledge
that
questions
remain,
and
so
we're
going
to
continue
to
monitor
in
the
coming
months.
For
these
somewhat
unanticipated
impacts
to
our
community
and
while
the
pandemic
has
not
ended,
we
are
going
to
be
transitioning
away
from
an
emergency
response
which
allows
our
agency
to
transition
into
and
return
to
some
of
our
core
functions.
B
A
large
component
of
the
plan
will
be
to
communicate
changes
to
our
partners
and
the
public
and
ensure
continued
access
to
testing
Therapeutics
immunizations,
especially
to
Priority
populations
and
in
priority
settings
next
slide.
Please,
and
as
we
enter
this
transition
phase,
our
teams
are
shifting
away
from
what
we've
called
a
priority
population
focus
into
what
we
call
a
priority
settings
focus
and
so
I
wanted
to
take
a
moment
to
clarify
what
we
mean
with
respect
to
our
plans.
Moving
forward
next
slide,
please.
B
Throughout
the
pandemic,
our
Focus
has
been
to
use
a
public
health
and
Health
Equity
lens,
as
we
focused
on
people
who
were
at
highest
risk
for
Contracting
the
disease
and
having
the
worst
Health
outcomes
such
as
hospitalizations
and
deaths.
So
we
refer
to
them
as
priority
populations
along
with
people
who
were
living
and
working
in
congregate.
Living
settings
referred
to
as
priority
settings
and
with
increasing
scarcity
of
resources
within
our
agency.
B
We've
narrowed
down
the
priority
populations
list
and
we're
focusing
on
things
like
making
sure
that
people
have
free
access
to
vaccines
and
ongoing
Communications
and
examples
of
these
priority
populations
are
on
the
left
side
of
the
chart
that
you're
looking
at
and
on
the
right
side
of
the
chart.
We
Define
priority
settings
such
as
jails,
shelters,
long-term
care
facilities
and
other
congregate
living
settings
which
have
substantial
impacts
on
public
health.
B
B
This
slide
just
illustrates
how
we
made
decisions
on
where
to
focus
our
interventions
on
certain
populations
and
the
graph
on
the
left.
For
example,
the
Orange
Line
shows
that
vaccine
uptake
in
Hispanic
populations
lagged
behind
other
populations
in
Boulder
County,
and
the
map
on
the
right
shows
how
we
created
maps
of
vaccine
rates
by
ZIP
code,
age
and
social
vulnerability
index
in
order
to
Target
interventions
among
certain
populations
and
then
next
slide.
Please.
B
This
slide
illustrates
the
reason
why
focusing
on
priority
settings
is
so
critical,
as
you
can
see
in
the
bar
graphs
from
2021
and
2022.
The
outbreaks
in
these
settings
increase
rapidly
during
the
pandemic,
leaving
those
facilities
in
dire
need
of
help
and
support
So,
particularly
within
long-term
care
facilities,
correctional
centers,
shelters,
early
care
and
education
and
school
settings
and
Health
Care
settings,
and
we
will
continue
to
focus
on
those
priority
settings
as
we
move
into
the
next
transition
period.
Next
slide,
please
and
I
will
hand
this
off
to
you
Colleen.
Thank
you.
C
Thanks
so
much
Steffi
hi
everyone,
my
name
is
Colleen
Sinclair
I'm,
an
emergency
management
planner
with
Boulder
County,
Public
Health.
This
is
my
first
cider
meeting
so
nice
to
see
folks
and
thank
you
so
much
for
your
time
today.
So
with
the
background
in
mind
that
stuff
we
talked
about
next,
we'll
go
over
some
of
our
agency
strategies
that
were
developed
by
our
teams
during
this
planning
process
to
make
adjustments
to
the
changes
that
we'll
see
as
a
result
of
the
end
of
the
federal
and
state
declarations
in
May
next
slide.
Please
thank
you.
C
Actually,
we
can
go
one
more,
even
first
of
all,
I'll
cover
testing
and
Therapeutics
for
everybody.
Thank
you.
So,
a
little
shout
out
to
my
colleagues
in
Boulder
County.
Well,
over
500
000
PCR
tests
were
accessed
at
multiple
sites
between
September
of
2020
and
January
of
2023..
I.
