Laboratory-based respiratory virus surveillance pilot project on select cruise ships in Alaska, 2013-15.

BACKGROUND: Influenza outbreaks can occur among passengers and crews during the Alaska summertime cruise season. Ill travellers represent a potential source for introduction of novel or antigenically drifted influenza virus strains to the United States. From May to September 2013-2015, the Alaska Division of Public Health, the Centers for Disease Control and Prevention (CDC), and two cruise lines implemented a laboratory-based public health surveillance project to detect influenza and other respiratory viruses among ill crew members and passengers on select cruise ships in Alaska. METHODS: Cruise ship medical staff collected 2-3 nasopharyngeal swab specimens per week from passengers and crew members presenting to the ship infirmary with acute respiratory illness (ARI). Specimens were tested for respiratory viruses at the Alaska State Virology Laboratory (ASVL); a subset of specimens positive for influenza virus were sent to CDC for further antigenic characterization. RESULTS: Of 410 nasopharyngeal specimens, 83% tested positive for at least one respiratory virus; 71% tested positive for influenza A or B virus. Antigenic characterization of pilot project specimens identified strains matching predominant circulating seasonal influenza virus strains, which were included in the northern or southern hemisphere influenza vaccines during those years. Results were relatively consistent across age groups, recent travel history, and influenza vaccination status. Onset dates of illness relative to date of boarding differed between northbound (occurring later in the voyage) and southbound (occurring within the first days of the voyage) cruises. CONCLUSIONS: The high yield of positive results indicated that influenza was common among passengers and crews sampled with ARI. This finding reinforces the need to bolster influenza prevention and control activities on cruise ships. Laboratory-based influenza surveillance on cruise ships may augment inland influenza surveillance and inform control activities. However, these benefits should be weighed against the costs and operational limitations of instituting laboratory-based surveillance programs on ships.

Elevated Blood Lead Levels Among Fire Assay Workers and Their Children in Alaska, 2010-2011.

In October 2010, an employee at Facility A in Alaska that performs fire assay analysis, an industrial technique that uses lead-containing flux to obtain metals from pulverized rocks, was reported to the Alaska Section of Epidemiology (SOE) with an elevated blood lead level (BLL) ≥10 micrograms per deciliter (µg/dL). The SOE initiated an investigation; investigators interviewed employees, offered blood lead screening to employees and their families, and observed a visit to the industrial facility by the Alaska Occupational Safety and Health Section (AKOSH). Among the 15 employees with known work responsibilities, 12 had an elevated BLL at least once from October 2010 through February 2011. Of these 12 employees, 10 reported working in the fire assay room. Four children of employees had BLLs ≥5 µg/dL. Employees working in Facility A's fire assay room were likely exposed to lead at work and could have brought lead home. AKOSH inspectors reported that they could not share their consultative report with SOE investigators because of the confidentiality requirements of a federal regulation, which hampered Alaska SOE investigators from fully characterizing the lead exposure standards.

2009 Pandemic influenza A H1N1 in Alaska: temporal and geographic characteristics of spread and increased risk of hospitalization among Alaska Native and Asian/Pacific Islander people.

Alaska Native people have suffered disproportionately from previous influenza pandemics. We evaluated 3 separate syndromic data sources to determine temporal and geographic patterns of spread of 2009 pandemic influenza A H1N1 (pH1N1) in Alaska, and reviewed records from persons hospitalized with pH1N1 disease in 3 areas in Alaska to characterize clinical and epidemiologic features of disease in Alaskans. A wave of pH1N1 disease swept through Alaska beginning in most areas in August or early September. In rural regions, where Alaska Native people comprise a substantial proportion of the population, disease occurred earlier than in other regions. Alaska Native people and Asian/Pacific Islanders (A/PI) were 2-4 times more likely to be hospitalized than whites. Alaska Native people and other minorities remain at high risk for early and substantial morbidity from pandemic influenza episodes. These findings should be integrated into plans for distribution and use of vaccine and antiviral agents.