he Public Health Department published its first monthly Public Health Spotlight on Communicable and Non-Communicable Diseases (NCDs) since the announced changed on August 31, 2022.

From the Desk of Sabrina Turner

The Public Health Spotlight originated from the need to keep our population informed with more in-depth epidemiological data relating to the COVID-19 pandemic.

As we move towards living safely and responsibly with COVID-19, this publication will grow and adapt to provide relevant public health information to the public and the media on a monthly basis.

As the Ministry of Health and Wellness (MHW) continues to make strides to collect and analyse data that will help to inform funding decisions, educational campaigns, programming and services, our Epidemiology Corner will expand to include more data on both communicable and non-communicable diseases.

Existing best practices in research, such as the biennial National Drug Council’s Cayman Islands Student Drug Use Survey (CISDUS), will also be highlighted and shared in future to help inform readers about work that is already being undertaken by the MHW’s departments and SAGCs .

This month’s issue will highlight the return of the flu, and provide insight on what that means while we continue to navigate the COVID-19 pandemic.  Additional information on the forthcoming COVID-19 fall booster programme will be included, along with the monthly COVID-19 statistics for September.

Our hope is that this publication will continue to be informative and will help our residents feel better equipped in making decisions about their own health and wellness.

At your service.

Return of the Flu

After nearly two years, the annual flu is returning to the Cayman Islands.

Current data from the Southern Hemisphere, which is closing off its winter  season and its flu season, shows the number of flu cases surpassing pre-pandemic levels.

The Australian Department of Health and Aged Care, which monitors the flu during the country’s flu season of May-September, reported nearly 225,000 cases of the flu through 25 September 2022, with 1,784 hospitalisations, of which 6.8% were admitted to the ICU.

If this is an indication of what Cayman can expect as it enters its Fall/Winter season, then residents will need to not only pay close attention to the trends, but also decide early on what will be the best course of action to safeguard their own health and wellness.

The American Centre for Disease Control (CDC) flag the population under the age of 2 and over the age of 65 as being the most vulnerable for flu related complications.

However, Australian figures indicate that in 2022 “people aged 5-9 years, children aged younger than 5 years, and people aged 10–19 years have the highest notification rates” of the flu this season.

In fact, USA TODAY reports that 60% of flu hospitalisations in Australia have come from youth under the age of 16.

The UK Health Security Agency (UKHSA) is strongly urging the population that is eligible to receive the flu vaccine to do so, given the lowered levels of natural immunity to the flu this year.

The flu vaccine is now available in the Cayman Islands.

Roll out of the flu vaccine began on 5 October 2022 at the George Town Hospital Atrium, and district clinics will begin rolling out the flu vaccine on 11 October, 2022.

The flu vaccine is recommended locally for all residents 6 months and older, and is especially important for those considered to be high risk for flu related complications including:

• children under the age of 2
• pregnant women
• residents 50+
• persons with underlying health conditions (heart, lung, kidney diseases or weakened immune system)
• close contacts of vulnerable/high risk groups
• health care workers

For more information: www.hsa.ky or contact the  Flu Hotline on: 1-800-534-8600 (toll free), 947 3077, [email protected]

Flu in the time of COVID- Key messages

On the H3N2 flu strain:

International surveillance shows that H3N2 – a subtype of influenza type A – is currently the most-commonly detected flu virus worldwide.

“The H3N2 flu strain can cause particularly severe illness. If you are elderly or vulnerable because of other conditions you are at greater risk, so getting the flu jab is a sensible, potentially life-saving thing to do.” Dr Susan Hopkins, Chief Medical Advisor at UKHS

On the interactions of H3N2 and COVID-19:

Study results from early in the pandemic show individuals who catch both flu and COVID-19 at the same time, known as co-infection, are around twice as likely to suffer death compared to those who only have COVID-19.

“Flu and COVID-19 are unpredictable but there are strong indications we could be facing the threat of widely circulating flu, lower levels of natural immunity due to less exposure over the last three winters and an increase in COVID-19 circulating with lots of variants that can evade the immune response. This combination poses a serious risk to our health, particularly those in high-risk groups.” Dr Susan Hopkins, Chief Medical Advisor at UKHS

Well Aware

While accessing the COVID-19 fall booster and the annual flu vaccine are important steps to take to safeguard one’s health this season, they must be supplemented by other actions for a more holistic approach to health and wellness.

Things to do:

• Continue practicing hand hygiene: wash hands regularly and sanitise when soap and water are not readily available.
• Avoid touching face
• Cover coughs
• Stay home and rest when unwell
• Exercise for at least 10 minutes a day
• Go outside: studies show that being outside in nature is relaxing, reducing our stress, cortisol levels, muscle tension and heart rates.

Things to eat:

A balanced diet rich in fruits and vegetables is the foundation for optimal health and wellness.  However, though foods cannot prevent or cure COVID-19 or flu related illnesses, research has shown that some foods work especially well in helping the body fight off infections:

Garlic and onions: Shown to possess anti-inflammatory, anti-bacterial and anti-fungal benefits, garlic and onions contain sulphur-containing compounds that helps to boost the body’s immune response.

Citrus fruits: Oranges, grapefruits, lemons and limes are high in vitamin C which encourages your immune system to produce white blood cells. White blood cells are essential in fighting infections.