C
So
public
health
will
continue
to
monitor
reporting
requirements,
they're
ending
at
the
federal
level.
They'll
remain
in
the
state
of
Colorado,
but
that
sounds
like
it'll
be
reevaluated
sometime
this
summer
and
next
slide.
Please
safely.
C
So
the
end
of
the
public
health
emergency
won't
directly
impact
Therapeutics,
since
the
eua
is
for
these
medications
they're
not
ending
and
looking
forward,
there
will
be
some
changes
coming
so
right
now.
The
U.S
government
has
large
stockpiles
of
oral
antivirals
and
they're
working
with
stakeholders
and
a
federally
qualified
Health
Centers
to
ensure
Equitable
access
to
these
Therapeutics
they'll
remain
free
until
the
stockpiles
are
depleted
or
until
commercialization
occurs.
We're
anticipating
seeing
that
towards
the
end
of
2023.
At
that
point,
pharmaceutical
companies
will
be
determining
pricing.
C
Private
insurance
companies
will
determine
what
that
cost.
Sharing
looks
like
for
their
beneficiaries.
Medicare
recipients
will
likely
have
to
pay
for
a
portion
of
Therapeutics,
and
then
Medicaid
will
reimburse
these
treatments,
but
only
for
FDA
approved
meds
right
now,
that's
Beck
Lurie,
the
States
will
determine
if
medications
that
are
covered
under
the
eua
are
will
will
be
covered.
That's
tax
law
benefiel
right
now
in
our
community,
most
members
are
accessing
Therapeutics
through
their
provider
or
the
Telehealth
programs
that
we've
seen
or
test
to
treat
sites.
These
might
be
ending.
C
Any
new
treatments
that
come
on
the
market
or
changes
to
the
existing
treatments,
we'll
also
big
big
communication
plans
here,
we'll
we'll
continue
to
communicate
information
to
community
members,
encouraging
them
to
have
a
plan
for
what
to
do
if
they
do
get
sick
and
provide
resources
for
Access
to
Health
Care,
where
needed,
we'll
continue,
review
changes
and
treatment
guidelines
that
come
out
as
well,
we'll
also
be
keeping
an
eye
out
monitoring,
Health
outcomes,
inequities
related
to
Therapeutics
and
make
sure
that
we're
working
with
the
under
or
uninsured
members
to
assist
them
with
access
to
care,
we'll
continue
to
work
with
leadership
of
Health.
C
Care
Providers
like
you
as
well
and
Facilities,
to
address
the
needs
of
community
amongst
first
and
with
that
I'm
going
to
pass
it
over
to
Keith
to
talk
about
immunizations
thanks.
D
Hello,
everyone.
Thank
you
good
afternoon.
My
name
is
Keith
Rawls
I'm,
an
immunization
program
coordinator.
The
immunization
program
is
in
the
season
of
transition
from
covid
response
to
routine
vaccination.
Cadence,
the
immunization
team
met
to
re-establish
goals
for
this
transition.
These
goals
include
the
following:
we
will
reignite
the
immunization
Coalition
and
connect
with
Partners.
The
immunization
team
will
continue
its
efforts
to
cultivate
our
provider
Network.
D
We
will
continue
to
offer
vaccines
for
low-income
children
on
Medicaid
at
our
two
vaccine
for
children,
clinics,
integrated,
covid-19
vaccination
appointments
into
our
vaccines
for
children,
clinics.
These
clinics
occur
Mondays
and
Wednesdays.
One
on
the
Monday
clinic
is
at
the
Hub
and
Longmont,
and
the
Wednesday
clinic
is
at
the
sunquist
building
on
Broadway
and
Iris.
D
The
good
news
is
is
that
the
the
Medicaid
will
allow
us
to
provide
these
shots
without
a
copay
or
a
cost
sharing
throughout
September
30
2024..
We
will
execute
a
fall
strategy
and
offer
coved
shots
in
the
community.
More
will
be
discussed
on
the
next
slide
on
this
we
will
develop
the
fall
Communications
campaign,
as
Colleen
alluded
to
as
we
get
back
to
school
and
next
slide.
Please.
D
Over
the
past
few
years,
the
immunization
program
responded
to
changing
needs.
