INFLUENZA SURVEILLANCE Julie L Freshwater, MPH PhD Influenza Surveillance Coordinator.
1 INFLUENZA (AND OTHER RESPIRATORY VIRUS) SURVEILLANCE IN WISCONSIN Thomas Haupt M.S. Wisconsin...
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Transcript of 1 INFLUENZA (AND OTHER RESPIRATORY VIRUS) SURVEILLANCE IN WISCONSIN Thomas Haupt M.S. Wisconsin...
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INFLUENZA (AND OTHER RESPIRATORY VIRUS) SURVEILLANCE IN WISCONSIN
Thomas Haupt M.S.Wisconsin Influenza Surveillance Coordinator
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Greetings and Thank You From Wisconsin!
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Population approximately 5.6 million
Average high temperature (July) 82 degrees
WISCONSIN THE “BADGER” STATE
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Population approximately 5.6 million
>6,000 Confirmed and Probable Cases
WISCONSIN THE “SWINE-FLU” STATE
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Surveillance MethodsCurrent and Future
Current• Virologic (Lab)• Rapid Test Site (RTS)• ILINET (Influenza-like illness)
Future• Enhanced ED monitoring• Hospitalizations• Enhance Antiviral Resistance Monitoring
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PANDEMIC INFLUENZA VIROLOGIC SURVEILLANCEIN PERSPECTIVE
Confirmed % cases Cases (worldwide)
WORLDWIDE 94,500 100%
UNITED STATES 37,250 39%
WISCONSIN 6,300 7%
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4 Labs Certified to do Pandemic Influenza Confirmation
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Week Ending April 25th
"
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending May 2nd
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending May 9th
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending May 16th
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending May 23rd
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending May 30th
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending June 6th
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending June 13th
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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Week Ending June 20th
Legend
APRIL 25MAY 2MAY 9MAY 16
MAY 23
MAY 30
JUNE 6JUNE 13
JUNE 20
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2-May 9-May 16-May 23-May 30-May 6-Jun 13-Jun 20-Jun 27-Jun 4-Jul
week ending
# T
ests
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% P
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tive
Tested Confirmed % Positive
WISCONSIN PANDEMIC INFLUENZA LAB SURVEILLANCE
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0
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3-Ja
n
10-Ja
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17-Ja
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24-Ja
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31-Ja
n
7-Feb
14-F
eb
21-F
eb
28-F
eb
7-Mar
14-M
ar
21-M
ar
28-M
ar
4-Apr
11-A
pr
18-A
pr
25-A
pr
2-May
9-May
16-M
ay
23-M
ay
30-M
ay
6-Ju
n
13-Ju
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20-Ju
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week ending
# T
ests
0%
5%
10%
15%
20%
25%
30%
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40%
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% P
osi
tive
Tested % Positive
WISCONSIN SEASONAL and PANDEMIC INFLUENZA LAB SURVEILLANCE
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Virologic Surveillance
• Need to determine a median between testing everyone and those needed to be tested– Severely ill– High risk patients, and – Residents of LTC, Corrections and other Institutions
• Need a more streamline, accurate (yet simple) method of reporting data i.e..
“Electronic lab reporting”
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Rapid Test Site (RTS) Surveillance
• Done for several years very informally
• 2008-09 CSTE Grant to Enhance Influenza Surveillance
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Geographic Distribution of Laboratory Surveillance Contributors
Douglas Bayfield
Ashland
SawyerWashburnBurnett
Polk Barron Rusk
Price
Iron
Vilas
Oneida
Lincoln
TaylorChippewaSt. Croix
Pierce
Dunn
Pepin
Eau Claire
BuffaloTrempealeau
Jackson
Monroe
Clark Marathon
Wood Portage
Juneau Adams
Sauk
LaCrosse
Vernon
Crawford
Richland
Grant
LaFayetteGreen
Rock
Dane
Iowa
Columbia Dodge
Jefferson Waukesha
Walworth
Kenosha
Racine
Ozaukee
SheboyganFond du Lac
Green Lake
Marquette
Waushara Winnebago
Calumet
Manitowoc
Kewaunee
Brown
OutagamieWaupaca
Shawano
Menominee
OcontoLanglade
Forest
Marinette
Florence
Door
Milwaukee
Washington
Virology Laboratory
Rapid Test Site
Green Bay
Milwaukee
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Wisconsin
0
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#Tes