Ginger: Ginger has a long history as a remedy for many ailments, and it has recognised anti-oxidative and anti-inflammatory properties.  Ginger’s benefits include helping to suppress coughing and helping to settle the stomach and reduce nausea.

Things to try:

Mental health plays a significant role in helping to maintain our physical health. There’s a close relationship between sleep and mental health, so don’t skimp on sleep.  Try setting a sleep routine to help ensure consistent, restful sleep.

COVID-19 Fall Booster Programme

The COVID-19 fall booster has arrived in the Cayman Islands, and the roll out of the vaccine will officially begin on Monday, 10 October 2022.

While everyone ages 16 and up can benefit from the fall booster, the programme will be rolled out in phases to ensure that priority groups are able to access the booster first.

Priority groups are:

• Elderly residents (70+)
• Frontline Health Care Workers
• Individuals with underlying medical conditions (16-49)
• Adults 50+

The COVID-19 fall booster vaccination schedule will be disseminated by HSA’s Public Health Department and will indicate which groups are eligible based on the roll out.

The first groups to be served will be elderly residents in care homes, elderly residents ages 70 and up and frontline heath care workers.  Residents are encouraged to stay tuned to official sources for the most up to date information on eligibility and access to the vaccination clinics.

Studies show a decrease in COVID-19 immunity 3 months after a vaccine, especially among the elderly and immunocompromised.

Boosters help to increase the body’s immune response which means longer lasting protection against infection.

Once the priority groups have received their fall boosters, the programme will be opened up to include all residents ages 16 and over.

The fall booster programme will be rolled out using the Moderna (bivalent) vaccine for adults ages 18+, and the Pfizer vaccine for youth ages 16-17.

Research has shown that a booster of a different vaccine causes similar or higher antibody responses than a booster of the same vaccine.

Research also indicates that the orginal boosters remain effective against COVID-19 variants, and that the timeliness within which boosters are administered is more important than the type of booster offered.

Eligible individuals wishing to get the fall booster will need to bring the following documents to the booster clinic:

• Vaccination card or digital vaccination certificate showing the date of the last dose/booster
• Government issued photo identification showing date of birth
• Facemasks (please bring your own)

For more information, and for the vaccination and booster schedules, log on to hsa.ky/coronavirus  or scan the QR code below.

Key message: Boosters minimise the chance of severe COVID-19 illness that requires hospitalisation and, subsequently, may lead to death.

Epidemiology Corner

Epidemiological Alert- Regional: Cholera in Haiti

The Pan American Health Organization (PAHO) has reported that on 2 October 2022, Haiti detected two confirmed cases of cholera. In addition, there is a cluster of more than 20 suspected cases and 7 deaths which are under investigation. This is the first resurgence of cholera in Haiti in more than three years. Cholera is a bacterial disease caused by Vibrio cholerae, and is transmitted through consumption of contaminated food or water.

In response to the outbreak in the region, the Cayman Islands will continue surveillance efforts to monitor for any suspected cholera cases. Currently, no cases have been detected.

Monkeypox

In the Cayman Islands, there remain to have been no detected cases of monkeypox.

Globally, there have been 68,998 laboratory confirmed monkeypox reported to WHO since the beginning of 2022 (data as of 4 October 2022). Over the past reporting week, there was a decline of 16.8% in new cases reported to WHO. This year, there have been 26 monkeypox deaths reported to WHO, with 7 reported during September and only one of these deaths occurring in the Region of the Americas.

COVID-19 surveillance data

September 2022 (data as of 3 October 2022)

Key points

Internationally: the number of COVID-19 cases and deaths reported to WHO has continued to decline. Reported cases decreased in all regions, apart from the European region where there was an 8% increase in reported cases during the past reporting week.

Local trends: In the Cayman Islands, hospitalisations have been gradually declining since July, with a slight increase in late September. There were a total of 21 COVID-19 patients admitted in September 2022, a 30% decrease from admissions during August, which includes both patients admitted due to COVID-19 morbidity and patients admitted for other health reasons who were detected to have COVID-19 on admission screening.

There have been five COVID-19 deaths during September and all five individuals had multiple comorbidities. Two of the patients were unvaccinated, two had received their second dose of the vaccine and one individual had also received their third dose.

Influenza-Like-Illness

The Public health team are notified of any cases of influenza-like-illness (ILI). As this is based on an individual’s symptoms, this does not indicate which pathogen is causing the illness. This data can provide insights on the level of reported respiratory illness in the population which shows a seasonal increase each winter, and how this compares to previous winters seasons.

As shown in Figure 5, respiratory illness in 2019/2020 shows a typical winter peak pattern, and decreases more rapidly from mid-March onwards (week 12) likely due to the implementation of the COVID-19 measures including closure of public places. The following winter season of 2020/2021 shows very low levels of ILI, likely linked to limited mixing and improvement in hand hygiene limiting influenza cases, as well as very few COVID-19 cases. Last winter, 2021/2022, the higher level of ILI reporting likely reflects the Delta wave of COVID-19 alongside potentially lower immunity to respiratory pathogens from reduced mixing the previous winter. Data from 2022 currently aligns to pre-COVID-19 levels of ILI.