This
included
ramping
up
for
a
mass
vaccination
campaign,
responding
to
lows
over
the
summer
and
peaks
in
our
demand.
In
the
winter
we
are
now
in
the
stable
environment
for
Staffing
to
respond
to
seasonal
approaches
to
respiratory
season
and
lieu
of
the
public
health
emergency
declaration.
Ending
we
will
likely
have
challenges
with
getting
free
vaccine
for
the
broader
community
and
will
need
to
shift
to
our
strategy
shift.
Our
strategy-
excuse
me
to
our
prioritized
populations.
D
I'll
know
more
in
the
summer
from
cdphe
about
the
additional
vaccine
stockpiles
the
immunization
team
successfully
pivoted
from
evening
clinics
at
the
Hub
to
incorporate
covet
vaccine
appointments
into
VOC
clinics
on
Mondays
and
Wednesdays.
At
this
time,
we
do
not
plan
to
run
any
additional
covid
vaccination
clinics.
This
fall
at
the
Hub.
Instead,
we
will
focus
on
limited
vaccine
resources
on
priority
populations.
D
All
vaccine
clinics
will
be
in
Outreach
settings
and
will
depend
on
how
much
free
vaccine
is
available.
In
summary,
the
immunization
program
will
continue
to
provide
vaccines
to
uninsured
and
uninsured
populations
of
Boulder
County
and
will
be
agile
in
this
space
going
forward.
The
next
person
I
believe,
is
Stacy.
Thank
you.
Folks.
E
Hey
everyone
I'm
going
to
keep
my
camera
off
just
because
it
sometimes
messes
with
my
with
my
sharing
of
the
slides,
so
I
am
with
the
communical
disease
program,
just
going
to
mention
some
things
about
epidemiology
infection,
prevention
and
surveillance.
E
Then
gradually
we
were
able
to
shift
those
epi-response
strategies
due
to
increased
Community
immunity
resulting
from
vaccine
vaccines,
widespread
disease
and,
along
with
access
to
Therapeutics,
focusing
on
priority
populations,
has
been
crucial
and
has
helped
us
with
these
relationships
with
our
key
Partners
in
priority
sectors
that
have
helped
us
be
successful.
E
With
many
changes
in
the
pandemic,
this
fall
or
this
late
summer
we
will
be
reducing
our
ELC
funded
staff,
resources
from
20
staff
to
six
ftes
for
all
coveted
related
epidemiology
infection,
prevention,
surveillance,
resource
navigation
and
call
center
needs,
and
the
remaining
staff
will
be
focusing
on
ensuring
stabilization
of
Key
activities
over
the
coming
months.
E
This
one
illustrates
the
ongoing
covid
response
needs
that
will
continue
for
our
team
in
2022
bcph
investigated
a
total
of
433
outbreaks
at
a
rate
of
122
outbreaks
per
100
000
population.
This
reflects
an
increase
over
the
pre-pandemic
five-year
average
of
19.2
per
year
by
approximately
two
thousand
percent
While.
Most
of
these
outbreaks
are
from
covid
and
they
accounted
for
80
of
them.
E
There
was
also
an
uptick
in
non-coveted
respiratory
outbreaks
and
enteric
outbreaks
in
2022,
compared
to
other
years
to
keep
up
with
the
increased
workload
we
anticipate,
Staffing
resource
needs
will
be
ongoing
after
the
response.
Related
funding
dries
up.
E
So
our
goal
is
ongoing
adaptive
operational
model
and
what
that
means
is
our
community
has
benefited
from
that
strong
collaboration
with
various
Partners,
such
as
cider,
which
engages
our
Healthcare
IPS,
our
ID
docs,
our
long-term
care
facilities
and
congregate.
Settings
such
as
the
jail
Public
Health
needs
to
be
prepared
for
future
threats,
such
as
how
climate
change
and
globalization
will
likely
accelerate
communical
disease
burden
and
emerging
threats.
B
B
The
green
map
on
the
left
is
you're,
probably
familiar
with,
shows
the
community
levels
and
shows
that
about
98
of
counties
in
the
United
States
are
in
low
Community
levels
and
again
this
is
based
on
a
seven-day
cumulative
case
held
per
100
000,
also
the
seven
day
total
new
Hospital
admissions
per
hundred
thousand.