ts
0%
10%
20%
30%
40%
% P
osi
tive
Flu Tests RSV Tests
% Flu + % RSV +
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Percent Positive Lab Tests
0%
10%
20%
30%
40%
50%
40 43 46 49 52 3 6 9 12 15
week
% P
osi
tive
Culture PCR Rapid
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Rapid Test Site (RTS) Surveillance
Advantages• Many more sites (Data)• Consistent with both PCR and Culture• Can be easily broken down by regions of
the state Disadvantage• Use early and late in season (Low PVP)• Use during Pandemic Influenza
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• Wisconsin had 66 Sentinel Clinicians, 50 of which were regular reporters– 30 of which do year-round surveillance
• Data analyzed by Public health Region and statewide– Baseline and threshold levels of ILI
• “Traditional” state– Limited electronic ILI, more syndromic
ILINet – WI Outpatient ILI surveillance
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ILINet – WI Outpatient ILI surveillance network, through Jun 27
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ILINet – WI Outpatient ILI surveillance network, through Jun 27
Wisconsin
0%
2%
4%
6%
8%
WI ILI WI BaselineWI Threshold Region V %Regional Baseline %
Southeastern Region
0%
2%
4%
6%
8%
10%
% IL
I
ILI % Baseline Threshold Milwaukee City
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• Continue to recruit/maintain clinicians
• Gear toward more electronic ILI reporting– Hospital ED surveillance– Validate criteria for surveillance
• Chief Complaint/ discharge diagnosis etc
ILINet – WI Outpatient ILI surveillance network
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Future Surveillance
• Enhance and develop “severity” surveillance
– Hospitalizations from flu
– ED data
– Deaths
• Antiviral Resistance
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Hospitalizations and ED Data
• Intra –state pilot program to identify admissions due to ILI and ED visits due to ILI on a daily/weekly basis– By age group (0-4,5-24,25-49,50-64, >64)– Web based reporting system (WI-Trac)– early results varied
• 10 minutes to 1 hour of ICP time• ability of hospitals to do it also varied
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Wisconsin Health Information Exchange (WHIE) Network
Currently in Milwaukee County only• 16 hospitals
Plan to expand to larger hospitals, hospital corporations this fall
Uses chief complaint “Fever” or “Flu”
Daily, weekly monthly
Hospital Death reporting being considered
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Weekly ED visits with chief complaint of “fever” or “flu” at 11 Milwaukee area hospitals, by age-group, Jan 2008 – Jul 4, 2009
Wisconsin Health Information Exchange (WHIE) data
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Wisconsin Health Information Exchange (WHIE) Network
Use in local areas is better than ILINet
Use in statewide or regional areas is being reviewed
Data needs to be validated for use in ILINet
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Wisconsin Health Information Exchange (WHIE) Network
Chief Complaint Categories
Fever Flu
Respiratory Asthma Sepsis
DiarrheaRash
Other
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Antiviral Resistance
• Wisconsin State Lab currently tests for seasonal influenza resistance to adamantanes and neuraminidase inhibitors
• Beginning July 2009 will test Pandemic H1N1 for resistance to adamantanes and neuraminidase inhibitors using CDC methodology
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What we don’t do
• Statewide school absenteeism– Some local surveillance that varies greatly
• Large Business absenteeism
• Long term care (Except for clusters)
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“Other” Respiratory Viruses Surveillance
Statewide and Regionally• RSV (Rapid tests)
Statewide• Parainfluenza (1-4)• Adenovirus• Rhinovirus• Human metapneumovirus• Coronavirus (OC-43 and others)• Enterovirusus
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VIRUS CULTUREBased on 206 tests
RAPID TESTS SELECT PCR TESTS
Virus % Positive
Virus #Tests
% Positive
Virus Positive/total
number
Total % Positive 16.0% Influenza A & B 44/206
Influenza (Tot.) Influenza A Influenza B hMPV
9.7%1.5%8.2%0%
Influenza (Tot) 957 13.6%
Influenza A 3.6% # A/H1 8
Influenza B 9.9% # A/H3 0
Influenza Unk.* 0.1% # B 34
RSV 1.9% RSV 207 9.2% RSV 6/122
Adenovirus 1.0% Adenovirus 55 0.0% Adenovirus 1/38
Parainfluenza 3.4% Parainfluenza 6/76
Rhinovirus 0.0% *Influenza unknown (Unk) are positive influenza test results that cannot be distinguished between Type A and B
Rhinovirus 3/38
Enterovirus
0.0% Enterovirus 0/38
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Again…
Thank you for invitation and hospitality !!
Questions and comments … Please