Update on Influenza surveillance in the U.S., 2006-7 season
17
VRBPAC Gaithersburg, MD 27-28 February, 2007 Joseph Bresee, MD Chief, Epidemiology and Prevention Branch Influenza Division Centers for Disease Control and Prevention Update on Influenza surveillance in the U.S., 2006-7 season
description
VRBPAC Gaithersburg, MD 27-28 February, 2007 Joseph Bresee, MD Chief, Epidemiology and Prevention Branch Influenza Division Centers for Disease Control and Prevention. Update on Influenza surveillance in the U.S., 2006-7 season. CDC’s U.S. Influenza Surveillance System. State and Territorial - PowerPoint PPT Presentation
Transcript of Update on Influenza surveillance in the U.S., 2006-7 season
VRBPACGaithersburg, MD27-28 February, 2007
Joseph Bresee, MDChief, Epidemiology and Prevention BranchInfluenza DivisionCenters for Disease Control and Prevention
Update on Influenza surveillance in the U.S., 2006-7 season
CDC’s U.S. Influenza Surveillance System
CDCLaboratories
Sentinel Providers
State and Territorial Epidemiologists
Vital StatisticsRegistrars
Public HealthOfficials
Physicians Media
PublicHealth Departments
Population-based Hospitalization
Pediatric Mortality
Other
U.S. Influenza Surveillance: Overview
CDCLaboratories
Sentinel Providers
State and Territorial Epidemiologists
Vital StatisticsRegistrars
Public HealthOfficials
Physicians Media
PublicHealth Departments
Population-based Hospitalization
Pediatric Mortality
Other
Visits for Influenza-like Illness Reported by Sentinel Providers, 2006-07 and Previous 2 Seasons
0
1
2
3
4
5
6
7
8
9
10
40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20
Week
% o
f V
isits fo
r IL
I
%ILI 2006-07 %ILI 2005-06 %ILI 2004-05 National baseline
NVSN Influenza Laboratory-Confirmed Cumulative Hospitalization Rates for Children 0 - 4 Years, 2006-07 and Previous 6 Seasons
0
2
4
6
8
10
12
14
40-41 42-43 44-45 46-47 48-49 50-51 52 -1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17
2006-2007 Influenza Season 2 Week Reporting Period
Po
pu
lati
on
-Bas
ed R
ate
per
10,
000
Ch
ildre
n
2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007
Laboratory-confirmed influenza hospitalizations, 0-4 yrs, New Vaccine Surveillance Network
Laboratory-confirmed influenza hospitalizations, Emerging Infections Program
0
2
4
6
8
10
12
14
40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Week
Pop
ulat
ion-
Bas
ed R
ate
per
10,0
00 C
hild
ren
2003-04, 0-4 years 2003-04, 5-17 years2004-05, 0-4 years 2004-05, 5-17 years2005-06, 0-4 years 2005-06, 5-17 years2006-07, 0-4 years 2006-07, 5-17 years
Epidemic Threshold
Seasonal Baseline
Pneumonia and Influenza Mortalityfor 122 U.S. Cities
Week Ending 01/20/2007
2004 2005
10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10
20062003
4
6
8
10
12
Weeks
% o
f All
Dea
ths
Due
to P
&I
Surveillance for Pediatric Deaths Attributed to Influenza Complications
As of February 15, 2007, CDC has received 15 reports of influenza-associated pediatric deaths this season
• 10 were 5 years of age or older
• Underlying medical conditions• 3 with underlying conditions that might have contributed to severity• 5 with no known underlying conditions• 2 with unknown previous health status
• Vaccination status• Unvaccinated (9)• Vaccinated (1 )
2004-2005: 44 deaths2005-2006: 48 deaths2003-2004: 153 deaths
U.S. WHO/NREVSS Collaborating LaboratoriesSummary, 2006-07
0
400
800
1200
1600
2000
40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20
Week
Nu
mb
er
of Is
ola
tes
0
3
6
9
12
15
18
21
24
27
30
Pe
rce
nt P
ositiv
e
A(H3)
A(H1)
A(Unsubtyped)
B
Percent Positive 10,458 viruses typed
84% A / 16% B
2,439 (28%) subtyped
87% A (H1)
13% A (H3)
High levels of adamantane-resistance identified during 2005*
• H1N1 : 2 of 8 (25%) adamantane-resistant• H3N2 : 192 of 209 (92%) adamantane-resistant
Fewer adamantane-resistant isolates in 2006-2007**
• Global surveillance• H1N1: 5 of 199 (3%) • H3N2: 24 of 54 (44%)
• U.S. isolates• H1N1: 1 of 91 (1%)• H3N2: 3 of 10 (33%)
No resistance to oseltamivir or zanamivir among isolates tested at CDC since 2005 (n=437)**
* Bright et al. (2006): JAMA 295; 891-4** L Gubareva, CDC, preliminary data
Antiviral resistance
Upcoming issues for ACIP, 2007-8
New vaccine strains?• Upcoming WHO and VRBPAC, Feb 2007
Extension of recommendation not to use adamantanes• Persistently high adamantane resistance among H3 viruses• Available alternative
Harmonize AAP and ACIP recs for young children• Children 6 mo - <9 yrs who received a single dose during the first year
will be recommended to receive 2 doses the following year
Age groups and risk groups for whom routine vaccination is recommended is not changed compared to 2006 recommendations
Thank you
Milestones in Recommendation Changes
2000: All adults 50 and older
2004: All children aged 6--23 monthsAll women who will be pregnant during influenza season
2005: All persons with any condition that can compromise respiratory function or the handling of respiratory secretions
2006: All children aged 24--59 months and their household contacts and out-of-home caregivers