And
thirdly,
the
percent
of
inpatient
beds
up
for
a
seven
day
average.
So
I
just
wanted
to
give
the
quick
caveat
that
the
case
numbers
are
vastly
under
reported
and
we'll
look
at
that
in
the
next
slide.
B
But
Hospital
admissions
are
also
often
under
reported,
since
a
rapid,
antigen
test
or
home
test
is,
is
often
accepted
and
the
cases
are
then
counted
as
suspect
cases
and
not
laboratory
confirmed
cases
and
the
map
on
the
right
shows
the
transmission
levels
map
that's
produced
by
the
CDC,
and
this
is
the
the
metric
that's
used
by
Healthcare
facilities
to
determine
infection
control
interventions.
B
Transmission
levels
were
based
on
seven
day
cumulative
case
count
per
100,
000
and
percent
positivity
and
so
importantly,
with
the
end
of
the
public
health
emergency
things
are
changing.
For
example,
the
reporting
of
negative
test
results
is
going
away
and
with
a
huge
decrease
in
PCR
testing
percent.
B
Positivity
is
essentially
no
longer
going
to
be
reported,
which
then
affects
the
the
metric
that
Healthcare
facilities
are
using
to
determine
infection
control
interventions,
so
I
just
wanted
to
let
you
know
that
the
CDC
is
currently
reevaluating,
how
they're
going
to
revise
the
reporting
of
transmission
levels
for
Health
Care
Facility
guidance
so
more
to
come
in
that
space
next
slide.
Please.
B
And
this
slide
just
demonstrates
how
Wastewater
surveillance
actually
shows
that
how
underreported
covid-19
cases
are
since
the
spring
of
22
2022,
when
home
testing
became
more
available
and
actually
free
community
test
sites
were
dropped
in
many
locations.
The
comparison
graphs
between
Wastewater
and
case
numbers
are
similar
in
Boulder
and
Longmont
utilities,
which
are
the
boulder
utilities
on
the
left.
B
The
Longmont
utilities
is
in
the
upper
right
graph,
but
it's
also
very
consistent
with
the
bottom
right
graph,
which
is
actually
from
biobot,
which
is
the
company
that
is
contracted
with
CDC,
to
do
the
Wastewater
analysis
for
the
United
States,
and
this
is
showing
a
very
similar
graph
of
Wastewater
surveillance
in
case
comparisons
across
the
United
States
I.
Think
it's
a
fairly
dramatic
illustration
of
what's
happening
with
case
reporting
next
slide.
Please,
the
next
couple
slides
just
look
at
our
variant,
update,
I'm,
not
sure
how
much
you
follow.
B
The
nowcast
report,
which
estimates
the
current
variants
in
the
United
States
xbb.1.5,
has
been
the
most
prevalent
some
very
sub-variant
for
quite
some
time.
Really
since
January
of
2023.
It
is
still
the
most
prevalent
at
about
68
percent
of
cases,
but
is
finally
decreasing
and
in
its
place,
we're
seeing
on
the
bottom
sort
of
right
corner
here.
The
purple
is
xbb.1.6
the
xbb.1.16,
sorry,
and
that
is
now
the
second
most
prevalent
variant
in
the
United
States
at
almost
12
percent.
This
is
a
variant
that
has
been
surging
in
in
in
India.
B
Early
data
suggests
a
higher
transmissibility
compared
to
xbb.1.5,
similar
immunescape
and
nothing
that's
showing
more
severe
disease.
They
do
suggest
an
additional
new
symptom
of
some
conjunctivitis,
but
we
also
note
that
xbb.1.9.1
and
1.2
are
also
increasing
in
the
United
States.
We
don't
have
much
data
on.
What's
what
to
expect
with
these
variants
and
next
slide.
Please.
B
And
this
slide
just
shows
the
nowcast
estimates
for
variance
by
region
in
the
United,
States
and
Colorado
is
in
region.
Eight.
We
can
see
that
xbb.1.5
is
still
the
most
prevalent
variant.
It
is
decreasing
on
all
the
different
regions.
Xbb.1.
B
A
Thanks
Steffy
I
think
I
forgot
to
introduce
myself
earlier
actually,
but
my
name
is
Elena
younger
and
I'm.
The
interim
Regional
epidemiologist
and
thanks
to
my
colleagues
for
all
those
super
important
covet,
updates
we're
now
going
to
actually
pivot
and
give
a
couple
brief
updates
on
some
non-covid
issues
that
we
think
should
be
on
everyone's
radar.
A
Okay,
so
the
first
one
pertains
to
a
health
alert
that
came
through
the
health
alert
Network
on
April
18th
regarding
opioid
overdoses,
involving
xylazine
cases
with
overdoses
involving
a
new
illicit
street
drug
that
mixes
opioids,
typically
fentanyl
with
xylazine,
which
is
a
Veterinary
tranquilizer,
are
being
reported
in
Colorado.
This
drug
combination
is
commonly
referred
to
as
tranth.
In
the
last
14
months.
There
have
been
four
drug
overdose
deaths
in
the
Denver
metro
area
that
involves
xylazine
in
some
form
and
we've
recently
been
informed
that
xylazine
has
been
detected
in
Boulder
County's,
illicit
drug
Supply.
A
The
DEA
lab
system
reports
that
in
2022,
approximately
23
percent
of
fentanyl
powder
and
seven
percent
of
fentanyl
Pills
contain
xylazine
common
symptoms
of
xylazine
least.
Drug
overdoses
include
unresponsiveness,
decreased
responsiveness,
hypotension,
bradycardia,
meiosis
and
reduced
or
slow
breathing,
because
xylazine,
which
is
a
non-opioid,
is
often
combined
with
an
opioid.
Naloxone
may
not
be
effective
in
treatment
of
a
tranq
overdose.
Nonetheless,
Healthcare
Providers
are
still
encouraged
to
administer
a
naloxone
and
manage
the
patient's
symptoms,
supportively,
with
a
heightened
awareness
and
management
of
the
patient's
Airway
and
breathing.
A
Additionally,
a
careful
skin
exam
should
be
performed
in
intravenous
drug
users,
as
xylazine
has
been
known
to
cause
severe
wounds
and
necrosis
that
can
lead
to
amputation.
Wounds
can
also
occur
in
other
locations,
even
when
xylazine
is
smoked
or
snorted
and
down
here
at
the
bottom,
we've
included
an
important
resource
for
all
of
you
that,
hopefully
you're
already
well
familiar
with,
but
the
Rocky
Mountain
poison
Center
can
provide
consultations.
24
7
at
the
phone
number
listed
below
on
any
case
of
suspected
opioid
related
overdose
with
xylazine
or
for
more
information
about
this
combination.
A
Next,
there
was
a
health
advisory
that
was
released
on
April
10th
regarding
an
update
for
the
ongoing
outbreaks
of
Marburg
virus
disease
in
Equatorial,
Guinea
and
Tanzania
Marburg
virus
disease
is
a
rare
but
highly
fatal
viral
hemorrhagic
fever
caused
by
two
zoonotic
viruses,
the
Marburg
virus
and
the
robin
virus,
and
these
are
both
phyloviruses
in
the
same
family
as
Ebola
virus
MVD
is
transmitted
by
a
direct
contact
with
blood
and
other
bodily
fluids,
in
fact
of
infected
people
and
animals
or
in
direct
contact
with
contaminated
surfaces
and
materials
such
as
clothing,
betting
and
medical
equipment.
A
It's
important
to
note
that
Marburg
virus,
like
Ebola,
is
not
an
airborne
disease
and
there
is
no
evidence
that
MVD
is
spread
by
coughing
or
sneezing.
There
is
no
approved
vaccine.
Although
a
vaccine
is
currently
in
development,
symptoms
of
barbaric
virus
disease
appear
2
to
21
days
after
exposure,
typically
with
rapid
onset
of
fever,
chills
headache
and
myalgia
around
the
fifth
day
after
a
symptom
onset,
a
macupapular
rash
may
appear,
and
this
might
be
most
prominent
on
the
trunk.
Additional
symptoms
may
include
nausea
vomiting,
chest
pains
sore
throat,
abdominal
pain
and
diarrhea.
A
Symptoms
typically
become
increasingly
severe
and
include
jot
or
accounting
include
jaundice
inflammation
of
the
pancreas,
severe
weight
loss,
delirium
shock,
liver
failure,
massive
hemorrhaging
and
multi-organ
dysfunction.
Again,
there
is
typically
a
high
case,
fatality
rate
with
Marburg
virus
disease,
ranging
between
23
to
90
percent
on
average
is
about
50
percent,
and
it
does
depend
on
the
virus
strain
and
case
management,
which
is
typically
supportive.
A
So
there
are
two
unrelated
outbreaks
that
are
ongoing
of
Marburg
virus
disease
in
Equatorial,
Guinea
and
Tanzania.
Again,
these
are
unrelated
outbreaks
with
different
strains
of
the
virus,
and
they
are
at
this
point
fully
contained
to
both
of
those
regions.
So
again,
to
reiterate
no
confirmed
cases
of
MVD
have
been
reported
in
the
United
States
or
outside
of
regions.
However,
there
is
always
the
risk
for
potentially
imported
cases.
A
The
CDC
is
currently
sending
mobile
text
messages
to
Travelers,
who
have
been
been
in
Equatorial,
Guinea
or
Tanzania,
and
have
now
arrived
back
in
the
United
States.
The
message
explains
what
symptoms
they
should
watch
for
and
to
contact
their
local
Health,
Department
or
their
health
care
provider
if
they
are
to
develop
symptoms
of
illness
within
21
days
and
tree
screening
and
risk
assessments
are
not
currently
being
performed
involved.
Bcph
is
being
notified
of
Travelers
returning
from
these
regions.
We
are
not
performing
any
active
monitoring
because
it
is
not
currently
recommended
by
the
CDC.
A
If
MVD
is
suspected
among
any
of
your
patients,
you
should
all
follow
the
same
protocols
more
or
less
than
what
we
do
for
Ebola
virus
disease
primarily
identify,
isolate
and
inform.
So
if
someone
is
presenting
to
an
ed
or
another
Healthcare
setting
relevant
exposure,
history
should
be
taken,
including
criteria
about
whether
the
patient
has
traveled
internationally,
particularly
to
an
area
with
an
active
outbreak
or,
if
they've,
had
any
direct
contact
with
any
individuals
with
MVD
or
other
viral
hemorrhagic
fevers
in
the
last
21
days.
A
If
patients
do
meet
these
exposure
criteria,
they
should
be
further
evaluated
to
see
for
the
presence
of
any
symptoms
compatible
with
margar's
disease.
If
they
do
have
symptoms
or
signs
compatible
with
MVD,
they
should
be
isolated
in
a
private
room
and
Personnel
should
follow
the
same
infection,
prevention
and
control
measures,
as
recommended
for
Ebola
disease.
A
And,
of
course,
please
do
make
sure
that
if
you
have
any
individuals
with
the
consistent
exposure,
history
and
consistent
signs
or
symptoms
to
go
ahead
and
call
cdpg
immediately
add
either
phone
number
that
is
listed
and
cdphe
will
help
determine.
If
this
individual
should
be
considered
a
suspect
case,
and
rather
and
if
additional
testing
or
additional
precautions
need
to
be
employed.
A
Okay,
we
do
have
some
updated
resources
to
share
with
you
all
I
know
that
seeing
the
links
doesn't
you
know
in
the
in
the
presentation,
doesn't
allow
you
to
click
on
them
or
anything
so
we'll
be
sure
to
send
out
all
of
these
links
and
resources,
along
with
the
recording
after
this
meeting
but
cdph,
she
has
updated
their
viral
hemorrhagic
fever
web
page,
and
it
now
includes
a
great
toolkit
for
hospitals
on
what
to
do.
If
you
suspect,
a
patient
has
Ebola
disease
or
a
Marburg
virus
disease.
A
And
of
course,
if
you
are
hearing
both
of
these
updates
for
the
very
first
time
that
means
that
you're
probably
not
registered,
to
receive
Health
advisories
and
health
alerts
through
the
health
alert
Network,
you
can
register
for
any
alerts
that
are
originated
at
the
state
level
by
following
this
link.
That's
provided
under
the
last
section
and
just
be
aware
that
signing
up
at
that
link
does
not
enroll
you
to
any
Hans
that
originate
with
Boulder
County
Public
Health,
but
we
are
doing
an
update
project.